痙攣型雙邊麻痺兒童粗動作型態之發展及玻巴斯治療方法

The Development of Gross Motor Patterns in Spastic Diplegics and the Treatment Approaches Based on Bobath's Concepts

廖華芳(Hua-Fang Liao)

《中華民國物理治療學會雜誌》 15卷 (1990/09) Pp. 63-71

https://doi.org/10.29616/JPTAROC.199009.0009

摘要

本文以神經生理與生物力學之角度來描述痙孿型雙邊麻痺兒童粗動作之發展。大部份患童早期沒有異常動作型態，僅是生理性屈曲姿勢佔優勢之時期較正常兒童長，到後期，由於活動量增加，過份出力引發聯合反應(associated reaction)，使下肢伸肌痙孿愈來愈明顯。然後在爬及坐之發展階段，下肢即呈現屈肌和伸肌同時收縮之半伸半屈姿勢，即使是到能站能走的階段，也維特此一特性。根據步態分析實驗室之研究顯示，患童由於缺乏足夠的平衡反應，加上痙孿的影響，痙孿型雙邊麻痺兒童於步行時所使用之代償方式之變異性相當大。接受過跟腱建長術之患童，如果跟腱過份延長，行走時常因膝屈曲力矩增加，以致造成進行性屈膝步態(progressive crouch gait)。另一種在痙孿型雙邊麻痺兒童常見的異常步態，則因犢肌(calfm.)痙孿太強，使其在步行之站立期(stance phase)初期脛骨便無法前移，以致造成膝關節後頂步態(hyperextended knee)。著者並根據玻巴斯(Bobath)治療概念，分析異常動作之成因及治療原則，並介紹在不同發展階段之運動治療方法。

關鍵字

腦性麻痺 ； 動作發展 ； 痙孿型雙邊麻痺

並列摘要

The development of gross motor pattern in spastic diplegics is presented in this article in view of neurophysiology and biomechanics. The child usually showed physiological flexion posture in the early infancy, then extensor spasticity gradually appeared with the increasing activities.
In the later stage, because of the flexion positions in sitting and crawling, the semiflexion posture gradually developed with the co-contraction of flexor and extensor. This semiflexion posture usually remained through the standing and walking stage. The two most common gait deviations are described as follows. One is the progressive crouch gait of spastic diplegic child which was caused by the increasing flexion torque of knee joint and the deformity of patella alta. The other is the hyperextended knee during early stance phase which was usually induced by the decreased forward advancement of the tibia affected by the strong calf muscle activities. The treatment principles and methods introduced in this paper were based on the Bobath's concepts. Such as using active inhibiting pattern rather than the passive or static reflex inhibiting pattern to reduce the hypertonus; using key point control to facilitate the normal postural reactions arid to inhibit the abnormal movement patterns; facilitating the movement patterns that deviating from synergic pattern; avoiding effort during treatment; weight shifting training in weight bearing posture; using proper sensory stimulation to normalize muscle tone; to prevent the development of contracture or deformities.

並列關鍵字

Cerebral palsy ； Movement development ； Spastic diplegics