CRRCAE软件的研发及其在左基底节区脑出血失语评定中的应用

发布时间：2018-02-08 11:36

本文关键词： 中国康复研究中心汉语标准失语症检查量表应用软件失语症基底节脑出血微侵袭手术　出处：《扬州大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景语言是大脑的重要功能之一,有许多研究提示基底节与情感、学习、记忆、思维、语言等高级神经功能有关。人类语言中枢一般位于优势半球,绝大数人以左侧为优势侧。左侧基底节区脑出血患者可出现多种类型的语言功能障碍,如经皮质运动性失语、经皮质感觉性失语、经皮质混合性失语等。其语言功能的障碍包括：流畅度、韵律、对语言的理解程度、复述、命名、阅读、书写以及构音等障碍,以对语言听力理解及书写障碍为著,而复述能力障碍相对较轻。对语言功能的评价方法较多,国内常用的有中国康复研究中心汉语标准失语症检查(China Rehabilitation Research Center Aphasia Examination, CRRCAE)、汉语失语成套测验等。CRRCAE是借鉴日本标准失语症检查量表的设计理论和框架,适用于汉语言语环境并能适用于失语症的诊断和治疗评估作用的评定量表,结合汉语的语言特点,用词习惯、规则以及语言环境等于1990年编制完成,目前已广泛应用于各种原因引起的失语症的评价,并且在国内多家医院及康复中心得到应用,其信度、效度及敏感度已得到验证。完成该量表可以制定个性化语言康复训练计划,更有利于患者语言的恢复。是一套与临床诊治联系紧密的评价量表。但该量表评定方法较为繁琐,费力,评估的数据和资料的统计、分析、保存也不方便,同时评分人的工作量大,易出错,效率偏低。伴随着医学领域的信息化和计算机的普及,将医学领域中的一些测试量表及工具转换为计算机测试评估系统已成为一种趋势。为此,我们设想与软件工程人员合作将CRRCAE纸质测试工具开发为中文计算机软件测试系统,并将其应用于我国失语的患者以接受信效度检验,同时探讨其较纸质测试工具可能存在的优越性,为临床语言功能的评价提供更高效、客观的检查方法。目的根据纸质CRRCAE量表研发中文电脑软件测评系统,并检测CRRCAE电脑软件测评系统的信度和效度,同时探讨CRRCAE测试系统的优越性,为临床推广应用提供依据。 2.探讨CRRCAE电脑测评系统在左侧基底节区脑出血患者语言功能评定及疗效观察中的应用价值。方法根据CRRCAE量表操作及评分的基本思想,将人工操作和记分转换为中文计算机应用软件,并将软件装机后应用于临床评定,同时收集受试者的反馈意见,对软件进行修改和调试使之更优化。软件调试、定版后,经过病例组(37例)与对照组(41例)受试对象均按首次接受CRRCAE测试时间进行,病例组首先先接受纸质版测试,2周后接受计算机软件测试(电脑版),对照组则以相反顺序进行测试,即首次接受电脑版测试后间隔2周再次予以纸质版测试。测试结束后分析受试者电脑版与纸质版测试总分及各条目得分相关性以检验电脑版测试的标准效度,并对电脑版与纸质版测试时间以及对两种测试的倾向性进行比较。随后,对24例左侧基底节区脑出血患者行微创手术治疗,术后行语言康复训练等治疗,并在术前、术后4w,8w应用CRRCAE(电脑版)行语言功能评定,总结出左侧基底节区脑出血的失语特点等。结果本次研究中病例组及对照组共84例受试者中有6例受试者因失访而未完成测试,其中病例组5例,对照组1例,其余受试者均按要求完成纸质版及电脑版测试。本次研究共发放问卷84份,共收回有效问卷78份(问卷回收率92.68%)。在CRRCAE电脑软件初步版本修改调试后病例组对象分别接受纸质版与电脑版测试,其总体平均得分别为(93.69±18.26分,94.15±18.12分,r=0.996,P0.01)相关性较高,电脑版与纸质版测试各条目得分具有良好的相关性(0.782-0.992,P0.01),说明CRRCAE具有良好的标准效度。病例组37例对象于电脑版测试后2周再次接受CRRCAE电脑版测试,两次电脑版测试总体平均得分分别为相关性较好(94.15±18.12分,96.43±16.01分,r=0.684,P0.01)。且各项条目得分均具有较高的相关性(r=0.792-0.964,P0.01),说明该软件测试系统具有可靠的重测信度。本次研究中病例组和对照组共78名研究对象完成测试,病例组电脑版与纸质版平均受测时间分别为3602.69±421.38s与4251.24±475.86s,其中对照组电脑版与纸质版平均受测时间分别为1917.30±236.74s与2313.25±312.98s,经配对t检验表明电脑版受试时间均显著低于纸质版受试时间(P0.01)。在问卷反馈信息中,当问及如果有必要再进行一次CRRCAE测试,受试者更倾向于接受哪种版本测试的问题时,78名受试者中有73人(93.59%73/78)表明倾向选择电脑版测试。其中,病例组35人(94.59%35/37),对照组41人(92.68%38/41),经卡方检验表明对照组与病例组电脑版选择率差异有显著性(χ2=55.86,P0.01)。对24例左侧基底节区脑出血患者经过手术等治疗后,应用CRRCAE电脑软件测评系统对语言功能进行评价,发现CRRCAE测评系统各项评分均有明显提高,且随着时间的推移,患者的语言功能明显提高。结论本次研究发现生成的CRRCAE电脑软件测评系统在脑部疾病引起的失语患者的语言功能评价上具有良好的标准信度,能明显缩短评定时间,降低了评分员的工作量,测试过程更流畅、简便,提高了工作效率；增加了数据库的管理和保存,方便临床和科研。软件携带方便,可随机安装,便于临床的推广；用于评定脑出血患者失语的特点及经过治疗后其语言恢复的程度,具有较好的临床应用价值。
[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.

【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34

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