[{"data":1,"prerenderedAt":5257},["ShallowReactive",2],{"\u002Fblog\u002FASD":3,"post-count":295,"series-global-data":296,"authors-all":451,"series-sidebar-小兒物治":647},{"id":4,"title":5,"author":6,"body":7,"date":282,"description":283,"draft":284,"edited_at":282,"extension":285,"featured_image":286,"meta":287,"navigation":288,"path":289,"pinned":284,"seo":290,"sitemap":291,"stem":292,"tags":293,"__hash__":294},"blog\u002Fblog\u002FASD.md","ASD","hibiki12141132",{"type":8,"value":9,"toc":278},"minimark",[10,14,27,30,37,53,59,62,98,113,116,169,172,238,241],[11,12,13],"p",{},"根據DSM-IV，Pervasive developmental disorders(PDD，廣發性發展障礙)主要分成這三個分類",[15,16,17,21,24],"ul",{},[18,19,20],"li",{},"ASD：三歲前確診",[18,22,23],{},"非特定性廣泛性發展障礙(非典型ASD)：不一定會有ASD的全部特徵",[18,25,26],{},"亞斯伯格症：三歲後確診，一般會在五歲六歲之間被確診",[11,28,29],{},"（根據最新的DSM-V，以上三種病已經被歸類成自閉症類群障礙，就稱作ASD，不過老師講義是用DSM-IV，那就還是先寫出來再說）",[11,31,32,33,36],{},"假如當一個兄弟姐妹先被確診有ASD，那其他兄弟姐妹有高達20%的機率也會有ASD",[34,35],"br",{},"\n盛行率一般110個小孩裡會有1個被確診是ASD",[11,38,39,46,47,49,50,52],{},[40,41,45],"span",{"className":42},[43,44],"underline","red-3","男嬰","在患用ASD風險上是女嬰的五倍",[34,48],{},"\n發生率為150個小孩裡有1個被診確為ASD",[34,51],{},"\n病因包括：前產或周產期神經性病變，或遺傳問題",[11,54,55,56,58],{},"先來講診斷方式，我們可以利用ADOS和ADI-R來評估",[34,57],{},"\nADOS適用年紀從12個月大到成人，9分以上是ASD，7~9分是自閉症光譜，評估時間需45分鐘到1小時",[11,60,61],{},"接著會講一些跟ASD很像的病",[15,63,64,77,90],{},[18,65,66,67],{},"雷特氏症：之前有寫過的，不過還是簡單說一下",[15,68,69],{},[18,70,71,72,76],{},"雷特氏症主要是",[40,73,75],{"className":74},[44,43],"女生","會有，是基因遺傳問題，在5個月~5歲時會有腦部發育遲緩問題，並且後面會喪失手部功能",[18,78,79,80],{},"兒童期崩解症（CDD）",[15,81,82],{},[18,83,84,85,89],{},"在2歲到10歲會出現",[40,86,88],{"className":87},[43,44],"發展倒退","問題，例如突然喪失語言能力",[18,91,92,93],{},"X染色體脆折症",[15,94,95],{},[18,96,97],{},"是基因遺傳問題，有較大的頭圍、前額、臉型、耳朵，有肌張力低下和關節鬆馳度增加等問題",[11,99,100,101,103,104,106,107,109,110,112],{},"再多在這裡著墨兩筆好了",[34,102],{},"\n在寫這裡的時候我查了一下資料，DSM-IV把ASD，非典型ASD，亞斯伯格症，CDD，雷特氏症一同列入為PDD裡",[34,105],{},"\n但是在最新版的DSM-V中，已經把PDD這個舊類別刪除，並把ASD，非典型ASD，亞斯伯格症，CDD統一歸納成ASD",[34,108],{},"\nCDD會加進來，是因為發病時呈現的症狀以及介入手法與ASD相似，所以才被歸納進來",[34,111],{},"\n那雷特氏症是因為被驗證出是X染色體出問題，屬基因疾病，所以從精神疾病中踢出",[11,114,115],{},"那回來繼續講ASD會有的問題",[15,117,118,132,143],{},[18,119,120,121],{},"認知功能障礙",[15,122,123,126,129],{},[18,124,125],{},"注意力與社交技巧，並且對事物的專注力增加",[18,127,128],{},"語言能力",[18,130,131],{},"執行功能——固執，缺乏彈性",[18,133,134,135],{},"感覺知覺障礙",[15,136,137,140],{},[18,138,139],{},"感覺調節——包括視嗅味觸聽本體覺與前庭覺，在3到10歲會有這的複合型障礙",[18,141,142],{},"非典型視覺與聽覺知覺",[18,144,145,146],{},"動作功能障礙",[15,147,148,151,154,157,160,163,166],{},[18,149,150],{},"刻板動作——重複的動作",[18,152,153],{},"動作協調與手臂功能——影響運動表現，且寫字不好看",[18,155,156],{},"動作發展遲緩",[18,158,159],{},"步態平衡——運動失調，手臂缺乏擺動，回饋及前饋存在缺陷",[18,161,162],{},"動作計畫，動作實踐，運用能力，模仿能力",[18,164,165],{},"肌肉力量弱，低張力",[18,167,168],{},"耐力表現差",[11,170,171],{},"評估會做的包括",[15,173,174,177,180,194,205,222],{},[18,175,176],{},"病史詢問",[18,178,179],{},"觀察自然環境下遊玩",[18,181,182,183],{},"認知評估",[15,184,185,188,191],{},[18,186,187],{},"Stanford-Binet Intelligence Test：2~85歲",[18,189,190],{},"Kaufman Brief Intelligence Test：4~85歲",[18,192,193],{},"Wechsler Intelligence Scale for children：6~16歲",[18,195,196,197],{},"感覺知覺評估",[15,198,199],{},[18,200,201],{},[40,202,204],{"className":203},[43,44],"Sensory Integration and Praxis Test",[18,206,207,208],{},"動作評估",[15,209,210,213,216,219],{},[18,211,212],{},"AIMS",[18,214,215],{},"MABC",[18,217,218],{},"PDMS II",[18,220,221],{},"BOT-2",[18,223,224,225],{},"動作實踐及模仿能力評估",[15,226,227,232],{},[18,228,229],{},[40,230,204],{"className":231},[43,44],[18,233,234],{},[40,235,237],{"className":236},[43,44],"Modified Florida Apraxia Battery",[11,239,240],{},"介入",[15,242,243,257,270],{},[18,244,245,246],{},"應用行為分析(Applied Behavior Analysis，ABA)：因應ASD小孩會重複性的去做同一件事，且他的執行功能單一，可以安排他",[15,247,248,251,254],{},[18,249,250],{},"重複性訓練",[18,252,253],{},"任務步驟拆解訓練",[18,255,256],{},"無錯誤訓練",[18,258,259,260],{},"感覺統合：飲食",[15,261,262],{},[18,263,264,265],{},"這裡問了一下Gemini，他的意思是說，因應孩子目前的狀態，可以給相應的食物材質來較正回來",[15,266,267],{},[18,268,269],{},"例如，太過興奮時，給他吃有嚼勁的食物；精神不好時，給他吃脆的東西(感覺強的)；要安慰時，給他濃稠的飲料",[18,271,272,273],{},"Relationship Development Intervention（RDI）",[15,274,275],{},[18,276,277],{},"那RDI下一篇再寫出來",{"title":279,"searchDepth":280,"depth":280,"links":281},"",2,[],"2026-06-15","Autism Spectrum Disorder",false,"md","\u002Fimages\u002Fuploads\u002F1781534983762-145645009_p0_master1200.webp",{},true,"\u002Fblog\u002FASD",{"title":5,"description":283},{"loc":289},"blog\u002FASD",null,"DIuztKMri2BBRfOH-GtPmdnNrViIPXUqv427Z0eTz2w",144,{"id":297,"extension":298,"meta":299,"series":300,"stem":449,"__hash__":450},"series\u002Fseries.json","json",{},{"微積分教學":301,"生活紀錄":304,"Motor Control":306,"生活隨筆":320,"Motor 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也是最大宗的一類(70%)",[34,713],{},"\n傷到了",[40,716,718],{"className":717},[665],"錐狀束","(錐體路徑 Pyramidal Tract)",[34,721],{},"\n而四肢張力都會變大 ",[40,724,726],{"className":725},[665],"上肢比下肢","還要嚴重",[34,729],{},[40,731,733],{"className":732},[43],"上肢為Flex協同動作 下肢為Exten協同動作","(詳細請見李老師CVA中的表)",[34,736],{},"\n併發症有 ",[40,739,742],{"className":740},[741],"green-5","斜視","(70%) ",[40,745,747],{"className":746},[741],"癲癇","(50%)",[34,750],{},"\n治療重點有",[34,753],{},"\n增加中軸張力(核心穩定)",[34,756],{},"\n降低肢體張力",[34,759],{},"\n提升抗重力能力",[11,762,763,764,714,766,770,771,773,774,778,779,781,782,784,785,751,787,789,790,792],{},"接著講徐動型(Athethoid)",[34,765],{},[40,767,769],{"className":768},[665],"基底核黃核","部位",[34,772],{},"\n張力",[40,775,777],{"className":776},[44],"時大時小","(有時候很硬 有時候很軟)",[34,780],{},"\n而頭部控制差 上肢較下肢嚴重 且有不隨意扭動",[34,783],{},"\n併發症有 聽覺障礙(高頻聽不見) 語言障礙",[34,786],{},[34,788],{},"\n對稱協調控制",[34,791],{},"\n雙側控制",[11,794,795,796,714,798,802,804,805,807,808,810,811,813,814,816,817,819,820,822],{},"最後來講失調型(Ataxia)",[34,797],{},[40,799,801],{"className":800},[665],"小腦",[34,803],{},"\n張力小",[34,806],{},"\n特徵有 步幅大(怕跌倒) 意向性震顫(手主動靠近目標 手越抖)",[34,809],{},"\n併發有 平衡 感覺統合 知覺都會較差",[34,812],{},"\n在治療重點上",[34,815],{},"\n會給他們穿加壓衣(增加感統知覺) ",[34,818],{},"\n穩定與張力提升",[34,821],{},"\n承重(增加感統知覺)",[11,824,825,826,828,829,831,832,834],{},"還有一些小分類 簡單帶過一下",[34,827],{},"\n首先是僵直型 這個是比痙攣型張力還要再強",[34,830],{},"\n接著是顫抖型 這個與失調型的意向性震顫不同 在靜止時也會自己節律的抖動",[34,833],{},"\n最後是低張型 名稱軟寶寶 多為一歲前會觀察到 到兩三歲會再發展成痙攣型抑或者徐動型",[11,836,837,838,840,841,843,844,846,847,849,850,852,853,855,856,860],{},"接著來講治療原則 主要有五點",[34,839],{},"\n早期教育(早療 黃金期)",[34,842],{},"\n個別化(畢竟每一個孩子的症狀都不盡相同 要針對他們的症狀計劃)",[34,845],{},"\n治療項目盡量以ADL為主",[34,848],{},"\n日常活動(結合孩子一天的作息去制定訓練 回家訓練)",[34,851],{},"\n感官輸入(如本體感覺 觸覺)",[34,854],{},"\n老師有圈了個重點 ",[40,857,859],{"className":858},[44],"張力 並不等於 肌力","(張力很大 但肌力通常低下 要控制張力同時訓練肌力)",[11,862,863,864,866,867,871,872,866,874,878,879,881,882,886],{},"最後來講預後",[34,865],{},"\n假如 ",[40,868,870],{"className":869},[43],"2歲前","的寶寶能自行坐起來 未來100%能夠自行走動",[34,873],{},[40,875,877],{"className":876},[43],"4歲的","寶寶還不會自行坐起來 未來不會走",[34,880],{},"\n假如 是",[40,883,885],{"className":884},[43],"偏癱","的寶寶 未來100%能夠自行走動",[11,888,889],{},[890,891],"img",{"alt":892,"src":893},"1.00","https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774841979537-Screenshot_20260330_100529_Gallery.png",[11,895,896],{},[890,897],{"alt":892,"src":898},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774842001784-Screenshot_20260330_100531_Gallery.png",[11,900,901,902,904],{},"一些講義的內容 我隨後會在另一篇裡加上 ",[34,903],{},[40,905,907],{"className":906},[665],"讀英文！！！",{"title":279,"searchDepth":280,"depth":280,"links":909},[],"2026-03-30","按余老師給的總結懶人包做填寫","\u002Fimages\u002Fuploads\u002F1774842345403-129630217_p0_master1200.jpg",{},"\u002Fblog\u002F腦性痲痺-CP",{"title":650,"description":911},{"loc":914},"blog\u002F腦性痲痺-CP",[919],"小兒PT","Oa9L6eaO1VoQayD-z7Id8c20dDInqUv2J9f4wkCkC9g",{"id":922,"title":344,"author":6,"body":923,"date":1090,"description":1091,"draft":284,"edited_at":1090,"extension":285,"featured_image":1092,"meta":1093,"navigation":288,"path":1094,"pinned":284,"seo":1095,"sitemap":1096,"stem":1097,"tags":293,"__hash__":1098},"blog\u002Fblog\u002FCP補充（一）.md",{"type":8,"value":924,"toc":1088},[925,928,931,960,963,969,992,997,1041,1044,1047,1083],[11,926,927],{},"好多，先把老師特別叫我們看的先讀完好了，看後面還有沒有時間讀",[11,929,930],{},"第七頁的這一份作業，他把腦損傷的時間點分成三個並說明了原因",[932,933,934,940,957],"ol",{},[18,935,936,937,939],{},"產前——先天性腦部畸型，血管問題（中腦動脈阻塞），母體攝入毒素",[34,938],{},"\n母體感染（德國痲疹，巨細胞病毒，弓形蟲病），代謝障礙，基因綜合徵",[18,941,942,943,948,950,951,953,954,956],{},"產中——主要為",[40,944,947],{"className":945},[43,946],"green-3","胎兒中毒以及產時窒息",[34,949],{},"\n血液樣本顯示為代謝性酸中毒，pH\u003C7以及鹼剩餘>12mmol\u002FL",[34,952],{},"\n妊娠周數>34周，早期會出現中度或重度腦病變",[34,955],{},"\n低血糖，未經治療的黃疽，嚴重的新生兒感染亦會導致CP",[18,958,959],{},"產後——感染，外傷，腦膜炎，敗血症",[961,962],"hr",{},[11,964,965,966,968],{},"腦型麻痺類別——1（雖然總結有提到，但還是再寫一次好了）",[34,967],{},"\n分成了",[932,970,971],{},[18,972,973,974,976,977,979,980,982,983,985,986,988,989,991],{},"肢體受影響的分佈模式——",[34,975],{},"\n雙側痲痺(腳比手影響嚴重)",[34,978],{},"\n單側痲痺(單側受影響)",[34,981],{},"\n四肢痲痺（手比腳嚴重）",[34,984],{},"\n單肢痲痺",[34,987],{},"\n三肢痲痺",[34,990],{},"\n下肢痲痺",[11,993,994],{},[890,995],{"alt":892,"src":996},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776134449314-Screenshot_2026-04-14_104024.png",[932,998,999],{},[18,1000,1001,1002,1004,1005,1007,1008,1010,1011,1015,1017,1018,1022,1023,1028,1029,1031,1032,1034,1035,1037,1038,1040],{},"根據張力與動作異常形態區分——",[34,1003],{},"\n痙攣型——佔比七成，傷到錐狀束，上肢Flexor tone強+pronation，下肢Extenor tone強",[34,1006],{},"\n徐動型——佔比一成五，傷到基底核，皮質無影響，所以智力正",[34,1009],{},"\n僵直型——傷到皮質，比",[40,1012,1014],{"className":1013},[43,44],"痙攣型張力還大",[34,1016],{},"\n運動失調型——佔比一成三，傷到小腦，",[40,1019,1021],{"className":1020},[43,44],"協調能力差","且尤其是",[40,1024,1027],{"className":1025},[1026],"yellow-3","下肢","特別明顯，步寬大，走路搖晃",[34,1030],{},"\n低張力型——為暫時性(CP無永久低張)，之後會發展成其他類型，CP，因為low tone，所以ROM大且無法抗重力",[34,1033],{},"\n顫抖型——較徐動型有節奏，在遠端顫抖",[34,1036],{},"\n混合型",[34,1039],{},"\n無法分類型",[11,1042,1043],{},"類別——2（P8）",[11,1045,1046],{},"他提到了按照ICF思路去想各個層級寶寶的問題",[932,1048,1049,1052,1060,1067,1075],{},[18,1050,1051],{},"首先是健康問題，受了甚麼傷",[18,1053,1054,1055],{},"其次是受限，這個傷會讓寶寶",[40,1056,1059],{"className":1057},[43,1058],"blue-3","做不了哪些動作",[18,1061,1062,1063],{},"再來是侷限，這些做不了的動作會讓寶寶",[40,1064,1066],{"className":1065},[43,44],"失去甚麼功能性",[18,1068,1069,1070,1074],{},"然後是環境因素，例如失去了這些功能性的話，與",[40,1071,1073],{"className":1072},[43,946],"環境的互動","有甚麼障礙",[18,1076,1077,1078,1082],{},"與環境因素平級的有個人因素，例如寶寶的年紀，性別，家庭背景；這些都會影響寶寶的例如",[40,1079,1081],{"className":1080},[43,1026],"動機","等因素",[11,1084,1085],{},[890,1086],{"alt":892,"src":1087},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776135419925-Screenshot_2026-04-14_105040.png",{"title":279,"searchDepth":280,"depth":280,"links":1089},[],"2026-04-14","前面CP的大段文字英翻中","\u002Fimages\u002Fuploads\u002F1776137123982-e925b25f25c941afa92d440eefa3b271.webp",{},"\u002Fblog\u002FCP補充（一）",{"title":344,"description":1091},{"loc":1094},"blog\u002FCP補充（一）","8cDECsO9Ab18dGecDdRUOUB4ETPPEAjd1AS3dqL2ii4",{"id":1100,"title":1101,"author":6,"body":1102,"date":1090,"description":1458,"draft":284,"edited_at":1090,"extension":285,"featured_image":1459,"meta":1460,"navigation":288,"path":1461,"pinned":284,"seo":1462,"sitemap":1463,"stem":1464,"tags":293,"__hash__":1465},"blog\u002Fblog\u002FCP—Rood-&-Bobath.md","CP—Rood & Bobath（一）",{"type":8,"value":1103,"toc":1456},[1104,1107,1110,1126,1144,1176,1179,1225,1227,1230,1306,1314,1396,1398,1401],[11,1105,1106],{},"(就先只寫余老師有在上課做註記的版書，讀不完啦)",[11,1108,1109],{},"1940前肌能教再育>1950年後神經成熟理論>1990年動態系統理論",[11,1111,1112,1113,1115,1116,1120,1121,1125],{},"接下來講Bobath認為的治療核心，先將高張抑制，再教導動作（1reflex,2reaction）",[34,1114],{},"\n手法有RIP(",[40,1117,1119],{"className":1118},[43,946],"異常reflex抑制",")，接著誘發動作(",[40,1122,1124],{"className":1123},[44,43],"翻正反應,平衡反應)","，再加一些本體覺和觸覺輸入",[11,1127,1128,1129,1131,1132,1134,1135,1139,1140],{},"那假如抑制了張力但還沒有正常動作出來，我們會使用key point control來誘發動作",[34,1130],{},"\n借由近端的點(中軸附近例如頭肩髖)，來引導做翻正反應，同時抑制異常反",[34,1133],{},"\n主要是",[40,1136,1138],{"className":1137},[43,44],"打破錯的感覺運動經驗","，",[40,1141,1143],{"className":1142},[43,1026],"重新教寶寶正確的動作形態",[11,1145,1146,1147,1149,1150,1152,1153,1155,1156,1160,1161,1163,1164,1166,1167,1171,1172],{},"現在稍微說一下RIP，像剛說的為了抑制異常張力或反射來誘發出動作出來",[34,1148],{},"\n例如寶寶想向前reach，但flexor tone 過大做不出來，我們就做RIP方式抑制張力，讓寶寶去完成reach",[34,1151],{},"\n那像是這裡提到的flexor tone過大，我們就幫他做extension",[34,1154],{},"\n在這過程中會利用到GTO的這一個機制，原理是擺位在tone過大的",[40,1157,1159],{"className":1158},[1026],"反方向","，誘發GTO關閉tone",[34,1162],{},"\n(著重在擺位)",[34,1165],{},"\n現在的RIP是改為",[40,1168,1170],{"className":1169},[946],"partial RIP","，只利用",[40,1173,1175],{"className":1174},[43,44],"Key point來達到抑制與誘發",[11,1177,1178],{},"那RIP的注意事項有如下",[15,1180,1181,1193,1205,1213,1216,1219],{},[18,1182,1183,1184,1188,1189],{},"RIP只做在",[40,1185,1187],{"className":1186},[43,44],"有痙攣","的地方，",[40,1190,1192],{"className":1191},[946],"hypotone則不需要做",[18,1194,1195,1196,1200,1201],{},"力度需",[40,1197,1199],{"className":1198},[1026,43],"緩慢施加","，因為痙攣的部位容易",[40,1202,1204],{"className":1203},[44],"contracture",[18,1206,1207,1208,1212],{},"從近端開始做，並且做",[40,1209,1211],{"className":1210},[665,43],"旋轉以及Protraction(shoulder)是最容易打破張力","的手段",[18,1214,1215],{},"在拉開後，慢慢的放開手，讓他自己用力維持這個姿勢，誘發他做出正常的功能性動作",[18,1217,1218],{},"新的Bobath目的是做ADL動作",[18,1220,1221,1222,1224],{},"也不會在最強的痙攣部位開始做去，就像是Extensor tone過大配合有TLR 發生",[34,1223],{},"\n我們可以先將寶寶從Supine>side-lying>prone，將TLR關閉，讓張力消掉，再讓寶寶回到supine",[961,1226],{},[11,1228,1229],{},"接下來講抑制Extensor的技巧，先來講第一個",[932,1231,1232,1235,1241,1266,1274,1295,1303],{},[18,1233,1234],{},"首先PT要坐在有靠背的椅子上保護好PT的背",[18,1236,1237,1238,1240],{},"將小孩的身體放在PT大腿上，腿面向PT，呈現total flexion姿勢",[34,1239],{},"\n一來可以借這個姿勢拉到hamstring，二來寶寶為了想看PT也會嘗試抬頭，三來可以將寶寶上肢放到他胸前",[18,1242,1243,1244,1246,1247,1251,1252,1256,1260,1261,1265],{},"那痙攣型的寶寶co-contraction(共同收縮)都比較強，所以旋轉能力較差",[34,1245],{},"\n可以在剛提到的姿勢下順便訓練旋轉，PT一手將",[40,1248,1250],{"className":1249},[43,44],"小孩的腳轉","到一側，另一手轉動寶寶的",[40,1253,1255],{"className":1254},[43,665],"身體",[40,1257,1259],{"className":1258},[43],"到對側","（",[40,1262,1264],{"className":1263},[665],"是身體，不是頭","）",[18,1267,1268,1269,1273],{},"而因為extensor張力太大，肩胛骨會retraction，所以我們可以兩手放在小孩的",[40,1270,1272],{"className":1271},[44,43],"肩胛骨內緣","後主推做protraction",[18,1275,1276,1277,1279,1280,1284,1285,1287,1288,1292,1294],{},"那小孩也因為extensor張力太大，可能沒有意識到有手的存在",[34,1278],{},"\n我們就得將他的手帶到胸前",[40,1281,1283],{"className":1282},[44,43],"進入視野範圍","，讓他開始吃或者自己的手",[34,1286],{},"\n而有些小孩會緊張會保持抓握姿勢，我們可以從",[40,1289,1291],{"className":1290},[43,44],"大拇指開始扳開慢慢張手打開",[34,1293],{},"\n讓他去做手碰手、手碰嘴、手碰腳、嘴碰嘴",[18,1296,1297,1298,1302],{},"而在抑制的過程中也可以做一些",[40,1299,1301],{"className":1300},[44,43],"誘發flexion動作","的手法，訓練屈肌，這樣也能降低extensor tone",[18,1304,1305],{},"習慣了以上姿勢後，就可以放寶寶在地上自己玩了",[11,1307,1308,1309,1313],{},"接著來講第二個，這個是",[40,1310,1312],{"className":1311},[665,43],"利用滾筒","的方式，結合了誘發動作的方式",[932,1315,1316,1343,1372],{},[18,1317,1318,1319,1323,1325,1326,1330,1332,1333,1337,1338,1342],{},"首先讓小孩在滾筒上side-lying，",[40,1320,1322],{"className":1321},[43,946],"手抬高將滾筒卡在腋下",[34,1324],{},"\n這時候PT要對小孩上方的髖做",[40,1327,1329],{"className":1328},[43,44],"Abd，extension和external rotation",[34,1331],{},"\n由於有一些痙攣的下肢會出現hemiflexion，所以在擺位仍然會將hip放在",[40,1334,1336],{"className":1335},[44,43],"extension","姿勢(",[40,1339,1341],{"className":1340},[43],"正常站立角度",")",[18,1344,1345,1346,1348,1349,1351,1352,1354,1355,1359,1363,1367,1368,1265],{},"接著按照這個上面這個姿勢教導旋轉，首先一手卡在滾筒側腋下，一手放在hip做固定",[34,1347],{},"\n然後將卡在腋下的手慢慢帶動shoulder，最後處在prone姿，而這時hip仍然被固定，所以呈軀幹扭轉姿勢",[34,1350],{},"\n這時小孩會想要翻過來，我們會慢慢的引導他的hip翻到prone姿",[34,1353],{},"\n而這時候會想要去訓練他的抬頭（雖然",[40,1356,1358],{"className":1357},[43,44],"抬頭是extension姿勢",[40,1360,1362],{"className":1361},[43],"但這個跟",[40,1364,1366],{"className":1365},[43,1026],"extensor muscle tone不一樣","，還是得教導",[40,1369,1371],{"className":1370},[44],"正確方式",[18,1373,1374,1375,1377,1378,1380,1381,1383,1384,1388,1390,1391,1395],{},"剛剛講的是從side-lying到prone，現在講反過來的從prone到side-lying",[34,1376],{},"\n一手放在pelvis，一手固定shoulder，",[34,1379],{},"\n這次先將pelvis，翻回side-lying，然後慢慢協助將shoulder帶到side-lying",[34,1382],{},"\n（而假如我們先將shoulder拉到side-lying，正常人的話也會因為被從往後拉動，肩胛骨也會被拉到",[40,1385,1387],{"className":1386},[43,44],"retraction",[34,1389],{},"\n對於CP小兒而言",[40,1392,1394],{"className":1393},[44,43],"誘發出extensor tone","，所以要先將pelvis帶走）",[961,1397],{},[11,1399,1400],{},"然後來介紹到抑制Flexor的技巧，核心是利用重力去抑制",[932,1402,1403,1423,1438,1453],{},[18,1404,1405,1406,1410,1411,1415,1417,1418,1422],{},"讓小孩supine在球上，這過程要",[40,1407,1409],{"className":1408},[44,43],"緩慢以及穩","，不要讓小孩感到害怕，假如",[40,1412,1414],{"className":1413},[665,43],"小孩恐懼就不要做這個",[34,1416],{},"\n因為flexor tone 高的小孩比較少動，所以",[40,1419,1421],{"className":1420},[43,44],"前庭覺十分敏感","，所以初期要多給支持，適應之後再將手慢慢放到遠端支持",[18,1424,1425,1426,1430,1431,1435,1437],{},"而通常都會在這支勢下扶穩小孩的shoulder，前後左右的輕微的搖擺，讓小孩",[40,1427,1429],{"className":1428},[946,43],"逐漸放鬆","，同時也能",[40,1432,1434],{"className":1433},[43,44],"靠重力牽拉flexor肌肉",[34,1436],{},"\n再進階就遠端例如hip去做同樣的事",[18,1439,1440,1441,1443,1444,1448,1449],{},"進一步的做法是，抓住小孩的小肢，將球往小孩的頭側推",[34,1442],{},"\n這樣因為滾動的原因變成頭反而靠近地面，呈",[40,1445,1447],{"className":1446},[946,43],"頭靠近地面","，這樣也能讓",[40,1450,1452],{"className":1451},[44,43],"extensor tone上升",[18,1454,1455],{},"還能結合旋轉去訓練，一樣也是抓住腳帶動軀幹做輕微旋轉，以降低張力",{"title":279,"searchDepth":280,"depth":280,"links":1457},[],"主要是寫有特別註解的 到抑制flexor張力的部份","\u002Fimages\u002Fuploads\u002F1776176663348-EbXNw8qWkAMAVcN.webp",{},"\u002Fblog\u002FCP—Rood-&-Bobath",{"title":1101,"description":1458},{"loc":1461},"blog\u002FCP—Rood-&-Bobath","hbxSp87ZZts-QV-3eWuNwBK9q66v8uar73myHqp0-sQ",{"id":1467,"title":1468,"author":6,"body":1469,"date":1090,"description":1579,"draft":284,"edited_at":1580,"extension":285,"featured_image":1581,"meta":1582,"navigation":288,"path":1583,"pinned":284,"seo":1584,"sitemap":1585,"stem":1586,"tags":293,"__hash__":1587},"blog\u002Fblog\u002FCP—Rood-&-Bobath（二）.md","CP—Rood & Bobath（二）",{"type":8,"value":1470,"toc":1577},[1471,1474,1480,1485,1488],[11,1472,1473],{},"那剛剛一篇講的都Bobath的手法，那現在講Rood的",[11,1475,1476,1477,1479],{},"那Rood 提到說，人類有發展次序，mobility>stability>mobility on stability>skill movement",[34,1478],{},"\n也強調了可以利用感覺輸入誘發動作",[11,1481,1482],{},[890,1483],{"alt":892,"src":1484},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776217678571-Screenshot_2026-04-15_094736.png",[11,1486,1487],{},"那感覺刺激的部份根據強度及頻率而有這四種變化",[15,1489,1490,1496,1535,1541],{},[18,1491,1492,1493,1495],{},"快速且短暫的刺激",[34,1494],{},"\n可以用心智狀態提高，全身muscle tone 增高，反應力上升（喚醒）",[18,1497,1498,1499,1501,1502,1504,1505,1507,1509,1510,1514,1515,1517,1518,1520,1521,1525,1527,1531,1532,1534],{},"快速且重複的刺激",[34,1500],{},"\n中度，可維持心智，身體，注意力等反應，可利用前庭與本體覺持續被刺激使身體保持在適當的姿勢",[34,1503],{},"\n利用Vibration(按摩棒)，引起肌肉或肌腱反射（誘發），也可以有減敏效果",[34,1506],{},[34,1508],{},"\n這邊提到一個叫TLI的東西，用處是維持全身伸肌肌群反應，從",[40,1511,1513],{"className":1512},[44,43],"頸部開始訓練","(inversion在GA26~29就出現)",[34,1516],{},"\n操作方式為，將小孩腹部放到球上(prone姿)，並固定他的骨盤，進行前往左右搖晃，呈頭下腳上姿勢",[34,1519],{},"\n治療師採坐姿，而且不是用手在帶動，是",[40,1522,1524],{"className":1523},[43,44],"利用治療師身體帶動",[34,1526],{},[40,1528,1530],{"className":1529},[665],"注意","：要給小孩安全感，inversion不能過久，保持頭部的正確位置",[34,1533],{},"\n避免在頭的背部(後方)施加壓力，小孩手要自由活動但不能碰到地板，持續觀察小孩反應",[18,1536,1537,1538,1540],{},"緩慢且規律重覆的刺激",[34,1539],{},"\n通常用來減敏",[18,1542,1543,1544,1546,1547,1549,1551,1552,1556,1557,1561,1562,1564,1566,1567,1571,1572,1576],{},"持續性的刺激",[34,1545],{},"\n強調翻正反應，例如抗重力時，重力能夠對姿勢穩定的肌肉去做持續刺激",[34,1548],{},[34,1550],{},"\n對於",[40,1553,1555],{"className":1554},[43,44],"痙攣","的小孩，先從",[40,1558,1560],{"className":1559},[44,43],"不敏感的地方開始","，再往較敏感的位慢慢刺激，嘴巴也一樣",[34,1563],{},[34,1565],{},"\n但對於",[40,1568,1570],{"className":1569},[43,1026],"低張","的小孩，則相反，從",[40,1573,1575],{"className":1574},[43,1026],"最敏感的地方開始","刺激",{"title":279,"searchDepth":280,"depth":280,"links":1578},[],"Rood 到結尾","2026-04-15","\u002Fimages\u002Fuploads\u002F1776222460274-Ee4ldTMUcAEiPzF.webp",{},"\u002Fblog\u002FCP—Rood-&-Bobath（二）",{"title":1468,"description":1579},{"loc":1583},"blog\u002FCP—Rood-&-Bobath（二）","56_IFu2CIimvGKbXPweMAs8MdVF91nlzrjRw9LcNlb0",{"id":1589,"title":1590,"author":6,"body":1591,"date":2055,"description":2056,"draft":284,"edited_at":2057,"extension":285,"featured_image":2058,"meta":2059,"navigation":288,"path":2060,"pinned":284,"seo":2061,"sitemap":2062,"stem":2063,"tags":293,"__hash__":2064},"blog\u002Fblog\u002FMotor-Learning.md","Motor Learning小兒（一）",{"type":8,"value":1592,"toc":2053},[1593,1596,1605,1614,1632,1641,1650,1666,1675,1704,1779,1794,1797,1839,1845,1894,1940,1981,1984,2022,2037],[11,1594,1595],{},"那這一節課著重在動態模組理論，跟黃老師教的是互通的",[11,1597,1598,1599,1601,1602,1604],{},"那首先是講感覺統合的部份",[34,1600],{},"\n意思是指 知覺+大腦以往的經歷 結合成為認知的這麼一個過程",[34,1603],{},"\n而感覺統合就是結合的過程 認知是結果這樣(這跟神經物治講的動作控制學雷同)",[11,1606,1607,1608,1610,1611,1613],{},"而接下來講到動作的發展",[34,1609],{},"\n那老師用的理論是動態模組理論",[34,1612],{},"\n假如還記得黃老師的Motor Control最後一課講的應該不難吃",[11,1615,1616,1617,1619,1620,1622,1623,1625,1626,1628,1629,1631],{},"不過我還是先列出來老師PPT裡的五個角度",[34,1618],{},"\n第一 動作技巧的顯現",[34,1621],{},"\n第二 動作型態的精準度",[34,1624],{},"\n第三 動作成果(可從評估表推估) ",[34,1627],{},"\n第四 組合技巧的獲得(次系統組合的結果)",[34,1630],{},"\n第五 對環境適應力的增強",[11,1633,1634,1635,1637,1638,1640],{},"我們現在來講平衡系統的發展",[34,1636],{},"\n1)平衡系統有三個人一起負責 迷路系統 本體覺與觸覺 視角",[34,1639],{},"\n以站立來形容的話",[11,1642,1643,1644,1646,1647,1649],{},"2)人類的重心(COM)基本會在S2 ",[34,1645],{},"\n那壓力中心(COP)是動態的 他會因應COM的改變而改變",[34,1648],{},"\n那底面積(BOS)就是兩隻腳踩在地面的距離",[11,1651,1652,1653,1657,1658,1660,1661,1665],{},"3)那平衡的演化 在早期 小孩會",[40,1654,1656],{"className":1655},[44,43],"極度依賴視角","來判斷",[34,1659],{},"\n但在成熟的過程中 我們會",[40,1662,1664],{"className":1663},[665],"越來越傾向用本體感覺","去判斷",[11,1667,1668,1669,1671,1672,1674],{},"4)穩定極限(LOS) 他把我們人類想象成一個倒立的三角錐",[34,1670],{},"\n在不移動的情況下身體能偏多少(前6度 側8度 後4度)",[34,1673],{},"\n因為前面有腳趾輔助 而且側邊是比較寛 但後面甚麼都沒有 所以角度就變成這樣了(可以看游老師的講義)",[11,1676,1677,1678,1680,1681,1685,1686,1691,1692,1694,1695,1699,1700],{},"5)承受外力時的反應時 人類會有兩種變化",[34,1679],{},"\n第一種就是假如這",[40,1682,1684],{"className":1683},[43,946],"外力少到一定範圍"," 就只會用",[40,1687,1690],{"className":1688},[1689],"bg-green-3","姿勢穩定反應","來做調整",[34,1693],{},"\n另一種則是假如外力",[40,1696,1698],{"className":1697},[43,44],"超過姿勢穩定反應可以調整的程度"," 就會產生",[40,1701,1703],{"className":1702},[665],"保護性姿勢",[11,1705,1706,1707,1709,1710,1712,1713,1715,1716,1720,1722,1723,1727,1731,1733,1734,1736,1738,1739,1743,1744,1746,1747,1751,1752,1754,1755,1757,1759,1760,1762,1763,1765,1766,1770,1771,1773,1775,1776,1778],{},"6)",[34,1708],{},"\ni) 我們在平衡反應上還有兩種策略可以選 一種是固定BOS的 一種是改變BOS的",[34,1711],{},"\n首先是固定的一類 最熟悉的就是我們的踝策略和髖策略",[34,1714],{},"\n那一般而言 越成熟的人 會越偏好用",[40,1717,1719],{"className":1718},[44],"踝策略",[34,1721],{},"\n而目前比較新的提出 就是",[40,1724,1726],{"className":1725},[1026,43],"抓握",[40,1728,1730],{"className":1729},[1026],"是一種不算策略(Strategy)的方法",[34,1732],{},"\n例如老人在快摔倒時握緊拐仗穩定好自己 這也是一種功能性向的反應",[34,1735],{},[34,1737],{},"\nii) 而另一點則是改變BOS的 例子就有跨步策略 身體是",[40,1740,1742],{"className":1741},[44],"被迫做出","的 伸手出去支撐也是如此",[34,1745],{},"\n那在發展過程中 而在",[40,1748,1750],{"className":1749},[44],"方向性上也是有順序","的",[34,1753],{},"\n往前大概在6個月大才學會 而側向是8個月大 最後才是後向10個月大",[34,1756],{},[34,1758],{},"\niii) 那在臨床上 有些病人可能會因為關節或肌肉力量的原因 ",[34,1761],{},"\n我們會教導他們去利用拐仗 來增加BOS的大小 這樣他的LOS也會變大",[34,1764],{},"\n我們",[40,1767,1769],{"className":1768},[43],"可以通過適度的給他們外力","訓練他們",[34,1772],{},[34,1774],{},"\niv) 目前 reach test 是最好用來測病人靜態以及半靜態平衡的方法",[34,1777],{},"\n盡可能讓病人手伸出去多一點 那假如伸得遠出去 平衡就越好",[11,1780,1781,1782,1784,1785,1787,1788,1790,1791,1793],{},"那對於小兒的發展議題，主要有這幾個",[34,1783],{},"\ni)——新形式的起源(The origin of new form)",[34,1786],{},"\nii)——連續性與非連續性(Continuity vs discontinuity)",[34,1789],{},"\niii)——變異性(Variability)",[34,1792],{},"\niv)——生物與環境的影響(Biological vs. environmental influence)",[11,1795,1796],{},"那動態模組理論是經歷過以下發展而來的",[932,1798,1799,1806,1826],{},[18,1800,1801,1802],{},"那首先是小兒痲痺(1910s)——當年的理念是哪邊無力練哪邊",[40,1803,1805],{"className":1804},[43,665],"(肌肉再教育 muscle re-education)",[18,1807,1808,1809,1813,1814,1816,1817,1819,1820,1822,1823,1825],{},"接著是1950s——當年他們開始著重以神經成熟理論為基礎學派，著重在",[40,1810,1812],{"className":1811},[665,43],"感覺輸入","促進正常的動作以及動作發展",[34,1815],{},"\n神經成熟理論(1945s)由Gesell和McGraw提出，他們的關鍵理念有如下",[34,1818],{},"\nCNS髓鞘化(Increased myelination of CNS)",[34,1821],{},"\n皮質抑制皮質下中心(Inhibition of the subcortical centers by the higher cerebral cortex)",[34,1824],{},"\n層級控制(Hierarchical control)",[18,1827,1828,1829,1833,1834,1838],{},"最後來講到階層理論的雛型(1980s)——當年他們覺得動作發展",[40,1830,1832],{"className":1831},[43],"不只單一的神經支配","，把",[40,1835,1837],{"className":1836},[43,44],"其他的系統、環境","一併整合進來",[11,1840,1841,1842,1844],{},"那神經成熟理論貢獻有兩點，正常的發展與病理的進程，以及反射到動作里程碑的評估",[34,1843],{},"\n那它有三個假設",[932,1846,1847,1858,1878],{},[18,1848,1849,1850,1852,1853,1857],{},"從反射到隨意動作——意思是剛出生只有原始反射，但隨著大腦成熟這些反射會被抑制",[34,1851],{},"\n但在1979s有學者提出說，其實原始反射對於每個寶寶來說",[40,1854,1856],{"className":1855},[44],"變異性","也很大",[18,1859,1860,1861,1863,1864,1868,1869,1873,1874],{},"頭尾走向——意思是身體的發展一定是從頭到胸到骨盤再到下肢的發展",[34,1862],{},"\n但在1976s有學者發現到，南非的寶寶被家長",[40,1865,1867],{"className":1866},[43],"直立抱法或者練習坐","，會比美國寶寶",[40,1870,1872],{"className":1871},[44],"更快發展出下肢動作","，但",[40,1875,1877],{"className":1876},[946],"爬和翻身較慢",[18,1879,1880,1881,1883,1884,1888,1889,1893],{},"最後是近端到遠端——意思是身體發展要先學會控制近端(肩、軀幹)，而後才能控制遠端(手指)",[34,1882],{},"\n但在1988s有學者提出，寶寶的",[40,1885,1887],{"className":1886},[946],"伸手以及操作","的發展在近端遠端上是",[40,1890,1892],{"className":1891},[43,44],"同時存在","的(同步進行發展，並沒有明確上下關係)",[11,1895,1896,1897,1899,1900,1904,1905,1909,1911,1912,1916,1917,1919,1920,1924,1925,1929,1930,1934,1936,1937,1939],{},"那每個人在做動作時一定會受到自身物理特性影響例如關節角度、肌肉長度等因素",[34,1898],{},"\n那協調就是將這些複雜的東西，透過",[40,1901,1903],{"className":1902},[44],"降低自由度","，來",[40,1906,1908],{"className":1907},[946],"產生平滑的動作",[34,1910],{},"\n那降低自由度的策略會牽涉到一個叫",[40,1913,1915],{"className":1914},[665],"自我組織","的東西，那它的核心理念是說",[34,1918],{},"\n動作是有",[40,1921,1923],{"className":1922},[665],"適應性","的，次系統會根據",[40,1926,1928],{"className":1927},[43,44],"環境任務","等因素做調整，",[40,1931,1933],{"className":1932},[946],"再拼湊起來",[34,1935],{},"\n(舉例來說，即使一樣是走路，在光亮的環境和在昏暗的環境下，也會做一些微調)（Bernstein提出）",[34,1938],{},"\n有提到三個重點",[932,1941,1942,1948,1964],{},[18,1943,1944,1945,1947],{},"次序參數——它探討的是關節之間的協同",[34,1946],{},"\n例如在同一個動作型態上，做不同的任務，力度或關節角度也稍微不同，但假如相對時間相同，就能利用次序參數說明",[18,1949,1950,1951,1955,1956,1958,1959,1963],{},"那個體在發展過程中會因應不同的任務去做動作調整，而通常會採取",[40,1952,1954],{"className":1953},[43,665],"最省力、自然以及方便","的動作型態",[34,1957],{},"\n那假如這個動作達到了上述說的型態，便是",[40,1960,1962],{"className":1961},[44,43],"最穩定型態","，即使會因應任務去做改變也是十分穩定的",[18,1965,1966,1967,1969,1970,1974,1975,1977,1978,1980],{},"相移現象——意思就是說原本在做著一個穩定的動作型態",[34,1968],{},"\n因為一些",[40,1971,1973],{"className":1972},[44],"因素所干擾","，就會變成另一個動作型態",[34,1976],{},"\n(例如速度的改變從走路變成跑步，相對時間不同，所以是另一個型態，不適應次序參數)",[34,1979],{},"\n（對 黃老師教動態系統理論也提到過這個）",[11,1982,1983],{},"最後講兩個實驗",[932,1985,1986,2008],{},[18,1987,1988,1989,1991,1992,1994,1995,1999,2000,2004,2005,2007],{},"第一個是關於踏步反射的實驗，那踏步反射在作原始反射，在第四周會消失，但在一歲時又會再次出現",[34,1990],{},"\n而神經成熟理論認為，是因為大腦成熟了，讓高階抑制了低階",[34,1993],{},"\n但動態模組理論發現，其實是因為在第四周寶寶",[40,1996,1998],{"className":1997},[43,44],"長脂肪比長肌肉快","，導致",[40,2001,2003],{"className":2002},[946],"力量不足","做不出來",[34,2006],{},"\n將寶寶放在水中利用浮力降低脂肪重量，踏步反射就可以又被誘發出來",[18,2009,2010,2011,2013,2014,2016,2017,2021],{},"第二個實驗，是觀察青蛙生長的環境與發育的關係",[34,2012],{},"\n青蛙需要水跟泥土的環境才能發育健全，假如只給水不給泥土的環境，就會讓發育有缺陷",[34,2015],{},"\n所以神經成熟是可以讓動作型態形成，但必須得加上",[40,2018,2020],{"className":2019},[43,44],"環境，時間以及個體本身條件","才能讓型態表現更好",[11,2023,2024,2025,2027,2028,2030,2031,2033,2034,2036],{},"那在臨床意義上有以下幾點",[34,2026],{},"\n分散式控制(Distributed control)",[34,2029],{},"\n控制參數可能來自兒童或者環境(Control parameter may be from the child or from the environment)",[34,2032],{},"\n由兒童主導(Active role of the child)",[34,2035],{},"\n個體差異的訊息(variability provides important information)",[11,2038,2039,2040,2044,2045,2049,2050,2052],{},"評估",[40,2041,2043],{"className":2042},[43,1689],"不應只侷限在探討神經發展過程","，而是要根據",[40,2046,2048],{"className":2047},[665,43],"多個系統，家庭因素","等問題",[34,2051],{},"\n(之前聽到的例子，有一個治療師說家長假如一直給小兒玩手機沒讓他們多動，確實會讓發展遲緩)",{"title":279,"searchDepth":280,"depth":280,"links":2054},[],"2026-03-31","感覺統合~三個協調的重點","2026-04-10","\u002Fimages\u002Fuploads\u002F1775795013607-141589321_p0.jpg",{},"\u002Fblog\u002FMotor-Learning",{"title":1590,"description":2056},{"loc":2060},"blog\u002FMotor-Learning","EmOKsVRjY6Fz-rmd5PiPG83wEP6j59SCfF75Y1WnFNU",{"id":2066,"title":2067,"author":6,"body":2068,"date":2057,"description":2291,"draft":284,"edited_at":2292,"extension":285,"featured_image":2293,"meta":2294,"navigation":288,"path":2295,"pinned":284,"seo":2296,"sitemap":2297,"stem":2298,"tags":293,"__hash__":2299},"blog\u002Fblog\u002FMotor-Learning小兒（二）.md","Motor Learning小兒（二）",{"type":8,"value":2069,"toc":2289},[2070,2073,2079,2088,2091,2125,2128],[11,2071,2072],{},"阿對的，又要來講動作學習的定義了，雖然之前就有講過",[11,2074,2075,2076,2078],{},"那動作學習是一個過程，這個過程是借由學習或者經驗產生相當永久的動作行為(long-term effect)",[34,2077],{},"\n動作學習就是過程，而動作表現是動作做出來的結果。",[11,2080,2081,2082,2084,2085,2087],{},"而這邊講道Positive和Negative Sign",[34,2083],{},"\nPositive是指正常人沒有，但病人身上會出現的異常動作 ",[34,2086],{},"\nNegative則相反，正常人有的，但病人身上無法出現",[11,2089,2090],{},"對於動作學習有三大要素",[932,2092,2093,2096,2105],{},[18,2094,2095],{},"偵測練習——初期PT可以直接監測教導，而後讓病人自己監測自己動作，並且利用內在回饋方式，有利於long-term effect",[18,2097,2098,2099,2101,2102,2104],{},"動機——那對於動作的學習，肯定是動機最為重要，這樣能讓學習過程變佳，那有以下幾點可以引發動機",[34,2100],{},"\n利用喜歡的東西作為目標去做、任務是有趣的、從容易的去做起讓他們有成熟感激發動機",[34,2103],{},"\n同儕競爭互相鼓勵、最後才是給予獎勵作為誘因激發動機",[18,2106,2107,2108,2112,2113,2115,2116,2120,2121],{},"對於目標的清淅程度——就是",[40,2109,2111],{"className":2110},[946],"任務具體","並且病人不會理解錯，像是抬高手拿東西而不是單純抬高手",[34,2114],{},"\n而任務",[40,2117,2119],{"className":2118},[44],"越具體","，更能",[40,2122,2124],{"className":2123},[44,43],"引導寶寶產生興趣",[11,2126,2127],{},"那動作學習有以下三個考量點",[932,2129,2130,2182,2228],{},[18,2131,2132,2133,2137,2138,2142,2143,1342,2150,2152,2153,2155,2156,2160,2161,2163,2164,2168,2169,2173,2174,2176,2177,2181],{},"轉移——意思是",[40,2134,2136],{"className":2135},[43,946],"相同相似的技巧","在不同情景下可以變化",[40,2139,2141],{"className":2140},[44,43],"產生新的","動作型態 (這裡也有說到 ",[2144,2145,2149],"a",{"href":2146,"rel":2147},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002F%E5%8B%95%E4%BD%9C%E5%AD%B8%E7%BF%92%EF%BC%88%E5%85%AB%EF%BC%89%E7%B7%B4%E7%BF%92%E6%96%B9%E5%BC%8F-2?series=Motor%20learning",[2148],"nofollow","在最後一段",[34,2151],{},"\n栗子：一樣是站起來，從椅子上站起來與亞洲蹲的情況下站起來，這兩者都是Hip和Knee的Extend才能達成，當然後者更難",[34,2154],{},"\n所以我們可以借由",[40,2157,2159],{"className":2158},[946],"先學簡單","且技巧相同相似的動作，慢慢的去訓練到難的或具有功能性ADL等的動作",[34,2162],{},"\n也可以透過",[40,2165,2167],{"className":2166},[43,44],"環境改造","達成這一點，例如說寶寶的手還沒有能握住細筷子的能力，可以用",[40,2170,2172],{"className":2171},[43],"加粗","的方式讓寶寶更好握住",[34,2175],{},"\n但記得靠轉移來學習新的動作型態",[40,2178,2180],{"className":2179},[43,44],"不能一下子改太多太難","參數",[18,2183,2184,2185,1139,2190,1265,2194,2196,2197,2201,2202,2204,2205,2209,2211,2212,2216,2217,2219,2220,2224,2225,2227],{},"接著是練習的方式，對沒錯，之前有讀過，現在我只精簡寫一下好了，詳寫的看這兩篇（",[2144,2186,2189],{"href":2187,"rel":2188},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002F%E5%8B%95%E4%BD%9C%E5%AD%B8%E7%BF%92%EF%BC%88%E4%B8%83%EF%BC%89%E7%B7%B4%E7%BF%92%E6%96%B9%E5%BC%8F-1?series=Motor%20learning",[2148],"一",[2144,2191,2193],{"href":2146,"rel":2192},[2148],"二",[34,2195],{},"\n集中VS分散，分散休息時間更長，對",[40,2198,2200],{"className":2199},[43],"學習較難或易疲勞病人","來說更佳",[34,2203],{},"\n段落VS隨機，隨機較難，但通常對",[40,2206,2208],{"className":2207},[946,43],"形成長期記憶以記轉移效果更有",[34,2210],{},"\n固定VS變異，變異在",[40,2213,2215],{"className":2214},[44,43],"轉移效果上","更佳",[34,2218],{},"\n全部VS分段，分段有",[40,2221,2223],{"className":2222},[43,44],"減負效果","，在學習較難動作時可以運用，將同一套動作數個技巧慢慢拆分練習",[34,2226],{},"\n心像練習，在腦中模擬動作型態",[18,2229,2230,2231,1139,2235,1139,2239,1139,2244,1342,2249,2251,2252,2254,2255,2257,2258,1265,2262,2264,2265,2269,2270,2272,2273,2277,2278,2280,2281,2283,2284,2288],{},"最後是回饋方式，對，又來了，一樣在這裡寫精寫的，詳細看..哇，我居然分開了四篇來寫(",[2144,2232,2189],{"href":2233,"rel":2234},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002F%E5%8B%95%E4%BD%9C%E5%AD%B8%E7%BF%92%EF%BC%88%E4%B9%9D%EF%BC%89%E5%9B%9E%E9%A5%8B-1?series=Motor%20learning",[2148],[2144,2236,2193],{"href":2237,"rel":2238},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002F%E5%8B%95%E4%BD%9C%E5%AD%B8%E7%BF%92%EF%BC%88%E5%8D%81%EF%BC%89%E5%9B%9E%E9%A5%8B-2-%E6%93%B4%E5%A2%9E%E6%80%A7(KR)?series=Motor%20learning",[2148],[2144,2240,2243],{"href":2241,"rel":2242},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002F%E5%8B%95%E4%BD%9C%E5%AD%B8%E7%BF%92%EF%BC%88%E5%8D%81%E4%B8%80%EF%BC%89%E5%9B%9E%E9%A5%8B-3-%E6%93%B4%E5%A2%9E%E6%80%A7(KP)?series=Motor%20learning",[2148],"三",[2144,2245,2248],{"href":2246,"rel":2247},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002F%E5%8B%95%E4%BD%9C%E5%AD%B8%E7%BF%92%EF%BC%88%E5%8D%81%E4%B8%80%EF%BC%89%E5%9B%9E%E9%A5%8B-4-(%E9%96%93%E9%9A%94+%E7%89%A9%E7%90%86%E5%BC%95%E5%B0%8E)?series=Motor%20learning",[2148],"四",[34,2250],{},"\nKR與KP，KR效度比KP更佳",[34,2253],{},"\n總結VS延時VS立即，總結是多次動作後給予回饋，延時為動作後隔一小段時間給予回饋，這兩種都比立即回饋效果更佳",[34,2256],{},"\n（",[2144,2259,2261],{"href":2246,"rel":2260},[2148],"這裡第一段有提到",[34,2263],{},"\n回饋的方法，",[2144,2266,2268],{"href":2237,"rel":2267},[2148],"這一篇的後半段","有提到，可以再複習一下",[34,2271],{},"\n先設定一個",[40,2274,2276],{"className":2275},[946],"區間","，達到的都算得分",[34,2279],{},"\n回饋也可以做遞減，逐漸減少依賴",[34,2282],{},"\n假如病人",[40,2285,2287],{"className":2286},[44,43],"主動要求回饋","，我們再給予，也會更佳",{"title":279,"searchDepth":280,"depth":280,"links":2290},[],"Motor Learning定義~結束","2026-04-13","\u002Fimages\u002Fuploads\u002F1775875520542-37128694_p0_master1200.jpg",{},"\u002Fblog\u002FMotor-Learning小兒（二）",{"title":2067,"description":2291},{"loc":2295},"blog\u002FMotor-Learning小兒（二）","vCmIeebtfGfHQk7UoNr_yn1XC2gwpWX_B8fsdXmUsJc",{"id":2301,"title":2302,"author":6,"body":2303,"date":2502,"description":2503,"draft":284,"edited_at":2502,"extension":285,"featured_image":2504,"meta":2505,"navigation":288,"path":2506,"pinned":284,"seo":2507,"sitemap":2508,"stem":2509,"tags":293,"__hash__":2510},"blog\u002Fblog\u002FGait-analysis小兒（一）.md","Gait analysis小兒（一）",{"type":8,"value":2304,"toc":2500},[2305,2308,2311,2328,2331,2342,2345,2362,2388,2394,2397,2414,2423,2434,2449,2455,2483,2486],[11,2306,2307],{},"我也不知道這一課要怎麼說開篇語，還是乖乖按著老師的講對寫好了",[11,2309,2310],{},"那下肢雙關節肌肉有以下",[932,2312,2313,2316,2319,2322,2325],{},[18,2314,2315],{},"腰大肌——Hip Flexion, Trunk Flexion",[18,2317,2318],{},"腿後肌——Hip Extension, Knee Flexion",[18,2320,2321],{},"股直肌——Hip Flexion, Knee Extension",[18,2323,2324],{},"腓腸肌——Knee Flexion, PF",[18,2326,2327],{},"縫匠肌——Hip Flexion, Hip ER",[11,2329,2330],{},"那單關節的肌肉有",[932,2332,2333,2336,2339],{},[18,2334,2335],{},"臀大肌——Hip Extension, Hip ER",[18,2337,2338],{},"脛前肌——DF, inversion",[18,2340,2341],{},"腓骨長肌——PF, eversion",[11,2343,2344],{},"那以下動作的抗重力與無抗重力的擺位姿勢為",[932,2346,2347,2350,2353,2356,2359],{},[18,2348,2349],{},"Hip Extension——Prone 抗重力, side-lying 無抗重力",[18,2351,2352],{},"Hip Flexion——Sitting 抗重力, side-lying 無抗重力",[18,2354,2355],{},"Hip Abduction——Side-lying 抗重力, supine 無抗重力",[18,2357,2358],{},"Knee Extension——Sitting 抗重力, side-lying 無抗重力",[18,2360,2361],{},"PF——Standing 抗重力, prone 無抗重力",[11,2363,2364,2365,2367,2368,2372,2373,2377,2379,2380,2382,2383,2387],{},"接下來講一個異常步態——Crouch gait",[34,2366],{},"\n為甚麼他會呈現屈曲狀態，主要是因為",[40,2369,2371],{"className":2370},[43,44],"雙關節肌肉張力過強","，而",[40,2374,2376],{"className":2375},[43,946],"單關節肌肉力量不足",[34,2378],{},"\n不是單純的肌肉太緊，也是一種肌力失衡的表現",[34,2381],{},"\n其中，在",[40,2384,2386],{"className":2385},[43],"腿固定時(stand)，屈曲大腿的肌肉作用，會讓骨盤前傾","(像是髂腰肌)",[11,2389,2390,2391,2393],{},"接著來講步態的參數",[34,2392],{},"\nStep length(步距,左右之間距離),Stride length(步幅,左右左的左左之間距離),Speed(速度),Cadence(步頻)",[11,2395,2396],{},"這邊提到一個中風後會出現的代償步態",[15,2398,2399,2402,2405,2408,2411],{},[18,2400,2401],{},"步速下降",[18,2403,2404],{},"步距縮短或不對稱",[18,2406,2407],{},"步寬變大(BOS增加)",[18,2409,2410],{},"雙腳站立期變長",[18,2412,2413],{},"依賴手部支撐",[11,2415,2416,2417,2419,2420,2422],{},"接著講Gait cycle，分別為站立期以及擺盪期",[34,2418],{},"\n而站立期要去做承重以及單腳支撐的任務，擺盪期則要做肢體向前的任務",[34,2421],{},"\n完成這三個任務又分成了這八個動作",[932,2424,2425,2428,2431],{},[18,2426,2427],{},"承重——Initial contact和Loading Response",[18,2429,2430],{},"單腳支撐——Mid-stance, Terminal Stance和Pre-swing",[18,2432,2433],{},"肢體向前——Pre-swing, Initial swing, Mid-swing和Terminal Swing",[11,2435,2436,2437,2441,2442,2444,2445],{},"而Pre-swing雖然腳尖還沒離地，但",[40,2438,2440],{"className":2439},[43,946],"重心其實已經轉移去另一隻腳","了",[34,2443],{},"\n其中 ",[40,2446,2448],{"className":2447},[43],"Initial contact和Pre-swing為雙腳承重期",[11,2450,2451,2452,2454],{},"我們現在攤開來看站立期和擺盪期下肢各關節變化",[34,2453],{},"\n首先是站立期",[932,2456,2457,2465,2468,2474,2480],{},[18,2458,2459,2460,2464],{},"在雙腳承重期，",[40,2461,2463],{"className":2462},[43,946],"足部會放平","，準備Push Off",[18,2466,2467],{},"Hip的話，在Initical Contact的Flexion到Terminal Stance的Hyperextension",[18,2469,2470,2471,2473],{},"Knee的話，會從Flexion姿勢，到Mid-stance的Extension，再變回Pre-swing的Flexion",[34,2472],{},"\n(Flexion>Extension>Flexion)",[18,2475,2476,2477,2479],{},"Ankle的話，在Initical Contact的Neutral姿勢，Loading Response的PF，",[34,2478],{},"\nMid-stance的DF，最後是Terminal Stance\u002FPre-swing的PF（Neutral>PF>DF>PF）",[18,2481,2482],{},"Pelvis的話，基本保持水平，但在Terminal stance會略微前傾",[11,2484,2485],{},"然後是擺盪期",[932,2487,2488,2491,2494,2497],{},[18,2489,2490],{},"Knee的話，在Initical swing時會呈現Flexion，在Terminal swing會Full-extension",[18,2492,2493],{},"Hip的話，從Initical swing的Hyperextension，在Terminal swing會變成Flexion",[18,2495,2496],{},"Ankle的話，保持DF狀態，使腳尖不會碰到地板",[18,2498,2499],{},"Pelvis的話，會Rotation",{"title":279,"searchDepth":280,"depth":280,"links":2501},[],"2026-04-11","肌肉~步態各分期關節姿勢","\u002Fimages\u002Fuploads\u002F1775885400167-37100769_p0.png",{},"\u002Fblog\u002FGait-analysis小兒（一）",{"title":2302,"description":2503},{"loc":2506},"blog\u002FGait-analysis小兒（一）","twQeon3uGQlDYDjG3t_oGlDC93CraJNGOOTRTTxdazk",{"id":2512,"title":2513,"author":6,"body":2514,"date":2502,"description":2702,"draft":284,"edited_at":2502,"extension":285,"featured_image":2703,"meta":2704,"navigation":288,"path":2705,"pinned":284,"seo":2706,"sitemap":2707,"stem":2708,"tags":293,"__hash__":2709},"blog\u002Fblog\u002FGait-analysis小兒（二）.md","Gait analysis小兒（二）",{"type":8,"value":2515,"toc":2700},[2516,2519,2633,2636,2671,2683,2689],[11,2517,2518],{},"現在我們將八個步態分期拆開了細看",[932,2520,2521,2545,2559,2577,2587,2608,2627,2630],{},[18,2522,2523,2524,2528,2532,2533,2537,2541,2542,2544],{},"Initical Contact——用",[40,2525,2527],{"className":2526},[43],"股四頭肌和脛前肌做",[40,2529,2531],{"className":2530},[43,44],"離心收縮","，這時",[40,2534,2536],{"className":2535},[43],"腿後肌做",[40,2538,2540],{"className":2539},[43,946],"向心收縮","協同加速穩定",[34,2543],{},"\n（減速與準備承重）",[18,2546,2547,2548,2552,2555,2556,2558],{},"Loading Response——",[40,2549,2551],{"className":2550},[43],"肌內側肌與脛前肌做",[40,2553,2531],{"className":2554},[43,44],"，而臀大肌以及腿後肌輔助Hip加速，將重心向前移動",[34,2557],{},"\n（避震）",[18,2560,2561,2562,2372,2566,2570,2573,2574,2576],{},"Mid-stance——膝蓋後方有關節囊結構的緣故，肌四頭肌幾乎",[40,2563,2565],{"className":2564},[946],"不需用力",[40,2567,2569],{"className":2568},[43],"比目魚肌此時做",[40,2571,2531],{"className":2572},[43,44],"控制脛骨速度",[34,2575],{},"\n（省力）",[18,2578,2579,2580,2584,2586],{},"Terminal stance——",[40,2581,2583],{"className":2582},[43,946],"腓腸肌與比目魚肌做向心收縮",[34,2585],{},"\n（產生推進力）",[18,2588,2589,2590,2594,1139,2597,2599,2600,2604],{},"Pre-swing——假如是慢速走路，會利用",[40,2591,2593],{"className":2592},[43],"縫匠肌(Sartorius)和肌薄肌(Graillis)做",[40,2595,2540],{"className":2596},[43,946],[34,2598],{},"\n快速行走則靠",[40,2601,2603],{"className":2602},[43],"肌直肌做",[40,2605,2607],{"className":2606},[43,1026],"等長收縮",[18,2609,2610,2611,2615,2618,2620,2621,2624],{},"Initial swing——在慢速走路中，",[40,2612,2614],{"className":2613},[43],"股薄肌與縫匠肌會進行",[40,2616,2540],{"className":2617},[43,946],[34,2619],{},"\n而快速走路中，",[40,2622,2603],{"className":2623},[43],[40,2625,2607],{"className":2626},[43,1026],[18,2628,2629],{},"Mid swing——靠慣性推進，基本沒有肌肉參與",[18,2631,2632],{},"Terminal swing——腿後肌做等長收縮，限制Knee extension速度",[11,2634,2635],{},"接著來講小腿後肌群無力的話會有甚麼問題",[15,2637,2638,2648],{},[18,2639,2640,2641,1139,2645,2647],{},"Mid-stannce——比目魚肌無力的話，會讓",[40,2642,2644],{"className":2643},[44,43],"Ankle做DF",[34,2646],{},"\n那由於代償原因，Knee會做flexion來讓腳踩在地面，結果變成股四頭肌必須要加入收縮才能穩定站立",[18,2649,2650,2651,2655,2657,2658,2662,2663,1999,2667],{},"Terminal stance和Pre-swing——腓腸肌力量不足的話，",[40,2652,2654],{"className":2653},[43,44],"沒辦法產生足夠的推進力",[34,2656],{},"\n只好讓",[40,2659,2661],{"className":2660},[44,43],"髖屈肌收縮","提起整段下肢，確保",[40,2664,2666],{"className":2665},[946],"腳尖離地",[40,2668,2670],{"className":2669},[665],"步距變短",[11,2672,2673,2674,2676,2677,2679,2680,2682],{},"最後講小孩的步態發展過程",[34,2675],{},"\n在18個月就會出現交互雙手擺動以及腳跟著地（Heel strike）的形態",[34,2678],{},"\n2歲的小孩懂得矢狀面(Sagittal-plane)關節旋轉",[34,2681],{},"\n7歲的小孩步態已經能達到成人標準了",[11,2684,2685,2686,2688],{},"CP的小孩在五歲時——有54%不需要輔具獨立行走，16%需要輔具行走，30%無法行走",[34,2687],{},"\n那CP小孩預測能力方面也分成了三個時段",[932,2690,2691,2694,2697],{},[18,2692,2693],{},"9~18個月——頭部控制能力",[18,2695,2696],{},"24個月——不需要支撐能獨自坐穩",[18,2698,2699],{},"30個月——做爬行",{"title":279,"searchDepth":280,"depth":280,"links":2701},[],"八分期肌肉拆解，腿後肌力不足的問題以及小兒步態發展過程","\u002Fimages\u002Fuploads\u002F1775898442489-136249570_p0_master1200.webp",{},"\u002Fblog\u002FGait-analysis小兒（二）",{"title":2513,"description":2702},{"loc":2705},"blog\u002FGait-analysis小兒（二）","x7y-Smp4poLa_EJUkNUpEi-ow03rff_xJb4B-xlHN1k",{"id":2711,"title":351,"author":6,"body":2712,"date":2502,"description":2856,"draft":284,"edited_at":2857,"extension":285,"featured_image":2858,"meta":2859,"navigation":288,"path":2860,"pinned":284,"seo":2861,"sitemap":2862,"stem":2863,"tags":293,"__hash__":2864},"blog\u002Fblog\u002F小兒發展（一）.md",{"type":8,"value":2713,"toc":2854},[2714,2717,2732,2738,2741,2767,2776,2778,2781,2798,2800,2803],[11,2715,2716],{},"（PS：別問我為甚麼寫完步態動作寫習跟CP才回頭來寫這個，我真忘了你信嗎）",[11,2718,2719,2720,2722,2723,2725,2726,2728,2729,2731],{},"那先來講發展遲緩的定義，它不單指運動層面上，還包括了",[34,2721],{},"\n知覺，語言，心理，社會，情緒等層面",[34,2724],{},"\n而這個動作遲緩有標準的",[34,2727],{},"\n發展過程成未達到正常小孩的90%，或者在評估測驗分數上落後兩個標準差，即屬發展遲緩",[34,2730],{},"\n根據WHO的數據，發生率為6~8%",[11,2733,2734,2735,2737],{},"那高危族群有以下",[34,2736],{},"\n視障兒童，聽障兒童，心理行為障礙兒童，生理狀況障礙兒童，家庭問題兒童",[11,2739,2740],{},"接下來講寶寶的正常發育過程，先從視角說起，如下",[932,2742,2743,2746,2749,2752,2755,2758,2761,2764],{},[18,2744,2745],{},"剛出生數天——眨眼反射",[18,2747,2748],{},"六周——注射物體",[18,2750,2751],{},"二到三個月——對明亮的東西感興趣",[18,2753,2754],{},"四個月——協調眼球轉動",[18,2756,2757],{},"一歲——影像認知發展完成，能看清輪廓",[18,2759,2760],{},"三歲——能分辨紅黃藍綠",[18,2762,2763],{},"五到六歲——可以分辨大多數顏色",[18,2765,2766],{},"八歲以前——有遠視現象（我問了Gemini也看不太懂就是了）",[11,2768,2769,2770,2772,2773,2775],{},"那關於視覺發展異常的問題包括了",[34,2771],{},"\n視覺注視不良，視線不隨物體移動，對熟悉的臉孔或物體缺乏反應 手眼協調異常",[34,2774],{},"\n眼睛外觀異常，因視覺問題的代償性頭部姿勢異常，只能看近物，怕光",[961,2777],{},[11,2779,2780],{},"接著是聽覺發展，如下",[932,2782,2783,2786,2789,2792,2795],{},[18,2784,2785],{},"四個月——追尋聲音或說話來源",[18,2787,2788],{},"七到八個月——被叫名字有反應",[18,2790,2791],{},"十個月——仿說（無意義內容）",[18,2793,2794],{},"一到一歲半——初步聽懂簡單的話",[18,2796,2797],{},"兩歲以後——鸚鵡式學說話",[961,2799],{},[11,2801,2802],{},"接下來是粗大動作的發展，如下",[932,2804,2805,2808,2811,2814,2817,2820,2823,2826,2829,2837,2845,2848,2851],{},[18,2806,2807],{},"兩個月——不穩定的抬頭控制",[18,2809,2810],{},"四個月——抬頭控制適當",[18,2812,2813],{},"五個月——翻身（先學會Prone to supine, 接著是supine to prone）",[18,2815,2816],{},"七個月——坐起來",[18,2818,2819],{},"八個月——爬行",[18,2821,2822],{},"九個月——需要支撐的站起來",[18,2824,2825],{},"十個月——僅需要極小輔助的從坐到站",[18,2827,2828],{},"一歲——獨立行走",[18,2830,2831,2832,2836],{},"兩歲——跑，",[40,2833,2835],{"className":2834},[946],"上樓梯","，踢球，投球，蹲下來",[18,2838,2839,2840,2844],{},"三歲——",[40,2841,2843],{"className":2842},[44],"下樓梯","，雙腳跳，騎三輪車",[18,2846,2847],{},"四歲——單腳跳",[18,2849,2850],{},"五歲——走直線",[18,2852,2853],{},"六歲——騎腳踏車",{"title":279,"searchDepth":280,"depth":280,"links":2855},[],"定義~粗大動作發展","2026-04-12","\u002Fimages\u002Fuploads\u002F1775957410970-EebbBUPUcAYSTE9.webp",{},"\u002Fblog\u002F小兒發展（一）",{"title":351,"description":2856},{"loc":2860},"blog\u002F小兒發展（一）","PRBPkkWsOaM11PriYRM9bPFgTo_bGZSIOZZuLMzA1sk",{"id":2866,"title":352,"author":6,"body":2867,"date":2857,"description":3019,"draft":284,"edited_at":2857,"extension":285,"featured_image":3020,"meta":3021,"navigation":288,"path":3022,"pinned":284,"seo":3023,"sitemap":3024,"stem":3025,"tags":293,"__hash__":3026},"blog\u002Fblog\u002F小兒發展（二）.md",{"type":8,"value":2868,"toc":3017},[2869,2872,2889,2891,2894,2922,2924,2927,2953,2955,2958,2972,2974,2977,2991,2993,2996,3004,3006,3009],[11,2870,2871],{},"那正常的寶寶下肢的生理變化也會按照一個叫鐘擺現象的過程發展",[932,2873,2874,2877,2880,2883,2886],{},[18,2875,2876],{},"新生兒——中度的膝內翻（O型腿）",[18,2878,2879],{},"六個月——輕度的O型腿",[18,2881,2882],{},"一歲半——直的",[18,2884,2885],{},"三歲半——輕度的膝外翻（X型腿）",[18,2887,2888],{},"五到七歲——直的",[961,2890],{},[11,2892,2893],{},"而步態的發展會按照以下時期發展",[932,2895,2896,2899,2907,2910,2913,2916,2919],{},[18,2897,2898],{},"反射踏步（靠反射）",[18,2900,2901,2902,1265],{},"抑制或靜止期（不過這裡有實驗提到，是因為脂肪比肌肉重，導致反射出不來，並不是因為高階抑制低制—— ",[2144,2903,2906],{"href":2904,"rel":2905},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002Fmotor-learning?series=%E5%B0%8F%E5%85%92%E7%89%A9%E6%B2%BB",[2148],"倒數第二段",[18,2908,2909],{},"過渡期",[18,2911,2912],{},"刻意跨步",[18,2914,2915],{},"獨立行走",[18,2917,2918],{},"Heell-toe步態",[18,2920,2921],{},"整合或直立行走成熟期",[961,2923],{},[11,2925,2926],{},"接著來看不同系統的發展進程，從出生至九個月",[15,2928,2929,2935,2941,2947],{},[18,2930,2931,2932,2934],{},"神經系統——在九個月的時候感覺系統已經成熟（視覺，本體覺，前庭覺）",[34,2933],{},"\n尤其是視覺發展遠大於粗大動作",[18,2936,2937,2938,2940],{},"身體機能——寶寶的脂肪站比高，在六個月時體重就已經是剛出生兩倍，一歲時還來到了三倍",[34,2939],{},"\n那關節部份——剛出生的寶寶：Hip會呈flexion contracture, ER>IR；膝內翻；假如承重時，會呈現旋前足",[18,2942,2943,2944,2946],{},"抗重力肌力——Hip flexor(訓練方法是supine kicking)；Hip extensor(訓練方法是prone, 爬行, 跪姿)",[34,2945],{},"\nHip abduction(訓練方法是扶物側行)",[18,2948,2949,2950,2952],{},"功能性步態——那在扶著的情況下寶寶的腳會呈現弓形腿(bowed legs)，拆開來看是",[34,2951],{},"\n步寬外展；外轉(O型腿)；髖屈曲；足跟外翻",[961,2954],{},[11,2956,2957],{},"時間來到了九個月到第十五個月之間的發展進程",[932,2959,2960,2963,2966],{},[18,2961,2962],{},"神經系統——開始能在視覺刺激或引導情況下行走，且開始具備有CPG的能力(反射抑或身體機能成熟以達成)",[18,2964,2965],{},"力學因素——重心較高(在下胸椎層級)，BOS左右積大前後面積小，直立姿勢下肌力尚有不足",[18,2967,2968,2969,2971],{},"功能性步態——雖然能獨自行走，但還是會呈現弓形腿(bowed legs)，拆開來看是",[34,2970],{},"\n步頻增加；步寬大；髖和膝關節屈曲角度增加；全足著地；擺盪期有垂足",[961,2973],{},[11,2975,2976],{},"接下來時間來到了十八個月到二十四個月的發展進程",[932,2978,2979,2985],{},[18,2980,2981,2982,2984],{},"力學因素——重心下降(由於腿快速生長)，BOS減少",[34,2983],{},"\nROM的話O型腿消失，但有旋前足出現",[18,2986,2987,2988,2990],{},"功能性步態——擺盪期學會用慣性甩出腳，支撐腳也開始會伸直承重；",[34,2989],{},"\n足跟著地還不穩定；Initical contact有knee屈曲(在足跟著地發展後出現)",[961,2992],{},[11,2994,2995],{},"時間繼續來到了三歲到三歲半的發展進程",[932,2997,2998,3001],{},[18,2999,3000],{},"力學因素——ROM的話膝外翻(X型腿)，且有旋前足出現",[18,3002,3003],{},"功能性步態——足跟著地穩定，且出現Knee flexion",[961,3005],{},[11,3007,3008],{},"最後時間來到了六歲到七歲的發展進程",[932,3010,3011,3014],{},[18,3012,3013],{},"力學因素——已經能直立行走，並且不在有旋前足",[18,3015,3016],{},"功能性步態——與成人一樣",{"title":279,"searchDepth":280,"depth":280,"links":3018},[],"步態~步態發展","\u002Fimages\u002Fuploads\u002F1775979234822-139196433_p0_master1200.webp",{},"\u002Fblog\u002F小兒發展（二）",{"title":352,"description":3019},{"loc":3022},"blog\u002F小兒發展（二）","tgAyAngzwVGZGqD2GsTT7J1O1RchC3cKRE-f381-bqo",{"id":3028,"title":353,"author":6,"body":3029,"date":2857,"description":3253,"draft":284,"edited_at":2292,"extension":285,"featured_image":3254,"meta":3255,"navigation":288,"path":3256,"pinned":284,"seo":3257,"sitemap":3258,"stem":3259,"tags":293,"__hash__":3260},"blog\u002Fblog\u002F小兒發展（三）.md",{"type":8,"value":3030,"toc":3251},[3031,3034,3037,3066,3068,3071,3088,3090,3093,3119,3121,3124,3157,3163,3182,3188,3214,3217,3220,3243,3246],[11,3032,3033],{},"寫著寫著發現這一課東西好多（悲",[11,3035,3036],{},"接著講精細動作的發展過程",[932,3038,3039,3042,3045,3048,3051,3054,3057,3060,3063],{},[18,3040,3041],{},"四個月——可以合掌",[18,3043,3044],{},"五個月——手可以向前伸並抓東西",[18,3046,3047],{},"七個月——握緊奶瓶",[18,3049,3050],{},"十個月——拍手",[18,3052,3053],{},"一歲——亂塗鴉",[18,3055,3056],{},"一歲半——疊兩到四個積木",[18,3058,3059],{},"兩歲——疊四到八個積木；畫直線",[18,3061,3062],{},"三歲——畫圓圈",[18,3064,3065],{},"五歲——畫出人形",[961,3067],{},[11,3069,3070],{},"假如有發展遲緩的問題，會有以下徵候",[15,3072,3073,3076,3079,3082,3085],{},[18,3074,3075],{},"以翻身作為移動方式",[18,3077,3078],{},"手腳不協調的爬行方式",[18,3080,3081],{},"W坐姿",[18,3083,3084],{},"兔子跳",[18,3086,3087],{},"一歲前出現明顯慣用手(因為一歲前大多為雙手並用)",[961,3089],{},[11,3091,3092],{},"而寶寶出現以下徵候，可能他有CP問題",[15,3094,3095,3098,3101,3104,3107,3110,3113,3116],{},[18,3096,3097],{},"躁動",[18,3099,3100],{},"缺乏精力",[18,3102,3103],{},"吸吮無力伴隨舌頭往前突",[18,3105,3106],{},"六個月大頭部控制不佳",[18,3108,3109],{},"口腔過度敏感",[18,3111,3112],{},"強直性咬合反射",[18,3114,3115],{},"不對稱動作形態",[18,3117,3118],{},"異常姿勢",[961,3120],{},[11,3122,3123],{},"接著講正常的語言發展，分成了語言準備期以及語言發展期",[11,3125,3126,3127,3129,3130,3134,3135,3139,3141,3142,3146,3147,3151,3152,3156],{},"首先是語言準備期，分成了表達跟理解兩個面向",[34,3128],{},"\n這時候寶寶還小，表達還只能靠",[40,3131,3133],{"className":3132},[43],"反射發聲","，有哭聲和verbal play(發一聲奇怪的聲音探索自己的聲音)，或者",[40,3136,3138],{"className":3137},[43],"學身邊的人咿咿呀呀",[34,3140],{},"\n而這個時候",[40,3143,3145],{"className":3144},[43,946],"理解能力比表達能力還要發展得快","，知覺部份開始分得出",[40,3148,3150],{"className":3149},[946],"語氣快慢聲源","等，也能",[40,3153,3155],{"className":3154},[946],"理解一些簡單的短語","例如yes or no等",[11,3158,3159,3160,3162],{},"然後是語言發展期，這時年齡為十二個月以上，發音能力基本清淅正確",[34,3161],{},"\n而語法構造則分為以下部份",[15,3164,3165,3173],{},[18,3166,3167,3168,3172],{},"句子表達能力——分成剛開始學的不完整句子，",[40,3169,3171],{"className":3170},[43,946],"只講關鍵的詞","；和發展到後面的會講完整句子",[18,3174,3175,3176,3178,3179,3181],{},"理解能力的話——十二個月已經聽懂簡單的句子指令；到兩三歲已經能理解和記住故事內容",[34,3177],{},"\n六歲理解被動句；七歲理解雙重否定句；之後能理解語句結構例如名 動 賓 謂 定 狀 補之類",[34,3180],{},"\n最後也能理解對哪個人說甚麼樣的話",[11,3183,3184,3185,3187],{},"然後講一下正常語言發展能力，雖然跟聽覺有部份重合，",[34,3186],{},"\n但我個人解讀是因為wernicke跟broca區是連在一起的會有重複的發展形態應該說得過去(?)",[932,3189,3190,3193,3196,3199,3202,3205,3208,3211],{},[18,3191,3192],{},"四個月——頭尋找聲源",[18,3194,3195],{},"六到七個月——仿說",[18,3197,3198],{},"九到十二個月——叫爸爸媽媽",[18,3200,3201],{},"一歲到一歲半——只會講一兩個字且沒有意義",[18,3203,3204],{},"兩歲到兩歲半——講片語（例如像鸚鵡般學大人說啥）",[18,3206,3207],{},"三歲——開始能講句子，講顏色，倒數十，說出身體部位",[18,3209,3210],{},"四歲——能說出數種顏色",[18,3212,3213],{},"五歲——計算五個積木",[11,3215,3216],{},"(所以看起來三歲已經具備認知能力?)",[11,3218,3219],{},"那假如語言發展異常會有以下徵象",[15,3221,3222,3225,3228,3231,3234,3237,3240],{},[18,3223,3224],{},"一歲前——太安靜",[18,3226,3227],{},"兩歲——還沒有出現有意思的字詞",[18,3229,3230],{},"三歲——沒有出現任何句子",[18,3232,3233],{},"四歲——有構音困難",[18,3235,3236],{},"五歲——說話結巴",[18,3238,3239],{},"年紀越大話越少",[18,3241,3242],{},"鼻音重，說話小聲，不當的臉部表情，說話會喘",[11,3244,3245],{},"然後，對，還有個訪說測驗，但我完全看不懂注音，原樣上圖好了(悲",[11,3247,3248],{},[890,3249],{"alt":892,"src":3250},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776047406679-Screenshot_2026-04-13_102943.png",{"title":279,"searchDepth":280,"depth":280,"links":3252},[],"精細動作~語言發展","\u002Fimages\u002Fuploads\u002F1776047258825-ElqW51yVoAI09Jg.webp",{},"\u002Fblog\u002F小兒發展（三）",{"title":353,"description":3253},{"loc":3256},"blog\u002F小兒發展（三）","cGrD26dwyUjVzawlHZHH_OnTqXRpbSPGvcZEZluSbRk",{"id":3262,"title":354,"author":6,"body":3263,"date":2292,"description":3406,"draft":284,"edited_at":2292,"extension":285,"featured_image":3407,"meta":3408,"navigation":288,"path":3409,"pinned":284,"seo":3410,"sitemap":3411,"stem":3412,"tags":293,"__hash__":3413},"blog\u002Fblog\u002F小兒發展（四）.md",{"type":8,"value":3264,"toc":3404},[3265,3268,3291,3293,3296,3322,3324,3327,3347,3349,3352,3366,3368,3371,3385,3387,3390],[11,3266,3267],{},"接下來講到括約肌控制發展（大小便控制）",[932,3269,3270,3273,3282,3288],{},[18,3271,3272],{},"十五個月——能告訴爸媽想上廁所或者褲子濕了",[18,3274,3275,3276,3278,3279,3281],{},"十八個月——白天褲子不太會濕，當然也有意外；",[34,3277],{},"\n這邊有一位學者研究說假如太早訓練寶寶大小便，會有焦慮症問題；",[34,3280],{},"\n所以歐美都偏向包尿布到兩三歲，但東方人則偏好早點訓練",[18,3283,3284,3285,3287],{},"兩到三歲——半夜讓小孩上廁所就整晚不會尿床",[34,3286],{},"\n有研究表明，晚上會叫尿床的都比較神經質(講義原句XD)",[18,3289,3290],{},"三歲——能自己上廁所但擦不乾淨，要到六歲才能擦乾淨",[961,3292],{},[11,3294,3295],{},"接著講ADL的發展",[932,3297,3298,3301,3304,3310,3313,3316,3319],{},[18,3299,3300],{},"剛出生到二十四周——可以用吸吮吞嚥反射以及杯子喝水，但後者較難，需要嘴唇及吞嚥協調才不會嗆到",[18,3302,3303],{},"六個月——開始長牙，能夠吃一些固體食物例如餅乾，這時也已經可以訓練舌頭口腔的協調",[18,3305,3306,3307,3309],{},"十五個月——用湯匙進食(但foreman supination還沒成熟，所以靠轉動湯匙進食)，可以吃半固體例如果醬；",[34,3308],{},"\n也開始可以脫襪子和鞋子",[18,3311,3312],{},"十八個月——會脫襪子鞋子，將拉鏈拉開，不需要轉動湯匙進食",[18,3314,3315],{},"兩歲——可以穿脫襪子鞋子褲子",[18,3317,3318],{},"三歲——除了背後有鈕扣以外，都會穿脫衣服了；分不清左右，要到六歲才能分清",[18,3320,3321],{},"五歲——會綁鞋子",[961,3323],{},[11,3325,3326],{},"社會性情緒發展部份",[932,3328,3329,3332,3338,3341,3344],{},[18,3330,3331],{},"剛出生到六個月——認得懂媽媽，找不到媽媽，不知道媽媽意思是甚麼，逗他會笑",[18,3333,3334,3335,3337],{},"六到十二個月——十分依賴，認得且會得媽媽",[34,3336],{},"\n這個階段很重要，形成安全連結，以媽媽作為探索世界的據點，後面才能發展社會性",[18,3339,3340],{},"十二到十八個月——有物體恆久的概念，例如媽媽只是暫時離開，會回來",[18,3342,3343],{},"十八到二十四個月——與媽媽分開會有焦慮；開始可以接觸陌生環境",[18,3345,3346],{},"二十四到三十六個月——越來越適應陌生環境，上托兒所",[961,3348],{},[11,3350,3351],{},"自我概念發展部份",[932,3353,3354,3357,3360,3363],{},[18,3355,3356],{},"剛出生到六個月——動作控制不佳；稍微分得出自我跟非自我",[18,3358,3359],{},"六到十二個月——可以自我翻身；自我跟環境分得開，有自我概念",[18,3361,3362],{},"十八到二十四個月——對自己名字敏感",[18,3364,3365],{},"二十四到三十六個月——看到男女上廁所的差異，對性別有概念",[961,3367],{},[11,3369,3370],{},"情緒發展部份",[932,3372,3373,3376,3379,3382],{},[18,3374,3375],{},"剛出生到六個月——早期只有哭跟高興表情",[18,3377,3378],{},"六到十二個月——開始有其他情緒例如厭惡，害怕，憤怒",[18,3380,3381],{},"十二到十八個月——從高興分得出喜愛，有喜歡的人事物，也喜歡做讓自己有成就感的事",[18,3383,3384],{},"十八到二十四個月——能夠用語言表達情緒",[961,3386],{},[11,3388,3389],{},"依賴及獨立發展",[932,3391,3392,3395,3398],{},[18,3393,3394],{},"剛出生到十二個月——完全依賴照顧",[18,3396,3397],{},"十二到十八個月——知道自己是個體後，想自我尋求",[18,3399,3400,3401,3403],{},"二十四到三十六個月——覺得自己了不起，但遇到無法達成的事還是有挫折感；",[34,3402],{},"\n在適當協助下明白甚麼事能做跟不能做，建立初步信心",{"title":279,"searchDepth":280,"depth":280,"links":3405},[],"括約肌控制~依賴獨立發展","\u002Fimages\u002Fuploads\u002F1776052282656-EXjYORHUcAALULe.webp",{},"\u002Fblog\u002F小兒發展（四）",{"title":354,"description":3406},{"loc":3409},"blog\u002F小兒發展（四）","iCO6Xr2Vz0v9l6ulRBKlWBt93Dzu8k8I4HDGsX-Dbpc",{"id":3415,"title":355,"author":6,"body":3416,"date":1090,"description":3556,"draft":284,"edited_at":1090,"extension":285,"featured_image":3557,"meta":3558,"navigation":288,"path":3559,"pinned":284,"seo":3560,"sitemap":3561,"stem":3562,"tags":293,"__hash__":3563},"blog\u002Fblog\u002F小兒發展（五）.md",{"type":8,"value":3417,"toc":3554},[3418,3424,3438,3441,3461,3463,3466,3495,3497,3500,3520,3522,3525],[11,3419,3420,3421,3423],{},"接下來講到一個叫皮亞傑的人，他提出了發展理論",[34,3422],{},"\n先來講他說的四大認知階段",[932,3425,3426,3429,3432,3435],{},[18,3427,3428],{},"感覺運動期(0-24m)——假如有嚴重殘疾的小孩可能會永遠停留在這期",[18,3430,3431],{},"前運思期(2-7y\u002Fo)——他們容易被表像所騙，沒有抽象能力；所以借由具體的東西來讓小孩理解（過家家）",[18,3433,3434],{},"具體運思期(7-12y\u002Fo)——開始有邏輯能力，但只限定自己碰過見過的事物(經驗談)，也開始有抽象能力",[18,3436,3437],{},"形式運思期(12y\u002Fo-more)——具備抽象能力，不需要真的有經驗也能有一定的發想",[11,3439,3440],{},"接著是他提到的感覺運動期",[932,3442,3443,3446,3449,3452,3455,3458],{},[18,3444,3445],{},"反射期(0-2m)——對，就一堆反射",[18,3447,3448],{},"初級循環反應期(3-5m)——摸索自己身體",[18,3450,3451],{},"次級循環反應期(6-9m)——會開始摸索物體（例如將玩具送嘴裡咬之類的）",[18,3453,3454],{},"兩個基模協調(9-12m)——透過兩種動作模式達成目的；理解因果",[18,3456,3457],{},"三級循環反應期(1-1.5y\u002Fo)——利用試錯將任務達成；例如用不同的聲音或動作引起照顧者反應",[18,3459,3460],{},"內化方案(1.5-2y\u002Fo)——不再試錯，而是結合經驗或觀察，再完成任務",[961,3462],{},[11,3464,3465],{},"然後是個人與社會發展",[932,3467,3468,3471,3474,3477,3480,3483,3486,3489,3492],{},[18,3469,3470],{},"兩個月——會對別人笑",[18,3472,3473],{},"六個月——自己拿玩具玩",[18,3475,3476],{},"六到八個月——開始理解陌生，不讓陌生人抱",[18,3478,3479],{},"十個月——搖手bye bye（maybe是已經將動作與語言結合?）",[18,3481,3482],{},"一歲——拿杯子喝水",[18,3484,3485],{},"十五個月——拿湯匙、脫下外套、學刷牙",[18,3487,3488],{},"兩歲——會洗手",[18,3490,3491],{},"三歲——會穿脫鞋",[18,3493,3494],{},"四歲——穿衣服，扣鈕扣，刷牙",[961,3496],{},[11,3498,3499],{},"接下來講ASD的臨床徵象（即使動作發展正常，也會有語言delay）",[932,3501,3502,3505,3508,3511,3514,3517],{},[18,3503,3504],{},"人際關係障礙——不能互動，缺乏眼神交流注視，不尋求撫慰，無法分享，無法參與遊戲",[18,3506,3507],{},"語言溝通障礙——語句單調，不太會說話，仿說，詞性錯亂，不正確肢體語言",[18,3509,3510],{},"特殊行為問題——對刺激反應異常，動作反覆，拒絕改變(習慣或者常規)，同一僵化固執行為",[18,3512,3513],{},"注意力不集中——無法持久學習",[18,3515,3516],{},"衝動——人際關係緊張",[18,3518,3519],{},"好動——無法遵守規矩，破壞力強",[961,3521],{},[11,3523,3524],{},"吞嚥異常的臨床徵象",[932,3526,3527,3530,3533,3536,3539,3542,3545,3548,3551],{},[18,3528,3529],{},"反覆性肺炎",[18,3531,3532],{},"營養不良",[18,3534,3535],{},"抗拒食物",[18,3537,3538],{},"吞嚥困難",[18,3540,3541],{},"口中有異物感",[18,3543,3544],{},"嗆咳",[18,3546,3547],{},"口中有異味",[18,3549,3550],{},"經營嘔吐",[18,3552,3553],{},"流口水",{"title":279,"searchDepth":280,"depth":280,"links":3555},[],"皮亞傑~結束","\u002Fimages\u002Fuploads\u002F1776132158232-tHG70Gg.webp",{},"\u002Fblog\u002F小兒發展（五）",{"title":355,"description":3556},{"loc":3559},"blog\u002F小兒發展（五）","hzbfl2qpxvvTUq5Hn8aXvAKEpMa7oP19s8AD5xnz-1Q",{"id":3565,"title":356,"author":6,"body":3566,"date":3909,"description":3910,"draft":284,"edited_at":3909,"extension":285,"featured_image":3911,"meta":3912,"navigation":288,"path":3913,"pinned":284,"seo":3914,"sitemap":3915,"stem":3916,"tags":293,"__hash__":3917},"blog\u002Fblog\u002FGMFCS.md",{"type":8,"value":3567,"toc":3907},[3568,3571,3574,3591,3734,3737,3763,3765,3768,3785,3787,3790,3810,3812,3815,3835,3837,3840,3856,3858,3861,3878,3880,3883,3902,3904],[11,3569,3570],{},"寫完繼續趕神經 不然我會發神經",[11,3572,3573],{},"GMFCS分級定義",[932,3575,3576,3579,3582,3585,3588],{},[18,3577,3578],{},"一級——行走不受限",[18,3580,3581],{},"二級——行走受限",[18,3583,3584],{},"三級——使用手持輔具",[18,3586,3587],{},"四級——需要電動輪椅",[18,3589,3590],{},"五級——需要別人手推輪椅",[3592,3593,3594,3621],"table",{},[3595,3596,3597],"thead",{},[3598,3599,3600,3606,3609,3612,3615,3618],"tr",{},[3601,3602,3604],"th",{"align":3603},"left",[34,3605],{},[3601,3607,3608],{"align":3603},"0-2y",[3601,3610,3611],{"align":3603},"2-4y",[3601,3613,3614],{"align":3603},"4-6y",[3601,3616,3617],{"align":3603},"6-12y",[3601,3619,3620],{"align":3603},"12-18y",[3622,3623,3624,3648,3671,3694,3712],"tbody",{},[3598,3625,3626,3630,3633,3636,3640,3644],{},[3627,3628,3629],"td",{"align":3603},"I",[3627,3631,3632],{"align":3603},"1. Sitting free on the floor            2. Crawl on hands and knee 3. Pull to stand  4. Takes few step with support",[3627,3634,3635],{"align":3603},"Independent walking without assistance",[3627,3637,3638],{"align":3603},[34,3639],{},[3627,3641,3642],{"align":3603},[34,3643],{},[3627,3645,3646],{"align":3603},[34,3647],{},[3598,3649,3650,3653,3656,3659,3663,3667],{},[3627,3651,3652],{"align":3603},"II",[3627,3654,3655],{"align":3603},"1. Sitting may need support   2. Creep on stomach",[3627,3657,3658],{"align":3603},"but sitting with support",[3627,3660,3661],{"align":3603},[34,3662],{},[3627,3664,3665],{"align":3603},[34,3666],{},[3627,3668,3669],{"align":3603},[34,3670],{},[3598,3672,3673,3676,3679,3682,3686,3690],{},[3627,3674,3675],{"align":3603},"III",[3627,3677,3678],{"align":3603},"1. Low back supported        2. Roll or creep on stomach",[3627,3680,3681],{"align":3603},"1. W-sitting      2. Creep or crawl                3. Walking with walker indoor",[3627,3683,3684],{"align":3603},[34,3685],{},[3627,3687,3688],{"align":3603},[34,3689],{},[3627,3691,3692],{"align":3603},[34,3693],{},[3598,3695,3696,3699,3702,3705,3708,3710],{},[3627,3697,3698],{"align":3603},"IV",[3627,3700,3701],{"align":3603},"1. Head control  2. Roll to supine; may roll to prone",[3627,3703,3704],{"align":3603},"1. Sitting with support (cannot maintain in good alignment) 2. Roll or creep or crawl without reciprocal movements",[3627,3706,3707],{"align":3603},"Self mobility with powered W\u002FC",[3627,3709,3707],{"align":3603},[3627,3711,3707],{"align":3603},[3598,3713,3714,3717,3720,3722,3726,3730],{},[3627,3715,3716],{"align":3603},"V",[3627,3718,3719],{"align":3603},"Unable maintain antigravity head control",[3627,3721,3719],{"align":3603},[3627,3723,3724],{"align":3603},[34,3725],{},[3627,3727,3728],{"align":3603},[34,3729],{},[3627,3731,3732],{"align":3603},[34,3733],{},[11,3735,3736],{},"接著是操作的部份",[15,3738,3739,3742,3745,3748,3751,3754,3757,3760],{},[18,3740,3741],{},"軀幹支持行助行器——可以支撐pelvis trunk",[18,3743,3744],{},"手持式移動輔具——手杖，拐杖，前推或後拉式助行器這一類都的不支撐trunk",[18,3746,3747],{},"肢體協助——需要別人協助移動",[18,3749,3750],{},"電動移動輔助——電動輪椅，代步車，等",[18,3752,3753],{},"手動輪椅自推——自己推",[18,3755,3756],{},"被動運送——被人推",[18,3758,3759],{},"行走——可以帶矯具但不能用輔具",[18,3761,3762],{},"輪式移動工具——包括電動輪椅，手動輪椅還有推車",[961,3764],{},[11,3766,3767],{},"兩歲前",[15,3769,3770,3773,3776,3779,3782],{},[18,3771,3772],{},"一級——能自行轉變姿勢；坐姿能雙手伸出抓物；可以四足爬、扶物站起、扶物跨步；18~24個月獨立行走不用輔具",[18,3774,3775],{},"二級——需用手支撐平衡；腹貼地爬或四足爬行；扶物站起、扶物跨步",[18,3777,3778],{},"三級——下背部被支撐才能坐穩；會翻身、腹貼地爬",[18,3780,3781],{},"四級——有頭控制能力，但坐需要扶住整個身軀；會翻身prone to supine\u002Fsupine to prone但不會爬",[18,3783,3784],{},"五級——因身體功能受損限制自主動作；無法在爬或坐姿控制頭部及軀幹",[961,3786],{},[11,3788,3789],{},"二到四歲",[15,3791,3792,3795,3798,3804,3807],{},[18,3793,3794],{},"一級——坐姿雙手伸出抓物；坐到站\u002F站到坐自行轉換；以行走為移動首選，不需輔助",[18,3796,3797],{},"二級——坐姿雙手伸出抓物會不穩；坐到站\u002F站到坐能自行轉換不需大人，但要拉穩定物體站；以四足爬或輔具作移動首選",[18,3799,3800,3801,3803],{},"三級——以W坐姿維持自行坐，需大人協且進入坐姿；會以腹貼地爬或四足爬（不具備雙腳交替能力）",[34,3802],{},"\n能扶穩定物站，短距離扶物走；可用輔具短距離走，轉向需協助",[18,3805,3806],{},"四級——無支撐會倒，需適應性輔具協具坐和站（九個月沒有站要注意）；以翻滾、腹貼地爬、四足爬坐為移動首選",[18,3808,3809],{},"五級——幾乎不會動",[961,3811],{},[11,3813,3814],{},"四到六歲",[15,3816,3817,3820,3826,3829,3832],{},[18,3818,3819],{},"一級——在椅子坐站切換，且坐穩不需支撐；椅子地板坐站切換不需支撐；室內外自由走，會爬樓梯；開始展現跑跳能力",[18,3821,3822,3823,3825],{},"二級——在椅上能放開雙手，椅子地板坐站切換需支撐穩定表面；",[34,3824],{},"\n室內走不需協助，室外平坦地面短距走；需扶欄杆走樓梯，但無法跑跳",[18,3827,3828],{},"三級——坐姿需被支撐才能雙手活動；移動需輔具；上樓梯需協助",[18,3830,3831],{},"四級——需適應性座椅才能雙手活動；椅子坐站切換需協助；可使用電動輪椅自行移動",[18,3833,3834],{},"五級——幾乎不動",[961,3836],{},[11,3838,3839],{},"六到十二歲",[15,3841,3842,3845,3848,3851,3854],{},[18,3843,3844],{},"一級——能自行室內外獨立行走上下樓梯；有跑跳但速度平衡協調還在進化",[18,3846,3847],{},"二級——大多數環境可以走；需手持或輪式輔具；爬樓梯需扶手或協助；跑跳能力受限",[18,3849,3850],{},"三級——大多數環境需手持輔具行走；坐椅子需骨盤支持帶；長距離，社區，不平整環境需輪式輔具",[18,3852,3853],{},"四級——需他人協助或電動輪椅移動",[18,3855,3834],{},[961,3857],{},[11,3859,3860],{},"十二到十八歲",[15,3862,3863,3866,3869,3872,3875],{},[18,3864,3865],{},"一級——所有環境移動；跑跳與同儕一致，但速度平衡協調可能不同",[18,3867,3868],{},"二級——多數環境移動；不平整或長距需手持或輪式輔具；在校或工作會使用輪式輔助；爬樓梯需扶手",[18,3870,3871],{},"三級——需手持輔具移動；在學校社區需輪式輔具；坐椅子需骨盤支持帶或軀幹支撐才能使用雙手；平整地可短距行走",[18,3873,3874],{},"四級——需輪式輔具移動；需肢體協助設備；常用電動輪椅移動",[18,3876,3877],{},"五級——被動協助移動",[961,3879],{},[11,3881,3882],{},"各分級比較",[15,3884,3885,3888,3891,3899],{},[18,3886,3887],{},"一級VS二級——二級在長距離移動和平衡較差；為平穩多選擇手持扶具；爬樓梯需扶手",[18,3889,3890],{},"二級VS三級——主要為移動形態差異；二級多數環境能獨立；三級在平穩地面手持輔具，社區需輪式",[18,3892,3893,3894],{},"三級VS四級——主要為坐姿及自動移動差異；",[15,3895,3896],{},[18,3897,3898],{},"三級僅需簡單支撐，且具一定獨立行走能力；四級需適應性支撐，且需依靠電動輪椅",[18,3900,3901],{},"四級VS五級——五級在頭部抗重力與軀幹穩定極差；所有動作領域嚴重不足；若要求自行移動需高度改裝電動輪椅",[961,3903],{},[11,3905,3906],{},"還好內容不多也不難啃，嚇死我了",{"title":279,"searchDepth":280,"depth":280,"links":3908},[],"2026-04-19","好像是要自己看的補充","\u002Fimages\u002Fuploads\u002F1776579606728-El0Kc5OVMAEdbG5.webp",{},"\u002Fblog\u002FGMFCS",{"title":356,"description":3910},{"loc":3913},"blog\u002FGMFCS","G29aDr074P62Nd9uZoQMiZkkv7riTkIuliNENvcBRcI",{"id":3919,"title":357,"author":6,"body":3920,"date":4145,"description":4146,"draft":284,"edited_at":4147,"extension":285,"featured_image":4148,"meta":4149,"navigation":288,"path":4150,"pinned":284,"seo":4151,"sitemap":4152,"stem":4153,"tags":293,"__hash__":4154},"blog\u002Fblog\u002FBPI.md",{"type":8,"value":3921,"toc":4143},[3922,3928,3937,3946,3952,3958,3969,3972,3974,3977,3994,3997,4040,4042,4051,4057,4093,4096,4101,4108,4111,4125],[11,3923,3924,3925,3927],{},"BPI，臂叢傷害，在1768年在英國第一次被提出來",[34,3926],{},"\n臂叢包括了從C5到T1的五條神經",[11,3929,3930,3931,3933,3934,3936],{},"功能包括了接收來自手臂和手的訊號、傳送大腦發出的訊號",[34,3932],{},"\n那假如這條路徑受傷，訊號就傳不到大腦，反過來也傳不到手臂跟手",[34,3935],{},"\n感覺會退化，肌肉也會逐漸萎縮，進一步的變成肌肉和關節攣縮",[11,3938,3939,3940,3942,3943,3945],{},"假如神經裡面的nerve covering沒有受損，這樣的話神經是可以再生的",[34,3941],{},"\n在剛出生第一年恢復會很快，但肌肉無力還是會存在",[34,3944],{},"\n（大概每個月長1 inch\u002F每天1 mm）",[11,3947,3948,3949,3951],{},"會造成臂叢傷害，可能是因為嬰兒太大",[34,3950],{},"\n在自然分娩時頭出來但嬰兒肩膀還卡在骨盤裡",[11,3953,3954,3955,3957],{},"那為了避免頭部傷害，都會將頭部往下拉，可能會使臂叢被拉傷",[34,3956],{},"\n手臂無力在剛出生就可以被觀察到，相關併發症有",[15,3959,3960,3963,3966],{},[18,3961,3962],{},"鎖骨骨折",[18,3964,3965],{},"肱骨骨折",[18,3967,3968],{},"霍納氏症候群：眼瞼下垂，較小的瞳孔",[11,3970,3971],{},"發生率在每1000個裡有0.6~3個",[961,3973],{},[11,3975,3976],{},"按照神經受傷類型分成",[15,3978,3979,3982,3985,3988,3991],{},[18,3980,3981],{},"Avulsion撕脫——神經跟脊髓連接斷開，無法靠再生或開刀修復",[18,3983,3984],{},"Rupture斷裂——斷裂處不在脊髓，可靠開刀修復",[18,3986,3987],{},"Neuroma神經瘤——神經再生時會長出疤痕組織，會阻斷傳導，需開刀移除疤痕組織",[18,3989,3990],{},"Axonotmesis軸突斷裂——傷到了fiber，但nerve covering還在，能再生，但速度慢慢的長回支配的肌肉",[18,3992,3993],{},"Neuropraxis神經失用症——輕度傷害，沒有撕裂，在出生後三個月後才能看出明顯不同",[11,3995,3996],{},"按照傷到的哪一條神經又分成",[15,3998,3999,4017,4034,4037],{},[18,4000,4001,4002,4006,4007],{},"Erb’s Palsy or upper-plexus type（",[40,4003,4005],{"className":4004},[44,43],"最常見","）——傷到C5和C6",[15,4008,4009],{},[18,4010,4011,4012],{},"功能喪失包括：肩外展，肩屈曲，肘屈曲，腕伸展；手臂無法從身側抬高",[15,4013,4014],{},[18,4015,4016],{},"呈現下垂姿勢，在肩內收，肩內旋，前臂旋前，手指屈曲的姿勢——類似小費手",[18,4018,4019,4020,4024,4025],{},"Klumpke’s Palsy or lower-plexus type（",[40,4021,4023],{"className":4022},[43,44],"少見","）——C7到T1",[15,4026,4027],{},[18,4028,4029,4030,1265],{},"手部內在肌無力（特別是",[40,4031,4033],{"className":4032},[946],"尺側",[18,4035,4036],{},"Duchennes Palsy——C7",[18,4038,4039],{},"Whole arm type——C5到T1",[961,4041],{},[11,4043,4044,4045,4047,4048,4050],{},"手術處置的話，假如在出生後九個月沒有任何進步就會開刀，抑或者有些嚴重的會在出生約3到4個月就會開刀",[34,4046],{},"\n第一次開刀主要是移除疤痕組織，或者神經移植（會用不那麼重要的感覺神經做移植）",[34,4049],{},"\n（通常在一歲前肩部問題要處理好）",[11,4052,4053,4054,4056],{},"那這邊老師給了一張叫Hospital for Sick Children Active Movement Scale的量表（AMS）",[34,4055],{},"\n評分一共七個，是按照MMT改過來的（我感覺是）",[15,4058,4059,4079],{},[18,4060,4061,4062],{},"非抗重力",[15,4063,4064,4067,4070,4073,4076],{},[18,4065,4066],{},"0——沒有任何反應",[18,4068,4069],{},"1——有肌肉收縮，無動作",[18,4071,4072],{},"2——能活動範圍\u003C1\u002F2",[18,4074,4075],{},"3——能活動範圍>1\u002F2",[18,4077,4078],{},"4——full range",[18,4080,4081,4082],{},"抗重力",[15,4083,4084,4087,4090],{},[18,4085,4086],{},"5——能活動範圍\u003C1\u002F2",[18,4088,4089],{},"6——能活動範圍>1\u002F2",[18,4091,4092],{},"7——full range",[11,4094,4095],{},"這一個是Mallet classification(Mallet Scale) 錄肩部和手臂功能變化的評分系統",[11,4097,4098],{},[890,4099],{"alt":892,"src":4100},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1780284740177-malletslace_full.gif",[11,4102,4103],{},[2144,4104,4107],{"href":4105,"rel":4106},"https:\u002F\u002Fwww.stlouischildrens.org\u002Fconditions-treatments\u002Fneurosurgery-services\u002Fbrachial-plexus-center\u002Ftreatment-goals\u002Fmedical-treatment",[2148],"此圖我從這裡找的",[11,4109,4110],{},"評估反射的內容包括",[15,4112,4113,4116,4119,4122],{},[18,4114,4115],{},"Moro",[18,4117,4118],{},"Galant",[18,4120,4121],{},"Neck righting, hand placing",[18,4123,4124],{},"Visual tracking",[11,4126,4127,4128,4130,4131,4133,4134,4136,4137,4139],{},"那我們介入的時間，在出血跟水腫都消退後就可以開始了，當然是越早越好",[34,4129],{},"\n提供對恢復有利的環境",[34,4132],{},"\n將攣縮問題降到最低",[34,4135],{},"\n以及著手運動訓練",[34,4138],{},[40,4140,4142],{"className":4141},[43,44],"（那PT介入是無法使神經再生加快，目的是處理減少無力，攣縮等問題，還有動作訓練）",{"title":279,"searchDepth":280,"depth":280,"links":4144},[],"2026-05-29","BPI，斜頸等下再寫","2026-06-01","\u002Fimages\u002Fuploads\u002F1780287451942-138768698_p0_master1200.webp",{},"\u002Fblog\u002FBPI",{"title":357,"description":4146},{"loc":4150},"blog\u002FBPI","BKiUvsIFaniao4lSrn5PHOXgLG4FS10Qmaqzt74VOCs",{"id":4156,"title":358,"author":6,"body":4157,"date":4147,"description":4434,"draft":284,"edited_at":4435,"extension":285,"featured_image":4436,"meta":4437,"navigation":288,"path":4438,"pinned":284,"seo":4439,"sitemap":4440,"stem":4441,"tags":293,"__hash__":4442},"blog\u002Fblog\u002F先天性肌肉斜頸症CMT.md",{"type":8,"value":4158,"toc":4432},[4159,4177,4189,4195,4197,4200,4315,4317,4320],[11,4160,4161,4162,4164,4165,4167,4168,4170,4171,4173,4174,4176],{},"那顧名思義，就是歪脖子，他是SCM過緊導致的（這條肌肉從耳後連到了鎖骨）",[34,4163],{},"\n每1000個新生兒中就有3到20例",[34,4166],{},"\n病因包括：",[34,4169],{},"\n胎位不正，難產，任何外傷引發斜頸，可能有腫瘤的神經學徵象",[34,4172],{},"\n而斜頸的特徵為",[34,4175],{},"\n頸向患側傾，頭向健側看；頭部跟臉部不對稱；SCM有腫塊，通常出生四周會被發現，八個月後消退（但假如沒摸到腫塊也不代表不是先天性斜頸）",[11,4178,4179,4180,4182,4183,4185,4186,4188],{},"斜頸是表徵，不是診斷結果",[34,4181],{},"\n其中又有80%是天生的",[34,4184],{},"\n斜頸可以是慢性存在，也可以是急性發作",[34,4187],{},"\n可能伴隨不對稱的眼睛位置",[11,4190,4191,4192,4194],{},"通常PT可以做牽拉患側，增加健側肌肉力量，以及擺位",[34,4193],{},"\n假如有很嚴重的畸型，可以在1歲時進行手術",[961,4196],{},[11,4198,4199],{},"現在說一下可能會引發斜頸的問題",[15,4201,4202,4210,4218,4226,4234,4242,4265,4276,4284,4292,4307],{},[18,4203,4204,4205],{},"Arnold-Chiari Malformation（小腦扁桃體下疝畸形）——特徵有頸痛（咳嗽或打噴嚏時會加劇），可能會出現視力模糊，吞嚥困難，嘔吐反射，眼球震顫",[15,4206,4207],{},[18,4208,4209],{},"原因因為小腦與第四腦室向下移位至頸椎管；可以用MRI診斷；可能需要手術擴大後顱窩",[18,4211,4212,4213],{},"Brucellosis——脖子跟喉部會有痛，壓痛，腫脹；可能是頸椎感染了布魯氏菌而引起的",[15,4214,4215],{},[18,4216,4217],{},"跟結核一樣是細菌感染；要用培養確認菌種；可利用抗生素，偶爾需要手術",[18,4219,4220,4221],{},"Clevical spine fractures and dislocations（頸椎骨折和脫臼）——有嚴重外傷史",[15,4222,4223],{},[18,4224,4225],{},"一般是車禍或高空墜落造成",[18,4227,4228,4229],{},"Chordomas（脊索瘤）——呈現下運動神經元問題，但小腦功能正常",[15,4230,4231],{},[18,4232,4233],{},"要看那顆瘤長在哪，才知道具體症狀",[18,4235,4236,4237],{},"Clavical fracture with or without BPI（鎖骨骨折伴隨或不伴隨BPI）——在Moro反射中，患側手不會動，而且移動患側手嬰兒會哭鬧",[15,4238,4239],{},[18,4240,4241],{},"因體重超重，或胎位不正導致難產",[18,4243,4244,4245],{},"Congenital muscular torticollis（先天性肌肉斜頸症CMT）——就上面提到的，頸向患側傾，頭向健側看，SCM有腫塊且緊繃，頸部活動度減少",[15,4246,4247,4250,4253,4256,4259,4262],{},[18,4248,4249],{},"SCM會處於緊繃狀態；屬慢性問題，假如不去處理會導置臉部和顱骨不對稱",[18,4251,4252],{},"SCM摸到腫塊，在二到三個月內會消退（但講義上面寫八個月內）",[18,4254,4255],{},"那跟C1C2半脫位引發的斜頸不同，這個是頭頸同向，跟CMT的頭頸反向不同",[18,4257,4258],{},"反射檢查如X光不會照到異常",[18,4260,4261],{},"治療通常是運動為主",[18,4263,4264],{},"假如是出生之後幾年才被確診的小孩，需要做手術鬆開SCM",[18,4266,4267,4268],{},"Drug intoxication（藥物中毒）——服藥過量，如抗癲癇藥物",[15,4269,4270,4273],{},[18,4271,4272],{},"那兒童的肌張力不全，一般會在腿部足部開始發作，再慢慢影響到全身",[18,4274,4275],{},"而後天性的肌張力不全，頭部可能會前傾或後仰，不會偏向特定一側",[18,4277,4278,4279],{},"Extraocular muscle Paresis（眼外肌麻痺）——無法讓眼睛全範圍運動",[15,4280,4281],{},[18,4282,4283],{},"所以小孩需要透過傾斜頭跟脖子來看清；接受了眼科矯正手術之後斜頸也會消失",[18,4285,4286,4287],{},"Juvenile Rheumatoid Arthritis（幼年型類風濕關節炎JRA）——在頭前傾姿勢十分常見",[15,4288,4289],{},[18,4290,4291],{},"單關節和少關節類型的JRA裡不太會出現斜頸；多關節類型侵犯過多之後才會累及，造成斜頸",[18,4293,4294,4295],{},"Multiple congenital cervical spine anomalies（先天性頸椎病變Klipel-Feil Disorder）——脖子短且寬，髮際線靠低，頸部活動度受損",[15,4296,4297,4300],{},[18,4298,4299],{},"患者在40~50歲會有神經系統方面的問題",[18,4301,4302],{},[2144,4303,4306],{"href":4304,"rel":4305},"https:\u002F\u002Fwww.tfrd.org.tw\u002Ftfrd\u002Frare_b\u002Fview\u002Fid\u002F266",[2148],"這個中文名字翻譯我從這裡找的",[18,4308,4309,4310],{},"Muscle strain（肌肉拉傷）——有外傷史",[15,4311,4312],{},[18,4313,4314],{},"會造成暫時性的斜頸，且沒有固定型態，要看是傷了哪一條肌肉",[961,4316],{},[11,4318,4319],{},"接下來講可能會導致斜頸的神經性運動障礙",[15,4321,4322,4330,4338,4346,4354,4362,4365,4373,4381,4389,4397,4405,4408,4416,4424],{},[18,4323,4324,4325],{},"Benign paroxysmal torticollis of infancy（良性陣發性嬰幼兒斜頸症）——類似於癲癇的症狀",[15,4326,4327],{},[18,4328,4329],{},"是多重原因導致",[18,4331,4332,4333],{},"Dystonia musculorum deformans（畸型性肌張力不全）——許多腦部疾病，如腦炎後遺症，亨丁頓氏症",[15,4334,4335],{},[18,4336,4337],{},"可以是顯性或隱性，原因不明",[18,4339,4340,4341],{},"Sandifer’s syndrome（桑迪弗氏症候群）——有胃食道逆流，突然斜頸的問題",[15,4342,4343],{},[18,4344,4345],{},"通常跟腦麻相關，有癲癇病史",[18,4347,4348,4349],{},"Pharyngeal abscess（咽後膿腫）——發炎時會有嚴重斜頸狀況",[15,4350,4351],{},[18,4352,4353],{},"口腔跟喉嚨會痠痛",[18,4355,4356,4357],{},"Posterior fossa tumor（後顱窩腫瘤）——出現小腦功能障礙問題，可以觀察到斜視，動暈症，嘔吐",[15,4358,4359],{},[18,4360,4361],{},"機制不明，初期症狀與CMT容易被混淆",[18,4363,4364],{},"Psychogenic（心因性）——非典型的頸椎問題（例如發展遲緩）",[18,4366,4367,4368],{},"Rotary subluxation of C1-C2（C1C2半脫位）——是原本正常的小孩，突然間出現斜頸狀況",[15,4369,4370],{},[18,4371,4372],{},"會維持在同一方向傾斜和旋轉（跟CMT不同），可由X光確認",[18,4374,4375,4376],{},"Spastic Tordicollis（痙攣型斜頸）——頭會轉向一邊",[15,4377,4378],{},[18,4379,4380],{},"通常伴有呼吸道感染；好發在5~11歲；治療可靠熱敷及頸圈",[18,4382,4383,4384],{},"Spinal cord tumors（脊髓瘤）——出現下運動神經無力問題，但小腦功能正常",[15,4385,4386],{},[18,4387,4388],{},"具體要看腫瘤長在哪才知道狀況（感覺跟上面脊索瘤挺像）",[18,4390,4391,4392],{},"Sprengel’s deformity（先天性肩胛骨高位症）——肩胛骨上移，頭部動作通常不受限",[15,4393,4394],{},[18,4395,4396],{},"從胚胎裡，肩胛骨會在C4長出，並在胚胎慢慢長大而下降，高位應該就是下降出問題",[18,4398,4399,4400],{},"Syringomyelia（脊髓空洞症）——感覺喪失，肌肉萎縮，肌健反射消失",[15,4401,4402],{},[18,4403,4404],{},"病況取決於病灶level",[18,4406,4407],{},"Systematic fungal infection（全身性真菌感染）——頸部和喉嚨會有疼痛，壓痛，腫脹（感覺跟上面布魯氏菌像）",[18,4409,4410,4411],{},"Thyroglossal duct cyst（甲狀舌骨囊腫）——頸部正中央會長出一塊柔軟的腫塊，而不是長在SCM上，且比起SCM的腫塊要更表淺",[15,4412,4413],{},[18,4414,4415],{},"需手術切除",[18,4417,4418,4419],{},"Tonsillitis\u002FAdenitis（扁桃腺炎）——嚴重發炎並引起斜頸，造成口腔與喉嚨發炎，可能會導致吞嚥與呼吸困難",[15,4420,4421],{},[18,4422,4423],{},"可使用抗生素治療",[18,4425,4426,4427],{},"Tuberculosis of the Cervical Spine（頸椎結核）——頸部和喉嚨會有疼痛，壓痛，腫脹",[15,4428,4429],{},[18,4430,4431],{},"通常是不對稱的傷害椎體，導致旋轉伴隨後凸",{"title":279,"searchDepth":280,"depth":280,"links":4433},[],"Congenital Muscular Torticollis","2026-06-03","\u002Fimages\u002Fuploads\u002F1780462622920-121146410_p0_master1200.webp",{},"\u002Fblog\u002F先天性肌肉斜頸症CMT",{"title":358,"description":4434},{"loc":4438},"blog\u002F先天性肌肉斜頸症CMT","1IZxGkst_bAVHix9u2lgPuJocdxwcKhvepyQjaOjwuM",{"id":4444,"title":359,"author":6,"body":4445,"date":4552,"description":4553,"draft":284,"edited_at":4552,"extension":285,"featured_image":4554,"meta":4555,"navigation":288,"path":4556,"pinned":284,"seo":4557,"sitemap":4558,"stem":4559,"tags":293,"__hash__":4560},"blog\u002Fblog\u002FMR智能不足.md",{"type":8,"value":4446,"toc":4550},[4447,4450,4453,4468,4477,4480,4538],[11,4448,4449],{},"先鬼轉來小兒好了 東西好像有點多",[11,4451,4452],{},"智能不足的定義是指IQ小於等於70以下的寶寶",[11,4454,4455,4456,4458,4459,4461,4462,4464,4465,4467],{},"那評估的表有",[34,4457],{},"\nStandford-Binet Intellectual Scale——適用於2.5歲",[34,4460],{},"\n中華智力發展量表——適用於6歲",[34,4463],{},"\nBayley Scale——適用於0~3歲",[34,4466],{},"\nWechsler Preschool and Primary scale of intelligence——適用於學齡前",[11,4469,4470,4471,4473,4474,4476],{},"跟據美國智能不足協會(AAMR)定義，將適應能力分成十個項目，包括了",[34,4472],{},"\n溝通，Self-care，居家生活，社交技巧，社區資源運用(community use)",[34,4475],{},"\n自我導向(self-direction)，健康安全(healthy and safely)，功能性學業(functional academic)，休閒娛樂(leisure)，work",[11,4478,4479],{},"從IQ範圍區分出",[15,4481,4482,4496,4510,4524],{},[18,4483,4484,4485],{},"輕度智能不足：IQ 50~70",[15,4486,4487,4490,4493],{},[18,4488,4489],{},"學齡期前：外表看起來正常",[18,4491,4492],{},"學齡期：在學業上需特殊教育（可達國小六年級程度）",[18,4494,4495],{},"成年人：可獨立生活",[18,4497,4498,4499],{},"中度：IQ 35~50",[15,4500,4501,4504,4507],{},[18,4502,4503],{},"學齡期前：社交技巧差",[18,4505,4506],{},"學齡期：需特殊訓練（可達國小四年級程度）",[18,4508,4509],{},"成年人：可從事非技術性職業",[18,4511,4512,4513],{},"重度：IQ 20~35",[15,4514,4515,4518,4521],{},[18,4516,4517],{},"學齡期前：缺乏溝通能力",[18,4519,4520],{},"學齡期：無法學習",[18,4522,4523],{},"成年人：日常活動需他人協助",[18,4525,4526,4527],{},"極嚴重：IQ\u003C20",[15,4528,4529,4532,4535],{},[18,4530,4531],{},"學齡期前：依賴他人照護",[18,4533,4534],{},"學齡期：依賴他人照護",[18,4536,4537],{},"成年人：依賴他人照護",[11,4539,4540,4541,4543,4544,4546,4547,4549],{},"從接受教育程度上，分成",[34,4542],{},"\nEducable：可被教育，可以上一般班級或資源班",[34,4545],{},"\nTrainable：可被訓練，學習一些謀生技巧",[34,4548],{},"\nDependent：依賴",{"title":279,"searchDepth":280,"depth":280,"links":4551},[],"2026-06-12","Intellectual disability","\u002Fimages\u002Fuploads\u002F1781247645586-145852080_p0_master1200.webp",{},"\u002Fblog\u002FMR智能不足",{"title":359,"description":4553},{"loc":4556},"blog\u002FMR智能不足","NZFChlk4JSzba5twGABUXtvtVQmu1tEvseZHqvvw_z4",{"id":4562,"title":4563,"author":6,"body":4564,"date":4552,"description":4726,"draft":284,"edited_at":4552,"extension":285,"featured_image":4727,"meta":4728,"navigation":288,"path":4729,"pinned":284,"seo":4730,"sitemap":4731,"stem":4732,"tags":293,"__hash__":4733},"blog\u002Fblog\u002FDown-Syndrome.md","Down Syndrome",{"type":8,"value":4565,"toc":4724},[4566,4572,4575,4586,4588,4591,4597,4609,4618,4628,4658,4667,4670,4673,4693,4702,4705],[11,4567,4568,4569,4571],{},"那唐氏症發生率是每1000個新生兒裡有1.3個",[34,4570],{},"\n母親是高齡產婦的話，風險會增加",[11,4573,4574],{},"這個不是遺傳疾病來的，起因有三",[15,4576,4577,4580,4583],{},[18,4578,4579],{},"第21對染色體多了一條小的染色體：91%的唐氏症都是這種類型",[18,4581,4582],{},"第21對跟第22對染色體互換：4%的唐氏症是這類型",[18,4584,4585],{},"嵌合體：智力正常，只有外觀有特徵，臨床工作者一般會建議孩子整形",[961,4587],{},[11,4589,4590],{},"從病理學來看",[11,4592,4593,4594,4596],{},"唐氏症的大腦比一般正常孩子的大腦重量小，大概只有正常的76%",[34,4595],{},"\n形狀呈圓，短，前後較窄，外側較寬——對應了最常見的唐氏症頭形：短頭畸形",[11,4598,4599,4600,4602,4603,4605,4606,4608],{},"40%的唐氏症有先天性心臟病缺陷，常見的類型為",[34,4601],{},"\n房室通道缺損(Atrioventricular canal defects)",[34,4604],{},"\n心室中膈缺損(Ventriculoseptal defects)",[34,4607],{},"\n情況良好的唐氏症小孩都會建議開刀，才能進行後續訓練，所以一般我們PT接到的都已經是開過刀的小孩了",[11,4610,4611,4612,4614,4615,4617],{},"感覺功能也會有缺失",[34,4613],{},"\n在107個受試者中，有64%的唐氏症有聽力喪失",[34,4616],{},"\n在75個受試者中，有41.3%有視覺缺陷",[11,4619,4620,4621,4623,4624],{},"肌肉骨骼系統上也會有差異",[34,4622],{},"\n低張力是主要原因，韌帶鬆馳，",[40,4625,4627],{"className":4626},[43,44],"第一二節頸椎半脫位",[11,4629,4630,4631,4633,4634,4636,4637,4639,4640,4642,4643,4645,4646,4648,4649,4651,4652],{},"那寰樞椎脫位是唐氏症最大問題的點，我們PT也要十分注意，症狀包括",[34,4632],{},"\n步態改變（踝關節不穩定）",[34,4635],{},"\n尿滯留",[34,4638],{},"\n斜頸",[34,4641],{},"\n不願意轉頭",[34,4644],{},"\n深層肌鍵反射增加",[34,4647],{},"\n2歲可以用X光進行檢查，有12~20%發現脫位，原因是齒突韌帶過鬆，所以C1C2會有十分大的活動度",[34,4650],{},"\n所以，",[629,4653,4654],{},[40,4655,4657],{"className":4656},[43,44],"前庭刺激手法對於唐氏症來說是禁忌",[11,4659,4660,4661,4663,4664,4666],{},"從肌肉上，全身呈現低張力，尤其是肢體，頸部，軀幹較明顯",[34,4662],{},"\n也會有肌肉缺失問題，包括掌長肌（斷掌）和前臂屈肌",[34,4665],{},"\n顴大小肌和提上唇肌這三條臉部肌肉缺乏明顯的肌腹分化",[11,4668,4669],{},"也會存在智力問題，通常IQ會小或等於70",[11,4671,4672],{},"在學習上的特徵有",[15,4674,4675,4678,4681,4684,4687,4690],{},[18,4676,4677],{},"能學的不多",[18,4679,4680],{},"要重複性學習",[18,4682,4683],{},"類化不好，無法順利轉化為技巧",[18,4685,4686],{},"容易忘記自己學過的技巧",[18,4688,4689],{},"反應慢",[18,4691,4692],{},"受刺激時，反應少",[11,4694,4695,4696,4698,4699,4701],{},"所以早期介入對於唐氏症小孩是最好的，整體表現會呈現輕度跟中度，很少會演變成重度",[34,4697],{},"\n一般有早期介入的唐氏症小孩在行走上是正常的",[34,4700],{},"\n且因應他的智力再安排他進入不同的班級，例如資源班或者特教班",[11,4703,4704],{},"由於存在低張力問題，可以安排",[15,4706,4707,4710,4713,4721],{},[18,4708,4709],{},"在幼兒期，利用抱姿或擺位，增加抗地心引力適應力和承重能力",[18,4711,4712],{},"也要加強抗地心引力的伸直與屈曲肌，促進關節周圍肌肉的共同收縮",[18,4714,4715,4716,4720],{},"且著重在早期的",[40,4717,4719],{"className":4718},[43,946],"動態探索","，而不是靜態探索",[18,4722,4723],{},"長大後，要去加強他的體適能及靈巧性（靈敏度）",{"title":279,"searchDepth":280,"depth":280,"links":4725},[],"唐氏症","\u002Fimages\u002Fuploads\u002F1781265657338-135232550_p0_master1200.webp",{},"\u002Fblog\u002FDown-Syndrome",{"title":4563,"description":4726},{"loc":4729},"blog\u002FDown-Syndrome","FOhG_wFbJIVxV3O-nKWt4g8KuD4rdC8E6Nyq7UBM67s",{"id":4735,"title":4736,"author":6,"body":4737,"date":4552,"description":4866,"draft":284,"edited_at":4867,"extension":285,"featured_image":4868,"meta":4869,"navigation":288,"path":4870,"pinned":284,"seo":4871,"sitemap":4872,"stem":4873,"tags":293,"__hash__":4874},"blog\u002Fblog\u002FRett-Syndrome.md","Rett Syndrome",{"type":8,"value":4738,"toc":4864},[4739,4742,4748,4756,4759,4762,4843,4846,4849,4855,4861],[11,4740,4741],{},"接下來講雷特氏症，先來整理一下老師給的兩頁雷特氏症的特徵",[11,4743,4744,4745,4747],{},"雷特氏症是一種發展性障礙疾病",[34,4746],{},"\n好發於女性，因為是X染色體出問題導致的，有75%的典型跟非典型RS會有這個叫MECP2的異常，最新的研究這個也跟FXYD1有關係",[11,4749,4750,4751,4755],{},"主要的奇怪行為是常",[40,4752,4754],{"className":4753},[43,44],"搓自己的手，拍自己的手，玩自己的手","，以及其他身體的怪異動作",[11,4757,4758],{},"雷特氏症的小孩在臨床上表現出四個時期的變化",[11,4760,4761],{},"RS的小孩雖然會合併自閉徵候，但RS合併MR更加明顯",[15,4763,4764,4778,4803,4823],{},[18,4765,4766,4767],{},"第一期（六個月到一歲半，早期）",[15,4768,4769,4775],{},[18,4770,4771,4772,4774],{},"發展通常正常，這個病在這個時期會被父母忽略；父母可能會覺得小孩目光不太注視外人",[34,4773],{},"\n對玩具逐漸不感興趣，較安靜乖巧，會喜歡搓手，而且頭圍成長趨緩",[18,4776,4777],{},"大段文字：會有一些發展遲緩問題，例如雙手協調動作未出現，臀部位移等",[18,4779,4780,4781],{},"第二期（一歲到四歲，發展明顯遲緩及退化期，那大段文字叫快速退化期）",[15,4782,4783,4800],{},[18,4784,4785,4786,4788,4789,4793,4794,4796,4797,4799],{},"小孩會顯現快速退化跟發展遲緩現象，包括語言表達逐漸喪失",[34,4787],{},"\n有反覆",[40,4790,4792],{"className":4791},[43,44],"洗手，捻手，搓手","等刻板動作，偶爾手會無理由放在背後觸摸，握緊手，張手",[34,4795],{},"\n有的小孩還會吐舌，陣發喘氣，睡眠不安，或走路不穩",[34,4798],{},"\n頭圍成長趨緩",[18,4801,4802],{},"大段文字：會喪失已學習過的技巧；會癲癇",[18,4804,4805,4806],{},"第三期（兩歲到十歲，幼兒園到國小穩定期；那大段文字叫假性穩定期）",[15,4807,4808,4817],{},[18,4809,4810,4811,4813,4814,4816],{},"小孩呈失用症，不會正常使用肢體",[34,4812],{},"\n躁動，愛哭，自閉程度比之前好，會對外界事物感興趣，語言溝通較進步",[34,4815],{},"\n這個時期可以維持相當一段時間",[18,4818,4819,4820,4822],{},"大段文字：手部運動功能喪失逐漸明顯；逐漸喪失自主能力",[34,4821],{},"\n長達數年到數十年",[18,4824,4825,4826],{},"第四期（五到二十五歲，運動退化晚期）",[15,4827,4828,4837],{},[18,4829,4830,4831,4833,4834,4836],{},"通常會在十歲左右出現運動失能現象，逐漸不能走路，有的下肢還會強直，所以要坐輪椅",[34,4832],{},"\n認知，溝通，手部動作較穩定，注視他人能力能維持",[34,4835],{},"\n有些會有脊椎側彎",[18,4838,4839,4840,4842],{},"大段文字：全身性肌肉萎縮，骨骼變形，對外界無反應；最終因細菌感染，敗血病或肺炎去世",[34,4841],{},"\n長達數十年",[11,4844,4845],{},"情緒上也會有波動，例如早上很安靜，中午很容易生氣，下午會突然很穩重，晚上會變活潑與好奇",[11,4847,4848],{},"他們之前學會過的任務，卻會忘記自己學過",[11,4850,4851,4852,4854],{},"在做一件任務時，興奮的動機才是誘發出正常動作的方法，他們能夠自己做出來，但假如由別人要求他再多一次出來，他就會失敗",[34,4853],{},"\n所以情緒上的照顧尤為要注意，假如他不開心，就該立即停止要求他去做",[11,4856,4857,4858,4860],{},"行走能力是最關鍵的，假如喪失行走能力，會導致脊椎側彎，骨質疏鬆，甚至會影響呼吸與消化功能",[34,4859],{},"\n即使時間很少，但也要著重訓練行走能力",[11,4862,4863],{},"學者認為，他們不是真的退化，他們還是能學到新的技巧的",{"title":279,"searchDepth":280,"depth":280,"links":4865},[],"雷特氏症","2026-06-13","\u002Fimages\u002Fuploads\u002F1781344227040-145949253_p0_master1200.webp",{},"\u002Fblog\u002FRett-Syndrome",{"title":4736,"description":4866},{"loc":4870},"blog\u002FRett-Syndrome","wp6UeSpNuWVzCMj8UKCOqphsSpW8MVmlDua_xz0r-Y0",{"id":4876,"title":362,"author":6,"body":4877,"date":4867,"description":362,"draft":284,"edited_at":282,"extension":285,"featured_image":5052,"meta":5053,"navigation":288,"path":5054,"pinned":284,"seo":5055,"sitemap":5056,"stem":5057,"tags":293,"__hash__":5058},"blog\u002Fblog\u002F行為改變技術.md",{"type":8,"value":4878,"toc":5050},[4879,4885,4897,4903,4964,4970,4982,5010,5024,5033,5036],[11,4880,4881,4882,4884],{},"行為改變技術旨義在建立新行為，增加或維持良好行為，以及消除不良行；透過分析，操作來影響他人的行為",[34,4883],{},"\n在小兒物治上，遇到不論遲緩，過動，或單純日常常規行為建立上，也可以使用這個技術來引導他們建立良好的行為模式",[11,4886,4887,4888,4893,4894,4896],{},"接下來會講古典制約跟操作制約，其實就跟黃老師講",[2144,4889,4892],{"href":4890,"rel":4891},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002F%E5%8B%95%E4%BD%9C%E5%AD%B8%E7%BF%92%EF%BC%88%E4%BA%8C%EF%BC%89form-of-learning?series=Motor%20learning",[2148],"Moter learning","裡的東西一樣",[34,4895],{},"\n不過我就不寫唾液制約跟恐懼制約(類化)了",[11,4898,4899,4900,4902],{},"接下來有個叫Jones的人做了七個可以做新聯結的實驗，來測試哪個更有效",[34,4901],{},"\n（他覺得制約是後天的，是可以被破壞以及聯結新的制約）",[15,4904,4905],{},[18,4906,4907,4908],{},"假如小孩有對白鼠恐懼的制約",[15,4909,4910,4918,4925,4932,4940,4948,4956],{},[18,4911,4912,4913],{},"廢棄法：只需要一段時間沒有白鼠出現，就會解除這個制約",[15,4914,4915],{},[18,4916,4917],{},"給論無效",[18,4919,4920,4921],{},"合理化：告訴小孩其實白鼠是可愛的",[15,4922,4923],{},[18,4924,4917],{},[18,4926,4927,4928],{},"消極適應法：讓白鼠一直出現，直到小孩不怕",[15,4929,4930],{},[18,4931,4917],{},[18,4933,4934,4935],{},"抑制法：PUA小孩害怕的行為",[15,4936,4937],{},[18,4938,4939],{},"結論無效",[18,4941,4942,4943],{},"分心法：當白鼠出現時，同時給他做另一件事，分散其注意，慢慢就不怕",[15,4944,4945],{},[18,4946,4947],{},"給論短期有效",[18,4949,4950,4951],{},"引導制約法：就是拿一件好的事物去跟不好的事做連結，例如白鼠出現就會有小孩最喜歡的糖果吃，慢慢的糖果和白鼠出現做連結，會對白鼠有好感",[15,4952,4953],{},[18,4954,4955],{},"給論有效，臨床上常用",[18,4957,4958,4959],{},"社會模仿法：今天讓一群喜歡白鼠的小孩跟一個不喜歡白鼠的小孩玩在一起，利用同儕心理來讓不喜歡白鼠的小孩漸漸適應白鼠",[15,4960,4961],{},[18,4962,4963],{},"結論有效，說明團體治療比個體治療更有效",[11,4965,4966,4967,4969],{},"接著是操作制約理論，意思是將某件動作跟某些結果做強聯結，達到制約效果，例如按按鈕能夠掉糖果出來",[34,4968],{},"\n這個操作制約也適用在智能不足的兒童身上，當他做到某些動作時，能拿到糖果，那麼他也會願意會做出我們想要他們做的動作，也是一種制約反應",[11,4971,4972,4973,4975,4976,4978,4979,4981],{},"在操作制約理論中，小孩的哭鬧或其他不良反應，其實是為了達到某種目的，例如得到糖果，這也算是一種制約反應",[34,4974],{},"\n所以在操作上，可以先切斷小孩這樣的不良聯結，例如小孩再哭鬧就不管他，讓他覺得這樣的聯結不再有效",[34,4977],{},"\n這時我們可以給他新的聯結，例如教導小孩說出自己想要的，表達自己想要的，那我們再即時給他想要的，建立新的聯結",[34,4980],{},"\n這個就是功能性溝通訓練",[11,4983,4984,4985,4987,4988,4990,4991,4993,4994,4996,4997,4999,5000,5002,5003,5005,5006],{},"當一個人經歷某些挫折時，會經歷3個過程，包括",[34,4986],{},"\n事件(Activating events，我自己翻成挫折本身)：例如老人跌倒",[34,4989],{},"\n信念系統(Belief system，與內心價值觀溝通)：覺得自己身體能力不如別人",[34,4992],{},"\n結果(Consequence)：不開心",[34,4995],{},"\n這時候治療師可以在這後面介入，包括",[34,4998],{},"\n駁斥(Dispute，我的理解是開導)：治療師以同理心了解其原因，再引導他回到正面想法，例如其實是練得不夠多，多練就好",[34,5001],{},"\n效果(Effect)：回到正面想法並建立新的想法，那老人就會一直練，練到不會跌倒",[34,5004],{},"\n這個是",[40,5007,5009],{"className":5008},[43,44],"認知行為改變法",[11,5011,5012,5013,5017,5018,5020,5021,5023],{},"那我們治療師在臨床上，認知行為改變法主要是適用在",[40,5014,5016],{"className":5015},[43,44],"父母","上",[34,5019],{},"\n有的父母可能他們的孩子是身心障礙而感到自卑，有的會牽怒，有的還會因孩子進步不如預期感到傷心或沮喪等",[34,5022],{},"\n這時我們就可以利用認知行為改變法，了解了父母的想法，再去引導他們建立良好的想法，這樣對孩子的進步會有更良好一面的發展",[11,5025,5026,5027,5029,5030,5032],{},"那在社會學習理論當中，我們人類，不一定要經歷過挫折，才會學習一樣動作，有的可以單靠觀察就能學會",[34,5028],{},"\n而在小孩學習過程中，比起一定要我們治療師一句一字一步步帶著小孩，小孩自己觀察探索摸索來自己學會，更加有效",[34,5031],{},"\n我們能做的，是鼓勵或者誘發他的動機，激發他的社會學習能力，這樣對日後他的成長也有更正面的幫助",[11,5034,5035],{},"在社會學習理論中，我們可以先建立一個偶像，提供給小孩進行觀察，模仿和學習，其中會經歷這四個過程",[932,5037,5038,5041,5044,5047],{},[18,5039,5040],{},"attentional process：假如小孩對偶像不感興趣，我們要怎樣引起他的興趣？利用他感興趣的事物引起他的注意",[18,5042,5043],{},"retentional process：這時偶像就可以做動作，記住，動作最好要簡潔，不必有複雜的動作，這一步是為了讓小孩自己在腦中整理，給小孩記住",[18,5045,5046],{},"Motor reproduction process：這時可以在日常生活中，創造更多的環境條件，讓小孩把看過並記住的動作自己做出來，並進行自主訓練",[18,5048,5049],{},"motivational process：最後就是，增加小孩的動機，讓他自己想做這個動作，例如做完一次動作給他誇獎，這樣下次他就會更想要做出來",{"title":279,"searchDepth":280,"depth":280,"links":5051},[],"\u002Fimages\u002Fuploads\u002F1781501618637-99016056_p0_master1200.webp",{},"\u002Fblog\u002F行為改變技術",{"title":362,"description":362},{"loc":5054},"blog\u002F行為改變技術","sdXpsIbtXZ8aSRsAoUnQX0hHLHXeEuKnYTFBkMSHcGs",{"id":4,"title":5,"author":6,"body":5060,"date":282,"description":283,"draft":284,"edited_at":282,"extension":285,"featured_image":286,"meta":5254,"navigation":288,"path":289,"pinned":284,"seo":5255,"sitemap":5256,"stem":292,"tags":293,"__hash__":294},{"type":8,"value":5061,"toc":5252},[5062,5064,5072,5074,5078,5087,5091,5093,5119,5129,5131,5169,5171,5222,5224],[11,5063,13],{},[15,5065,5066,5068,5070],{},[18,5067,20],{},[18,5069,23],{},[18,5071,26],{},[11,5073,29],{},[11,5075,32,5076,36],{},[34,5077],{},[11,5079,5080,46,5083,49,5085,52],{},[40,5081,45],{"className":5082},[43,44],[34,5084],{},[34,5086],{},[11,5088,55,5089,58],{},[34,5090],{},[11,5092,61],{},[15,5094,5095,5104,5113],{},[18,5096,66,5097],{},[15,5098,5099],{},[18,5100,71,5101,76],{},[40,5102,75],{"className":5103},[44,43],[18,5105,79,5106],{},[15,5107,5108],{},[18,5109,84,5110,89],{},[40,5111,88],{"className":5112},[43,44],[18,5114,92,5115],{},[15,5116,5117],{},[18,5118,97],{},[11,5120,100,5121,103,5123,106,5125,109,5127,112],{},[34,5122],{},[34,5124],{},[34,5126],{},[34,5128],{},[11,5130,115],{},[15,5132,5133,5143,5151],{},[18,5134,120,5135],{},[15,5136,5137,5139,5141],{},[18,5138,125],{},[18,5140,128],{},[18,5142,131],{},[18,5144,134,5145],{},[15,5146,5147,5149],{},[18,5148,139],{},[18,5150,142],{},[18,5152,145,5153],{},[15,5154,5155,5157,5159,5161,5163,5165,5167],{},[18,5156,150],{},[18,5158,153],{},[18,5160,156],{},[18,5162,159],{},[18,5164,162],{},[18,5166,165],{},[18,5168,168],{},[11,5170,171],{},[15,5172,5173,5175,5177,5187,5196,5208],{},[18,5174,176],{},[18,5176,179],{},[18,5178,182,5179],{},[15,5180,5181,5183,5185],{},[18,5182,187],{},[18,5184,190],{},[18,5186,193],{},[18,5188,196,5189],{},[15,5190,5191],{},[18,5192,5193],{},[40,5194,204],{"className":5195},[43,44],[18,5197,207,5198],{},[15,5199,5200,5202,5204,5206],{},[18,5201,212],{},[18,5203,215],{},[18,5205,218],{},[18,5207,221],{},[18,5209,224,5210],{},[15,5211,5212,5217],{},[18,5213,5214],{},[40,5215,204],{"className":5216},[43,44],[18,5218,5219],{},[40,5220,237],{"className":5221},[43,44],[11,5223,240],{},[15,5225,5226,5236,5246],{},[18,5227,245,5228],{},[15,5229,5230,5232,5234],{},[18,5231,250],{},[18,5233,253],{},[18,5235,256],{},[18,5237,259,5238],{},[15,5239,5240],{},[18,5241,264,5242],{},[15,5243,5244],{},[18,5245,269],{},[18,5247,272,5248],{},[15,5249,5250],{},[18,5251,277],{},{"title":279,"searchDepth":280,"depth":280,"links":5253},[],{},{"title":5,"description":283},{"loc":289},1781537023096]