Su C Y, Chang J J, Chen H M, Su C J, Chien T H, Huang M H
Division of Occupational Therapy, School of Rehabilitation Medicine, Kaohsiung Medical College, Taiwan, Republic of China.
Arch Phys Med Rehabil. 2000 Jun;81(6):706-14. doi: 10.1016/s0003-9993(00)90097-2.
OBJECTIVE: To assess perceptual performances of patients with intracerebral hemorrhage (ICH) compared with those of ischemic patients early after stroke and to analyze the psychometric properties of three perceptual tests used in the study. DESIGN: Cross-sectional study. SETTING: A rehabilitation unit at a teaching hospital. PATIENTS: Twenty-two stroke patients with ICH and 22 demographically matched stroke patients with infarction. MAIN OUTCOME MEASURES: Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), Rivermead Perceptual Assessment Battery (RPAB), and Motor-Free Visual Perception Test (MVPT). RESULTS: Stroke patients with ICH had significantly more severe deficits on a task of thinking operations than did patients with infarction. A significant lateralized effect of stroke existed in the ICH group, with patients with right-hemisphere strokes scoring lower than patients with left-hemisphere strokes on the figure-ground discrimination subtest of the RPAB. A considerable overlap among the three instruments was found. Yet, the observed correlations between supposedly similar subtests from the tests proved to be moderate, indicating that to a certain extent these test measures tap different perceptual processes. Four factors were generated from a joint LOTCA-RPAB-MVPT factor analysis. They assessed different facets of perceptual functioning, including higher-level and lower-level perceptual skills, part/whole conceptual integration, and color perception. This factor pattern accounted for 75.5% of the variance. CONCLUSIONS: Higher-level perceptual functions tend to be relatively susceptible to ICH stroke pathology early in the course of the disease. This information has important clinical implications in the early treatment planning for the stroke patients with ICH, such that specific compensatory strategies for these deficiencies should be devised to facilitate a successful rehabilitation. Knowledge regarding the influences of specific deficits on the performance of daily activities may also be useful to the patients' family.
目的：评估脑出血（ICH）患者与缺血性脑卒中患者在卒中早期的感知功能，并分析本研究中使用的三项感知测试的心理测量特性。 设计：横断面研究。 地点：一家教学医院的康复科。 患者：22例脑出血性脑卒中患者和22例人口统计学匹配的缺血性脑卒中患者。 主要观察指标：洛温斯坦职业疗法认知评估（LOTCA）、里弗米德感知评估量表（RPAB）和非运动视觉感知测试（MVPT）。 结果：脑出血性脑卒中患者在思维操作任务上的缺陷比缺血性脑卒中患者严重得多。脑出血组存在明显的卒中侧化效应，在RPAB的图形-背景辨别子测试中，右半球卒中患者的得分低于左半球卒中患者。发现这三种工具之间有相当程度的重叠。然而，这些测试中假定相似的子测试之间的观察相关性被证明是中等的，这表明这些测试措施在一定程度上涉及不同的感知过程。通过联合LOTCA-RPAB-MVPT因素分析产生了四个因素。它们评估了感知功能的不同方面，包括高级和低级感知技能、部分/整体概念整合以及颜色感知。这种因素模式解释了75.5%的方差。 结论：在疾病早期，高级感知功能往往相对易受脑出血性脑卒中病理变化的影响。这一信息在脑出血性脑卒中患者的早期治疗规划中具有重要的临床意义，因此应制定针对这些缺陷的具体补偿策略，以促进成功康复。了解特定缺陷对日常活动表现的影响，对患者家属也可能有用。
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