平衡与姿势ppt课件.ppt

BalanceandPosture,AndrewL.McDonough,平衡和姿势安得烈-麦克唐纳,WhatisBalance?,Technicallydefinedastheabilitytomaintainthecenter-of-gravity(COG)ofanobjectwithinitsbase-of-support(BOS),什么是平衡,学术上定义为物体在支撑面上保持重心稳定的能力。Technically：adv.技术上，工艺上；学术上；专业上,WhatisPosture?,Thestereotypicalalignmentofbody/limbsegmentsTypesStanding(static)Walking-running(dynamic)SittingLyingLifting,什么是姿势？,身体或肢体的常规标准是：Types：类型；类型Standing(static)：站（静态）Walking-running(dynamic);步行运行（动态)Sitting:坐Lying：卧Lifting：举起，抬起,Stereotypical：n.常规Alignment：n.队列，排成直线；结盟；校直，调整；工准线Limb：n.肢，翼；大树枝；分支；枝干vt.割断的四肢，肢解；砍树枝Segments：n.部分（segment的名词复数）；瓣；计算机（字符等的）分段；动物学节片,Relationship-Balance40posteriorly,稳定性平衡,许多变量的相互作用的结果（见模型）稳定性的限制-一个主体在任何方向上不通过改变支撑面而是通过倾斜远离中线影响因素：支撑面的坚固性肌肉反应的强度和速度variables:变量Determinants:影响因素：Firmness:坚固性Anteriorly:前方Posteriorly:向后,LimitsofStability,稳定性的限制,ModelComponentsMusculoskeletalSystem,ROMofjointsStrength/powerSensationPainReflexiveinhibitionAbnormalmuscletoneHypertonia(spasticity)Hypotonia,骨骼肌系统的模型组成,关节活动度力量感觉-疼痛-反射性的抑制肌肉张力异常-肌肉张力增加（痉挛）-肌肉张力,ModelComponentsGoal/TaskOrientation,Whatisthenatureoftheactivityortask?Whatarethegoalsorobjectives?,目标/任务导向的模型组件,活动或任务的本质是什么？目标或目的是什么？,ModelComponentsCentralSet,Pastexperiencemayhavecreated“motorprograms”CNSmayselectamotorprogramtofine-tuneamotorexperience,中心点的模型组成部分,根据以往的经验可能已经创建了“运动程序”中枢神经系统会选择一个运动程序发现一个微小的运动经验,ModelComponentsEnvironmentalOrganization,NatureofcontactsurfaceTextureMovingorstationary?Natureofthe“surrounds”Regulatoryfeaturesoftheenvironment(Gentile),模型组件环保组织,接触表面的性质-材质-移动或静止周围环境的性质-环境调整特征（金泰尔）Texture：质地；结构；本质Regulatory：调整的,ModelComponentsMotorCoordination,MovementstrategiesBasedonrepertoireofexistingmotorprogramsFeedback步行运行（动态)Sitting:坐Lying：卧Lifting：举起，抬起,Posture,PositionorattitudeofthebodyPosturalsetsareameansofmaintainingbalanceaswevedefineditStanding(static)Walking-running(dynamic)SittingLyingLifting,姿势,位置或身体的态度我们定义姿势集为保持平衡Standing(static)：站（静态）Walking-running(dynamic);步行运行（动态)Sitting:坐Lying：卧Lifting：举起，抬起,WhatDoesPostureDoforUs?,AllowsbodytomaintainuprightalignmentPermitsefficientmovementpatternsAllowsjointstobeloadedsymmetricallyDecreasesordistributesloadsonLigamentsandotherCTMuscleCartilageandboneGoodpostureusuallyresultsintheleastamountofenergyexpended,姿势为我们做什么？,让身体保持直立校准允许有效的运动模式允许关节对称加负荷-减少或分配负荷-韧带和其他CT？-肌肉-软骨和骨“良好的姿势通常会导致在最少的能源消耗,ErectStandingPosture&theGravityLine(SagittalAnalysis),Gravitylinefalls:ForwardofankleThroughorforwardofthekneeThroughofbehindthehip(commonhipaxis)BehindorthroughthoracicspineThroughacromiumThroughorforwardofatlanto-occipitaljt.,直立站立姿势“的重力线”（矢状面分析）,重力线落在：-脚踝的前边-通过或在膝盖的前边-通过背后的髋关节（髋关节为轴共同）-通过背后胸椎-通过肩峰-通过寰枕前面,ErectStandingPosture&theGravityLine(FrontalAnalysis),Gravitylinefalls:SymmetricallybetweentwofeetThroughtheumbilicusThroughthexiphoidprocessThroughthechin&noseBetweentheeyes,直立站立姿势“的重力线”（前沿分析法)(),重力线落在：-两脚之间-通过肚脐-通过剑突-通过下巴和鼻子-两眼之间的,TheGravityLineandAnti-gravityMuscles(SagittalPlane),Gravitylinefalls:ForwardofankleThroughorforwardofthekneeThroughofbehindthehip(commonhipaxis)BehindorthroughthoracicspineThroughacromiumThroughorforwardofatlanto-occipital,Anti-gravitymuscle:Gastroc-soleusQuadricepsHipextensorsParaspinalsNeckextensors,“重力线和抗重力肌肉（矢状面）,重力线落在：-脚踝的前边-通过或在膝盖的前边-通过背后的髋关节（髋关节为轴共同）-通过背后胸椎-通过肩峰-通过寰枕前面,抗重力肌肉-腓肠肌，比目鱼肌-股四头肌-髋部伸肌-椎旁肌？-颈部伸肌,Relaxedvs.MilitaryStandingPosture,TheMilitaryPosturerequires30%moreenergyexpenditurecomparedwithamorerelaxeduprightstandingposture,放松姿势VS军姿,军姿相比正常轻松站立姿势要多消耗30%能源Expenditure:n.花费，支出；费用，经费,SittingPosture,DiscpatientsoftencannotsitIncreasedintra-discpressurecomparedwithstandingOftenlossoflordoticcurve-mayreverseleadingtoasymmetricaldiscloading,坐姿,椎间盘突出患者往往不能坐-相对于站在盘内压力增加-通常损失前凸曲线可逆转导致不对称的盘负重Disc:.圆盘；唱片；磁盘Lordotic:脊柱前凸的,SittingPosture-Elements,BackagainstchairLumbarsupportSeatheightDontallowfeettodangleorkneestoohighSeatlengthToolongforceslossoflordosisFeetflatwithhips&kneesat900Forearmssupported,坐姿-元素,回到靠在椅子上-腰部支撑座椅的高度-不要让脚悬吊或者膝盖太高座椅长度-太长前凸的力量会丢失脚平与臀部与膝盖90度前臂支持,Lying(Sleeping)Posture,ElementsFirmmattressforsupportNottoomanypillows-MaybenoneLyingflatonbackmaydecreaselordosisHook-lyingmaypreservelordosisSide-lyingmaybemorecomfortable,躺（睡觉）姿势,元素-硬床垫的支持-没有太多的枕头-也许没有-平躺在后面可能会降低前凸-沟躺会保护前凸-侧卧可能会更舒适Mattress：床垫；褥垫；空气垫,LiftingPosture-PTsvs.Patients,ControlCOG(PTs&patients)vs.BOSDontover-extendwhilereachingforpatientLoadLEssymmetrically-NOrotation!Maintaincorrectspinalcurvature-especiallylumbarspine