正常成人與單側腦中風個案在空間注意力測驗上之表現及忽略症之功能意義

Abstract

前言：空間忽略症影響中風患者功能性表現預後，然而過去研究較少針對不同忽略症亞型與功能預後進行探究，例如以身體為基（egocentric neglect），與以物件為基（allocentric neglect）空間忽略症。 目的： 本文研究目的有三，包含探究健康成人在忽略症測驗表現以及建立截斷分數；探究不同空間忽略症亞型與功能表現之關聯；瞭解忽略症亞型與功能性失認症之關係。研究假設為不同忽略症亞型影響中風患者功能表現；對功能性失認症與忽略症亞型不同亦有關聯；當控制年齡、動作、與感覺等變項後，空間忽略症與功能性表現之關係維持不變。 方法： 共有四種身體外空間忽略症測驗以一種肢體忽略症測驗於本研究中進行施測，並利用自評與他評兩種巴氏量表評量中風患者功能性表現。身體外空間忽略症測驗截斷分數取決於八十一位健康成人表現。中風患者組別中，五十八位為右腦傷患者，五十七位為左腦傷， 所有中風個案皆來自台灣北區醫院。 結果： 形狀刪除測驗對於右腦傷忽略症患者最為敏感 (62%)，而文字刪除測驗對於左腦傷患者則最為敏感 (32%)。此外，各種忽略症亞型影響功能性表現之差異（如身體外空間忽略與身體忽略症、身體為基與物件為基空間忽略症），並且在左右腦傷患者上有顯著不同。而功能表現自評與他評差異在右腦傷患者組別中，顯示功能性失認症對於功能預後具有預測力。當控制干擾變項後，各忽略症亞型與功能表現鄉關結果不變。 結論： 忽略症測驗敏感度在不同測驗與不同腦傷組別亦隨之不同。而忽略症不同亞型型態影響其功能性表現。其中身體為基及物件為基空間忽略症與否影響右惱傷患者之功能性表現，且巴氏量表自評得分相對於他評得分影響差異更明顯。而若進一步分析功能性失認症得分(BID)，發現身體忽略症對於功能性失認症具有預測性，並能區辨左右腦傷不同之功能表現。

Background: Previous studies on neglect have shown that there is significant influence to functional outcome to patients with stroke. Less evidence provided neglect subtypes, such as egocentric and allocentric neglect related to function. Purpose: (a) to investigate the performance on spatial attention tests of healthy adults to establish cut-off level; and (b) to investigate personal neglect and extra-personal neglect in patients groups related to function; (c) to exam the neglect subtypes predictive of anosognosia for functional deficits. The hypotheses of this study were (a) neglect subtypes would influence the functional performance in patients groups; (b) anosognosia for functional deficit related to neglect subtypes; (c) when further control age, motor, and sensory, the relationship between spatial attention and function would still remain. Methods: Four extrapersonal neglect tests and one personal neglect test were applied to assess neglect. Self-report and therapist-report Barthel Index (BIS and BIT) were used to measure functional performance. Cut-off level on extrapersonal neglect tests was determined by 81 healthy adults. And 58 patients with right brain damage (RBD) and 57 with left brain damage (LBD) were recruited from the hospital in north Taiwan. Results: The random shape cancellation test was the most sensitive to RBD (62%) and so was the Random Chinese Word Cancellation test to LBD (32%). Besides, neglect subtypes (extra-personal vs. personal neglect; egocentric vs. allocentric neglect) related to different functional status. Anosognosia showed predictive to function of RBD (p<0.001). And after controlling confounders, the correlation still remained. Conclusions: Sensitivity differed from tasks and brain lesion sites. And neglect subtypes influence function, as well as egocentric and allocentric neglect would influence functional performance significantly, especially to patients with RBD. And BIS could be differentiated functional performance of egocentric and allocentric neglect better than BIT. If further analyzed anosognosia score (BID), personal neglect showed the predictive for unawareness of functional deficit.