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系統識別號 U0026-1607201216251400
論文名稱(中文) 探討職災所致腦傷患者復工與未復工兩組之執行功能差異
論文名稱(英文) Executive function as a predictor of returning to work in traumatic brain injury workers
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 100
學期 2
出版年 101
研究生(中文) 楊沛勳
研究生(英文) Pei-Shing Yang
學號 S86981060
學位類別 碩士
語文別 中文
論文頁數 102頁
口試委員 指導教授-郭乃文
口試委員-郭育良
口試委員-郭進榮
中文關鍵字 創傷性腦傷  執行功能  職業災害  復工 
英文關鍵字 Traumatic brain injury  Executive function  occupational injury  return to work 
學科別分類
中文摘要 目的:過去研究指出創傷性腦傷常導致個人的情緒、行為以及認知功能之功能變化,進而影響職業生涯發展與經營。本研究以職災後大腦功能受損的創傷性腦傷患者為研究對象,排除腦傷後之神經生理障礙以及確認日常生活均能自理情況下,執行功能是影響成功回到職場的重要因素。
方法:從台灣勞工保險局2009年前十個月職災者資料中的415位腦傷患者中,選取台北、高雄、台南與屏東市共198位,經由電訪同意參與者共62位,再以日常生活功能(ADL、ÍADL)回復正常和肢體功能完整者納入本研究,共完成59位,在傷後1.5-2年中持續追蹤,其中33(55.9%)位已返回原職位,29位未返回原職位。使用神經心理功能工具包括Wisconsin Card Sorting Test(WCST)、非語文性注意力與記憶力測驗組、郭氏語文記憶測驗、數符替代、圖型設計以及情緒問卷等,評估其執行功能。統計上採用獨立樣本T檢定與卡方檢定分析結果。
結果:復工與未復兩組之人口學變項和基本心智功能均無顯著差異,包含年齡、性別、教育程度、基本心智狀態、情緒狀態以及動作控制。但未復工組在集中注意力、抑制注意力與抗拒分心測驗上出現顯著較多錯誤,且訊息處理速度較慢;在語文性工作記憶與非語文工作記憶能力上,記憶完整度與提取流暢度皆顯著較差;於WCST概念形成能力顯著較差,錯誤反應與執續反應皆顯著較多。
討論:本研究中,一般生活能力已恢復正常的職災腦傷患者,未復工組在注意力監控能力、計畫與監控等高階自我調控能力之執行功能仍不足,或許是未能回到職場的重要原因。而資料結果也顯示情緒調控可能也是影響因素之一。此結果呈現兩大未來研究發展方向,其一:早期介入神經心理治療之效益性研究,由其是執行功能的介入;其二,深入討論情緒對個人社會職業功能受損之影響,以協助提升適應能力。
英文摘要 Objectives: Previous studies pointed out that traumatic brain injury often lead to change in the function of the individuals’s emotion, behavioral, and cognitive function. And then influencing of career development and management. We investigated Workers with traumatic brain injury (TBI) caused by occupational accidents , the executive function(EF) problem that interferes with a successful return to work (RTW).
Methods: From a population of 415 workers diagnosed with severe TBI enrolled in the Taiwan Labor Insurance Bureau’s 2009 database, we recruited 59 patients considered to have normal daily life abilities. Thirty-three (55.9%) had returned to their original job position (RTW group), while 26 did not (no-RTW group), at follow up for 1.5-2 years after injury. Seven instruments were used to evaluate their neurocognitive functions: the Wisconsin Card Sorting Test (WCST), Comprehensive Non-verbal Attention Test Battery (CNAT), Comprehensive Non-verbal Memory Test Battery (CNMT), Serial Verbal Memory Task, Digit Symbol, Block Design, and emotional questionnaire. Using independent samples t-test and chi-square test to analysis.
Results: Their age, gender, education level, mental status, social communication, and motor performance did not differ significantly. Compared with the RTW group, the no-RTW group made more errors on the WCST and in focusing attention on tasks, showed slower prcessing of information, poorer recall, poorer serial retrieval, poorer concept formation, and were more easily distracted.
Conclusions: The no-RTW group showed poorer attentional regulation, flexibility, and working memory, which suggested that EF ability is important for determining whether a seemingly normal worker with TBI can successfully return to work. This result presents two major directions of future research: (1) effectiveness of early intervention treatment of neuropsychology. (2) discussion of individual psychological conditions of sociooccupational dysfunction.
論文目次 第一章、緒論 1
第一節、研究動機 1
第二節、文獻探討 3
一、創傷性腦傷之概念與定義 3
二、創傷性腦傷之心智功能缺損 5
三、腦傷患者之認知功能對職業功能的影響 9
第三節、創傷性腦傷回到職場之研究 17
第四節、研究目的與假設 20
一、研究目的 20
二、研究假設 21
第二章 研究方法 22
第一節、研究設計與流程 22
第二節 研究對象 24
第三節 研究工具 25
一、納入與排除工具 25
二、一般心智狀態篩檢 29
三、執行功能測驗 31
四、情緒問卷 42
第四節、施測程序 43
第五節、資料分析 44
第三章 研究結果 45
第一節、兩組基本資料與納入-排除工具表現之差異 45
第二節、兩組一般心智功能表現之差異 48
第三節、兩組執行功能測驗表現之差異 51
第四節、兩組情緒問卷表現之差異 66
第四章、討論 68
第一節 研究工具之討論 68
第二節 受試者之功能狀態討論 71
第三節、兩組之執行功能表現討論 74
第四節、研究限制 79
第五節、認知復健之建議 80
第六節、未來研究展望 82
參考文獻 84
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