| Part I Effect of computer-assisted cognitive training combined with daily life-oriented cognitive training on cognitive function and generalization in stroke patientsObjective: To explore the effect of computer-assisted cognitive training combined with daily life-oriented cognitive training on the improvement of cognitive function in stroke patients and the effect of cognitive training on daily life.Methods:Forty-seven stroke patients with cognitive impairment were randomly divided into treatment group(n=24)and control group(n=23).Baseline data of the two groups including gender,age,education level,disease type,mini-mental state examination(MMSE)and Brunnstrom grading were equalized.All patients received routine rehabilitation training,such as exercise therapy,occupational therapy and physical therapy,while the treatment group received computer-assisted cognitive training and daily life-oriented cognitive training on the basis of routine training.The time of therapy was 5 days per week,once per day,30 minutes per time for 3weeks.The Montreal cognitive assessment(Mo CA),Digit span test(DST),Verbal fluency test(VFT)and Clock drawing test(CDT)were used to evaluate the overall cognitive function and cognitive domains,such as sensory perception,attention,memory and executive ability.Modified Barthel Index(MBI)was used to evaluate activities of daily living,so as to evaluate the generalization effect of cognitive training.Results:1.Overall cognitive function: Before treatment,there was no statistical difference in Mo CA score between two groups(P>0.05).After 3 weeks of training,the scores in both groups were improved(P<0.05),and the scores of the treatment group were significantly higher than that of the control group with statistical significance(P<0.05).2.Results of cognitive domains: Before treatment,there was no statistical difference in the scores in each cognitive domain between two groups(P>0.05).After 3 weeks of training,the scores of treatment groups were higher than before,with statistical differences(P<0.05).There were statistical differences between the scores of DST-forward and CDT in control group(P<0.05).After treatment,the scores of DST and CDT in treatment group were significantly higher than those in control group,and the difference was statistically significant(P<0.05).3.Daily living ability: Before treatment,there was no statistical difference in MBI scores between the two groups(P>0.05).After 3 weeks of training,MBI scores of two groups were improved than before(P<0.05).The scores of the treatment group were significantly higher than that of control group(P<0.05).Conclusions:1.Computer-assisted cognitive treatment combined with daily life-oriented cognitive training can improve the overall cognitive function as well as attention and executive function in stroke patients with cognitive impairment.2.The effect of cognitive training can be generalized to daily life and cognitive training can improve the ability of daily activities.Part II Effect of transcranial direct current stimulation combined with cognitive training on patients with unilateral neglect after strokeObjective: To explore the effect of transcranial direct current stimulation(tDCS)combined with cognitive training on stroke patients with unilateral neglect(UN).Based on the UN neural network,to explore a new model of the treatment of tDCS on UN.Methods: Thirty stroke patients with UN after stroke were randomly divided into multi-site tDCS group(treatment group A),single-site tDCS group(treatment group B)and sham stimulation group(control group),with 10 patients in each group.All patients in the three groups received cognitive training for UN,including left attention maintenance training,visual scanning training,visual search training and reading training.Treatment group A received multi-site tDCS from inferior parietal lobule,middle temporal gyrus to prefrontal lobe.Group B received single-site tDCS of the inferior parietal lobule.The control group received sham stimulus.The anode was placed in the corresponding part of the right hemisphere and the cathode was placed in the opposite shoulder.In the treatment group,the electricity was 2m A,20 min per time,for 15 times,while in control group,the current was 2m A,10 s per time,for15 times.The improvement of UN symptoms were evaluated by the scores of Deviation index(DI)and Behavioral Inattention Test conventional(BIT-C)tests.Results: 1.DI: There was no statistical difference in DI scores among all groups before treatment(P>0.05).After 3 weeks of training,DI in all groups decreased compared with before treatment,with statistical significance(P<0.05).The DI score of two treatment groups was lower than that of control group,and the difference was statistically significant(P<0.05).The score of treatment group A was lower than that of group B,and the difference was not statistically significant(P>0.05).2.BIT-c: Before treatment,there was no statistical difference in BIT-c scores among all groups(P>0.05).After 3 weeks of training,BIT-c scores in all groups were increased compared with before treatment,with statistical significance(P<0.05).The scores of the two treatment groups were higher than that of the control group,and the difference was statistically significant(P<0.05).Although the score of treatment group A was higher than that of group B,the difference was not statistically significant(P>0.05).3.Paper-and-pencil tests: Before treatment,there was no statistical difference in the scores of paper and pencil tests among all groups(P>0.05).After 3 weeks of training,scores of all paper-and-pencil tests in all groups were improved compared with before treatment,with statistical significance(P<0.05).The scores of the two treatment groups were higher than those of the control group,and there were statistical differences in Line crossing,Star cancellation test,Letter cancellation test and line bisection test scores compared with the control group(P<0.05).Except DR,the scores of all paper-and-pencil tests in treatment group A were higher than those in treatment group B,but the differences were not statistically significant(P>0.05).Conclusions: 1.Transcranial direct current stimulation combined with cognitive training can improve the UN symptoms of stroke patients,and its effect is significantly better than single cognitive training.2.Both single-site tDCS and multi-site tDCS have therapeutic effects on UN after stroke,and the difference of effects between the two modes still needs further research. |
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