卒中后失语临床管理专家共识

doi:10.3969/j.issn.1006-9771.2022.01.003

摘要/Abstract

中图分类号:

R743.3

中华医学会神经病学分会神经康复学组, 中国康复医学会脑血管病专业委员会, 中国康复研究中心. 卒中后失语临床管理专家共识[J]. 《中国康复理论与实践》, 2022, 28(1): 15-23.

图/表 4

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参考文献 51

[1]	WORTMAN-JUTT S, EDWARDS D. Poststroke aphasia rehabilitation: Why all talk and no action?[J]. Neurorehabil Neural Repair, 2019, 33(4):235-244. doi: 10.1177/1545968319834901
[2]	WALLACE S J, WORRALL L, ROSE T, et al. Using the International Classification of Functioning, Disability, and Health to identify outcome domains for a core outcome set for aphasia: a comparison of stakeholder perspectives[J]. Disabil Rehabil, 2019, 41(5):564-573. doi: 10.1080/09638288.2017.1400593
[3]	SHEPPARD S M, SEBASTIAN R. Diagnosing and managing post-stroke aphasia[J]. Expert Rev Neurother, 2021, 21(2):221-234. doi: 10.1080/14737175.2020.1855976
[4]	邱卓英, 李伦, 陈迪, 等. 基于世界卫生组织国际健康分类家族康复指南研究:理论架构和方法体系[J]. 中国康复理论与实践, 2020, 26(2):125-135.
	QIU Z Y, LI L, CHEN D, et al. Research on rehabilitation guidelines using World Health Organization Family International Classifications: framework and approaches[J]. Chin J Rehabil Theory Pract, 2020, 26(2):125-135.
[5]	世界卫生组织. 康复2030:国际康复发展状况与行动呼吁[J]. 李安巧,邱卓英,吴弦光,等,译. 中国康复理论与实践, 2017, 23(4):379.
	World Health Organization. Rehabilitation 2030: A Call for Action[J]. LI A Q, QIU Z Y, WU X G, et al., trans. Chin J Rehabil Theory Pract, 2017, 23(4):379.
[6]	ZENG B, CHEN D, QIU Z, et al. Expert consensus on protocol of rehabilitation for COVID-19 patients using framework and approaches of WHO International Family Classifications[J]. Aging Med (Milton), 2020, 3(2):82-94.
[7]	ALMEIDA M S C, SOUSA FILHO L F, RABELLO P M, et al. International Classification of Diseases-11th revision: from design to implementation[J]. Rev Saude Publica, 2020, 54:104. doi: 10.11606/s1518-8787.2020054002120
[8]	GRÖNBERG A, HENRIKSSON I, LINDGREN A. Accuracy of NIH Stroke Scale for diagnosing aphasia[J]. Acta Neurol Scand, 2021, 143(4):375-382. doi: 10.1111/ane.v143.4
[9]	FROMM D, FORBES M, HOLLAND A, et al. Discourse characteristics in aphasia beyond the Western Aphasia Battery cutoff[J]. Am J Speech Lang Pathol, 2017, 26(3):762-768. doi: 10.1044/2016_AJSLP-16-0071
[10]	张庆苏, 纪树荣, 李胜利, 等. 中国康复研究中心汉语标准失语症检查量表的信度与效度分析[J]. 中国康复理论与实践, 2005, 11(9):703-705.
	ZHANG Q S, JI S R, LI S L, et al. Reliability and validity of Chinese Rehabilitation Research Center Standard Aphasia Examination[J]. Chin J Rehabil Theory Pract, 2005, 11(9):703-705.
[11]	RANGAMANI G N, JUDOVSKY H M. Quality of communication life in people with aphasia: implications for intervention[J]. Ann Indian Acad Neurol, 2020, 23(Suppl 2):S156-S161.
[12]	林润, 陈锦秀, 冯木兰, 等. 脑卒中失语症患者生活质量量表汉化及信效度测评[J]. 中华护理杂志, 2013, 48(4):349-351.
	LIN R, CHEN J X, FENG M L, et al. Reliability and validity of the Stroke and Aphasia Quality of Life Scale[J]. Chin J Nurs, 2013, 48(4):349-351.
[13]	THIEL A, ZUMBANSEN A. The pathophysiology of post-stroke aphasia: a network approach[J]. Restor Neurol Neurosci, 2016, 34(4):507-518.
[14]	FRIDRIKSSON J, HILLIS A E. Current approaches to the treatment of post-stroke aphasia[J]. J Stroke, 2021, 23(2):183-201. doi: 10.5853/jos.2020.05015
[15]	SAXENA S, HILLIS A E. An update on medications and noninvasive brain stimulation to augment language rehabilitation in post-stroke aphasia[J]. Expert Rev Neurother, 2017, 17(11):1091-1107. doi: 10.1080/14737175.2017.1373020
[16]	ZHANG X, SHU B, ZHANG D, et al. The efficacy and safety of pharmacological treatments for post-stroke aphasia[J]. CNS Neurol Disord Drug Targets, 2018, 17(7):509-521. doi: 10.2174/1871527317666180706143051
[17]	REUTER B, GUMBINGER C, SAUER T, et al. Access, timing and frequency of very early stroke rehabilitation: insights from the Baden-Wuerttemberg stroke registry[J]. BMC Neurol, 2016, 16(1):222. doi: 10.1186/s12883-016-0744-7
[18]	GODECKE E, ARMSTRONG E, RAI T, et al. A randomized control trial of intensive aphasia therapy after acute stroke: The Very Early Rehabilitation for SpEech (VERSE) study[J]. Int J Stroke, 2021, 16(5):556-572. doi: 10.1177/1747493020961926
[19]	HARVEY S R, CARRAGHER M, DICKEY M W, et al. Treatment dose in post-stroke aphasia: a systematic scoping review[J]. Neuropsychol Rehabil, 2021, 31(10):1629-1660. doi: 10.1080/09602011.2020.1786412
[20]	FCET2EC study group. Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting[J]. Lancet, 2017, 389(10078):1528-1538. doi: 10.1016/S0140-6736(17)30067-3
[21]	CROSSON B, RODRIGUEZ A D, COPLAND D, et al. Neuroplasticity and aphasia treatments: new approaches for an old problem[J]. J Neurol Neurosurg Psychiatry, 2019, 90(10):1147-1155. doi: 10.1136/jnnp-2018-319649
[22]	HARVEY D Y, PODELL J, TURKELTAUB P E, et al. Functional reorganization of right prefrontal cortex underlies sustained naming improvements in chronic aphasia via repetitive transcranial magnetic stimulation[J]. Cogn Behav Neurol, 2017, 30:133-144. doi: 10.1097/WNN.0000000000000141
[23]	LUISA C, PAWEL K, MARTINA G, et al. Telerehabilitation for people with aphasia: a systematic review and meta-analysis[J]. J Commun Disord, 2021, 92:106111. doi: 10.1016/j.jcomdis.2021.106111
[24]	BRADY M C, KELLY H, GODWIN J, et al. Speech and language therapy for aphasia following stroke[J]. Cochrane Database Syst Rev, 2016(6):D425.
[25]	ROSE M L, COPLAND D, NICKELS L, et al. Constraint-induced or Multi-modal Personalized Aphasia Rehabilitation (COMPARE): a randomized controlled trial for stroke-related chronic aphasia[J]. Int J Stroke, 2019, 14(9):972-976. doi: 10.1177/1747493019870401
[26]	ROSE M L, RAI T, COPLAND D, et al. Statistical analysis plan for the COMPARE trial: a 3-arm randomised controlled trial comparing the effectiveness of Constraint-induced Aphasia Therapy Plus and Multi-modality Aphasia Therapy to usual care in chronic post-stroke aphasia (COMPARE)[J]. Trials, 2021, 22(1):303. doi: 10.1186/s13063-021-05238-0
[27]	LEONARDI S, CACCIOLA A, DE LUCA R, et al. The role of music therapy in rehabilitation: improving aphasia and beyond[J]. Int J Neurosci, 2018, 128(1):90-99. doi: 10.1080/00207454.2017.1353981
[28]	吴晓莉, 张晓颖, 张庆苏, 等. 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 X L, ZHANG X Y, ZHANG Q S, et al. Effect of melodic intonation therapy on nonfluent aphasia after stroke[J]. Chin J Rehabil Theory Pract, 2020, 26(11):1327-1332.
[29]	HARO-MARTÍNEZ A M, LUBRINI G, MADERO-JARABO R, et al. Melodic intonation therapy in post-stroke nonfluent aphasia: a randomized pilot trial[J]. Clin Rehabil, 2019, 33(1):44-53. doi: 10.1177/0269215518791004
[30]	CHOI M J, KIM H, NAH H W, et al. Digital therapeutics: emerging new therapy for neurologic deficits after stroke[J]. J Stroke, 2019, 21(3):242-258. doi: 10.5853/jos.2019.01963
[31]	GIACHERO A, CALATI M, PIA L, et al. Conversational therapy through semi-immersive virtual reality environments for language recovery and psychological well-being in post stroke aphasia[J]. Behav Neurol, 2020, 2020:2846046.
[32]	FISICARO F, LANZA G, GRASSO A A, et al. Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls[J]. Ther Adv Neurol Disord, 2019, 12:1756286419878317.
[33]	LEFAUCHEUR J P, ALEMAN A, BAEKEN C, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014-2018)[J]. Clin Neurophysiol, 2020, 131(2):474-528. doi: 10.1016/j.clinph.2019.11.002
[34]	REN C, ZHANG G, XU X, et al. The effect of rTMS over the different targets on language recovery in stroke patients with global aphasia: a randomized sham-controlled study[J]. Biomed Res Int, 2019, 2019:4589056.
[35]	YAO L, ZHAO H, SHEN C, et al. Low-frequency repetitive transcranial magnetic stimulation in patients with poststroke aphasia: systematic review and meta-analysis of its effect upon communication[J]. J Speech Lang Hear Res, 2020, 63(11):3801-3815. doi: 10.1044/2020_JSLHR-19-00077
[36]	FISICARO F, LANZA G, GRASSO A A, et al. Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls[J]. Ther Adv Neurol Disord, 2019, 12:1756286419878317.
[37]	HARA T, ABO M, KAKITA K, et al. Does a combined intervention program of repetitive transcranial magnetic stimulation and intensive occupational therapy affect cognitive function in patients with post-stroke upper limb hemiparesis?[J]. Neural Regen Res, 2016, 11(12):1932-1939. doi: 10.4103/1673-5374.197134
[38]	ZHENG Y, ZHONG D, HUANG Y, et al. Effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) on aphasia in cerebrovascular accident patients: Protocol of a systematic review and meta-analysis[J]. Medicine (Baltimore), 2019, 98(52):e18561. doi: 10.1097/MD.0000000000018561
[39]	陈韵佳, 陈柱, 朱燕, 等. 神经调控技术在失语症治疗中的应用进展[J]. 中国康复理论与实践, 2019, 25(8):930-935.
	CHEN Y J, CHEN Z, ZHU Y, et al. Application of neuromodulation technique in treatment of aphasia (review)[J]. Chin J Rehabil Theory Pract, 2019, 25(8):930-935.
[40]	BIOU E, CASSOUDESALLE H, COGNÉ M, et al. Transcranial direct current stimulation in post-stroke aphasia rehabilitation: a systematic review[J]. Ann Phys Rehabil Med, 2019, 62(2):104-121. doi: 10.1016/j.rehab.2019.01.003
[41]	LEFAUCHEUR J P, ANTAL A, AYACHE S S, et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS)[J]. Clin Neurophysiol, 2017, 128(1):56-92. doi: 10.1016/j.clinph.2016.10.087
[42]	ELSNER B, KUGLER J, POHL M, et al. Transcranial direct current stimulation (tDCS) for improving aphasia in adults with aphasia after stroke[J]. Cochrane Database Syst Rev, 2019, 5(5):CD009760.
[43]	柳波, 夏扬, 黄嘉, 等. 经颅直流电刺激对卒中后运动性失语患者抑郁状态的疗效[J]. 中国康复理论与实践, 2019, 25(11):1348-1351.
	LIU B, XIA Y, HUANG J, et al. Effects of transcranial direct current stimulation on post-stroke depression with Broca's aphasia[J]. Chin J Rehabil Theory Pract, 2019, 25(11):1348-1351.
[44]	ARHEIX-PARRAS S, BARRIOS C, PYTHON G, et al. A systematic review of repetitive transcranial magnetic stimulation in aphasia rehabilitation: leads for future studies[J]. Neurosci Biobehav Rev, 2021, 127:212-241. doi: 10.1016/j.neubiorev.2021.04.008
[45]	FRIDRIKSSON J, RORDEN C, ELM J, et al. Transcranial direct current stimulation vs sham stimulation to treat aphasia after stroke: a randomized clinical trial[J]. JAMA Neurol, 2018, 75(12):1470-1476. doi: 10.1001/jamaneurol.2018.2287
[46]	ALHARBI M F, ARMIJO-OLIVO S, KIM E S. Transcranial direct current stimulation (tDCS) to improve naming ability in post-stroke aphasia: a critical review[J]. Behav Brain Res, 2017, 332:7-15. doi: 10.1016/j.bbr.2017.05.050
[47]	ELSNER B, KUGLER J, MEHRHOLZ J. Transcranial direct current stimulation (tDCS) for improving aphasia after stroke: a systematic review with network meta-analysis of randomized controlled trials[J]. J Neuroeng Rehabil, 2020, 17(1):88.
[48]	SILVA F, MAC-KAY A, CHAO J C, et al. Transcranial direct current stimulation: a study on naming performance in aphasic individuals[J]. Codas, 2018, 30(5):e20170242.
[49]	PESTALOZZI M I, DI PIETRO M, MARTINS G C, et al. Effects of prefrontal transcranial direct current stimulation on lexical access in chronic poststroke aphasia[J]. Neurorehabil Neural Repair, 2018, 32(10):913-923. doi: 10.1177/1545968318801551
[50]	MARANGOLO P. The potential effects of transcranial direct current stimulation (tDCS) on language functioning: combining neuromodulation and behavioral intervention in aphasia[J]. Neurosci Lett, 2020, 719:133329. doi: 10.1016/j.neulet.2017.12.057
[51]	PERIN C, BOLIS M, LIMONTA M, et al. Differences in rehabilitation needs after stroke: a similarity analysis on the ICF core set for stroke[J]. Int J Environ Res Public Health, 2020, 17(12):4291. doi: 10.3390/ijerph17124291

编号	临床问题
1	脑卒中患者何时及使用何种方法筛查言语功能障碍?
2	PSA患者如何评估其活动和参与受限?
3	哪些指标可帮助判断PSA患者的预后?
4	药物治疗对PSA患者是否有效?
5	PSA患者康复训练开始时机和训练强度如何建议?
6	对于不同类型的PSA患者如何选择言语功能康复治疗的新技术?
7	PSA患者进行经颅磁刺激治疗的适应证、禁忌证及技术参数设置?
8	PSA患者进行经颅直流电刺激治疗的适应证、禁忌证及技术参数设置?
9	针对PSA患者的个人因素和环境因素进行哪些干预可提高患者的生活参与?

证据来源	专家共识度	推荐强度
严谨的Meta分析、大型随机对照试验	一致共识	强推荐
一般质量的Meta分析、小型随机对照试验、设计良好的大型回顾性研究、病例对照研究	基本一致共识,争议小(支持意见60%~80%)	推荐

卒中后失语临床管理专家共识

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