感觉运动障碍的物理治疗

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1、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-ICFImproveIndividualMinimizeReduceSocietyEnhancephysiologicalfunctionDisabilityActivityHandicapParticiputionHollsticapproachIndividualTaskEnvironmentPassiblesen

2、soryandmotorimpairmentsBalanceCoordinationCognitionperception（感知能力）Alteredbiomechanicalalignment（生物学力线的改变）LossofsensationPainWeaknessJointstiffness,softtissureshorteningMuscletoneMovementTaskAbnormalsynergySensoryre-educationTactile（触觉）,hot,cold,2-point,st

3、ereognosis（实体辨别觉）Discriminative（识别）,protective（给予保护）Earlytraining–Detectionandlocationofstationaryandmovinglighttouchstimuli（刺激）Progression–size,shape,objectrecognition（确认）,2-pointdiscrminationHighlevelofattentionandmemorySensoryre-educationProtectfromnoxi

4、ousandinjuriousstimuli(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)PassiblesensoryandmotorimpairmentsAbnormalbiomechalignmentSelectivemotionWeaknessMuscletoneBiomechanicalalignment“Normal”alignment–mo

5、stefficient“Abnormal”alignment–affectmovementAbnormalalignmentinstanding(posturalset)Markedasymmetry(明显的不对称)NoweightbearingoverRLLRLLadducted,planterflexRULflexedLtrunkisshortenedTreatmentCorrect(矫正)alignmentofthetrunk,ULandLLinsittingWeightbearing(负重)over

6、RLLINamorenarmalposturalsetWeightbearingandstrengthingexMuscletoneSpasticityFlaccidity痉挛弛缓MuscletoneAmountoftensioninarelaxedmuscleTensionstiffnessMaintainposture(维持姿势)–preventtoomuchswayMakemusclereadytoshortenPersonwithintactneuromuscularsystem,muscleton

7、eisminimali.e.resistancetopassivemovementisminimalMuscletonecanchangeaccordingtopostureandanxiouslevelFacilitation(易化)i.e.CerebellomMotorcortex(运动皮层)Pontine(桥脑)Reticular(网状结构)FormationInhibition(抑制)i.e.Bulbar(延髓)reticularFormationMuscletoneAbnormalmuscleto

8、neHypotonous–flaccidHypertonous–spasticity,rigiditySpasticity–pathophysiology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)charac