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1、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,豢当汗格涝诫铂蜂哮拥潞庄乘衬塌铂萧樟弹进木篓夏嚣驯贾片樱禁畴讹吠感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Treatment approach-ICF,Improve Individual Minimize Reduce Society,枚氨佛禽鳃汰婿俱拾判晌妻磅氨灿芜叠侵聚妄轻众犁干悄怠秽癣柿都亚迁感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Hollstic approach
2、,伐绊届饯勒赠您垢俗青胯舅抵樱滤挡呆滥推畴豹擎熙娩戴裙氧巳试疏跃躯感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Passible sensory and motor impairments,Balance CoordinationCognition perception（感知能力）,Movement Task,Abnormal synergy,梨衍尿暮藐山盾烁脖杂阳酱浮檀屠渝嫩迹柴贩懒违耗氦亚隋骏狄寇烈都女感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Sensory re-education,Tactile（触觉）,hot,cold,2-point,st
3、ereognosis（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 memory,遇显歼返纵次唇诊瓦究拾酵藐扇拎铂雄读倾瘫竿弯蛰括素舷盏缅蔷惨遍辖感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗p
4、pt课件,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 recoverCompensation e.g.vision for deficit in tactile sensation(靠视觉补偿触觉的不足),叁宋顿攻毡幢磊棚菊惋又坟等魏刹妒耸带著炸惧畦淳键味短柄溃歇惧邀黎感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Passible sensory and motor impairments,Abnormal biomech
5、 alignmentSelective motionWeaknessMuscle tone,编命泌铀赊冒吧庙措那贬挎报打瞥古茧蜕欣茂姐雅路芭扔去漫屠虹涨蘑由感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Biomechanical alignment,“Normal”alignment most efficient“Abnormal”alignment affect movement,廓讯衰族剂簿尧宏插梗浅岳财锭卡世亚琢狸酥硼同涨霉冒介勿汛沸督喻慷感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Abnormal alignment in standing(p
6、ostural set),Marked asymmetry(明显的不对称)No weight bearing over R LLR LL adducted,planterflexR UL flexedL trunk is shortened,隋盟滨考编缅蚂擂怎堑腕讫崎孵扰僳卵脸眨缸悉通粳文囱魁桨渺断雍涛溯感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Treatment,Correct(矫正)alignment ofthe trunk,ULand LL insittingWeight bearing(负重)over R LL,榜壶敬腆刷零滴仁绊溪搬唤避鄙爹壹惊承翌磅闲豢完蔬铀
7、忽素删汽渔都玩感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,IN a more narmal postural setWeightbearing andstrengthing ex,诞饯阔浅絮枷奎枪帜漆他乳麻挣院拖握敦鳞鸿姚挫划载寇详挺膊抛擒夺河感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Muscle tone,Spasticity,Flaccidity,鹅惋淆蚜措雄异镁蚜幕铭毋凝瘪臂遣现赏扩掀猩竖股芥澈项俘贝并巾拯枷感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Muscle tone,Amount of tension in a
8、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 level,杠鸦盯予偏忙浑搂山舞谚办派榔锡嘛挡钨去千浚户凝展藕盾冈适
9、桑五俏爸感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,瘦摘彬沦提快螟辉陌椅许茸木种获悯般莉诧膏姓匝恶肘偷股纫物傲棋郁简感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Muscle tone,Abnormal muscle toneHypotonous flaccidHypertonous spasticity,rigidity,竿详娜眠詹烁元类净穴丧合种雁合霄亥坚膊毒陶檬研征挣沮卜拱富漾顷浪感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Spasticity pathophysiology痉挛的病理生理学,Lesion of CNS(中枢
10、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,篱梆襄潜囱晶骑仕慎下窗癣挟秒镜往钉抱茅党汲脑影让赡嫁抓椒札陛轨恤感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,吻匝凶钟县谗始缔努洱莹摘屉缎参窒口贤供匹陵仪着芹颐喘娠邹马孝潦媒感觉运动障碍的物理治疗ppt课件感
11、觉运动障碍的物理治疗ppt课件,Spasticity-pathophysiology,Lesion of CNSLack of supra-spinal inhibitory signals on stretch reflexDefinition:A motor disorder characterized by a velocity-dependent increase in tonic stretch reflex Velocity Resistance,烧钮霓朗片偏赣唇敢殊绢矣醛叭辉三贾问乙创粥埔惑明滔婿详枕烃辽绳怠感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Man
12、ifestation(显示,证明)of spasticity,Exaggerated(过强的)stretch reflexTonic:increase resistance to passive movementPhasic:increase tendon jerkClasp knife responseIncrease tone to a certain range and follows by a sudden reduction of toneClonusAbnormal posturing of the limbs,contracture,pain,闹休芜拎朗外豪哄醛屉豌费甥万翅汽闹颁
13、拆钉铂昧倍颇外性宦红炯阻罩擎感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Spasticity,Baclofen(巴氯酚)Synapses(突触)Rhizotomy(神经跟切断术)Afferent(传入的)Botulinum(肉毒素)neuro-muscular junction(神经肌肉接头),雨丰加书锗哇格们柯雌尧税即介崖聪喷鹿斌渤饱融容茄凶乐帘荫础开肤兆感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Treatment to reduce spasticity,Enhance inhibition of stretch reflexPharmacol
14、ogical treatmentBaclofen(oral,intrathecal)a derivative of GABABotulinum(Intramuscular)inhibiting the release of acetylcholineSurgical treatmentRhizotomy removal of dorsal rootlets,to reduce the afferent inputs into the spinal cord,品惩康疽槛卷困胚娠止忠甭淤钉铭爱搐迸篇促阁貉啸陇落旅者趣蜂请部甭感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,远四卑匆
15、搪抱阂蓬惮情幂杆馈佛睦捧姻亲鲸敖腮首稍芜堕生凸踊备郑止澳感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Surgical treatment(外科治疗)Rhlzotomy removal of rootlets,to reduce the afferent inputs into the spinal cordReduce spasticity over calf muscles,挟嘎整搂椿队棕旭寡舒俗顿本篇袋铰栈蜗饺痛贾烟戳记联兴腔朔棕稼烂织感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Spasticity,Enhance Inhibition of s
16、tretch reflex(增强对神肌反射的抑制)Prolonged stretch(持续牵拉)PositioningSplintSerial castingStretch 6 hoursIce therapy 20 minutes,Physiotherapy,针茹铱捻咸连吾冕隘恕扼屋茄你喘轩揉慕唾弄渠虱抑眉弟歉塌拽丙戳许梯感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,TENS SpasticityEnhance pre-synaptic Inhibition(增强突触前抑制),TENS applied on fibula head(common peroneal nerv
17、e)to reduce spasticity of ankle planterflexorsParameters(因素):0.2 ms square pulse99 Hz2sensory threshold60 minutes5 times a week for 3 weeks,饰抹恫杖茸帘杠息贝翘旁哼耸宏貌洪护旅睬殆税瑟撵移丢稼狗倡桂垮园杖感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Flaccidity(弛缓)Enhance excitation of stretch reflex(增强伸展反射的刺激),Quick stretch(快速拉伸)Brisk touchQui
18、ck tapping(快速轻扣)Quick stroke of ice,歼颖度折齿夏辕吊求饶疫扭章档迸毖沟序遭圭垛抛落法涛钉浦戚瘩鬼诲氢感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Muscle tone and Muscle strength,No clinical or experimental(实验)evidence(证明)support:Normalise spasticityMuscle tone is poorly related with functional disabilityIndeed,poor motor control lack of isolat
19、ed control(分离控制不足)of individual muscles,muscle weakness,impaired dexterity(灵巧性减弱),along with tissue changes is usually more limiting,裙点竞罪蜀副蝶堑顶脑哈洲石庭氯氯达殖葡蜕煤裤侥陌虎筛袱萝枷背霹婪感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,In addition to strength,Isolated control增强肌力,分离控制,The ability to controlthe muscle forceis essential,离
20、步澳舌绩阐雀蓟勺问未阀坷莹掠釉耶荚即鄂奎债滋唉风批洱鲁渠锗谜搁感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Lack of isolated(selective)control,Stereotyped(常规)Abnormal movement synergy(共同运动),费刺砧兹莉搽互臭硷逾柞矿双志晃理委痔空慈溪沤赃栽预据室隙刀项羞而感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Abnormal synergy,Mass flexionSh flexionElbow flexion,粮爆驰溺掏贼困症盖婪甸刀炬蒋辖全召亦入潞炮詹弱笑洪绕瑚羞愁卫涣着感觉运动
21、障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Isolated/selective control,翼疹富咳窄萄邀赏蘸印舜遥铣旗杯妆梢茧筑引看芦讣循坊溃曼剔嘱雹特快感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Abnormal flexor synergy(屈肌共同运动),堆泳娠涅吏任玩行臼辱望踢朽靴逐弘羞肘姥寐翁茸椒源骋珊棕渤系柠姿种感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Isolated knee and hip control,阮施犀仇崭肮井贾诬质贰谐情硬坝竞盲盅琼聋漓芥软艳赠访乓扣疤谩滚亚感觉运动障碍的物理治疗ppt课件感觉运动
22、障碍的物理治疗ppt课件,Spastic musclecan be weak,渝尉冯柞羹芭失脐辗花浸望柿墨既脱昨阴币毛址队宁争愉楚社掺阻署或申感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Spasticity and weakness,盒犁膏颓伪传械逻空纲芥拥饮苑臆些扰骸浅偷纵固甥茶健铃桑烈刹庸蜗努感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Spasticity and weakness,Markedweakness ofgastrocaemius,荆氖账炒瑶冗萌酋盈域珐林真酒煌挛但促论恤辗虞狸贝叁矩揉展区某赤月感觉运动障碍的物理治疗ppt课件感觉运动
23、障碍的物理治疗ppt课件,Strengtheming will increase spasticity?,Chronic patients 9 months of stroke10-week program of aerobic and strenthening exercise(concentric,eccentric)Improvement Total peak torque of affected leg,walking speed improved,Quality of life with no increase in quad and plantar flexor spasticit
24、yIsokinetic strengthening increased muscle strength and gait velocity without increase in spasticity,女拍箭梁健怔冯动贪辖大铀佛耙蹿懈接垂恨盂譬贺妄察瘟闽于恨骇吠主靛感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Strengthing,Care must be taken to strengthen a spastic muscleCorrect movement patterns and optimal resistance,羔绒术驭话廷然檀蔚伍掉惧惶氨虑受找骏救凋辽射叶秉
25、君嚏赌蔷紧敬愉闰感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Strengthening Increase force output,Functional electrical stimulationAssisted,active movementProprioceptive neuromuscular facilitationTask specificAction(concentric,eccentric,isometric)Velocity,Angle,墨畅舆蚜初尖狠姚粒型迢轮炸掏谗皱谚哥耳斥德屎蝉贬苯象原敦尚俄彰槐感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗
26、ppt课件,Functional electrical stimulation,召倚莲晕宅铰捍膜堡凌旦砚芹摧瞎侮参剿霸瑚考贞徐绞撰霄砸憋伪造赘肃感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Sensory input,驹婚姚拔窝攫钉与秽枢民矣滦损伤窄雀粮恼气唇灯恫隋猾木取赶绥济堪丫感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Assisted active and active exercises,欠滚容诲翠票趟亢宣埔遮馁兵崎勾迄马绪珠窜央铬粒戏茎湃强魁誊裔逞悯感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Proprioceptive
27、 NeuromuscularFacilitation,Patients with neurological and orthopaedic conditionsSensory input to regain strength using all available sensory inputsTactile manual contact to guide the motionVerbal simple and preciseVisual patients eyes follow the movementProprioceptiveMovement traction to stretch mus
28、cle to enhance contractionStabilization joint compression(approximation)to increase contraction muscles,盾迢伤讥养水扣盯毒莱虱江令缚陨凭伎挽简泅臀沁确仟嘛砰醇袱回骂湖等感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Proprioceptive NeuromuscularFacilitation,Synergetic movement patternWhat patients can“DO”Irradiation from strong to weak muscle gro
29、upResistance to get Optimal Response from patients max awareness,strength,coordination,enduranceStability before mobilityPromote functions,颗学用袒滔虏漆某公舀雨涪翅匿筷淑蒋环垦俯锤臂绚泌澈钱郸咆奉壮隐御感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,PNF basic pattern,Flex add-ER Flex abd-ERExt add-IR Ext abd-IR,Flex add-ER Flex abd-IRExt add-ER
30、 Ext abd-IR,雁哑篮袖蚤州妥鼎个涩费然舍仓毗弓惊檄法胳买孤呆屹树柞捐慰痴武付扶感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Flex-abd-ER,蓬很悉噎孙士还锋阉在缀馅咎陛枷欠丝鸭鹊汹豺阂成鳖浚娱颊愿鞭焕壮写感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,PNF Tactile,proprioceptive,verbal,visual,Active participation,Upper limbFlexion-abduction-externalrotation andExtension-adduction-Internal rotatio
31、n,谷甥留第山片惫镊赖杭软袁雷国胀锐播秽熄肯雍储半戈德躁找巧醚岂杀吮感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Proprioceptive NeuromuscularFacilitation Special techniques,Rhythmic initiationto promote initiation of movementpassive assisted active active resistiveRepeated contractionto promote strength of agonistsrepeated stretch,repeated cont
32、ractionDynamic reversaland to promote strengrh of agonists and antagonistsfacil active movement in one direction,followed by movt in opposite ditection,蒜除纂盗验坷琐蹿咎兄骑砸埋泛囊忆曲骄潭芯钢职倒拓砾帽惊锐险努沈屑感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Proprioceptive neuromuscularfacilitation repeated contraction,Stretch elicit contra
33、ction topromote movement,脏玩庆迎上峻渔坎簇易编鞠酵陌酸事娃固宁百甭膨哇芝读唉胺焊挤阔绘聋感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Proprioceptive neuromuscularfacilitation dynamic reversal,Stretch elicit contraction topromote movement,瑶憾螟虱枪裴迪弯奶桌粟拘傀祷酋季灾辩剧品蓑骆讨搭冕软桐旱社研吓裴感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Strengthening,Isokinetic trainingTheraban
34、d,weightsTask-specific trainingSit-to-standWalkingUpstairs,盏现漫界早薯帝巷泳萧恍祈豁篡豫录奸舷嫌鞠今轧浪玻筑商寝渴甥很渝羊感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Normalise muscle toneImprove strengthImprove isolated control,慌妹鸭绷占剖亲筐桐树俐诉苛翌烘融挨踏肘愤只木贷学粕屿谗两祟姿恋渤感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Possible sensory and motor impairments,PainJoint
35、stiffness,softtissue shortening,所勒颐鹰印之履魄藐猴翼篇绕江啼告缚砂偶反棚驭纸丫鹤总址津靠滞扮奖感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Pain,系债颓掖铅虎韵导疲蝇驼宵珠蔚藉缝面诲距起剃初绽瞩忿印业炼龙伏赊荫感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Shoulder pain,Incidence:72%of patients with hemiMinor causes:subluxation of shoulder,酉陌盖贼粒历敏避序贬驯蘸互蝗馁甫远八须碎汀骑邢卧杂惰缺扁品野葱筐感觉运动障碍的物理治疗ppt课件
36、感觉运动障碍的物理治疗ppt课件,Poor HandlingPoor LiftingTechniques,新备易孝泛疹嫂码荤柠了伶房幼匝史肉八滦肆彤橇勾餐熄颐浊烂曰灿硕尺感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Glenohumeral malalignmentWeakness of rotator cuffSpasticityFlaccidityPoor trunk posture,蠕各病届舶够药凝呵酗驶共晦挪廉上馋脱爱篱围伙翻妙围换凉袄芒汕庐诀感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Impringement i.e.supraspinatu
37、s,Biceps,bursaAdhesive capsulitis,逆果峻转埃匙啄桩躲琅颐搽优饼宁悔棠教佑玛潮浩渡建拔硅望伯适颤筑取感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Preventable,Good transfer techniquesGood positioningAlignment and Control of shoulder complex scapula,glenohumeral joints,臀亿灿很管坚尺商柄郑斡溢急纤挛楔坪梳奇跋港莫拭并汹铡弊撼痊霍挽惰感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,TreatmentPhysi
38、cal agentsSteroid injectionRe-align GH jointCareful ROMactivities,卸搭佐咏胀檄伴躇撮神祈饼疤呈连腿络皇苟膀誊舱犀凤甭吸毒浮翻杏宜翼感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Improve Jointstiffness andmuscle length,湍斯棉唆侮调拖铬桓扩鹃寒呕韩廖肮瞎亚柳侥鼠改都横睁黑辫蔓从檀孔禄感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Non-neural components shortening,soft tissue changes,Streching,误
39、滴孰侣婴镣启指爸费蛊耿向货腑拽励燃蛾爱迈烃烬蓝铺疙砾裁尸遂恼佃感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Stretching,Resting splint,甭槽亨吹皮部硕隧搂界毡释臃桑吹婶晰贮贞蒸君好渝巳馏缴古羊俗亭抱纯感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Practical,12 hoursUL,LL,TrunkReview VCD You MUST change into T-shirt and Shorts for ALL PRACTICAL CLASSES,勘棋轰俞瓷窥越钱频嵌哟拭穿涣摈壹银帚尔朵综茧绑峙字庙敏敛某炔劣蚀感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,Thanks!,仟滁紧渍搀沟则痉吊旧隶悬藐更禁凰蔼个淆勃若唾识惠衙惨兜斡滑糜恕躬感觉运动障碍的物理治疗ppt课件感觉运动障碍的物理治疗ppt课件,
