悬吊技术在儿童康复中的应用
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懸吊技術在兒童康復中的應用
Edited by Wei-Pin Huang
1
簡短經歷
➢1992 中山復健醫學系/林口長庚復健科物理治療室 ➢1995 長庚兒童醫院物理治療室 ➢1998 台灣首屆早期療育物理治療種子人員 ➢1998 美國TAMO (Tscharnuter Akademie for Movement
15
Sensorimotor Function
➢Body adjust to gravity change ➢ Closed chain exercise ➢ unstable surface:
➢ stand on sling ➢ inflatable rubber cushion
16
Vestibular stimulation
12
Stability
➢Training the stabilizing musculature
➢Facilitate agonist and antagonist muscle co-contraction ➢Training proximal stability
13
14
Suspension Air Pillow
28
28
Medial Suspension Point
• Negative weight in movement toward the suspension point • Increased resistance in movement away from suspension point • Oblique plane of movement leads to combined movements
Organization)治療法受訓合格 ➢1999 台大物理治療學研究所 ➢2003 挪威 SET課程受訓 ➢2010 長庚大學復健科學研究所 ➢2011 挪威 Neruac 1 國際講師 ➢2015 美國特奧會運動員健康計劃之趣味體適能檢測受訓合格 ➢2016 CranioSacral Therapy 顱薦治療 level I II 檢定合格 ➢曾任林口長庚物理治療組長，長庚大學兼任講師，高醫兼任
joint Activation of
agonist/synergist/antagonist For functional training 18
Open Kinetic Chain
➢Involve isolated activation of agonists and synergists without co-contraction of antagonist
➢In S-E-T : isolated muscle strengthening exercise
19
Closed Kinetic Chain
➢The loading is grading by hanging the placement of the sling on the body ➢rope length ➢suspension point
7
Enablement Model
健康狀態 Health Condition (disorder/disease)
身體功能 Body function
&structure (Impairment)
活動 Activities (Limitation)
社會參與 Participation (Restriction)
➢ ↓gravity by sling device ➢ ↑control and move joint to end range
9
Musculoskeletal Disorder
•Bone abnormalities
disrupt normal
length/tension of muscle and result weakness
物理治療臨床助理教授 ➢現任弘光科大學物理治療系專技副教授
2
History
➢Sling exercise therapy (S-E-T) ➢Schlingentish (Sling table) ➢ Norway – 1960 ➢Therapimaster sling exercise device : Kare Mosberg
20
Poor sitting posture
• poor sitting posture of children with Cerebral palsy -Pelvic posterior tilt -Scapular adduction -Poor trunk erect -Hip ADD and IR
環境因素
Environmental Factors
個人因素
Personal Factors
(WHO, 2001)
Mobility Exercise
➢Primary impairment : ↓neuromotor control ↓mobility experience
➢Secondary impairment : ↓ ROM and ↑ contracture
• To train individual muscle groups
Close Kinetic Chain Distal segment is weight-
bearing Distal segment is fixed Increasing static/dynamic
stability Increase compression in the
33
Sling suspension device for children
Strength of suspension exercise •Motivation •Active treatment •Early mobilization •Easy use in clinical
35
謝謝
36
30
Helping hand principle
➢ free the therapist’s hands
➢ provide relief from heavy weight loads
➢ provide increased relaxation and security
31
Treatment Concept
➢Active therapy ➢Work on weak link and movement control ➢Find the right exercise at right level ➢Progress as tolerated
32
Sling suspension device for children
Poor sitting posture training
• Pelvic posterior tilt
Pelvic posterior tilt
-
Pelvic posterior tilt
Helping hand principle
➢ free the therapist’s hands
➢ provide relief from heavy weight loads
➢ provide increased relaxation and security
25
26
Progress ladder system
Biomechanical Basis of Suspension Point (SP)
➢SP means the “place” where the rope comes out of suspension device.
• Goal-directed, functional behaviors • consider the importance of multiple system of individual as well as the environment in learning to accomplish specific functional goal • Increase the possibility of activity and participation • Enablement model
Muscle Strength : Kinetic Chain
•Open Kinetic Chain
• Distal segment is no weight-bearing • Distal segment is free to move • Focus on isolated training of muscles
➢Depending on the placement of the suspension point in relation to the joint, we distinguish between axial, caudal, cranial, medial, lateral and neutral suspension. • Axial SP • Cranial SP • Caudal SP • Medial SP • Lateral SP
individual
task
environment
Children need to be active learners to problem-solve how to accomplish a specific task,
given their constraints
New approaches
3
Dynamic Systems Theory
• The biological system are complex
• motor behavior: • Many component of the organ, environment and task interact
• Task specific
•Musculoskeletal system and the neurologic system are intertwined
•Promote musculoskeletal adaptations
• Effort to prevent or correct physical impairment • Enhancing function and participation in daily life activities
Motivation
11
Relaxation
➢Place body part in a desired position in the sling device ➢Gently move the body part
➢Used before and after treatment ➢Emphasize terminate specific muscle activity
SP
29
Lateral Suspension Point
• Negative weight in
SP
movement toward the
suspension point
Fra Baidu bibliotek
• Increased resistance in movement away from suspension point
• Oblique plane of movement leads to combine movement
• Negative sign • Strength
Dynamic Therapy
• Problem oriented : Top down approach • ICF : components of health
(WHO, 2001)
International Classification of Functioning, Disability and Health (ICF)
Edited by Wei-Pin Huang
1
簡短經歷
➢1992 中山復健醫學系/林口長庚復健科物理治療室 ➢1995 長庚兒童醫院物理治療室 ➢1998 台灣首屆早期療育物理治療種子人員 ➢1998 美國TAMO (Tscharnuter Akademie for Movement
15
Sensorimotor Function
➢Body adjust to gravity change ➢ Closed chain exercise ➢ unstable surface:
➢ stand on sling ➢ inflatable rubber cushion
16
Vestibular stimulation
12
Stability
➢Training the stabilizing musculature
➢Facilitate agonist and antagonist muscle co-contraction ➢Training proximal stability
13
14
Suspension Air Pillow
28
28
Medial Suspension Point
• Negative weight in movement toward the suspension point • Increased resistance in movement away from suspension point • Oblique plane of movement leads to combined movements
Organization)治療法受訓合格 ➢1999 台大物理治療學研究所 ➢2003 挪威 SET課程受訓 ➢2010 長庚大學復健科學研究所 ➢2011 挪威 Neruac 1 國際講師 ➢2015 美國特奧會運動員健康計劃之趣味體適能檢測受訓合格 ➢2016 CranioSacral Therapy 顱薦治療 level I II 檢定合格 ➢曾任林口長庚物理治療組長，長庚大學兼任講師，高醫兼任
joint Activation of
agonist/synergist/antagonist For functional training 18
Open Kinetic Chain
➢Involve isolated activation of agonists and synergists without co-contraction of antagonist
➢In S-E-T : isolated muscle strengthening exercise
19
Closed Kinetic Chain
➢The loading is grading by hanging the placement of the sling on the body ➢rope length ➢suspension point
7
Enablement Model
健康狀態 Health Condition (disorder/disease)
身體功能 Body function
&structure (Impairment)
活動 Activities (Limitation)
社會參與 Participation (Restriction)
➢ ↓gravity by sling device ➢ ↑control and move joint to end range
9
Musculoskeletal Disorder
•Bone abnormalities
disrupt normal
length/tension of muscle and result weakness
物理治療臨床助理教授 ➢現任弘光科大學物理治療系專技副教授
2
History
➢Sling exercise therapy (S-E-T) ➢Schlingentish (Sling table) ➢ Norway – 1960 ➢Therapimaster sling exercise device : Kare Mosberg
20
Poor sitting posture
• poor sitting posture of children with Cerebral palsy -Pelvic posterior tilt -Scapular adduction -Poor trunk erect -Hip ADD and IR
環境因素
Environmental Factors
個人因素
Personal Factors
(WHO, 2001)
Mobility Exercise
➢Primary impairment : ↓neuromotor control ↓mobility experience
➢Secondary impairment : ↓ ROM and ↑ contracture
• To train individual muscle groups
Close Kinetic Chain Distal segment is weight-
bearing Distal segment is fixed Increasing static/dynamic
stability Increase compression in the
33
Sling suspension device for children
Strength of suspension exercise •Motivation •Active treatment •Early mobilization •Easy use in clinical
35
謝謝
36
30
Helping hand principle
➢ free the therapist’s hands
➢ provide relief from heavy weight loads
➢ provide increased relaxation and security
31
Treatment Concept
➢Active therapy ➢Work on weak link and movement control ➢Find the right exercise at right level ➢Progress as tolerated
32
Sling suspension device for children
Poor sitting posture training
• Pelvic posterior tilt
Pelvic posterior tilt
-
Pelvic posterior tilt
Helping hand principle
➢ free the therapist’s hands
➢ provide relief from heavy weight loads
➢ provide increased relaxation and security
25
26
Progress ladder system
Biomechanical Basis of Suspension Point (SP)
➢SP means the “place” where the rope comes out of suspension device.
• Goal-directed, functional behaviors • consider the importance of multiple system of individual as well as the environment in learning to accomplish specific functional goal • Increase the possibility of activity and participation • Enablement model
Muscle Strength : Kinetic Chain
•Open Kinetic Chain
• Distal segment is no weight-bearing • Distal segment is free to move • Focus on isolated training of muscles
➢Depending on the placement of the suspension point in relation to the joint, we distinguish between axial, caudal, cranial, medial, lateral and neutral suspension. • Axial SP • Cranial SP • Caudal SP • Medial SP • Lateral SP
individual
task
environment
Children need to be active learners to problem-solve how to accomplish a specific task,
given their constraints
New approaches
3
Dynamic Systems Theory
• The biological system are complex
• motor behavior: • Many component of the organ, environment and task interact
• Task specific
•Musculoskeletal system and the neurologic system are intertwined
•Promote musculoskeletal adaptations
• Effort to prevent or correct physical impairment • Enhancing function and participation in daily life activities
Motivation
11
Relaxation
➢Place body part in a desired position in the sling device ➢Gently move the body part
➢Used before and after treatment ➢Emphasize terminate specific muscle activity
SP
29
Lateral Suspension Point
• Negative weight in
SP
movement toward the
suspension point
Fra Baidu bibliotek
• Increased resistance in movement away from suspension point
• Oblique plane of movement leads to combine movement
• Negative sign • Strength
Dynamic Therapy
• Problem oriented : Top down approach • ICF : components of health
(WHO, 2001)
International Classification of Functioning, Disability and Health (ICF)