.第五章 肌张力的评估.pptVIP

* * 痉挛模式 脑外伤(TBI) 多发性硬化 (MS) 脊髓损伤 (SCI) 脑卒中(Stroke) * * 被动: 个人自理障碍 治疗前 治疗后 小指、中指严重屈曲，难以清洁手掌和手指 屈指肌BOTOX注射后症状改善 * * 被动: 体位 体位: 进食 坐 睡 * * 主动:运动控制障碍 上肢 取 抓 移动 放开 治疗前 治疗后 * * 膀胱/直肠护理 * * UMNS动态和静态肌力失衡的表现 上肢 肩内收、内旋 屈肘 前臂旋前 屈腕 握拳 拇指在拳内 下肢 屈髋 大腿内收 屈膝 膝僵硬 足下垂/足内翻 大拇趾背伸 * * 屈肘/握拳 * * 拇指内收 * * 大腿内收/足下垂 * * 拇趾背伸 * * 肌肉痉挛的利弊 利 维持静态姿势 避免肌肉萎缩 减少静脉血栓 弊 影响肢体随意运动 影响生活自理、体位、护理 疼痛 挛缩畸形 * * 康复医学领域常见痉挛相关的疾病 脑卒中 脑外伤 缺氧性脑病 脊髓损伤 脑瘫 运动神经元病 * * * * Whilst the pattern of spasticity is not specific to one cause, generalised spasticity, which is diffuse and affects multiple regions of the body is most often associated with traumatic brain injury and multiple sclerosis. Regional spasticity affecting a large area of the body is most often associated with spinal cord injury, and focal spasticity, which is localised to a particular area, is often a characteristic of spasticity following stroke. * * Passive: Personal Care Problems These problems are manifestations of UMN dysfunction that interfere with the personal care of the patient. They include problems with dressing, personal hygiene and bathing, difficulty toileting and caring for the perineal region, and problems with skin integrity. This slide shows a patient with clenched fist deformity, which often leads to skin maceration and malodor of the affected region. Chemodenervation of the flexor digitorum sublimis resulted in marked improvement of this condition. * * Passive: Positioning Passive issues related to positioning can involve those of feeding, sitting, and sleeping. This slide shows a patient with adducted thighs that interfered with wheelchair positioning * * Active: Limb Use Problems Active problems of UMN dysfunction can interfere with limb use. These include problems with reach, grasp, transport, and release. This example demonstrates the inability of the patient to hold and lift the can prior to treatment * * Common UMN Patterns Generated by Unbalanced Dynamic and Static Forces As listed on this slide, manifestations of UMN