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題名 中重度頭部外傷患者執行功能異常之自我覺察追蹤研究
Self-Awareness of Dysexecutive Symptoms after Moderate to Severe Traumatic Brain Injury: A Follow-up Study作者 莊富雅
Chuang, Fu-Ya貢獻者 楊啟正
莊富雅
Chuang, Fu-Ya關鍵詞 中重度頭部外傷
執行功能異常症狀
自我覺察
Moderate-to-severe TBI
Dysexecutive syndrome
Self-awareness日期 2023 上傳時間 6-Jul-2023 16:58:17 (UTC+8) 摘要 背景：頭部外傷患者的自我覺察缺損常表現在身體、行為與認知等不同層面；過去研究雖已探討不同評估者觀點作為自我覺察能力指標的準確性，以及其與認知功能的關連性，但鮮少分析自我覺察在受傷後不同時期的變化，以及與認知功能的關係。另一方面，不同研究中的評估者、患者嚴重程度、患者所在場域及評估時間點等，皆仍未釐清。有鑑於此，本研究以縱貫研究法來探討自我覺察缺損的復原歷程。方法：本研究招募11位中重度頭部外傷患者與11位健康控制組的受試者，並採用執行功能異常症狀問卷（Dysexecutive Questionnaire, DEX）評估受試者日常生活中出現執行功能異常症狀的頻率；同時，以DEX「差異分數」（自評與重要他人評估差異、自評與研究者評估差異）作為自我覺察能力的指標。以健康組患者的一次評估作為比較基準點，評估患者分別於急性期（受傷後一個月）、亞急性期（受傷後三個月）、慢性期（受傷後六個月）的執行功能異常症狀與自我覺察能力，並比較不同評估者（患者、重要他人、研究者）觀點的差異。除此之外，藉由急性期與慢性期的神經心理功能評估，驗證DEX「差異分數」所反映之自我覺察能力。結果：本研究發現急性期不同評估者的觀點差異較大，以研究者較能呈現患者之自我覺察缺損；亞急性期評估者間的差異減少，以重要他人的評估較能反映日常生活中的缺損；慢性期則患者多數已無自我覺察缺損。其次，藉由DEX「差異分數」於三次評估的變化，可發現自我覺察復原歷程上的異質性。最後，執行功能與自我覺察具關連的趨勢。結論：藉由DEX「差異分數」可呈現患者的自我覺察改變，亦可能藉由DEX評估初步瞭解患者面臨的認知功能缺損或生活適應困難。據此，從急性期開始納入DEX多觀點的評估，可補足神經心理功能評估較無法呈現之日常生活中的缺損，以及自我覺察缺損。
Background: Impairment of self-awareness is not uncommon after traumatic brain injury (TBI), which is manifested in multiple domains including physical, behavioral, and cognitive ones. Many studies have investigated the accuracy of different informants’ index to evaluate self-awareness and its association with cognitive functions. However, the trajectory of self-awareness after TBI in different recovery phases is still unknown. In addition, the criteria of self-awareness assessment in past studies were still unclear in terms of informants, severity, stages and places. This study thus aims to explore the recovery trajectory of self-awareness along with the recovery process within six months post-injury.Methods: This study recruited 11 participants with moderate-to-severe TBI and 11 healthy controls. The dysexecutive syndrome in daily life was measured by Dysexecutive Questionnaire (DEX) and self-awareness was assessed by discrepancy scores between participants and others (patients/significant other discrepancies and patients/researcher discrepancies) on DEX. Using healthy control’s DEX scores and awareness index as a baseline, we compared the assessment of patients at acute stage (one-month post-injury), subacute stage (three-months post-injury), and chronic stage (six-months post-injury), and we also analyzed the difference of informants’ index (subject, significant other, researcher). In addition, we clarify the relationship between DEX discrepancy scores and self-awareness through the neuropsychological assessment at acute and chronic stage.Result: The results showed that the informants’ index was different at acute stage, indicating that researcher’s perspective was more able to uncover patients’ impaired self-awareness. The differences among informants’ index were decreasing at subacute stage, showing that significant other’s perspective was more able to reveal patients’ impairments in daily life. Most of the patients did not show impaired self-awareness at chronic stage. Furthermore, the heterogeneity in the recovery process of impaired self-awareness was revealed by using discrepancy scores of DEX. Lastly, there was a significant association between executive function and self-awareness.Conclusion: The trajectory of impaired self-awareness could be presented by discrepancy scores of DEX, which might also provide a preliminary information of cognitive deficits and adaptation to life changes of patients. 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國立政治大學
心理學系
108752008資料來源 http://thesis.lib.nccu.edu.tw/record/#G0108752008 資料類型 thesis dc.contributor.advisor 楊啟正 zh_TW dc.contributor.author (Authors) 莊富雅 zh_TW dc.contributor.author (Authors) Chuang, Fu-Ya en_US dc.creator (作者) 莊富雅 zh_TW dc.creator (作者) Chuang, Fu-Ya en_US dc.date (日期) 2023 en_US dc.date.accessioned 6-Jul-2023 16:58:17 (UTC+8) - dc.date.available 6-Jul-2023 16:58:17 (UTC+8) - dc.date.issued (上傳時間) 6-Jul-2023 16:58:17 (UTC+8) - dc.identifier (Other Identifiers) G0108752008 en_US dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/145912 - dc.description (描述) 碩士 zh_TW dc.description (描述) 國立政治大學 zh_TW dc.description (描述) 心理學系 zh_TW dc.description (描述) 108752008 zh_TW dc.description.abstract (摘要) 背景：頭部外傷患者的自我覺察缺損常表現在身體、行為與認知等不同層面；過去研究雖已探討不同評估者觀點作為自我覺察能力指標的準確性，以及其與認知功能的關連性，但鮮少分析自我覺察在受傷後不同時期的變化，以及與認知功能的關係。另一方面，不同研究中的評估者、患者嚴重程度、患者所在場域及評估時間點等，皆仍未釐清。有鑑於此，本研究以縱貫研究法來探討自我覺察缺損的復原歷程。方法：本研究招募11位中重度頭部外傷患者與11位健康控制組的受試者，並採用執行功能異常症狀問卷（Dysexecutive Questionnaire, DEX）評估受試者日常生活中出現執行功能異常症狀的頻率；同時，以DEX「差異分數」（自評與重要他人評估差異、自評與研究者評估差異）作為自我覺察能力的指標。以健康組患者的一次評估作為比較基準點，評估患者分別於急性期（受傷後一個月）、亞急性期（受傷後三個月）、慢性期（受傷後六個月）的執行功能異常症狀與自我覺察能力，並比較不同評估者（患者、重要他人、研究者）觀點的差異。除此之外，藉由急性期與慢性期的神經心理功能評估，驗證DEX「差異分數」所反映之自我覺察能力。結果：本研究發現急性期不同評估者的觀點差異較大，以研究者較能呈現患者之自我覺察缺損；亞急性期評估者間的差異減少，以重要他人的評估較能反映日常生活中的缺損；慢性期則患者多數已無自我覺察缺損。其次，藉由DEX「差異分數」於三次評估的變化，可發現自我覺察復原歷程上的異質性。最後，執行功能與自我覺察具關連的趨勢。結論：藉由DEX「差異分數」可呈現患者的自我覺察改變，亦可能藉由DEX評估初步瞭解患者面臨的認知功能缺損或生活適應困難。據此，從急性期開始納入DEX多觀點的評估，可補足神經心理功能評估較無法呈現之日常生活中的缺損，以及自我覺察缺損。 zh_TW dc.description.abstract (摘要) Background: Impairment of self-awareness is not uncommon after traumatic brain injury (TBI), which is manifested in multiple domains including physical, behavioral, and cognitive ones. Many studies have investigated the accuracy of different informants’ index to evaluate self-awareness and its association with cognitive functions. However, the trajectory of self-awareness after TBI in different recovery phases is still unknown. In addition, the criteria of self-awareness assessment in past studies were still unclear in terms of informants, severity, stages and places. This study thus aims to explore the recovery trajectory of self-awareness along with the recovery process within six months post-injury.Methods: This study recruited 11 participants with moderate-to-severe TBI and 11 healthy controls. The dysexecutive syndrome in daily life was measured by Dysexecutive Questionnaire (DEX) and self-awareness was assessed by discrepancy scores between participants and others (patients/significant other discrepancies and patients/researcher discrepancies) on DEX. Using healthy control’s DEX scores and awareness index as a baseline, we compared the assessment of patients at acute stage (one-month post-injury), subacute stage (three-months post-injury), and chronic stage (six-months post-injury), and we also analyzed the difference of informants’ index (subject, significant other, researcher). In addition, we clarify the relationship between DEX discrepancy scores and self-awareness through the neuropsychological assessment at acute and chronic stage.Result: The results showed that the informants’ index was different at acute stage, indicating that researcher’s perspective was more able to uncover patients’ impaired self-awareness. The differences among informants’ index were decreasing at subacute stage, showing that significant other’s perspective was more able to reveal patients’ impairments in daily life. Most of the patients did not show impaired self-awareness at chronic stage. Furthermore, the heterogeneity in the recovery process of impaired self-awareness was revealed by using discrepancy scores of DEX. Lastly, there was a significant association between executive function and self-awareness.Conclusion: The trajectory of impaired self-awareness could be presented by discrepancy scores of DEX, which might also provide a preliminary information of cognitive deficits and adaptation to life changes of patients. Therefore, different informant’s index of DEX in assessment from acute stage would add more information about impairments in daily life and impaired self-awareness. en_US dc.description.tableofcontents 第一章 緒論 1中重度頭部外傷 1執行功能異常 8自我覺察概念與缺損表現 12自我覺察的評估 21自我覺察的改變 28研究目的 29第二章 方法 33研究參與者 33研究程序 36研究工具 37分析方法 43第三章 結果 46急性期神經心理功能與自我覺察表現 46亞急性期職業功能與自我覺察表現 73慢性期神經心理功能、職業功能、自我覺察表現 86第四章 討論 100急性期神經心理功能與自我覺察表現 100亞急性期職業功能與自我覺察表現 115慢性期神經心理功能、職業功能、自我覺察表現 119研究限制 126未來方向 128參考文獻 129附錄一：執行功能異常症狀問卷 165附錄二：研究倫理委員會同意書 169 zh_TW dc.format.extent 5625056 bytes - dc.format.mimetype application/pdf - dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0108752008 en_US dc.subject (關鍵詞) 中重度頭部外傷 zh_TW dc.subject (關鍵詞) 執行功能異常症狀 zh_TW dc.subject (關鍵詞) 自我覺察 zh_TW dc.subject (關鍵詞) Moderate-to-severe TBI en_US dc.subject (關鍵詞) Dysexecutive syndrome en_US dc.subject (關鍵詞) Self-awareness en_US dc.title (題名) 中重度頭部外傷患者執行功能異常之自我覺察追蹤研究 zh_TW dc.title (題名) Self-Awareness of Dysexecutive Symptoms after Moderate to Severe Traumatic Brain Injury: A Follow-up Study en_US dc.type (資料類型) thesis en_US dc.relation.reference (參考文獻) 王子蘭（2012）。長庚大學額葉指標-台灣版額葉評估量表與額葉行為量表之常模研究（碩士論文）。長庚大學，桃園市。胡佳妗（2015）。台灣版執行功能異常症候群行為衡鑑測驗之常模研究（碩士論文）。長庚大學，桃園市。高至潔（2009）。台灣正常中老年人尼爾森修訂版卡片分類測驗之常模研究（碩士論文）。取自：https://scholars.lib.ntu.edu.tw/handle/123456789/40258郭曉燕（2009）。臺灣正常中老年人彩色路徑描繪測驗之常模研究（碩士論文）。取自：https://scholars.lib.ntu.edu.tw/handle/123456789/40255陳勁秀（2010）。台灣正常中老年人語意流暢度測驗之北部地區常模研究（碩士論文）。國立臺灣大學，台北市。樊皖君（2013）。台灣正常人史楚普字色測驗之常模研究（碩士論文）。國立臺灣大學，台北市。衛生福利部統計處（2020）。109年度全民健康保險醫療統計年報。取自：https://dep.mohw.gov.tw/dos/lp-5103-113.htmlAllen, C. 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