運(yùn)動(dòng)控制在手功能(PDF格式發(fā)言)

1、運(yùn)動(dòng)控制在手功能康復(fù)的應(yīng)用武漢大學(xué)中南醫(yī)院康復(fù)醫(yī)學(xué)科 廖維靖電子郵件：weijingliao提綱一、引言二、手運(yùn)動(dòng)障礙及控制三、手運(yùn)動(dòng)控制的方法四、展望提一、引言二、運(yùn)動(dòng)障礙及控制三、運(yùn)動(dòng)控制的方法四、展望綱It is said that the hand is an agency ofthe brain. It reflects activities of thebrain and thereby it is a sort of mirrorto the mind. It is the hand that is themost intriguing and most human ofappe

2、ndages.大意：手是腦功能的作用表現(xiàn)形式。手反映了腦的活動(dòng)，是腦的一種鏡像。手正是最能激發(fā)人研究興趣和最具人性特點(diǎn)的器官。世界偉人的最后歲月Lenin's Last Year(December 1922 - January 1924)Lerner, V., Finkelstein, Y. & Witztum, E.The enigma of Lenin's (18701924) malady.European Journal of Neurology 11 (6), 371-376.Lenin in his Kremlin office. 1918Lenin in

3、his wheelchair at Gorki July or August 1923Lenin's health had already been severely damaged by thestrains of revolution and war. The assassination attemptearlier in his life also added to his health problems. Thebullet was still lodged in his neck, too close to his spinefor medical techniques of

4、 the time to remove. On May 26,1922, Lenin had his first stroke. He was left partiallyparalyzed on his right side, and his role in governmentdeclined. After the second stroke in December 16 of thesame year, he resigned from active politics. On March 15,1923, he suffered his third stroke and was left

5、 bedriddenfor the remainder of his life, no longer able to speak. OnJanuary 21, 1924, he died as his father had, from acerebral hemorrhage.列寧醫(yī)療檔案解密報(bào)告中樞性運(yùn)動(dòng)功能障礙的本質(zhì)上運(yùn)動(dòng)神經(jīng)元受損（高位中樞失控）皮層以下運(yùn)動(dòng)反射釋放（運(yùn)動(dòng)模式異常）肌張力增高、痙攣、肌群協(xié)調(diào)紊亂（協(xié)同運(yùn)動(dòng)、聯(lián)合反應(yīng)、緊張性反射）Brunnstrom 6階段周?chē)园c瘓中樞性癱瘓01I 遲緩期治療的目標(biāo)II 痙攣期III共同運(yùn)動(dòng)2IV部分分離運(yùn)動(dòng)345VI正常V分離運(yùn)動(dòng)Sig

6、ne Brunnstrom was aFullbright Scholar and pioneerphysical therapist who made anunusually strong impact on theprofession through her scientificapproach to applied clinicalresearch and her ability to teachthe "therapeutic art" of physicaltherapy.瑞典物理治療師She authored several classic texts and

7、dozens of journalarticles in clinical kinesiology and the treatment of patients withhemiplegia.Personal photographs and documents highlight thecareer of this individual who exerted great influence on thedevelopment of physical therapy and rehabilitation.Author:Signe BrunnstromHistory of PNF?Develope

8、d by: Dr. Herman Kabat and MaggieKnott in the late 1940s and early 1950s as a meansof rehabilitation for neurological disorders such asmultiple sclerosis, cerebral palsy and poliomyelitis.Dr Karel Bobath, a physician, and Berta Bobath, a physiotherapist, were born inBerlin and moved to England durin

9、g World War 2.They developed theirapproach to theevaluation andtreatment of childrenand adults with lesionsof the central nervoussystem.The Bobaths died in1991.The Primary Motor Cortex and Premotor AreaNeuromotor Basis for Motor ControlConcept: The neuromotor system forms thefoundation for the contr

10、ol of movementControl of Complex Movements· Involve Cerebral Cortex Basal Ganglia Cerebellum Thalamus Brain Stem Spinal CordCarr & Shepherd, 7 Categories of FunctionalDaily Activities1. Upper limb function2. Orofacial function3. Sitting up over the side of the bed4. Balanced sitting5. Stand

11、ing up & sitting down6. Balanced standing7. WalkingConstraint-induced Movement Therapy:Another form of NDT or SomethingCompletely Different?Brunnstrom評(píng)價(jià)運(yùn)動(dòng)功能評(píng)價(jià)（motor functional test, MFT）Forelimb 上肢Hand手Hindlimb 下肢上肢/手功能訓(xùn)練大關(guān)節(jié)活動(dòng)恢復(fù)較早、較好，手部精細(xì)動(dòng)作恢復(fù)較慢、較差。強(qiáng)化訓(xùn)練：A 肩關(guān)節(jié)和肩帶的活動(dòng)B 肘關(guān)節(jié)活動(dòng)C 腕關(guān)節(jié)屈伸及橈、尺側(cè)偏移D 掌指、指間關(guān)節(jié)E

12、手的靈活性、協(xié)調(diào)性和精細(xì)動(dòng)作訓(xùn)練提一、引言二、運(yùn)動(dòng)障礙及控制三、運(yùn)動(dòng)控制的方法四、展望綱運(yùn)動(dòng)控制Muscle toneSpasticityFlaccidity協(xié)調(diào)痙攣遲緩Crawling is a vital development stage that children whospend too much time in pushchairs and baby seats aremissing out on湖北潛江市腦癱兒童湖北潛江市腦癱兒童湖北潛江市腦癱兒童湖北潛江市腦癱兒童視頻文件3667腦癱兒童上肢/手的功能障礙武漢大學(xué)中南醫(yī)院病例患者周xx視頻文件7260武漢大學(xué)中南醫(yī)院病例，任xx

13、，男，64歲視頻文件6995武漢大學(xué)中南醫(yī)院病例，陳xx趙xx，女，47歲，腦梗死，視頻文件5221武漢大學(xué)中南醫(yī)院病例Neuromotor processes“These are the organizational mechanismswithin the central nervous system (CNS) thatconstrain and sequence movement” (Gentile,1987, 96).Gentile, A.M. (1987) Skill acquisition: Action, movement, andneuromotor processes. I

14、n J.H. Carr, R.B. Shepherd, J. Gordon, A.M.Gentile, & J.M. Held, Movement Science. Foundations for PhysicalTherapy in Rehabilitation. MD: Aspen Publishers.Definition andlevels of analysisNeurofacilitationApproachesMotorHierarchyTheories ofMotor ControlTask-BasedApproachesMap of EssentialConcepts

15、ReflexTheoryComplexSystemsTheoryFall 2006DM McKeoughTheories of Motor control· Definition and levels of analysis· Reflex theory· Hierarchical theory· Complex systems theory· Neurofacilitation Approaches· Motor Re-learning, Task-Based Rehabilitation· Motor HierarchR

16、eflex Theory· Reflex Theory (Charles Sherrington, early 1900s) Complex behavior (movement) is controlled by a series ofchained reflexes (e.g. Frog)Complex Systems Theory· Movement emerges spontaneously from the interactionof the individual, the task, and the performanceenvironmentTaskIndiv

17、idualEnvironmentMovement機(jī)能的代償解剖、機(jī)能的基礎(chǔ)同型性發(fā)芽（sprouting）異型性發(fā)芽細(xì)胞的可塑性去傳入敏感升高突觸去抑制神經(jīng)網(wǎng)絡(luò)機(jī)能的變通性代償模式結(jié)構(gòu)的重組機(jī)能的重建影響代償?shù)囊蛩匚锓N年齡損傷的程度和部位藥物作用功能性鍛煉和學(xué)習(xí)動(dòng)機(jī)（心理）神經(jīng)系統(tǒng)機(jī)能代償?shù)臋C(jī)制與影響因素（Lacour，1999）穩(wěn)態(tài)1網(wǎng)絡(luò)協(xié)調(diào)神經(jīng)網(wǎng)絡(luò)：輸入單位（輸入神經(jīng)元）、內(nèi)在單位（中間神經(jīng)元）和輸出單位（輸出神經(jīng)元）組成。突觸功效細(xì)胞特性分子構(gòu)造穩(wěn)態(tài)2Neuron Network突觸功效：神經(jīng)元之間突觸聯(lián)系的力度。Exploring the World: Physical Develop

18、ment inInfancy and Early ChildhoodActivity Can Modify Cortical MapsGlobal Evidence: The cortex is reorganized under controlledconditions of learningW. M. Jenkins, M. M. Merzenich, M. T. Ochs, T. Allard, E. Guic-Robles.J Neurophysiol, 1990, 63: 82-104W. M. Jenkins, M. M. Merzenich, M. T. Ochs, T. All

19、ard, E. Guic-Robles.J Neurophysiol, 1990, 63: 82-104研究實(shí)例Increased Cortical Representation of the LeftHand Fingers in String PlayersThomas Elbert, Christo Pantev, Christian Wienbruch,Brigitte Rockstroh, Edward TaubScience, 1995, 270, 305-307Alteration of digital representations insomatosensory cortex

20、 in focal hand dystoniaThomas Elbert, Victor Candia, Eckart Altenmüller, Harald Rau, Annette Sterr,Brigitte Rockstroh, Christo Pantev, Edward TaubClinical Neuroscience, 1998, 9: 3571-3575Fusion of Cortical Representations（Elbert T, et al. 1998）Primary motor cortex with homunculusSMAPMM1 S1PPC&#

21、183; Simple finger flexion only M1 activation· Sequence of complex finger movements M1 + SMA activation · Mental rehearsal of finger movements only SMA activation Descending Motor ControlRightandLeftLeft Hemisphere:Right hemisphere(develop before left):§ Holistic§ non verbal, mus

22、ic§ visual§ Face recognition§ ambiguity§ empathy§ autobiographical memoryintegrated map of thebody§§§§§Linear processingLinguisticLogical-syllogistic reasoningLiteralbrings cohesion (notcoherence) to “make sense”(integration) needscommunication with

23、RightHemisphere/corpus callosum.提一、引言二、運(yùn)動(dòng)障礙及控制三、運(yùn)動(dòng)控制的方法四、展望綱痙攣的康復(fù)治療采取階梯化治療步驟手術(shù)治療藥物治療物理治療癱瘓手的日?；顒?dòng)！強(qiáng)制性使用運(yùn)動(dòng)療法A 吃面包卷（左側(cè)癱瘓，用左手）B 飲用液體（右側(cè)癱瘓，用右手）C 刷牙（右側(cè)癱瘓，用右手，左側(cè)健手幫助）Mirror therapy what is it?UnaffectedlegUnaffectedhandGarry, Loftus & Summers（2004）鏡像治療Constraint induced therapy does it work inchronic s

24、troke?unaffected limb武漢大學(xué)中南醫(yī)院病例魏xx，女，51歲強(qiáng)制性使用運(yùn)動(dòng)治療視頻文件5039（章志超完成）視頻文件4812（章志超完成）視頻文件6035（章志超完成）Splinting and BracingMore recent devices have been developed for specificfunctional purposes. This device is produced by Bioness, acompany in the United States. The electrodes over fivemuscle groups pick up

25、 electrical signals and assist in themovement of the wrist and hand.使用冰袋進(jìn)行局部冷療抑制痙攣武漢大學(xué)中南醫(yī)院病例，劉xx，女，33歲，腦外傷物理治療牽伸手指，握住掌指關(guān)節(jié)手指屈肌群跨越肘關(guān)節(jié)，保持肘關(guān)節(jié)伸展和腕關(guān)節(jié)背屈物理治療治療性手法抑制痙攣傳統(tǒng)康復(fù)治療針灸（體針、頭針、耳針）按摩、氣功頭針叢刺長(zhǎng)留針?lè)汞d攣針?lè)ㄒ曨l文件5264黑龍江中醫(yī)藥大學(xué)附屬二院Dr. Alberto EsquenaziChair of theDepartment ofPhysical Medicine andRehabilitationDirec

26、tor of the Gaitand Motion AnalysisLaboratory, MossRehab, Albert Einstein,Philadelphia, USA局部注射藥物治療（肉毒毒素）肌電顯示儀引導(dǎo)注射超聲介導(dǎo)下肉毒毒素注射治療武漢大學(xué)中南醫(yī)院病例，蔡x，45歲，腦出血The Brain Can Adapt to New InputGlobal Evidence: The cortex is reorganized when physical change takes placeEverybody PostAbout MirrorNeurons!We learn about theneural networksinvolved in mirrorsystem activity真實(shí)運(yùn)動(dòng)和想象運(yùn)動(dòng)的皮質(zhì)激活區(qū)激活區(qū)域：1、初級(jí)運(yùn)動(dòng)區(qū)（BA4）2、運(yùn)動(dòng)前區(qū)（BA6)*3、S(BA13）4、SII（BA40,43）5、核團(tuán)*真實(shí)的手指運(yùn)動(dòng)想象手指運(yùn)動(dòng)激活區(qū)域：1、運(yùn)動(dòng)前區(qū)（BA6）*2、額葉下部（BA44）3、前額葉區(qū)（BA9,46）4、頂葉區(qū)（BA7,40）5、核團(tuán)*When the phenomenon of "mirror neurons" that fire b