動作功能損傷與認知功能缺損在慢性腦中風患者當中為常見症狀，其中上肢功能損傷、注意力缺損和抑制功能缺損為常見的功能缺損。研究顯示自發性使用患側上肢的量、注意力和衝動性皆與慢性腦中風患者的日常生活功能有關，然而，過去研究鮮少將慢性腦中風患者的注意力與衝動性對自發性使用患側上肢量關聯進行研究，本研究針對此議題進行探討。本研究招募21位於慢性期中之初次腦中風患者。注意力與衝動性以彩色路徑描繪測驗（Color Trails Test）評估、自發性使用患側上肢量以上肢動作活動記錄（Motor Activity Log）測量、患側上肢基本動作功能以傅格-梅爾量表（Fugl-Meyer Assessment）評估。研究發現注意力缺損中和高衝動性在慢性腦中風患者中佔有相當之比例，此外較少自發使用患側上肢的慢性腦中風患者可能有較高的衝動性，然而研究亦發現患者在衝動性指標上的表現具有明顯異質性。慢性腦中風患者中的高衝動性可能與低自發性使用患側上肢有關，慢性腦中風患者之注意力缺損可能與高衝動性相關，進而減損自發性使用患側上肢之能力。針對患者衝動性的偵測與介入或許為提升其生活功能之方式，然患者中衝動性的異質性亦需受到關注。

Motor and cognitive impairments are common among patients with chronic stroke, especially impairments in the upper extremity, attention, and inhibition. Research has suggested that the amount of spontaneous affected upper extremity (UE) use, attention, and impulsivity are associated with the activities of daily living functioning among chronic stroke patients respectively. However, very limited studies have evaluated the impacts of attentional impairments and impulsivity on the amount of affected UE among patients with chronic stroke. Thus, the current study aimed to explore these issues. Twenty one chronic patients survived after the first episode of stoke were recruited. Attention functioning and impulsivity were evaluated by using the Color Trials Test (CTT). The amount of spontaneous use and basic motor functions of the affected UE were assessed by using the Motor Activity Log and the Fugl-Meyer Assessment, respectively. The average performance level between patients who often use their affected UEs spontaneously and patients who rarely use their affected UEs spontaneously did not differ on any indices reflecting attention and impulsivity. However, higher ratio of patients who rarely used their affected UEs spontaneously exhibited deficits on an index reflecting impulsivity, as compared to the ratio among patients who often used their affected UEs spontaneously. These findings suggest that impaired attention may be associated with impulsivity among chronic stroke patients. In addition, the impulsivity may be correlated with the reduced spontaneous affected UE use among the patients. However, heterogeneity in impulsivity may also be common among patients with chronic stroke.

中文摘要 iii
Abstract iv
Table of Contents v
List of Tables vii
List of Figures ix
Introduction 1
Post-stroke upper extremity and activities of daily living 1
Post-stroke cognitive impairments 2
Attentional functions 3
Post-stroke attention deficits and ADL 4
Impulsivity and ADL 5
Impulsivity among stroke surviviors 6
Aims 6
Methods 8
Participants 8
Assessment tools 9
Statistical analysis 12
Results 13
Demographics, clinical characteristics, and function of the affected UE 13
Attention and impulsivity among the patients 13
Attention and impulsivity between groups 14
Discussion 16
Attention among stroke survivors 16
Impulsivity among stroke survivors 17
Post-stroke spontaneous use of affected arm and ADL 17
Limitations 18
Conclusion 19
References 21
Appendix 48

Table 1.Cognitive indices of the CTT 30
Table 2. Demographics, clinical characteristics, and function of the affected UE among the participants 31
Table 3. Comparisons of demographics, clinical characteristics, and function of the affected UE between participants with ischemic or hemorrhagic stroke 32
Table 4. Comparisons of demographics, clinical characteristics, and function of the affected UE between participants with paresis in right or left UE 33
Table 5. Comparisons of demographics, clinical characteristics, and function of the affected UE between HSUEU and LSUEU groups 34
Table 6. Number of errors committed by the participants across the CTT cognitive indices 35
Table 7. Number of participants with impaired performance across the CTT cognitive indices 36
Table 8. Comparisons of the performance of participants across the cognitive indices of CTT between participants with ischemic or hemorrhagic stroke 37
Table 9. Comparisons of the performance of participants across the cognitive indices of CTT between participants with left- or right-sided affected UE 38
Table 10. Comparisons of the performance of participants with deficits across the cognitive indices of CTT between HSUEU and LSUEU groups 39
Table 11. Comparisons of the proportion of participants with deficits across the cognitive indices of CTT between participants with ischemic or hemorrhagic stroke 40
Table 12. Comparisons of the proportion of participants with deficits across the cognitive indices of CTT between participants with left- or right-sided affected UE 41
Table 13. Comparisons of the proportion of participants with deficits across the cognitive indices of CTT between HSUEU and LSUEU groups 42
Table 14. Comparisons of the proportion of participants with deficits across the cognitive indices of CTT between age groups (age > 53 years and ≤ 53 years) 43
Table 15. Comparisons of the proportion of participants with deficits across the cognitive indices of CTT between chronicity groups (chronicity > 19 months and ≤ 19 months) 44
Table 16. Comparisons of the proportion of participants with deficits across the cognitive indices of CTT between basic motor function groups (FMA > 47 and ≤ 47) 45

Figure 1. Number and percentage of participants with impaired performance across CTT indices 46
Figure 1. Number of participants with impaired performance across four factors 47

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