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    政大機構典藏 > 理學院 > 心理學系 > 學位論文 >  Item 140.119/145912
    Please use this identifier to cite or link to this item: https://nccur.lib.nccu.edu.tw/handle/140.119/145912


    Title: 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
    Authors: 莊富雅
    Chuang, Fu-Ya
    Contributors: 楊啟正
    莊富雅
    Chuang, Fu-Ya
    Keywords: 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
    Date: 2023
    Issue Date: 2023-07-06 16:58:17 (UTC+8)
    Abstract: 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. 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.
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