| Objective: Stroke is one of the diseases with high mortality and disability.Among stroke survivors,more than 50% of patients have cognitive dysfunction,which seriously hinders patients’ normal life and work,and greatly reduces their quality of life.Studies have found that exercise improves cognitive function and promotes brain remodeling.In addition to cognitive training intervention,whether task-oriented training on the upper limbs occupying a large area in the central control area can play a better therapeutic effect.Based on this,this study adopted task-oriented and cognitive-motor dual-task training to intervene patients with post-stroke cognitive impairment for a period of 4 weeks,and evaluated the cognitive function,upper limb motor function and ability of daily living activities before and after intervention at different time points to explore the effect of intervention and the effective intervention period.In this study,without the assistance of equipment,elements affecting upper limb function were incorporated into the rehabilitation strategy of patients’ cognitive function intervention,providing a basis for exploring a simple and effective,reproducible and extendable rehabilitation treatment method for post-stroke cognitive disorder.Methods: A total of 45 patients with post-stroke cognitive impairment were selected from the Occupational therapy department of Shaanxi Rehabilitation Hospital and randomly divided into control group,task-oriented group(TOT group)and task-oriented + cognitive-motor dual task training group(TOT+DTT combined group),with 12 patients in each group due to cases lost during the intervention.In addition to the conventional rehabilitation treatment(30min/ time),the TOT group also received task-oriented intervention(30min/ time),and the TOT+DTT group also received task-oriented and cognitive-motor dual task training intervention(30min/time).The intervention period of the three groups was 4 weeks,5 times a week.The Montreal Cognitive Assessment Scale(MoCA),Upper Limb Fugl-Meyer Motor Function Scale,Brunnstrom stage and modified Barthel Index were used to assess cognitive function,upper limb motor function and ability of daily living before intervention,2 weeks after intervention and 4 weeks after intervention,respectively.The results were analyzed statistically.Results:(1)MoCA scoreAfter 2 weeks of intervention,compared with before intervention,the visuospatial and executive function,orientation and total score of MoCA in the combination group were improved and had significant differences(P < 0.05).After 4weeks of intervention,compared with before intervention,the total scores of attention,delayed recall and MoCA in the TOT group were increased and had significant differences(P < 0.05),and the scores of other items in the combination group were increased and had significant differences(P < 0.05)except for the three scores of naming,language and abstraction.After 2 weeks of intervention,compared with the control group,the visual space and executive function,the scores of oriented items in the combination group were improved and had significant differences(P < 0.05);Compared with the TOT group,the oriented item score of the combination group was increased and had significant difference(P < 0.05).After 4 weeks of intervention,compared with the control group,the attention item score in the TOT group was increased and had significant differences(P < 0.05),and the combined group was increased and had significant differences in the visual space and executive function,attention,orientation and total score of MoCA(P < 0.05).Compared with the TOT group,the combination group had significant differences in visual space,executive function and orientation(P < 0.05).(2)Upper limb Fugl-meyer scoreAfter 2 weeks of intervention,the TOT group was significantly higher than that before intervention(P < 0.05);After 4 weeks of intervention,TOT and combination group were significantly increased compared with before intervention(P < 0.05).After 2 weeks of intervention,there were no significant differences among the three groups(P > 0.05).After 4 weeks of intervention,TOT group and combination group were significantly better than control group(P < 0.05),but there was no significant difference between TOT group and combination group(P > 0.05).(3)Brunnstrom stage of upper limbAfter 2 weeks of intervention,there were no significant differences among the three groups compared with before intervention(P > 0.05).After 4 weeks of intervention,there were significant differences between the TOT group and the combination group(P < 0.05).After 2 weeks of intervention,there were no significant differences among the three groups(P > 0.05).After 4 weeks of intervention,the TOT group and the combination group were significantly better than the control group(P < 0.05),but there was no significant difference between the TOT group and the combination group(P > 0.05).(4)ADL scoreAfter 2 weeks of intervention,compared with before intervention,the total score of ADL in combination group was increased and had significant difference(P < 0.05);After 4 weeks of intervention,compared with before intervention,the control group in toilet use,stairs up and down,ADL total score increased and had significant differences(P < 0.05),TOT group in dressing,toilet use,stairs up and down,bed chair transfer,flat walking,ADL total score increased and had significant differences(P < 0.05).There were significant differences in 8 items of grooming,feeding,bathing,dressing,toilet use,up and down stairs,bed chair transfer and total ADL in the combined group(P < 0.05).After 2 weeks of intervention,there were no significant differences in all scores among the three groups(P > 0.05).After 4 weeks of intervention,TOT group was significantly better than control group in grooming,feeding,bathing,dressing and total score of ADL in dressing and combination group(P < 0.05).The combination group was significantly better than the TOT group in eating and bathing(P < 0.05).(5)Correlation between cognitive function and upper limb motor function after interventionAfter 2 weeks of intervention,the total score of MoCA and total score of ADL in TOT group and combination group were highly positively correlated(r=0.903,p<0.01;r=0.895,p<0.01).After 4 weeks of intervention,the total score of MoCA in TOT group was positively correlated with the total score of Fugl-Meyer and ADL in upper limbs(r=0.695,p=0.012;R = 0.812,p = 0.001);The total score of MoCA in the combined group was highly positively correlated with the total score of Fugl-Meyer,Brunnstrom stage and ADL(r=0.982,p<0.01;R = 0.830,p = 0.001;R = 0.851,p <0.01).Conclusion:(1)Within 4 weeks,both task-oriented and task-oriented combined cognitive-motor tasks can improve PSCI cognitive function,and the effect of the combined group is better than that of the task-oriented group;(2)After 4 weeks of task-oriented and task-oriented combined cognitive-motor dual task intervention,the total MoCA score of stroke patients showed a moderate or high positive correlation with upper limb motor function,suggesting that upper limb function is closely related to cognitive function in stroke patients,and cognitive function can be improved by upper limb function intervention. |
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