感觉运动障碍的物理治疗
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Rhizotomy Surgical procdure to reduce spasticity in gastrocaemius
In addition to strength, Isolated control
增强肌力,分离控制
Lack of isolated (selective) control
Stereotyped(常规)
Abnormal movement synergy(共同运动)
Abnormal synergy
Coordination Cognition perception
（感知能力）
Loss of sensation Pain
Weakness
Joint stiffness, soft tissure shortening Muscle tone
Sensory re-education
Tactile（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
Lesion of CNS Lack of supra-spinal inhibitory signals on stretch reflex Definition: A motor disorder characterized by a velocity-dependent increase in tonic stretch reflex Velocity Resistance
A comparison between agematched normal & spastic hemiparetic subjects Hyperactive tonic stretch reflexes - increase resistance to passive movement
Spasticity - pathophysiology
Enhance Inhibition of stretch reflex(增强对神
肌反射的抑制)
Prolonged stretch(持续牵拉) Positioning Splint Serial casting Stretch – 6 hours Ice therapy – 20 minutes
TENS – Spasticity Enhance pre-synaptic Inhibition
Facilitation(易化) i.e. Cerebellom Motor cortex(运动皮层) Pontine(桥脑) Reticular(网状结构) Formation
Inhibition(抑制)
i.e. Bulbar(延髓)
reticular Formation
Muscle tone
Disability
Activity
Reduce Handicap Society
Participution
Individual
Task
Environment
Passible sensory and motor impairments
Altered biomechanical alignment（生物学力线的改变） Balance
Flaccidity(弛缓)
Enhance excitation of stretch reflex(增强伸展反射的刺激)
Quick stretch(快速拉伸) Brisk touch Quick tapping(快速轻扣) Quick stroke of ice
Muscle tone and Muscle strength
Abnormal alignment in standing (postural set)
Marked asymmetry(明显的不对称) No weight bearing over R LL R LL adducted, planterflex R UL flexed L trunk is shortened
No clinical or experimental(实验) evidence(证明) support: Improved motor Normalise spasticity performance(运动绩效的改善) Muscle tone is poorly related with functional disability Indeed, poor motor control – lack of isolated 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……
Mass flexion Sh flexion Elbow flexion
Isolated / selective control
Abnormal flexor synergy
(屈肌共同运动)
Flexion of hip associated with flexion of the knee during heel-strike
Abnormal biomech alignment Selective motion
Weakness
Muscle tone
Biomechanical alignment
“Normal” alignment – most efficient “Abnormal” alignment – affect movement
(增强突触前抑制)
TENS applied on fibula head (common peroneal nerve) to reduce spasticity of ankle planterflexors Parameters(因素) : • 0.2 ms square pulse • 99 Hz • 2×sensory threshold • 60 minutes • 5 times a week for 3 weeks
Treatment to reduce spasticity
Enhance inhibition of stretch reflex Pharmacological treatment Baclofen (oral, intrathecal) – a derivative of GABA Botulinum (Intramuscular) – inhibiting the release of acetylcholine Surgical treatment Rhizotomy – removal of dorsal rootlets, to reduce the afferent inputs into the spinal cord
Isolated knee and hip control
Spastic muscle can be weak
Spasticity and weakness
Diplegia Walk on tip-toe
Spasticபைடு நூலகம்gastrocaemius
Spasticity and weakness
痉挛
弛缓
Muscle tone
Amount of tension in a relaxed muscle Tension stiffness Maintain posture(维持姿势) – prevent too much sway Make muscle ready to shorten Person with intact neuromuscular system, muscle tone is minimal i.e. resistance to passive movement is minimal Muscle tone can change according to posture and anxious level
Abnormal muscle tone Hypotonous – flaccid Hypertonous – spasticity, rigidity
Spasticity – pathophysiology
痉挛的病理生理学
Lesion of CNS (中枢神经系统损伤) 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
• Increase tone to a certain range and follows by a sudden reduction of tone
Clonus Abnormal posturing of the limbs, contracture, pain
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)
(防护来自物理和化学的伤害)
If sensation does not recover Compensation e.g. vision for deficit in tactile sensation (靠视觉补偿触觉的不足)
Passible sensory and motor impairments
Surgical treatment
(外科治疗)
Rhlzotomy – removal of rootlets, to reduce the afferent inputs into the spinal cord
Reduce spasticity over calf muscles
Spasticity
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 - ICF
Enhance physiological function
Improve
Individual Minimize
激）
Progression – size, shape, object recognition（确认）, 2-point discrmination High level of attention and memory
Sensory re-education
Protect from noxious and injurious stimuli
Manifestation
(显示, 证明)
of spasticity
Exaggerated(过强的) stretch reflex
• Tonic: increase resistance to passive movement • Phasic: increase tendon jerk
Clasp knife response
Treatment
Correct (矫正) alignment of the trunk, UL and LL in sitting
Weight bearing(负重) over R LL
IN a more narmal postural set
Weight bearing and strengthing ex
In addition to strength, Isolated control
增强肌力,分离控制
Lack of isolated (selective) control
Stereotyped(常规)
Abnormal movement synergy(共同运动)
Abnormal synergy
Coordination Cognition perception
（感知能力）
Loss of sensation Pain
Weakness
Joint stiffness, soft tissure shortening Muscle tone
Sensory re-education
Tactile（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
Lesion of CNS Lack of supra-spinal inhibitory signals on stretch reflex Definition: A motor disorder characterized by a velocity-dependent increase in tonic stretch reflex Velocity Resistance
A comparison between agematched normal & spastic hemiparetic subjects Hyperactive tonic stretch reflexes - increase resistance to passive movement
Spasticity - pathophysiology
Enhance Inhibition of stretch reflex(增强对神
肌反射的抑制)
Prolonged stretch(持续牵拉) Positioning Splint Serial casting Stretch – 6 hours Ice therapy – 20 minutes
TENS – Spasticity Enhance pre-synaptic Inhibition
Facilitation(易化) i.e. Cerebellom Motor cortex(运动皮层) Pontine(桥脑) Reticular(网状结构) Formation
Inhibition(抑制)
i.e. Bulbar(延髓)
reticular Formation
Muscle tone
Disability
Activity
Reduce Handicap Society
Participution
Individual
Task
Environment
Passible sensory and motor impairments
Altered biomechanical alignment（生物学力线的改变） Balance
Flaccidity(弛缓)
Enhance excitation of stretch reflex(增强伸展反射的刺激)
Quick stretch(快速拉伸) Brisk touch Quick tapping(快速轻扣) Quick stroke of ice
Muscle tone and Muscle strength
Abnormal alignment in standing (postural set)
Marked asymmetry(明显的不对称) No weight bearing over R LL R LL adducted, planterflex R UL flexed L trunk is shortened
No clinical or experimental(实验) evidence(证明) support: Improved motor Normalise spasticity performance(运动绩效的改善) Muscle tone is poorly related with functional disability Indeed, poor motor control – lack of isolated 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……
Mass flexion Sh flexion Elbow flexion
Isolated / selective control
Abnormal flexor synergy
(屈肌共同运动)
Flexion of hip associated with flexion of the knee during heel-strike
Abnormal biomech alignment Selective motion
Weakness
Muscle tone
Biomechanical alignment
“Normal” alignment – most efficient “Abnormal” alignment – affect movement
(增强突触前抑制)
TENS applied on fibula head (common peroneal nerve) to reduce spasticity of ankle planterflexors Parameters(因素) : • 0.2 ms square pulse • 99 Hz • 2×sensory threshold • 60 minutes • 5 times a week for 3 weeks
Treatment to reduce spasticity
Enhance inhibition of stretch reflex Pharmacological treatment Baclofen (oral, intrathecal) – a derivative of GABA Botulinum (Intramuscular) – inhibiting the release of acetylcholine Surgical treatment Rhizotomy – removal of dorsal rootlets, to reduce the afferent inputs into the spinal cord
Isolated knee and hip control
Spastic muscle can be weak
Spasticity and weakness
Diplegia Walk on tip-toe
Spasticபைடு நூலகம்gastrocaemius
Spasticity and weakness
痉挛
弛缓
Muscle tone
Amount of tension in a relaxed muscle Tension stiffness Maintain posture(维持姿势) – prevent too much sway Make muscle ready to shorten Person with intact neuromuscular system, muscle tone is minimal i.e. resistance to passive movement is minimal Muscle tone can change according to posture and anxious level
Abnormal muscle tone Hypotonous – flaccid Hypertonous – spasticity, rigidity
Spasticity – pathophysiology
痉挛的病理生理学
Lesion of CNS (中枢神经系统损伤) 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
• Increase tone to a certain range and follows by a sudden reduction of tone
Clonus Abnormal posturing of the limbs, contracture, pain
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)
(防护来自物理和化学的伤害)
If sensation does not recover Compensation e.g. vision for deficit in tactile sensation (靠视觉补偿触觉的不足)
Passible sensory and motor impairments
Surgical treatment
(外科治疗)
Rhlzotomy – removal of rootlets, to reduce the afferent inputs into the spinal cord
Reduce spasticity over calf muscles
Spasticity
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 - ICF
Enhance physiological function
Improve
Individual Minimize
激）
Progression – size, shape, object recognition（确认）, 2-point discrmination High level of attention and memory
Sensory re-education
Protect from noxious and injurious stimuli
Manifestation
(显示, 证明)
of spasticity
Exaggerated(过强的) stretch reflex
• Tonic: increase resistance to passive movement • Phasic: increase tendon jerk
Clasp knife response
Treatment
Correct (矫正) alignment of the trunk, UL and LL in sitting
Weight bearing(负重) over R LL
IN a more narmal postural set
Weight bearing and strengthing ex