认知行为疗法对颅脑损伤后吞咽障碍干预的个案报告

目的:探讨认知行为治疗对颅脑损伤后吞咽障碍进行干预的康复效果。方法:对1例颅脑损伤后吞咽障碍3个月的患者进行三个阶段全面评估及治疗,评估采用30ML洼田饮水试验、改良吞咽能力评价标准表、格拉斯哥昏迷量表及改良瑞秋洛斯阿米哥斯量表四个量表。根据评估结果,三个阶段(能够吞咽→不能吞咽→不愿吞咽→经口进食)分别采取侧重点不同的治疗方案,使患者的吞咽功能得到改善,最终脱离管道喂养。在患者不愿吞咽的阶段进行系统化,规范化的认知行为治疗,使患者的吞咽功能得到根本性改善。结果:经过系统化,规范化的认知行为治疗后,患者吞咽功能得到改善,成功拔除鼻饲管并可安全有效经口进食。结论:对本例患者进行认知行为治疗干预后,患者吞咽功能得到改善,GCS评分15分,RLAS-RV级,洼田饮水试验Ⅰ级,MMASA评分153分,患者可经口正常进食,异常的吞咽行为模式消失,认知行为治疗对颅脑损伤后吞咽障碍的干预是有效的。

A Case Report of Cognitive Behavioral Therapy in the Treatment of Dysphagia after Traumatic Brain Injury

Objective:To investigate the effect of cognitive behavior thearpy on the recovery of dysphagia after traumatic brain injury.Methods:The patient with dysphagia after traumatic brain injury were evaluated and treated in three stages during three months.Adopting the four scales to evaluate the patient,include the Watian drinking water test,the modified mana assessment of Swallowing Ability Glasgow coma scale and cognitive function classification.According to the results,the patient were taken to focus on different treatments in the three stages(can swallow→cannot swallow→unwilling to swallow→oral feeding),so that the patient improved swallowing function and pulled out the tube feeding.After the treatment of systematic and standardized cognitive behavior therapy,the patient’s swallowing function has been a fundamental improvement.Results:After the treatment of systematic and standardized cognitive behavior therapy,the patient’s swallowing function has been a fundamental improvement and the tube feeding was removed successfully.Meanwhile,the patient could take food through the mouth safely and effectively.Conclusion:After the intervention of cognitive behavior therapy,the swallowing function of the patients was improved.GCS score was 15,RLAS-R V,drinking water test Ⅰ,MMASA score was 153.The patients could eat normally and the abnormal swallowing behavior pattern disappeared.Cognitive behavior therapy was effective in the intervention of dysphagia after craniocerebral injury.Cognitive behavior therapy is effective in the intervention of dysphagia after traumatic brain injury.