뇌졸중 후 인지기능이 재활치료 과정에서 기능회복에 미치는 영향

다국어 초록 (Multilingual Abstract)

Objectives : Cognitive dysfunction is one of the main complications and an important factor which negatively influences on functional recovery after stroke. However, there was little systematic researches on the impact of cognitive function on functional recovery during rehabilitation in patients with stroke. This study investigated the relationships between functional outcome and cognitive status during the rehabilitation of stroke patients.
Methods : This retrospective study included eighty patients who had taken rehabilitation program due to first-ever stroke between April, 2006 and August, 2010. General characteristics of the patients and stroke, scores of cognitive function tests and functional outcome scales were reviewed. Cognitive function tests included Korean version of MMSE (K-MMSE) and domain specific sub-tests for attention, memory and executive function which were evaluated by computerized neurocognitive function test (CNT). The primary outcomes were discharge placement and changes of modified Barthel index (MBI) score between admission and discharge from rehabilitation program. Secondary outcomes were measured by National Institute of Health Stroke Scale (NIHSS) and Berg balance scale (BBS).
Results : Mean age of the subjects was 61.4 years and forty-three patients were ischemic stroke. The mean interval from onset to beginning of rehabilitation program and duration of inpatient rehabilitation program were 29.5 and 31.1 days, respectively. The average score of K-MMSE was 20.5 at the beginning of rehabilitation program and one of the sub-test of CNT were abnormal in all patients. The scores of MMSE, MBI, NIHSS and BBS improved significantly after rehabilitation program (p<0.05). The functional outcomes were better in the hemorrhagic stroke, the early participants in rehabilitation program and the younger age group. Cognitive improvement contributed to the functional recovery significantly in older age group (p<0.05), but this finding was not observed in younger age group. The home-discharge group showed higher scores in executive function tests and the most important cognitive domains for functional recovery after stroke were visual attention and visual working memory.
Conclusion : In this study, the results suggested that improvement of cognitive impairment was a significant predictor of functional outcome in stroke rehabilitation, particularly in elderly patients. Among the cognitive skills, visual attention and visual working memory were important for functional gains. Cognitive rehabilitation should be included as a routine stroke rehabilitation program.

목차 (Table of Contents)

• Abstract ii
• 1. 서론 1
• 2. 연구 대상과 방법 2
• 3. 결과 5
• 4. 고찰 9
• 5. 결론 13
• 참고 문헌 14