题名

腦震盪後症候群:臨床神經心理學觀點

并列篇名

Post-Concussion Syndrome From a Perspective of Clinical Neuropsychology

DOI

10.6550/ACP.202012_14(1_2).0002

作者

楊啟正(Chi-Cheng Yang)

关键词

輕度頭部外傷 ; 腦震盪後症候群 ; 生理—心理—社會 ; 精準治療 ; mild traumatic brain injury ; post-concussion syndrome ; bio-psycho-social ; precision treatment

期刊名称

臨床心理學刊

卷期/出版年月

14卷1/2期(2020 / 12 / 01)

页次

18 - 32

内容语文

繁體中文

中文摘要

目的:腦震盪後症候群(post-concussion syndrome, PCS)為輕度頭部外傷(mild traumatic brain injury, MTBI)後常見的困擾。PCS通常於受傷後三個月內可明顯改善,但仍有許多患者會有持續性之PCS長達一年以上。過去研究已試圖從神經病理與心理社會等多面向來分析此症候群的成因與影響因素,並且找出適當之處遇方法。然而,國內對於MTBI與PCS的瞭解仍較為侷限。有鑑於此,本研究整理國內外對於MTBI與PCS的相關研究,期能提供PCS更加完整的評估與治療。方法:本研究主要從三個不同角度來呈現MTBI與PCS。在臨床特性部分,主要說明PCS的病程與回復狀況。在PCS的可能成因與影響因素方面,分別說明神經病理、心理與整合式成因之看法。在治療方面,則討論PCS的藥物與非藥物治療。最後,則提供關於PCS的三個未來研究方向,包括「PCS的縱貫式呈現」、「個別PCS之影響」與「行動科技對於PCS的治療」。結果:PCS的成因複雜且影響因素眾多,即使過去已有許多不同角度之治療方法,臨床上仍需要謹慎評估每位患者的PCS表現型態。結論:綜合「生理—心理—社會」等面向與特定症狀之分析後,才得以對PCS提供最精準之治療。

英文摘要

Objectives: Post-concussion syndrome (PCS) is not uncommon after mild traumatic brain injury (MTBI). Although PCS improves in three months after injury, a few patients still experience persistent PCS for more than one year. Many researchers have explored the PCS from multiple aspects, including its etiology and influencing factors, but the understanding of PCS and MTBI is still misted in Taiwan. This review thus aims to organize the results of past studies and provide a more comprehensive evaluation and treatment directions for PCS. Methods: This review mainly depicts MTBI and PCS from three perspectives. In terms of clinical features of PCS, the disease course and recovery process are presented. In terms of etiology and associating factors, the neuropathological, psychological and holistic views are illustrated. In addition, the non-pharmacological and pharmacological treatments for PCS are discussed. Lastly, the three future issues of PCS, which includes "the evaluation of longitudinal PCS," "influence from individual PCS," and "mobilized technology for PCS treatment," are presented. Results: A variety of etiologies and factors may contribute to the presence of PCS. Conclusions: Although different evaluations and interventions have been developed, a case formulation focusing on the individual symptom endorsement from "bio-psychosocial" perspectives is merited.

主题分类 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
社會科學 > 心理學
参考文献
  1. American Congress of Rehabilitation Medicine(1993).Definition of mild traumatic brain injury.Journal of Head Trauma Rehabilitation,8(3),86-87.
  2. Arciniegas, D. B.,Anderson, C. A.,Topkoff, J.,McAllister, T. W.(2005).Mild traumatic brain injury: A neuropsychiatric approach to diagnosis, evaluation, and treatment.Neuropsychiatric Disease and Treatment,1(4),311-327.
  3. Ashman, T. A.,Cantor, J. B.,Gordon, W. A.,Spielman, L.,Flanagan, S.,Ginsberg, A.,Engmann, C.,Egan, M.,Ambrose, F.,Greenwald, B.(2009).A randomized controlled trial of sertraline for the treatment of depression in persons with traumatic brain injury.Archives of Physical Medicine and Rehabilitation,90(5),733-740.
  4. Barker-Collo, S.,Theadom, A.,Starkey, N.,Kahan, M.,Jones, K.,Feigin, V.(2018).Factor structure of the Rivermead PostConcussion Symptoms Questionnaire over the first year following mild traumatic brain injury.Brain Injury,32(4),453-458.
  5. Bhatnagar, S.,Iaccarino, M. A.,Zafonte, R.(2016).Pharmacotherapy in rehabilitation of post-acute traumatic brain injury.Brain Research,1640,164-179.
  6. Bigler, E. D.(2013).Neuroimaging biomarkers in mild traumatic brain injury (mTBI).Neuropsychology Review,23(3),169-209.
  7. Bigler, E. D.,Maxwell, W. L.(2012).Neuropathology of mild traumatic brain injury: Relationship to neuroimaging findings.Brain Imaging and Behavior,6(2),108-136.
  8. Binder, L. M.,Rohling, M. L.,Larrabee, G. J.(1997).A review of mild head trauma. Part I: Meta-analytic review of neuropsychological studies.Journal of Clinical and Experimental Neuropsychology,19(3),421-431.
  9. Borgaro, S. R.,Prigatano, G. P.,Kwasnica, C.,Rexer, J. L.(2003).Cognitive and affective sequelae in complicated and uncomplicated mild traumatic brain injury.Brain Injury,17(3),189-198.
  10. Broshek, D. K.,De Marco, A. P.,Freeman, J. R.(2015).A review of post-concussion syndrome and psychological factors associated with concussion.Brain Injury,29(2),228-237.
  11. Carroll, L. J.,Cassidy, J. D.,Peloso, P. M.,Borg, J.,von Holst, H.,Holm, L.,Paniak, C.,Pépin, M.(2004).Prognosis for mild traumatic brain injury: Results of the WHO Collaborating Centre task force on mild traumatic brain injury.Journal of Rehabilitation Medicine,36(Suppl. 43),84-105.
  12. Chamelian, L.,Feinstein, A.(2004).Outcome after mild to moderate traumatic brain injury: The role of dizziness.Archives of Physical Medicine and Rehabilitation,85(10),1662-1666.
  13. Chu, S.-Y.,Tsai, Y.-H.,Xiao, S.-H.,Huang, S.-J.,Yang, C.-C.(2017).Quality of return to work in patients with mild traumatic brain injury: A prospective investigation of associations among post-concussion symptoms, neuropsychological functions, working status and stability.Brain Injury,31(12),1674-1682.
  14. Cicerone, K. D.(2002).Remediation of "working attention" in mild traumatic brain injury.Brain Injury,16(3),185-195.
  15. Cicerone, K. D.,Dahlberg, C.,Kalmar, K.,Langenbahn, D. M.,Malec, J. F.,Bergquist, T. F.,Felicetti, T.,Giacino, J. T.,Harley, J. P.,Harrington, D. E.,Herzog, J.,Kneipp, S.,Laatsch, L.,Morse, P. A.(2000).Evidence-based cognitive rehabilitation: Recommendations for clinical practice.Archives of Physical Medicine and Rehabilitation,81(12),1596-1615.
  16. Comper, P.,Bisschop, S. M.,Carnide, N.,Tricco, A.(2005).A systematic review of treatments for mild traumatic brain injury.Brain Injury,19(11),863-880.
  17. Cooper, D. B.,Bunner, A. E.,Kennedy, J. E.,Balldin, V.,Tate, D. F.,Eapen, B. C.,Jaramillo, C. A.(2015).Treatment of persistent post-concussive symptoms after mild traumatic brain injury: A systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans.Brain Imaging and Behavior,9(3),403-420.
  18. Corso, P.,Finkelstein, E.,Miller, T.,Fiebelkorn, I.,Zaloshnja, E.(2006).Incidence and lifetime costs of injuries in the United States.Injury Prevention,12(4),212-218.
  19. Curran, C. A.,Ponsford, J. L.,Crowe, S.(2000).Coping strategies and emotional outcome following traumatic brain injury: A comparison with orthopedic patients.Journal of Head Trauma Rehabilitation,15(6),1256-1274.
  20. Depp, C. A.,Mausbach, B.,Granholm, E.,Cardenas, V.,Ben-Zeev, D.,Patterson, T. L.,Lebowitz, B. D.,Jeste, D. V.(2010).Mobile interventions for severe mental illness: Design and preliminary data from three approaches.The Journal of Nervous and Mental Disease,198(10),715-721.
  21. Dikmen, S.,Machamer, J.,Temkin, N.(2017).Mild traumatic brain injury: Longitudinal study of cognition, functional status, and post-traumatic symptoms.Journal of Neurotrauma,34(8),1524-1530.
  22. Dischinger, P. C.,Ryb, G. E.,Kufera, J. A.,Auman, K. M.(2009).Early predictors of postconcussive syndrome in a population of trauma patients with mild traumatic brain injury.Journal of Trauma: Injury, Infection, and Critical Care,66(2),289-297.
  23. Evans, R. W.,Evans, R. I.,Sharp, M. J.(1994).The physician survey on the post-concussion and whiplash syndromes.Headache: The Journal of Head and Face Pain,34(5),268-274.
  24. Fenton, G.,McClelland, R.,Montgomery, A.,MacFlynn, G.,Rutherford, W.(1993).The postconcussional syndrome: Social antecedents and psychological sequelae.The British Journal of Psychiatry,162(4),493-497.
  25. Fourtassi, M.,Hajjioui, A.,Ouahabi, A. E.,Benmassaoud, H.,Hajjaj-Hassouni, N.,Khamlichi, A. E.(2011).Long term outcome following mild traumatic brain injury in Moroccan patients.Clinical Neurology and Neurosurgery,113(9),716-720.
  26. Franklin, V. L.,Waller, A.,Pagliari, C.,Greene, S. A.(2006).A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes.Diabetic Medicine,23(12),1332-1338.
  27. Garden, N.,Sullivan, K. A.(2010).An examination of the base rates of post-concussion symptoms: The influence of demographics and depression.Applied Neuropsychology,17(1),1-7.
  28. Garden, N.,Sullivan, K. A.,Lange, R. T.(2010).The relationship between personality characteristics and postconcussion symptoms in a nonclinical sample.Neuropsychology,24(2),168-175.
  29. Gasquoine, P. G.(1997).Postconcussion symptoms.Neuropsychology Review,7(2),77-85.
  30. Greiffenstein, M. F.,Baker, W. J.(2001).Comparison of premorbid and postinjury MMPI-2 profiles in late postconcussion claimants.The Clinical Neuropsychologist,15(2),162-170.
  31. Hedtke, P. A.(2008).Can wireless technology enable new diabetes management tools?.Journal of Diabetes Science and Technology,2(1),127-130.
  32. Hiploylee, C.,Dufort, P. A.,Davis, H. S.,Wennberg, R. A.,Tartaglia, M. C.,Mikulis, D.,Hazrati, L.-N.,Tator, C. H.(2017).Longitudinal study of postconcussion syndrome: Not everyone recovers.Journal of Neurotrauma,34(8),1511-1523.
  33. Hsu, H.-H.,Lai, W.-H.,Yu, H.-T.,Xiao, S.-H.,Tsai, Y.-H.,Wang, K.-C.,Huang, S.-J.,Yang, C.-C.(2020).Long-term presentation of postconcussion symptoms and associated factors: Analysis of latent class modeling.Archives of Clinical Neuropsychology,36(1),62-73.
  34. Hyder, A. A.,Wunderlich, C. A.,Puvanachandra, P.,Gururaj, G.,Kobusingye, O. C.(2007).The impact of traumatic brain injuries: A global perspective.NeuroRehabilitation,22(5),341-353.
  35. Iverson, G. L.(2019).Network analysis and precision rehabilitation for the post-concussion syndrome.Frontiers in Neurology,10,Article 489.
  36. Iverson, G. L.,Lange, R. T.,Brooks, B. L.,Rennison, V. L. A.(2010)."Good old days" bias following mild traumatic brain injury.The Clinical Neuropsychologist,24(1),17-37.
  37. Karr, J. E.,Iverson, G. L.,Huang, S.-J.,Silverberg, N. D.,Yang, C. C.(2020).Perceived change in physical, cognitive, and emotional symptoms after mild traumatic brain injury in patients with pre-injury anxiety or depression.Journal of Neurotrauma,37(10),1183-1189.
  38. Kendall, E.(1996).Psychosocial adjustment following closed head injury: A model for understanding individual differences and predicting outcome.Neuropsychological Rehabilitation,6(2),101-132.
  39. King, N. S.(2003).Post-concussion syndrome: Clarity amid the controversy?.The British Journal of Psychiatry,183(4),276-278.
  40. Kopelowicz, A.,Liberman, R. P.,Zarate, R.(2006).Recent advances in social skills training for schizophrenia.Schizophrenia Bulletin,32(Suppl. 1),12-S23.
  41. Lange, R. T.,Iverson, G. L.,Rose, A.(2011).Depression strongly influences postconcussion symptom reporting following mild traumatic brain injury.Journal of Head Trauma Rehabilitation,26(2),127-137.
  42. Lercher, K.,Reddy, C. C.(2014).Treating prolonged symptoms of mild traumatic brain injury: Neuropharmacology.Progress in Neurological Surgery,28,139-148.
  43. Management of Concussion/mTBI Working Group(2009).Clinical practice guideline: Management of concussion/mild traumatic brain injury.Journal of Rehabilitation Research & Development,46(6),CP1-CP68.
  44. McCrea, M.A.(2007).PCS as a neuropsychological disorder.Mild traumatic brain injury and postconcussion syndrome-The new evidence base for diagnosis and treatment
  45. Miller, L. P.(Ed.),Hayes, R. L.(Ed.),Newcomb, J. K.(Ed.)(2001).Head trauma: Basic, preclinical, and clinical directions.John Wiley & Sons.
  46. Mittenberg, W.,Canyock, E. M.,Condit, D.,Patton, C.(2001).Treatment of post-concussion syndrome following mild head injury.Journal of Clinical and Experimental Neuropsychology,23(6),829-836.
  47. Mittenberg, W.,Tremont, G.,Zielinski, R. E.,Fichera, S.,Rayls, K. R.(1996).Cognitive-behavioral prevention of postconcussion syndrome.Archives of Clinical Neuropsychology,11(2),139-145.
  48. Mittenberg, W.,Zielinski, R.,Fichera, S.(1993).Recovery from mild head injury: A treatment manual for patients.Psychotherapy in Private Practice,12(2),37-52.
  49. Patrick, K.,Griswold, W. G.,Raab, F.,Intille, S. S.(2008).Health and the mobile phone.American Journal of Preventive Medicine,35(2),177-181.
  50. Peeters, W.,van den Brande, R.,Polinder, S.,Brazinova, A.,Steyerberg, E. W.,Lingsma, H. F.,Maas, A. I. R.(2015).Epidemiology of traumatic brain injury in Europe.Acta Neurochirurgica,157(10),1683-1696.
  51. Pharow, P.,Blobel, B.,Ruotsalainen, P.,Petersen, F.,Hovsto, A.(2009).Portable devices, sensors and networks: Wireless personalized eHealth services.Studies in Health Technology and Informatics,150,1012-1016.
  52. Plass, A. M.,Van Praag, D.,Covic, A.,Gorbunova, A.,Real, R.,von Steinbuechel, N.,Dutch and Flemish CENTER TBI investigators(2019).The psychometric validation of the Dutch version of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) after traumatic brain injury (TBI).PloS One,14(10),Article e0210138.
  53. Ponsford, J.,Cameron, P.,Fitzgerald, M.,Grant, M.,Mikocka-Walus, A.,Schönberger, M.(2012).Predictors of postconcussive symptoms 3 months after mild traumatic brain injury.Neuropsychology,26(3),304-313.
  54. Ponsford, J.,Nguyen, S.,Downing, M.,Bosch, M.,McKenzie, J. E.,Turner, S.,Chau, M.,Mortimer, D.,Gruen, R. L.,Knott, J.,Green, S.(2019).Factors associated with persistent post-concussion symptoms following mild traumatic brain injury in adults.Journal of Rehabilitation Medicine,51(1),32-39.
  55. Ponsford, J.,Willmott, C.,Rothwell, A.,Cameron, P.,Kelly, A.-M.,Nelms, R.,Curran, C.(2002).Impact of early intervention on outcome following mild head injury in adults.Journal of Neurology, Neurosurgery & Psychiatry,73(3),330-332.
  56. Potter, S.,Brown, R. G.(2012).Cognitive behavioural therapy and persistent post-concussional symptoms: Integrating conceptual issues and practical aspects in treatment.Neuropsychological Rehabilitation,22(1),1-25.
  57. Robertson, E., Jr.,Rath, B.,Fournet, G.,Zelhart, P.,Estes, R.(1994).Assessment of mild brain trauma: A preliminary study of the influence of premorbid factors.Clinical Neuropsychologist,8(1),69-74.
  58. Ruff, R.(2005).Two decades of advances in understanding of mild traumatic brain injury.Journal of Head Trauma Rehabilitation,20(1),5-18.
  59. Ruff, R. M.,Camenzuli, L.,Mueller, J.(1996).Miserable minority: Emotional risk factors that influence the outcome of a mild traumatic brain injury.Brain Injury,10(8),551-566.
  60. Rush, B. K.,Malec, J. F.,Moessner, A. M.,Brown, A. W.(2004).Preinjury personality traits and the prediction of early neurobehavioral symptoms following mild traumatic brain injury.Rehabilitation Psychology,49(4),275-281.
  61. Rutherford, W. H.(1989).Postconcussion symptoms: Relationship to acute neurological indices, individual differences, and circumstances of injury.Mild head injury
  62. Ryan, L. M.,Warden, D. L.(2003).Post concussion syndrome.International Review of Psychiatry,15(4),310-316.
  63. Sayegh, A. A.,Sandford, D.,Carson, A. J.(2010).Psychological approaches to treatment of postconcussion syndrome: A systematic review.Journal of Neurology, Neurosurgery & Psychiatry,81(10),1128-1134.
  64. Scheenen, M. E.,van der Horn, H. J.,de Koning, M. E.,van der Naalt, J.,Spikman, J. M.(2017).Stability of coping and the role of self-efficacy in the first year following mild traumatic brain injury.Social Science & Medicine,181,184-190.
  65. Schultz, B. A.,Cifu, D. X.,McNamee, S.,Nichols, M.,Carne, W.(2011).Assessment and treatment of common persistent sequelae following blast induced mild traumatic brain injury.NeuroRehabilitation,28(4),309-320.
  66. Servadei, F.,Teasdale, G.,Merry, G.(2001).Defining acute mild head injury in adults: A proposal based on prognostic factors, diagnosis, and management.Journal of Neurotrauma,18(7),657-664.
  67. Shenton, M. E.,Hamoda, H. M.,Schneiderman, J. S.,Bouix, S.,Pasternak, O.,Rathi, Y.,Vu, M.-A.,Purohit, M. P.,Helmer, K.,Koerte, I.,Lin, A. P.,Westin, C.-F.,Kikinis, R.,Kubicki, M.,Stern, R. A.,Zafonte, R.(2012).A review of magnetic resonance imaging and diffusion tensor imaging findings in mild traumatic brain injury.Brain Imaging and Behavior,6(2),137-192.
  68. Silverberg, N. D.,Hallam, B. J.,Rose, A.,Underwood, H.,Whitfield, K.,Thornton, A. E.,Whittal, M. L.(2013).Cognitive-behavioral prevention of postconcussion syndrome in at-risk patients: A pilot randomized controlled trial.Journal of Head Trauma Rehabilitation,28(4),313-322.
  69. Silverberg, N. D.,Panenka, W. J.,Iverson, G. L.(2018).Work productivity loss after mild traumatic brain injury.Archives of Physical Medicine and Rehabilitation,99(2),250-256.
  70. Snell, D. L.,Hay-Smith, E. J. C.,Surgenor, L. J.,Siegert, R. J.(2013).Examination of outcome after mild traumatic brain injury: The contribution of injury beliefs and Leventhal’s common sense model.Neuropsychological Rehabilitation,23(3),333-362.
  71. Tate, D. F.,Finkelstein, E. A.,Khavjou, O.,Gustafson, A.(2009).Cost effectiveness of internet interventions: Review and recommendations.Annals of Behavioral Medicine,38(1),40-45.
  72. Teasdale, G.,Jennett, B.(1974).Assessment of coma and impaired consciousness: A practical scale.The Lancet,304(7872),81-84.
  73. Theadom, A.,Starkey, N.,Barker-Collo, S.,Jones, K.,Ameratunga, S.,Feigin, V.,BIONIC4you Research Group(2018).Population-based cohort study of the impacts of mild traumatic brain injury in adults four years post-injury.PloS One,13(1),Article e0191655.
  74. Thornhill, S.,Teasdale, G. M.,Murray, G. D.,McEwen, J.,Roy, C. W.,Penny, K. I.(2000).Disability in young people and adults one year after head injury: Prospective cohort study.Britich Medical Journal,320,1631-1635.
  75. Trahan, D. E.,Ross, C. E.,Trahan, S. L.(2001).Relationships among postconcussional-type symptoms, depression, and anxiety in neurologically normal young adults and victims of mild brain injury.Archives of Clinical Neuropsychology,16(5),435-445.
  76. Vikane, E.,Hellstrøm, T,Røe, C.,Bautz-Holter, E.,Aßmus, J.,Skouen, J. S.(2016).Predictors for return to work in subjects with mild traumatic brain injury.Behavioural Neurology,2016,Article 8026414.
  77. Warriner, E. M.,Rourke, B. P.,Velikonja, D.,Metham, L.(2003).Subtypes of emotional and behavioural sequelae in patients with traumatic brain injury.Journal of Clinical and Experimental Neuropsychology,25(7),904-917.
  78. Webb, T.,Joseph, J.,Yardley, L.,Michie, S.(2010).Using the Internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy.Journal of Medical Internet Research,12(1),Article e4.
  79. Williams, D. H.,Levin, H. S.,Eisenberg, H. M.(1990).Mild head injury classification.Neurosurgery,27(3),422-428.
  80. Yang, C.-C.,Chiu, H.-C.,Xiao, S.-H.,Tsai, Y.-H.,Lee, Y.-C.,Ku, Y.-T.,Lin, R.-S.,Lin, W.-C.,Huang, S.-J.(2018).Iatrogenic effect? Cautions when utilizing an early health education for post-concussion symptoms.Archives of Clinical Neuropsychology,33(2),131-142.
  81. Yang, C.-C.,Hua, M.-S.,Tu, Y.-K.,Huang, S.-J.(2009).Early clinical characteristics of patients with persistent post-concussion symptoms: A prospective study.Brain Injury,23(4),299-306.
  82. Yang, C.-C.,Tu, Y.-K.,Hua, M.-S.,Huang, S.-J.(2007).The association between the postconcussion symptoms and clinical outcomes for patients with mild traumatic brain injury.Journal of Trauma: Injury, Infection, and Critical Care,62(3),657-663.
  83. Yang, C.-C.,Yuen, K.-M.,Huang, S.-J.,Hsiao, S.-H.,Tsai, Y.-H.,Lin, W.-C.(2014)."Good-old-days" bias: A prospective follow-up study to examine the preinjury supernormal status in patients with mild traumatic brain injury.Journal of Clinical and Experimental Neuropsychology,36(4),399-409.
  84. Yue, J. K.,Cnossen, M. C.,Winkler, E. A.,Deng, H.,Phelps, R. R. L.,Coss, N. A.,Sharma, S.,Robinson, C. K.,Suen, C. G.,Vassar, M. J.,Schnyer, D. M.,Puccio, A. M.,Gardner, R. C.,Yuh, E. L.,Mukherjee, P.,Valadka, A. B.,Okonkwo, D. O.,Lingsma, H. F.,Manley, G. T.,TRACK-TBI Investigators(2019).Pre-injury comorbidities are associated with functional impairment and post-concussive symptoms at 3- and 6-months after mild traumatic brain injury: A TRACK-TBI study.Frontiers in Neurology,10,Article 343.
  85. Yuen, K.-M.,Tsai, Y.-H.,Lin, W.-C.,Yang, C.-C.,Huang, S.-J.(2016).Retrospectively evaluated preinjury personality traits influence postconcussion symptoms.Applied Neuropsychology: Adult,23(5),322-332.
  86. Zasler, N. D.(Ed.),Katz, D. I.(Ed.),Zafonte, R. D.(Ed.)(2007).Brain injury medicine: Principles and practice.Demos.
  87. Zee, D. S.(1985).Perspectives on the pharmacotherapy of vertigo.JAMA Otolaryngology-Head & Neck Surgery,111(9),609-612.
  88. 紀煥庭,邱文達,楊大羽,蔡行瀚(2007)。台北市輕度頭部外傷之流行病學及醫療資源使用情形。中華民國急救加護醫學會雜誌,18(2),61-70。
  89. 游于涵(2014)。長庚大學。
  90. 衛生福利部統計處(2019)。107 年度全民健康保險醫療統計年報。https://dep.mohw.gov.tw/DOS/lp-5103-113-xCat-y107.html