多层次执行功能综合训练对脑卒中恢复期患者执行功能障碍的影响

The effect of hierarchical executive function training on stroke survivors＇ executive dysfunction during recovery

目的 探讨多层次执行功能综合训练对脑卒中后执行功能障碍的影响。 方法 采用随机数字表法将36例脑卒中恢复期患者分为观察组及对照组。2组患者均予以常规康复训练及药物治疗；观察组患者在此基础上辅以多层次执行功能综合训练，包括工作记忆训练、抑制性控制和定势转换训练、中枢执行功能训练等，共持续治疗3周。于训练前、治疗3周后采用蒙特利尔认知评估量表（MoCA）筛查患者认知功能，采用数字广度测试（DST）、数字颜色连线测验（CTT）、复杂词语流畅性和简单词语流畅性测验评定患者执行功能改善情况。 结果 训练前2组患者MoCA、DST、CTT、复杂和简单词语流畅性评分组间差异均无统计学意义（P〉0.05）。观察组训练后与训练前比较，其MoCA评分［分别为（20.67±5.67）分和（16.06±7.03）分］、DST评分［分别为（12.17±2.57）分和（10.22±2.73）分］、CTT评分［分别为（330.64±185.07）分和（573.45±386.01）分］、复杂词语流畅性评分［分别为（13.11±4.36）分和（8.55±4.22）分］和简单词语流畅性评分［分别为（8.39±3.60）分和（6.00±4.31）分］均明显提高（P〈0.05）；对照组训练后仅MoCA评分［（15.39±4.64）分］较训练前提高（P〈0.05）。与训练后对照组比较，观察组MoCA评分、DST评分、复杂词语流畅性和简单词语流畅性评分均明显增高（P〈0.05）。 结论 多层次执行功能综合训练可有效改善脑卒中恢复期患者执行功能子成分（包括工作记忆、定势转换能力和词语流畅性等），该疗法值得临床推广、应用。

Objective To explore the effect of hierarchical executive function training on executive dysfunction among stroke survivors. Methods Thirty-six recovering stroke survivors with executive dysfunction were randomly divided into an experimental group （n=18） and a control group （n=18）. Both groups received routine rehabilitation training and medication for three weeks, but the experimental group also received working memory training, inhibitory control training, set shifting training, and central executive function training. Before and after the training, everyone′s cognitive functioning was screened using the Montreal Cognitive Assessment （MoCA）, and executive functioning was evaluated using the digit span test （DST）, the color trail test （CTT）, the complex fluency test and the simple fluency test. Results Before the training there were no significant differences in clinical indicators between the two groups. After the treatment, the average MoCA, DST, CTT complex fluency test and simple fluency test scores of the experimental group had all improved significantly, but no significant improvement in any of the measurements was observed in the control group except for a significant improvement in their average MoCA score. Conclusion Hierarchical executive function training can improve the sub-components of executive function among recovering stroke survivors, including working memory, set shifting and fluency.