运动康复背景下脑卒中左右半球定位的精神障碍特征:比较研究

A. Kuzyukova, Irina A. Belyaeva, Yana G. Pekhova, O. V. Yurova, A. D. Fesyun
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To study cognitive, emotional disorders and quality of life in patients with ischemic stroke depending on the localization of the lesion in the right or left cerebral hemisphere and their dynamics on the background of motor rehabilitation. \nMATERIALS AND METHODS. 39 patients with localization of an ischemic focus in the middle cerebral artery territory (group 1 (n = 19) — right hemisphere, and group 2 (n = 20) — left hemisphere) in the recovery period after an ischemic stroke, underwent an inpatient course of motor rehabilitation. Conditions of the patients were assessed at the beginning and at the end of hospitalization using the 6-point muscular strength scale, the modified Ashfort scale, a TUG test, the FIM and Berg balance scales, MMSE, MoCA, the Schulte Table methods, he Beck Depression Inventory, the State-Trait Anxiety Inventory (Spielberger-Khanin) and the Quality of Life at stroke. \nRESULTS. 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摘要

引言。脑卒中后患者的认知和情绪病变发生率很高,因此,为了取得显著的康复效果,考虑到其精神状态的特殊性是非常重要的。有关大脑不对称的数据表明,某些心理功能(语言、情感和认知功能)存在一定的侧向性。研究目的研究缺血性脑卒中患者的认知、情感障碍和生活质量,这取决于病变在右脑或左脑半球的位置及其在运动康复背景下的动态变化。39 名大脑中动脉缺血灶定位患者(第 1 组(n = 19)--右半球,第 2 组(n = 20)--左半球)在缺血性脑卒中恢复期接受了住院运动康复治疗。在住院开始和结束时,使用 6 点肌力量表、改良阿什福尔特量表、TUG 测试、FIM 和 Berg 平衡量表、MMSE、MoCA、舒尔特表法、贝克抑郁量表、状态-特质焦虑量表(Spielberger-Khanin)和中风时的生活质量对患者进行了评估。结果第 1 组和第 2 组患者中发现注意力障碍的比例分别为 84.6% 和 75%。近一半的脑卒中后患者被诊断出患有情绪障碍,焦虑症多于抑郁症。在第 2 组中,MMSE 得分低于 23 分的患者比第 1 组多 5 倍。而在第 1 组中,抑郁症的发病率是焦虑症的 4 倍。然而,组间差异在统计学上并不显著。康复结束时,两组的特质焦虑水平均显著下降,而第一组的注意力稳定性有所提高。讨论观察到 LMCA 组的认知障碍更为严重,RMCA 组的情绪障碍更为严重,这与大脑不对称的数据相符。结论。运动康复对脑卒中后患者的情绪状态有积极影响,而对其认知功能的影响不明显,再加上认知障碍的高发生率,有必要考虑从运动康复向认知运动康复过渡,以提高治疗效果。
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Features of Mental Disorders in Right- and Left-Hemisphere Localization of Stroke on the Background of Motor Rehabilitation: Comparative Study
INTRODUCTION. In post-stroke patients have a high incidence of cognitive and emotional pathology, it is very important to take into account the particular features of mental state in order to achieve significant results of rehabilitation. The data on brain asymmetry indicate a certain lateralization of some mental functions (speech, emotional and cognitive functions). AIM. To study cognitive, emotional disorders and quality of life in patients with ischemic stroke depending on the localization of the lesion in the right or left cerebral hemisphere and their dynamics on the background of motor rehabilitation. MATERIALS AND METHODS. 39 patients with localization of an ischemic focus in the middle cerebral artery territory (group 1 (n = 19) — right hemisphere, and group 2 (n = 20) — left hemisphere) in the recovery period after an ischemic stroke, underwent an inpatient course of motor rehabilitation. Conditions of the patients were assessed at the beginning and at the end of hospitalization using the 6-point muscular strength scale, the modified Ashfort scale, a TUG test, the FIM and Berg balance scales, MMSE, MoCA, the Schulte Table methods, he Beck Depression Inventory, the State-Trait Anxiety Inventory (Spielberger-Khanin) and the Quality of Life at stroke. RESULTS. Attention disorders were found in patients of groups 1 and 2 in 84.6 and 75 %, respectively. Emotional disorders were diagnosed in almost half of post-stroke patients, anxiety disorders prevailed over depressive ones. In group 2 patients scoring ≤ 23 points on the MMSE were found 5 times more frequently. In group 1 depression was 4 times more frequent. However, the obtained intergroup differences were not statistically significant. At the end of the rehabilitation, both groups demonstrated a significant decrease in the level of trait anxiety, and in group 1 an increase in the attentional stability. DISCUSSION. The observed prevalence of more severe cognitive impairments in the LMCA group and emotional impairments in the RMCA group are consistent with the data on brain asymmetry. CONCLUSION. Motor rehabilitation has a positive effect on the emotional state of patients after a stroke, and insignificantly on their cognitive functions, which, along with a high incidence of cognitive impairments, necessitates consideration of the transition from motor to cognitive-motor rehabilitation in order to improve the effectiveness of the treatment.
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