计算机辅助认知训练对脑卒中后认知障碍的效果
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摘要
目的探讨计算机辅助认知训练对脑卒中后认知障碍(PSCI)的临床疗效。方法将30例PSCI患者随机分为计算机组和对照组各15例。对照组只接受常规药物治疗及人工认知训练,计算机组在常规药物治疗及人工认知训练基础上增加基于六六脑?脑康复云系统的计算机辅助认知训练,1次/d,30 min/次,5次/周,于治疗前、治疗12周后对各组患者的认知功能、日常生活能力和独立能力进行疗效评估,采用蒙特利尔认知评估量表(MoCA)、改良Barthel指数量表(MBI)和功能独立评定量表(FIM)评分法。结果 (1)认知功能变化:治疗12周后,两组MoCA评分较治疗前均明显提高(P<0.05),其中计算机组命名、注意力、抽象能力、延迟回忆和定向力项目评分和对照组延迟回忆项目评分均明显高于治疗前(P<0.05),计算机组MoCA总分要高于对照组且组间差异有统计学意义(P<0.05)。(2)日常生活和独立能力:计算机组MBI、FIM评分比治疗前明显提高(P<0.05),而对照组MBI、FIM评分与治疗前比较差异无统计学意义(P>0.05),治疗后计算机组MBI、FIM评分明显高于对照组(P<0.05)。结论基于六六脑?脑康复云系统的计算机辅助认知训练对改善脑卒中后认知功能有明显的积极作用,与传统人工训练结合应用的临床疗效优于单用人工认知训练。
Objective To investigate the clinical effect of computer-assisted cognitive training on post-stroke cognitive impairment(PSCI). Methods Thirty patients with PSCI were randomly divided into computer group and control group(n=15). The control group only received routine medical therapy and artificial cognitive training, while the computer group received routine medical therapy and artificial cognitive training aided computer-assisted cognitive training on the basis of 66 brain training system. The treatment effectiveness was assessed by montreal cognitive assessment scale(MoCA), modified barthel index(MBI) and functional independence measure(FIM). The evaluation was performed before and at the 12 weeks after the treatment. Results After treatment, the results of MoCA were significantly improved in both groups(P<0.05), and the scores of nomination, abstract ability, attention, delayed recall and orientation items in the computer group and the scores of the delayed recall item in the control group were significantly higher than before(P<0.05), and the total score of MoCA in the computer group was significantly higher than that in the control group(P<0.05). The scores of MBI and FIM in the computer group were significantly higher than before(P<0.05). After treatment, the scores of MBI and FIM in the computer group were significantly higher than those in the control group(P<0.05). Conclusion Computer-assisted cognitive training has a positive effect on improving PSCI. The treatment effect combined with the traditional artificial training is obviously better than the artificial cognitive training alone.
Objective To investigate the clinical effect of computer-assisted cognitive training on post-stroke cognitive impairment(PSCI). Methods Thirty patients with PSCI were randomly divided into computer group and control group(n=15). The control group only received routine medical therapy and artificial cognitive training, while the computer group received routine medical therapy and artificial cognitive training aided computer-assisted cognitive training on the basis of 66 brain training system. The treatment effectiveness was assessed by montreal cognitive assessment scale(MoCA), modified barthel index(MBI) and functional independence measure(FIM). The evaluation was performed before and at the 12 weeks after the treatment. Results After treatment, the results of MoCA were significantly improved in both groups(P<0.05), and the scores of nomination, abstract ability, attention, delayed recall and orientation items in the computer group and the scores of the delayed recall item in the control group were significantly higher than before(P<0.05), and the total score of MoCA in the computer group was significantly higher than that in the control group(P<0.05). The scores of MBI and FIM in the computer group were significantly higher than before(P<0.05). After treatment, the scores of MBI and FIM in the computer group were significantly higher than those in the control group(P<0.05). Conclusion Computer-assisted cognitive training has a positive effect on improving PSCI. The treatment effect combined with the traditional artificial training is obviously better than the artificial cognitive training alone.
引文
[1] 孙家浩,郁金泰,谭兰.卒中后认知损害:流行病学、机制及治疗措施[C].成都:中华医学会第十八次全国神经病学学术会议论文汇编(下),2015.
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[3] Stuifbergen AK,Becker H,Perez F,et al.Computer-assisted cognitive rehabilitation in persons with multiple sclerosis:Results of a multi-site randomized controlled trial with six month follow-up[EB/OL].Disabil Health J,2018,11(3):427-434.
[4] Cho HY,Kim KT,Jung JH.Effects of computer assisted cognitive rehabilitation on brain wave,memory and attention of stroke patients:a randomized control trial[J].J Phys Ther Sci,2015,27(4):1029-1032.
[5] 常辛欣,房芳,何永生.计算机辅助认知康复训练治疗脑卒中后认知功能障碍的研究进展[J].神经疾病与精神卫生,2017,17(3):212-215.
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[7] 曲艳吉,卓琳,詹思延.中国脑卒中后认知障碍流行病学特征的系统评价[J].中华老年心脑血管病杂志,2013,15(12):1294-1301.
[8] 张英,杨颖华,武士勇,等.轻度认知障碍认知训练的研究进展[J].中国康复医学杂志,2018,30(2):249-253.
[9] 吴毅,刘罡.神经系统可塑性的理论研究与实践[J].中华物理医学与康复杂志,2007,29(4):284-286.
[10] 张国庆,邵肖梅.丰富环境对于中枢神经系统可塑性的影响[J].中国康复医学杂志,2006,21(3):280-283.
[11] Peralta P,Gascón A,Latorre E.Occupational Therapy Prevents Cognitive Impairment on Long-Term Care Residents[J].Phys Occupat Ther Geriatr,2017,(2):1-13.
[12] Hoffmann T,Bennett S,Koh C,et al.The Cochrane review of occupational therapy for cognitive impairment in stroke patients[J].Cochra Datab Syst Rev,2010,47(9):CD006430.
[13] Shin SH,Ji SK,Yong KK.The Effects of a Computer-assisted Cognition Training Program (RehaCom?) in Stroke Patients[J].Brain Neurorehabilit,2008,1(2):181.
[14] Mohammadi MR,Keshavarzi Z,Talepasand S.The effectiveness of computerized cognitive rehabilitation training program in improving cognitive abilities of schizophrenia clients[J].Iran J Psychiatry,2014,9(4):209-215.
[15] Stuifbergen A,Becker H,Morgan S,et al.Home-Based Computer-Assisted Cognitive Training:Feasibility and Perceptions of People with Multiple Sclerosis[J].Int J MS Care,2012,13(4):189-198.
[16] 周惠嫦,张盘德,陈丽珊,等.计算机辅助认知训练对血管性认知障碍的疗效观察[J].中国康复医学杂志,2012,27(6):551-553.
[17] 王晓娜,顾莹,刘敏.电脑辅助认知康复系统治疗脑卒中后认知障碍的疗效观察[J].中国康复,2013,28(5):330-332.
[18] 李明,陕大艳,肖林,等.电脑辅助认知康复系统治疗脑卒中后认知障碍的疗效观察[J].昆明医科大学学报,2016,37(10):78-80.
[19] 姜荣荣,陈艳,罗丽娟,等.一种新型认知障碍诊治系统用于卒中后认知障碍康复治疗的疗效观察[J].中国康复医学杂志,2017,32(4):414-418.
[20] 单晶丽,李红颖,王丽莹,等.电脑辅助认知康复系统对脑卒中后认知功能障碍的影响[J].医药前沿,2017,7(10):91-92.
[21] 蔡天燕,冉春风,钞强,等.计算机辅助工作记忆训练对脑卒中后认知障碍的影响[J].中国康复,2016,31(5):377-379.
[2] 《卒中后认知障碍管理专家共识(2017)》防治要点[J].实用心脑肺血管病杂志,2017,25(6):37-42.
[3] Stuifbergen AK,Becker H,Perez F,et al.Computer-assisted cognitive rehabilitation in persons with multiple sclerosis:Results of a multi-site randomized controlled trial with six month follow-up[EB/OL].Disabil Health J,2018,11(3):427-434.
[4] Cho HY,Kim KT,Jung JH.Effects of computer assisted cognitive rehabilitation on brain wave,memory and attention of stroke patients:a randomized control trial[J].J Phys Ther Sci,2015,27(4):1029-1032.
[5] 常辛欣,房芳,何永生.计算机辅助认知康复训练治疗脑卒中后认知功能障碍的研究进展[J].神经疾病与精神卫生,2017,17(3):212-215.
[6] 中华医学会神经病学分会.中国脑血管疾病分类2015[J].中华神经科杂志,2017,50(3):168-171.
[7] 曲艳吉,卓琳,詹思延.中国脑卒中后认知障碍流行病学特征的系统评价[J].中华老年心脑血管病杂志,2013,15(12):1294-1301.
[8] 张英,杨颖华,武士勇,等.轻度认知障碍认知训练的研究进展[J].中国康复医学杂志,2018,30(2):249-253.
[9] 吴毅,刘罡.神经系统可塑性的理论研究与实践[J].中华物理医学与康复杂志,2007,29(4):284-286.
[10] 张国庆,邵肖梅.丰富环境对于中枢神经系统可塑性的影响[J].中国康复医学杂志,2006,21(3):280-283.
[11] Peralta P,Gascón A,Latorre E.Occupational Therapy Prevents Cognitive Impairment on Long-Term Care Residents[J].Phys Occupat Ther Geriatr,2017,(2):1-13.
[12] Hoffmann T,Bennett S,Koh C,et al.The Cochrane review of occupational therapy for cognitive impairment in stroke patients[J].Cochra Datab Syst Rev,2010,47(9):CD006430.
[13] Shin SH,Ji SK,Yong KK.The Effects of a Computer-assisted Cognition Training Program (RehaCom?) in Stroke Patients[J].Brain Neurorehabilit,2008,1(2):181.
[14] Mohammadi MR,Keshavarzi Z,Talepasand S.The effectiveness of computerized cognitive rehabilitation training program in improving cognitive abilities of schizophrenia clients[J].Iran J Psychiatry,2014,9(4):209-215.
[15] Stuifbergen A,Becker H,Morgan S,et al.Home-Based Computer-Assisted Cognitive Training:Feasibility and Perceptions of People with Multiple Sclerosis[J].Int J MS Care,2012,13(4):189-198.
[16] 周惠嫦,张盘德,陈丽珊,等.计算机辅助认知训练对血管性认知障碍的疗效观察[J].中国康复医学杂志,2012,27(6):551-553.
[17] 王晓娜,顾莹,刘敏.电脑辅助认知康复系统治疗脑卒中后认知障碍的疗效观察[J].中国康复,2013,28(5):330-332.
[18] 李明,陕大艳,肖林,等.电脑辅助认知康复系统治疗脑卒中后认知障碍的疗效观察[J].昆明医科大学学报,2016,37(10):78-80.
[19] 姜荣荣,陈艳,罗丽娟,等.一种新型认知障碍诊治系统用于卒中后认知障碍康复治疗的疗效观察[J].中国康复医学杂志,2017,32(4):414-418.
[20] 单晶丽,李红颖,王丽莹,等.电脑辅助认知康复系统对脑卒中后认知功能障碍的影响[J].医药前沿,2017,7(10):91-92.
[21] 蔡天燕,冉春风,钞强,等.计算机辅助工作记忆训练对脑卒中后认知障碍的影响[J].中国康复,2016,31(5):377-379.