創傷性腦傷患者亞急性期復健療效之分析

Rehabilitation Effect Analysis of Subacute Traumatic Brain Injury

黃寶(Pao Huang) ； 王仁宏(Jen‐Hung Wang) ； 樊志成(Chih‐Cheng Fan) ； 梁忠詔(Chung‐Chao Liang) ； 林書蔓(Shu‐Man Lin) ； 楊士賢(Clement Shih‐Hsien Yang)

《台灣復健醫學雜誌》 43卷3期 (2015/09) Pp. 171-179

https://doi.org/10.6315/2015.43(3)04

摘要

目的：創傷性腦傷一般指所有因為外力而造成的腦部組織損傷，常伴隨著生理、認知、行為、情緒的損害及社會適應等問題。在臺灣的盛行率為0.33%，幸存者因為殘存的障礙易造成家庭人力及經濟問題。本次研究有兩項目的：(1)初步了解創傷性腦傷的患者接受復健的情況。(2)分析創傷性腦傷患者接受復健治療的成效。方法：本研究為回溯性世代研究，蒐集2009年到2014年4月，所選取的病患需有兩份以上的復健進程記錄，評估內容包含日常生活功能獨立量表(FIM)、動作平衡能力量表(PASS)及5種知覺認知功能，共81位，受傷原因以車禍、高處跌落為主因。到院24時內的GCS3-8分佔47%、GCS9-12分佔25%、GCS13-15分佔28%，且合併顱內出血者佔89%。結果：以功能恢復程度來看，在日常生活獨立功能、動作平衡能力及知覺認知功能於受傷3個月時，進步幅度約為30%；於6個月時，進步幅度介於42%至51%；日常生活功能及動作平衡能力於9個月時趨近於穩定，在知覺認知功能部份，記憶功能、安全判斷功能、定向感及注意力功能，在滿3個月時進步呈穩定。結論：日常生活獨立功能，動作平衡能力及知覺認知功能可隨復健治療的介入而有持續性的進步，本研究大部分個案追蹤到6個月，故無法推斷殘存的後遺症對個案之後所需長期照護介入的需求，未來研究建議可連結跨醫學中心的資料並結合衛福部身心障礙者福利需求評估結果，做社會經濟支出的參考。

關鍵字

腦外傷 ； 日常生活功能獨立量表 ； 動作平衡能力量表

並列摘要

Objective: Traumatic brain injury generally occurs when external force brings about damage to the tissues of the brain and is commonly accompanied by changes in the physical, cognitive, behavioral, and emotional domains of the affected person; such changes can result in social adaptation problems. Issues involving finance and/or family caregiver human resources also occur due to the fact that the survivor's disabilities linger. The primary goals of the present study are (1) to obtain an initial understanding of the rehabilitation services available to traumatic brain injury patients and (2) to analyze the effects of such rehabilitation on traumatic brain injury patients. Methods: This study is a retrospective cohort study. The patients chosen for this study were patients who were injured during the period from January 2009 to April 2014 and were found to have at least two rehabilitation progress reports. These reports needed to include scores for the Functional Independent Measure (FIM), for the Postural Assessment Scale for Stroke patients (PASS), and for a measure that tests the five areas of cognitive functioning. In total there were 81 patients who qualified; these individuals were identified as having been injured in a motor vehicle accident or due to a fall from a high place. Within 24 hours of being admitted to hospital, 47% of the Glasgow Coma Scale (GCS) scores of the patients were within the range 3 to 8, while 25% of the patients had GCS score between 9 to 12, 28% of the patients had GCS score between 13 to 15. Overall, 89% of the patients also had suffered from intracranial hemorrhaging. Results: In terms of the patients recovering brain functions, the progress with respect to performing daily activities independently, maintaining a posture, cognitive functions and perceptive functions showed 30% progress by the third month after injury and 42% to 51% progress by the sixth month after injury. Performing daily activities independently and maintaining a posture had stabilized and did not show further improvement by the ninth month. By way of contrast, cognitive and perceptive functions such as the ability to memorizing items, the ability to make safety judgments, having a sense of direction, and the ability to pay attention stabilized earlier and did not show further improvement after the third month. Conclusions: Performing activities of daily living independently, maintaining a posture, cognitive functions and perceptive functions make continuous progress when there is intervention involving rehabilitation therapy. However, this study only followed most of the identified cases for six months, it is impossible to judge whether the cases with lingering disabilities needed further intervention and longer term care. This study suggests that future research should include other medical centers and carry out longitudinal follow-up surveys. This should be combined with the Ministry of Health and Welfare's evaluation results of this type of patient in order to identify the benefits to disabled individuals of intervention. Such findings would provide a reference when assessing social welfare expenditure needs in the future.

並列關鍵字

traumatic brain injury ； functional independence measure ； postural assessment scale for stroke

參考文獻

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Centers for Disease Control and Prevention (CDC). CDC grand rounds: reducing severe traumatic brain injury in the United States. MMWR 2013; 62(27):549-52.