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研究生: 張騰方
Chang, Teng-Fang
論文名稱: 早期發展正常之極低出生體重早產兒於學齡期執行功能受損發展與介入研究
Development and Interventions for Executive Function Deficits in school-age Children Born Very Low Birth Weight with Normal Early Development
指導教授: 郭乃文
Guo, Nai-Wen
學位類別: 碩士
Master
系所名稱: 醫學院 - 行為醫學研究所
Institute of Behavioral Medicine
論文出版年: 2016
畢業學年度: 104
語文別: 中文
論文頁數: 107
中文關鍵詞: 極低出生體重早產兒執行功能學齡期兒童介入神經心理治療
外文關鍵詞: VLBW, executive function, school-age, intervention, neuropsychotherapy
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  • 目的:研究指出早期發展正常之早產兒於六歲入學期間之非語文工作記憶、計畫以及認知彈性等執行功能仍顯著差於同齡足月出生的正常兒童(Ni, Huang, & Guo, 2011)。本研究將探討早期發展正常之早產兒於入學後學齡期間之執行功能發展,並探討運用神經心理治療理論來治療學齡期執行功能遲緩之成效。
    方法:本研究包括三組受試者,分別為早產組、對照組以及受治療組。早產組來自「財團法人中華民國早產兒基金會」轉介之台南區2002年8月至2009年8月出生之極低出生體重早產兒,為6、12、18、24個月時在貝萊嬰幼兒發展量表第二版 (Bayley Scales of Infant Development, Second Edition, BSIDⅡ)的MDI與PDI以及於5歲時在魏氏幼兒智力量表中文版修訂版的FSIQ分數皆高於70分者,並排除視覺障礙、聽覺障礙與腦性麻痺等疾患,共納入6歲組185人,8歲組70人,其中62人為6歲與8歲皆有接受追蹤者。對照組為來自社區之足月正常兒童,6歲組共114位,8歲組共54位。選用四項執行功能測驗,包含魏氏兒童智力測驗中文版第四版之逆序背誦記憶廣度分測驗、Knox’s方塊仿效測驗、廣泛性非語文注意力測驗、倫敦塔以及威斯康辛卡片分類測驗來評估上述兩組兒童之執行功能,分數低於正常組Q1(25%)以下的該項功能視為遲緩。受治療組為於7-8歲時在神經心理衡鑑中呈現執行功能遲緩之兒童共9位,其中有8位來自早產組,4男4女,平均8歲3個月;以及1位來自對照組之男童,年齡為8歲1個月。本神經心理治療計畫著重於執行功能之訓練,內容包括生態化素材、自創卡牌遊戲「動腦玩,玩腦動」(Executive FUNction Training, EFT)治療、廣泛性記憶力訓練系統(Comprehensive Memory Training System, CMTS),兩到三人一組,小團體進行,每週1次2小時,期長10週。所有個案都接受介入前後的評估,並以前後差異作為療效討論。
    結果:(1)早產組於6歲時,其工作記憶、計畫能力、認知彈性以及抑制能力皆顯著較足月兒童差,此發現仍認為早產組之執行功能是遲緩的。(2)八歲時之兩組平均未呈現執行功能差異。(3)於6歲部分執行功能不足者,在8歲時仍有顯著高比例仍有執行功能不足的情況,尤其是在工作記憶、計畫能力以及認知彈性。(4)本治療於工作記憶、計畫能力以及認知彈性等執行功能部件有正向影響,在家長評估之兒童日常生活執行功能量表上也顯示進步。
    結論:早期發展正常之極低出生體重早產兒雖於學齡前之執行功能發展遲緩,而隨年齡發展,學齡期似乎並未呈現顯著差異,未來仍需進一步針對早期發展正常之選樣要件進行探討。而學齡前執行功能不足者有較高比例在學齡期仍有執行功能不足的情況,因此建議早期進行篩檢並進行介入治療。著重於執行功能訓練的神經心理治療介入,依然能促進八歲執行功能不足之早期發展正常之極低出生體重早產兒於學齡期之執行功能,其增強之能力且能被家長所認同。

    The aim of this study was to investigate the development of executive function deficits in school-age children born very low birth weight with normal early development, and innovated a neuropsychological training model focused on EFs for school-age children born very low birth weight with EFs deficits. Three groups of participants was included as the VLBW group, the Normal group, and the Training group. The total available case of the VLBW group of aged 6 was 185, of aged 8 was 70, with 62 individuals traced both at age 6 and 8. The Normal group included full-term children from community. The case number of the Normal group of aged 6 was 114 and of aged 8 was 54. Four tests were applied for investigating the executive function. Scoring lower than Q1 (25%) was taken as delayed. The training group included 8 VLBW children from the VLBW group and 1 children from the Normal group. The study revealed that the average EFs of preterm group was significantly inferior to that of the Normal group at age 6, which was not identified at age 8. However, children who had EFs deficits at age 6 have higher rate showing EFs deficits at age 8 than those who are EF normal. The results of the training program indicated improvement in nonverbal working memory, cognitive flexibility, planning, and daily executive functions in children post training.

    第壹章 緒論 1 第一節、執行功能 1 一、執行功能定義 1 二、 兒童期與學齡期之執行功能發展與衡鑑 3 第二節、早產兒執行功能發展 10 一、早產兒定義 10 二、早產兒之功能發展遲緩與早期發展正常 11 三、早產兒之執行功能發展 13 第三節、執行功能之神經心理治療 17 一、神經心理治療 17 二、執行功能之神經心理治療 18 第四節、研究動機與問題假設 25 一、 研究動機 25 二、 研究假設 26 第貳章 研究方法 27 第一節、研究設計與流程 27 一、早期發展正常之早產兒於入學後學齡期間之執行功能發展 27 二、著重於執行功能訓練的神經心理治療之研究設計 27 第二節、研究對象 30 一、受試者篩選與招募:早產組、對照組以及受治療組 30 第三節、研究工具 33 一、基本資料問卷 33 二、回溯性資料 34 三、智力衡鑑 36 四、執行功能衡鑑 36 五、學業成就衡鑑 41 第四節、著重於執行功能訓練的神經心理治療 42 一、訓練方案 42 二、著重於執行功能訓練的神經心理治療方式 43 第五節、統計分析 46 第參章 結果 47 第一節、人口學分析 47 一、 參與組與未參與組早產兒之人口學分析 47 二、早產組與對照組之人口學分析 51 第二節、早產組與對照組之執行功能分析 56 一、六歲與八歲對照組執行功能Q1分數 56 二、早產組與對照組之執行功能分析 59 三、早產組於六歲與八歲時之執行功能遲緩分析 66 第三節、執行功能遲緩神經心理治療之成效探討 69 一、人口學變項 69 二、個別療效探討 70 第肆章 討論 85 第一節、早產兒執行功能發展 85 第二節、著重於執行功能訓練的神經心理治療之療效分析 85 第三節、研究限制 87 第四節、研究貢獻與展望 88 參考文獻 89

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