旋律音调疗法治疗脑卒中后非流畅性失语的效果

doi:10.3969/j.issn.1006-9771.2020.11.014

摘要/Abstract

摘要：

目的观察旋律音调疗法对脑卒中后非流畅性失语的临床康复疗效以及脑功能改变。方法 2017年3月至2019年8月,选取本院脑卒中后非流畅性失语患者40例,随机分为对照组和音乐组各20例,两组均接受言语治疗,音乐组在此基础上接受以旋律音调疗法为主的音乐治疗。治疗前和治疗4周后,采用中国康复研究中心汉语标准失语症检查表(CRRCAE)评定其听理解、复述、阅读、命名。两组各选3例患者,治疗前后行静息态fMRI,比较大脑半球局部一致性(ReHo)。结果治疗后,对照组听理解(名词、动词、句子)、复述(名词、动词)、阅读(名词)和命名(动作说明)评分提高(t > 2.221, P < 0.05),音乐组听理解(名词、动词、句子)、复述(名词、动词、句子)、阅读(名词、动词)和命名(名词、动作说明)评分提高( t > 2.179, P < 0.05)。治疗前后差值比较,音乐组复述(名词、动词)评分增加更多( t > 2.299, P < 0.05),阅读(句子)评分有增加的趋势。治疗后,患者静息状态下左侧小脑、颞枕区的ReHo增强,双侧额叶、颞叶皮质ReHo降低。结论在言语训练基础上,联合旋律音调疗法可进一步改善脑卒中后非流畅性失语患者的言语功能,特别在句子阅读和单词复述方面。ReHo改变可能与脑损伤后神经修复有关。

关键词: 脑卒中, 非流畅性失语, 旋律音调疗法, 音乐治疗, 言语治疗

Abstract:

Objective To observe the effect of melodic intonation therapy combined with speech training on nonfluent aphasia after stroke, and the changes of brain function.Methods From March, 2017 to August, 2019, 40 patients with nonfluent aphasia after stroke were randomly divided into control group (n = 20) and intensive group (n = 20). Both groups accepted routine speech training, and the intensive group accepted melodic intonation therapy in addition. They were assessed with China Rehabilitation Research Center Chinese Standard Aphasia Examination before and four weeks after treatment. Three patients from each group were examined with resting-state functional magnetic resonance imaging to observe the changes of regional homogeneity (ReHo) of cerebral hemisphere.Results The scores of comprehension (noun, verb and sentence), repetition (noun and verb), read (noun) and naming (verb) increased in the control group (t > 2.221, P < 0.05), while it increased in comprehension (noun, verb and sentence), repetition (noun, verb and sentence), reading (noun and verb) and naming (noun and verb) in the intensive group ( t > 2.179, P < 0.05). The scores of repetition (noun and verb) increased more in the intensive group than in the control group ( t > 2.299, P < 0.05), and the scores of reading (sentence) increased somehow. The ReHo in left cerebellum and temporal occipital area increased and the ReHo in bilateral frontal and temporal cortex decreased after treatment. Conclusion Melodic intonation therapy based on speech therapy can promote the recovery of speech function for patients with nonfluent aphasia after stroke, especially in sentence reading and words repetition. The changes of the ReHo in resting state may associate with the neurological repairment after brain injury.

Key words: stroke, nonfluent aphasia, melodic intonation therapy, music therapy, speech therapy

中图分类号:

R743.3

吴晓莉,张晓颖,张庆苏,杨凌宇,厉含之,高飞,杨宇琦,胡雪艳,陈予东,叶长青,张玉阁,山磊,刘丽旭. 旋律音调疗法治疗脑卒中后非流畅性失语的效果[J]. 《中国康复理论与实践》, 2020, 26(11): 1327-1332.

WU Xiao-li,ZHANG Xiao-ying,ZHANG Qing-su,YANG Ling-yu,LI Han-zhi,GAO Fei,YANG Yu-qi,HU Xue-yan,CHEN Yu-dong,YE Chang-qing,ZHANG Yu-ge,SHAN Lei,LIU Li-xu. Effect of Melodic Intonation Therapy on Nonfluent Aphasia after Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(11): 1327-1332.

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项目		对照组 (n= 20)	音乐组 (n= 20)	χ²/t值	P值
性别(n)	男	18	17	0.229	0.633
性别(n)	女	2	3	0.229
年龄(岁)		50.30±9.521	53.60±10.410	1.046	0.903
病程(d)		56.65±34.559	52.80±30.033	0.235	0.631
文化程度(n)	小学及以下	2	1	1.867	0.393
文化程度(n)	中学	13	10
	大学及以上	5	9
卒中类型(n)	梗死	10	12	0.404	0.525
卒中类型(n)	出血	10	8
发病到诊治时间(h)		6.78±15.498	3.64±3.523	0.916	0.181
康复介入时间(d)		24.85±14.687	23.45±10.625	0.283	0.288
言语治疗介入时间(d)		47.95±34.740	47.65±30.819	0.165	0.669
FMA评分		35.95±30.295	22.80±23.525	1.536	0.056
MBI评分		46.25±22.877	41.75±17.112	0.704	0.222

项目		n	治疗前	治疗后	t值	P值
听理解	名词	20	27.00±28.672	51.00±3.388	4.405	< 0.001
	动词	20	23.50±29.961	42.50±34.622	4.433	< 0.001
	句子	20	2.50±7.864	21.00±24.257	4.234	< 0.001
复述	名词	20	17.00±33.888	28.00±35.333	3.168	0.005
	动词	20	18.00±35.924	23.50±36.458	2.979	0.008
	句子	20	1.58±6.882	8.42±23.396	1.753	0.097
阅读	名词	20	15.50±32.683	21.50±34.224	3.269	0.004
	动词	20	9.50±24.810	18.00±34.580	2.001	0.060
	句子	20	1.50±4.894	5.00±13.179	1.437	0.167
命名	名词	20	14.00±28.359	20.00±35.541	1.641	0.117
命名	动作说明	20	10.50±24.165	17.00±32.298	2.221	0.039

项目		n	治疗前	治疗后	t值	P值
听理解	名词	20	25.00±30.349	53.50±27.773	5.904	< 0.001
	动词	20	17.50±24.682	46.50±22.070	6.493	< 0.001
	句子	20	10.00±20.000	30±24.709	4.951	< 0.001
复述	名词	20	31.50±39.105	58.50±35.285	4.477	< 0.001
	动词	20	19.50±30.860	38.00±35.184	4.069	0.001
	句子	20	1.50±4.894	9.50±10.990	3.760	0.001
阅读	名词	20	6.50±14.244	12.00±18.238	2.238	0.037
	动词	20	1.00±4.472	9.50±13.169	3.101	0.006
	句子	20	0.00±0.000	2.50±5.501	2.032	0.056
命名	名词	20	6.00±13.534	17.00±21.051	3.168	0.005
命名	动作说明	20	1.50±3.663	7.50±13.328	2.179	0.042

项目		n	对照组	音乐组	t值	P值
听理解	名词	20	24.00±24.366	28.50±21.588	0.618	0.540
	动词	20	19.00±19.167	29.00±19.974	1.616	0.114
	句子	20	18.50±19.541	20.00±18.064	0.252	0.802
复述	名词	20	11.00±15.526	27.00±26.970	2.299	0.027
	动词	20	5.50±8.256	18.502±0.333	2.649	0.012
	句子	20	6.50±16.631	8.00±9.515	0.350	0.728
阅读	名词	20	12.00±26.278	18.50±20.844	0.867	0.392
	动词	20	9.00±19.974	16.00±23.709	1.010	0.319
	句子	20	6.50±14.244	18.00±26.077	1.731	0.092
命名	命名	20	6.00±16.351	11.00±15.526	0.992	0.328
命名	动作说明	20	6.50±13.089	6.00±12.312	0.124	0.902