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研究生: 簡珮馨
Jian, Pei-Sin
論文名稱: 聆聽喜愛音樂對急性腦傷患者功能復原影響之探討
Effects of Listening to Pleasant Music on Recovery of General Function in Acute Patients with Brain Injury
指導教授: 蔡佩倫
Tsai, Pei-Luen
學位類別: 碩士
Master
系所名稱: 醫學院 - 職能治療學系
Department of Occupational Therapy
論文出版年: 2015
畢業學年度: 103
語文別: 中文
論文頁數: 151
中文關鍵詞: 腦傷音樂警醒度認知顱內壓
外文關鍵詞: brain injury, music, arousal, cognition, intracranial pressure
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  • 在腦傷後的急性期階段,醫療人員多致力給予患者醫療及護理介入以提升其存活率,但對於病患之警醒度及認知功能的恢復卻較無法提供具體的協助。感覺刺激介入計畫已被建議做為急性腦傷患者的主要臨床介入策略,用以提升其警醒反應。先前相關研究多藉由聆聽親人聲音為主要的感覺刺激來源,但發現對患者之生理功能和動作表現的影響並不一致。由於相較於一般聽覺刺激,聆聽音樂可能更具有誘發情緒及調節警醒度的作用,在近年來已成為腦傷患者之認知復健的新興療法之一;然而,迄今卻少有研究針對急性期腦傷患者檢驗聆聽音樂的療效。故本研究的目的在於探討聆聽喜愛音樂對加護病房急性期腦傷患者之警醒度和功能復原的影響。本研究於台灣南部地區醫院招募15位神經外科加護病房之腦傷病患,採隨機控制試驗方式分成兩組(喜愛音樂組與親人聲音組)進行。主要介入方式為讓個案每天聆聽兩次喜愛音樂或親人聲音各15分鐘,持續3至5天。成效評量包括顱內壓數值、心跳速率及血壓等生理測量值,以及動作行為的改變量,並在介入後一個月以格拉斯哥昏迷量表(Glasgow Coma Scale)、擴充版格拉斯預後量表(Glasgow Outcome Scale-Extended)、簡易智能量表(Mini-mental state examination)及巴氏量表(Barthel Index)評量個案之基本認知功能及日常生活自我照顧能力。研究結果主要發現,喜愛音樂可促進急性期腦傷患者的粗大動作反應,同時改善長期的整體意識恢復狀態;而親人聲音則無此正向效果。本研究的成果初步支持聆聽喜愛音樂對急性期腦傷患者之功能復原的效益。未來研究可擴大樣本數以驗證本研究之成果。

    The purpose of this study is to investigate the effects of listening to pleasant music on the arousal and general function for acute patients with brain injury in the intensive care unit (ICU). In the repeated measures designs study, a total of 15 patients with brain injury in the ICU were recruited and were divided into two groups (pleasant music group and family voice group) with stratified randomized controlled approach. All subjects were given to listening to their preferred pleasant music or family voice for 15 minutes twice a day for up to 3 to 5 days. Outcome measures for the intervention included behavioral performance, physiological function, and other functional assessments. Results revealed that the participants produced more gross motor behaviors while listening to pleasant music, and showed improvement on states of consciousness after the intervention finished and during the follow-up phase. However, participants of family voice group showed no significant differences in all outcome measures. The findings support the positive effects of pleasant music on functional recovery in acute patients with brain injury. Future research with larger study populations is necessary to validate these findings.

    中文摘要 i 英文延伸摘要 ii 致謝 vii 目錄 ix 表目錄 xiv 圖目錄 xv 第一章 緒論 1 第一節 動機與重要性 1 第二節 研究目的與研究假設 4 第二章 文獻回顧 6 第一節 加護病房急性期腦傷患者之處置簡介與職能治療的角色 6 壹、 腦傷定義與機制 6 貳、 急性期腦傷患者的介入模式 8 參、 加護病房環境之特性與對急性腦傷患者所導致的認知問題 10 肆、 職能治療師在加護病房中的角色 13 第二節 感覺刺激介入於腦傷個案的應用 17 壹、 理論基礎與運作機制 17 貳、 感覺刺激介入與職能治療 19 參、 聽覺刺激對腦傷患者的影響及相關研究 22 第三節 音樂刺激於腦傷患者之認知功能的應用 28 壹、 音樂與認知功能 29 貳、 音樂對警醒度的影響 31 參、 音樂對情緒的影響 34 肆、 相關理論與神經機制 37 伍、 情緒與警醒度的測量 40 第四節 聆聽音樂應用於急性期腦傷患者之相關研究 43 第五節 文獻回顧總結 47 第三章 研究方法 50 第一節 研究對象 50 第二節 研究工具 51 壹、基本資料表 51 貳、動作行為改變紀錄表 51 參、格拉斯哥昏迷量表(Glasgow Coma Scale, GCS) 52 肆、簡易智能量表(Mini-mental state examination, MMSE) 52 伍、巴氏量表(Barthel Index) 53 陸、格拉斯預後量表擴充版(Glasgow outcome scale—extended) 53 第三節 研究設備 55 壹、生理監測器 55 貳、顱內壓監測器或腦室外引流管 55 參、擴音喇叭與分貝機 56 肆、攝影機 57 伍、聽覺刺激類型 57 第四節 研究程序 59 第五節 資料統計分析 62 第四章 研究結果 65 第一節 受試者基本資料 65 第二節 喜愛音樂組之音樂類型分析 67 第三節 聆聽喜愛音樂對急性期腦傷患者之短期療效分析 69 壹、動作表現 69 貳、生理功能 70 參、意識狀態 71 第四節 聆聽喜愛音樂對急性期腦傷患者之長期療效分析 73 壹、意識狀態 73 貳、基本認知功能 74 參、日常生活自我照顧能力 75 肆、腦傷後功能性復原狀況 76 伍、住院天數 77 陸、追蹤期之居住地點現況 77 第五章 討論 78 第一節 喜愛音樂對急性期腦傷患者之動作表現的影響 79 第二節 喜愛音樂對急性期腦傷患者之生理功能的影響 85 第三節 喜愛音樂對急性期腦傷患者之長期成效探討 89 第四節 喜愛音樂對急性期腦傷患者的臨床應用性 93 第五節 研究限制與未來方向 95 第六章 結論 97 參考文獻 98 附錄 142

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