远程康复用于脑卒中后运动性构音障碍的效果观察

Effects of tele-rehabilitation program on ataxic dysarthria following stroke

目的观察远程康复方案用于脑卒中后运动性构音障碍患者的效果。方法收集2021年1月至2023年10月在湖州市第一人民医院就诊的脑卒中后运动性构音障碍患者101例为研究对象,采用随机对照临床研究方法,按照随机数字表法分为观察组51例和对照组50例。对照组患者接受常规家庭康复指导,观察组接受远程康复方案,干预时间为12周。干预前和干预后12周,应用Frenchay构音障碍评定(FDA)、语音清晰度测试评估言语功能,比较两组干预前后FDA评分、语音清晰度评分的变化。观察组依据FDA评分结果分为轻度、中度和重度3个亚组,比较干预后3个亚组间效果的差异。结果干预后12周,观察组和对照组FDA评分、语音清晰度[观察组:(43.88±16.13)分、(68.65±16.99)%,对照组:(49.68±12.09)分、(62.36±14.20)%]均较干预前[观察组:(55.12±12.63)分、(57.96±13.48)%,对照组:(54.16±10.69)分、(57.84±12.78)%]改善(t=12.23、-14.01,12.42、-13.86,均P<0.001),且观察组较对照组改善显著(t=2.04、-2.01,均P<0.05)。干预后12周,轻度组和中度组FDA评分、语音清晰度[轻度组:(31.41±3.08)分、(82.94±6.97)%,中度组:(40.08±4.67)分、(70.92±6.26)%]均较干预前[轻度组:(42.24±6.78)分、(70.53±7.98)%,中度组:(56.17±4.65)分、(57.58±6.54)%]改善(t=10.06、-20.25、45.21、-21.34,均P<0.001),重度组FDA评分、语音清晰度[(74.20±4.29)分、(38.90±5.80)%]较干预前[(74.50±4.01)分、(37.50±4.74)%]均无明显改善(t=1.96、-1.44,均P>0.05)。结论远程康复方案可以改善脑卒中后运动性构音障碍,尤其对轻中度运动性构音障碍患者疗效显著。

Objective To investigate the effect of tele-rehabilitation program on ataxic dysarthria following stroke.Methods A total of 101 patients with stroke and dysarthria who received treatment at The First People's Hospital of Huzhou between January 2021 and October 2023 were included in this study.They were divided into an observation group(n=51)and a control group(n=50)using the random number table method.Patients in the control group received conventional family rehabilitation guidance,while those in the observation group participated in a tele-rehabilitation program.All patients were treated for 12 weeks.Before and 12 weeks after the intervention,the Frenchay Dysarthria Assessment(FDA)and speech clarity tests were used to assess speech function.Changes in FDA scores and speech clarity scores post-intervention were compared with pre-intervention scores.The observation group was further divided into mild,moderate,and severe groups based on FDA scores,and the differences in effect of tele-rehabilitation program on ataxic dysarthria among the three groups after the intervention were compared.Results At 12 weeks after intervention,both the observation and control groups showed improvements in FDA scores and speech clarity[observation group:(43.88±16.13)points,(68.65±16.99)%;control group:(49.68±12.09)points,(62.36±14.20)%]compared with their baseline measurements[observation group:(55.12±12.63)points,(57.96±13.48)%;control group:(54.16±10.69)points,(57.84±12.78)%](t=12.23,-14.01,12.42,-13.86,all P<0.001).Moreover,the observation group showed significant improvements compared with the control group(t=2.04,-2.01,both P<0.05).At 12 weeks after intervention,both the mild and moderate groups showed improvements in FDA scores and speech clarity score[mild group:(31.41±3.08)points,(82.94±6.97)%,moderate group:(40.08±4.67)points,(70.92±6.26)%]compared with their baseline measurements[mild group:(42.24±6.78)points,(70.53±7.98)%,moderate group:(56.17±4.65)points,(57.58±6.54)%,t=10.06,-20.25,45.21,-21.34,all P<0.001].There were no significant improvements in the severe group for FDA scores and speech clarity score[(74.20±4.29)points,(38.90±5.80)%]compared with their baseline measurements[(74.50±4.01)points,(37.50±4.74)%,t=1.96,-1.44,both P>0.05].Conclusion The tele-rehabilitation program can improve post-stroke ataxic dysarthria,particularly showing significant effectiveness for patients with mild to moderate ataxic dysarthria.