感觉运动障碍的物理治疗.pptVIP

PT management of patients with sensori-motor disorders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 Treatment approach - ICF Improve Individual Minimize Reduce Society Passible sensory and motor impairments Balance Coordination Cognition perception （感知能力） Sensory re-education Tactile（触觉）, hot, cold, 2-point, stereognosis（实体辨别觉） Discriminative（识别）, protective（给予保护） Early training – Detection and location of stationary and moving light touch stimuli（刺激） Progression – size, shape, object recognition（确认）, 2-point discrmination High level of attention and memory Sensory re-education Protect from noxious and injurious stimuli (防护来自物理和化学的伤害) If sensation does not recover Compensation e.g. vision for deficit in tactile sensation (靠视觉补偿触觉的不足) Passible sensory and motor impairments Abnormal biomech alignment Selective motion Weakness Muscle tone Biomechanical alignment “Normal” alignment – most efficient “Abnormal” alignment – affect movement Abnormal alignment in standing (postural set) Marked asymmetry(明显的不对称) No weight bearing over R LL R LL adducted, planterflex R UL flexed L trunk is shortened Treatment Correct (矫正) alignment of the trunk, UL and LL in sitting Weight bearing(负重) over R LL IN a more narmal postural set Weight bearing and strengthing ex Muscle tone Amount of tension in a relaxed muscle Tension stiffness Maintain posture(维持姿势) – prevent too much sway Make muscle ready to shorten Person with intact neuromuscular system, muscle tone is minimal i.e. resistance to passive movement is minimal Muscle tone can change according to posture and anxious level Muscle tone Abnormal muscle tone Hypotonous – flaccid Hypertonous – spasticity, rigidity Spasticity – pathophysiology痉挛的病理生理学 Lesion of CNS (中枢神经系统损伤) Lack of supra-spinal inhibitory signals on stretch reflex(反射性伸展的上行性抑制信号不足) Definition : A motor disorder(失调) characterized(特征) by a velocity-dependent increase in tonic stretch reflex Spasticity - pathoph