執行功能對慢性期創傷性腦傷患者自評創傷後成長狀態的影響

目的：為研究創傷性腦傷（traumatic brain injury, TBI）患者於創傷事件後經歷正向心理改變，即創傷後成長（posttraumatic growth, PTG）的不同狀態，基於過去研究結果紛雜，而提出以腦功能為基礎且可以量化的執行功能（executive function, EF）來探討不同EF對TBI患者之PTG狀態的影響。方法：共67位受傷後滿一年TBI患者參與研究，男性占61.2%，其中輕度占79.1%，平均年齡為34.2歲（±12.7），腦傷後24.5月（±3.9）。研究使用自編PTG量表，並進行專家效度、內部一致性考驗（α=.93）以及因素分析（總解釋量69.39%），共得到四個因素。受試者接受EF測驗組，共六個指標代表衝動抑制、工作記憶以及認知彈性的三類EF功能。依受試者在EF測驗的表現，高於PR值60以上者為高分組，低於PR值40以下者為低分組，以t檢定比較兩組在PTG量表中新可能性、行動力、資源力及心靈力四個因素分數的差異。結果：衝動抑制、聽覺工作記憶以及認知彈性高分組皆顯著報告在新可能性有較佳的成長。且衝動抑制組高分組也顯著報告有較佳的行動力。而三種EF皆未對資源力與心靈力達到顯著影響。結論：慢性期TBI患者的EF對於PTG確實有影響，尤其對於PTG內的新可能性面向，同時較佳衝動抑制更能影響其行動力。因此，提升TBI患者的EF作為促進傷後PTG應是可行的途徑，此可作為未來神經心理治療之參考。

關鍵字

創傷性腦傷；執行功能；創傷後成長

並列摘要

Objectives: To study the positive changes which are called the different states of posttraumatic growth (PTG) in traumatic brain injury (TBI) patients after injury. Because of the mixed results of past studies, the objective of this study is to propose brain-based and quantifiable executive function (EF) to investigate how each aspect of EF can affect the PTG factors that are present in TBI patients. Methods: A total of 67 TBI patients who are one year after injury were enrolled from a medical center in Tainan City after they signed an informed consent: 61.2% of the patients are male, 79.1% are mild TBI, average age is 34.2 years (± 12.7), and the average post-injury time is 24.5 months (± 3.9). Four factors were obtained by using the self-edited PTG scale after conducting for expert validity, internal consistency test (α = .93) and factor analysis (69.39%). After taking EF tests (including inhibition, working memory, and cognitive flexibility), they were divided into preferred groups (percentile rank score of 60 or above) and less preferred groups (percentile rank score of 40 or below) according to the results, to which an independent samples t-test was carried out to examine the differences between the two groups in terms of different PTG factors (including new possibility, active power, resources power, and mind power). Results: In terms of inhibition, auditory working memory, and cognitive flexibility, the preferred group had higher scores in new possibility. In terms of inhibition, the preferred group also had higher scores in active power. EFs had no effect on resources power and mind power. Conclusions: Inhibition, cognitive flexibility, and auditory working memory can have great effects on the condition of PTG factors that are present in chronic TBI patients, and may affect the new possibility of PTG mostly. Especially the better control of inhibition would affect the active power of PTG. Accordingly, it is feasible to promote PTG by enhancing the EFs of TBI patients. These results can be contributed to build the future basis of neuropsychological therapy.

並列關鍵字

traumatic brain injury ； executive function ； posttraumatic growth

參考文獻

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執行功能對慢性期創傷性腦傷患者自評創傷後成長狀態的影響

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