Division of Rehabilitation and Ageing, Community Health Sciences, University of Nottingham, UK.
Clin Rehabil. 2012 Aug;26(8):675-85. doi: 10.1177/0269215511431089. Epub 2011 Dec 16.
To investigate two approaches to treating patients with persistent dressing problems and cognitive difficulties following stroke.
Pilot randomized controlled trial.
Inpatient stroke rehabilitation service.
Seventy consecutive stroke patients with persistent dressing problems and accompanying cognitive difficulties at two weeks after their stroke.
Patients were randomly allocated to six weeks of either a systematic neuropsychological approach, based on analysis of dressing problems and further cognitive testing, or to the control group who received conventional (functional) dressing practice. Both groups received treatment three times a week in accordance with two separately prepared manuals.
Nottingham Stroke Dressing Assessment (NSDA), Line Cancellation, 10-hole peg transfer test, Object Decision, Gesture Imitation. Patients were assessed at six weeks after randomization by an independent assessor masked to group allocation.
Both neuropsychological and functional groups improved performance on the NSDA over the treatment period (31% and 22%, respectively) but there was no significant difference between groups at six weeks. However, the neuropsychological group showed a significantly greater improvement on a line cancellation test of visual neglect (t(62) = 2.1, P < 0.05) and a planned subanalysis for those with right hemisphere damage showed a trend towards better dressing outcome (P = 0.07, one-tailed).
Results demonstrate the potential benefits of a systematic neuropsychological approach to dressing therapy, particularly for patients with right hemisphere damage. This study suggests the need for a phase III study evaluating the efficacy of a systematic neuropsychological approach in treating dressing difficulties, targeting patients with right hemisphere stroke and visuospatial impairments.
探索两种方法治疗卒中后持续存在穿衣问题和认知困难的患者。
试点随机对照试验。
住院卒中康复服务。
70 例连续卒中患者，在卒中后两周持续存在穿衣问题和伴随的认知困难。
患者随机分为 6 周的系统神经心理学方法组，基于穿衣问题分析和进一步的认知测试，或对照组，接受常规（功能）穿衣练习。两组均根据两个单独准备的手册每周接受 3 次治疗。
诺丁汉卒中穿衣评估（NSDA）、直线消去、10 孔钉转移测试、物体决策、手势模仿。患者在随机分组后 6 周由独立评估员进行评估，评估员对分组情况不知情。
神经心理学组和功能组在治疗期间 NSDA 评分均有所提高（分别为 31%和 22%），但组间无显著差异。然而，神经心理学组在视觉忽视的直线消去测试中表现出显著更大的改善（t(62) = 2.1，P < 0.05），并且对于右侧半球损伤的计划亚分析显示出更好的穿衣结果的趋势（P = 0.07，单侧）。
结果表明系统神经心理学方法治疗穿衣治疗的潜在益处，特别是对于右侧半球损伤的患者。本研究表明需要进行 III 期研究，评估系统神经心理学方法治疗穿衣困难的疗效，针对右侧半球卒中和视觉空间损伤的患者。
