言语听觉反馈认知训练在脑外伤认知障碍患者中的应用研究

doi:10.3761/j.issn.0254-1769.2023.05.006

摘要/Abstract

摘要：

目的探讨Forbrain言语听觉反馈认知训练在脑外伤认知障碍患者中的应用效果。方法 2021年10月—2022年5月选取唐山市某三级甲等医院神经外科住院保守治疗的80例脑外伤认知障碍患者，随机分为试验组与对照组，各40例，试验组在对照组干预措施的基础上增加Forbrain言语听觉反馈认知训练，对照组接受神经外科康复护理干预，均干预2周。于入组首日收集患者的一般资料与疾病资料，使用蒙特利尔认知评定量表（Montreal Cognitive Assessment，MoCA）和Barthel指数量表（Barthel Index，BI）完成患者认知功能和日常生活能力的评估，干预2周后使用相同量表再次进行评估。结果试验组39例，对照组37例完成研究。干预前，两组一般资料及MoCA和BI评分均具有可比性（P>0.05）。干预后，①认知功能评估，试验组的MoCA总分与进步分数均高于对照组（P<0.001）；试验组在视空间功能、注意力、语言、抽象与记忆力维度的进步幅度大于对照组（P<0.001）；②日常生活能力评估，试验组的BI总分与进步分数均高于对照组（P<0.001）。结论 Forbrain言语听觉反馈认知训练能够提高脑外伤患者的认知功能与日常生活能力，促进患者注意力、记忆力与语言等功能的恢复。

关键词: 脑外伤, 认知障碍, 认知训练, 日常生活活动, 康复护理

Abstract:

Objective To explore the impact of Forebrain verbal and auditory feedback cognitive training on cognitive function and daily living ability of patients with brain trauma. Methods From October 2021 to May 2022，80 patients with cognitive impairment after traumatic brain injury who met the inclusion and exclusion criteria were selected from the neurosurgery department of a tertiary hospital in Tangshan City，and they were randomly divided into a treatment group and a matched group according to the "RAND-function". 40 patients in the treatment group received routine nursing on the first day of enrollment，and Forbrain training was added on the second day while receiving rehabilitation nursing. The intervention time was for 2 weeks. At the same time，40 patients in the matched group received neurosurgery rehabilitation nursing measures for 2 weeks. The researchers collected the patients’ general and disease data on the first day of admission. MoCA and BI are used to complete the evaluation of the patient’s cognitive function and daily life ability，and the same scales were used for re-evaluation after 2 weeks of intervention. Results The baseline indexes of the 2 groups were comparable（P>0.05）. After 2 weeks，regarding the cognitive function，the researchers found that the cognitive score and difference score of the treatment group were significantly higher than those of the matched group（P<0.001）；the treatment group had higher differences in all 5 cognitive dimensions than the matched group，including visuospatial function，attention，language，abstraction and memory（P<0.05）. Regarding activity of daily living，the researchers found that the BI score and difference score of the treatment group were significantly higher than those of the matched group（P<0.001）. Conclusion Forbrain training can improve cognitive function and daily living ability of patients with brain injury，and promote the recovery of attention，memory and language functions.

Key words: Brain Injury, Cognitive Impairment, Cognitive Training, Activities of Daily Living, Rehabilitation Nursing

张雪茹, 郝习君, 陈长香. 言语听觉反馈认知训练在脑外伤认知障碍患者中的应用研究[J]. 中华护理杂志, 2023, 58(5): 552-557.

ZHANG Xueru, HAO Xijun, CHEN Changxiang. Application of Forbrain training in patients with cognitive impairment after traumatic craniocerebral injury[J]. Chinese Journal of Nursing, 2023, 58(5): 552-557.

图/表 4

表1 两组一般资料比较[例（百分比，%）]

Table 1 Comparison of general data between 2 groups of patients with traumatic brain injury[case（percent，%）]

表2 两组干预前后蒙特利尔认知评定量表得分比较[分，M（P25，P75）]

Table 2 Comparison of total scores of Montreal Cognitive Assessment in patients with brain injury[score，M（P25，P75）]

表3 两组干预前后蒙特利尔认知评定量表各维度得分比较[分，M（P25，P75）]

Table 3 Comparison of dimensions of Montreal Cognitive Assessment Scale before and after intervention[score，M（P25，P75）]

表4 两组干预前后Barthel指数评分比较[分，M（P25，P75）]

Table 4 Comparison of total scores of Barthel index in patients with brain injury[score，M（P25，P75）]

参考文献 24

[1]	Robinson CP. Moderate and severe traumatic brain injury[J]. Continuum(Minneap Minn), 2021, 27(5):1278-1300.
[2]	Khellaf A, Khan DZ, Helmy A. Recent advances in traumatic brain injury[J]. J Neurol, 2019, 266(11):2878-2889. DOI PMID
[3]	Howe EI, Fure SCR, Løvstad M, et al. Effectiveness of combining compensatory cognitive training and vocational intervention vs. treatment as usual on return to work following mild-to-moderate traumatic brain injury: interim analysis at 3 and 6 month follow-up[J]. Front Neurol, 2020, 11:561400. DOI URL
[4]	赵晓坤, 周俊杰, 张倩倩. 低频重复经颅磁刺激联合有氧运动训练对脑外伤后认知障碍患者认知功能的影响[J]. 中国疗养医学, 2021, 30(7):706-708. DOI
	Zhao XK, Zhou JJ, Zhang QQ. Effects of low-frequency repetitive transcranial magnetic stimulation combined with aerobic exercise training on cognitive function in patients with cognitive impairment after brain injury[J]. Chin J Conval Med, 2021, 30(7):706-708.
[5]	谢蓓菁, 孙长慧, 杨铭, 等. 头皮针结合认知训练治疗脑外伤后认知障碍的效果[J]. 中国康复理论与实践, 2019, 25(3):298-301.
	Xie BJ, Sun CH, Yang M, et al. Effects of scalp acupuncture combined with cognitive training on cognitive impairment after traumatic brain injury[J]. Chin J Rehabilitation Theory Pract, 2019, 25(3):298-301.
[6]	孙金菊, 陈长香, 张敏, 等. 言语听觉反馈训练对脑卒中患者认知功能障碍的康复效果[J]. 中华行为医学与脑科学杂志, 2017, 26(6):524-528.
	Sun JJ, Chen CX, Zhang M, et al. Effects of speech-auditory feedback training on cognitive dysfunction in patients with stroke[J]. Chin J Behavioral Medicine and Brain Sci, 2017, 26(6):524-528.
[7]	Escera C, López-Caballero F, Gorina-Careta N. The potential effect of forbrain as an altered auditory feedback device[J]. J Speech Lang Hear Res, 2018, 61(4):801-810. DOI URL
[8]	顾宇丹, 费雅雅, 秦殊, 等. 刺激性干预在老年创伤性颅脑损伤昏迷患者中的应用[J]. 中华护理杂志, 2020, 55(2):228-231. DOI
	Gu YD, Fei YY, Qin S, et al. Effect analysis of stimulation intervention in elderly patients with traumatic brain injury and coma[J]. Chin J Nurs, 2020, 55(2):228-231. DOI
[9]	Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment,MoCA:a brief screening tool for mild cognitive impairment[J]. J Am Geriatr Soc, 2005, 53(4):695-699. DOI PMID
[10]	廖晨霞, 李伦兰, 戴晴, 等. 脊髓损伤患者认知功能的影响因素分析[J]. 中华护理杂志, 2021, 56(7):1015-1022. DOI
	Liao CX, Li LL, Dai Q, et al. Influencing factors analysis of cognitive function in patients with spinal cord injury[J]. Chin J Nurs, 2021, 56(7):1015-1022. DOI
[11]	Pinto TCC, Machado L, Bulgacov TM, et al. Is the Montreal Cognitive Assessment(MoCA) screening superior to the Mini-Mental State Examination(MMSE) in the detection of mild cognitive impairment(MCI) and Alzheimer’s disease(AD) in the elderly?[J]. Int Psychogeriatr, 2019, 31(4):491-504. DOI URL
[12]	宋歌, 王颖, 高欢玲, 等. 老年慢性阻塞性肺疾病患者认知衰弱风险筛查模型的构建及验证[J]. 中华护理杂志, 2022, 57(15):1859-1867. DOI
	Song G, Wang Y, Gao HL, et al. Construction and validation of a risk screening model for cognitive frailty in elderly patients with chronic obstructive pulmonary disease[J]. Chin J Nurs, 2022, 57(15):1859-1867. DOI
[13]	Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index[J]. Md State Med J, 1965, 14:61-65. PMID
[14]	Tofani M, Massai P, Fabbrini G, et al. Psychometric properties of the Italian version of the Barthel Index in patients with Parkinson’s disease:a reliability and validity study[J]. Funct Neurol, 2019, 34(3):145-150. PMID
[15]	Scarboro M, McQuillan KA. Traumatic brain injury update[J]. AACN Adv Crit Care, 2021, 32(1):29-50. DOI PMID
[16]	Fleming J, Ownsworth T, Doig E, et al. Efficacy of prospective memory rehabilitation plus metacognitive skills training for adults with traumatic brain injury: a randomized controlled trial[J]. Neurorehabil Neural Repair, 2022, 36(8):487-499. DOI URL
[17]	赵巧珍. 脑卒中后合并焦虑抑郁应用Forbrain大脑训练治疗的应用及意义评定[J]. 中国社区医师, 2020, 36(22):67-68.
	Zhao QZ. Application and significance evaluation of brain training of Forbrain in the treatment of poststroke complicated anxiety and depression[J]. Chin Community Dr, 2020, 36(22):67-68.
[18]	Wang J, Yamasaki BL, Weiss Y, et al. Both frontal and temporal cortex exhibit phonological and semantic specialization during spoken language processing in 7-to 8-year-old children[J]. Hum Brain Mapp, 2021, 42(11):3534-3546. DOI PMID
[19]	Champion S. Assessment of hearing in high risk infants,using brainstem evoked response audiometry[J]. Indian J Otolaryngol Head Neck Surg, 2021, 73(3):383-388. DOI
[20]	李晨曦, 尚云峰, 王丽云, 等. 计算机认知训练对轻度认知障碍老年人认知功能的影响研究[J]. 中华护理杂志, 2021, 56(5): 667-673. DOI
	Li CX, Shang YF, Wang LY, et al. Research on the influence of computer cognitive training on the cognitive function of the elderly with mild cognitive impairment[J]. Chin J Nurs, 2021, 56(5):667-673. DOI
[21]	陈肖敏, 金艾香, 朱慧, 等. 虚拟认知康复训练在乳腺癌化疗相关认知障碍患者中的应用[J]. 中华护理杂志, 2019, 54(5):664-668. DOI
	Chen XM, Jin AX, Zhu H, et al. Application and effect of virtual cognitive rehabilitation training in breast cancer patients with cognitive impairment after chemotherapy[J]. Chin J Nurs, 2019, 54(5):664-668. DOI
[22]	张雪茹, 郝习君, 李朝征, 等. 脑外伤患者认知功能障碍的危险因素[J]. 中国康复理论与实践, 2022, 28(2):212-219.
	Zhang XR, Hao XJ, Li CZ, et al. Risk factors for cognitive dysfunction in patients with traumatic brain injury[J]. Chin J Rehabilitation Theory Pract, 2022, 28(2):212-219.
[23]	吴光柳, 杨明莹, 樊红, 等. 脑外伤患者认知功能障碍与日常生活活动能力及生活质量的相关性研究[J]. 中华现代护理杂志, 2017, 23(33):4234-4238.
	Wu GL, Yang MY, Fan H, et al. Correlative study of cognitive dysfunction,activities of daily living and quality of life in patients with traumatic brain injury[J]. Mod Nurs, 2017, 23(33):4234-4238.
[24]	马丁莹, 吕晓, 何结石, 等. 肌内效贴辅助康复训练改善脑卒中后偏瘫恢复期患者上肢功能的临床疗效观察[J]. 中华物理医学与康复杂志, 2021, 43(1):37-39.
	Ma DY, Lü X, He JS, et al. Effect of intramuscular patch assisted rehabilitation training on upper limb function in patients with hemiplegia after stroke[J]. Chin J Phys Med Rehabilitation, 2021, 43(1):37-39.