感觉运动障碍物理治疗.pptxVIP

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 - ICFEnhance physiological functionImprove Individual Minimize Reduce Society Disability ActivityHandicap ParticiputionHollstic approachIndividualTaskEnvironmentPassible sensory and motor impairmentsLoss of sensationAltered　biomechanical alignment（生物学力线的改变）Pain Balance CoordinationCognition perception（感知能力）Abnormal synergyWeaknessMovement TaskJoint stiffness, softtissure shorteningMuscle toneSensory re-educationTactile（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 discrminationHigh level of attention and memorySensory re-educationProtect from noxious and injurious stimuli (防护来自物理和化学的伤害)If sensation does not recoverCompensation e.g. vision for deficit in tactile sensation (靠视觉补偿触觉的不足)Passible sensory and motor impairmentsAbnormal biomech alignmentSelective motionWeaknessMuscle toneBiomechanical alignment“Normal” alignment – most efficient“Abnormal” alignment – affect movementAbnormal alignment in standing (postural set)Marked asymmetry(明显的不对称)No weight bearing over R LLR LL adducted, planterflexR UL flexedL trunk is shortenedTreatmentCorrect (矫正)alignment ofthe trunk, ULand LL insittingWeight bearing(负重)over R LL IN a more narmal postural setWeightbearing andstrengthing exMuscle toneSpasticity痉挛Flaccidity弛缓Muscle toneAmount of tension in a relaxed muscleTension stiffnessMaintain posture(维持姿势) – prevent too much swayMake muscle ready to shortenPerson with intact neuromuscular system, muscle tone is minimal i.e. resistance to passive movement is minimalMuscle tone can change according to posture and anxious levelFacilitation(易化)i.e. CerebellomMotor cortex(运动皮层)Pontine(桥脑)Reticular(网状结构)FormationInhibition(抑制)i.e. Bulbar(延髓)reticularFormationMuscle toneAbnormal m