医院培训课件：《认知神经复健与职能治疗的应用》.pptx

1CognitiveNeurorehabilitationin

OccupationalTherapy

認知神經復健於職能治療的應用

2神經復健

(動作復健、認知復健、腦重塑)●腦側化/腦塑性（腦傷側效應與腦復原的潛力）●腦傷所形成的神經與行為失能→神經復健●動作復健：現代任務導向途徑、迫用療法、雙肢復健●認知復健：忽略症復健（例）●個案是學習者，治療師是雕塑者：治療讓個案透過大量練習累積經驗，提供腦重塑的機會(use-dependentplasticity)。

3現代動作復健途徑ContemporaryMotorRehabilitationApproachesConstraint-InducedTherapy(CIT)BilateralArmTraining(BAT)Robot-AssistedTherapy(RT)

4Constraint-InducedTherapy(CIT)

（侷限誘發療法;制動療法;迫用療法）AbehavioralapproachtostrokerehabilitationToovercomethelearnednonusephenomenonTreatmentcomponents:Constraintmitt（侷限健側）Forceduse（迫用患側）Intensivepractice（密集練習）Behavioralshaping（行為雕塑）CITanditsDistributedForms:CITDistributedCITTreatmenthours6h/d,5d/wk,for2wks2h/d,5d/wk,for3wksRestrainthours90%ofwakinghours6hoursperday

5EffectsofModifiedConstraint-InducedMovementTherapyonReach-to-GraspMovementsandFunctionalPerformanceAfterChronicStroke:

ARandomizedControlledStudy

Keh-chungLin,Ching-yiWu,Tzu-huiWei,Chia-yiLee,andJung-senLiu

ClinRehabil2007;21:1075–1086.PPV=PercentageofmovementtimewherepeakvelocityoccursAhigherPPVindicatesalongeraccelerationphase,suggestinglessonlineerrorcorrectionandmorepreplannedcontrolofthereachingmovements(i.e.,feedforwardcontrol).

6雙肢演練（機械式、活動式）的致效機制：

啟動雙肢偶合效應(BilateralCoupling)(CauraughSummers,2005)Ipsilateralpathways:10-15%non-decussatingdescendingfibers.Motorcommandsgeneratefromtheundamagedhemispheremayinfluencethemotoroutputoftheaffectedarm.LeftarmmovementintentionRightarmmovementintentionLeftmotorcortexRightmotorcortexNeuralaverageNeuralaverageCorpuscallosumconnectionsLeftarmoutputRightarmoutputCross-talk

7MajorCategoriesofPerceptualDisordersVisualperceptualdeficitsDeficitsinvisualperceptualfunctioningaftercerebralinsult(e.g.,objectagnosia,figure-grounddiscriminationdeficits,deficitsinspatialvision,etc.)Con