高張力的機轉與評估：反射性與非反射性

Mechanisms and Assessment of Hypertonia: Reflex and Non-Reflex Components

林光華(Kwan-Hwa Lin) ； 黃國榮(Kok-Eng Ooi) ； 王淑芬(Shwu-Fen Wang) ； 葉純妤(Chun-Yu Yeh)

《物理治療》 29卷2期 (2004/04) Pp. 110-119

摘要

中樞神經系統損傷病患缺乏活動，容易造成神經肌肉的改變，常見的是肌肉高張力。而痙攣（與速度有關之強直性反射過度興奮）被認為是高張力的主要成分。傳統上認為肌肉張力過高是歸因於無法抑制的神經活化，引起強直性牽張反射過度的興奮。雖然神經反射為主流學說，但是最近二十年來有一些學者發現非反射性因子也會明顯促成肌肉高張力的現象。所以，形成肌肉高張力的原因被分為反射性和非反射性。反射性與牽張等反射有關；而非反射性與肌肉、肌腱的機械黏彈性質有關。本文是綜合近年來的研究，做簡短的總論，使對臨床上肌肉張力增加的機轉有進一步的了解，有助於臨床治療方式的選擇。

關鍵字

高張力 ； 牽張反射 ； 黏彈性質

並列摘要

Patients with central nervous system (CNS) lesions usually lack mobility, which result in neuromuscular changes. The common clinical sign of CNS lesion is hypertonia. Spasticity (velocity dependent tonic reflex hyper-excitability) is considered as one component of hypertonia. Traditionally, hypertonia is believed to be due to disinhibiti on of descending excitatory influence on spinal motoneurons, which in turn induces tonic stretch reflex hyper-excitability. However, over the last two decades, researchers have found that non-reflex factors also contribute significantly to hypertonia. Therefore, the reflex and non-reflex components are included in hypertonia. The reflex component is related to the stretch reflex, and the non-reflex component is related to the viscoelastic property of muscles, tendons, and ligaments. This article summarises findings of recent studies, and provides the clinicians with the mechanisms of hypertonia. This will assist the therapists to select the appropriate intervention strategies for patients with central nervous lesions.

並列關鍵字

Hypertonia ； Stretch reflex ； Viscoelastic property