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| Title: | 腦震盪後症狀趨勢、認知休息策略與復學品質之相關研究：以輕度頭部外傷之學生為例
The association between trajectory of post-concussion symptoms, strategies of cognitive resting, and quality of return to school in students with mild traumatic brain injury |
| Authors: | 馬天祐
Ma, Tien-You |
| Contributors: | 楊啟正
Yang, Chi-Cheng
馬天祐
Ma, Tien-You |
| Keywords: | 青少年輕度頭部外傷
腦震盪後症狀
症狀恢復軌跡
認知休息
復學品質
Adolescence mild traumatic brain injury
Post-concussion symptoms
PCS Trajectory
Cognitive rest
Quality of return to school |
| Date: | 2024 |
| Issue Date: | 2024-07-01 12:31:42 (UTC+8) |
| Abstract: | 背景：根據衛福部統計，臺灣每年約有17至18萬名青少年輕度頭部外傷（mild traumatic brain injury, mTBI）患者，且其中多數具學生身分。腦震盪後症狀（post concussion symptoms, PCS）與認知功能缺損是mTBI後的常見症狀，並在課堂與復學歷程中嚴重干擾學生患者，對復學品質造成不良影響。有鑑於此，本研究欲探討學生患者受傷後三十天內，PCS的表現軌跡與其對課堂學習的影響；復學歷程中採用的認知休息策略以及復學品質之表現，並檢驗症狀嚴重程度、神經心理功能與因應復學之認知休息策略，對復學品質以及症狀軌跡之相關性。
方法：本研究共納入11名高中與大學之mTBI患者，並且以聽覺序列加法測驗—修改版，以及臺灣版字詞序列學習測驗評估受傷當下與受傷後一個月的認知功能表現。以症狀日記紀錄患者受傷後三十天內，與受傷後半年的PCS表現、認知休息策略與效果，以及患者於課堂中受症狀影響的天數、因症狀而缺席的天數，以及症狀影響學習之擔心程度三項復學品質指標。本研究以描述性統計分析症狀表現、神經心理功能、採用的認知休息策略和復學品質指標；以無母數−Wilcoxon符號等級檢定分析受傷後神經心理功能變化。再者，利用群組化軌跡模式將症狀恢復軌跡分組；最後則以皮爾森相關和簡單線性迴歸探討神經心理功能、年級、PCS表現對復學品質和症狀恢復軌跡之預測力。
結果：本研究發現，大多數mTBI患者在受傷後第一週到第二週，症狀皆會有顯著的改善，並可區分出嚴重且緩慢恢復（SSR）、輕微且快速恢復（MFR）和極輕微症狀（MS）三種的症狀恢復軌跡。在症狀方面，疲倦是在受傷後受最多緩者報告、嚴重程度最高、持續時間也最久的症狀。在神經心理功能方面，有25%患者在受傷後出現語文記憶缺損，有兩成患者缺損持續至受傷後一個月，但處理速度並無明顯缺損。在認知休息策略方面，僅一位患者因應復學時使用完整的認知休息策略；當課堂中出現症狀，多數學生也不會使用認知休息幫助症狀減緩。在復學品質方面，患者容易在課堂學習時出現頭痛、頭暈、疲倦以及情緒和認知症狀，對於未來症狀影響學習的擔心程度會隨時間緩解。最後，急性期的症狀嚴重程度以及年級對復學品質有預測力，症狀緩解的速度、對學習的影響程度和認知活動的都可能和復學品質有關。
結論：mTBI青少年患者症狀的症狀恢復軌跡與復學品質可能受到症狀嚴重程度、認知休息測略的使用與神經心理功能影響，也可能也和學生族群的認知活動型態、國內學習文化以及mTBI後復學相關制度有關。
Background: According to Taiwan Ministry of Health and Welfare, there are 170,000 to 180,000 adolescents experiencing mild traumatic brain injury (mTBI) annually, most of whom are students. Cognitive impairments and post-concussion symptoms (PCS) are commonly observed after mTBI, negatively influencing patients’ classroom participation and quality of return to school. This study aims to explore the trajectory of PCS and its impact on return to school within one-month post-injury and to further analyze the associations between neuropsychological performance, symptomatology, cognitive rest, PCS trajectory and the quality of return to school.
Methods: This study recruited 11 high school and university mTBI patients. The Paced Auditory Serial Addition Test-Revised and the Taiwanese version of the Word Sequence Learning Test were used to assess information processing and verbal memory ability at acute phase and one-month post-injury. A symptom diary was used to record the PCS profile, cognitive rest strategy, school missed days, symptom-affected days and levels of subjective concern within 30 days and six-months post injury. Descriptive statistics were used to examine symptomatology, neuropsychological function, cognitive rest strategies, and return-to-school quality. The Wilcoxon signed-rank test was used to analyze improvements in neuropsychological function. Group-based trajectory modeling was used to categorize symptom recovery trajectories. Pearson correlation and simple linear regression were used to investigate the relation between neuropsychological function, symptomatology, PCS trajectories, cognitive rest and return-to-school quality.
Results: The results showed that most mTBI patients experienced significant symptom improvement within the first two weeks post-injury. Symptom recovery trajectories could be categorized into three groups: Fast Symptom recovery Group(FSRG), Slow Symptom recovery Group(SSRG) and Persist Symptom Group(PSG). Fatigue was the most commonly reported symptom post-injury, with the highest severity and longest duration. Regarding neuropsychological function, 25% of patients experienced verbal memory deficits after the injury, with 20% still exhibiting deficits one-month post-injury. No clinical deficits were observed in processing speed. In terms of cognitive rest, only one patient utilized a standard cognitive rest strategy during retur-to-school. Most students did not employ cognitive rest to alleviate symptoms that arose during learning. Concerning the quality of returning to school, patients frequently experienced headaches, dizziness, fatigue, and emotional and cognitive symptoms during. The level of concern about symptoms affecting learning decreased over time. The severity of acute symptoms and grade were predictive of the quality of returning to school. Symptom trajectory, impact on learning, and cognitive activity might all be related to the quality of returning to school.
Conclusions: Symptom trajectories and return-to-school quality of adolescent mTBI patients may be influenced by the severity of symptoms at acute stage, the use of cognitive rest strategies, and neuropsychological function, also could be related to the cognitive-activity characteristic of students, learning culture, and return-to-school policies. |
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| Description: | 碩士
國立政治大學
心理學系
110752009 |
| Source URI: | http://thesis.lib.nccu.edu.tw/record/#G0110752009 |
| Data Type: | thesis |
| Appears in Collections: | [心理學系] 學位論文
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