脊髓损伤后言语语言病理学住院康复干预及患者特征与预后的关系：脊髓损伤康复项目（SCIRehab）

Relationship of speech-language pathology inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project.

作者信息

Gordan Wendy, Gerber Donald, David Dana Spivack, Adornato Viki, Brougham Rebecca, Gassaway Julie, Kreider Scott E D, Whiteneck Gale

机构信息

Craig Hospital, Englewood, CO, USA.

出版信息

J Spinal Cord Med. 2012 Nov;35(6):565-77. doi: 10.1179/2045772312Y.0000000063.

DOI:10.1179/2045772312Y.0000000063

PMID:23318037

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3522897/

Abstract

BACKGROUND/OBJECTIVE: Describe associations of patient characteristics and speech-language pathology (SLP) interventions provided during impatient rehabilitation for spinal cord injury (SCI) to outcomes at discharge and 1-year post-injury.

METHODS

Speech-language pathologists at six inpatient rehabilitation centers documented details of treatment provided. Least squares regression modeling was used to predict outcomes at discharge and 1-year injury anniversary. Cognitive, participation, and mood outcomes for a subsample of patients with traumatic brain injury (TBI) and cognitive-communication limitations (CCLs) were examined.

RESULTS

SLP treatment factors explain a small amount of variation in cognitive Functional Independence Measure (FIM), participation, and mood. Variation explained by treatment factors for cognitive outcomes at the time of discharge increased when the patient group was more homogeneous (patients with TBI and CCLs). More time in SLP cognitive-communication interventions had a negative relationship, while longer length of stay was positive. The added explanatory power was not seen for similar outcomes at 1-year post-injury.

CONCLUSION

Patients with SCI who have the greatest need for interventions to address cognitive limitations due to TBI receive the most SLP cognitive-communication treatment and show the greatest amount of improvement during rehabilitation. Their cognitive functioning remained impaired at discharge; this likely accounts for the consistent finding that more hours of SLP cognitive-communication treatment is associated with lower cognitive FIM scores at discharge. Future research on individuals with dual SCI and TBI should include more comprehensive assessment of individual differences in cognitive performance in order to better examine the complex relationships between SLP treatments and outcomes. Note: This is the fifth of nine articles in this SCIRehab series.

摘要

背景/目的：描述脊髓损伤（SCI）患者在住院康复期间的特征及接受的言语语言病理学（SLP）干预与出院时及伤后1年结局之间的关联。

方法

6家住院康复中心的言语语言病理学家记录了所提供治疗的详细情况。采用最小二乘回归模型预测出院时及伤后1年的结局。对创伤性脑损伤（TBI）和认知交流障碍（CCL）患者亚组的认知、参与和情绪结局进行了研究。

结果

SLP治疗因素对认知功能独立性测量（FIM）、参与和情绪方面的变异解释量较小。当患者组更具同质性（TBI和CCL患者）时，出院时治疗因素对认知结局的变异解释量增加。接受SLP认知交流干预的时间越长呈负相关，而住院时间越长呈正相关。伤后1年时类似结局未见额外的解释力。

结论

因TBI而最需要认知限制干预措施的SCI患者接受了最多的SLP认知交流治疗，且在康复期间改善程度最大。他们出院时的认知功能仍受损；这可能解释了一直以来的发现，即更多时长的SLP认知交流治疗与出院时较低的认知FIM评分相关。未来对合并SCI和TBI个体的研究应包括对认知表现个体差异的更全面评估，以便更好地研究SLP治疗与结局之间的复杂关系。注：这是本SCIRehab系列9篇文章中的第5篇。