计算机认知矫正疗法对卒中后认知功能障碍的效果

doi:10.3969/j.issn.1006-9771.2025.12.008

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (12): 1439-1449.doi: 10.3969/j.issn.1006-9771.2025.12.008

计算机认知矫正疗法对卒中后认知功能障碍的效果

颜如秀¹^,^2a, 宋鲁平¹^,³(), 黄富表¹^,^2a(), 梁艳华¹^,^2b, 崔尧¹^,^2c, 杨昊¹^,^2a

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，a作业疗法科；b.运动疗法一科；c.理疗科，北京市 100068
3.深圳大学附属南山医院康复医学科，广东深圳市 518000

收稿日期:2025-08-05 修回日期:2025-10-06 出版日期:2025-12-25 发布日期:2025-12-29
通讯作者: 宋鲁平,黄富表 E-mail:songluping882002@aliyun.com
作者简介:颜如秀(1987-)，男，汉族，福建三明市人，主管技师，主要研究方向：神经康复作业疗法、认知康复。
基金资助:
1.中国康复研究中心项目(2022ZX-35);2.深圳市南山区卫生健康系统科技重大项目(NSZD2023014)

Effect of computerized cognitive remediation therapy on post-stroke cognitive impairment

YAN Ruxiu¹^,^2a, SONG Luping¹^,³(), HUANG Fubiao¹^,^2a(), LIANG Yanhua¹^,^2b, CUI Yao¹^,^2c, YANG Hao¹^,^2a

1. Capital Medical University of Rehabilitation Medicine, Beijing 100068, China
2. a. Department of Occupational Therapy; b. Section One of Physical Therapy Department; c. Department of Physiotherapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. Department of Rehabilitation Medicine, Nanshan Hospital Affiliated to Shenzhen University, Shenzhen, Guangdong 518000, China

Received:2025-08-05 Revised:2025-10-06 Published:2025-12-25 Online:2025-12-29
Contact: SONG Luping, HUANG Fubiao E-mail:songluping882002@aliyun.com
Supported by:
China Rehabilitation Research Center Project(2022ZX-35);Nanshan District Health System Technology Major Project in Shenzhen(NSZD2023014)

摘要/Abstract

摘要：

目的观察计算机认知矫正疗法(CCRT)对卒中后认知功能障碍(PSCI)患者认知功能和日常生活活动能力(ADL)的影响。
方法选择2021年11月至2023年5月在北京博爱医院住院的PSCI患者56例，随机分为对照组(n = 28)和试验组(n = 28)。对照组接受常规认知训练结合作业疗法认知作业活动，试验组接受常规认知训练结合CCRT，共4周。分别于训练前后，采用洛文斯顿作业疗法认知评定量表(LOTCA)和重复性成套神经心理状态测验(rBANS)评定认知功能，采用改良Barthel指数(MBI)评定ADL。
结果对照组和试验组各脱落3例。训练后，两组LOTCA总分、rBANS总分和MBI评分均显著提高(|t| ≥ 8.944, P < 0.001)。试验组治疗前后LOTCA的视运动组织和思维操作评分差值大于对照组(|t| ≥ 2.120, P < 0.05)，治疗前后rBANS的即刻记忆、言语功能、注意和延时记忆评分差值大于对照组(|t| ≥ 2.392, P < 0.05)。
结论 CCRT可以有效改善PSCI患者的总体认知功能，提高其ADL。与OT认知作业活动比较，CCRT在视运动组织、思维操作、即刻记忆、言语功能、注意以及延时记忆等方面疗效更佳。

关键词: 卒中后认知功能障碍, 计算机认知矫正疗法, 计算机辅助认知康复, 日常生活活动能力

Abstract:

Objective To observe the effect of computerized cognitive remediation therapy (CCRT) on cognitive function and activities of daily living (ADL) in patients with post-stroke cognitive impairment (PSCI).
Methods From November, 2021 to May, 2023, 56 inpatients with PSCI in Beijing Bo'ai Hospital were recruited and randomly divided into control group (n = 28) and experimental group (n = 28). The control group received conventional cognitive training combined with occupational therapy cognitive training activities, while the experimental group received conventional cognitive training combined with CCRT, for four weeks. They were evaluated with Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), Repeatable Battery for Assessment of Neuropsychological Status (rBANS) and modified Barthel Index (MBI) before and after treatment.
Results Three cases dropped out in each group. After treatment, the total scores of LOTCA and rBANS, and the score of MBI increased significantly in both groups (|t| ≥ 8.944, P < 0.001). The differences in the scores of visuomotor organization and thinking operations domains in LOTCA between pre-treatment and post-treatment (|t| ≥ 2.120, P < 0.05), and the differences in the scores of immediate memory, speech function, attention and delayed memory domains in rBANS between pre-treatment and post-treatment (|t| ≥ 2.392, P < 0.05) were higher in the experimental group than in the control group.
Conclusion CCRT can effectively improve the overall cognitive function and ADL of PSCI patients. Compared with occupational therapy cognitive training activities, CCRT demonstrates superior efficacy on aspects such as visuomotor organization, thinking operations, immediate memory, speech function, attention and delayed memory domains.

Key words: post-stroke cognitive impairment, computerized cognitive remediation therapy, computer-assisted cognitive rehabilitation, activities of daily living

中图分类号:

R743.3

颜如秀, 宋鲁平, 黄富表, 梁艳华, 崔尧, 杨昊. 计算机认知矫正疗法对卒中后认知功能障碍的效果[J]. 《中国康复理论与实践》, 2025, 31(12): 1439-1449.

YAN Ruxiu, SONG Luping, HUANG Fubiao, LIANG Yanhua, CUI Yao, YANG Hao. Effect of computerized cognitive remediation therapy on post-stroke cognitive impairment[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(12): 1439-1449.

图/表 6

表1

表2

两组训练前后LOTCA总分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	25	前测	84.92±16.11	-15.982	< 0.001
		后测	94.16±15.16
		训练前后差值	9.24±2.89
试验组	25	前测	86.04±17.51	-13.335	< 0.001
		后测	99.96±14.54
		训练前后差值	13.92±5.22
训练前两组均值差			-1.12±4.76	-0.235	0.815
训练后两组均值差			-5.80±4.20	-1.381	0.174
两组差值均值差			-4.68±1.19	-3.922	< 0.001

表2

表3

两组训练前后LOTCA各项因子比较"

项目因子	组别	n	测试	$x - ± s$	t值	P值
定向	对照组	25	前测	11.68±3.84	-6.107	< 0.001
			后测	13.04±3.25
			训练前后差值	1.36±1.11
	试验组	25	前测	11.72±4.17	-6.149	< 0.001
			后测	13.68±3.39
			训练前后差值	1.96±1.59
	训练前两组均值差			-0.04±1.13	-0.035	0.972
	训练后两组均值差			-0.64±0.94	-0.682	0.499
	两组差值均值差			-0.60±0.39	-1.543	0.129
视知觉	对照组	25	前测	14.08±1.61	-6.647	< 0.001
			后测	15.16±1.21
			训练前后差值	1.08±0.81
	试验组	25	前测	13.72±1.79	-6.914	< 0.001
			后测	15.36±1.47
			训练前后差值	1.64±1.19
	训练前两组均值差			0.36±0.48	0.748	0.458
	训练后两组均值差			-0.20±0.38	-0.525	0.602
	两组差值均值差			-0.56±0.29	-1.948	0.058
空间知觉	对照组	25	前测	10.12±2.46	-4.575	< 0.001
			后测	10.88±2.09
			训练前后差值	0.76±0.83
	试验组	25	前测	10.08±2.74	-6.914	0.001
			后测	11.00±2.10
			训练前后差值	0.92±1.08
	训练前两组均值差			0.04±0.74	0.054	0.957
	训练后两组均值差			-0.12±0.59	-0.203	0.840
	两组差值均值差			-0.16±0.27	-0.588	0.559
动作运用	对照组	25	前测	10.12±2.05	-5.237	< 0.001
			后测	10.92±1.55
			训练前后差值	0.80±0.76
	试验组	25	前测	10.56±1.71	-6.914	< 0.001
			后测	11.52±1.09
			训练前后差值	0.96±1.02
	训练前两组均值差			-0.44±0.53	-0.825	0.414
	训练后两组均值差			-0.60±0.38	-1.584	0.120
	两组差值均值差			-0.16±0.25	-0.628	0.533
视运动组织	对照组	25	前测	20.56±4.67	-7.135	< 0.001
			后测	22.88±4.37
			训练前后差值	2.32±1.63
	试验组	25	前测	21.16±5.49	-7.906	< 0.001
			后测	24.64±4.30
			训练前后差值	3.48±2.20
	训练前两组均值差			-0.60±1.44	-0.416	0.679
	训练后两组均值差			-1.76±1.23	-1.435	0.158
	两组差值均值差			-1.16±0.55	-2.120	0.039
思维操作	对照组	25	前测	18.36±5.76	-11.332	< 0.001
			后测	21.28±5.90
			训练前后差值	2.92±1.29
	试验组	25	前测	18.80±5.96	-14.224	< 0.001
			后测	23.76±5.37
			训练前后差值	4.96±1.74
	训练前两组均值差			-0.44±1.66	-0.266	0.792
	训练后两组均值差			-2.48±1.60	-1.554	0.127
	两组差值均值差			-2.04±0.43	-4.705	< 0.001

表3

表4

两组训练前后rBANS总分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	25	前测	61.52±19.80	-10.633	< 0.001
		后测	67.76±20.88
		训练前后差值	6.24±2.63
试验组	25	前测	59.28±15.00	-10.523	< 0.001
		后测	71.92±16.76
		训练前后差值	12.64±6.01
训练前两组均值差			2.24±4.97	0.451	0.654
训练后两组均值差			-4.16±5.36	-0.777	0.441
两组差值均值差			-6.40±1.31	-4.879	< 0.001

表4

表5

两组训练前后rBANS各项因子比较"

项目因子	组别	n	测试	$x - ± s$	t值	P值
即刻记忆	对照组	25	前测	60.52±22.50	-9.222	< 0.001
			后测	66.52±23.58
			训练前后差值	6.00±3.25
	试验组	25	前测	55.72±18.22	-7.915	< 0.001
			后测	66.12±19.36
			训练前后差值	10.40±6.57
	训练前两组均值差			4.80±5.79	0.829	0.411
	训练后两组均值差			0.40±6.10	0.066	0.948
	两组差值均值差			-4.40±1.47	-3.001	0.005
视觉广度	对照组	25	前测	77.36±21.33	-10.792	< 0.001
			后测	85.08±22.53
			训练前后差值	7.72±3.58
	试验组	25	前测	80.08±22.41	-6.589	< 0.001
			后测	91.60±19.35
			训练前后差值	11.52±8.74
	训练前两组均值差			-2.72±6.19	-0.440	0.662
	训练后两组均值差			-6.52±5.94	-1.098	0.278
	两组差值均值差			-3.80±1.89	-2.012	0.053
言语功能	对照组	25	前测	66.20±24.00	-7.095	0.001
			后测	71.20±25.47
			训练前后差值	5.00±3.52
	试验组	25	前测	68.12±20.68	-6.028	< 0.001
			后测	77.04±21.58
			训练前后差值	8.92±7.40
	训练前两组均值差			-1.92±6.34	-0.303	0.763
	训练后两组均值差			-5.84±6.68	-0.875	0.386
	两组差值均值差			-3.92±1.64	-2.392	0.022
注意	对照组	25	前测	61.48±19.15	-6.426	0.002
			后测	66.04±18.53
			训练前后差值	4.56±3.55
	试验组	25	前测	61.52±17.17	-8.865	< 0.001
			后测	72.76±17.71
			训练前后差值	11.24±6.34
	训练前两组均值差			-0.04±5.14	-0.008	0.994
	训练后两组均值差			-6.72±5.13	-1.311	0.196
	两组差值均值差			-6.68±1.45	-4.597	< 0.001
延时记忆	对照组	25	前测	62.96±24.50	-10.092	< 0.001
			后测	69.08±25.03
			训练前后差值	6.12±3.03
	试验组	25	前测	61.80±19.97	-9.396	< 0.001
			后测	74.12±21.22
			训练前后差值	12.32±6.56
	训练前两组均值差			1.16±6.32	0.184	0.855
	训练后两组均值差			-5.04±6.56	-0.768	0.446
	两组差值均值差			-6.20±1.44	-4.292	< 0.001

表5

表6

两组训练前后MBI评分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	25	前测	61.36±18.50	-10.937	< 0.001
		后测	73.08±16.88
		训练前后差值	11.72±5.36
试验组	25	前测	63.72±20.04	-8.944	< 0.001
		后测	78.84±15.65
		训练前后差值	15.12±8.45
训练前两组均值差			-2.36±5.46	-0.433	0.667
训练后两组均值差			-5.76±4.60	-1.251	0.217
两组差值均值差			-3.40±2.00	-1.699	0.096

表6

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项目	对照组(n = 25)	试验组(n = 25)	t/χ²值	P值
性别(男/女)/n	16/9	17/8	-0.089	0.765
年龄/岁	52.04±18.57	51.00±15.07	0.217	0.829
受教育程度/年	13.28±2.99	13.80±3.50	-0.565	0.575
脑卒中类型(脑梗死/脑出血) /n	12/13	7/18	-2.122	0.145
病程/月	2.44±1.45	2.24±1.42	0.493	0.624
病灶侧(左侧/右侧)/n	19/6	17/8	-0.397	0.529
MMSE总分	18.88±5.75	19.76±6.16	-0.522	0.604
定向力	6.28±2.91	6.84±2.32	-0.752	0.456
记忆力	2.84±0.37	2.64±0.70	1.260	0.216
注意力与计算力	2.36±1.91	2.64±1.96	-0.512	0.611
回忆能力	1.44±0.92	1.40±0.96	0.151	0.881
语言能力	5.96±2.17	6.24±2.01	-0.474	0.638

计算机认知矫正疗法对卒中后认知功能障碍的效果

Effect of computerized cognitive remediation therapy on post-stroke cognitive impairment

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