基于认知泛化的任务导向训练在老年脑卒中后认知障碍患者中的应用

Application of task-oriented training based on cognitive generalization in elderly patients with post-stroke cognitive impairment

目的探讨基于认知泛化的任务导向训练对老年脑卒中后认知障碍(PSCI)患者功能康复的影响。方法陕西省人民医院康复医学科于2022年1月开始基于认知泛化的任务导向训练,将实施前(2021年6~12月)实施常规康复训练的40例患者纳入对照组,将实施后(2022年1~6月)实施基于认知泛化的任务导向训练的40例患者纳入观察组,持续干预4周,比较两组患者干预前及干预4周后的认知功能[简易智力状态(MMSE)/蒙特利尔认知量表(MoCA)]、运动功能与日常生活能力[简式Fugl-Meyer运动功能评测表(FMA)、改良Barthe指数量表(BI)]、康复训练依从性、自我效能[脑卒中康复自我效能量表(SSEQ)]和不良心理情绪[汉密尔顿焦虑量表(HAMA)、抑郁量表(HAMD)]。结果观察组患者干预后的MMSE评分、MoCA评分分别为(22.80±2.11)分、(20.53±2.33)分,明显高于对照组的(21.23±1.86)分、(19.08±2.07)分,差异均有统计学意义(P<0.05);观察组患者干预后的FMA评分、BI评分分别为(45.46±3.83)分、(57.36±5.15)分,明显高于对照组的(42.07±4.11)分、(54.25±4.04)分,差异均有统计学意义(P<0.05);观察组干预后康复训练依从性明显优于对照组,差异有统计学意义(P<0.05);观察组患者干预后的SSEQ评分为(82.99±6.46)分,明显高于对照组的(74.73±7.17)分,差异有统计学意义(P<0.05);观察组患者干预后的HAMA、HAMD评分分别为(9.14±1.01)分、(8.43±0.88)分,明显低于对照组的(10.93±1.77)分、(9.47±0.95)分,差异均有统计学意义(P<0.05)。结论基于认知泛化的任务导向训练可有效促进老年PSCI患者认知功能、肢体功能、日常生活能力的恢复,提升患者康复训练依从性,加强其自我效能,减轻不良心理情绪。

Objective To explore the effects of task-oriented training based on cognitive generalization on functional recovery in elderly patients with post-stroke cognitive impairment(PSCI).Methods The task-oriented training based on cognitive generalization was implemented in Department of Rehabilitation Medicine,Shaanxi People's Hospital from January 2022.Forty cases given routine rehabilitation training(between June and December 2021)were enrolled as the control group,and 40 cases given task-oriented training based on cognitive generalization were enrolled as the observation group(between January and June 2022).All the patients were continuously intervened for 4 weeks.The cognitive function[mini-mental State Examination/Montreal Cognitive Assessment(MMSE,MoCA)],motor function and activities of daily living[Fugl-Meyer motor function assessment(FMA),modified Barthe index scale(BI)],rehabilitation training compliance,self-efficacy[Stroke Self-efficacy Questionnaire(SSEQ)],and adverse psychological emotions[Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD)]in the two groups were compared before and after 4 weeks of intervention.Results After intervention,MMSE and MoCA scores in observation group were(22.80±2.11)points and(20.53±2.33)points,significantly higher than(21.23±1.86)points and(19.08±2.07)points in the control group(P<0.05).After intervention,FMA and BI scores in the observation group were(45.46±3.83)points and(57.36±5.15)points,significantly higher than(42.07±4.11)points and(54.25±4.04)points in the control group(P<0.05).After intervention,rehabilitation training compliance in the observation group was significantly better than that in the control group(P<0.05);SSEQ score was significantly higher than that in the control group:(82.99±6.46)points vs(74.73±7.17)points,P<0.05;scores of HAMA and HAMD were significantly lower than those in the control group:(9.14±1.01)points vs(10.93±1.77)points,(8.43±0.88)points vs(9.47±0.95)points,P<0.05.Conclusion Task-oriented training based on cognitive generalization can effectively promote the recovery of cognitive function,limb function,and activities of daily living in elderly patients with PSCI,improve rehabilitation training compliance,enhance self-efficacy,and relieve adverse psychological emotions.