康复医学)运动疗法.ppt

运动疗法 Kinesiotherapy,P106,掌握 理论0.5学时,运动疗法的基本概念、疗法特点、应用原则及它在康复中的作用。,What is Kinesiotherapy?,运动疗法是根据伤病的特点，采取体育运动的手段或机体功能练习的方法，以达到伤病的预防、治疗及康复的目的。 Kinesiotherapy utilizes kinesiology, the science of human movement, to design and implement therapeutic exercise programs for individuals with musculoskeletal injuries and/or neuromuscular disorders.,运动疗法kinesitherapy /exercise,effects作用： to prevent and improve the disable or handicap 预防和治疗功能障碍 1.提高中枢神经系统和植物神经系统的调节(regulate)能力 2.提高代谢(metabolism)能力，改善心肺功能 3.维持和恢复运动器官的shape和function 4.促进compensation mechanism(代偿机制)的formation(形成)和发展,Kinesiotherapy is defined as the application of scientifically based exercise principles adapted to enhance the strength, endurance, and mobility of individuals with functional limitations or those requiring extended physical conditioning.,运 动 治疗therapeutic exercise,运动治疗技术： 关节活动技术 joint motion 软组织牵伸技术 stretching 肌力训练技术 muscle power training Neurodevelopment treatment,NDT 神经发育疗法 Rood、Bobath、 Brunnstrom、 PNF。 motor relearning program, MRP 运动再学习 Constraint-induced movement therapy,CIMT强制性使用运动疗法,运 动 疗 法 exercise,关节活动技术 被动活动（passive activity）：手法、器械 CPM、牵引 助力运动（assistive exercise）：器械练习、悬吊练习、滑轮练习 主动运动（active exercise）：体操 注意：全范围、各方向,运 动 疗 法 kinesiotherapy exercise,软组织牵伸技术stretching 拉长挛缩或缩短软组织的治疗方法。 增加伸展性、降低肌张力、增加关节活动范围 手法牵伸 自我牵伸 器械辅助下牵伸 要点： 时间、放松 临床应用：颈腰痛、外伤后 腰背肌的牵伸、膝后肌及跟腱的牵伸、运动前预备活动,Stretching Stretching and flexibility exercises should include every major joint (hip, back, shoulder, knee, upper trunk, neck). It is best not to stretch “cold“ muscles, so engage in a few minutes of low intensity aerobic exercise first. Movement into a stretch should be slow, and the stretch itself should be held for approximately 10 to 30 seconds. Do not bounce while beginning or performing a stretch. Each exercise should be performed several times. Stretch and yoga classes are also a good way to remain flexible. The stretch should not cause pain, but only mild discomfort.,运 动 疗 法 kinesiotherapy exercise,2.肌力训练技术 方法： 肌肉收缩方式-等长isometric 、等张isotonic 是否施加阻力-抗阻（resistive training） 等张（concentric/eccentric） 等长isometric 等速(isokinetic exercise) -非抗阻,肌力大小选择方法 0-1级：神经肌肉电刺激 1-2级：助力运动 3级：主动运动 4级：主动，抗阻,Resistance training,Resistance training can be done with weights, machines, or exercise bands. It should be performed at least twice a week with at least 48 hours of rest between sessions. Resistance training is commonly described in terms of “sets“ of “repetitions.“,渐进抗阻训练,10RM , , 全量 渐进抗阻、减退抗阻,运 动 疗 法 kinesiotherapy exercise,增强肌力训练原则 1.阻力原则 2.超常负荷原则 3.训练次数宜多 4.至疲劳但不过度疲劳,注意事项,肌群muscle groups 1.心血管反应 2.选择适当的训练方法 3.阻力施加及调整 4.掌握好运动量,神经发育疗法Neurodevelopment treatment,NDT,治疗原则： 以神经系统作为治疗重点对象，将神经发育学、神经生理学的基本原理和法则应用到脑损伤后肢体运动障碍的康复治疗中。 典型代表： Bobath技术、 Brunnstrom技术、 Rood 技术、Kabat-Knott-Voss(PNF)技术,Neurodevelopmental Approaches (1940-70s),Sensorimotor Approach (Rood, 1940s) Movement Therapy Approach (Brunnstrom, 1950s) NDT Approach (Bobath, 1960-70s) PNF Approach (Knot and Voss, 1960-70s),治疗目的 把治疗与功能活动结合，在治疗环境中学习动作、使用动作、发展技巧性动作。,治疗顺序 头尾，近端远端 等长等张 离心性控制向心性控制 对称性的运动模式不对称的运动模式 学习和控制动作,治疗方法 多种感觉刺激：躯体、语言、视觉 反复强化,工作方式： 早期、综合、相关专业配合 患者和家属的主动参与,Brunnstroms Movement Therapy Approach,Emphasised the synergistic patterns of movement that develop during recovery from hemiplegia. She encouraged the development of flexor and extensor synergies during early recovery, hoping that synergistic activation of muscle would, with training, transition into voluntary activation.,Bobaths Neurodevelopmental Technique Approach,Aims to inhibit spasticity and synergies, using inhibitory postures and movements, and to facilitate normal autonomic responses that are involved in voluntary movement.,Roods Sensorimotor Approach,Involves superficial cutaneous stimulation using stroking, brushing, icing, or muscle stimulation with vibration, to evoke voluntary activation.,PNF Approach Proprioceptive Neuromuscular Stimulation,Relies on quick stretching and manual resistance of muscle activation of the limbs in functional directions, which often are spiral and diagonal in direction.,motor relearning program, MRP 运动再学习,概念：以神经生理学、运动科学、生物力学、行为科学等为理论基础，以脑损伤后的可塑性和功能重组为理论依据，把中枢神经系统损伤后运动功能的恢复训练视为一种再学习或再训练的过程。 实现功能重组的主要条件：针对性的重复训练，练习越多，重组越有效。,MRP由7个部分组成： 1.上肢功能2.口面部功能3.仰卧到床边坐起4.坐位平衡5.站起与坐下6.站立平衡7.步行 每个部分分四个步骤： 1.分析缺失的基本成分 2.针对性反复训练 3.与正常运动结合 4.在真实生活环境中实践,Motor Re-learning Program,Incorporates functional training for key motor tasks such as sitting, standing, standing up, or walking. The therapist analyses each task, determines which component of the task cannot be performed, trains the patient in those components of the task, and ensures carryover of this training during daily activities.,Constraint-induced movement therapy,CIMT强制性使用运动疗法,概念：在生活环境中，限制脑损伤患者使用健侧上肢，强制性反复使用患侧上肢。 主要用于慢性脑卒中患者的上肢治疗。,Constraint-induced movement therapy (CI) forces the use of the affected side by restraining the unaffected side. With CI therapy, the therapist constrains the survivors unaffected arm in a sling. The survivor t