计算机辅助认知训练对脑损伤患者认知功能与功能独立性的影响
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摘要
目的应用同济医院康复科研制的计算机辅助认知训练软件(2001版)治疗脑损伤认知障碍患者,探讨计算机辅助的认知训练在脑损伤患者认知功能恢复中的作用及对功能独立性的影响,观察停止认知治疗后患者治疗效果的维持情况;为进一步完善该套认知软件的设计与操作及在临床广泛推广应用奠定基础。
方法40例脑损伤住院患者,经中文版神经行为认知状态评定(neurobehavioral cognitivestatus examination,NCSE)软件确定为认知受损者,随机分成认知训练组和对照组,每组20例患者,2组一般资料差异无统计学意义。训练组和对照组给予常规药物治疗、高压氧、物理治疗及传统治疗,训练组在此基础上接受8周的计算机辅助的认知训练,主要是记忆训练软件。分别于入组时、治疗第8周及停止治疗后第4周采用NCSE软件及功能独立性评定(functional independence measure,FIM)量表对2组患者的认知功能和功能独立性进行评定。
结果训练组与对照组在入组时NCSE评分及FIM评分差异无统计学意义(P>0.05);治疗第8周及停止治疗后第4周,2组的NCSE评分和FIM评分均显著提高,且以训练组患者改善幅度更为明显,与治疗前及对照组比较,差异有统计学意义(P<0.05)。
结论本套计算机辅助认知训练软件设计合理,操作方便,趣味性强,有助于改善脑损伤患者的认知功能与运动功能,整体提高患者的功能独立性;停止认知训练后,患者的认知水平及功能独立性有一定的后续维持作用;临床应用范围广泛,适用于不同类型脑损伤后遗认知障碍的治疗。
Objective To study the effects of computer assisted cognitive training on cognitive and functional independence in patients with brain injury by the 2001 version cognitive training software;prepare the groud for further improvement of the software (designing and operation) and for promotion of its clinical application.
Metheds Forty brain injury patients with cognitive disfunction assessed by neurobehavioral cognitivestatus examination (NCSE) were randomly divided into two groups:cognitive training group and control group.Both groups received the same medical therapy, hyperbaric oxygen, physical therapy and traditional therapy,which the cognitive intervention group received eight-week computer assisted cognitive training based on. NCSE and FIM were evaluated at the beginning and the eighth week respetively, observeed the cognitive and motor function after ceasing the cognitive intervention,and then reevaluated by NCSE and FIM at the twelveth week.
Result At the beginning the NCSE scores and the FIM scores in both groups have no significant difference(P>0.05).At the eighth week and after ceasing the cognitive intervention 4 weeks the NCSE scores and the FIM scores were improved in both groups ,especially in the training group (P<0.05).
Conclusion The 2001 version cognitive training software can improve the patients’overall level of cognitive and motor function with brain injury; the therapeutic efficacy can be maintained within a short term after ceasing the cognitive training.Study showed that this software can be widely utilized in clinical intervention.
方法40例脑损伤住院患者,经中文版神经行为认知状态评定(neurobehavioral cognitivestatus examination,NCSE)软件确定为认知受损者,随机分成认知训练组和对照组,每组20例患者,2组一般资料差异无统计学意义。训练组和对照组给予常规药物治疗、高压氧、物理治疗及传统治疗,训练组在此基础上接受8周的计算机辅助的认知训练,主要是记忆训练软件。分别于入组时、治疗第8周及停止治疗后第4周采用NCSE软件及功能独立性评定(functional independence measure,FIM)量表对2组患者的认知功能和功能独立性进行评定。
结果训练组与对照组在入组时NCSE评分及FIM评分差异无统计学意义(P>0.05);治疗第8周及停止治疗后第4周,2组的NCSE评分和FIM评分均显著提高,且以训练组患者改善幅度更为明显,与治疗前及对照组比较,差异有统计学意义(P<0.05)。
结论本套计算机辅助认知训练软件设计合理,操作方便,趣味性强,有助于改善脑损伤患者的认知功能与运动功能,整体提高患者的功能独立性;停止认知训练后,患者的认知水平及功能独立性有一定的后续维持作用;临床应用范围广泛,适用于不同类型脑损伤后遗认知障碍的治疗。
Objective To study the effects of computer assisted cognitive training on cognitive and functional independence in patients with brain injury by the 2001 version cognitive training software;prepare the groud for further improvement of the software (designing and operation) and for promotion of its clinical application.
Metheds Forty brain injury patients with cognitive disfunction assessed by neurobehavioral cognitivestatus examination (NCSE) were randomly divided into two groups:cognitive training group and control group.Both groups received the same medical therapy, hyperbaric oxygen, physical therapy and traditional therapy,which the cognitive intervention group received eight-week computer assisted cognitive training based on. NCSE and FIM were evaluated at the beginning and the eighth week respetively, observeed the cognitive and motor function after ceasing the cognitive intervention,and then reevaluated by NCSE and FIM at the twelveth week.
Result At the beginning the NCSE scores and the FIM scores in both groups have no significant difference(P>0.05).At the eighth week and after ceasing the cognitive intervention 4 weeks the NCSE scores and the FIM scores were improved in both groups ,especially in the training group (P<0.05).
Conclusion The 2001 version cognitive training software can improve the patients’overall level of cognitive and motor function with brain injury; the therapeutic efficacy can be maintained within a short term after ceasing the cognitive training.Study showed that this software can be widely utilized in clinical intervention.
引文
1. Fleming JM,Strong J,Ashton R.Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationship to outcome.J Head Trauma Rehabil,1998,13:16-28.
2. Hoenig H,Sanford JA,Butterfield T,et al.Development of a teletechnology protocol for in-home rehabilitation.J Burn Care Res,2006,43:287-298.
3.谭声辉,宋元良,文伟光,等.电脑辅助及远程认知康复的发展与应用.中华物理医学与康复杂志,2003,25:572-573.
4. Ewing-Cobbs L,Prasad MR,Landry SH,et al.Executive functions following traumatic brain Injury in young children:A preliminary analysis.Dev Neuropsychol,2004,26:487-512.
5.许涛,尤春景,孙百勇,等.中文版计算机辅助认知功能障碍评定系统的编制.中国康复医学杂志,2004,19:19-21.
6.尤春景,许涛,欧阳多,等.脑外伤认知障碍与功能恢复的相关研究.中华物理医学与康复杂志,2003,25:158-160.
7.许涛,尤春景,黄晓琳,等.神经行为认知状态检查表信度与效度的初步测定.
8.李文讯,尤春景,许涛,等.记忆训练软件的设计及临床初步应用.中华物理医学与康复杂志,2004,26:106-108.
9. Fleming JM,Shum D,Strong J,et al.Prospective memory rehabilitation for adults with traumatic brain injury:A compensatory training programme.Brain Inj,2005,19:1-10.
10. Knight RG,Titov N,Crawford M.The effects of distraction on prospective remembering following traumatic brain injury assessed in a simulated naturalistic environment.J Int Neuropsychol Soc,2006,12:8-16.
11. Knight RG, Titov N, Crawford M. The effects of traumatic brain injury on the predicted and actual performance of a test of prospective remembering. Brain Inj, 2005,9:27–38.
12.Christiansen C,Abreu B,Ottenbacher K ,et al,Task performance in virtual environments used for cognitive rehabilitation after traumatic brain injury. Arch Phys Med Rehabil.1998,79(8):888-892.
13.Grealy MA, Johnson DA, Rushton SK.Improving cognitive function after brain injury: the use of exercise and virtual reality.Arch Phys Med Rehabil.1999,80(6):661-667.
14.You SH,Jang SH,Kim YH,et al.Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke:an experimenter-blind randomized study.Stroke.2005,36(6):1166-1171.
1. Kwasnica CM.Unilateral neglect syndrome after stroke:theries and management issues.Clinical reviews in Physical and Rehabilitation Medicine,2002,14(1):25-40.
2. Christiansen C,Abreu B,Ottenbacher K ,et al,Task performance in virtual environments used for cognitive rehabilitation after traumatic brain injury . Arch Phys Med Rehabil.1998,79(8):888-892.
3. Grealy MA,Johnson DA,Rushton SK.Improving cognitive function after brain injury:the use of exercise and virtual reality.Arch Phys Med Rehabil.1999,80(6):661-667.
4. Schmitter-Edgecombe M,Fahy JF ,et al. Memory remediation after severe closed head injury:notebook training versus supportive therapy.Consult Clin Psychol.1995,63(3):484-489.
5. Fleming JM.Prospective memory rehabilitation for adults with traumatic brain injury:a compensatory training programme.Brain Inj.2005,19(1):1-10.
6. Marshall L,Molle M,Hallschmid M,et al.Transcranial direct current stimulation during sleep improves declarative memory.Neurosci.2004,24(44):9985-9992.
7. Hunkin NM,Squires EJ.Are the benefits of errorless learning dependent on implicit memory?Neuropsychologia.1998,36(1):25-36.
8. Tailby R,Haslam C.An investigation of errorless learning in memory-impaired patients:improving the technique and clarifying theory.Neuropsychologia.2003,41(9):1230-1240.
9.窦祖林,欧海宁.无错性学习在脑损伤患者记忆功能恢复中的应用。中国临床康复.2005,9(16):84-87.
10.Golay L,Hauert CA,Greber C,et al.Dynamic modulation of visual detection by auditory cues in spatial neglect.Neuropsychologia. 2005,43(9):1258-1265.traumatic brain injury acute rehabilitation outcomes.Brain Inj. 2004,18(8):739-750.
21.Khateb A,Ammann J,Jean-Marie Annoni,et al.Cognition-enhancing effects of donepezil in traumatic brain injury.Eur Neurol. 2005,54(1):39-45.
22.Leone.H, Polsonetti BW.Amantadine for traumatic brain injury: does it improve cognition and reduce agitation? Clinical Pharmacy and Therapeutics.2005,30:101-104.
23.张建宏,范建中.,齐志强.电针治疗轻中型颅脑损伤记忆及认知功能障碍的临床研究.中国康复医学杂志,2003,18(10):588-589.
24.Sarah EL,Jennifer M.Interventions for improving self-awarenes following acquired brain injury.Australian Occupational Therapy .2005,52:160-170.
25.Prigatano GP.Disturbances of self-awareness and rehabilitation of patients with traumatic brain injury: a 20-year perspective.Head Trauma Rehabilitation.2005,20(1):19-29.
26.Fleming JM,Strong J,Ashton R.Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationship to outcome.Head Trauma Rehabilitation.1998,13:16-28.
27.Rose FD,Brooks BM,Rizzo AA.Virtual reality in brain damage rehabilitation: review.Cyberpsychol Behav.2005,8(3):241-262.
28.文伟光.香港认知康复发展的概况.中华物理医学与康复杂志.2003, 25(12): 757-760.
1.Rose FD,Attree EA,Brooks BM.Virtual environments in neuropsychological assessment and rehabilitation.Stud Health Technol Inform,1997,44:147-145.
2.Knight RG,Harnett M,Titov N. The effects of traumatic brain injury on the predicted and actual performance of a test of prospective remembering.Brain Injury. 2005 January;19(1): 27–38.
3. Knight RG, Titov N,Crawford M.The effects of distraction on prospective remembering following traumatic brain injury assessed in a simulated naturalistic environment . Journal of the International Neuropsychological Society .2006, 12:8–16.
4. Fleming JM, Shum D, Strong J, Lightbody S. Prospective memory rehabilitation for adults with traumatic brain injury: a compensatory training programme. Brain Injury. 2005 ,19(1):1-10.
5.许涛,尤春景,孙百勇,等.中文版计算机辅助认知功能障碍评定系统的编制.中国康复医学杂志.2004,9(1)19-21.
6. Baddeley A.D, Kopelman M.D. and Wilson B.A. Memory Disorders for Clinicians.C_2004John Wiley&Sons,Ltd.ISBN 0-470-09141-X.
7.McDaniel MA, Robinson-Riegler B, Einstein GO. Prospective remembering: perceptually driven or conceptually driven processes? Mem Cognit. 1998 ,26(1):121-34.
8.Guynn MJ, McDaniel MA, Einstein GO. Prospective memory: when reminders fail. Mem Cognit. 1998 ,26(2):287-298.
2. Hoenig H,Sanford JA,Butterfield T,et al.Development of a teletechnology protocol for in-home rehabilitation.J Burn Care Res,2006,43:287-298.
3.谭声辉,宋元良,文伟光,等.电脑辅助及远程认知康复的发展与应用.中华物理医学与康复杂志,2003,25:572-573.
4. Ewing-Cobbs L,Prasad MR,Landry SH,et al.Executive functions following traumatic brain Injury in young children:A preliminary analysis.Dev Neuropsychol,2004,26:487-512.
5.许涛,尤春景,孙百勇,等.中文版计算机辅助认知功能障碍评定系统的编制.中国康复医学杂志,2004,19:19-21.
6.尤春景,许涛,欧阳多,等.脑外伤认知障碍与功能恢复的相关研究.中华物理医学与康复杂志,2003,25:158-160.
7.许涛,尤春景,黄晓琳,等.神经行为认知状态检查表信度与效度的初步测定.
8.李文讯,尤春景,许涛,等.记忆训练软件的设计及临床初步应用.中华物理医学与康复杂志,2004,26:106-108.
9. Fleming JM,Shum D,Strong J,et al.Prospective memory rehabilitation for adults with traumatic brain injury:A compensatory training programme.Brain Inj,2005,19:1-10.
10. Knight RG,Titov N,Crawford M.The effects of distraction on prospective remembering following traumatic brain injury assessed in a simulated naturalistic environment.J Int Neuropsychol Soc,2006,12:8-16.
11. Knight RG, Titov N, Crawford M. The effects of traumatic brain injury on the predicted and actual performance of a test of prospective remembering. Brain Inj, 2005,9:27–38.
12.Christiansen C,Abreu B,Ottenbacher K ,et al,Task performance in virtual environments used for cognitive rehabilitation after traumatic brain injury. Arch Phys Med Rehabil.1998,79(8):888-892.
13.Grealy MA, Johnson DA, Rushton SK.Improving cognitive function after brain injury: the use of exercise and virtual reality.Arch Phys Med Rehabil.1999,80(6):661-667.
14.You SH,Jang SH,Kim YH,et al.Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke:an experimenter-blind randomized study.Stroke.2005,36(6):1166-1171.
1. Kwasnica CM.Unilateral neglect syndrome after stroke:theries and management issues.Clinical reviews in Physical and Rehabilitation Medicine,2002,14(1):25-40.
2. Christiansen C,Abreu B,Ottenbacher K ,et al,Task performance in virtual environments used for cognitive rehabilitation after traumatic brain injury . Arch Phys Med Rehabil.1998,79(8):888-892.
3. Grealy MA,Johnson DA,Rushton SK.Improving cognitive function after brain injury:the use of exercise and virtual reality.Arch Phys Med Rehabil.1999,80(6):661-667.
4. Schmitter-Edgecombe M,Fahy JF ,et al. Memory remediation after severe closed head injury:notebook training versus supportive therapy.Consult Clin Psychol.1995,63(3):484-489.
5. Fleming JM.Prospective memory rehabilitation for adults with traumatic brain injury:a compensatory training programme.Brain Inj.2005,19(1):1-10.
6. Marshall L,Molle M,Hallschmid M,et al.Transcranial direct current stimulation during sleep improves declarative memory.Neurosci.2004,24(44):9985-9992.
7. Hunkin NM,Squires EJ.Are the benefits of errorless learning dependent on implicit memory?Neuropsychologia.1998,36(1):25-36.
8. Tailby R,Haslam C.An investigation of errorless learning in memory-impaired patients:improving the technique and clarifying theory.Neuropsychologia.2003,41(9):1230-1240.
9.窦祖林,欧海宁.无错性学习在脑损伤患者记忆功能恢复中的应用。中国临床康复.2005,9(16):84-87.
10.Golay L,Hauert CA,Greber C,et al.Dynamic modulation of visual detection by auditory cues in spatial neglect.Neuropsychologia. 2005,43(9):1258-1265.traumatic brain injury acute rehabilitation outcomes.Brain Inj. 2004,18(8):739-750.
21.Khateb A,Ammann J,Jean-Marie Annoni,et al.Cognition-enhancing effects of donepezil in traumatic brain injury.Eur Neurol. 2005,54(1):39-45.
22.Leone.H, Polsonetti BW.Amantadine for traumatic brain injury: does it improve cognition and reduce agitation? Clinical Pharmacy and Therapeutics.2005,30:101-104.
23.张建宏,范建中.,齐志强.电针治疗轻中型颅脑损伤记忆及认知功能障碍的临床研究.中国康复医学杂志,2003,18(10):588-589.
24.Sarah EL,Jennifer M.Interventions for improving self-awarenes following acquired brain injury.Australian Occupational Therapy .2005,52:160-170.
25.Prigatano GP.Disturbances of self-awareness and rehabilitation of patients with traumatic brain injury: a 20-year perspective.Head Trauma Rehabilitation.2005,20(1):19-29.
26.Fleming JM,Strong J,Ashton R.Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationship to outcome.Head Trauma Rehabilitation.1998,13:16-28.
27.Rose FD,Brooks BM,Rizzo AA.Virtual reality in brain damage rehabilitation: review.Cyberpsychol Behav.2005,8(3):241-262.
28.文伟光.香港认知康复发展的概况.中华物理医学与康复杂志.2003, 25(12): 757-760.
1.Rose FD,Attree EA,Brooks BM.Virtual environments in neuropsychological assessment and rehabilitation.Stud Health Technol Inform,1997,44:147-145.
2.Knight RG,Harnett M,Titov N. The effects of traumatic brain injury on the predicted and actual performance of a test of prospective remembering.Brain Injury. 2005 January;19(1): 27–38.
3. Knight RG, Titov N,Crawford M.The effects of distraction on prospective remembering following traumatic brain injury assessed in a simulated naturalistic environment . Journal of the International Neuropsychological Society .2006, 12:8–16.
4. Fleming JM, Shum D, Strong J, Lightbody S. Prospective memory rehabilitation for adults with traumatic brain injury: a compensatory training programme. Brain Injury. 2005 ,19(1):1-10.
5.许涛,尤春景,孙百勇,等.中文版计算机辅助认知功能障碍评定系统的编制.中国康复医学杂志.2004,9(1)19-21.
6. Baddeley A.D, Kopelman M.D. and Wilson B.A. Memory Disorders for Clinicians.C_2004John Wiley&Sons,Ltd.ISBN 0-470-09141-X.
7.McDaniel MA, Robinson-Riegler B, Einstein GO. Prospective remembering: perceptually driven or conceptually driven processes? Mem Cognit. 1998 ,26(1):121-34.
8.Guynn MJ, McDaniel MA, Einstein GO. Prospective memory: when reminders fail. Mem Cognit. 1998 ,26(2):287-298.
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