本文關(guān)鍵詞： 中國(guó)康復(fù)研究中心漢語(yǔ)標(biāo)準(zhǔn)失語(yǔ)癥檢查量表 應(yīng)用軟件 失語(yǔ)癥 基底節(jié)腦出血 微侵襲手術(shù)　出處：《揚(yáng)州大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：背景 語(yǔ)言是大腦的重要功能之一,有許多研究提示基底節(jié)與情感、學(xué)習(xí)、記憶、思維、語(yǔ)言等高級(jí)神經(jīng)功能有關(guān)。人類(lèi)語(yǔ)言中樞一般位于優(yōu)勢(shì)半球,絕大數(shù)人以左側(cè)為優(yōu)勢(shì)側(cè)。左側(cè)基底節(jié)區(qū)腦出血患者可出現(xiàn)多種類(lèi)型的語(yǔ)言功能障礙,如經(jīng)皮質(zhì)運(yùn)動(dòng)性失語(yǔ)、經(jīng)皮質(zhì)感覺(jué)性失語(yǔ)、經(jīng)皮質(zhì)混合性失語(yǔ)等。其語(yǔ)言功能的障礙包括：流暢度、韻律、對(duì)語(yǔ)言的理解程度、復(fù)述、命名、閱讀、書(shū)寫(xiě)以及構(gòu)音等障礙,以對(duì)語(yǔ)言聽(tīng)力理解及書(shū)寫(xiě)障礙為著,而復(fù)述能力障礙相對(duì)較輕。 對(duì)語(yǔ)言功能的評(píng)價(jià)方法較多,國(guó)內(nèi)常用的有中國(guó)康復(fù)研究中心漢語(yǔ)標(biāo)準(zhǔn)失語(yǔ)癥檢查(China Rehabilitation Research Center Aphasia Examination, CRRCAE)、漢語(yǔ)失語(yǔ)成套測(cè)驗(yàn)等。CRRCAE是借鑒日本標(biāo)準(zhǔn)失語(yǔ)癥檢查量表的設(shè)計(jì)理論和框架,適用于漢語(yǔ)言語(yǔ)環(huán)境并能適用于失語(yǔ)癥的診斷和治療評(píng)估作用的評(píng)定量表,結(jié)合漢語(yǔ)的語(yǔ)言特點(diǎn),用詞習(xí)慣、規(guī)則以及語(yǔ)言環(huán)境等于1990年編制完成,目前已廣泛應(yīng)用于各種原因引起的失語(yǔ)癥的評(píng)價(jià),并且在國(guó)內(nèi)多家醫(yī)院及康復(fù)中心得到應(yīng)用,其信度、效度及敏感度已得到驗(yàn)證。完成該量表可以制定個(gè)性化語(yǔ)言康復(fù)訓(xùn)練計(jì)劃,更有利于患者語(yǔ)言的恢復(fù)。是一套與臨床診治聯(lián)系緊密的評(píng)價(jià)量表。但該量表評(píng)定方法較為繁瑣,費(fèi)力,評(píng)估的數(shù)據(jù)和資料的統(tǒng)計(jì)、分析、保存也不方便,同時(shí)評(píng)分人的工作量大,易出錯(cuò),效率偏低。 伴隨著醫(yī)學(xué)領(lǐng)域的信息化和計(jì)算機(jī)的普及,將醫(yī)學(xué)領(lǐng)域中的一些測(cè)試量表及工具轉(zhuǎn)換為計(jì)算機(jī)測(cè)試評(píng)估系統(tǒng)已成為一種趨勢(shì)。為此,我們?cè)O(shè)想與軟件工程人員合作將CRRCAE紙質(zhì)測(cè)試工具開(kāi)發(fā)為中文計(jì)算機(jī)軟件測(cè)試系統(tǒng),并將其應(yīng)用于我國(guó)失語(yǔ)的患者以接受信效度檢驗(yàn),同時(shí)探討其較紙質(zhì)測(cè)試工具可能存在的優(yōu)越性,為臨床語(yǔ)言功能的評(píng)價(jià)提供更高效、客觀的檢查方法。目的 根據(jù)紙質(zhì)CRRCAE量表研發(fā)中文電腦軟件測(cè)評(píng)系統(tǒng),并檢測(cè)CRRCAE電腦軟件測(cè)評(píng)系統(tǒng)的信度和效度,同時(shí)探討CRRCAE測(cè)試系統(tǒng)的優(yōu)越性,為臨床推廣應(yīng)用提供依據(jù)。 2.探討CRRCAE電腦測(cè)評(píng)系統(tǒng)在左側(cè)基底節(jié)區(qū)腦出血患者語(yǔ)言功能評(píng)定及療效觀察中的應(yīng)用價(jià)值。 方法 根據(jù)CRRCAE量表操作及評(píng)分的基本思想,將人工操作和記分轉(zhuǎn)換為中文計(jì)算機(jī)應(yīng)用軟件,并將軟件裝機(jī)后應(yīng)用于臨床評(píng)定,同時(shí)收集受試者的反饋意見(jiàn),對(duì)軟件進(jìn)行修改和調(diào)試使之更優(yōu)化。 軟件調(diào)試、定版后,經(jīng)過(guò)病例組(37例)與對(duì)照組(41例)受試對(duì)象均按首次接受CRRCAE測(cè)試時(shí)間進(jìn)行,病例組首先先接受紙質(zhì)版測(cè)試,2周后接受計(jì)算機(jī)軟件測(cè)試(電腦版),對(duì)照組則以相反順序進(jìn)行測(cè)試,即首次接受電腦版測(cè)試后間隔2周再次予以紙質(zhì)版測(cè)試。測(cè)試結(jié)束后分析受試者電腦版與紙質(zhì)版測(cè)試總分及各條目得分相關(guān)性以檢驗(yàn)電腦版測(cè)試的標(biāo)準(zhǔn)效度,并對(duì)電腦版與紙質(zhì)版測(cè)試時(shí)間以及對(duì)兩種測(cè)試的傾向性進(jìn)行比較。 隨后,對(duì)24例左側(cè)基底節(jié)區(qū)腦出血患者行微創(chuàng)手術(shù)治療,術(shù)后行語(yǔ)言康復(fù)訓(xùn)練等治療,并在術(shù)前、術(shù)后4w,8w應(yīng)用CRRCAE(電腦版)行語(yǔ)言功能評(píng)定,總結(jié)出左側(cè)基底節(jié)區(qū)腦出血的失語(yǔ)特點(diǎn)等。 結(jié)果 本次研究中病例組及對(duì)照組共84例受試者中有6例受試者因失訪而未完成測(cè)試,其中病例組5例,對(duì)照組1例,其余受試者均按要求完成紙質(zhì)版及電腦版測(cè)試。本次研究共發(fā)放問(wèn)卷84份,共收回有效問(wèn)卷78份(問(wèn)卷回收率92.68%)。 在CRRCAE電腦軟件初步版本修改調(diào)試后病例組對(duì)象分別接受紙質(zhì)版與電腦版測(cè)試,其總體平均得分別為(93.69±18.26分,94.15±18.12分,r=0.996,P0.01)相關(guān)性較高,電腦版與紙質(zhì)版測(cè)試各條目得分具有良好的相關(guān)性(0.782-0.992,P0.01),說(shuō)明CRRCAE具有良好的標(biāo)準(zhǔn)效度。 病例組37例對(duì)象于電腦版測(cè)試后2周再次接受CRRCAE電腦版測(cè)試,兩次電腦版測(cè)試總體平均得分分別為相關(guān)性較好(94.15±18.12分,96.43±16.01分,r=0.684,P0.01)。且各項(xiàng)條目得分均具有較高的相關(guān)性(r=0.792-0.964,P0.01),說(shuō)明該軟件測(cè)試系統(tǒng)具有可靠的重測(cè)信度。 本次研究中病例組和對(duì)照組共78名研究對(duì)象完成測(cè)試,病例組電腦版與紙質(zhì)版平均受測(cè)時(shí)間分別為3602.69±421.38s與4251.24±475.86s,其中對(duì)照組電腦版與紙質(zhì)版平均受測(cè)時(shí)間分別為1917.30±236.74s與2313.25±312.98s,經(jīng)配對(duì)t檢驗(yàn)表明電腦版受試時(shí)間均顯著低于紙質(zhì)版受試時(shí)間(P0.01)。 在問(wèn)卷反饋信息中,當(dāng)問(wèn)及如果有必要再進(jìn)行一次CRRCAE測(cè)試,受試者更傾向于接受哪種版本測(cè)試的問(wèn)題時(shí),78名受試者中有73人(93.59%73/78)表明傾向選擇電腦版測(cè)試。其中,病例組35人(94.59%35/37),對(duì)照組41人(92.68%38/41),經(jīng)卡方檢驗(yàn)表明對(duì)照組與病例組電腦版選擇率差異有顯著性(χ2=55.86,P0.01)。 對(duì)24例左側(cè)基底節(jié)區(qū)腦出血患者經(jīng)過(guò)手術(shù)等治療后,應(yīng)用CRRCAE電腦軟件測(cè)評(píng)系統(tǒng)對(duì)語(yǔ)言功能進(jìn)行評(píng)價(jià),發(fā)現(xiàn)CRRCAE測(cè)評(píng)系統(tǒng)各項(xiàng)評(píng)分均有明顯提高,且隨著時(shí)間的推移,患者的語(yǔ)言功能明顯提高。結(jié)論 本次研究發(fā)現(xiàn)生成的CRRCAE電腦軟件測(cè)評(píng)系統(tǒng)在腦部疾病引起的失語(yǔ)患者的語(yǔ)言功能評(píng)價(jià)上具有良好的標(biāo)準(zhǔn)信度,能明顯縮短評(píng)定時(shí)間,降低了評(píng)分員的工作量,測(cè)試過(guò)程更流暢、簡(jiǎn)便,提高了工作效率；增加了數(shù)據(jù)庫(kù)的管理和保存,方便臨床和科研。軟件攜帶方便,可隨機(jī)安裝,便于臨床的推廣；用于評(píng)定腦出血患者失語(yǔ)的特點(diǎn)及經(jīng)過(guò)治療后其語(yǔ)言恢復(fù)的程度,具有較好的臨床應(yīng)用價(jià)值。
[Abstract]:background
Language is one of the important functions of the brain, many studies suggest that the basal ganglia with emotion, learning, memory, thinking, language and other senior neural function. Human language center is generally located in the dominant hemisphere, the vast majority of people in the left side for the advantage. The left basal ganglia hemorrhage can occur in patients with various types of language dysfunction, such as transcortical motor aphasia, transcortical sensory aphasia, mixed transcortical aphasia. Including their language dysfunction: Fluency, rhythm of language comprehension, repetition, naming, reading, writing and articulation of language barriers to listening comprehension and writing obstacles, and the ability to repeat obstacles are relatively light.
Many evaluation methods of language functions, commonly used in China have China rehabilitation research center aphasia examination (China Rehabilitation Research Center Aphasia Examination, CRRCAE), aphasia battery.CRRCAE is to learn from the Japanese Standard Aphasia Examination scale design theory and framework, assessment scale for Chinese language environment and can be applied to aphasia the diagnosis and treatment evaluation, combined with the characteristics of Chinese language, words and language habits, rules of equal to 1990 to complete the preparation, evaluation has been widely used in various causes of aphasia, and applied in many hospitals and rehabilitation centers for its reliability, validity and sensitivity has been verified. This scale can develop personalized language rehabilitation training program, more conducive to patient recovery. Language is a set of clinical diagnosis and treatment of joint It is a close evaluation scale. However, the scale assessment method is rather tedious and laborious. It is not convenient for statistics, analysis and preservation of the data and data to be evaluated, and at the same time, people's workload is large, error prone and inefficient.
Along with the popularization of computer and information technology in the field of medicine, some test scale and conversion tools in the field of medical computer test and assessment system has become a trend. Therefore, our staff and ideas of software engineering cooperation CRRCAE paper test tool development for Chinese computer software testing system, and its application in Chinese aphasia the patients to accept the validity, and discusses its superiority over paper testing tools that may exist for the clinical evaluation of language function to provide more efficient and objective method to check.
According to the paper CRRCAE scale, the Chinese computer software evaluation system was developed, and the reliability and validity of the CRRCAE software evaluation system were tested. Meanwhile, the superiority of the CRRCAE test system was discussed, providing a basis for clinical application.
2. to explore the application value of CRRCAE computer evaluation system in the assessment of language function and observation of curative effect in patients with cerebral hemorrhage in the left basal ganglia region.
Method
According to the basic idea of operation and grading of CRRCAE scale, we convert manual operation and scoring into Chinese computer application software, and apply it to clinical evaluation after installing the software. Meanwhile, we collect the feedback of the subjects, modify and debug the software, and make it more optimized.
Software debugging, version, after the case group (37 cases) and control group (41 cases) subjects were carried out according to received the first CRRCAE test time, the case group first accepts the paper version of the test, 2 weeks after the acceptance testing of computer software (computer version), the control group in the reverse order of tests, i.e. for the first time to accept the computer version of the test after 2 weeks apart again to print test. Analysis of subjects of computer version and paper version of the test score and each item score correlations to test the computer version of the test standard of validity after the end of the test, and the computer version and paper version of the test and the two test tendency were compared.
Subsequently, 24 patients with cerebral hemorrhage in the left basal ganglia were treated by minimally invasive surgery. After speech rehabilitation training, 4W and 8W were applied to evaluate the language function before operation, CRRCAE and computer.
Result
In this study the case group and the control group of 84 subjects in 6 subjects due to lost and did not complete the test, 5 cases, 1 cases in the control group, the subjects were asked to finish the paper version and the computer version of the test. In this study, a total of 84 questionnaires, a total recovery of 78 valid questionnaires (questionnaire recovery rate 92.68%).
Modify the debugging patients received paper version and computer version of the test in the CRRCAE computer software preliminary version, the overall average respectively (93.69 + 18.26, 94.15 + 18.12, r=0.996, P0.01) high correlation, the computer version and paper version of the test of each item score has good correlation (0.782-0.992, P0.01). It shows that CRRCAE has good criterion validity.
A total of 37 cases in the computer version of the test object again for 2 weeks after receiving CRRCAE computer version of the test, the two computer version of the test overall average scores were correlated well (94.15 + 18.12, 96.43 + 16.01, r=0.684, P0.01). The correlation and the item scores were high (r= 0.792-0.964 P0.01), explained the software test system has the test-retest reliability.
In this study the case group and the control group of 78 subjects completed the test cases, the computer version and paper version of the average test time were 3602.69 + 421.38s and 4251.24 + 475.86s, which controls the computer version and paper version of the average test time were 1917.30 + 236.74s and 2313.25 + 312.98s, paired t test show that the computer version of the test time were significantly lower than the paper version of the test time (P0.01).
In the questionnaire feedback information, when asked if it is necessary to conduct a CRRCAE test, subjects were more likely to accept a version of the test questions, there are 73 people in 78 subjects (93.59%73/78) showed a tendency to choose the computer version of the test. Among them, 35 cases (94.59%35/37), the control group 41 (92.68%38/41), by chi square test showed that the control group and the case group computer version selection rate had significant difference (2=55.86, P0.01).
For patients after surgery after treatment, 24 cases of left basal ganglia hemorrhage, application of CRRCAE computer software evaluation system to evaluate the function of language, CRRCAE evaluation system scores were significantly improved, and with the passage of time, the language function of the patients improved significantly. Conclusion
The study found that has good reliability evaluation function caused by CRRCAE language computer software evaluation system generated in the brain disease aphasia patients, can significantly shorten the evaluation time, reduce the workload of raters, the testing process more smooth, convenient, improve work efficiency; increase the management and preservation of the database, convenient the clinical and scientific research. The software is convenient to carry, random installation, convenient for clinical popularization; for the characteristics of patients with aphasia assessment of cerebral hemorrhage after treatment and the degree of its language recovery, has good clinical application value.

【學(xué)位授予單位】：揚(yáng)州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R743.34

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相關(guān)期刊論文 前6條

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本文編號(hào)：1495348