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系統識別號 U0026-1507202020251100
論文名稱(中文) 慢性期複雜型創傷性腦傷患者有無錯誤後減慢現象之神經心理功能探討
論文名稱(英文) The Neuropsychological Function in Chronic Complicated Traumatic Brain Injury Patients with and without Post-error Slowing
校院名稱 成功大學
系所名稱(中) 行為醫學研究所
系所名稱(英) Institute of Behavioral Medicine
學年度 108
學期 2
出版年 109
研究生(中文) 吳佩芩
研究生(英文) Pei-Chin Wu
學號 S86064020
學位類別 碩士
語文別 中文
論文頁數 121頁
口試委員 指導教授-郭乃文
共同指導教授-李怡慧
口試委員-郭進榮
中文關鍵字 複雜型慢性期創傷性腦傷  錯誤後減慢  神經心理功能 
英文關鍵字 complicated traumatic brain injury  neuropsychological functions  post-error slowing 
學科別分類
中文摘要 目的:創傷性腦傷(Traumatic Brain Injury, TBI)是指因外力導致的腦部功能改變,而不論損傷原因為何,皆可能引起一系列複雜的神經病理機制或結構的改變,過去研究指出腦傷常見的型態包含額顳葉、胼胝體及其他白質區域等之脆弱性。因此,慢性期複雜型TBI患者的後遺症或預後異質性大,其中又以注意力、記憶力、訊息處理速度及執行功能為主要受損,進而面臨難以回歸生活、復學與復工等長期適應議題。錯誤後減慢(post-error slowing, PES)是錯誤後調整的其一,展現的是個體持續監控自身表現與環境,並做出適當調節之認知控制歷程。過去研究發現TBI患者難覺察其自身認知、情感或社交的困難,或難理解自身與環境之間的關係而常在生活中出錯,但鮮少研究探討TBI患者的PES現象以及與此現象相關聯之神經心理功能。綜上,本研究欲探討慢性期複雜型TBI患者的PES現象,並進一步探究哪些神經心理功能與PES現象有關。
方法:研究樣本實驗組為100至104年南部某醫學中心符合頭部損傷國際疾病分類診斷碼之患者共2522人,經醫師與研究人員雙重確認,並依納入及排除條款篩選出共1141人,以電話聯絡納入受試者並邀請參與衡鑑,共639人完成電訪,其中90人同意參與,排除未完成完整衡鑑或資料不全各1人,共88人進行結果分析。88位TBI受試者中,52位男性和36位女性,平均年齡為33.39歲,平均教育年數為13.88年,嚴重度輕/中/重度分別為69/8/11人,平均腦傷後時間長度為19.25個月,針對實驗組所使用的神經心理功能測量工具如下:(1)廣泛認知功能篩檢測驗:簡短式智能評估-中文版(MMSE-C)、盧-尼神經心理測驗組篩檢測驗(ST-LNNB);(2)注意力測驗:廣泛性非語文注意力測驗(CNAT);(3)記憶力測驗:廣泛性非語文記憶力測驗(CNMT)、郭氏語文記憶測驗、日常生活工作記憶量表;(3)執行功能測驗:威斯康辛卡片分類測驗(WCST)、倫敦塔測驗(ToL)、Stroop作業。研究樣本對照組為一般健康成人受試者,共118人同意參與,因資料不完整排除12位,共106人進行結果分析其中包含29位男性和77位女性,平均年齡為44.44歲,平均教育年數為14.65年,針對對照組所使用的測量工具為CNAT。PES現象是依據電腦化神經心理測驗-CNAT之逐題反應時間與錯誤類型分析之,PES操作型定義為在受試者內,錯誤後嘗試反應時間大於正確嘗試的平均反應時間,並進一步計算減慢指標(slowing index)為錯誤後嘗試反應時間減去正確嘗試的平均反應時間。採用卡方檢定、曼-惠特尼U檢定及獨立樣本T檢定分析之。
結果:(1)在簡單反應作業中探討衝動錯誤後的PES現象,依嘗試次分析、人數分析,以及減慢指標的次序等級分析,腦傷組與對照組在統計上皆無顯著差異。(2)在抑制作業中探討衝動錯誤後的PES現象,依嘗試次分析,腦傷組與對照組呈現PES現象之比例分別為57.1%與87.5%依人數分析,腦傷組與對照組呈現PES現象之比例分別為58.3%與87.5%,皆未達顯著差異;依減慢指標的次序等級分析,腦傷組與對照組的減慢指標等級平均數分別為10.82與12.69,兩組減慢指標的次序等級未達顯著差異。(3)在抑制作業中探討違反錯誤後的PES現象,依嘗試次分析,腦傷組與對照組呈現PES現象之比例分別為42.9%與46.7%;依人數分析,腦傷組與對照組呈現PES現象之比例分別為42.9%與53.8%,亦皆未達顯著差異;依減慢指標的次序等級分析,腦傷組與對照組的減慢指標等級平均數分別為13.71與10.47,兩組減慢指標的次序等級無顯著差異。(4)在雙重作業中探討違反錯誤後PES現象,依嘗試次分析,腦傷組與對照組呈現PES現象之比例分別為50.0%與83.3%,達顯著差異(p=.031);依人數分析,腦傷組與對照組呈現PES現象之比例分別為74.3%與77.8%,未達顯著差異;依減慢指標的次序等級分析,腦傷組與對照組的減慢指標等級平均數分別為39.00與56.08,兩組減慢指標的次序等級達顯著差異(p=.022)。進一步依據錯誤後嘗試有無PES現象將腦傷組分為有覺察TBI組與無覺察TBI組,並比較兩組之神經心理功能,發現無覺察TBI組在CNAT中的錯誤總數、漏失錯誤總數、違反錯誤總數皆較多;在CNMT中空間提取中首次完成次數較多、順序提取中跳躍錯誤數較多。
結論:(1)在簡單作業中,複雜型TBI患者與一般人有相同錯誤覺察與調整,然隨著作業難度提升,在抑制作業中,複雜型TBI患者開始出現對錯誤覺察與調整的困難,而在複雜且耗費注意力資源的雙重作業中,複雜型TBI患者便不再像一般健康成人一樣能覺察與調整錯誤。(2)其中,這些未能覺察與調整的腦傷患者呈現神經心理功能較差,尤其是注意力監控能力明顯不足以及記憶完整性略為不足。
英文摘要 Previous studies have mentioned that common patterns of traumatic brain injury(TBI) are the vulnerability of the frontotemporal lobes, corpus callosum, and other white matter area. The patients with TBI have difficulty in aware of themselves condition or the environment, so often make mistakes in life. Post-error slowing (PES) is one of the post-error adaptations. The objective of this study was to explore the PES in the chronic complicated TBI patients, and further explore which neuropsychological functions are related to the PES. This study included 88 chronic complicated TBI patients from a medical center in the South as TBI group and 106 healthy adult people as control group. The TBI group was taken the assessment, including MMSE-C, ST-LNNB, CNAT, CNMT, GVM, SIVWM-D, WCST, ToL, Stroop task; the control group was taken CNAT. The PES is defined that the reaction time(RT) of the post-error trial is longer than the average RT of the correct in CNAT, and to calculate a slowing index(S), which is the difference of RT between the post-error and the correct trials. The result has revealed that the percentage of PES in the two group is no statistically significant difference in simple reaction time task; the percentage of PES in the TBI group is smaller than the controls but not significant in the go/nogo task ; the PES in the TBI group is significant weaker than the controls in the dual task. And, the TBI group was divided into awareness and non-awareness group according to the PES or not. Compared with the awareness group, the non-awareness group has poorer neuropsychological function, especially attention and memory. As the increasing of attention capacity required to complete a complicated task, with TBI patients no longer make post-error adaptations as healthy people.
論文目次 第一章 緒論 1
第一節 複雜型創傷性腦傷患者 1
一、創傷性腦傷之定義 1
二、創傷性腦傷患者之類型 3
三、創傷性腦傷患者之神經心理功能缺損 7
第二節 錯誤後減慢現象 9
一、錯誤後減慢現象之定義 9
二、錯誤後減慢現象之理論 10
三、錯誤後減慢現象之神經生理基礎 14
四、錯誤後減慢現象之測量方法 16
第三節 創傷性腦傷患者之錯誤後減慢現象 17
一、 創傷性腦傷患者之錯誤覺察 17
二、 創傷性腦傷患者之錯誤後減慢現象 20
第四節 研究動機與假設 22
一、 研究動機 22
二、 研究假設 23
第二章 研究方法 24
第一節 研究架構 24
第二節 研究程序 25
一、 研究流程 25
二、 研究倫理審查 27
三、 收案流程 27
第三節 研究對象 29
一、 實驗組-慢性期複雜型創傷性腦傷 29
二、 對照組-一般健康成人 32
第四節 研究工具 34
一、 錯誤後減慢之測量 34
二、 神經心理功能之測驗工具 39
第五節 第四節 資料分析 49
第三章 研究結果 50
第一節 基本人口學統計資料 50
第二節 TBI組與對照組之錯誤後減慢現象 54
一、在簡單反應作業中,分析犯衝動錯誤之後的TBI組與對照組所呈現的PES現象 54
二、在抑制作業中,分析犯衝動錯誤之後的TBI組與對照組所呈現的PES現象 60
三、在抑制作業中,分析犯違反錯誤之後的TBI組與對照組所呈現的PES現象 66
四、在雙重作業中,分析犯違反錯誤之後的TBI組與對照組所呈現的PES現象 72
五、依據雙重作業中錯誤後嘗試是否呈現PES將TBI組分為有覺察TBI組與無覺察TBI組 78
第三節 有無覺察的兩組TBI患者於神經心理功能測驗之差異比較 81
一、有無覺察的兩組TBI患者之人口學與神經學變項之比較 81
二、有無覺察的兩組TBI患者於廣泛認知功能篩檢測驗之差異比較 83
三、有無覺察的兩組TBI患者於注意力測驗之差異比較 85
四、有無覺察的兩組TBI患者於記憶力測驗之差異比較 89
五、有無覺察的兩組TBI患者於執行功能測驗之差異比較 93
第四章 討論與結論 96
第一節 受試者之討論 96
第二節 研究工具之討論 100
第三節 慢性期複雜型創傷性腦傷患者的錯誤後減慢現象之討論 101
第四節 錯誤後減慢現象與神經心理功能之關聯性 102
第五節 研究貢獻與限制 105
參考文獻 107
附件一: CNAT各分測驗情境中起始聲響與亮燈間之時距和燈號位置 119

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