Nicholas Marjorie L, Burch Kari, Mitchell Julianne R, Fox Annie B, Baum Carolyn M, Connor Lisa Tabor
Department of Communication Sciences & Disorders, MGH Institute of Health Professions, Boston, MA, United States.
Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States.
Front Neurol. 2020 Jun 9;11:474. doi: 10.3389/fneur.2020.00474. eCollection 2020.
Persons with and without aphasia experience decreased participation in meaningful activities post-stroke that result in reduced autonomy and poorer quality of life. Physical, cognitive, and/or communication deficits are prevalent post-stroke and many activities given up are purported to require high levels of communicative, cognitive, or physical skill. However, the relationship between deficits after stroke and participation in life activities that appear to require high skill levels in these three areas has not been investigated fully. The objectives of this study are to: (1) determine differences in reported participation in communicatively-, cognitively-, or physically-demanding activities in persons after stroke with and without aphasia living in the community, and to (2) investigate whether performance on commonly used self-perception assessments of these three areas predicts reported participation in activities requiring higher levels of skill in these domains. In a cross-sectional design, 82 individuals at least 6 months post-stroke with ( = 34) and without aphasia ( = 48) were administered a battery of neuropsychological and participation-based assessments. Supported communication techniques maximized inclusion of individuals with aphasia. A series of regression analyses investigated the relationship between self-perceived communicative, cognitive, and physical functioning and reported participation in activities post-stroke that required high amounts of skilled function in these areas. People with and without aphasia did not differ in terms of the percentage retained in communicatively-, cognitively-, or physically-demanding activities. All individuals retained higher levels of participation in communicatively- and cognitively-demanding activities (at least 60% retained), compared to participation inphysically-demanding activities (about 50% retained). The strongest predictor for retaining participation in two of the three domains of activities was self-perception of physical function, though much of the variance remained unexplained. Self-perception of communication was not related to participation retention in any of the three domains. Rehabilitation professionals should be aware of the impact that a variety of communicative, cognitive, and physical factors may have on participation post-stroke. Self-perceptions of impairments in communication and cognition may not directly predict participation in activities requiring high levels of communicative and/or cognitive skill, at least for those with mild impairment, even though activities requiring those skills are given up or done less after stroke.
有失语症和没有失语症的人在中风后参与有意义活动的情况都会减少，这会导致自主性降低和生活质量下降。身体、认知和/或沟通缺陷在中风后很普遍，许多被放弃的活动据称需要高水平的沟通、认知或身体技能。然而，中风后的缺陷与参与似乎在这三个领域需要高技能水平的生活活动之间的关系尚未得到充分研究。本研究的目的是：（1）确定社区中患有和未患有失语症的中风患者在报告的参与沟通、认知或身体要求高的活动方面的差异，以及（2）调查在这三个领域常用的自我认知评估中的表现是否能预测报告的参与这些领域需要更高技能水平的活动情况。在横断面设计中，对82名中风后至少6个月的个体进行了一系列神经心理学和基于参与的评估，其中有失语症的34人，无失语症的48人。支持性沟通技术最大限度地纳入了失语症患者。一系列回归分析研究了自我感知的沟通、认知和身体功能与报告的中风后参与在这些领域需要大量技能功能的活动之间的关系。有失语症和没有失语症的人在保留参与沟通、认知或身体要求高的活动的百分比方面没有差异。与参与身体要求高的活动（约50%保留）相比，所有个体在参与沟通和认知要求高的活动方面保留的水平更高（至少60%保留）。保留参与三个活动领域中两个领域的最强预测因素是对身体功能的自我感知，尽管大部分方差仍无法解释。沟通的自我感知与在任何一个领域的参与保留均无关。康复专业人员应意识到各种沟通、认知和身体因素可能对中风后的参与产生的影响。沟通和认知障碍的自我感知可能不会直接预测参与需要高水平沟通和/或认知技能的活动，至少对于那些轻度受损的人来说是这样，尽管中风后需要这些技能的活动会被放弃或减少参与。
