针对性运动疗法结合认知训练治疗脑外伤后运动功能障碍的临床效果研究

张树宇 唐琳 高琛 高晋 崔金雪

[摘要] 目的 研究分析針对性运动疗法结合认知训练治疗脑外伤后运动功能障碍的临床效果。 方法 将2018年4月～2019年4月我院收治的88例脑外伤患者纳为研究对象，并依据入院时间对其进行分组：2018年4～10月收治的44例作为常规组，予以常规疗法，2018年11月～2019年4月收治的44例则作为研究组，予以针对性运动疗法结合认知训练。比较分析两组患者的简易上肢机能检查（Simple Test Evaluating Hand Function，STEF）量表、Fugl-Meyer运动功能（Fugl-Meyer Assessment ，FMA）量表、简明精神状态量表（Minimum Mental State Examination，MMSE）、日常生活活动能力量表（Activity of Daily Living，ADL）评分及Holden步行功能分级情况。 结果 治疗后，研究组的STEF评分、FMA评分、MMSE 评分、ADL评分均高于常规组;此外，研究组Holden步行功能0、1级患者例数均少于常规组，4、5级患者例数则均多于常规组（P<0.05）。 结论 在脑外伤后患者中采用针对性运动疗法结合认知训练能够有效改善其上肢功能及肢体运动障碍，促进运动功能恢复，同时提高步行能力及日常生活能力，效果显著。

[关键词] 脑外伤;运动功能障碍;针对性运动疗法;认知训练

[中图分类号] R493          [文献标识码] B          [文章编号] 1673-9701（2020）17-0124-04

A study of the clinical effect of targeted exercise therapy combined with cognitive training in the treatment of movement disorders after traumatic brain injury

ZHANG Shuyu1   TANG Lin2   GAO Chen3   GAO Jin1   CUI Jinxue1

1.General Hospital of Heilongjiang Farms & Land Reclamation Administration，  Harbin   150088， China; 2.The Fourth Hospital of Harbin Medical University， Harbin   150001， China; 3.Military Sports Training Center， Shenyang   110000， China

[Abstract] Objective To investigate and analyze the clinical effect of targeted exercise therapy combined with cognitive training in the treatment of movement disorders after traumatic brain injury. Methods 88 patients with traumatic brain injury admitted to our hospital from April 2018 to April 2019 were selected as research subjects and were divided into groups according to admission time： 44 patients admitted from April 2018 to October 2018 were treated with conventional therapy as the conventional group， while 44 patients admitted from November 2018 to April 2019 were treated with targeted exercise therapy combined with cognitive training as the study group. The scores of Simple Test Evaluating Hand Function（STEF）， Fugl-Meyer Assessment（FMA）， Minimum Mental State Examination（MMSE） and Activity of Daily Living（ADL） and Holden's functional ambulation category（FAC） scale were compared between the patients of the two groups. Results After treatment， STEF scores， FMA scores， MMSE scores and ADL scores of the study group were all higher than those of the conventional group. In addition， the number of patients with both grade 0 and grade 1 of Holden's FAC in the study group was smaller than that in the conventional group， and the number of patients with both grade 4 and grade 5 was larger than that in the conventional group（P<0.05）. Conclusion Targeted exercise therapy combined with cognitive training can effectively ameliorate the upper limb function and limb dyskinesia， promote the recovery of movement function， and also improve walking ability and daily living ability of the patients with traumatic brain injury. The effect is obvious.

[Key words] Traumatic brain injury; Movement disorders; Targeted exercise therapy; Cognitive training

脑外伤（traumatic brain injury，TBI）指因外力导致的脑损伤，无论是原发性损伤或是继发性损伤，一般可引起较为严重的后果，常出现广泛的、不同程度的全脑损伤。临床常见症状为失语或言语不清、意识模糊、四肢无力或偏瘫等[1-2]。脑外伤导致的功能障碍具有多样性和复杂性，如行为障碍、认知障碍、运动功能障碍、言语障碍等，其中，运动功能障碍表现亦多种多样，但主要为上运动神经元损伤性障碍，且常伴认知功能障碍，因而康复难度较大[3-4]。针对此种情况，有学者指出[5]，既往常规疗法较为片面、针对性不强，难以满足脑外伤后患者的运动康复需求;而在此基础上，临床提出了将针对性运动疗法与认知训练结合用于本病患者康复治疗的建议，并认为上述联合疗法能够有效改善患者的认知及运动功能。……