Callosal Syndrom: Implications in Rehabilitation: Case Report

胼胝體症候群之復健指引

黃翠莉(Chui-Lee Wong) ； 許美慧(Mei-Hue Hsu)

《中華民國復健醫學會雜誌》 20期 (1992/12) Pp. 221-225

摘要

胼胝體症候群是相當少見於額葉梗塞的患者。其症狀亦可能被額葉梗塞的其他症狀，例如注意力不堡中，做事起動慢或肢體乏力所掩蔽。一般需要敏銳的觀察及特殊的臨床測試才易發現其存在。本文報告一位慣用右手五十三歲男性患者在右額葉梗塞後被察覺證實患有胼胝體症候群。其症狀及徵候包括口腔失用症，左手意想性運動不能，左手失用性失寫症，左手構成性失用症，cross-replication of hand posture 的異常，forced grasping 及intermanual conflict。腦梗塞八週後，以上大部份的症狀及徵候已改善。患者走的是reciprocal pattern步態，可自理日常生活。綜合治療患者及回顧文獻所得的經驗與知識，就復健方面提出一些建議。對於此類患者，在治療時應懂得使患者放輕鬆，不宜多用口頭命令，宜用模仿及實物的操作來改善其失能症。需反覆練習一些兩手操作的活動(bimanual activity)以期改善兩手之間的協調性。因forced grasping 及inter-manual conflict 可能性與其餘留的forced gasping 及 intermanual conflict 的嚴重程度有極大的關係。

並列摘要

A 53 year-old male patient, who sustained infarction of the right medial frontal lobe with extension into the corpus callosum, demonstrated inattention, slow initiation and left hemiparesis initially. As the strength recovered, forced grasping of the left hand, and intermanual conflict appeared. Besides, left ideomotor apraxia, left constructional apraxia, left apraxic agraphia, and abnormalities of cross-replication of hand posture were detected after specific clinical testing. Most of these deficits improved eight weeks after stroke. In rehabilitation these patients with callosal syndrome, the forced grasping and intermanual conflict should be observed keenly in view of their potential harmfulness. Instead of too much verbal commands , imitation and manipulation of actual objects should be used to improvepraxis. Bimanual activities should be repeatedly practiced to enhance the cooperation of both hands. Independency in activities of daily living and possibility of going back to work depend on the frequency and/or severity of the residual forced grasping and inter-manual conflict.

並列關鍵字

callosal syndrome ； rehabilitation ； stroke