感知运动康复和心理治疗技术对脑卒中恢复期心理情绪的影响

A. Kuzyukova, Yana G. Pekhova, O. I. Odarushenko, O. V. Yurova, A. D. Fesyun
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引用次数: 0

摘要

简介中风是导致人口残疾的主要原因。除运动障碍外,认知障碍和情感障碍也是导致残疾的原因之一。制定有效的神经康复计划不仅能减轻运动障碍的严重程度,还能及时纠正脑卒中患者的心理情感障碍,这对康复医学非常重要。鉴于体育锻炼对焦虑和抑郁有积极的治疗作用,对认知功能有保护作用,研究运动康复对中风患者心理情感障碍的影响很有意义。 研究目的与复杂的心理治疗技术相比,研究感觉运动康复对中风恢复期患者情感和认知障碍的影响。 材料和方法:本研究调查了两组处于缺血性中风恢复期(最长 2 年)、存在焦虑和/或抑郁障碍的患者,他们的性别、年龄、中风病程和病灶、神经功能缺损的严重程度具有可比性。第一组 24 名患者接受感官运动康复治疗,不针对情感障碍;第二组 25 名患者接受为期 18 天的复杂医疗和心理适应治疗。康复效果采用经过验证的量表和问卷进行评估(Rivermead 活动指数、6 点肌力评估量表、改良的 Ashfort 痉挛量表;Berg 平衡量表、Beck 抑郁症、Spielberger-Khanin 焦虑症、MMSE、MoCA;Schulte 表法、SS-QOL 脑卒中生活质量评估量表)。统计分析使用 StatTech v. 2.8.8 程序(由俄罗斯 Stattech LLC 公司开发)进行。 结果与讨论对两组患者进行的初步评估显示,焦虑状态比抑郁状态多出两倍,88%的患者伴有认知障碍,其中注意力障碍最为常见(这些指标在组间没有差异)。在完成感知运动康复和医学心理康复治疗后,两组患者的斯皮尔伯格-卡宁量表(Spielberger-Khanin scale)中的情境焦虑和个人焦虑水平都有显著下降,莫Са量表(MoСа scale)和SS-QOL问卷中的积极动态也有显著下降,而只有第二组患者在使用专业心理治疗技术的背景下,贝克量表(Beck scale)中的抑郁水平才有显著下降。 结论。运动康复与复杂的医疗和心理适应具有积极的可比性,它影响缺血性中风患者的焦虑和认知功能,可被视为纠正焦虑状态和预防这些患者认知障碍的有效方法之一,而在抑郁症的治疗中,应优先考虑专业的医疗和心理干预。
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Sensorimotor Rehabilitation and Psychotherapeutic Techniques Effect on the Psychoemotional State in the Stroke Recovery Period
INTRODUCTION. Stroke is the leading cause of disability of the population. In addition to motor disorders, cognitive and affective disorders contribute to the development of disability. The development of effective neurorehabilitation programs aimed not only at reducing the severity of motor deficits, but also at timely correction of psychoemotional disorders in stroke patients is very relevant for restorative medicine. In view of the proven positive therapeutic effect of physical exercises on anxiety and depression, their protective effect on cognitive functions, it is of interest to study the effect of motor rehabilitation on psychoemotional disorders in stroke patients. AIM. To study the effect of sensorimotor rehabilitation on affective and cognitive disorders in patients in the recovery period of stroke in comparison with a complex psychotherapeutic technique. MATERIALS AND METHODS. The study examined 2 groups of patients in the recovery period of ischemic stroke (up to 2 years) with the presence of anxiety and/or depressive disorders, comparable in gender, age, duration and focus of stroke localization, severity of neurological deficit. The 1st group — 24 patients — received a course of sensorimotor rehabilitation without targeted impact on affective disorders; the 2nd group — 25 patients — a course of complex medical and psychological adaptation lasting 18 days. The effectiveness of rehabilitation was assessed using validated scales and questionnaires (Rivermead Mobility Index, 6-point muscle strength assessment scale, modified Ashfort spasticity scale; Berg balance scales, Beck depression, Spielberger-Khanin anxiety, MMSE, MoCA; Schulte Table Methodology, SS-QOL Stroke Quality of Life Assessment Scale). Statistical analysis was carried out using the StatTech v. 2.8.8 program (developed by Stattech LLC, Russia). RESULTS AND DISCUSSION. The preliminary assessment carried out in both groups showed a twofold predominance of anxiety states over depressive ones, concomitant cognitive impairments were detected in 88 % of patients, among whom attention disorders were most often recorded (there was no intergroup difference in these indicators). After completing the course of both sensorimotor and medico-psychological rehabilitation, both groups showed a significant decrease in the level of situational and personal anxiety on the Spielberger-Khanin scale, positive dynamics on the MoСа scale, the SS-QOL questionnaire, while a significant decrease in the level of depression on the Beck scale was registered only in patients of the 2nd group on against the background of the use of specialized psychotherapeutic techniques. CONCLUSION. Motor rehabilitation is positively comparable with complex medical and psychological adaptation, it affects anxiety and cognitive functions in patients with ischemic stroke, it can be considered as one of the effective ways to correct anxiety states and prevent cognitive impairment in these patients, while in the treatment of depression the priority is should be given to specialized medical and psychological intervention.
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