- 期刊
合併前瞻記憶歷程訓練於神經心理復健在創傷性腦傷後重度失憶病患：病例報告
Neuropsychological Rehabilitation with Prospective Memory Process Training in A Patient with Severe Amnesia after Traumatic Brain Injury: A Case Report
摘要
重度失憶症病患因新訊息儲存與提取困難，導致前瞻性記憶受損，是造成病患持續失能的主因之一。其治療方式及效果少有研究報告。本文以腦創傷後重度失憶症病患為對象，於神經心理復健中合併前瞻記憶歷程訓練（prospective memory process training, PROMPT），呈現其治療過程並討論其效果。本文報告一位腦創傷後重度失憶症成年23歲男性，腦創傷後26個月開始進行記憶復健，包括前瞻記憶歷程訓練、定向感訓練、教導代償策略、鼓勵個案使用後設認知策略，以及對家屬提供衛教。介入期間為12個月，在介入後6、9與12個月進行追蹤評估，使用簡式智能評估、盧－尼神經心理測驗組－篩檢測驗以及中文字詞次序學習測驗為評估工具。個案在介入後6個月其定向感、工作記憶與立即回憶表現進步，其他治療師主動表示個案學習能力提升，顯示有類化效果。介入12個月，個案在線索回憶、類比能力與工作記憶上進步，臨床觀察個案能以關鍵字回憶前一天發生的特殊事件，顯示其提取功能可能有部分回復，仍需持續追蹤。案父表示病患因記憶障礙導致生活失能的情形改善，個案開始正職工作。然而，治療後個案在無線索之延宕回憶仍有明顯損傷。由此病例報告可知，對於腦創傷後重度失憶病患，可運用前瞻記憶歷程訓練於記憶復健中，促進立即回憶與工作記憶之矯治；亦可透過自我覺察等後設認知策略來增加記憶功能，此訓練效果可以類化至生活情境。
並列摘要
Patients with severe amnesia frequently experience difficulty in storing and retrieving new information, resulting in prospective memory impairment, one of the main reasons for sustained loss of functioning in daily life. Currently, little literature on the neuropsychological interventions for severe amnesia patients has been published. The present study applied prospective memory process training (PROMPT) in neuropsychological intervention to a patient with severe amnesia caused by traumatic brain injury, and investigated the efficacy of this method. The intervention was administered for 12 months long to a 23-year-old male participant with severe amnesia caused by traumatic brain injury. The intervention was administered at 26 months after the trauma. The psychological assessments used were the Mini-Mental Status Examination (MMSE), Luria-Nebraska Neuropsychological Battery-Screening Test (LNNB-S), and Word Sequence Learning Test, and the pretest and posttest performance was compared. The observations of caregivers and therapists concerning the participant's daily performance were also considered. The participant's performance on the MMSE, LNNB-S, and Word Sequence Learning Test improved 6 months after treatment, particularly in the aspects of orientation, immediate recall, and working memory; the performance of cued recall was improved after 12 months of the intervention. However, delayed recall and recognition remained significantly impaired. The caregiver reported that the daily life functioning of the participant improved. He could complete some daily tasks independently, and he has got a full-time job. Although the intervention was administered 26 months after the trauma, through PROMPT in memory rehabilitation, the participant was able to restore immediate recall and working memory. By improving self-awareness, the participant exhibited increased frequency of encoding the keyword of conversation and other compensatory strategies.