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眩暈病人的物理治療原則

Principles of Physical Therapy Management for the Dizzy Patients

摘要


頭暈,指的是頭重腳輕、昏昏的、或想吐的感覺。有的病人伴隨有眩暈的症狀,即感覺自己在轉;或轉動幻視,即感覺周遭環境在轉的症狀。多數病人會因此而失去平街,有跌倒的危險。臨床上,越來越多的病人有中樞性或周圍性的頭暈或眩暈的症狀而接受物理治療。本文主旨乃在回顧與眩暈病人的物理治療原則有關的文獻,以作為物理治療師之臨床參考。 眩暈症狀的產生,主要與前庭系統的功能有關。而前庭系統的功能主要在感知身體的動作、引導人體保持垂直、控制身體的重心、以及維持頭部穩定。前庭功能缺失後,其功能的恢復主要來自三種機制,即自發性的復原、前庭的適應功能、以及功能代償等。眩暈病人必需學會利用視覺及體感覺來代償所喪失的前庭功能,或學習整合不同感覺回饋(即前庭、視覺及體感覺的回饋)之間的訊息,才能達到功能上的進步。 物理治療的原則包括完整的評估及以前庭系統為訓練目標的訓練計畫。完整的前庭評估包括病史及耳科檢查之查閱,下肢肌力、感覺、肌肉張力、顫抖現象、協調能力等之檢查,以及動、靜態平衡,感覺整合與站立平衡測驗,步態,以活動為基礎之平衡評估、及前庭系統的動作敏感度測試等。治療計畫除病患的衛教外,應包括前庭適應運動、平衡再訓練、及一般性體能訓練等。最終以減輕眩暈症狀、改善平衡、及減少功能障礙為目標。 國外文獻均指出前庭系統的物理治療訓練可有效減輕症狀、改善功能,是物理治療一門新興領域,然而國內的相關研究尚屬起步,希望本文可以引起臨床治療師對前庭物理治療的興趣,以提供病人更好的服務。

關鍵字

物理治療 頭暈 平衡

並列摘要


Dizziness, a sense of lightheadedness, fainting, or nauseating, can be accompanied by vertigo, the illusion of self-movement, or oscillopsia, the illusory movement of a stationary visual target. Patients complaining dizziness related symptoms may experience imbalance and require physical therapy to relieve their symptoms. The purpose of this article is to review principles of physical therapy management for the dizzy patients. The vestibular system dysfunction often induces dizziness. The primary roles of the vestibular system are: sensing and perceiving self-motion, orienting the body to vertical, controlling the center of mass, and stabilizing the head. Three mechanisms are related to the recovery from vestibular deficits: spontaneous recovery, vestibular adaptation, and substitution. In order to maintain balance and avoid dizzy, a person must be able to substitute the impaired vestibular feedback information with the visual or somatosensory information; or able to integrate the three senses efficiently and accurately. The principles of physical therapy are an integrated systems evaluation and a treatment program for the vestibular system. The integrated systems evaluation includes a history survey, evaluation of muscle strength, sensation, muscle tone, tremor, coordination, static and dynamic balance, gait, and motion sensitivity. The physical therapy training program includes patient education, vestibular habituation exercises, balance retraining, and general re-conditioning exercises. It has been shown that vestibular exercises are effective in reducing dizzy and improving balance for patients with vestibular deficits. The domestic clinicians may follow the principles of physical therapy outlined in this review and provide better care for dizzy patients.

並列關鍵字

Physical therapy Dizzy Balance

被引用紀錄


李建志(2007)。不同劑量感覺操弄平衡訓練對輕度創傷性腦傷患者之療效研究〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2007.03199

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