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目的:比较认知干预和技巧干预对脑外伤患者的心理推理能力和社会功能缺陷的疗效。方法:选取外伤后6个月以上的稳定期脑外伤患者90名,随机分成认知干预组(n=30)、技巧干预组(n=30)和对照组(n=30)。认知干预组采用针对患者现实生活表现的认知取向的生活事件讨论、情境扮演、家庭作业的方法进行康复训练,技巧干预组采用针对测试技巧的心理推理能力故事理解、图片理解的方法进行康复训练,对照组进行一般的门诊随诊服务。三组干预均为每周1次,共12周。干预前、干预后、干预结束后3个月采用心理推理能力经典任务、脑外伤患者心理推理能力他评量表、社会功能缺陷筛选量表(SDSS)评定三组患者的心理推理能力和社会功能。结果:干预前,三组患者各项得分差异无统计学意义(P>0.05)。干预后,认知干预组与技巧干预组的心理推理能力经典任务总分[(14.7±1.3),(15.2±1.7)vs.(12.5±1.6)]、脑外伤患者心理推理能力他评量表得分[(128.7±17.8),(126.8±17.9)vs.(109.5±16.5)]高于对照组(均P<0.05),SDSS得分低于对照组[(9.4±1.1),(10.0±1.0)vs.(12.1±1.3),P<0.05],认知干预组和技巧干预组间差异无统计学意义(P>0.05)。干预结束后3个月,认知干预组与技巧干预组的心理推理能力经典任务总分[(16.5±1.4),(15.9±1.2)vs.(13.3±1.5)]、脑外伤患者心理推理能力他评量表得分[(146.6±15.7),(134.5±14.6)vs.(115.8±21.2)]高于对照组(均P<0.05),SDSS得分低于对照组[(7.1±1.2),(8.0±0.9)vs.(11.4±0.8),P<0.05],认知干预组的他评量表得分高于技巧干预组[(146.6±15.7)vs.(134.5±14.6),P<0.05],SDSS得分低于技巧干预组[(7.1±1.2)vs.(8.0±0.9),P<0.05]。结论:认知干预和技巧干预均能提高脑外伤患者的心理推理能力,并提高患者的社会功能,认知干预方法的疗效可能优于技巧干预。
Objective: To compare the efficacy of cognitive intervention and skill intervention on psychological reasoning ability and social dysfunction in traumatic brain injury patients. Methods: Ninety patients with stable traumatic brain injury more than 6 months after trauma were randomly divided into cognitive intervention group (n = 30), skill intervention group (n = 30) and control group (n = 30). The cognitive intervention group used the life event discussion, situational play, and homework methods for the patients’ cognition of the real life performance to carry out rehabilitation training. The skill intervention group used the psychological reasoning ability skill of the test skill to understand the story and the picture understanding Training, control group general outpatient service. Three interventions were weekly, a total of 12 weeks. Three months after the intervention, three tasks were followed: the classic task of psychological reasoning ability, the psychological reasoning ability assessment scale of patients with traumatic brain injury, and the Social Function Deficiency Screening Scale (SDSS) to evaluate the psychological reasoning ability and social function of three groups . Results: Before the intervention, there was no significant difference among the three groups (P> 0.05). After intervention, the score of classical task ([14.7 ± 1.3], (15.2 ± 1.7) vs. (12.5 ± 1.6)], psychological reasoning ability of cognitive intervention group and skill intervention group The score of SDSS was lower than that of the control group [(9.4 ± 1.1), (10.0 ± 1.0), (128.7 ± 17.8), (126.8 ± 17.9) vs. (109.5 ± 16.5) (12.1 ± 1.3), P <0.05]. There was no significant difference between the intervention group and the intervention group (P> 0.05). At 3 months after the intervention, the scores of classic tasks ([(16.5 ± 1.4), (15.9 ± 1.2) vs. (13.3 ± 1.5)] of psychological reasoning ability in cognitive intervention group and skill intervention group were significantly higher than those in psychological intervention group His rating scale score was significantly higher (146.6 ± 15.7 vs 134.8 ± 21.6 vs. 115.8 ± 21.2, P <0.05), and the SDSS score was lower than that in the control group [(7.1 ± 1.2) vs. 8.0 ± 0.9) vs. (11.4 ± 0.8), P <0.05]. The scores of his assessment scale in cognitive intervention group were higher than those in technical intervention group [(146.6 ± 15.7) vs. (134.5 ± 14.6), P <0.05] , SDSS score was lower than that of the skill intervention group [(7.1 ± 1.2) vs. (8.0 ± 0.9), P <0.05]. Conclusion: Both cognitive intervention and skill intervention can improve the psychological reasoning ability of patients with traumatic brain injury and improve the social function of patients. Cognitive intervention may be more effective than skill intervention.