Treatment strategies

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1、TREATMENTSTRATEGIESFORSCIPATIENTS脊髓损伤康复策略南京医科大学第一附属医院康复医学中心蔡可书Respiraterymanagement呼吸治疗Movementstratigies特殊运动策略Functionalmatskills功能性垫上技巧Transferskills转移技巧Wheelchairskills轮椅技巧Ambulation平衡训练RespirationandPTmanagement呼吸功能康复训练呼吸相关的肌肉A.吸气肌平静吸气①膈肌（C3、4

2、、5）：75%,②肋间外肌（T1-11）：25%,用力吸气：膈肌、肋间外肌、胸锁乳突肌、斜角肌B.呼气肌平静呼气：被动活动，无肌肉收缩，仅依赖肺和胸廓的弹性回缩用力深呼气①腹肌（T7-12）②肋间内肌（T1-11）C.咳嗽过程用力最大吸气–-声门关闭--腹肌收缩—开启声门和口腔—气流冲出呼吸肌MusclesofRespirationMusclesthatASSISTwithrespiration辅助呼吸肌Thescaleneshelpincreasethoraciccavitydimensi

3、onsbyelevatingthefirstandsecondribsduringforcedinhalation.斜角肌上拉1、2肋，抬高胸廓，扩大胸腔容积Theribselevateuponcontractionoftheexternalintercostals,therebyincreasingthetransversedimensionsofthethoraciccavityduringinhalation.肋间外肌收缩上提肋骨，增大吸气过程中的胸廓横径Contractionoftheinte

4、rnalintercostalsdepressestheribs,butthisonlyoccursduringforcedexhalation.用力呼气时，肋间内肌收缩使肋骨下降，减小横径Normalexhalationrequiresnoactivemusculareffort.正常呼气过程无需主动用力。MusclesthatASSISTwithrespiration辅助呼吸肌Otheraccessorymusclesassistwithrespiratoryactivities.Thepect

5、oralisminor胸小肌,serratusanterior前锯肌,andsternocleidomastoid胸锁乳突肌helpwithforcedinhalation。辅助用力吸气whiletheabdominalmuscles腹肌(externalandinternalobliques,transversusabdominis,andrectusabdominis)assistinactiveexhalationandcough.辅助主动呼吸和咳嗽。ThoracicVolume胸廓容积变化肌肉功

6、能支配神经神经根膈肌膈肌收缩膈神经C3-5肋间外肌辅助吸气胸段脊神经T1-11肋间内肌辅助用力呼气胸段脊神经T1-11胸锁乳突肌上提胸骨柄副神经（Ⅺ）三角肌上部：上提肩胛骨副神经（Ⅺ）C3-4中部：外展肩胛骨下部：降肩胛骨斜角肌辅助深吸气颈段脊神经前部：C5—6中部：C3-8后部：C6-8腹直肌压缩腹腔，用力呼胸段脊神经T7-12气，咳嗽腹外斜肌腹内斜肌T8-12腹横肌RespiratoryStructuresinBrainstem脑干呼吸中枢桥脑呼吸组膈神经延髓呼吸中枢延髓Twophasesofpulm

7、onaryventilation肺通气的两个阶段Inspiration,orinhalation吸气-averyactiveprocessthatrequiresinputofenergy.Thediaphragm,contracts,movingdownwardandflattening,whenstimulatedbyphrenicnerves.膈肌收缩吸气时主动过程，消耗能量，膈神经支配膈肌收缩，使本来向上隆起的膈肌向下变平的过程。Expiration,orexhalation-apassiv

8、eprocessthattakesadvantageoftherecoilpropertiesofelasticfiber.･Thediaphragmrelaxes.Theelasticityofthelungsandthethoraciccageallowsthemtoreturntotheirnormalsizeandshape.呼气是被动过程。吸气末，膈肌开始放松，肺和胸廓的弹性回缩力使其恢复到原状。正常呼吸和咳嗽模式