目的 探讨八段锦对脑外伤康复期患者认知功能和焦虑、抑郁情绪的影响。 方法 2018年1月至7月,脑外伤康复期患者64例分为对照组和试验组,最终对照组31例、试验组29例纳入试验。试验组进行八段锦锻炼,对照组不进行任何规律性运动锻炼。试验前以及干预后6周、12周和24周采用洛文斯顿作业疗法认知评定(LOTCA)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)进行评定。 结果 干预后,试验组HAMA、HAMD评分均显著下降(P < 0.001),且低于对照组(P < 0.05),对照组评分无显著性差异(P > 0.05)。干预12周后,试验组LOTCA定向、空间知觉、视运动组织时间评分升高(P < 0.05),且高于对照组(P < 0.05);干预24周后,试验组LOTCA各维度评分和总分均显著提高(P < 0.05),且高于对照组(P < 0.05)。LOTCA总分与HAMA、HAMD评分负相关(P < 0.05)。 结论 规律性八段锦锻炼可明显改善脑外伤患者认知功能和负性情绪。
关键词:
脑外伤; 八段锦; 认知; 焦虑; 抑郁
Objective To explore the effects of Baduanjin on cognitive function, anxiety and depression in patients in recovery stage after traumatic brain injury. Methods From January to July, 2018, 64 patients in recovery stage after traumatic brain injury were included. Finally, there were 31 patients in control group and 29 in experimental group. The experimental group received Baduanjin exercise, while the control group did not receive any regular exercise. They were assessed with Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) before intervention, and six weeks, twelve weeks and 24 weeks after intervention. Results The scores of HAMA and HAMD decreased in the experimental group after intervention (P < 0.05), but there was no significance in the control group (P > 0.05). The scores of orientation, visual and spatial perception, and visuomotor organization increased in the experimental group twelve weeks after intervention (P < 0.05), but there was no significance in the control group (P > 0.05). The scores of all the areas of LOTCA and total scores increased in the experimental group 24 weeks after intervention (P < 0.05), but there was no significance in the control group (P > 0.05). LOTCA total scores negtively correlated with HAMA and HAMD scores (P < 0.05). Conclusion Regular Baduanjin exercise can improve the cognition and mood of patients after traumatic brain injury.
1 BellonK, HaynerS, WrightJ, et al. A home based walking study to ameliorate perceived stress and depressive symptoms in people with a traumatic brain injury [J]. Brain Inj, 2014, 29(3): 1-7.
2 于伟,武洋,张自茂. 重度脑外伤恢复期患者认知障碍的临床特点及其影响因素[J]. 中国康复理论与实践, 2019, 25(5): 575-578.
3 WadeR L, KindermannS L, HouQ, et al. Comparative assessment of adherence measures and resource use in SSRI/SNRI treated patients with depression using second-generation antipsychotics or L-methylfolate as adjunctive therapy [J]. J Manag Care Pharm, 2014, 20(1): 76-85.
4 Jacotte-SimancasA, Costa MiserachsD, Coll AndreuM, et al. Effects of voluntary physical exercise, citicoline, and combined treatment on object recognition memory, neurogenesis and neuro protection after traumatic brain injury in rats [J]. J Neurotrauma, 2015, 32(10): 739-751.
5 ChinL M, KeyserR E, DsurneyJ, et al. Effects of exercise and aerobic exercise training in people with traumatic brain injury [J]. Arch Phys Med Rehabil, 2015, 96(4): 754-759.
6 LeeY S C, AshmanT, ShangA, et al. Brief report: effects of exercise and self-affirmation intervention after traumatic brain injury [J]. NeuroRehabilitation, 2014, 35(1): 57-65.
7 SchwandtM, HarrisJ E, ThomasS, et al. Feasibility and effect of aerobic exercise for lowering depressive symptoms among individuals with traumatic brain injury: a pilot study [J]. J Head Trauma Rehabil, 2012, 27(2): 99-103.
8 WiseE K, HoffmanJ M, PowellJ M, et al. Benefits of exercise maintenance after traumatic brain injury [J]. Arch Phys Med Rehabil, 2012, 93(8): 1319-1323.
9 ZhengG H, HuangM M, LiS Z, et al. Effect of Baduanjin exercise on cognitive function in older adults with mild cognitive impairment: study protocol for a randomised controlled trial [J]. BMJ Open, 2016, 6(4): e010602.
10 ZhengG, ZhengY, XiongZ, et al. Effect of Baduanjin exercise on cognitive function in patients with post-stroke cognitive impairment: study protocol for a randomised controlled trial [J]. BMJ Open, 2018, 8: 20954.
11 张捷,章文雯,沈慧. 习练八段锦对广泛性焦虑症临床疗效的影响[J]. 中国运动医学杂志, 2016, 35(3): 231-233.
12 WilsonL, StewartW, Dams-ConnorK, et al. The chronic and evolving neurological consequences of traumatic brain injury [J]. Lancet Neurol, 2017, 16(10): 813-825.
13 张小年,张皓. 创伤性颅脑损伤后认知障碍临床治疗进展[J]. 中国康复医学杂志, 2014, 29(1): 86-89.
14 吴毅,PeterE. 功能独立性评价(FIM)量表作为康复治疗病人出院和随访的功能评价指标[J]. 中华物理医学与康复杂志, 2001, 23(6): 331-333.
15 KoI G, KimS E, HwangL, et al. Late starting treadmill exercise improves spatial leaning ability through suppressing CREP/BDNF/TrkB signaling pathway following traumatic brain injury in rats [J]. J Exerc Rehabil, 2018, 14(3): 327-334.
16 JorgeR, RobinsonR G. Mood disorders following traumatic brain injury [J]. NeuroRehabilitation, 2002, 17(4): 311-324.
17 WeinsteinA A, ChinL M K, CollinsJ, et al. Effect of aerobic exercise training on mood in people with traumatic brain injury:a pilot study [J]. J Head Trauma Rehabil, 2017, 32(3): E50-E56.
18 WangC, ChanC, HoR, et al. Managing stress and anxiety through qigong exercise in healthy adults: a systematic review and meta-analysis of randomized controlled trials [J]. BMC Complement Altern Med, 2014, 14: 8.
19 YackleK, SchwarzL, KamK, et al. Breathing control center neurons that promote arousal in mice [J]. Science, 2017, 355(6332): 1411-1415.
20 DunnA L, DishmanR K. Exercise and the neurobiology of depression [J]. Exercise Sport Sci Rev, 1991, 19: 41-98.
21 MeeusenR, DeMeirleirK. Exercise and brain neurotransmission [J]. Sports Med, 1995, 20(3): 160-188.
22 DishmanR K. Brain monoamines, exercise, and behavioral stress: animal models [J]. Med Sci Sports Exercise, 1997, 29(1): 63-74.
23 AltarC A. Neurotrophins and depression [J]. Trends Pharmacol Sci, 1999, 20(2): 59-61.
24 ShallcrossA J, FordB Q, FloerkeV A, et al. Getting better with age: the relationship between age, acceptance, and negative affect [J]. J PersSoc Psychol, 2013, 105(4): 718-719.
25 YiiA C, KohM S. A review of psychological dysfunction in asthma: affective, behavioral and cognitive factors [J]. J Asthma, 2013, 50(9): 915-921.
26 DuncanH D, NikelskiJ, PilonR, et al. Structural brain differences between monolingual and multilingual patients with mild cognitive impairment and Alzheimer disease: evidence for cognitive reserve [J]. Neuropsychologia, 2017, 11(26): 32-39.
27 SpitzG, SchönbergerM, PonsfordJ. The relations among cognitive impairment, coping style and emotional adjustment following traumatic brain injury [J]. J Head Trauma Rehabil, 2013, 28(2): 116-125.