脊髓損傷的痙攣

An Overview of Spasticity in Spinal Cord Injuries

林光華(Kwan-Hwa Lin) ； 王亭貴(Tyng-Guey Wang)

《中華民國物理治療學會雜誌》 15卷 (1990/09) Pp. 54-62

https://doi.org/10.29616/JPTAROC.199009.0008

摘要

痙孿是脊髓損傷常見的臨床症狀，會有肌肉張力增加、深部反射增強及陣孿的現象。脊髓損傷的痙孿多半是γ痙孿，與牽張反射有密切的關係。造成痙孿的神經生理機，可能是(l)喪失正常的抑制作用，(2)神經切除後約的反應過度，(3)側枝發茅。至於影響脊髓損傷痙孿的因素包括：(1)受傷的解剖位置，(2)受傷的時間，(3)早期的擺姿，(4)內外在的刺激。這些可影響痙孿變成彎曲式或伸直式，以及痙攣的強度。本文進而討論脊體損傷痙孿的各種療法，包括物理治療、藥物治療、化學藥劑神經鬆解術及手術療法。因為物理治療為痙孿預防與治療的第一線，值得重視。所討論的物理治療包括：(1)冷敷，(2)熱療，(3)支架與副木，(4)姿勢反射，(5)運動治療，(6) 電刺激，(7)肌肉振動，(8)肌電圖回饋，(9)雷射治療及(10)其他的療法。有的物理治療法，仍在嘗試性的階段，有待進一步的探討與研究。

關鍵字

痙孿 ； 脊髓損傷 ； 牽張反射

並列摘要

Spasticity is one of the common clinical syndromes in spinal cord injury. It is characterized by hypertonia, hyperreflexia and clonus. The patients with spinal cord injury usually manifest with γ-spasticity which is closely related to stretch reflex. The neurophysiological mechanisms of spasticity are considered as: (1) loss of normal inhibition, (2) denervation hypersensitivity, and (3) collateral sprouting. Recent reports have mentioned the factors which can affect the type (flexor or extensor) and the magnitude of spasticity in spinal cord injury. Those factors mainly are: (1) anatomical lesion site, (2) interval of injury, (3) early positioning, and (4) internal-external stimuli. This review paper also introduce the management of spasticity, such as physical therapy, durg therapy, chemical neurolysis and surgery. Physical therapy is very important because it is the first line of prevention and treatment of spasticity. The physical therapy used today includes: (1) cooling, (2) heat, (3) bracing and splinting, (4) postural reflex, (5) exercise therapy, (6) electrical stimulation, (7) muscle vibration, (8) EMG biofeedback, (9) laser therapy, and (10) others. Some of the methods are not well established, and may require further studies.

並列關鍵字

Spasticity ； Spinal cord injury ； Stretch reflex