基于PASS理论的认知训练对卒中后认知障碍的效果

doi:10.3969/j.issn.1006-9771.2020.01.013

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (1): 70-76.doi: 10.3969/j.issn.1006-9771.2020.01.013

基于PASS理论的认知训练对卒中后认知障碍的效果

雷幸幸¹,宋鲁平^1,^2,³()

1.首都医科大学康复医学院,北京市 100068
2.中国康复研究中心北京博爱医院,北京市 100068
3.神经损伤与康复北京市重点实验室,北京市 100068

收稿日期:2019-07-24 修回日期:2019-10-12 出版日期:2020-01-25 发布日期:2020-02-07
通讯作者: 宋鲁平 E-mail:songluping882002@aliyun.com
作者简介:雷幸幸(1995-),女,汉族,河南洛阳市人,硕士研究生,主要研究方向：神经康复、认知神经科学。|宋鲁平(1964-),女,汉族,山东招远市人,主任医师、教授,博士生导师,主要研究方向：神经康复、认知神经科学。
基金资助:
1.北京市卫生与健康科技成果和适宜技术推广项目(No. 2018-TG-84)(2018-TG-84);2.中国康复研究中心项目(No. 2018ZX-12)(2018ZX-12);3.国家重点研发计划重点专项(No. 2016YFF0201002)(2016YFF0201002)

Effect of Cognitive Training Based on PASS Theory on Post-stroke Cognitive Impairment

LEI Xing-xing¹,SONG Lu-ping^1,^2,³()

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing 100068, China

Received:2019-07-24 Revised:2019-10-12 Published:2020-01-25 Online:2020-02-07
Contact: SONG Lu-ping E-mail:songluping882002@aliyun.com
Supported by:
Beijing Health and Wellness Science and Technology Achievements and Appropriate Technology Promotion Project(2018-TG-84);China Rehabilitation Research Center Project(2018ZX-12);National Key Research and Development Program(2016YFF0201002)

摘要/Abstract

摘要：

目的观察基于PASS理论的认知训练对卒中后认知障碍(PSCI)患者认知功能的影响。
方法 2018年8月至2019年6月,PSCI患者42例随机分为对照组和干预组,各21例。干预组采用基于PASS理论设计的计算机辅助认知训练,对照组进行常规计算机辅助认知训练,共4周。训练前后采用简易精神状态检查(MMSE)和洛文斯顿作业疗法用认知评定量表(LOTCA)进行评定。
结果两组各18例完成试验。训练后,两组MMSE和LOTCA评分均显著升高(t > 8.831, P < 0.001),干预组升高更多( t > 2.198, P < 0.05)。训练后,LOTCA各项因子评分,两组定向、视知觉、空间知觉、动作运用、视运动组织和思维操作评分升高( t > 2.122, P < 0.05),干预组视知觉、空间知觉和思维操作因子评分升高更多( t > 2.356, P < 0.05),视运动组织因子评分差值干预组更高( t = 2.354, P < 0.05)。
结论基于PASS理论的计算机辅助认知训练可更有效改善PSCI患者的认知功能,对视知觉、空间知觉、思维操作和视运动组织的改善更明显。

关键词: 脑卒中, 卒中后认知障碍, PASS理论, 计算机辅助认知康复

Abstract:

Objective To observe the effect of cognitive training based on PASS theory on cognition in patients with post-stroke cognitive impairment (PSCI).
Methods From August, 2018 to June, 2019, 42 patients with PSCI were randomly divided into control group (n = 21) and intervention group (n = 21). The intervention group accepted computer-assisted cognitive training based on the PASS theory, and the control group accepted routine computer-assisted cognitive training, for four weeks. They were assessed with Mini-Mental State Examination (MMSE) and Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) before and after training.
Results There were 18 patients in each group finishing the trail. After training, the scores of MMSE and LOTCA increased in both groups (t > 8.831, P < 0.001), and increased more in the intervention group than in the control group ( t > 2.198, P < 0.05). For the LOTCA factors scores, it increased in orientation, visual perception, spatial perception, motion praxis, visuomotor organization and thinking operations in both groups ( t > 2.122, P < 0.05) after training, and increased more in the intervention group than in the control group in visual perception, spatial perception and thinking operations ( t > 2.356, P < 0.05), and the differences of visuomotor organization was more in the intervention group than in the control group ( t = 2.354, P < 0.05).
Conclusion Cognitive training based on PASS theory can improve cognition for patients with PSCI, especially for visual perception, spatial perception, thinking operations and visuomotor organization.

Key words: stroke, post-stroke cognitive impairment, PASS theory, computer-assisted cognitive rehabilitation

中图分类号:

R743.3

雷幸幸,宋鲁平. 基于PASS理论的认知训练对卒中后认知障碍的效果[J]. 《中国康复理论与实践》, 2020, 26(1): 70-76.

LEI Xing-xing,SONG Lu-ping. Effect of Cognitive Training Based on PASS Theory on Post-stroke Cognitive Impairment[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(1): 70-76.

图/表 10

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项目	对照组(n = 18)	干预组(n = 18)	χ²/t值	P值
性别(男/女, n)	16/2	15/3		1.000
年龄(岁)	48.33±9.38	48.11±12. 93	-0.059	0.953
受教育程度(年)	14.72±2.45	14.39±3.52	-0.330	0.743
病程(月)	2.54±1.25	2.82±1.30	0.641	0.526
卒中类型(出血/梗死, n)	9/9	10/8	0.111	0.738
病灶侧别(左/右, n)	13/5	13/5	-	1.000
MMSE	16.61±5.33	18.61±3.99	1.275	0.211
LOTCA	76.89±18.30	83.72±15.48	1.210	0.235
简式Fugl-Meyer评定量表	31.61±31.81	43.50±30.00	1.154	0.257
Fugl-Meyer评定量表平衡部分	7.17±3.78	8.94±3.21	1.522	0.137
NIHSS	8.83±3.99	6.94±3.54	-1.503	0.142
改良Barthel指数	48.06±24.92	55.56±24.25	0.915	0.367

项目	对照组(n = 18)	干预组(n = 18)	χ²/Z值	P值
病灶部位(n)			5.800	0.326
额叶	1	1
颞叶	0	1
额颞叶	0	2
额顶叶	2	2
额颞顶叶	3	3
颞顶叶	3	2
基底节区	8	5
放射冠区	0	1
丘脑	0	1
侧脑室旁	1	0
基础慢性病史(n)			2.533	0.639
无	2	6
高血压	7	2
心脏病	3	2
2型糖尿病	1	1
高血压、高血脂	1	1
高血压、2型糖尿病	3	3
其他	1	3
病因(n)			4.667	0.587
高血压性	8	4
动脉粥样硬化性	7	7
脑血管畸形	0	5
动脉瘤破裂	1	1
心源性	2	0
其他	0	1
手功能分级(n)			-0.652	0.589
废用手	13	10
辅助手C	2	1
辅助手B	0	1
辅助手A	0	3
实用手B	0	2
实用手A	3	1
功能步行分级(n)			-0.417	0.677
0级	8	4
Ⅰ级	3	4
Ⅱ级	1	2
Ⅲ级	2	2
Ⅳ级	2	5
Ⅴ级	2	1

组别	n	训练前	训练后	差值	t值^a	P值^a
对照组	18	16.61±5.33	21.50±5.80	4.89±2.35	23.61	< 0.001
干预组	18	18.61±3.99	25.22±4.24	6.61±2.33	12.039	< 0.001
t值		1.275	2.198	2.209
P值		0.211	0.035	0.034

组别	n	训练前	训练后	差值	t值^a	P值^a
对照组	18	76.89±18.30	86.89±18.61	10.00±4.37	9.718	< 0.001
干预组	18	83.72±15.48	100.17±13.48	16.44±2.96	8.831	< 0.001
t值		1.210	2.451	5.186
P值		0.235	0.02	< 0.001

组别	n	训练前	训练后	差值	t值^a	P值^a
对照组	18	10.78±3.62	12.83±2.40	2.06±1.98	4.395	< 0.001
干预组	18	11.44±3.00	14.28±2.45	2.83±1.89	6.372	< 0.001
t值		0.602	1.521	0.296
P值		0.551	0.138	0.77

基于PASS理论的认知训练对卒中后认知障碍的效果

Effect of Cognitive Training Based on PASS Theory on Post-stroke Cognitive Impairment

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组别	n	训练前	训练后	差值	t值^a	P值^a
对照组	18	12.00±2.79	13.50±2.41	1.50±1.20	5.301	< 0.001
干预组	18	13.17±2.36	15.11±1.18	1.94±1.70	4.862	< 0.001
t值		1.356	2.549	0.497
P值		0.184	0.015	0.619

组别	n	训练前	训练后	差值	t'值^a	P值^a
对照组	18	8.94±2.24	10.33±2.20	1.39±1.34	4.415	< 0.001
干预组	18	10.33±2.45	11.67±0.97	1.33±1.97	2.871	0.011
t'值		1.777	2.356	1.497
P值		0.085	0.027	0.150

组别	n	训练前	训练后	差值	t'值^a	P值^a
对照组	18	10.50±2.62	10.89±2.48	0.39±0.78	2.122	0.049
干预组	18	11.39±1.65	11.78±0.94	0.39±2.17	2.122	0.049
t'值		1.219	1.426	1.427
P值		0.233	0.168	0.169

组别	n	训练前	训练后	差值	t值^a	P值^a
对照组	18	19.28±6.05	21.78±6.16	2.50±2.20	4.815	< 0.001
干预组	18	21.06±6.11	24.72±4.61	3.67±2.17	7.171	< 0.001
t值		0.877	1.623	2.354
P值		0.386	0.114	0.029

组别	n	训练前	训练后	差值	t值^a	P值^a
对照组	18	15.39±5.14	17.67±6.11	2.28±2.27	4.257	0.001
干预组	18	16.33±5.63	22.67±6.04	6.33±2.93	9.169	< 0.001
t值		0.526	2.470	0.451
P值		0.602	0.019	0.359

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