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1、运动控制在手功能康复的应用武汉大学中南医院康复医学科 廖维靖电子邮件：提纲一、引言二、手运动障碍及控制三、手运动控制的方法四、展望提一、引言二、运动障碍及控制三、运动控制的方法四、展望纲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 ofappendages.大意：手
2、是脑功能的作用表现形式。手反映了脑的活动，是脑的一种镜像。手正是最能激发人研究兴趣和最具人性特点的器官。世界伟人的最后岁月Lenins Last Year(December 1922 - January 1924)Lerner, V., Finkelstein, Y. & Witztum, E. The enigma of Lenins (18701924) malady. European Journal of Neurology 11 (6), 371-376.Lenin in his Kremlin office. 1918Lenin in his wheelchair at Gorki
3、 July or August 1923Lenins 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 the time to remove. On May
4、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 bedriddenfor the remainder
5、of his life, no longer able to speak. OnJanuary 21, 1924, he died as his father had, from acerebral hemorrhage.列宁医疗档案解密报告中枢性运动功能障碍的本质上运动神经元受损（高位中枢失控）皮层以下运动反射释放（运动模式异常）肌张力增高、痉挛、肌群协调紊乱（协同运动、联合反应、紧张性反射）Brunnstrom 6阶段周围性瘫痪中枢性瘫痪01I 迟缓期治疗的目标II 痉挛期III共同运动2 IV部分分离运动 345VI正常V分离运动Signe Brunnstrom was a Fullbr
6、ight Scholar and pioneer physical therapist who made an unusually strong impact on the profession through her scientific approach to applied clinical research and her ability to teach the “therapeutic art“ of physical therapy. 瑞典物理治疗师She authored several classic texts and dozens of journal articles
7、in clinical kinesiology and the treatment of patients with hemiplegia.Personal photographs and documents highlight the career of this individual who exerted great influence on the development of physical therapy and rehabilitation.Author:Signe BrunnstromHistory of PNF?Developed by: Dr. Herman Kabat
8、and Maggie Knott in the late 1940s and early 1950s as a means of rehabilitation for neurological disorders such as multiple sclerosis, cerebral palsy and poliomyelitis.Dr Karel Bobath, a physician, and Berta Bobath, a physiotherapist, were born in Berlin and moved to England during World War 2.They
9、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 the foundation for the control of movementCont
10、rol of Complex Movements Involve Cerebral Cortex Basal Ganglia Cerebellum Thalamus Brain Stem Spinal CordCarr & Shepherd, 7 Categories of Functional Daily Activities1. Upper limb function2. Orofacial function3. Sitting up over the side of the bed4. Balanced sitting5. Standing up & sitting down6. Bal
11、anced standing7. WalkingConstraint-induced Movement Therapy:Another form of NDT or SomethingCompletely Different?Brunnstrom评价运动功能评价（motor functional test, MFT）Forelimb 上肢Hand手Hindlimb 下肢上肢/手功能训练大关节活动恢复较早、较好，手部精细 动作恢复较慢、较差。强化训练：A 肩关节和肩带的活动B 肘关节活动C 腕关节屈伸及桡、尺侧偏移D 掌指、指间关节E 手的灵活性、协调性和精细动作训练提一、引言二、运动障碍及控制
12、三、运动控制的方法四、展望纲运动控制Muscle toneSpasticityFlaccidity协调痉挛迟缓Crawling is a vital development stage that children who spend too much time in pushchairs and baby seats are missing out on湖北潜江市脑瘫儿童湖北潜江市脑瘫儿童湖北潜江市脑瘫儿童湖北潜江市脑瘫儿童视频文件3667脑瘫儿童上肢/手的功能障碍武汉大学中南医院病例患者周xx视频文件7260武汉大学中南医院病例，任xx，男，64岁视频文件6995武汉大学中南医院病例，陈xx
13、赵xx，女，47岁，脑梗死，视频文件5221武汉大学中南医院病例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, and neuromotor processes. In J.H. Carr, R.B. Shepherd,
14、 J. Gordon, A.M. Gentile, & J.M. Held, Movement Science. Foundations for Physical Therapy in Rehabilitation. MD: Aspen Publishers.Definition and levels of analysisNeurofacilitation ApproachesMotor HierarchyTheories of Motor ControlTask-Based Approaches Map of Essential ConceptsReflex TheoryComplex S
15、ystems TheoryFall 2006 DM 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 HierarchReflex Theory Reflex Theory (Charles Sherrington, early 1900s
16、) Complex behavior (movement) is controlled by a series of chained reflexes (e.g. Frog)Complex Systems Theory Movement emerges spontaneously from the interactionof the individual, the task, and the performanceenvironmentTaskIndividualEnvironmentMovement机能的代偿解剖、机能的基础同型性发芽（sprouting）异型性发芽细胞的可塑性去传入敏感升高突触去抑制神经网络机能的变通性代偿模式结构的重组机能的重建影响代偿的因素物种年龄损伤的程度和部位药物作用功能性锻炼和学习动机（心理）神经系统机能代偿的机制与影响因素（Lacour，1999）稳态1网络协调神经网络：输入单位（输入 神经元）、内在单位（中间 神经元）和输出单位（输出 神经元）组成。 突触功效
