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目的:运用认知行为疗法对脑卒中后认知障碍患者的干预,观察其对偏瘫患者恢复肢体功能和ADL能力方面的影响。方法:将116例患者根据简易智力状态检查(MMSE)的评定结果分为2组,MMSE积分低于24分者为认知治疗组共46例,其余为对照组共70例。2组患者在接受康复治疗的前后,均进行相关的功能评定,包括偏瘫肢体综合功能评定(上田敏法)、日常生活活动能力ADL评定(改良Barthel指数法)、认知状况采用MMSE。2组患者均采用住院康复治疗,入院后所有患者均接受有关疾病的健康教育,同时每天进行1～2小时以上的一对一的功能康复训练,认知治疗组每天在常规康复治疗的基础上,运用认知行为疗法,结合强制性训练和集体医疗体操。结果:2组患者康复训练后,通过自身前后比较发现,综合肢体功能和ADL能力均有明显提高,且对照组积分普遍高于治疗组,但经统计学处理2组间并无显著性意义。结论:认知障碍是影响偏瘫患者康复疗效的一个重要因素,积极的心理治疗是康复治疗顺利进行的基本保证,有利于促进偏瘫患者的功能恢复。康复离不开心理治疗,心理治疗应贯穿康复过程始终。
OBJECTIVE: To investigate the effect of cognitive behavioral therapy on patients with post-stroke cognitive impairment and its effect on the recovery of limb function and ADL in patients with hemiplegia. Methods: One hundred and sixty-six patients were divided into two groups according to MMSE. Among them, 46 patients with MMSE score less than 24 were divided into cognitive therapy group and 70 patients in control group. Before and after rehabilitation treatment, both groups performed relevant functional assessment, including comprehensive functional assessment of the hemiparetic limbs (Ueda Min method), ADL assessment of daily living activities (modified Barthel index method), and cognitive status using MMSE. All patients in the two groups were treated with in-hospital rehabilitation. After admission, all patients received health education about the disease. At the same time, one-on-one functional rehabilitation training was performed for more than 1 to 2 hours every day. On the basis of routine rehabilitation treatment , The use of cognitive behavioral therapy, combined with mandatory training and collective medical gymnastics. Results: After rehabilitation training, two groups of patients were found before and after comparison, the comprehensive function of the limbs and ADL abilities were significantly improved, and the control group scores were generally higher than the treatment group, but there was no statistical significance between the two groups. Conclusion: Cognitive impairment is an important factor affecting the rehabilitation of patients with hemiplegia. Active psychotherapy is the basic guarantee for the successful rehabilitation and is conducive to the functional recovery of patients with hemiplegia. Rehabilitation is inseparable from psychological treatment, psychological treatment should be through the rehabilitation process.