Jankowska Agnieszka M, Klimkiewicz Robert, Kubsik Anna, Klimkiewicz Paulina, Śmigielski Janusz, Woldańska-Okońska Marta
Department of Rehabilitation and Physical Medicine, WAM University Hospital, Łódź, Poland.
Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Poland.
Adv Clin Exp Med. 2017 Aug;26(5):767-776. doi: 10.17219/acem/63138.
Executive dysfunctions are part of the clinical symptoms of a stroke and can inhibit the process of rehabilitation. Patients with impaired executive functions may manifest aggression, impulsiveness, impaired thinking and planning.
The aim of this study was to assess the effect of the ischemic focus location on the effectiveness of physiotherapy in improving the executive functions in patients after stroke.
Ninety patients after unilateral ischemic cerebral stroke were studied. We studied 45 patients treated at the Department of Rehabilitation and Physical Medicine of the WAM University Hospital of Lodz for 5 weeks. The rehabilitation program included: kinesitherapy, physiotherapy, speech therapy, psychological consultations and psychotherapy. The control group consisted of patients who were waiting for admission to the Department of Rehabilitation. The patients in both groups were divided into three subgroups with different locations of stroke: front, back and subcortical. Executive functions were measured by the Wisconsin Card Sorting Test (WCST), the trail making test (TMT - A, TMT - B), the verbal fluency test (VFT).
Patients rehabilitated in the hospital with the front and subcortical lesion location reported improvement in executive functions in terms of a greater number of the analyzed indicators of the Wisconsin Card Sorting Test (WCST) than those with the back lesion location. Patients rehabilitated at home with the subcortical lesion location did not experience a significant improvement in executive functions in any of the analyzed indicators of the Wisconsin Card Sorting Test (WCST). Most of the indicators, with the exception of the total errors of Wisconsin Card Sorting Test (WCST) and TMT B, have not been modified by the location of stroke.
Executive dysfunction occurs not only in patients with an anterior location of the stroke, but also in the posterior and subcortical locations. Patients with a subcortical location of the stroke require more treatment to mitigate the dysfunction.
执行功能障碍是中风临床症状的一部分，会阻碍康复进程。执行功能受损的患者可能表现出攻击性、冲动性、思维和计划能力受损。
本研究旨在评估缺血病灶位置对中风后患者执行功能改善的物理治疗效果的影响。
研究了90例单侧缺血性脑中风患者。我们对在罗兹瓦姆大学医院康复与物理医学科接受治疗5周的45例患者进行了研究。康复计划包括：运动疗法、物理治疗、言语治疗、心理咨询和心理治疗。对照组由等待进入康复科的患者组成。两组患者根据中风的不同位置分为三个亚组：前部、后部和皮质下。通过威斯康星卡片分类测验（WCST）、连线测验（TMT - A、TMT - B）、言语流畅性测验（VFT）来测量执行功能。
与病灶位于后部的患者相比，病灶位于前部和皮质下的住院康复患者在威斯康星卡片分类测验（WCST）的更多分析指标方面报告执行功能有所改善。皮质下病灶位置的居家康复患者在威斯康星卡片分类测验（WCST）的任何分析指标中执行功能均未出现显著改善。除威斯康星卡片分类测验（WCST）的总错误数和TMT B外，大多数指标未因中风位置而改变。
执行功能障碍不仅发生在中风前部位置的患者中，也发生在后部和皮质下位置的患者中。皮质下位置中风的患者需要更多治疗来减轻功能障碍。
