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系統識別號 U0026-2402201422412500
論文名稱(中文) 運用神經生理回饋訓練模組計畫於中重度腦傷患者之執行功能療效分析
論文名稱(英文) The Therapeutic Effects of Neurofeedback Training Program in Executive Function of Moderate to Severe Traumatic Brain Injury Patient
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 102
學期 2
出版年 103
研究生(中文) 林育岑
研究生(英文) Yu-Tsen Lin
學號 S86004046
學位類別 碩士
語文別 中文
論文頁數 134頁
口試委員 指導教授-郭乃文
口試委員-官大紳
口試委員-郭進榮
中文關鍵字 神經心理治療  創傷性腦傷  神經生理回饋  執行功能 
英文關鍵字 neuropsychotherapy  TBI  neurofeedback  executive function 
學科別分類
中文摘要 目的:Yucha與Montgomery(2008)後設分析研究指出運用神經生理回饋(Neurofeedback, NF)於創傷性腦傷(traumatic brain injury, TBI)個案的療效證據等級為三:可能有效(Probably Efficacious)。然而,過去NF訓練多以Cz電極點為介入點,介入次數多為20~40次,較少研究針對中重度TBI個案探討執行功能療效。故本研究欲修改Will Well NF(WWNF)訓練模組,試圖縮短治療時間,以F3與F4為介入點,且以多層次指標來驗證其療效。
方法:修改WWNF為每週二次、每次一小時,共十八次之訓練模組。八名中重度TBI個案,經基礎線測量後進入一個月等待期,此階段個案回復其原治療模式,接著進行前測、訓練及後測。療效採四層級指標驗證,含腦波指標、神經心理衡鑑指標、問卷指標,以及能力類化指標。資料分析分為兩部份,其一為群體療效探討,採拔靴法之相依T檢定方式分析;其二為個別療效分析。
結果:群體分析與個別分析顯示四層次療效指標中,神經心理衡鑑、問卷、能力類化三層次指標有所進步。WWNF可提升TBI個案注意力監控、認知彈性,以及概念形成之表現,並降低執續錯誤。家屬與個案認為可有效改善日常生活執行功能,能力可類化至家務活動。
討論:多數個案於計畫能力與衝動抑制力沒有受損,無法針對此兩功能進行療效分析。未來研究應發展出適合個別差異大個案之療效分析方法。
英文摘要 Introduction: The results of meta-analysis study of Yucha&Montgomery(2008) revealed that neurofeedback(NF) training can be probably effectively in subjects with traumatic brain injury(TBI). Yet questions remain concerning that NF training often target at Cz, need 20~40 sessions, and less studies were concerning the effects on executive functions. To address these issues, this study aimed to examine the effectiveness of a modify Will Well NF(WWNF) program, which taking less training time,targeting at F3&F4, and used four level of indexes to discuss the therapeutic effects.
Method: 8 moderate to severe TBI patient received the modified WWNF training program. 18 sessions were conducted in 9 weeks. Each session lasted one hours. All patients finished the baseline test, were in accordance with original therapies for a month. After a month long waiting phase, all patients were tested before and after WWNF training program with a set of tests. This study used four level indexes to discuss the therapeutic effects, including EEG, neuropsychological assessments, questionnaires of executive functions and generalized functions. The bootstrapping method of dependent T test were used for discuss the whole therapeutic effects and the case report were used for discuss the individual therapeutic effects.
Result: Patients who received the modified WWNF training program improved significantly at neuropsychological assessments, questionnaires of executive functions and generalized functions. Results indicated improvement in attentional control, cognitive flexibility, concept formation, perseveration errors, questionnaires of executive functions and generalized functions in patients post WWNF.
Discussion: It’s hard to discuss the therapeutic effects of planning and inhibition because most patients with no planning and inhibition problem. Future studies should development an anylysis method to explain the therapeutic effect of training in very different clinical patient.
論文目次 第一章 緒論 1
第一節 研究動機與背景 1
第二節 文獻回顧 3
一、創傷性腦傷之概念與定義 3
二、創傷性腦傷患者之執行功能缺損 6
三、神經心理治療之簡介 8
四、神經回饋治療 11
第三節 研究目的與假設 17
第二章 研究方法 18
第一節 研究架構 18
第二節 研究流程 19
第三節 受試者 20
第四節 研究工具 21
第五節 治療方案與治療設備 31
第六節 資料分析 39
第三章、研究結果 40
第一節 人口學變項 40
第二節 整體療效探討 41
第三節 個別療效探討 54
第四節 個別療效統整 101
第四章、討論 109
第一節 結果分析 109
第二節 研究限制 111
第三節 研究貢獻與未來展望 111
參考文獻 112
中文部份 112
英文部份 114
附錄………… 123
附錄一 家庭支持系統 123
附錄二 日常生活執行功能量表 129
附錄三 照護需求層級量表 131
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