Effects of Theory of Mind on Frequency of Social Interaction in Patients with Traumatic Brain Injury

在受傷後多年，許多頭部外傷病人仍有社交問題。探討社交功能之主要影響因子，可作為安排復健計畫之參考，有助於病人未來社交互動，也可以避免對社會造成負擔。過去研究一致支持頭部外傷病人常在失態偵測作業表現不好，與其前額葉損傷有關，影響個體在社會情境中推論他人的想法與情緒。然而，過去研究未探討心智推理能力對於社交功能表現之影響程度，也未比較該能力和執行功能與語文理解智力對於社交功能表現的重要性。 研究受試者為30位輕度與中重度頭部外傷病人與29位正常人，所有病人透過電腦斷層掃描或磁振照影顯示腦部神經病理證據。每位受試者皆進行完整神經心理學測驗與失態偵測作業，而且頭部外傷病人與其家屬頇分別填寫社交功能表現問卷。先透過預備性研究，修訂適合國內使用的社交功能表現問卷並進行信效度研究，然後在正式研究中，使用該問卷評估病人社交功能現況分數與改變分數。 研究結果顯示，比較病人與正常人的社交功能表現，輕度頭部外傷病人與中重度頭部外傷病人表現較差；比較創傷前與目前社交功能表現，輕度頭部外傷病人與中重度頭部外傷病人目前表現較差。迴歸分析結果，語文理解智力分數與失態偵測作業表現是病人自評的社交功能現況分數與改變分數的顯著影響因子，解釋力為51％ ~ 52％；語文理解智力分數是家屬評估的社交功能現況分數與改變分數的顯著影響因子，解釋力為22％ ~ 33％。 依據上述研究結果，頭部外傷病人不論其創傷的嚴重程度皆呈現社交功能的問題，影響這些功能的改變主要源自病人語文理解智力與心智推理能力的受損。有鑑於此，本研究結果建議將這兩項功能評估納入頭部外傷病人的神經心理衡鑑中，以利於安排改善病人社交功能表現之復建計畫。Poor social functional outcome is common among patients with traumatic brain injury (TBI) even years after the injury. Exploring the main factors contributing social functional outcome will provide useful information for rehabilitation plans, which would help with patient’s social interaction and reduce possible social cost. Previous results supported that TBI patients had poor performances on the faux pas task. This is probably due to their prefrontal lesions that affect their ability to infer others’ thoughts and feelings in social context. However, previous studies neither explore the effect of theory of mind on social functional outcome, nor compare the importance of theory of mind with executive function and verbal comprehension intelligence. Thirty mild, moderate and severe TBI patients as well as twenty nine normal controls participated in the present study. All TBI patients’ brain computed tomography or magnetic resonance imaging showed abnormal findings. Each participant received a battery of neuropsychological tests and the faux pas task. TBI patients and their families also completed a social functional outcome questionnaire that had been revised and validated in Taiwan in pilot study. Current score and change score of social function outcome were both measured. The results revealed that both mild TBI patients as well as moderate and severe TBI patients had significantly poor performance on the social functional outcome questionnaire than the control group. Meanwhile, they performed significantly poorer on the social functional outcome than they did at the pre-morbid state. Performance scores of the faux pas task and the verbal comprehension intelligence test were significantly contributory to the patients’ self ratings of the current score and the change score of the social functional outcome questionnaire, accounting for 51％ ~ 52％ of the variance. However, only the verbal comprehension intelligence test significantly contributed to the family measures’ ratings of the current score and the change score of the social functional outcome questionnaire, accounting for 22％ ~ 33％ of the variance. Based on the results, TBI patients had significantly lower frequency of social interaction after injury regardless of the severity resulting from the impairment of verbal comprehension intelligence and theory of mind. It is thus suggested that neuropsychological assessment including the tests of theory of mind and verbal comprehension intelligence could directly link to proper rehabilitation plans to improve patients’ social functions