以國際健康功能與身心障礙分類系統對外傷性腦損傷患者進行身心障礙鑑定之初步研究

The preliminary study of disability certification for patients with traumatic brain injury by using ICF system

郭心馨(Hsin-Hsin Kuo)

指導教授 ： 邱文達

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2009年)

摘要

在世界各國，外傷性腦損傷為重要的公共衛生議題，所造成的傷害更直接威脅生命，導致終生殘障、植物人等後遺症。2012年起我國開始全面使用國際健康功能與身心障礙分類系統(International Classification of Functions, Disability and Health, ICF)來評估身心障礙者，做為身心障礙鑑定等級的標準，因此，本研究希望以台北地區領有身心障礙手冊之外傷性腦損傷病患為議題，進行先驅性之分析研究，做為日後施行之參考。
本研究對象選取3個月以上穩定之外傷性腦損傷且領有身心障礙手冊之病患共30名，平均年齡為47.4±18.7歲，男女比例為9:1，身心障礙等級輕度有8人，中度有6人，重度有12人及極重度有4人。在事故發生時喪失意志者有27人，顱內出血者有28人，痙攣者有14人，神經障礙者有22人，合併傷害者有6人。依據ICF核心組合(core set)的方法分別評估病患在身體功能、活動與參與及環境因子之影響，結果顯示，超過30%病患會勾選的功能障礙及影響之項目共計41項。將ICF總分與外傷性腦損傷基本資料之各變項分析結果，身體功能總分與身心障礙等級有關；活動與參與總分與身心障礙等級及格拉斯哥昏迷指數(GCS)有關；環境因子總分與有無痙攣、有無健忘及有無神經障礙3個變項有關。從本研究中發現，ICF分類系統鑑定結果與現行身心障礙分類制度成正相關。本研究結果可做為發展台灣版外傷性腦損傷之ICF core set之參考。

關鍵字

ICF ； 外傷性腦損傷 ； 身心障礙

並列摘要

Traumatic brain injury (TBI) is an important public health problem which can result in death and permanent disabilities. Taiwan will start to use the International Classification of Functions, Disability and Health (ICF) for disability classification in 2012. The aim of this preliminary study is to try out ICF on TBI patients who have disability certificate.
This study recruited 30 TBI patients with mean age of 47.4 ± 18.7. The ratio of male to female is 9:1. There are 8 minor, 6 moderate, 12 severe and 4 critical disabled patients according to their certificates. At the time of injury occurrence, 27 patients had initial loss of consciousness, 28 intracranial hemorrhage, 14 amnesia, 22 neurological deficients and 6 co-morbidities. According to ICF core set, patients were evaluated separately for Body Function, Activities and Participation, and Environmental Factors. The result shows that 41 items may be relevant because more than 30% of patients had coded with these items. Relating ICF scores with TBI variables, it was found that disability classification and Body Function total score are statistically associated; Activities and Participation total score is significantly related to both disability classification and Glasgow Coma Score; convulsion, amnesia and neurological deficients are significantly associated with the Environmental Factors total score. In this study, we find ICF system and disability classification are positively related. Thus we can use the result of this study as a future reference for ICF core set for TBI patients in Taiwan.

並列關鍵字

ICF ； Traumatic brain injury ； Disability

參考文獻

35. WHO. World Health Organization. International Classification of Functioning, Disabilityand Health: ICF. Geneva 2001.

1. Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE. Traumatic brain injury in the United States: A public health perspective. J Head Trauma Rehabil 1999;14:602-15.

2. Kraus JF. Epidemiology of head injury. Baltimore;Williams & Wilkins 1993.

3. Bernabeu M, Laxe S, Lopez R, et al. Developing Core Sets for Persons With Traumatic Brain Injury Based on the International Classification of Functioning, Disability, and Health. Neurorehabil Neural Repair 2009.

5. Andelic N, Sigurdardottir S, Brunborg C, Roe C. Incidence of hospital-treated traumatic brain injury in the Oslo population. Neuroepidemiology 2008;30:120-8.