认知-步行双任务训练对脑卒中患者执行及步行功能的影响

Effects of cognitive-walking dual-task training on executive and walking function in patients with stroke

目的探讨认知-步行双任务训练对脑卒中患者执行及步行功能的干预效果。方法选择2020年6月至2020年10月在保定泰和康复医院康复科住院治疗的脑卒中患者70例作为研究对象,按照计算机随机数字法将70例脑卒中偏瘫患者随机分为对照组(n=35)和试验组(n=35),采用前瞻性队列研究方法进行研究。对照组给予常规的步行训练,试验组进行与对照组相同时长与频次的认知-步行双任务训练。在干预前,干预4周后用E-Prime软件评估患者的执行功能,包括Flanker任务、1-back任务和More-odd shifting任务三个子测试,记录各个测试的反应时;记录简明精神状态量表(Mini-Mental Status Examination,MMSE)和改良Rankin量表(Modified Rankin Scale,MRS)的分值变化;计算10 m步行测试(10 m Walk Test,10MWT)时的单任务步行时间、连续减3运算时的双任务步行时间以及双任务步行时间成本。最后试验组33例、对照组31例完成研究。结果干预4周后,试验组和对照组患者的MMSE评分较干预前有所提高[试验组(26.39±1.90)分与(24.42±2.69)分,t=10.824,P<0.001;对照组(25.45±1.77)分与(24.61±2.16)分,t=7.325,P<0.001],并且试验组明显优于对照组(t=2.049,P=0.045)。试验组和对照组患者的执行功能三项测试用时较干预前显著缩短[Flanker任务:试验组(752.38±178.28)ms和(939.42±260.11)ms,t=10.467,P<0.001;对照组(863.40±227.86)ms和(951.67±265.93)ms,t=8.140,P<0.001。1-back任务:试验组(983.31±314.16)ms和(1242.10±444.77)ms,t=10.386,P<0.001;对照组(1186.89±293.80)ms和(1238.27±305.95)ms,t=9.569,P<0.001。More odd shifting任务:试验组(1121.29±260.17)ms和(1362.32±352.80)ms,t=13.084,P<0.001;对照组(1255.81±269.41)ms和(1351.37±287.46)ms,t=8.550,P<0.001],并且试验组明显优于对照组(Flanker任务:t=-2.198,P=0.032;1-back任务:t=-2.691,P=0.009;More odd shifting任务:t=-2.044,P=0.045)。试验组和对照组患者的10 m步行测试成绩较干预前有所改善[单任务步行用时:试验组(20.71±9.61)s和(26.10±13.88)s,t=6.312,P<0.001;对照组(22.42±9.60)s和(25.62±10.97)s,t=13.009,P<0.001。双任务步行用时:试验组(22.73±10.28)s和(31.64±16.07)s,t=7.931,P<0.001;对照组(28.30±11.72)s和(31.89±13.65)s,t=9.348,P<0.001。双任务步行成本:试验组(10.32±6.87)%和(23.26±11.40)%,t=10.602,P<0.001;对照组(27.39±7.38)%和(24.94±7.48)%,t=2.719,P=0.011]。试验组双任务下的10 m步行测试用时较对照组短(t=2.027,P=0.047);试验组双任务步行时间成本低于对照组(t=9.583,P<0.001)。结论认知-步行双任务训练可改善患者的步行功能,相较于常规步行训练更有助于患者执行功能的恢复。

Objective To explore the intervention effect of cognitive-walking dual-task training on executive and walking function in patients with cerebral apoplexy.Methods A total of 70 stroke patients who were hospitalized in the Department of Rehabilitation Medicine of Baoding Taihe Rehabilitation Hospital from June 2020 to October 2020 were selected as the study subjects.All 70 hemiplegic patients with stroke were randomly divided into control group(n=35)and test group(n=35)by random number table method,and a prospective study was conducted.The control group was given routine walking training,and the test group was given cognitive-walking dual-task training at the same time and frequency as the control group.E-Prime software was used to evaluate the executive function of patients before and 4 weeks after intervention,including three sub-tests of Flanker,1-back and More-odd shifting,and the reaction time of each test was recorded.The score changes of Mini-Mental Status Examination(MMSE)and Modified Rankin Scale(MRS)were recorded.The single-task walking time,dual-task walking time and dual-task walking time cost during 10 m Walk Test were calculated.Finally,33 cases in the experimental group and 31 cases in the control group completed the study.Finally,33 cases in the experimental group and 31 cases in the control group completed the study.Results After 4 weeks of intervention,the MMSE scores of the experimental group and the control group were improved compared with those before intervention(the experimental group(26.39±1.90)and(24.42±2.69),t=10.824,P<0.001;the control group(25.45±1.77)and(24.61±2.16),t=7.325,P<0.001),and the experimental group was significantly better than the control group(t=2.049,P=0.045)).The duration of three tests of executive function in the experimental group and the control group was significantly shorter than that before the intervention(Flanker task:the experimental group(752.38±178.28)ms and(939.42±260.11)ms,t=10.467,P<0.001;the control group(863.40±227.86)ms and(951.67±265.93)ms,t=8.140,P<0.001.1-back task:the experimental group(983.31±314.16)ms and(1242.10±444.77)ms,t=10.386,P<0.001;the control group(1186.89±293.80)ms and(1238.27±305.95)ms,t=9.569,P<0.001.More odd shifting task:the experimental group(1121.29±260.17)ms and(1362.32±352.80)ms,t=13.084,P<0.001;the control group(1255.81±269.41)ms and(1351.37±287.46)ms,t=8.550,P<0.001),and the experimental group was significantly better than the control group(Flanker task:t=2.198,P=0.032;1-back task:t=2.691,P=0.009;more odd shifting task:t=2.044,P=0.045).The results of 10 m walking test in the experimental group and the control group were improved compared with those before the intervention(single task walking time:the experimental group(20.71±9.61)s and(26.10±13.88)s,t=6.312,P<0.001;the control group(22.42±9.60)s and(25.62±10.97)s,t=13.009,P<0.001).The duration of dual task walking:the experimental group(22.73±10.28)s and(31.64±16.07)s,t=7.931,P<0.001;the control group(28.30±11.72)s and(31.89±13.65)s,t=9.348,P<0.001.The cost of dual task walking:the experimental group(10.32±6.87)%and(23.26±11.40)%,t=10.602,P<0.001;the control group(27.39±7.38)%and(24.94±7.48)%,t=2.719,P=0.011).The 10 m walking test time of the experimental group was shorter than that of the control group(t=2.027,P=0.047),and the walking time cost of the experimental group was lower than that of the control group(t=9.583,P<0.001).Conclusion Cognitive walking dual task training can improve the walking function of patients,which is more conducive to the recovery of executive function than conventional walking training.