輕微頭部外傷患者平衡功能與暈眩 之相關性探討

The relationships between symptom of dizziness and balance function among patients with mild traumatic brain injury

張芷茹(Chih-Ju Chang)

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(2015年)

摘要

研究目的：本研究主要是利用平衡測試儀評估輕微頭部外傷患者在受傷後一周內的暈眩與平衡狀況，同時我們以量表讓患者主觀填寫描述，並比較兩者之間的相關性，以達到實驗的目的。
實驗參與者：本研究共徵招了244個符合輕微頭部外傷診斷的患者來參與實驗，且提供105位健康的參與者做為對照組。
實驗方法與統計：首先本研究針對輕微頭部外傷患者的年齡、性別、教育程度、昏迷指數、簡易智能量表、數字廣度測驗等資料，根據不同資料屬性利用卡方檢測與單因子變異數分別分析組間差異；蒐集輕微頭部外傷患者主觀填寫之DHI量表，內容包含生理面向、情緒面相、功能面向，並依所得分數將障礙程度區分為輕度、中度、重度；另外也利用平衡儀實際測量這三個小組與控制組在不同移動方向站立板上的重心偏移情形，與輕微頭部外傷患者不同的情境下(睜眼、閉眼)在不同平面下(硬、軟)的身體穩定情形，使用單因子變異數分析統計組間之差異。最後就輕微頭部外傷組與控制組暈眩障礙量表(DHI)各面向分數、總分與儀器實測所得之平衡穩定與感覺整合結果，利用逐步前溯性回歸法(Step-wise forward regression analysis)分析兩者間的相關性。
實驗結果：利用暈眩障礙量表(DHI)來了解輕微頭部外傷患者的平衡功能障礙，結果發現患者與控制組在量表本身的三個面向中，記錄所得的評分組間有明顯的差異(p＜0.05)。輕微頭部外傷患者經由DHI區分出輕度暈眩障礙、中度暈眩障礙、重度暈眩障礙這三個族群，在閉眼站立於平穩表面(ECFIS)與閉眼站立於軟墊表面(ECFOS)等測驗項目，發現組間具有統計上顯著差異(p＜0.05)。利用事後比較檢定(Post-hoc analysis)分析在ECFIS測試中，輕度與中度間無顯著差異(p＝0.97)，輕度與重度間有顯著差異(p＝0.01)，中度與重度間有顯著差異(p＝0.02) ；在ECFOS測試中，控制組與重度間有顯著差異(p＝0.01)。最後，在患者主觀暈眩症狀抱怨與客觀測量之間的關聯性分析上，本研究發現DHI的情緒面向、功能面向、整體障礙方面與平衡功能實測之感覺統合中ECFIS的項目是具有關聯性的(情感面向r=0.14, p=0.043；功能面向r=0.12, p=0.013；整體障礙r=0.13, p=0.017)；而經過年齡與性別的校正之後，發現輕微頭部外傷患者DHI總分與ECFIS的結果間仍具有相關性(r=0.13, p=0.048)。
結論：頭部外傷患者常常會影響其本身的日常生活、姿勢穩定平衡、和感覺的整合功能，而本研究顯示DHI量表的評估結果與平衡功能感覺整合測試ECFIS間有低度正相關(r=0.13, p=0.048)。

關鍵字

平衡功能、姿勢穩定、感覺統合、輕微頭部外傷

並列摘要

Objective
We compared the subjective and objective measurements of symptom of dizziness and postural stability among patients with mild traumatic brain injury (mTBIs) during the first week following injury.
Participants-We recruited 244 patients with mTBI and 105 controls for this study.
Primary Measures-Symptoms of dizziness, balance functions, and the ability to perform daily activities were assessed using the dizziness handicap inventory (DHI). We also performed the postural-stability test and a modified clinical test of sensory integration by using the Biodex Stability System (BSS).
Statistical analysis-ANOVA analysis was used to compare three subgroup (mild, moderate, severe) divided by DHI scores versus the 3 subcategories of the DHI (physical, emotional, and functional) in patients with mild traumatic brain injury. Step-wise forward regression analysis was used to determine the relationship between the patient’s complaints of dizziness, as quantified by the DHI, and the objective measurements of balance and sensory integration.
Results
Dizziness Handicap Inventory (DHI) scores (0–30, 31–60, and 61–100) versus the 3 subcategories of the DHI (physical, emotional, and functional) in patients with mild traumatic brain injury were significant different (p value=.00). The predictor of postural stability and sensory integration for each of the 3 DHI groups was ECFIS (eye close and firm surface) (p=.03). Post-hoc analysis revealed that Mild v.s. Moderate (p value=.97), Mild v.s. Severe (p value=.01), Moderate v.s. Severe (p value=.02). The emotional and total aspects of the subject’s complaints of dizziness were related to ECFIS. There was a significant relationship between emotional (r=0.14, p=.028),functional (r=0.12, p=.013), and total (r=0.13, p=.048) aspects of the DHI and sensory integration (ECFIS). There were not significant relationships between the physical, functional or total DHI and postural stability. There was no statistically significant association between the physical, functional aspect and all 4 sensory integration indices.
Conclusion
Activities of daily living, balance in postural stability and sensory integration were impaired in patients with mTBI, but revealed low correlation between subjective and objective measurements.

並列關鍵字

balance function, postural stability, sensory integration, mild traumatic brain injury (mTBI)

參考文獻

參考文獻

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