臺灣博碩士論文加值系統

本研究擬以了解廣泛語言能力與向度之架構為基礎，融合台灣華語文化背景，編制一套「華語綜合失語症測驗」 (Taiwan Comprehensive Aphasia Test, TCAT)，並做初步的信、效度之分析。
根據國外失語症相關教科書建議測驗編制之架構，並參考國內外失語症測驗內容設計，擬定 TCAT 之編制，送請國內失語症相關學者與臨床專家審視與建議，並執行預試，透過多次討論與修改，完成 TCAT 正式施測版本。
本研究於正式施測時共有 30 位受試者，有 29 位參與兩次 TCAT 之重測信度分析；有 26 位受試者除了施測 TCAT，另外施測簡明失語症測驗 (CCAT)，參與效標關聯效度之分析。此外，邀請兩位臨床語言治療師參與計分者信度之分析。
TCAT 之效度分析方面，在嚴謹地對失語症相關理論基礎與學理的文獻探討，並參考國內外失語症測驗的編制設計，加上專家審視之建議與預試回饋的多次修訂，TCAT 擁有良好的內容效度；利用內部一致性之分測驗與測驗總分相關法的分析，各類別分測驗幾乎獲得中度至高度以上之顯著相關，證實 TCAT 有可接受的建構效度；藉由 CCAT 作為效標量度，檢驗 TCAT 效標關聯效度之同時效標，也在各類別測驗整體之相關達中、高度以上顯著相關，由此可知 TCAT 具備可接受的效標關聯效度。
TCAT 之信度分析方面，在重測信度之分析結果，顯示 TCAT 重測得分之組內相關係數 ICC 值幾乎皆有高度的重測信度。在計分者間與計分者內信度分析結果，獲得不同背景與年資之計分者間，皆達高度信度。
TCAT目前在多項信度與效度的初步檢驗下，皆有可接受的研究成果，預期再細部調整使其更完備後，將於未來能在臨床上有效評估病人之失語症障礙，並提供相關失語症研究之評量，也可有助於後續相關失語症評估工具延伸與發展。

The research goal is to develop a Taiwan Comprehensive Aphasia Test (TCAT) and to examine the reliability and validity, in order to provide an overarching understanding of language ability and levels on Taiwan aphasia patient.
TCAT is a theory-driven evaluation with combination of Chinese language feature under Taiwanese culture and customs. It refers to foreign aphasia textbooks, literatures, and some comprehensive aphasia test. The finalized TCAT has been executed a pilot testing with concise definition, instruction, and applicability of research subtests items, which were fully scrutinized by Language Pathology Professors and Senior Language Pathologists with professional advices.
During this testing process, the author and three Speech-Language Pathologists participated in 30 chronic Aphasia patients TCAT assessment. Of this group, 29 patients experienced twice for retest reliability analysis, 26 patients also performed Concise Chinese Aphasia Test (CCAT) additionally for criterion-related validity. Besides, the author and two Speech-Language Pathologists participated intrarater and intrarater reliability analysis.
Results: According to related reference review and suggestions from professional scholars, clinical Speech-Language Pathologists, and pilot testing feedback, TCAT has a acceptable logical validity. For internal consistency analysis of construct validity, it has shown a moderate to high level substantial relationship in TCAT subtests outcome. As to the concurrent validity of criterion-related validity with CCAT, it has shown a moderate to high level substantial relationship existed in homogenous categories between TCAT and CCAT.
Furthermore, the test-retest test reliability analysis has shown a high level consequence that the ICC global scale was 0.99, and 0.68 to .0.99 for subscales. The interrater and intrarater reliability analysis has also shown a high reliability between Speech-Language Pathologists who have different background and experiences.
Under the multiple preliminary examinations and analyses, TCAT has shown a acceptable validity and reliability performance. For the purpose of this study, it would like to make detail adjustments to provide Aphasia patient clinical practice more valuable database and information for subsequent development in Aphasia patient evaluation.

目 次
論文審定書 i
誌 謝 ii
表 次 x
圖 次 xi
中文摘要 xii
Abstract xiv
第一章 緒論 1
第一節 研究動機 1
第二節 研究目的 5
一、 編制「華語綜合失語症測驗」 5
二、 檢驗「華語綜合失語症測驗」之效度 5
三、 檢驗「華語綜合失語症測驗」之信度 5
第二章 文獻探討 6
第一節 失語症評量 6
一、 失語症定義、影響及評量的重要性 6
二、 失語症評量目的 8
三、 失語症評量內容 8
四、 失語症語言能力評量的種類 10
(一) 評量方式 11
(二) 評量目的 12
1. 篩檢測驗 12
2. 綜合性失語症評量 12
3. 特定功能評量 (specific function evaluation) 13
4. 功能性溝通評量 13
5. 生活品質調查 14
第二節 失語症語言功能的評量 15
一、 聽覺理解 15
(一) 詞彙聽覺理解 15
(二) 語句聽覺理解 17
(三) 短文聽覺理解 19
二、 口語表達 20
(一) 簡單口語表達測驗 (Simple Speech Production Tests) 21
(二) 複誦測驗 21
(三) 詞彙表達 22
(四) 語句表達測驗 25
(五) 對談表達測驗 27
三、 閱讀能力 30
(一) 符號辨識 30
(二) 朗讀能力 31
(三) 閲讀理解能力 33
1. 詞彙閱讀理解 33
2. 語句閱讀理解 34
3. 短文閱讀理解 35
四、 書寫能力 35
(一) 仿寫測驗 36
(二) 序列性書寫測驗 37
(三) 聽寫測驗 37
(四) 自發性書寫測驗 38
五、 肢體動作控制 39
第三節 現有測驗比較 40
一、 國外重要測驗 40
(一) 波區溝通能力指數 (PICA) 40
(二) 波士頓失語症測驗 (BDAE) 42
(三) 西方失語症測驗 (WAB) 44
(四) 心理語言歷程失語症測驗 (PALPA) 47
(五) Comprehensive Aphasia Test (CAT) 48
二、 國內測驗 49
(一) 簡明失語症測驗 49
(二) 其他未出版測驗 52
三、 「華語綜合失語症測驗」之定位 53
第四節 心理計量問題 56
一、 信度 56
(一) 重測信度 (Test-retest Reliability) 57
(二) 複本信度 (Alternate-Form Reliability) 58
(三) 內部一致性方法 (Internal Consistency of the Test) 58
二、 效度 60
(一) 內容效度 (content validity) 60
(二) 效標關聯效度 (criterion-related validity) 61
(三) 建構效度 (construct validity) 61
三、 各失語症測驗心理計量的比較 64
(一) 波區溝通能力指數 64
(二) 波士頓失語症測驗-第三版 65
(三) 修訂西方失語症測驗 66
(四) 簡明失語症測驗 67
第三章 研究一：「華語綜合失語症測驗」之編制 69
第一節 研究程序 69
第二節 研究工具 73
一、 擬定分測驗與題目 73
(一) 聽覺理解 73
1. 詞彙聽覺理解 73
2. 語句聽覺理解 74
3. 短文聽覺理解 75
(二) 口語表達 76
1. 簡單口語表達 76
2. 複誦能力 77
3. 詞彙表達 78
4. 自發性口語表達 80
(三) 閱讀能力 82
1. 符號與詞彙區辨 83
2. 朗讀 83
3. 閱讀理解 84
(1) 字詞閱讀理解 84
(2) 語句閱讀理解 85
(3) 短文閱讀理解 85
(四) 書寫能力 86
1. 仿寫 86
2. 序列性書寫 86
3. 聽寫 87
4. 看圖書寫 87
5. 看國字寫注音 88
(五) 言語機轉評量 89
(六) 肢體動作控制 (praxis) 89
第三節 研究對象 90
第四節 資料分析與統計方法 92
第五節 研究結果 93
一、 華語綜合失語症測驗初版之修訂 93
(一) 聽覺理解 93
1. 詞彙聽覺理解 93
2. 語句聽覺理解 93
3. 短文聽覺理解 94
(二) 口語表達 95
1. 簡單口語表達 95
2. 複誦能力 95
3. 詞彙表達 95
4. 自發性口語表達 96
(三) 閱讀能力 96
1. 符號與詞彙區辨 97
2. 朗讀 97
3. 閱讀理解 98
(1) 字詞閱讀理解 98
(2) 語句閱讀理解 98
(3) 短文閱讀理解 99
(四) 書寫能力 99
1. 仿寫 99
2. 序列性書寫 99
3. 聽寫數字 99
4. 看圖書寫 100
5. 看國字寫注音 100
(五) 言語機轉測驗 100
(六) 肢體動作控制測驗 100
第四章 研究二：「華語綜合失語症測驗」信度、效度之測試 106
第一節 研究對象 106
一、正式施測之受試者 106
二、正式施測之施測者 109
三、計分者間與計分者內信度之參與者 109
第二節 研究工具 111
一、 華語綜合失語症測驗 111
二、 簡明失語症測驗 111
第三節 研究程序 113
第五節 資料分析與統計方法 116
一、 描述性統計 116
二、 效度分析 116
(一) 內容效度分析 116
(二) 效標關聯效度分析-同時效度 116
(三) 建構效度-內部一致性之分測驗分數與測驗總分相關法 117
三、 信度分析 117
(一) 重測信度分析 117
(二) 計分者信度分析 117
第五節 研究結果 118
一、 「華語綜合失語症測驗」效度之檢驗結果 118
(一) 內容效度 118
(二) 建構效度 120
(三) 效標關聯效度 124
二、 「華語綜合失語症測驗」信度之檢驗結果 127
(一) 重測信度檢驗之結果 127
(二) 計分者信度檢驗之結果 131
第五章 討論 132
第一節 「華語綜合失語症測驗」的內容編制 132
一、 「華語綜合失語症測驗」的測驗架構 132
二、 「華語綜合失語症測驗」的測驗內容 133
(一) 是非問句理解分測驗 134
(二) 聽覺詞彙圖片配對分測驗 134
(三) 阿拉伯數字與簡單國字數字配對分測驗 135
(四) 繁體與簡體字配對分測驗 135
(五) 圖字配對分測驗 136
(六) 字圖配對分測驗 136
(七) 書寫姓名分測驗 137
(八) 書寫數字 1-20 分測驗 137
(九) 仿寫分測驗 138
第二節 「華語綜合失語症測驗」之效度 139
一、 建構效度 139
(一) 分測驗與類別測驗總分之相關 139
(二) 各類別測驗分數與測驗總分之相關 142
二、 效標關聯效度 142
(一) TCAT 與 CCAT 間各類別測驗之相關分析 142
(二) TCAT 與 CCAT 間同質性分測驗之相關分析 143
第三節 「華語綜合失語症測驗」的信度 147
一、 重測信度 147
(一) 「是非問句理解」與「字圖配對」分測驗 147
(二) 「阿拉伯數字與簡單國字數字配對」分測驗 149
二、 計分者信度 149
第四節 結論 150
一、 「華語綜合失語症測驗」測驗之編制 150
二、 「華語綜合失語症測驗」之效度分析 150
三、 「華語綜合失語症測驗」之信度分析 150
第五節 研究限制 152
一、 測驗編制的理論與架構 152
二、 收案對象 152
三、 研究方法 152
四、 題目內容 153
五、 不同語言版本 154
第六節 未來研究之建議 155
一、 編制的理論與架構 155
二、 收案對象 155
三、 研究方法 156
四、 題目內容 156
五、 不同語言版本 157
參考文獻 158
中文文獻 158
英文文獻 160
附錄 ……………………………………………………………………………...174
附錄1 各測驗比較 174
附錄2 各測驗聽覺理解分測驗之比較 175
附錄3 各測驗自發性口語表達分測驗之比較 176
附錄4 各測驗唸名分測驗之比較 177
附錄5 各測驗構音靈活度、複誦能力項分測驗之比較 178
附錄6 各測驗閱讀能力分測驗之比較 179
附錄7 各測驗書寫能力分測驗之比較 180
附錄8 編制團隊與內容效度專家名單 181

表 次
表 3-1 失語症流暢度語言特質計分表………………………………………..82
表 3-2 預試正常組之受試者基本資料表……………………………………..90
表 3-3 預試失語症組之受試者基本資料表…………………………………..91
表 3-4 預試正常組受試者意見調查表………………………………………101
表 3-5 預試正常組受試者意見回饋統計表…………………………………101
表 3-6 預試失語症組受試者意見調查表……………………………………102
表 3-7 預試失語症組受試者意見回饋統計表………………………………102
表 4-1 正式收案之受試者基本資料表………………………………………107
表 4-2 參與 TCAT 正式施測之施測者資料表……………………………..109
表 4-3 TCAT 計分者信度參與者之資料表…………………………………110
表 4-4 TCAT 與 CCAT比較效標關聯效度之分測驗……………………...112
表 4-5 正式施測受試者之意見調查表………………………………………119
表 4-6 正式施測受試者之意見回饋統計表…………………………………120
表 4-7 建構效度之內部一致性分析 (類別總分與分測驗總分之相關) …..123
表 4-8 CCAT 各分測驗得分統計表…………………………………………124
表 4-9 TCAT 與 CCAT 各類總分之相關－效標效度分析………………..125
表 4-10 TCAT 與 CCAT 同質性分測驗總分之相關－效標效度分析……..126
表 4-11 兩次 TCAT 各分測驗之得分範圍與平均分數統計表……………..128
表 4-12 TCAT 各分測驗重測 ICC 值……………………………………….130
表 4-13 TCAT 計分者間信度之 ICC 值…………………………………….131
表 4-14 TCAT 計分者內信度之 ICC 值…………………………………….131

圖 次
圖 3-1 TCAT 編制流程圖…………………… ………………………………..72
圖 3-2 TCAT 施測流程圖…………………………………………………….105
圖 4-1 TCAT 信效度檢驗之研究流程圖…………………………………….115

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