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1、康复治疗 : There are alterations that occur in muscles and connective tissue associated wi t h chronic spasticity. Spastic muscles have been shown to have shorter resting sarcomere length wit h evidence of changes in connective tissue constituents, such as collagen and titin (Friden and Lieber, 2003). 与
2、慢性痉挛有关的肌肉和结缔组织会发生改变。痉挛肌的静息肌节长度变短，结缔组织的成分也发生明显的改变，如胶原蛋白和titin (Friden and Lieber, 2003). Biomechanical interventions, including range of motion exercises and splinting, may help minimize these changes. Passive range of motion of spastic muscles, performed at least 2-3 times a day, should be an integr
3、al part of any treatment regimen for spasticity. Although the improvement in tone is only temporary (several hours), routine range of motion exercises may help prevent the development of contractures (Nuyens etal.,2002). 生物力学干预，包括活动范围训练和夹板可能对减少这些改变有帮助。痉挛肌的被动活动范围练习每天至少进行 2-3 次，而且应该成为任何痉挛治疗训练课的主要部分。尽管
4、肌张力的改善只是暂时的（几个小时），但常规的活动范围练习对预防发展成为挛缩可能有帮助(Nuyens etal.,2002). 。There are certain physical therapy philosophies that stress the inhibition of spasticity in their treatment approach. For example, the neurodevelopmental technique is based on the attempt to inhibit tonic reflexes by passively bringing
5、patients into reflex inhibitory postures (Kabat and Knott, f954). 有些物理治疗体系的治疗方法中强调对痉挛的抑制。如神经发育技术就是基于被动地将病人置于发射性抑制体位来抑制张力反射的(Kabat and Knott, f954). 。The techniques of proprioceptive neuromuscular facilitation (PNF) emphasizes the instruction of normal patterns of movement to spastic patients (Pierso
6、n, 2002). Although studies have not demonstrated better functional outcomes in patients treated with this particular technique compared to others, patients wit h marked spasticity might be ones to benefit from these therapy approaches (Gelber et al., 1995). 本体感觉神经肌肉促进技术（PNF）强调对痉挛病人进行正常运动模式的指导(Pierso
7、n, 2002) 。尽管研究显示用这些特定的治疗技术在功能改善方面并没有比用其它治疗方法更好，但有显著痉挛的病人可能已经从这些治疗方法中受益(Gelber et al., 1995).。Anecdotal reports suggest that other therapy modalities might help reduce muscle tone. Vibration, especially of antagonist muscles, may help reduce tone in a spastic limb (Lee et al., 2002). Topical cold and
8、 anesthetics may reduce tone by decreasing the sensitivity of cutaneous receptors and slowing nerve conduction (Miglietta, 1973; Sabbahi et al., 1981). There are also case reports of improved spasticity following magnetic stimulation of the spinal cord and acupuncture (Nielsten 1995; Moon et al., 20
9、03). 一些报告建议其它的一些治疗形式可能对降低肌张力有帮助。震颤法（Vibration 振动？摇摆？） ，尤其是拮抗肌，可能对降低痉挛肢体的张力有帮助(Lee et al., 2002).局部的冷疗和麻醉剂可以降低皮肤受体的敏感性和减慢神经传导速度从而可能使肌张力降低(Miglietta, 1973; Sabbahi et al., 1981).。也有病例报道，磁刺激脊髓和针灸可以使痉挛缓解(Nielsten 1995; Moon et al., 2003).。Orthotic devices may also be considered in the management of spas
10、ticity, to reduce tone, improve range of motion, prevent contractures, and reduce pain. Orthoses also control joint instability and may alter the loading of a limb to prevent stretch reflex activity in antagonist muscles. 矫形器也可以被用来管理痉挛，降低张力，改善活动范围，预防挛缩和缓解疼痛。矫形器还可以控制关节不稳定和改变肢体负重来预防拮抗肌的牵张反射活跃The theor
11、y behind tone inhibiting orthoses suggests that prolonged stretch may actually change the mechanical properties of spastic muscles, perhaps by reducing muscle spindles reaction to stretch (Kogler , 2002). Although clinical observations suggest tone to be reduced with splints, experimental evidence i
12、s scarce and studies have not determined the most effective splint design (Langlois, et al., 1989). However, most commonly splints are fabricated to position affected joints opposite to the tonal response (Kogler, 2002). 抑制张力的原理或者长时间伸展（牵伸）可能是改变了痉挛肌肉的机械性能，可能是通过降低肌肉纺锤体对伸展的反应来实行的。Ankle-foot orthoses (A
13、FOs) are commonly prescribed in patients with spastic lower extremity paresis to inhibit tone, and if possible, improve ambulation (Lehmann et al., 1987, Sankey et al., 1989). Rarely, knee-ankle-foot orthoses (KAFOs) are used in the management of young patients with cerebral palsy (Kogler, 2002). 踝足
14、矫形器一般会下处方给下肢痉挛的病人用来抑制张力，以及可能的话改善步行(Lehmann et al., 1987, Sankey et al., 1989)，在儿童脑瘫病人的处理中很少用膝踝足矫形器。The goals of upper extremity splinting are to reduce tone, improve range of motion, and prevent palm maceration. Some of the commonly used wrist -hand-finger orthoses include the Snook splint (Snook, 1
15、979), cone splint, Bobath splint, and fingerabductor splint. Static or dynamic ortho ses can also be considered for management of elbow flexion spasticity (Kogler, 2002). 上肢夹板的目的是为了降低张力，改善活动范围，和预防手掌maceration （挛缩？）通常使用腕手指矫形器，包括Snook 夹板(Snook, 1979) ，cone 夹板， Bobath 夹板和手指外展夹板。静态或动态的矫形器可以用来处理肘关节屈曲痉挛。S
16、erial casting is an effective means for managing early soft tissue contractures resulting from spasticity, and is often combined with the use of botulinum toxin or medications (Mortenson and Eng, 2003). This process involves positioning an extremity at the end of passive range of motion and casting in that position. The cast is left in place for several days and is then removed (Pohl et al., 2002). 连续的铸型是控制痉挛造成的早期软组织挛缩的有效方法，并且通常与肉毒素或药物联合应用(Mortenson and Eng, 2003). 这个方法包括将肢体置于被动活动范围的末端，并在这个位置
