轮椅碰撞试验：一种评估行为偏侧忽略的新方法

目的采用一种新的方法——轮椅碰撞试验(WCT)评估脑卒中患者是否存在行为偏侧忽略并探讨其有效性。方法对19例首发脑卒中患者进行WCT检查,患者自行驱动轮椅通过2排错位排列的圆凳,圆凳间距离为120或140cm,由检查者记录患者驱动轮椅时轮椅碰撞圆凳的次数。同时采用凯瑟林波哥量表(CBS)进行行为偏侧忽略的评定,采用独立功能评定(FIM)评估患者的日常生活能力,并与WCT结果进行相关性分析。结果不同情况下,WCT的重测信度为0.68～0.97。经Kappa检验分析,圆凳间距120cm时WCT(以有碰撞和无碰撞来表示)与CBS(以有忽略和无忽略来表示)的一致率为68.4%,高于圆凳间距140cm时WCT与CBS的一致率(57.9%)。圆凳间距离为120cm和140cm时,WCT与CBS的Spearman相关系数分别为0.72(P<0.001)和0.75(P<0.001);WCT和CBS与FIM评分也有明显的相关性。结论WCT是检测患者是否存在行为偏侧忽略的一种简单、客观的方法,其结果与CBS和FIM均有明显的相关性,可以在临床推广应用。

Wheelchair collision test:a new method of behavioral assessment of unilateral neglect

Objective To establish a new wheelchair collision test (WCT) to evaluate hemineglect in stroke patients. Methods Nineteen patients with left hemiplegia resulting from first ever stroke were examined by the WCT, whereby the patient was asked to propel a wheelchair to pass four round chairs arranged in two rows. Separate tests were done using two different distances between the chairs: 120 cm and 140 cm. The number of collisions with the chairs was recorded. The Catherine Bergego Scale (CBS) was used to evaluate behavioral hemineglect. The Functional Independence Measure (FIM) was used to determine the function of daily activities. Results The test retest reliability ranged from 0.68 to 0.97 in different situations with the WCT. The rate of agreement tested by Kappa statistics between the WCT (expressed by no collisions and collisions) and CBS (expressed by no neglect and neglect) was higher when the distance between chairs was 120 cm than that when the distance was 140 cm (0.68 versus 0.58). The Spearman rank correlation coefficient between the WCT and CBS was 0.72 ( P =0.0005) if the distance between the chairs was 120 cm and 0.75 ( P =0.0002) if the distance was 140 cm. WCT and CBS correlated well with the FIM. Conclusion The WCT is a simple test for evaluation of the behavioral unilateral neglect. Its results have a significant relationship with the CBS and FIM and the test can be used widely.