[논문]뇌졸중 환자의 우울 및 사회인지 능력에 대한 인지자극순환프로그램의 효과

도지혜; 김은주

doi:10.14400/jdc.2019.17.6.439

뇌졸중 환자의 우울 및 사회인지 능력에 대한 인지자극순환프로그램의 효과
The Effects of Cognitive Stimulation Circulative Program on the Depression and Social Cognitive Ability of Stroke Patients 원문보기

디지털융복합연구 = Journal of digital convergence, v.17 no.6, 2019년, pp.439 - 446

도지혜 (연세대학교 작업치료학과 대학원) , 김은주 (전주대학교 작업치료학과)

초록
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이 연구의 목적은 뇌졸중 후 발생가능한 정서적, 사회인지 문제의 중재를 위해 작업 치료에 기초한 인지자극순환프로그램(CSCP ; Cognitive Stimulation Circulative Program)의 효과를 확인하는 것이다. 이 연구에는 12명의 뇌졸중 환자가 참여하였고 CSCP는 인지과정을 촉진시키는 방법으로 조직화되었으며 총 16회기의 순환 프로그램으로 실시되었다. 프로그램의 효과를 알아보기 위하여 우울증 척도와 관계 변화 척도, 삶의 질 평가 도구를 사용하였다. 연구결과 피험자의 우울증 척도와 역할의 물리적 및 사회적 인지 기능 능력을 평가하기 위해 사용된 관계 변화 척도는 통계적으로 유의미한 변화가 있었다(p<.05). 또한, 삶의 질 영역 중에서 신체적 역할, 사회적 기능의 항목에서 의미있는 향상이 있었다. CSCP가 뇌졸중 환자의 우울을 감소시키고 사회인지 기능을 향상시켜 삶의 질을 향상시키는 효율적인 중재 프로그램으로 사용 가능함을 입증하였다.

Abstract ▼ AI-Helper

Poststroke depression can have a secondary effect on social cognition, and this can lead to behavioral problems. The purpose of this study was to verify the effects of a Cognitive Stimulation Circulative Program(CSCP) based on occupational therapy. The participants of this study were 12 stroke patients. The CSCP was organized in such a way to promote the cognitive process. This program were carried out as a circuit program(16 sessions). As a result of this study, the depression scale of the subjects had statistically significant benefit(p<.05). Also, the evaluation results verified partial improvement in quality of life, and the relationship change scale which was used to evaluate role of physical and social cognitive function ability had statistically significant benefit(p<.05). The above results of this study verified that the CSCP was an efficient intervention program that reduces the depression of stroke patients and improve their social cognitive function ability, thus enhancing the quality of life.

주제어

표/그림 (1)

표 Table 1. Comparison of depression, social cognition and QOL in participations

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문제 정의

The acceleration of cognitive decline after stroke has been already proven by many studies Programs to maintain and enhance cognitive function around subjects who have no cognitive problems have been attempted recently, but the effects of such programs do not have sufficient evidences. The purpose of this study was to verify the effects of a cognitive stimulation circulative program based on occupational therapy which is an inclusive approach on the affective or social cognition problems that may develop after stroke.
In this study, they were transformed similarly and applied in circulation, and their effects were verified. Therefore, the significance of this study lies in the provision of a new paradigm for cognitive rehabilitation methods.
This study followed the trend of attempting interventions for ordinary elderly people living in communities owing to rising interest in the prevention of dementia in normal elderly people while maintaining and enhancing their cognitive function. This context of research is in line with the context of this study on stroke patients who have higher cognitive risk than normal elderly people even though their cognitive problems were not discovered.
This study was conducted to present a more-developed intervention method for stroke patients in communities by preventing depression that may develop after stroke and improving the quality of life while maintaining and enhancing the cognitive function of stroke patients through the cognitive stimulation circulative program.

제안 방법

In this study, subjects were selected in accordance with the process revealed in the subject selection criteria and the cognitive stimulation circulative program was conducted for the experimental group once a week, 60 minutes per session for a total of 16 weeks by two occupational therapists, two physical therapists, and 16 pre-trained occupational therapy students. A preliminary assessment was conducted for all subjects before starting the cognitive stimulation circulative program and post-assessment was conducted after completing the 16 week program.
If the overall social cognition could be evaluated together with cognitive function, it would support more systematically the claim that the cognitive stimulation circulative program has positive effects on the cognitive function and social cognitive capacity of stroke patients. Also needed is a study on the comparison of effects between the cognitive stimulation circulative program and the general cognitive rehabilitation program with a control group that can be used to compare effects with the experimental group in the study design.
In this study, subjects were selected in accordance with the process revealed in the subject selection criteria and the cognitive stimulation circulative program was conducted for the experimental group once a week, 60 minutes per session for a total of 16 weeks by two occupational therapists, two physical therapists, and 16 pre-trained occupational therapy students. A preliminary assessment was conducted for all subjects before starting the cognitive stimulation circulative program and post-assessment was conducted after completing the 16 week program.
Furthermore, the reality orientation, cognitive exercise, task-oriented, reminiscence programs used for intervention in this study had been already used independently and their effects had been verified in previous studies. In this study, they were transformed similarly and applied in circulation, and their effects were verified. Therefore, the significance of this study lies in the provision of a new paradigm for cognitive rehabilitation methods.
The cognitive exercise activities in this program consisted of cognitive exercises that maintain the coordination of hands, arms, and legs which can affect attention and cognitive function using 30cm rubber balls and elastic bands. A total of four sessions were conducted in the period of 16 weeks.
The program was organized in such a way to promote the cognitive process in each session in line with the characteristics of the subject through an activity analysis process together by two occupational therapists and two physical therapists. The first, second, third and fourth weeks of the program were reality orientation program, cognitive exercise program, task oriented program for cognitive stimulation, and reminiscence activity, respectively, and they were carried out as a circuit program. The details of the program are described below.
This program consisted of 16 sessions in total. The program was organized in such a way to promote the cognitive process in each session in line with the characteristics of the subject through an activity analysis process together by two occupational therapists and two physical therapists. The first, second, third and fourth weeks of the program were reality orientation program, cognitive exercise program, task oriented program for cognitive stimulation, and reminiscence activity, respectively, and they were carried out as a circuit program.
The reminiscence program in this study consisted of ‘past incidences on newspapers,’ ‘my childhood,’ ‘foods and plays in my memory,’ and ‘happy trips.

대상 데이터

The participants of this study were 12 stroke patients who were being treated in H health center in Jeonju who satisfied the selection criteria for this study and wanted to participate after sufficient understanding of this study. They received an explanation about the purpose and methods of the study and provided informed consent prior to participation in accordance with the ethical principles of the Declaration of Helsinki.

데이터처리

Thus, the nonparametric test method was used. A frequency analysis for the general characteristics of subjects was conducted using technical statistics. Furthermore, the Wilcoxon signed ranks test was used to compare the degree of depression, relationship scale, and quality of life before and after the intervention of the cognitive stimulation circulative program.

이론/모형

The GDS(Geriatric Depression Scale) is a representative questionnaire for evaluating the degree of depression of elderly people developed by Yesavage(1983)[14]. For this program, the translated questionnaire by Kee and Lee(1995) was used[15]. The test retest reliability of GDS-K was as high as r = .
A frequency analysis for the general characteristics of subjects was conducted using technical statistics. Furthermore, the Wilcoxon signed ranks test was used to compare the degree of depression, relationship scale, and quality of life before and after the intervention of the cognitive stimulation circulative program. The statistical significance level of this study (ɑ value) was set at 0.
A normality test for each item of subject data showed that the data did not meet the condition of normal distribution. Thus, the nonparametric test method was used. A frequency analysis for the general characteristics of subjects was conducted using technical statistics.
To examine the change of social cognition ability, the questionnaire for the relationship change scale RCS (Relationship Change Scale), which had been developed by Schlein and Guerney(1971) was used[16]. We used the RCS, translated by Moon(1980) and modified by Yang(2002)[17, 18].

성능/효과

As a result of the evaluation of the health-related quality of life, the general health score of the subjects changed from 3.50±1.35 before the program to 3.90±0.56 after the program, the physical function score changed from 3.00±1.15 to 2.30±0.48, the role physical score from 2.30±0.67 to 3.00±1.15, the bodily pain score from 3.00±0.94 to 2.90±0.31, the vitality score from 3.50±0.70 to 3.40±0.70, the social functioning score from 2.20±1.10 to 2.10±0.56, and role emotional score from 2.10±1.10 to 2.40±0.69.
As a result of this study, the depression scale of the subjects changed from 16.70±8.24 before the program to 14.50±8.24 after the program, and the difference was statistically significant (p<.05).
The evaluation results verified partial improvement in quality of life, and the differences in role physical and social functioning were statistically significant (p<.05) (see Table 1).
The relationship change scale which was used to evaluate social cognitive function ability changed from 80.20±9.57 before the program to 89.80±9.13 after the program, and the difference was statistically significant (p<.05).
In other words, depression in stroke patients was associated with lower quality of life and a better interpersonal relationship was associated with a higher quality of life. The results of these studies have something in common with the improved quality of life score in subjects with lower depression and better interpersonal relationship after applying the cognitive stimulation circulative program to stroke patients.
The results of this study showed that the depression of the subjects statistically significantly decreased and the relationship change scale for social cognitive ability also showed statistically significant changes after applying the program. Furthermore, the evaluation results for the health-related quality of life of the subjects showed statistically significant differences in role physical and social cognitive functioning after applying the program.
They aged 50-60 years, within 5-8 years duration after stroke. The selection criteria for the participants were no other neurological symptoms, 24 or higher score of the Korean version of mini-mental state examination(K-MMSE), no history of diagnosis with depression or administration of depression medicines, and possibility of passive and active exercises.

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