目的:探讨执行功能训练对脑卒中后失语症患者语言功能的影响.方法:选取60例脑卒中后失语症患者,随机分为对照组和干预组,对照组实施常规言语训练,干预组在对照组训练的基础上给予执行功能训练.采用西方失语症成套测验(WAB)、简易智力状况检查(MMSE)及执行功能测试对2组患者进行干预前后的评定.结果:训练4周后,对照组患者训练后WAB中的谈话、复述评分较训练前有明显提高(P＜0.05),理解、命名及失语商(AQ)评分差异无统计学意义;干预组患者训练后WAB中的谈话、理解、复述评分较训练前提高显著(P＜0.01),命名评分及AQ值较训练前明显提高(P＜0.05).训练后干预组患者理解、复述、命名、谈话评分及AQ值明显高于对照组(P＜0.05,0.01).训练后,对照组患者MMSE评分较训练前差异无统计学意义,干预组患者MMSE评分较训练前及对照组有明显提高(P＜0.05).训练后,对照组患者执行功能评定中的Stroop测试分值、词语流畅性测试(动物)(VFTa)较训练前有明显提高(P＜0.05);而伦敦塔测试分值、谚语测试分值、连线测验A(TMT-A)分值、连线测验B(TMT-B)分值、词语流畅性测试(果蔬)(VFTv)分值,较训练前相比,差异无统计学意义;而干预组患者执行功能各项评定较训练前均有显著提高(P＜0.05).干预组患者语言康复治疗的总有效率显著高于对照组(P＜0.05).结论:执行功能训练可以改善脑卒中失语症患者的执行功能和语言功能.

帕金森病(Parkinson'sdisease,PD)也被称为震颤麻痹,是中老年人常见的神经系统变性疾病之一.该疾病的主要病理生理学改变是黑质多巴胺(Dopamine,DA)能神经元发生变性死亡,引发多巴胺的水平明显下降而导致该病[1].在帕金森病患者中44％～53％会出现冻结步态,在疾病的中晚期这一比列会高达80％[2].冻结步态(Freezing of gait,FOG):在行走过程中或准备起步时无征兆下,患者突然出现步行动作的停止,特别在改变行走方向或通过狭窄空间时较易出现上述情况,患者自我感觉双脚似乎被地板吸住或者粘在地板上,想再次抬脚及迈步时明显困难,严重时该情况可能持续超过30 s,患者步行中止且无法采取任何有效的措施[3].出现冻结步态后患者整体运动功能和日常生活自理能力下降.除了运动功能的下降,冻结步态还可能导致患者的心理疾病如焦虑、抑郁、社会脱离等.不管是运动功能的下降,还是与其相关的并发症,都较大程度地影响了患者的生活质量[4-5].精准评定帕金森病患者的冻结步态对制定个体化康复方案及目标、评价临床干预效果及临床科研至关重要.本研究对近年来帕金森病冻结步态的评定方法作一综述,以期为临床应用提供参考.

BACKGROUND:Nonverbal cognitive training for aphasia has gained popularity. Prior research has found that cognitive status correlates with language function.OBJECTIVE:To determine whether nonverbal computer-assisted executive control training (CAET) to improve cognitive status affects language performance in patients with aphasia (PWA) and executive dysfunction.DESIGN:A single blind randomized trial.SETTING:Department of Rehabilitation, Affiliated Hospital of Xuzhou Medical University.PARTICIPANTS:A total of 68 individuals were randomized, underwent treatment and were included in the analysis (CAET group, n = 33; control group, n = 35).INTERVENTIONS:The experimental group was treated with 4 weeks of traditional speech and language therapy (SLT) combined with CAET. The control group underwent SLT only.MAIN OUTCOME MEASURES:Western Aphasia Battery [WAB]) with executive dysfunction (as assessed by the verbal fluency test [VFT], the Proverbs Test, the Tower of London Test [TLT], the Stroop Color and Word Test [SCWT], and the Trail Making Test [TMT]).RESULTS:Differences between pre- and posttreatment language outcomes except oral naming (group × time, p = .236) were significantly greater in the experimental group compared with the control group: spontaneous speech (group × time, p = .026), auditory comprehension (group × time, p < .001), speech repetition (group × time, p = .001), and aphasia quotient (AQ; group × time, p < .001). A similar effect was observed for cognitive function such as Trial Making Test (TMT)-A (group × time, p = .006), TMT-B (group × time, p = .005), and verbal fluency test (VFT-V; group × time, p = .018).CONCLUSION:The study demonstrates that CAET combined with SLT can yield favorable language outcomes for PWA, especially improvements in auditory comprehension and AQ. CAET combined with SLT generates benefits in both cognitive function and language performance.

目的 探讨纯视觉输入的非言语性认知功能评估工具的信度和效度.方法 选择85例认知功能正常受试者和50例轻度认知障碍(MCI)患者均采用纯视觉输入的非言语性认知功能评估工具和非语言性认知功能评估量表(NLCA)进行评估,再从85例正常受试者中随机选择46例于4 w后再次用纯视觉输入的非言语性认知功能评估工具评估一次,检验量表的信度和效度.结果 纯视觉输入的非言语性认知功能评估工具内部一致性良好,整个量表Cronbachα0.757,重测信度为0.929.纯视觉输入的非言语性认知功能评估工具与NLCA的相关系数为0.737.根据纯视觉输入的非言语性认知功能评估工具总分绘制的ROC曲线下面积为0.889(95％CI:0.818～0.960).结论 纯视觉输入的非言语性认知功能评估工具具有较高的信度和效度,其总分对认知功能损害程度有较好评估效果.

目的 探讨视频透视吞咽造影(VFSS)联合纤维鼻咽喉镜吞咽功能检查(FEES)在老年患者卒中后吞咽障碍诊断中的价值.方法 选取徐州医科大学附属医院卒中伴有吞咽障碍的住院患者34例,进行VFSS及FEES检查.结果 VFSS显示口腔期吞咽障碍25例,咽期吞咽障碍30例(咽缩肌无力28例、舌根后缩无力15例、会厌翻转运动差28例、滞留28例、渗漏23例、隐性误吸8例、显性误吸10例),食管期吞咽障碍17例(环咽肌开放不全10例、完全不开放5例、反流2例).FEES检查发现:咽缩肌无力25例,会厌翻转运动差24例,滞留27例,声门闭合不良21例,渗漏23例,误吸15例,其中还发现声带新生物及喉癌等4例.结论 VFSS联合FEES在咽期吞咽障碍诊断中检出率基本一致,既能相互佐证,又能相互补充.VFSS评估包括从口腔期到咽期到食道期,而FEES仅能观察咽期,但是FEES更直观,在卒中合并咽喉部器质性病变中有着不可替代的价值.

目的 探讨视频透视吞咽造影在帕金森病患者吞咽障碍诊断中的价值.方法 选取在徐州医科大学附属医院治疗的帕金森病合并吞咽障碍住院患者31例,对其分别进行反复吞咽唾液试验、洼田饮水试验、才藤吞咽障碍分级评估及视频透视吞咽造影检查,并对各评估方法的吞咽障碍检出率进行对比.结果 视频透视吞咽造影能全面精准评估吞咽功能,并能详细明确功能障碍的部位和程度,尤其在发现隐性误吸有着不可替代的作用.结论 视频透视吞咽造影在帕金森病合并吞咽障碍诊断中检出率高,能及时发现隐性误吸、能更全面的评估口腔期、咽期及食道期的功能障碍.

OBJECTIVE To evaluate whether extracorporeal shock wave therapy significantly improves spasticity in post-stroke patients. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE, EBSCO, Web of Science, Cochrane CENTRAL electronic databases. STUDY SELECTION Randomized controlled trials assessing the effect of extracorporeal shock wave therapy on post-stroke patients with spasticity were selected for inclusion. DATA EXTRACTION Two authors independently screened the literature, extracted data, and assessed the quality of included studies. Primary outcome was modified Ashworth scale (MAS). Secondary outcomes were Modified Tardieu Scale (MTS), H/M ratio and range of motion. DATA SYNTHESIS Eight randomized controlled trial studies (n = 385 patients) were included in the meta-analysis. There was a high level of evidence that extracorporeal shock wave therapy significantly ameliorates spasticity in post-stroke patients according to the 4 parameters: MAS (standard mean difference (SMD) -1.22; 95% confidence interval (95% CI): -1.77 to -0.66); MTS (SMD 0.70; 95% CI 0.42-0.99,); H/M ratio (weighted mean difference (WMD) -0.76; 95% CI -1.19 to -0.33); range of motion (SMD 0.69; 95% CI 0.06-1.32). However, there was no statically significant difference on the MAS at 4 weeks (SMD -1.73; 95% CI -3.99 to 0.54). CONCLUSION Extracorporeal shock wave therapy has a significant effect on spasticity in post-stroke patients.