音乐治疗在卒中后认知障碍患者康复中的应用

Application of music therapy in rehabilitation of post-stroke cognitive impairment

目的分析音乐治疗对卒中后认知障碍(post-stroke cognitive impairment,PSCI)患者的康复疗效,为PSCI患者的康复干预方法提供参考。方法前瞻性选取2020年12月-2022年7月在中国康复研究中心北京博爱医院住院并诊断为PSCI的患者,按照随机数字表法分为音乐治疗组和对照组。两组患者均给予神经内科常规药物治疗、护理以及常规康复治疗,音乐治疗组患者额外给予音乐治疗训练,两组均治疗1个月。治疗前后用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)、Fugl-Meyer运动功能评定量表(Fugl-Meyer Assessment Scale,FMA)和改良巴氏指数评定量表(modified Barthel Index,MBI)评定患者的认知功能、神经功能缺损程度、运动功能和日常生活活动能力。结果共纳入48例患者,两组均为24例。两组患者的性别、年龄、受教育程度、卒中类型、病灶部位、合并疾病、心肌梗死或外周血管疾病病史、是否吸烟差异无统计学意义(P>0.05)。治疗前后两组大部分患者的语言和延迟回忆评分都不得分,差异无统计学意义(P>0.05)。两组患者治疗前MoCA评分、视空间与执行功能、命名、注意、计算、抽象思维和定向评分差异无统计学意义(P>0.05)。治疗后音乐治疗组的MoCA评分、视空间与执行功能、命名、注意、计算、抽象思维和定向评分较治疗前改善(P<0.05),治疗后对照组的MoCA评分、视空间与执行功能、命名、注意、定向评分较治疗前改善(P<0.05)。治疗后,音乐治疗组的MoCA评分[5.0(3.0,6.0)vs.2.5(1.0,4.0)分]、注意[1.0(0.0,1.0)vs.0.0(0.0,1.0)分]和抽象思维评分[0.0(0.0,1.0)vs.0.0(0.0,0.0)分]改善程度优于对照组(P<0.05)。两组患者治疗前NIHSS、FMA、MBI评分差异无统计学意义(P>0.05),治疗后均较治疗前改善(P<0.05)。治疗后,两组患者的NIHSS、FMA、MBI评分改善程度差异无统计学意义(P>0.05)。结论与常规康复治疗相比,结合了音乐治疗的训练对PSCI患者认知功能的改善更有益,特别是注意和抽象思维认知域,但对于神经功能缺损程度、肢体运动功能和日常生活活动能力的改善尚未发现显著优势。

Objective To analyze the efficacy of music therapy on the rehabilitation of post-stroke cognitive impairment(PSCI)and to provide a reference for rehabilitation intervention methods for PSCI.Methods Patients hospitalized in Beijing Bo’Ai Hospital,China Rehabilitation Research Center and diagnosed with PSCI between December 2020 and July 2022 were prospectively selected.According to the random number table method,patients were divided into a music therapy group and a control group.Both groups were given conventional neurology medication,nursing care,and conventional rehabilitation.The music therapy group received additional music therapy training,and both groups received treatment for one month.The Montreal Cognitive Assessment(MoCA),National Institute of Health Stroke Scale(NIHSS),Fugl-Meyer Assessment Scale(FMA),and modified Barthel Index(MBI)were used before and after treatment to assess patients’cognitive function,degree of neurological deficits,motor function and activities of daily live.Results A total of 48 patients were included,with 24 patients in both groups.There was no statistically significant difference in gender,age,education level,stroke type,lesion location,comorbidities,history of myocardial infarction or peripheral vascular disease,and smoking status between the two groups of patients(P>0.05).Before and after treatment,most patients in the two groups did not score in terms of language and delayed recall scores,and the difference were not statistically significant(P>0.05).There was no statistically significant difference in MoCA scores,visual space and executive function,naming,attention,calculation,abstract thinking,and orientation scores between the two groups of patients before treatment(P>0.05).After treatment,the MoCA score,visual space and executive function,naming,attention,calculation,abstract thinking,and orientation scores of the music therapy group improved compared to before treatment(P<0.05),while the MoCA score,visual space and executive function,naming,attention,and orientation scores of the control group improved compared to before treatment(P<0.05).After treatment,the improvement in MoCA scores[5.0(3.0,6.0)vs.2.5(1.0,4.0)],attention[1.0(0.0,1.0)vs.0.0(0.0,1.0)],and abstract thinking scores[0.0(0.0,1.0)vs.0.0(0.0,0.0)]in the music therapy group were better than that in the control group(P<0.05).There was no statistically significant difference in NIHSS,FMA,and MBI scores between the two groups of patients before treatment(P>0.05),and both groups improved after treatment compared to before treatment(P<0.05).After treatment,there was no statistically significant difference in the improvement of NIHSS,FMA,and MBI scores between the two groups of patients(P>0.05).Conclusion Compared with conventional rehabilitation therapy,training combined with music therapy is more beneficial for improving cognitive function in PSCI patients,especially in the cognitive domains of attention and abstract thinking.However,significant advantages have not been found in improving the degree of neurological impairment,limb motor function,and daily living activities.