Hewetson Ronelle, Cornwell Petrea, Shum David
a Department of Speech Pathology , Metro North Hospital and Health Service , Brisbane , Australia.
b School of Applied Psychology , Griffith University , Brisbane , Australia.
Top Stroke Rehabil. 2017 Jul;24(5):330-336. doi: 10.1080/10749357.2017.1289622. Epub 2017 Feb 20.
Rehabilitation positively influences return to activities and social roles in people with aphasia. The cognitive-communication disorder (CCD) found following a right hemisphere stroke has been less extensively researched with rehabilitation access and outcomes yet to be determined.
To document rehabilitation access and outcomes for people with CCD post-stroke; and compare outcomes based on presence (viz CCD; aphasia) or absence of communication impairment.
A retrospective chart audit was completed for patients with first onset unilateral stroke, with a hospital length of stay (LOS) of at least two days and a communication assessment by a speech pathologist. Data extracted included presence and severity of communication impairment, access to and LOS in a rehabilitation unit, and functional outcome measures recorded at rehabilitation discharge.
The majority of the 115 patients who met inclusion criteria were living independently (n = 112, 97.4%) at the time of stroke. CCD (66%) was diagnosed with similar frequency to aphasia (68%). The presence of communication impairment did not result in significant differences in rehabilitation LOS and discharge destination when compared to hemispheric strokes without communication impairment. Severity of CCD was an independent predictor of functional gain by rehabilitation discharge.
People with CCD require comparable access to rehabilitation as people with aphasia, and severity of CCD should be considered in determining rehabilitation LOS. A large number of people are discharged with ongoing CCD which warrants exploration of potential participation restrictions created by the communication impairment.
康复对失语症患者恢复活动能力和社会角色有积极影响。右半球卒中后出现的认知-沟通障碍（CCD）的研究较少，其康复途径和结果尚待确定。
记录卒中后患有CCD的患者的康复途径和结果；并根据是否存在沟通障碍（即CCD；失语症）比较结果。
对首次发生单侧卒中、住院时间（LOS）至少两天且由言语病理学家进行沟通评估的患者进行回顾性病历审核。提取的数据包括沟通障碍的存在和严重程度、康复单元的入住情况和住院时间，以及康复出院时记录的功能结局指标。
115名符合纳入标准的患者中，大多数在卒中发生时独立生活（n = 112，97.4%）。CCD（66%）的诊断频率与失语症（68%）相似。与无沟通障碍的半球卒中相比，沟通障碍的存在并未导致康复住院时间和出院目的地的显著差异。CCD的严重程度是康复出院时功能改善的独立预测因素。
患有CCD的患者需要与失语症患者相当的康复机会，并且在确定康复住院时间时应考虑CCD的严重程度。大量患者出院时仍存在CCD，这值得探讨沟通障碍造成的潜在参与限制。
