言语训练结合头皮针灸治疗卒中失语症患者的疗效分析
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摘要
目的探讨分析言语训练结合头皮针灸在卒中失语症患者中改善言语功能、认知功能和日常生活活动能力的临床疗效。方法回顾性分析上海健康医学院附属嘉定区中心医院康复科和神经内科自2016年1月-2017年1月收治的卒中失语症患者90例,分成言语训练+头皮针灸组、言语训练组、对照组,使用改良Barthel指数、失语商(采用西部失语成套测验量表)、蒙特利尔认知评估(Montreal cognitive assessment,MoCA)三方面数据,评定治疗前、治疗1个月和3个月的功能恢复情况,以及停止治疗9个月的远期治疗效果。结果 (1)治疗1个月、3个月及停止治疗9个月的三组改良Barthel指数、MoCA指数、失语商均得到改善。(2)言语训练+头皮针灸组和言语训练组的MoCA指数和失语商在治疗后均呈现出持续改善的现象(均P<0.001)。(3)言语训练+头皮针灸组的MoCA指数和失语商改善程度优于言语训练组和对照组(P<0.05),言语训练+头皮针灸组的改良Barthel指数在治疗3个月内优于言语训练组(P<0.05)。结论言语训练结合头皮针灸的康复治疗方法改善言语障碍和认知障碍的效果明显,且短期内提高日常生活活动能力的效果较佳。
Objective To explore the therapeutic effect of speech training combined with scalp acupuncture in improving speech, cognitive function and activities of daily living in stroke patients with aphasia.Methods A retrospective analysis was made on 90 patients with apoplectic aphasia admitted to rehabilitation department and neurology department of our hospital from January 2016 to January 2017. They were divided into speech training combined with scalp needle group, speech training group and control group. Speech training combined with scalp needle group and speech training group served as observation groups, and compared before and after treatment. The functional recovery after treatment for 1 month and 3 months, and the long-term therapeutic effect at 9 months after discontinuation of treatment were evaluated by Barthel index(BI), Montreal cognitive assessment(MoCA) and aphasia quotient.Results(1) The BI, MoCA score and aphasia quotient of each group were all improved after 1 month and 3 months of treatment and at 9 months after ceasing treatment.(2) MoCA scores and aphasia quotient of the two observation groups both showed continuous improvement after treatment(P<0.001).(3) MoCA score and aphasia quotient of speech training combined with scalp needle group were better than that of speech training group and control group(P<0.05); the BI of speech training combined with scalp needle group was better than that of speech training group after 3 months of treatment(P<0.05).Conclusions Speech training combined with scalp needle rehabilitation therapy can obviously improve speech and cognitive impairment, and improve activities of daily living more better in a short term.
Objective To explore the therapeutic effect of speech training combined with scalp acupuncture in improving speech, cognitive function and activities of daily living in stroke patients with aphasia.Methods A retrospective analysis was made on 90 patients with apoplectic aphasia admitted to rehabilitation department and neurology department of our hospital from January 2016 to January 2017. They were divided into speech training combined with scalp needle group, speech training group and control group. Speech training combined with scalp needle group and speech training group served as observation groups, and compared before and after treatment. The functional recovery after treatment for 1 month and 3 months, and the long-term therapeutic effect at 9 months after discontinuation of treatment were evaluated by Barthel index(BI), Montreal cognitive assessment(MoCA) and aphasia quotient.Results(1) The BI, MoCA score and aphasia quotient of each group were all improved after 1 month and 3 months of treatment and at 9 months after ceasing treatment.(2) MoCA scores and aphasia quotient of the two observation groups both showed continuous improvement after treatment(P<0.001).(3) MoCA score and aphasia quotient of speech training combined with scalp needle group were better than that of speech training group and control group(P<0.05); the BI of speech training combined with scalp needle group was better than that of speech training group after 3 months of treatment(P<0.05).Conclusions Speech training combined with scalp needle rehabilitation therapy can obviously improve speech and cognitive impairment, and improve activities of daily living more better in a short term.
引文
[1]谢瑛,吴春薇,丁玎,等.基于镜像神经元理论治疗技术在卒中后运动和认知及言语康复中的应用[J].中国脑血管病杂志,2015,12(12):659-663.
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[4]张小罗,李秀彬,王位.眼针配合语言功能训练治疗中风失语症疗效观察[J].上海针灸杂志,2016,35(9):1036-1039.
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[7]江玉娟,杨玉霞,常娥,等.体表定位电头针结合Rosenbek八步训练法治疗脑卒中患者言语失用症的疗效观察[J].中国康复医学杂志,2015,30(4):366-368.
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[11]张浪.针刺结合语言康复治疗脑卒中后运动性失语[J].长春中医药大学学报,2013,29(4):636-637.
[12]吴积宝,刘晓加,吴小琴,等.非语言性认知功能评估量表的验证[J].国际脑血管病杂志,2013,21(4):282-287.
[13]王秋华,王丽,张国力,等.早期社区康复的脑卒中患者认知功能恢复的影响因素研究[J].中华老年心脑血管病杂志,2015,17(3):246-249.
[14]王茜,刘晓加.卒中后失语与卒中后认知功能障碍的相关因素研究现状[J/CD].中华临床医师杂志(电子版),2015,9(24):4685-4689.
[15]BERTHIER M L,PULVERM?LLER F.Neuroscience insights improve neurorehabilitation of poststroke aphasia[J].Nat Rev Neurol,2011,7(2):86-97.
[16]LEE W K.Effectiveness of computerized cognitive rehabilitation training on symptomatological,neuropsychological and work function in patients with schizophrenia[J].Asia Pac Psychiatry,2013,5(2):90-100.
[17]张华,吴瑞鹏,李娜.卒中后失语症康复治疗的现状及进展[J].宁夏医学杂志,2013,35(4):377-379.
[18]秦懿囡,杨红玲,张杰,等.针刺治疗脑出血常见后遗症临床研究进展[J].辽宁中医药大学学报,2017,19(2):130-132.
[19]陈新勇,吴富东.头针针刺病灶侧和非病灶侧对中风患者脑血流的影响[J].上海针灸杂志,2011,30(9):586-588.
[20]焦俊杰,郭洪亮,何有娣,等.眼针对脑梗死半身不遂患者神经功能缺损程度和Barthel指数的影响[J].中国针灸,2016,36(6):581-585.
[21]程红亮,李飞,胡培佳,等.通督调神针法治疗脑卒中后痉挛瘫期的临床研究[J].中医药临床杂志,2012,24(6):499-501.
[2]BERTHIER M L.Poststroke aphasia:epidemiology,pathophysiology and treatment[J].Drugs Aging,2005,22(2):163-182.
[3]唐强,李宏玉,朱路文,等.针康法对脑卒中后非流畅性失语患者言语功能的影响[J].针灸临床杂志,2016,32(7):35-37.
[4]张小罗,李秀彬,王位.眼针配合语言功能训练治疗中风失语症疗效观察[J].上海针灸杂志,2016,35(9):1036-1039.
[5]吴宏,许光,曾科学.言语训练配合太极针法治疗中风后失语的临床研究[J].世界中医药,2016,11(7):1323-1326.
[6]帅杰,叶建宁,何绮雪.脑血管病失语症患者语言康复治疗研究[J].重庆医学,2005,34(4):558-559.
[7]江玉娟,杨玉霞,常娥,等.体表定位电头针结合Rosenbek八步训练法治疗脑卒中患者言语失用症的疗效观察[J].中国康复医学杂志,2015,30(4):366-368.
[8]SCOBBIE L,MCLEAN D,DIXON D,et al.Implementing a framework for goal setting in community based stroke rehabilitation:a process evaluation[J/OL].BMC Health Serv Res,2013,13:190.https://doi.org/10.1186/1472-6963-13-190.
[9]RACETTE A,BARD C,PERETZ I.Making nonfluent aphasics speak:sing along![J].Brain,2006,129(Pt 10):2571-2584.
[10]OZDEMIR E,NORTON A,SCHLAUG G.Shared and distinct neural correlates of singing and speaking[J].Neuroimage,2006,33(2)628-635.
[11]张浪.针刺结合语言康复治疗脑卒中后运动性失语[J].长春中医药大学学报,2013,29(4):636-637.
[12]吴积宝,刘晓加,吴小琴,等.非语言性认知功能评估量表的验证[J].国际脑血管病杂志,2013,21(4):282-287.
[13]王秋华,王丽,张国力,等.早期社区康复的脑卒中患者认知功能恢复的影响因素研究[J].中华老年心脑血管病杂志,2015,17(3):246-249.
[14]王茜,刘晓加.卒中后失语与卒中后认知功能障碍的相关因素研究现状[J/CD].中华临床医师杂志(电子版),2015,9(24):4685-4689.
[15]BERTHIER M L,PULVERM?LLER F.Neuroscience insights improve neurorehabilitation of poststroke aphasia[J].Nat Rev Neurol,2011,7(2):86-97.
[16]LEE W K.Effectiveness of computerized cognitive rehabilitation training on symptomatological,neuropsychological and work function in patients with schizophrenia[J].Asia Pac Psychiatry,2013,5(2):90-100.
[17]张华,吴瑞鹏,李娜.卒中后失语症康复治疗的现状及进展[J].宁夏医学杂志,2013,35(4):377-379.
[18]秦懿囡,杨红玲,张杰,等.针刺治疗脑出血常见后遗症临床研究进展[J].辽宁中医药大学学报,2017,19(2):130-132.
[19]陈新勇,吴富东.头针针刺病灶侧和非病灶侧对中风患者脑血流的影响[J].上海针灸杂志,2011,30(9):586-588.
[20]焦俊杰,郭洪亮,何有娣,等.眼针对脑梗死半身不遂患者神经功能缺损程度和Barthel指数的影响[J].中国针灸,2016,36(6):581-585.
[21]程红亮,李飞,胡培佳,等.通督调神针法治疗脑卒中后痉挛瘫期的临床研究[J].中医药临床杂志,2012,24(6):499-501.