感觉运动障碍的物理治疗

PTmanagementofpatientswithsensori-motordisorders感觉运动障碍的物理治疗,昆明医学院附属第二医院康复科敖丽娟教授,Treatmentapproach-ICF,ImproveIndividualMinimizeReduceSociety,Hollsticapproach,Passiblesensoryandmotorimpairments,BalanceCoordinationCognitionperception（感知能力）,MovementTask,Abnormalsynergy,Sensoryre-education,Tactile（触觉）,hot,cold,2-point,stereognosis（实体辨别觉）Discriminative（识别）,protective（给予保护）EarlytrainingDetectionandlocationofstationaryandmovinglighttouchstimuli（刺激）Progressionsize,shape,objectrecognition（确认）,2-pointdiscrminationHighlevelofattentionandmemory,Sensoryre-education,Protectfromnoxiousandinjuriousstimuli(防护来自物理和化学的伤害)IfsensationdoesnotrecoverCompensatione.g.visionfordeficitintactilesensation(靠视觉补偿触觉的不足),Passiblesensoryandmotorimpairments,AbnormalbiomechalignmentSelectivemotionWeaknessMuscletone,Biomechanicalalignment,“Normal”alignmentmostefficient“Abnormal”alignmentaffectmovement,Abnormalalignmentinstanding(posturalset),Markedasymmetry(明显的不对称)NoweightbearingoverRLLRLLadducted,planterflexRULflexedLtrunkisshortened,Treatment,Correct(矫正)alignmentofthetrunk,ULandLLinsittingWeightbearing(负重)overRLL,INamorenarmalposturalsetWeightbearingandstrengthingex,Muscletone,Spasticity,Flaccidity,Muscletone,AmountoftensioninarelaxedmuscleTensionstiffnessMaintainposture(维持姿势)preventtoomuchswayMakemusclereadytoshortenPersonwithintactneuromuscularsystem,muscletoneisminimali.e.resistancetopassivemovementisminimalMuscletonecanchangeaccordingtopostureandanxiouslevel,Muscletone,AbnormalmuscletoneHypotonousflaccidHypertonousspasticity,rigidity,Spasticitypathophysiology痉挛的病理生理学,LesionofCNS(中枢神经系统损伤)Lackofsupra-spinalinhibitorysignalsonstretchreflex(反射性伸展的上行性抑制信号不足)Definition:Amotordisorder(失调)characterized(特征)byavelocity-dependentincreaseintonicstretchreflex,Spasticity-pathophysiology,LesionofCNSLackofsupra-spinalinhibitorysignalsonstretchreflexDefinition:Amotordisordercharacterizedbyavelocity-dependentincreaseintonicstretchreflexVelocityResistance,Manifestation(显示,证明)ofspasticity,Exaggerated(过强的)stretchreflexTonic:increaseresistancetopassivemovementPhasic:increasetendonjerkClaspkniferesponseIncreasetonetoacertainrangeandfollowsbyasuddenreductionoftoneClonusAbnormalposturingofthelimbs,contracture,pain,Spasticity,Baclofen(巴氯酚)Synapses(突触)Rhizotomy(神经跟切断术)Afferent(传入的)Botulinum(肉毒素)neuro-muscularjunction(神经肌肉接头),Treatmenttoreducespasticity,EnhanceinhibitionofstretchreflexPharmacologicaltreatmentBaclofen(oral,intrathecal)aderivativeofGABABotulinum(Intramuscular)inhibitingthereleaseofacetylcholineSurgicaltreatmentRhizotomyremovalofdorsalrootlets,toreducetheafferentinputsintothespinalcord,Surgicaltreatment(外科治疗)Rhlzotomyremovalofrootlets,toreducetheafferentinputsintothespinalcordReducespasticityovercalfmuscles,Spasticity,EnhanceInhibitionofstretchreflex(增强对神肌反射的抑制)Prolongedstretch(持续牵拉)PositioningSplintSerialcastingStretch6hoursIcetherapy20minutes,Physiotherapy,TENSSpasticityEnhancepre-synapticInhibition(增强突触前抑制),TENSappliedonfibulahead(commonperonealnerve)toreducespasticityofankleplanterflexorsParameters(因素):0.2mssquarepulse99Hz2sensorythreshold60minutes5timesaweekfor3weeks,Flaccidity(弛缓)Enhanceexcitationofstretchreflex(增强伸展反射的刺激),Quickstretch(快速拉伸)BrisktouchQuicktapping(快速轻扣)Quickstrokeofice,MuscletoneandMusclestrength,Noclinicalorexperimental(实验)evidence(证明)support:NormalisespasticityMuscletoneispoorlyrelatedwithfunctionaldisabilityIndeed,poormotorcontrollackofisolatedcontrol(分离控制不足)ofindividualmuscles,muscleweakness,impaireddexterity(灵巧性减弱),alongwithtissuechangesisusuallymorelimiting,Inadditiontostrength,Isolatedcontrol增强肌力,分离控制,Theabilitytocontrolthemuscleforceisessential,Lackofisolated(selective)control,Stereotyped(常规)Abnormalmovementsynergy(共同运动),Abnormalsynergy,MassflexionShflexionElbowflexion,Isolated/selectivecontrol,Abnormalflexorsynergy(屈肌共同运动),Isolatedkneeandhipcontrol,Spasticmusclecanbeweak,Spasticityandweakness,Spasticityandweakness,Markedweaknessofgastrocaemius,Strengthemingwillincreasespasticity?,Chronicpatients9monthsofstroke10-weekprogramofaerobicandstrentheningexercise(concentric,eccentric)ImprovementTotalpeaktorqueofaffectedleg,walkingspeedimproved,QualityoflifewithnoincreaseinquadandplantarflexorspasticityIsokineticstrengtheningincreasedmusclestrengthandgaitvelocitywithoutincreaseinspasticity,Strengthing,CaremustbetakentostrengthenaspasticmuscleCorrectmovementpatternsandoptimalresistance,StrengtheningIncreaseforceoutput,FunctionalelectricalstimulationAssisted,activemovementProprioceptiveneuromuscularfacilitationTaskspecificAction(concentric,eccentric,isometric)Velocity,Angle,Functionalelectricalstimulation,Sensoryinput,Assistedactiveandactiveexercises,ProprioceptiveNeuromuscularFacilitation,PatientswithneurologicalandorthopaedicconditionsSensoryinputtoregainstrengthusingallavailablesensoryinputsTactilemanualcontacttoguidethemotionVerbalsimpleandpreciseVisualpatientseyesfollowthemovementProprioceptiveMovementtractiontostretchmuscletoenhancecontractionStabilizationjointcompression(approximation)toincreasecontractionmuscles,ProprioceptiveNeuromuscularFacilitation,SynergeticmovementpatternWhatpatientscan“DO”IrradiationfromstrongtoweakmusclegroupResistancetogetOptimalResponsefrompatientsmaxawareness,strength,coordination,enduranceStabilitybeforemobilityPromotefunctions,PNFbasicpattern,Flexadd-ERFlexabd-ERExtadd-IRExtabd-IR,Flexadd-ERFlexabd-IRExtadd-ERExtabd-IR,Flex-abd-ER,PNFTactile,proprioceptive,verbal,visual,Activeparticipation,UpperlimbFlexion-abduction-externalrotationandExtension-adduction-Internalrotation,ProprioceptiveNeuromuscularFacilitationSpecialtechniques,RhythmicinitiationtopromoteinitiationofmovementpassiveassistedactiveactiveresistiveRepeatedcontractiontopromotestrengthofagonistsrepeatedstretch,repeatedcontractionDynamicreversalandtopromotestrengrhofagonistsandantagonistsfacilactivemovementinonedirection,followedbymovtinoppositeditection,Proprioceptiveneuromuscularfacilitationrepeatedcontraction,Stretchelicitcontractiontopromotemovement,Proprioceptiveneuromuscularfacilitationdynamicreversal,Stretchelicitcontractiontopromotemovement,Strengthening,IsokinetictrainingTheraband,weightsTask-specifictrainingSit-to-standWalkingUpstairs,NormalisemuscletoneImprovestrengthImproveisolatedcontrol,Possiblesensoryandmotorimpairments,PainJointstiffne