- 期刊
- OpenAccess
血管型失智症個案於日常工具使用表現之動作運用特質
Everyday Tool Use of a Person With Vascular Dementia: Characteristics of Praxis
摘要
學者提出不同動作運用（praxis）模型以闡述動作運用機制，這些動作運用模型多包含了概念系統（conceptual system）與產出系統（production system）。當概念系統受損時，經常會導致病患理解工具或手勢出現困難，進而無法正確或流暢使用工具；而產出系統沒有效率時則導致使用上的困難。但本個案報告發現一位個案在無法理解工具功能的狀況下，有時仍能正確使用該工具，這樣的現象值得深究，因此我們以這位個案為對象設計多重任務的實驗，進行概念與產出系統應為關聯（association）或互為分離（disassociation）的探討。我們徵募一位28歲左腦傷血管型失智症的男性個案，也伴隨失憶、失語、與失用等症狀，他接受了假裝、模仿、實際使用日常生活工具等產出系統的測驗，以及聽名取物、聽功能取物、辨識工具功能、工具使用方式等概念系統的測驗。結果發現個案無法理解部分工具的使用方式或功能，但卻可以正確使用這些工具；但在某些項目則能理解該工具使用方式或功能，但卻無法正確產出使用該工具之手勢；此外，也發現概念與產出均弱的項目。前述發現分別支持在不同狀況下，動作運用的概念系統與產出系統可能互為分離或具備關連性。
並列摘要
Researchers have proposed various models to investigate the mechanism of praxis, which usually includes both conceptual and productive systems. In general, disruption of the conceptual system results in poor understanding and use of objects, tools, and gestures, whereas inefficiency of the productive system results in difficulty using them. Here, we present the case of a patient with vascular dementia who could sometimes use a tool even if he could not understand its meaning of it. To explore this phenomenon, we designed multiple tasks, including productive and conceptual tool tasks, for him to complete and evaluated the associations as well as dissociations between tasks. A 28-year-old man was diagnosed as having vascular dementia; his symptoms included severe amnesia, aphasia, and apraxia. He could perform productive tasks, including pantomime, imitation of tool use, and actual tool use, as well as conceptual tasks, including picking up a tool or object after listening to its name and picking up a tool after being told its function. In addition, after being shown a tool's picture, he could recognize the tool's function, point out the tool, and use the actual tool. Further testing revealed that the patient was not able to understand the function of some tools, even though he was able to use them correctly. Conversely, he successfully recognized the functions of some other tools and knew exactly how to use them but failed to produce gestures related to the use of those tools. Finally, under some conditions, he failed to both understand the tool's function and demonstrate the ability to use it. These tests, therefore, enabled us to understand the dissociations and associations between the conceptual and production systems under different tool-processing conditions.