[{"data":1,"prerenderedAt":4762},["ShallowReactive",2],{"\u002Fblog\u002FBPI":3,"post-count":263,"series-global-data":264,"authors-all":417,"series-sidebar-小兒物治":613},{"id":4,"title":5,"author":6,"body":7,"date":249,"description":250,"draft":251,"edited_at":252,"extension":253,"featured_image":254,"meta":255,"navigation":256,"path":257,"pinned":251,"seo":258,"sitemap":259,"stem":260,"tags":261,"__hash__":262},"blog\u002Fblog\u002FBPI.md","BPI","hibiki12141132",{"type":8,"value":9,"toc":245},"minimark",[10,18,27,36,42,48,61,64,67,70,87,90,138,140,149,155,191,194,201,210,213,227],[11,12,13,14,17],"p",{},"BPI，臂叢傷害，在1768年在英國第一次被提出來",[15,16],"br",{},"\n臂叢包括了從C5到T1的五條神經",[11,19,20,21,23,24,26],{},"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",[15,22],{},"\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",[15,25],{},"\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",[11,28,29,30,32,33,35],{},"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",[15,31],{},"\n在剛出生第一年恢復會很快，但肌肉無力還是會存在",[15,34],{},"\n（大概每個月長1 inch\u002F每天1 mm）",[11,37,38,39,41],{},"會造成臂叢傷害，可能是因為嬰兒太大",[15,40],{},"\n在自然分娩時頭出來但嬰兒肩膀還卡在骨盤裡",[11,43,44,45,47],{},"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",[15,46],{},"\n手臂無力在剛出生就可以被觀察到，相關併發症有",[49,50,51,55,58],"ul",{},[52,53,54],"li",{},"鎖骨骨折",[52,56,57],{},"肱骨骨折",[52,59,60],{},"霍納氏症候群：眼瞼下垂，較小的瞳孔",[11,62,63],{},"發生率在每1000個裡有0.6~3個",[65,66],"hr",{},[11,68,69],{},"按照神經受傷類型分成",[49,71,72,75,78,81,84],{},[52,73,74],{},"Avulsion撕脫——神經跟脊髓連接斷開，無法靠再生或開刀修復",[52,76,77],{},"Rupture斷裂——斷裂處不在脊髓，可靠開刀修復",[52,79,80],{},"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",[52,82,83],{},"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",[52,85,86],{},"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",[11,88,89],{},"按照傷到的哪一條神經又分成",[49,91,92,113,132,135],{},[52,93,94,95,102,103],{},"Erb’s Palsy or upper-plexus type（",[96,97,101],"span",{"className":98},[99,100],"red-3","underline","最常見","）——傷到C5和C6",[49,104,105],{},[52,106,107,108],{},"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",[49,109,110],{},[52,111,112],{},"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",[52,114,115,116,120,121],{},"Klumpke’s Palsy or lower-plexus type（",[96,117,119],{"className":118},[100,99],"少見","）——C7到T1",[49,122,123],{},[52,124,125,126,131],{},"手部內在肌無力（特別是",[96,127,130],{"className":128},[129],"green-3","尺側","）",[52,133,134],{},"Duchennes Palsy——C7",[52,136,137],{},"Whole arm type——C5到T1",[65,139],{},[11,141,142,143,145,146,148],{},"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",[15,144],{},"\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）",[15,147],{},"\n（通常在一歲前肩部問題要處理好）",[11,150,151,152,154],{},"那這邊老師給了一張叫Hospital for Sick Children Active Movement Scale的量表（AMS）",[15,153],{},"\n評分一共七個，是按照MMT改過來的（我感覺是）",[49,156,157,177],{},[52,158,159,160],{},"非抗重力",[49,161,162,165,168,171,174],{},[52,163,164],{},"0——沒有任何反應",[52,166,167],{},"1——有肌肉收縮，無動作",[52,169,170],{},"2——能活動範圍\u003C1\u002F2",[52,172,173],{},"3——能活動範圍>1\u002F2",[52,175,176],{},"4——full range",[52,178,179,180],{},"抗重力",[49,181,182,185,188],{},[52,183,184],{},"5——能活動範圍\u003C1\u002F2",[52,186,187],{},"6——能活動範圍>1\u002F2",[52,189,190],{},"7——full range",[11,192,193],{},"這一個是Mallet classification(Mallet Scale) 錄肩部和手臂功能變化的評分系統",[11,195,196],{},[197,198],"img",{"alt":199,"src":200},"1.00","https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1780284740177-malletslace_full.gif",[11,202,203],{},[204,205,209],"a",{"href":206,"rel":207},"https:\u002F\u002Fwww.stlouischildrens.org\u002Fconditions-treatments\u002Fneurosurgery-services\u002Fbrachial-plexus-center\u002Ftreatment-goals\u002Fmedical-treatment",[208],"nofollow","此圖我從這裡找的",[11,211,212],{},"評估反射的內容包括",[49,214,215,218,221,224],{},[52,216,217],{},"Moro",[52,219,220],{},"Galant",[52,222,223],{},"Neck righting, hand placing",[52,225,226],{},"Visual tracking",[11,228,229,230,232,233,235,236,238,239,241],{},"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",[15,231],{},"\n提供對恢復有利的環境",[15,234],{},"\n將攣縮問題降到最低",[15,237],{},"\n以及著手運動訓練",[15,240],{},[96,242,244],{"className":243},[100,99],"（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":246,"searchDepth":247,"depth":247,"links":248},"",2,[],"2026-05-29","BPI，斜頸等下再寫",false,"2026-06-01","md","\u002Fimages\u002Fuploads\u002F1780287451942-138768698_p0_master1200.webp",{},true,"\u002Fblog\u002FBPI",{"title":5,"description":250},{"loc":257},"blog\u002FBPI",null,"BKiUvsIFaniao4lSrn5PHOXgLG4FS10Qmaqzt74VOCs",142,{"id":265,"extension":266,"meta":267,"series":268,"stem":415,"__hash__":416},"series\u002Fseries.json","json",{},{"微積分教學":269,"生活紀錄":272,"Motor Control":274,"生活隨筆":288,"Motor learning":292,"小兒物治":310,"中風":329,"平衡":342,"Network Communication":352,"CSA":359,"機器學習":365,"小腦":369,"SCI脊髓損傷":378,"Machine Learning":394,"Data 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也是最大宗的一類(70%)",[15,679],{},"\n傷到了",[96,682,684],{"className":683},[631],"錐狀束","(錐體路徑 Pyramidal Tract)",[15,687],{},"\n而四肢張力都會變大 ",[96,690,692],{"className":691},[631],"上肢比下肢","還要嚴重",[15,695],{},[96,697,699],{"className":698},[100],"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)",[15,702],{},"\n併發症有 ",[96,705,708],{"className":706},[707],"green-5","斜視","(70%) ",[96,711,713],{"className":712},[707],"癲癇","(50%)",[15,716],{},"\n治療重點有",[15,719],{},"\n增加中軸張力(核心穩定)",[15,722],{},"\n降低肢體張力",[15,725],{},"\n提升抗重力能力",[11,728,729,730,680,732,736,737,739,740,744,745,747,748,750,751,717,753,755,756,758],{},"接著講徐動型(Athethoid)",[15,731],{},[96,733,735],{"className":734},[631],"基底核黃核","部位",[15,738],{},"\n張力",[96,741,743],{"className":742},[99],"時大時小","(有時候很硬 有時候很軟)",[15,746],{},"\n而頭部控制差 上肢較下肢嚴重 且有不隨意扭動",[15,749],{},"\n併發症有 聽覺障礙(高頻聽不見) 語言障礙",[15,752],{},[15,754],{},"\n對稱協調控制",[15,757],{},"\n雙側控制",[11,760,761,762,680,764,768,770,771,773,774,776,777,779,780,782,783,785,786,788],{},"最後來講失調型(Ataxia)",[15,763],{},[96,765,767],{"className":766},[631],"小腦",[15,769],{},"\n張力小",[15,772],{},"\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)",[15,775],{},"\n併發有 平衡 感覺統合 知覺都會較差",[15,778],{},"\n在治療重點上",[15,781],{},"\n會給他們穿加壓衣(增加感統知覺) ",[15,784],{},"\n穩定與張力提升",[15,787],{},"\n承重(增加感統知覺)",[11,790,791,792,794,795,797,798,800],{},"還有一些小分類 簡單帶過一下",[15,793],{},"\n首先是僵直型 這個是比痙攣型張力還要再強",[15,796],{},"\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",[15,799],{},"\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",[11,802,803,804,806,807,809,810,812,813,815,816,818,819,821,822,826],{},"接著來講治療原則 主要有五點",[15,805],{},"\n早期教育(早療 黃金期)",[15,808],{},"\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)",[15,811],{},"\n治療項目盡量以ADL為主",[15,814],{},"\n日常活動(結合孩子一天的作息去制定訓練 回家訓練)",[15,817],{},"\n感官輸入(如本體感覺 觸覺)",[15,820],{},"\n老師有圈了個重點 ",[96,823,825],{"className":824},[99],"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)",[11,828,829,830,832,833,837,838,832,840,844,845,847,848,852],{},"最後來講預後",[15,831],{},"\n假如 ",[96,834,836],{"className":835},[100],"2歲前","的寶寶能自行坐起來 未來100%能夠自行走動",[15,839],{},[96,841,843],{"className":842},[100],"4歲的","寶寶還不會自行坐起來 未來不會走",[15,846],{},"\n假如 是",[96,849,851],{"className":850},[100],"偏癱","的寶寶 未來100%能夠自行走動",[11,854,855],{},[197,856],{"alt":199,"src":857},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774841979537-Screenshot_20260330_100529_Gallery.png",[11,859,860],{},[197,861],{"alt":199,"src":862},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774842001784-Screenshot_20260330_100531_Gallery.png",[11,864,865,866,868],{},"一些講義的內容 我隨後會在另一篇裡加上 ",[15,867],{},[96,869,871],{"className":870},[631],"讀英文！！！",{"title":246,"searchDepth":247,"depth":247,"links":873},[],"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":616,"description":875},{"loc":878},"blog\u002F腦性痲痺-CP",[883],"小兒PT","Oa9L6eaO1VoQayD-z7Id8c20dDInqUv2J9f4wkCkC9g",{"id":886,"title":312,"author":6,"body":887,"date":1052,"description":1053,"draft":251,"edited_at":1052,"extension":253,"featured_image":1054,"meta":1055,"navigation":256,"path":1056,"pinned":251,"seo":1057,"sitemap":1058,"stem":1059,"tags":261,"__hash__":1060},"blog\u002Fblog\u002FCP補充（一）.md",{"type":8,"value":888,"toc":1050},[889,892,895,923,925,931,954,959,1003,1006,1009,1045],[11,890,891],{},"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",[11,893,894],{},"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",[896,897,898,904,920],"ol",{},[52,899,900,901,903],{},"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",[15,902],{},"\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",[52,905,906,907,911,913,914,916,917,919],{},"產中——主要為",[96,908,910],{"className":909},[100,129],"胎兒中毒以及產時窒息",[15,912],{},"\n血液樣本顯示為代謝性酸中毒，pH\u003C7以及鹼剩餘>12mmol\u002FL",[15,915],{},"\n妊娠周數>34周，早期會出現中度或重度腦病變",[15,918],{},"\n低血糖，未經治療的黃疽，嚴重的新生兒感染亦會導致CP",[52,921,922],{},"產後——感染，外傷，腦膜炎，敗血症",[65,924],{},[11,926,927,928,930],{},"腦型麻痺類別——1（雖然總結有提到，但還是再寫一次好了）",[15,929],{},"\n分成了",[896,932,933],{},[52,934,935,936,938,939,941,942,944,945,947,948,950,951,953],{},"肢體受影響的分佈模式——",[15,937],{},"\n雙側痲痺(腳比手影響嚴重)",[15,940],{},"\n單側痲痺(單側受影響)",[15,943],{},"\n四肢痲痺（手比腳嚴重）",[15,946],{},"\n單肢痲痺",[15,949],{},"\n三肢痲痺",[15,952],{},"\n下肢痲痺",[11,955,956],{},[197,957],{"alt":199,"src":958},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776134449314-Screenshot_2026-04-14_104024.png",[896,960,961],{},[52,962,963,964,966,967,969,970,972,973,977,979,980,984,985,990,991,993,994,996,997,999,1000,1002],{},"根據張力與動作異常形態區分——",[15,965],{},"\n痙攣型——佔比七成，傷到錐狀束，上肢Flexor tone強+pronation，下肢Extenor tone強",[15,968],{},"\n徐動型——佔比一成五，傷到基底核，皮質無影響，所以智力正",[15,971],{},"\n僵直型——傷到皮質，比",[96,974,976],{"className":975},[100,99],"痙攣型張力還大",[15,978],{},"\n運動失調型——佔比一成三，傷到小腦，",[96,981,983],{"className":982},[100,99],"協調能力差","且尤其是",[96,986,989],{"className":987},[988],"yellow-3","下肢","特別明顯，步寬大，走路搖晃",[15,992],{},"\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",[15,995],{},"\n顫抖型——較徐動型有節奏，在遠端顫抖",[15,998],{},"\n混合型",[15,1001],{},"\n無法分類型",[11,1004,1005],{},"類別——2（P8）",[11,1007,1008],{},"他提到了按照ICF思路去想各個層級寶寶的問題",[896,1010,1011,1014,1022,1029,1037],{},[52,1012,1013],{},"首先是健康問題，受了甚麼傷",[52,1015,1016,1017],{},"其次是受限，這個傷會讓寶寶",[96,1018,1021],{"className":1019},[100,1020],"blue-3","做不了哪些動作",[52,1023,1024,1025],{},"再來是侷限，這些做不了的動作會讓寶寶",[96,1026,1028],{"className":1027},[100,99],"失去甚麼功能性",[52,1030,1031,1032,1036],{},"然後是環境因素，例如失去了這些功能性的話，與",[96,1033,1035],{"className":1034},[100,129],"環境的互動","有甚麼障礙",[52,1038,1039,1040,1044],{},"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",[96,1041,1043],{"className":1042},[100,988],"動機","等因素",[11,1046,1047],{},[197,1048],{"alt":199,"src":1049},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776135419925-Screenshot_2026-04-14_105040.png",{"title":246,"searchDepth":247,"depth":247,"links":1051},[],"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":312,"description":1053},{"loc":1056},"blog\u002FCP補充（一）","8cDECsO9Ab18dGecDdRUOUB4ETPPEAjd1AS3dqL2ii4",{"id":1062,"title":1063,"author":6,"body":1064,"date":1052,"description":1419,"draft":251,"edited_at":1052,"extension":253,"featured_image":1420,"meta":1421,"navigation":256,"path":1422,"pinned":251,"seo":1423,"sitemap":1424,"stem":1425,"tags":261,"__hash__":1426},"blog\u002Fblog\u002FCP—Rood-&-Bobath.md","CP—Rood & Bobath（一）",{"type":8,"value":1065,"toc":1417},[1066,1069,1072,1088,1106,1138,1141,1187,1189,1192,1267,1275,1357,1359,1362],[11,1067,1068],{},"(就先只寫余老師有在上課做註記的版書，讀不完啦)",[11,1070,1071],{},"1940前肌能教再育>1950年後神經成熟理論>1990年動態系統理論",[11,1073,1074,1075,1077,1078,1082,1083,1087],{},"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）",[15,1076],{},"\n手法有RIP(",[96,1079,1081],{"className":1080},[100,129],"異常reflex抑制",")，接著誘發動作(",[96,1084,1086],{"className":1085},[99,100],"翻正反應,平衡反應)","，再加一些本體覺和觸覺輸入",[11,1089,1090,1091,1093,1094,1096,1097,1101,1102],{},"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",[15,1092],{},"\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",[15,1095],{},"\n主要是",[96,1098,1100],{"className":1099},[100,99],"打破錯的感覺運動經驗","，",[96,1103,1105],{"className":1104},[100,988],"重新教寶寶正確的動作形態",[11,1107,1108,1109,1111,1112,1114,1115,1117,1118,1122,1123,1125,1126,1128,1129,1133,1134],{},"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",[15,1110],{},"\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",[15,1113],{},"\n那像是這裡提到的flexor tone過大，我們就幫他做extension",[15,1116],{},"\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",[96,1119,1121],{"className":1120},[988],"反方向","，誘發GTO關閉tone",[15,1124],{},"\n(著重在擺位)",[15,1127],{},"\n現在的RIP是改為",[96,1130,1132],{"className":1131},[129],"partial RIP","，只利用",[96,1135,1137],{"className":1136},[100,99],"Key point來達到抑制與誘發",[11,1139,1140],{},"那RIP的注意事項有如下",[49,1142,1143,1155,1167,1175,1178,1181],{},[52,1144,1145,1146,1150,1151],{},"RIP只做在",[96,1147,1149],{"className":1148},[100,99],"有痙攣","的地方，",[96,1152,1154],{"className":1153},[129],"hypotone則不需要做",[52,1156,1157,1158,1162,1163],{},"力度需",[96,1159,1161],{"className":1160},[988,100],"緩慢施加","，因為痙攣的部位容易",[96,1164,1166],{"className":1165},[99],"contracture",[52,1168,1169,1170,1174],{},"從近端開始做，並且做",[96,1171,1173],{"className":1172},[631,100],"旋轉以及Protraction(shoulder)是最容易打破張力","的手段",[52,1176,1177],{},"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",[52,1179,1180],{},"新的Bobath目的是做ADL動作",[52,1182,1183,1184,1186],{},"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",[15,1185],{},"\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",[65,1188],{},[11,1190,1191],{},"接下來講抑制Extensor的技巧，先來講第一個",[896,1193,1194,1197,1203,1227,1235,1256,1264],{},[52,1195,1196],{},"首先PT要坐在有靠背的椅子上保護好PT的背",[52,1198,1199,1200,1202],{},"將小孩的身體放在PT大腿上，腿面向PT，呈現total flexion姿勢",[15,1201],{},"\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",[52,1204,1205,1206,1208,1209,1213,1214,1218,1222,1223,131],{},"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",[15,1207],{},"\n可以在剛提到的姿勢下順便訓練旋轉，PT一手將",[96,1210,1212],{"className":1211},[100,99],"小孩的腳轉","到一側，另一手轉動寶寶的",[96,1215,1217],{"className":1216},[100,631],"身體",[96,1219,1221],{"className":1220},[100],"到對側","（",[96,1224,1226],{"className":1225},[631],"是身體，不是頭",[52,1228,1229,1230,1234],{},"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",[96,1231,1233],{"className":1232},[99,100],"肩胛骨內緣","後主推做protraction",[52,1236,1237,1238,1240,1241,1245,1246,1248,1249,1253,1255],{},"那小孩也因為extensor張力太大，可能沒有意識到有手的存在",[15,1239],{},"\n我們就得將他的手帶到胸前",[96,1242,1244],{"className":1243},[99,100],"進入視野範圍","，讓他開始吃或者自己的手",[15,1247],{},"\n而有些小孩會緊張會保持抓握姿勢，我們可以從",[96,1250,1252],{"className":1251},[100,99],"大拇指開始扳開慢慢張手打開",[15,1254],{},"\n讓他去做手碰手、手碰嘴、手碰腳、嘴碰嘴",[52,1257,1258,1259,1263],{},"而在抑制的過程中也可以做一些",[96,1260,1262],{"className":1261},[99,100],"誘發flexion動作","的手法，訓練屈肌，這樣也能降低extensor tone",[52,1265,1266],{},"習慣了以上姿勢後，就可以放寶寶在地上自己玩了",[11,1268,1269,1270,1274],{},"接著來講第二個，這個是",[96,1271,1273],{"className":1272},[631,100],"利用滾筒","的方式，結合了誘發動作的方式",[896,1276,1277,1304,1333],{},[52,1278,1279,1280,1284,1286,1287,1291,1293,1294,1298,1299,1303],{},"首先讓小孩在滾筒上side-lying，",[96,1281,1283],{"className":1282},[100,129],"手抬高將滾筒卡在腋下",[15,1285],{},"\n這時候PT要對小孩上方的髖做",[96,1288,1290],{"className":1289},[100,99],"Abd，extension和external rotation",[15,1292],{},"\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",[96,1295,1297],{"className":1296},[99,100],"extension","姿勢(",[96,1300,1302],{"className":1301},[100],"正常站立角度",")",[52,1305,1306,1307,1309,1310,1312,1313,1315,1316,1320,1324,1328,1329,131],{},"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",[15,1308],{},"\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",[15,1311],{},"\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",[15,1314],{},"\n而這時候會想要去訓練他的抬頭（雖然",[96,1317,1319],{"className":1318},[100,99],"抬頭是extension姿勢",[96,1321,1323],{"className":1322},[100],"但這個跟",[96,1325,1327],{"className":1326},[100,988],"extensor muscle tone不一樣","，還是得教導",[96,1330,1332],{"className":1331},[99],"正確方式",[52,1334,1335,1336,1338,1339,1341,1342,1344,1345,1349,1351,1352,1356],{},"剛剛講的是從side-lying到prone，現在講反過來的從prone到side-lying",[15,1337],{},"\n一手放在pelvis，一手固定shoulder，",[15,1340],{},"\n這次先將pelvis，翻回side-lying，然後慢慢協助將shoulder帶到side-lying",[15,1343],{},"\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",[96,1346,1348],{"className":1347},[100,99],"retraction",[15,1350],{},"\n對於CP小兒而言",[96,1353,1355],{"className":1354},[99,100],"誘發出extensor tone","，所以要先將pelvis帶走）",[65,1358],{},[11,1360,1361],{},"然後來介紹到抑制Flexor的技巧，核心是利用重力去抑制",[896,1363,1364,1384,1399,1414],{},[52,1365,1366,1367,1371,1372,1376,1378,1379,1383],{},"讓小孩supine在球上，這過程要",[96,1368,1370],{"className":1369},[99,100],"緩慢以及穩","，不要讓小孩感到害怕，假如",[96,1373,1375],{"className":1374},[631,100],"小孩恐懼就不要做這個",[15,1377],{},"\n因為flexor tone 高的小孩比較少動，所以",[96,1380,1382],{"className":1381},[100,99],"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",[52,1385,1386,1387,1391,1392,1396,1398],{},"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",[96,1388,1390],{"className":1389},[129,100],"逐漸放鬆","，同時也能",[96,1393,1395],{"className":1394},[100,99],"靠重力牽拉flexor肌肉",[15,1397],{},"\n再進階就遠端例如hip去做同樣的事",[52,1400,1401,1402,1404,1405,1409,1410],{},"進一步的做法是，抓住小孩的小肢，將球往小孩的頭側推",[15,1403],{},"\n這樣因為滾動的原因變成頭反而靠近地面，呈",[96,1406,1408],{"className":1407},[129,100],"頭靠近地面","，這樣也能讓",[96,1411,1413],{"className":1412},[99,100],"extensor tone上升",[52,1415,1416],{},"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":246,"searchDepth":247,"depth":247,"links":1418},[],"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":1063,"description":1419},{"loc":1422},"blog\u002FCP—Rood-&-Bobath","hbxSp87ZZts-QV-3eWuNwBK9q66v8uar73myHqp0-sQ",{"id":1428,"title":1429,"author":6,"body":1430,"date":1052,"description":1540,"draft":251,"edited_at":1541,"extension":253,"featured_image":1542,"meta":1543,"navigation":256,"path":1544,"pinned":251,"seo":1545,"sitemap":1546,"stem":1547,"tags":261,"__hash__":1548},"blog\u002Fblog\u002FCP—Rood-&-Bobath（二）.md","CP—Rood & Bobath（二）",{"type":8,"value":1431,"toc":1538},[1432,1435,1441,1446,1449],[11,1433,1434],{},"那剛剛一篇講的都Bobath的手法，那現在講Rood的",[11,1436,1437,1438,1440],{},"那Rood 提到說，人類有發展次序，mobility>stability>mobility on stability>skill movement",[15,1439],{},"\n也強調了可以利用感覺輸入誘發動作",[11,1442,1443],{},[197,1444],{"alt":199,"src":1445},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776217678571-Screenshot_2026-04-15_094736.png",[11,1447,1448],{},"那感覺刺激的部份根據強度及頻率而有這四種變化",[49,1450,1451,1457,1496,1502],{},[52,1452,1453,1454,1456],{},"快速且短暫的刺激",[15,1455],{},"\n可以用心智狀態提高，全身muscle tone 增高，反應力上升（喚醒）",[52,1458,1459,1460,1462,1463,1465,1466,1468,1470,1471,1475,1476,1478,1479,1481,1482,1486,1488,1492,1493,1495],{},"快速且重複的刺激",[15,1461],{},"\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",[15,1464],{},"\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",[15,1467],{},[15,1469],{},"\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",[96,1472,1474],{"className":1473},[99,100],"頸部開始訓練","(inversion在GA26~29就出現)",[15,1477],{},"\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",[15,1480],{},"\n治療師採坐姿，而且不是用手在帶動，是",[96,1483,1485],{"className":1484},[100,99],"利用治療師身體帶動",[15,1487],{},[96,1489,1491],{"className":1490},[631],"注意","：要給小孩安全感，inversion不能過久，保持頭部的正確位置",[15,1494],{},"\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",[52,1497,1498,1499,1501],{},"緩慢且規律重覆的刺激",[15,1500],{},"\n通常用來減敏",[52,1503,1504,1505,1507,1508,1510,1512,1513,1517,1518,1522,1523,1525,1527,1528,1532,1533,1537],{},"持續性的刺激",[15,1506],{},"\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",[15,1509],{},[15,1511],{},"\n對於",[96,1514,1516],{"className":1515},[100,99],"痙攣","的小孩，先從",[96,1519,1521],{"className":1520},[99,100],"不敏感的地方開始","，再往較敏感的位慢慢刺激，嘴巴也一樣",[15,1524],{},[15,1526],{},"\n但對於",[96,1529,1531],{"className":1530},[100,988],"低張","的小孩，則相反，從",[96,1534,1536],{"className":1535},[100,988],"最敏感的地方開始","刺激",{"title":246,"searchDepth":247,"depth":247,"links":1539},[],"Rood 到結尾","2026-04-15","\u002Fimages\u002Fuploads\u002F1776222460274-Ee4ldTMUcAEiPzF.webp",{},"\u002Fblog\u002FCP—Rood-&-Bobath（二）",{"title":1429,"description":1540},{"loc":1544},"blog\u002FCP—Rood-&-Bobath（二）","56_IFu2CIimvGKbXPweMAs8MdVF91nlzrjRw9LcNlb0",{"id":1550,"title":1551,"author":6,"body":1552,"date":2016,"description":2017,"draft":251,"edited_at":2018,"extension":253,"featured_image":2019,"meta":2020,"navigation":256,"path":2021,"pinned":251,"seo":2022,"sitemap":2023,"stem":2024,"tags":261,"__hash__":2025},"blog\u002Fblog\u002FMotor-Learning.md","Motor Learning小兒（一）",{"type":8,"value":1553,"toc":2014},[1554,1557,1566,1575,1593,1602,1611,1627,1636,1665,1740,1755,1758,1800,1806,1855,1901,1942,1945,1983,1998],[11,1555,1556],{},"那這一節課著重在動態模組理論，跟黃老師教的是互通的",[11,1558,1559,1560,1562,1563,1565],{},"那首先是講感覺統合的部份",[15,1561],{},"\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",[15,1564],{},"\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)",[11,1567,1568,1569,1571,1572,1574],{},"而接下來講到動作的發展",[15,1570],{},"\n那老師用的理論是動態模組理論",[15,1573],{},"\n假如還記得黃老師的Motor Control最後一課講的應該不難吃",[11,1576,1577,1578,1580,1581,1583,1584,1586,1587,1589,1590,1592],{},"不過我還是先列出來老師PPT裡的五個角度",[15,1579],{},"\n第一 動作技巧的顯現",[15,1582],{},"\n第二 動作型態的精準度",[15,1585],{},"\n第三 動作成果(可從評估表推估) ",[15,1588],{},"\n第四 組合技巧的獲得(次系統組合的結果)",[15,1591],{},"\n第五 對環境適應力的增強",[11,1594,1595,1596,1598,1599,1601],{},"我們現在來講平衡系統的發展",[15,1597],{},"\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",[15,1600],{},"\n以站立來形容的話",[11,1603,1604,1605,1607,1608,1610],{},"2)人類的重心(COM)基本會在S2 ",[15,1606],{},"\n那壓力中心(COP)是動態的 他會因應COM的改變而改變",[15,1609],{},"\n那底面積(BOS)就是兩隻腳踩在地面的距離",[11,1612,1613,1614,1618,1619,1621,1622,1626],{},"3)那平衡的演化 在早期 小孩會",[96,1615,1617],{"className":1616},[99,100],"極度依賴視角","來判斷",[15,1620],{},"\n但在成熟的過程中 我們會",[96,1623,1625],{"className":1624},[631],"越來越傾向用本體感覺","去判斷",[11,1628,1629,1630,1632,1633,1635],{},"4)穩定極限(LOS) 他把我們人類想象成一個倒立的三角錐",[15,1631],{},"\n在不移動的情況下身體能偏多少(前6度 側8度 後4度)",[15,1634],{},"\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)",[11,1637,1638,1639,1641,1642,1646,1647,1652,1653,1655,1656,1660,1661],{},"5)承受外力時的反應時 人類會有兩種變化",[15,1640],{},"\n第一種就是假如這",[96,1643,1645],{"className":1644},[100,129],"外力少到一定範圍"," 就只會用",[96,1648,1651],{"className":1649},[1650],"bg-green-3","姿勢穩定反應","來做調整",[15,1654],{},"\n另一種則是假如外力",[96,1657,1659],{"className":1658},[100,99],"超過姿勢穩定反應可以調整的程度"," 就會產生",[96,1662,1664],{"className":1663},[631],"保護性姿勢",[11,1666,1667,1668,1670,1671,1673,1674,1676,1677,1681,1683,1684,1688,1692,1694,1695,1697,1699,1700,1704,1705,1707,1708,1712,1713,1715,1716,1718,1720,1721,1723,1724,1726,1727,1731,1732,1734,1736,1737,1739],{},"6)",[15,1669],{},"\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",[15,1672],{},"\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",[15,1675],{},"\n那一般而言 越成熟的人 會越偏好用",[96,1678,1680],{"className":1679},[99],"踝策略",[15,1682],{},"\n而目前比較新的提出 就是",[96,1685,1687],{"className":1686},[988,100],"抓握",[96,1689,1691],{"className":1690},[988],"是一種不算策略(Strategy)的方法",[15,1693],{},"\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",[15,1696],{},[15,1698],{},"\nii) 而另一點則是改變BOS的 例子就有跨步策略 身體是",[96,1701,1703],{"className":1702},[99],"被迫做出","的 伸手出去支撐也是如此",[15,1706],{},"\n那在發展過程中 而在",[96,1709,1711],{"className":1710},[99],"方向性上也是有順序","的",[15,1714],{},"\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",[15,1717],{},[15,1719],{},"\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 ",[15,1722],{},"\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",[15,1725],{},"\n我們",[96,1728,1730],{"className":1729},[100],"可以通過適度的給他們外力","訓練他們",[15,1733],{},[15,1735],{},"\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",[15,1738],{},"\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",[11,1741,1742,1743,1745,1746,1748,1749,1751,1752,1754],{},"那對於小兒的發展議題，主要有這幾個",[15,1744],{},"\ni)——新形式的起源(The origin of new form)",[15,1747],{},"\nii)——連續性與非連續性(Continuity vs discontinuity)",[15,1750],{},"\niii)——變異性(Variability)",[15,1753],{},"\niv)——生物與環境的影響(Biological vs. environmental influence)",[11,1756,1757],{},"那動態模組理論是經歷過以下發展而來的",[896,1759,1760,1767,1787],{},[52,1761,1762,1763],{},"那首先是小兒痲痺(1910s)——當年的理念是哪邊無力練哪邊",[96,1764,1766],{"className":1765},[100,631],"(肌肉再教育 muscle re-education)",[52,1768,1769,1770,1774,1775,1777,1778,1780,1781,1783,1784,1786],{},"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",[96,1771,1773],{"className":1772},[631,100],"感覺輸入","促進正常的動作以及動作發展",[15,1776],{},"\n神經成熟理論(1945s)由Gesell和McGraw提出，他們的關鍵理念有如下",[15,1779],{},"\nCNS髓鞘化(Increased myelination of CNS)",[15,1782],{},"\n皮質抑制皮質下中心(Inhibition of the subcortical centers by the higher cerebral cortex)",[15,1785],{},"\n層級控制(Hierarchical control)",[52,1788,1789,1790,1794,1795,1799],{},"最後來講到階層理論的雛型(1980s)——當年他們覺得動作發展",[96,1791,1793],{"className":1792},[100],"不只單一的神經支配","，把",[96,1796,1798],{"className":1797},[100,99],"其他的系統、環境","一併整合進來",[11,1801,1802,1803,1805],{},"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",[15,1804],{},"\n那它有三個假設",[896,1807,1808,1819,1839],{},[52,1809,1810,1811,1813,1814,1818],{},"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",[15,1812],{},"\n但在1979s有學者提出說，其實原始反射對於每個寶寶來說",[96,1815,1817],{"className":1816},[99],"變異性","也很大",[52,1820,1821,1822,1824,1825,1829,1830,1834,1835],{},"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",[15,1823],{},"\n但在1976s有學者發現到，南非的寶寶被家長",[96,1826,1828],{"className":1827},[100],"直立抱法或者練習坐","，會比美國寶寶",[96,1831,1833],{"className":1832},[99],"更快發展出下肢動作","，但",[96,1836,1838],{"className":1837},[129],"爬和翻身較慢",[52,1840,1841,1842,1844,1845,1849,1850,1854],{},"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)",[15,1843],{},"\n但在1988s有學者提出，寶寶的",[96,1846,1848],{"className":1847},[129],"伸手以及操作","的發展在近端遠端上是",[96,1851,1853],{"className":1852},[100,99],"同時存在","的(同步進行發展，並沒有明確上下關係)",[11,1856,1857,1858,1860,1861,1865,1866,1870,1872,1873,1877,1878,1880,1881,1885,1886,1890,1891,1895,1897,1898,1900],{},"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",[15,1859],{},"\n那協調就是將這些複雜的東西，透過",[96,1862,1864],{"className":1863},[99],"降低自由度","，來",[96,1867,1869],{"className":1868},[129],"產生平滑的動作",[15,1871],{},"\n那降低自由度的策略會牽涉到一個叫",[96,1874,1876],{"className":1875},[631],"自我組織","的東西，那它的核心理念是說",[15,1879],{},"\n動作是有",[96,1882,1884],{"className":1883},[631],"適應性","的，次系統會根據",[96,1887,1889],{"className":1888},[100,99],"環境任務","等因素做調整，",[96,1892,1894],{"className":1893},[129],"再拼湊起來",[15,1896],{},"\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）",[15,1899],{},"\n有提到三個重點",[896,1902,1903,1909,1925],{},[52,1904,1905,1906,1908],{},"次序參數——它探討的是關節之間的協同",[15,1907],{},"\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",[52,1910,1911,1912,1916,1917,1919,1920,1924],{},"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",[96,1913,1915],{"className":1914},[100,631],"最省力、自然以及方便","的動作型態",[15,1918],{},"\n那假如這個動作達到了上述說的型態，便是",[96,1921,1923],{"className":1922},[99,100],"最穩定型態","，即使會因應任務去做改變也是十分穩定的",[52,1926,1927,1928,1930,1931,1935,1936,1938,1939,1941],{},"相移現象——意思就是說原本在做著一個穩定的動作型態",[15,1929],{},"\n因為一些",[96,1932,1934],{"className":1933},[99],"因素所干擾","，就會變成另一個動作型態",[15,1937],{},"\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)",[15,1940],{},"\n（對 黃老師教動態系統理論也提到過這個）",[11,1943,1944],{},"最後講兩個實驗",[896,1946,1947,1969],{},[52,1948,1949,1950,1952,1953,1955,1956,1960,1961,1965,1966,1968],{},"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",[15,1951],{},"\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",[15,1954],{},"\n但動態模組理論發現，其實是因為在第四周寶寶",[96,1957,1959],{"className":1958},[100,99],"長脂肪比長肌肉快","，導致",[96,1962,1964],{"className":1963},[129],"力量不足","做不出來",[15,1967],{},"\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",[52,1970,1971,1972,1974,1975,1977,1978,1982],{},"第二個實驗，是觀察青蛙生長的環境與發育的關係",[15,1973],{},"\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",[15,1976],{},"\n所以神經成熟是可以讓動作型態形成，但必須得加上",[96,1979,1981],{"className":1980},[100,99],"環境，時間以及個體本身條件","才能讓型態表現更好",[11,1984,1985,1986,1988,1989,1991,1992,1994,1995,1997],{},"那在臨床意義上有以下幾點",[15,1987],{},"\n分散式控制(Distributed control)",[15,1990],{},"\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)",[15,1993],{},"\n由兒童主導(Active role of the child)",[15,1996],{},"\n個體差異的訊息(variability provides important information)",[11,1999,2000,2001,2005,2006,2010,2011,2013],{},"評估",[96,2002,2004],{"className":2003},[100,1650],"不應只侷限在探討神經發展過程","，而是要根據",[96,2007,2009],{"className":2008},[631,100],"多個系統，家庭因素","等問題",[15,2012],{},"\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":246,"searchDepth":247,"depth":247,"links":2015},[],"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":1551,"description":2017},{"loc":2021},"blog\u002FMotor-Learning","EmOKsVRjY6Fz-rmd5PiPG83wEP6j59SCfF75Y1WnFNU",{"id":2027,"title":2028,"author":6,"body":2029,"date":2018,"description":2250,"draft":251,"edited_at":2251,"extension":253,"featured_image":2252,"meta":2253,"navigation":256,"path":2254,"pinned":251,"seo":2255,"sitemap":2256,"stem":2257,"tags":261,"__hash__":2258},"blog\u002Fblog\u002FMotor-Learning小兒（二）.md","Motor Learning小兒（二）",{"type":8,"value":2030,"toc":2248},[2031,2034,2040,2049,2052,2086,2089],[11,2032,2033],{},"阿對的，又要來講動作學習的定義了，雖然之前就有講過",[11,2035,2036,2037,2039],{},"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)",[15,2038],{},"\n動作學習就是過程，而動作表現是動作做出來的結果。",[11,2041,2042,2043,2045,2046,2048],{},"而這邊講道Positive和Negative Sign",[15,2044],{},"\nPositive是指正常人沒有，但病人身上會出現的異常動作 ",[15,2047],{},"\nNegative則相反，正常人有的，但病人身上無法出現",[11,2050,2051],{},"對於動作學習有三大要素",[896,2053,2054,2057,2066],{},[52,2055,2056],{},"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",[52,2058,2059,2060,2062,2063,2065],{},"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",[15,2061],{},"\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",[15,2064],{},"\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",[52,2067,2068,2069,2073,2074,2076,2077,2081,2082],{},"對於目標的清淅程度——就是",[96,2070,2072],{"className":2071},[129],"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",[15,2075],{},"\n而任務",[96,2078,2080],{"className":2079},[99],"越具體","，更能",[96,2083,2085],{"className":2084},[99,100],"引導寶寶產生興趣",[11,2087,2088],{},"那動作學習有以下三個考量點",[896,2090,2091,2141,2187],{},[52,2092,2093,2094,2098,2099,2103,2104,1303,2109,2111,2112,2114,2115,2119,2120,2122,2123,2127,2128,2132,2133,2135,2136,2140],{},"轉移——意思是",[96,2095,2097],{"className":2096},[100,129],"相同相似的技巧","在不同情景下可以變化",[96,2100,2102],{"className":2101},[99,100],"產生新的","動作型態 (這裡也有說到 ",[204,2105,2108],{"href":2106,"rel":2107},"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",[208],"在最後一段",[15,2110],{},"\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",[15,2113],{},"\n所以我們可以借由",[96,2116,2118],{"className":2117},[129],"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",[15,2121],{},"\n也可以透過",[96,2124,2126],{"className":2125},[100,99],"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",[96,2129,2131],{"className":2130},[100],"加粗","的方式讓寶寶更好握住",[15,2134],{},"\n但記得靠轉移來學習新的動作型態",[96,2137,2139],{"className":2138},[100,99],"不能一下子改太多太難","參數",[52,2142,2143,2144,1101,2149,131,2153,2155,2156,2160,2161,2163,2164,2168,2170,2171,2175,2176,2178,2179,2183,2184,2186],{},"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（",[204,2145,2148],{"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%E4%B8%83%EF%BC%89%E7%B7%B4%E7%BF%92%E6%96%B9%E5%BC%8F-1?series=Motor%20learning",[208],"一",[204,2150,2152],{"href":2106,"rel":2151},[208],"二",[15,2154],{},"\n集中VS分散，分散休息時間更長，對",[96,2157,2159],{"className":2158},[100],"學習較難或易疲勞病人","來說更佳",[15,2162],{},"\n段落VS隨機，隨機較難，但通常對",[96,2165,2167],{"className":2166},[129,100],"形成長期記憶以記轉移效果更有",[15,2169],{},"\n固定VS變異，變異在",[96,2172,2174],{"className":2173},[99,100],"轉移效果上","更佳",[15,2177],{},"\n全部VS分段，分段有",[96,2180,2182],{"className":2181},[100,99],"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",[15,2185],{},"\n心像練習，在腦中模擬動作型態",[52,2188,2189,2190,1101,2194,1101,2198,1101,2203,1303,2208,2210,2211,2213,2214,2216,2217,131,2221,2223,2224,2228,2229,2231,2232,2236,2237,2239,2240,2242,2243,2247],{},"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(",[204,2191,2148],{"href":2192,"rel":2193},"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",[208],[204,2195,2152],{"href":2196,"rel":2197},"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",[208],[204,2199,2202],{"href":2200,"rel":2201},"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",[208],"三",[204,2204,2207],{"href":2205,"rel":2206},"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",[208],"四",[15,2209],{},"\nKR與KP，KR效度比KP更佳",[15,2212],{},"\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",[15,2215],{},"\n（",[204,2218,2220],{"href":2205,"rel":2219},[208],"這裡第一段有提到",[15,2222],{},"\n回饋的方法，",[204,2225,2227],{"href":2196,"rel":2226},[208],"這一篇的後半段","有提到，可以再複習一下",[15,2230],{},"\n先設定一個",[96,2233,2235],{"className":2234},[129],"區間","，達到的都算得分",[15,2238],{},"\n回饋也可以做遞減，逐漸減少依賴",[15,2241],{},"\n假如病人",[96,2244,2246],{"className":2245},[99,100],"主動要求回饋","，我們再給予，也會更佳",{"title":246,"searchDepth":247,"depth":247,"links":2249},[],"Motor Learning定義~結束","2026-04-13","\u002Fimages\u002Fuploads\u002F1775875520542-37128694_p0_master1200.jpg",{},"\u002Fblog\u002FMotor-Learning小兒（二）",{"title":2028,"description":2250},{"loc":2254},"blog\u002FMotor-Learning小兒（二）","vCmIeebtfGfHQk7UoNr_yn1XC2gwpWX_B8fsdXmUsJc",{"id":2260,"title":2261,"author":6,"body":2262,"date":2461,"description":2462,"draft":251,"edited_at":2461,"extension":253,"featured_image":2463,"meta":2464,"navigation":256,"path":2465,"pinned":251,"seo":2466,"sitemap":2467,"stem":2468,"tags":261,"__hash__":2469},"blog\u002Fblog\u002FGait-analysis小兒（一）.md","Gait analysis小兒（一）",{"type":8,"value":2263,"toc":2459},[2264,2267,2270,2287,2290,2301,2304,2321,2347,2353,2356,2373,2382,2393,2408,2414,2442,2445],[11,2265,2266],{},"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",[11,2268,2269],{},"那下肢雙關節肌肉有以下",[896,2271,2272,2275,2278,2281,2284],{},[52,2273,2274],{},"腰大肌——Hip Flexion, Trunk Flexion",[52,2276,2277],{},"腿後肌——Hip Extension, Knee Flexion",[52,2279,2280],{},"股直肌——Hip Flexion, Knee Extension",[52,2282,2283],{},"腓腸肌——Knee Flexion, PF",[52,2285,2286],{},"縫匠肌——Hip Flexion, Hip ER",[11,2288,2289],{},"那單關節的肌肉有",[896,2291,2292,2295,2298],{},[52,2293,2294],{},"臀大肌——Hip Extension, Hip ER",[52,2296,2297],{},"脛前肌——DF, inversion",[52,2299,2300],{},"腓骨長肌——PF, eversion",[11,2302,2303],{},"那以下動作的抗重力與無抗重力的擺位姿勢為",[896,2305,2306,2309,2312,2315,2318],{},[52,2307,2308],{},"Hip Extension——Prone 抗重力, side-lying 無抗重力",[52,2310,2311],{},"Hip Flexion——Sitting 抗重力, side-lying 無抗重力",[52,2313,2314],{},"Hip Abduction——Side-lying 抗重力, supine 無抗重力",[52,2316,2317],{},"Knee Extension——Sitting 抗重力, side-lying 無抗重力",[52,2319,2320],{},"PF——Standing 抗重力, prone 無抗重力",[11,2322,2323,2324,2326,2327,2331,2332,2336,2338,2339,2341,2342,2346],{},"接下來講一個異常步態——Crouch gait",[15,2325],{},"\n為甚麼他會呈現屈曲狀態，主要是因為",[96,2328,2330],{"className":2329},[100,99],"雙關節肌肉張力過強","，而",[96,2333,2335],{"className":2334},[100,129],"單關節肌肉力量不足",[15,2337],{},"\n不是單純的肌肉太緊，也是一種肌力失衡的表現",[15,2340],{},"\n其中，在",[96,2343,2345],{"className":2344},[100],"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)",[11,2348,2349,2350,2352],{},"接著來講步態的參數",[15,2351],{},"\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)",[11,2354,2355],{},"這邊提到一個中風後會出現的代償步態",[49,2357,2358,2361,2364,2367,2370],{},[52,2359,2360],{},"步速下降",[52,2362,2363],{},"步距縮短或不對稱",[52,2365,2366],{},"步寬變大(BOS增加)",[52,2368,2369],{},"雙腳站立期變長",[52,2371,2372],{},"依賴手部支撐",[11,2374,2375,2376,2378,2379,2381],{},"接著講Gait cycle，分別為站立期以及擺盪期",[15,2377],{},"\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",[15,2380],{},"\n完成這三個任務又分成了這八個動作",[896,2383,2384,2387,2390],{},[52,2385,2386],{},"承重——Initial contact和Loading Response",[52,2388,2389],{},"單腳支撐——Mid-stance, Terminal Stance和Pre-swing",[52,2391,2392],{},"肢體向前——Pre-swing, Initial swing, Mid-swing和Terminal Swing",[11,2394,2395,2396,2400,2401,2403,2404],{},"而Pre-swing雖然腳尖還沒離地，但",[96,2397,2399],{"className":2398},[100,129],"重心其實已經轉移去另一隻腳","了",[15,2402],{},"\n其中 ",[96,2405,2407],{"className":2406},[100],"Initial contact和Pre-swing為雙腳承重期",[11,2409,2410,2411,2413],{},"我們現在攤開來看站立期和擺盪期下肢各關節變化",[15,2412],{},"\n首先是站立期",[896,2415,2416,2424,2427,2433,2439],{},[52,2417,2418,2419,2423],{},"在雙腳承重期，",[96,2420,2422],{"className":2421},[100,129],"足部會放平","，準備Push Off",[52,2425,2426],{},"Hip的話，在Initical Contact的Flexion到Terminal Stance的Hyperextension",[52,2428,2429,2430,2432],{},"Knee的話，會從Flexion姿勢，到Mid-stance的Extension，再變回Pre-swing的Flexion",[15,2431],{},"\n(Flexion>Extension>Flexion)",[52,2434,2435,2436,2438],{},"Ankle的話，在Initical Contact的Neutral姿勢，Loading Response的PF，",[15,2437],{},"\nMid-stance的DF，最後是Terminal Stance\u002FPre-swing的PF（Neutral>PF>DF>PF）",[52,2440,2441],{},"Pelvis的話，基本保持水平，但在Terminal stance會略微前傾",[11,2443,2444],{},"然後是擺盪期",[896,2446,2447,2450,2453,2456],{},[52,2448,2449],{},"Knee的話，在Initical swing時會呈現Flexion，在Terminal swing會Full-extension",[52,2451,2452],{},"Hip的話，從Initical swing的Hyperextension，在Terminal swing會變成Flexion",[52,2454,2455],{},"Ankle的話，保持DF狀態，使腳尖不會碰到地板",[52,2457,2458],{},"Pelvis的話，會Rotation",{"title":246,"searchDepth":247,"depth":247,"links":2460},[],"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":2261,"description":2462},{"loc":2465},"blog\u002FGait-analysis小兒（一）","twQeon3uGQlDYDjG3t_oGlDC93CraJNGOOTRTTxdazk",{"id":2471,"title":2472,"author":6,"body":2473,"date":2461,"description":2661,"draft":251,"edited_at":2461,"extension":253,"featured_image":2662,"meta":2663,"navigation":256,"path":2664,"pinned":251,"seo":2665,"sitemap":2666,"stem":2667,"tags":261,"__hash__":2668},"blog\u002Fblog\u002FGait-analysis小兒（二）.md","Gait analysis小兒（二）",{"type":8,"value":2474,"toc":2659},[2475,2478,2592,2595,2630,2642,2648],[11,2476,2477],{},"現在我們將八個步態分期拆開了細看",[896,2479,2480,2504,2518,2536,2546,2567,2586,2589],{},[52,2481,2482,2483,2487,2491,2492,2496,2500,2501,2503],{},"Initical Contact——用",[96,2484,2486],{"className":2485},[100],"股四頭肌和脛前肌做",[96,2488,2490],{"className":2489},[100,99],"離心收縮","，這時",[96,2493,2495],{"className":2494},[100],"腿後肌做",[96,2497,2499],{"className":2498},[100,129],"向心收縮","協同加速穩定",[15,2502],{},"\n（減速與準備承重）",[52,2505,2506,2507,2511,2514,2515,2517],{},"Loading Response——",[96,2508,2510],{"className":2509},[100],"肌內側肌與脛前肌做",[96,2512,2490],{"className":2513},[100,99],"，而臀大肌以及腿後肌輔助Hip加速，將重心向前移動",[15,2516],{},"\n（避震）",[52,2519,2520,2521,2331,2525,2529,2532,2533,2535],{},"Mid-stance——膝蓋後方有關節囊結構的緣故，肌四頭肌幾乎",[96,2522,2524],{"className":2523},[129],"不需用力",[96,2526,2528],{"className":2527},[100],"比目魚肌此時做",[96,2530,2490],{"className":2531},[100,99],"控制脛骨速度",[15,2534],{},"\n（省力）",[52,2537,2538,2539,2543,2545],{},"Terminal stance——",[96,2540,2542],{"className":2541},[100,129],"腓腸肌與比目魚肌做向心收縮",[15,2544],{},"\n（產生推進力）",[52,2547,2548,2549,2553,1101,2556,2558,2559,2563],{},"Pre-swing——假如是慢速走路，會利用",[96,2550,2552],{"className":2551},[100],"縫匠肌(Sartorius)和肌薄肌(Graillis)做",[96,2554,2499],{"className":2555},[100,129],[15,2557],{},"\n快速行走則靠",[96,2560,2562],{"className":2561},[100],"肌直肌做",[96,2564,2566],{"className":2565},[100,988],"等長收縮",[52,2568,2569,2570,2574,2577,2579,2580,2583],{},"Initial swing——在慢速走路中，",[96,2571,2573],{"className":2572},[100],"股薄肌與縫匠肌會進行",[96,2575,2499],{"className":2576},[100,129],[15,2578],{},"\n而快速走路中，",[96,2581,2562],{"className":2582},[100],[96,2584,2566],{"className":2585},[100,988],[52,2587,2588],{},"Mid swing——靠慣性推進，基本沒有肌肉參與",[52,2590,2591],{},"Terminal swing——腿後肌做等長收縮，限制Knee extension速度",[11,2593,2594],{},"接著來講小腿後肌群無力的話會有甚麼問題",[49,2596,2597,2607],{},[52,2598,2599,2600,1101,2604,2606],{},"Mid-stannce——比目魚肌無力的話，會讓",[96,2601,2603],{"className":2602},[99,100],"Ankle做DF",[15,2605],{},"\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",[52,2608,2609,2610,2614,2616,2617,2621,2622,1960,2626],{},"Terminal stance和Pre-swing——腓腸肌力量不足的話，",[96,2611,2613],{"className":2612},[100,99],"沒辦法產生足夠的推進力",[15,2615],{},"\n只好讓",[96,2618,2620],{"className":2619},[99,100],"髖屈肌收縮","提起整段下肢，確保",[96,2623,2625],{"className":2624},[129],"腳尖離地",[96,2627,2629],{"className":2628},[631],"步距變短",[11,2631,2632,2633,2635,2636,2638,2639,2641],{},"最後講小孩的步態發展過程",[15,2634],{},"\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",[15,2637],{},"\n2歲的小孩懂得矢狀面(Sagittal-plane)關節旋轉",[15,2640],{},"\n7歲的小孩步態已經能達到成人標準了",[11,2643,2644,2645,2647],{},"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",[15,2646],{},"\n那CP小孩預測能力方面也分成了三個時段",[896,2649,2650,2653,2656],{},[52,2651,2652],{},"9~18個月——頭部控制能力",[52,2654,2655],{},"24個月——不需要支撐能獨自坐穩",[52,2657,2658],{},"30個月——做爬行",{"title":246,"searchDepth":247,"depth":247,"links":2660},[],"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":2472,"description":2661},{"loc":2664},"blog\u002FGait-analysis小兒（二）","x7y-Smp4poLa_EJUkNUpEi-ow03rff_xJb4B-xlHN1k",{"id":2670,"title":319,"author":6,"body":2671,"date":2461,"description":2815,"draft":251,"edited_at":2816,"extension":253,"featured_image":2817,"meta":2818,"navigation":256,"path":2819,"pinned":251,"seo":2820,"sitemap":2821,"stem":2822,"tags":261,"__hash__":2823},"blog\u002Fblog\u002F小兒發展（一）.md",{"type":8,"value":2672,"toc":2813},[2673,2676,2691,2697,2700,2726,2735,2737,2740,2757,2759,2762],[11,2674,2675],{},"（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）",[11,2677,2678,2679,2681,2682,2684,2685,2687,2688,2690],{},"那先來講發展遲緩的定義，它不單指運動層面上，還包括了",[15,2680],{},"\n知覺，語言，心理，社會，情緒等層面",[15,2683],{},"\n而這個動作遲緩有標準的",[15,2686],{},"\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",[15,2689],{},"\n根據WHO的數據，發生率為6~8%",[11,2692,2693,2694,2696],{},"那高危族群有以下",[15,2695],{},"\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",[11,2698,2699],{},"接下來講寶寶的正常發育過程，先從視角說起，如下",[896,2701,2702,2705,2708,2711,2714,2717,2720,2723],{},[52,2703,2704],{},"剛出生數天——眨眼反射",[52,2706,2707],{},"六周——注射物體",[52,2709,2710],{},"二到三個月——對明亮的東西感興趣",[52,2712,2713],{},"四個月——協調眼球轉動",[52,2715,2716],{},"一歲——影像認知發展完成，能看清輪廓",[52,2718,2719],{},"三歲——能分辨紅黃藍綠",[52,2721,2722],{},"五到六歲——可以分辨大多數顏色",[52,2724,2725],{},"八歲以前——有遠視現象（我問了Gemini也看不太懂就是了）",[11,2727,2728,2729,2731,2732,2734],{},"那關於視覺發展異常的問題包括了",[15,2730],{},"\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",[15,2733],{},"\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",[65,2736],{},[11,2738,2739],{},"接著是聽覺發展，如下",[896,2741,2742,2745,2748,2751,2754],{},[52,2743,2744],{},"四個月——追尋聲音或說話來源",[52,2746,2747],{},"七到八個月——被叫名字有反應",[52,2749,2750],{},"十個月——仿說（無意義內容）",[52,2752,2753],{},"一到一歲半——初步聽懂簡單的話",[52,2755,2756],{},"兩歲以後——鸚鵡式學說話",[65,2758],{},[11,2760,2761],{},"接下來是粗大動作的發展，如下",[896,2763,2764,2767,2770,2773,2776,2779,2782,2785,2788,2796,2804,2807,2810],{},[52,2765,2766],{},"兩個月——不穩定的抬頭控制",[52,2768,2769],{},"四個月——抬頭控制適當",[52,2771,2772],{},"五個月——翻身（先學會Prone to supine, 接著是supine to prone）",[52,2774,2775],{},"七個月——坐起來",[52,2777,2778],{},"八個月——爬行",[52,2780,2781],{},"九個月——需要支撐的站起來",[52,2783,2784],{},"十個月——僅需要極小輔助的從坐到站",[52,2786,2787],{},"一歲——獨立行走",[52,2789,2790,2791,2795],{},"兩歲——跑，",[96,2792,2794],{"className":2793},[129],"上樓梯","，踢球，投球，蹲下來",[52,2797,2798,2799,2803],{},"三歲——",[96,2800,2802],{"className":2801},[99],"下樓梯","，雙腳跳，騎三輪車",[52,2805,2806],{},"四歲——單腳跳",[52,2808,2809],{},"五歲——走直線",[52,2811,2812],{},"六歲——騎腳踏車",{"title":246,"searchDepth":247,"depth":247,"links":2814},[],"定義~粗大動作發展","2026-04-12","\u002Fimages\u002Fuploads\u002F1775957410970-EebbBUPUcAYSTE9.webp",{},"\u002Fblog\u002F小兒發展（一）",{"title":319,"description":2815},{"loc":2819},"blog\u002F小兒發展（一）","PRBPkkWsOaM11PriYRM9bPFgTo_bGZSIOZZuLMzA1sk",{"id":2825,"title":320,"author":6,"body":2826,"date":2816,"description":2978,"draft":251,"edited_at":2816,"extension":253,"featured_image":2979,"meta":2980,"navigation":256,"path":2981,"pinned":251,"seo":2982,"sitemap":2983,"stem":2984,"tags":261,"__hash__":2985},"blog\u002Fblog\u002F小兒發展（二）.md",{"type":8,"value":2827,"toc":2976},[2828,2831,2848,2850,2853,2881,2883,2886,2912,2914,2917,2931,2933,2936,2950,2952,2955,2963,2965,2968],[11,2829,2830],{},"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",[896,2832,2833,2836,2839,2842,2845],{},[52,2834,2835],{},"新生兒——中度的膝內翻（O型腿）",[52,2837,2838],{},"六個月——輕度的O型腿",[52,2840,2841],{},"一歲半——直的",[52,2843,2844],{},"三歲半——輕度的膝外翻（X型腿）",[52,2846,2847],{},"五到七歲——直的",[65,2849],{},[11,2851,2852],{},"而步態的發展會按照以下時期發展",[896,2854,2855,2858,2866,2869,2872,2875,2878],{},[52,2856,2857],{},"反射踏步（靠反射）",[52,2859,2860,2861,131],{},"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—— ",[204,2862,2865],{"href":2863,"rel":2864},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002Fmotor-learning?series=%E5%B0%8F%E5%85%92%E7%89%A9%E6%B2%BB",[208],"倒數第二段",[52,2867,2868],{},"過渡期",[52,2870,2871],{},"刻意跨步",[52,2873,2874],{},"獨立行走",[52,2876,2877],{},"Heell-toe步態",[52,2879,2880],{},"整合或直立行走成熟期",[65,2882],{},[11,2884,2885],{},"接著來看不同系統的發展進程，從出生至九個月",[49,2887,2888,2894,2900,2906],{},[52,2889,2890,2891,2893],{},"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）",[15,2892],{},"\n尤其是視覺發展遠大於粗大動作",[52,2895,2896,2897,2899],{},"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",[15,2898],{},"\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",[52,2901,2902,2903,2905],{},"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)",[15,2904],{},"\nHip abduction(訓練方法是扶物側行)",[52,2907,2908,2909,2911],{},"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",[15,2910],{},"\n步寬外展；外轉(O型腿)；髖屈曲；足跟外翻",[65,2913],{},[11,2915,2916],{},"時間來到了九個月到第十五個月之間的發展進程",[896,2918,2919,2922,2925],{},[52,2920,2921],{},"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)",[52,2923,2924],{},"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",[52,2926,2927,2928,2930],{},"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",[15,2929],{},"\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",[65,2932],{},[11,2934,2935],{},"接下來時間來到了十八個月到二十四個月的發展進程",[896,2937,2938,2944],{},[52,2939,2940,2941,2943],{},"力學因素——重心下降(由於腿快速生長)，BOS減少",[15,2942],{},"\nROM的話O型腿消失，但有旋前足出現",[52,2945,2946,2947,2949],{},"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；",[15,2948],{},"\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)",[65,2951],{},[11,2953,2954],{},"時間繼續來到了三歲到三歲半的發展進程",[896,2956,2957,2960],{},[52,2958,2959],{},"力學因素——ROM的話膝外翻(X型腿)，且有旋前足出現",[52,2961,2962],{},"功能性步態——足跟著地穩定，且出現Knee flexion",[65,2964],{},[11,2966,2967],{},"最後時間來到了六歲到七歲的發展進程",[896,2969,2970,2973],{},[52,2971,2972],{},"力學因素——已經能直立行走，並且不在有旋前足",[52,2974,2975],{},"功能性步態——與成人一樣",{"title":246,"searchDepth":247,"depth":247,"links":2977},[],"步態~步態發展","\u002Fimages\u002Fuploads\u002F1775979234822-139196433_p0_master1200.webp",{},"\u002Fblog\u002F小兒發展（二）",{"title":320,"description":2978},{"loc":2981},"blog\u002F小兒發展（二）","tgAyAngzwVGZGqD2GsTT7J1O1RchC3cKRE-f381-bqo",{"id":2987,"title":321,"author":6,"body":2988,"date":2816,"description":3212,"draft":251,"edited_at":2251,"extension":253,"featured_image":3213,"meta":3214,"navigation":256,"path":3215,"pinned":251,"seo":3216,"sitemap":3217,"stem":3218,"tags":261,"__hash__":3219},"blog\u002Fblog\u002F小兒發展（三）.md",{"type":8,"value":2989,"toc":3210},[2990,2993,2996,3025,3027,3030,3047,3049,3052,3078,3080,3083,3116,3122,3141,3147,3173,3176,3179,3202,3205],[11,2991,2992],{},"寫著寫著發現這一課東西好多（悲",[11,2994,2995],{},"接著講精細動作的發展過程",[896,2997,2998,3001,3004,3007,3010,3013,3016,3019,3022],{},[52,2999,3000],{},"四個月——可以合掌",[52,3002,3003],{},"五個月——手可以向前伸並抓東西",[52,3005,3006],{},"七個月——握緊奶瓶",[52,3008,3009],{},"十個月——拍手",[52,3011,3012],{},"一歲——亂塗鴉",[52,3014,3015],{},"一歲半——疊兩到四個積木",[52,3017,3018],{},"兩歲——疊四到八個積木；畫直線",[52,3020,3021],{},"三歲——畫圓圈",[52,3023,3024],{},"五歲——畫出人形",[65,3026],{},[11,3028,3029],{},"假如有發展遲緩的問題，會有以下徵候",[49,3031,3032,3035,3038,3041,3044],{},[52,3033,3034],{},"以翻身作為移動方式",[52,3036,3037],{},"手腳不協調的爬行方式",[52,3039,3040],{},"W坐姿",[52,3042,3043],{},"兔子跳",[52,3045,3046],{},"一歲前出現明顯慣用手(因為一歲前大多為雙手並用)",[65,3048],{},[11,3050,3051],{},"而寶寶出現以下徵候，可能他有CP問題",[49,3053,3054,3057,3060,3063,3066,3069,3072,3075],{},[52,3055,3056],{},"躁動",[52,3058,3059],{},"缺乏精力",[52,3061,3062],{},"吸吮無力伴隨舌頭往前突",[52,3064,3065],{},"六個月大頭部控制不佳",[52,3067,3068],{},"口腔過度敏感",[52,3070,3071],{},"強直性咬合反射",[52,3073,3074],{},"不對稱動作形態",[52,3076,3077],{},"異常姿勢",[65,3079],{},[11,3081,3082],{},"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",[11,3084,3085,3086,3088,3089,3093,3094,3098,3100,3101,3105,3106,3110,3111,3115],{},"首先是語言準備期，分成了表達跟理解兩個面向",[15,3087],{},"\n這時候寶寶還小，表達還只能靠",[96,3090,3092],{"className":3091},[100],"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",[96,3095,3097],{"className":3096},[100],"學身邊的人咿咿呀呀",[15,3099],{},"\n而這個時候",[96,3102,3104],{"className":3103},[100,129],"理解能力比表達能力還要發展得快","，知覺部份開始分得出",[96,3107,3109],{"className":3108},[129],"語氣快慢聲源","等，也能",[96,3112,3114],{"className":3113},[129],"理解一些簡單的短語","例如yes or no等",[11,3117,3118,3119,3121],{},"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",[15,3120],{},"\n而語法構造則分為以下部份",[49,3123,3124,3132],{},[52,3125,3126,3127,3131],{},"句子表達能力——分成剛開始學的不完整句子，",[96,3128,3130],{"className":3129},[100,129],"只講關鍵的詞","；和發展到後面的會講完整句子",[52,3133,3134,3135,3137,3138,3140],{},"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",[15,3136],{},"\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",[15,3139],{},"\n最後也能理解對哪個人說甚麼樣的話",[11,3142,3143,3144,3146],{},"然後講一下正常語言發展能力，雖然跟聽覺有部份重合，",[15,3145],{},"\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(?)",[896,3148,3149,3152,3155,3158,3161,3164,3167,3170],{},[52,3150,3151],{},"四個月——頭尋找聲源",[52,3153,3154],{},"六到七個月——仿說",[52,3156,3157],{},"九到十二個月——叫爸爸媽媽",[52,3159,3160],{},"一歲到一歲半——只會講一兩個字且沒有意義",[52,3162,3163],{},"兩歲到兩歲半——講片語（例如像鸚鵡般學大人說啥）",[52,3165,3166],{},"三歲——開始能講句子，講顏色，倒數十，說出身體部位",[52,3168,3169],{},"四歲——能說出數種顏色",[52,3171,3172],{},"五歲——計算五個積木",[11,3174,3175],{},"(所以看起來三歲已經具備認知能力?)",[11,3177,3178],{},"那假如語言發展異常會有以下徵象",[49,3180,3181,3184,3187,3190,3193,3196,3199],{},[52,3182,3183],{},"一歲前——太安靜",[52,3185,3186],{},"兩歲——還沒有出現有意思的字詞",[52,3188,3189],{},"三歲——沒有出現任何句子",[52,3191,3192],{},"四歲——有構音困難",[52,3194,3195],{},"五歲——說話結巴",[52,3197,3198],{},"年紀越大話越少",[52,3200,3201],{},"鼻音重，說話小聲，不當的臉部表情，說話會喘",[11,3203,3204],{},"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",[11,3206,3207],{},[197,3208],{"alt":199,"src":3209},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776047406679-Screenshot_2026-04-13_102943.png",{"title":246,"searchDepth":247,"depth":247,"links":3211},[],"精細動作~語言發展","\u002Fimages\u002Fuploads\u002F1776047258825-ElqW51yVoAI09Jg.webp",{},"\u002Fblog\u002F小兒發展（三）",{"title":321,"description":3212},{"loc":3215},"blog\u002F小兒發展（三）","cGrD26dwyUjVzawlHZHH_OnTqXRpbSPGvcZEZluSbRk",{"id":3221,"title":322,"author":6,"body":3222,"date":2251,"description":3365,"draft":251,"edited_at":2251,"extension":253,"featured_image":3366,"meta":3367,"navigation":256,"path":3368,"pinned":251,"seo":3369,"sitemap":3370,"stem":3371,"tags":261,"__hash__":3372},"blog\u002Fblog\u002F小兒發展（四）.md",{"type":8,"value":3223,"toc":3363},[3224,3227,3250,3252,3255,3281,3283,3286,3306,3308,3311,3325,3327,3330,3344,3346,3349],[11,3225,3226],{},"接下來講到括約肌控制發展（大小便控制）",[896,3228,3229,3232,3241,3247],{},[52,3230,3231],{},"十五個月——能告訴爸媽想上廁所或者褲子濕了",[52,3233,3234,3235,3237,3238,3240],{},"十八個月——白天褲子不太會濕，當然也有意外；",[15,3236],{},"\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；",[15,3239],{},"\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",[52,3242,3243,3244,3246],{},"兩到三歲——半夜讓小孩上廁所就整晚不會尿床",[15,3245],{},"\n有研究表明，晚上會叫尿床的都比較神經質(講義原句XD)",[52,3248,3249],{},"三歲——能自己上廁所但擦不乾淨，要到六歲才能擦乾淨",[65,3251],{},[11,3253,3254],{},"接著講ADL的發展",[896,3256,3257,3260,3263,3269,3272,3275,3278],{},[52,3258,3259],{},"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",[52,3261,3262],{},"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",[52,3264,3265,3266,3268],{},"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；",[15,3267],{},"\n也開始可以脫襪子和鞋子",[52,3270,3271],{},"十八個月——會脫襪子鞋子，將拉鏈拉開，不需要轉動湯匙進食",[52,3273,3274],{},"兩歲——可以穿脫襪子鞋子褲子",[52,3276,3277],{},"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",[52,3279,3280],{},"五歲——會綁鞋子",[65,3282],{},[11,3284,3285],{},"社會性情緒發展部份",[896,3287,3288,3291,3297,3300,3303],{},[52,3289,3290],{},"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",[52,3292,3293,3294,3296],{},"六到十二個月——十分依賴，認得且會得媽媽",[15,3295],{},"\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",[52,3298,3299],{},"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",[52,3301,3302],{},"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",[52,3304,3305],{},"二十四到三十六個月——越來越適應陌生環境，上托兒所",[65,3307],{},[11,3309,3310],{},"自我概念發展部份",[896,3312,3313,3316,3319,3322],{},[52,3314,3315],{},"剛出生到六個月——動作控制不佳；稍微分得出自我跟非自我",[52,3317,3318],{},"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",[52,3320,3321],{},"十八到二十四個月——對自己名字敏感",[52,3323,3324],{},"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",[65,3326],{},[11,3328,3329],{},"情緒發展部份",[896,3331,3332,3335,3338,3341],{},[52,3333,3334],{},"剛出生到六個月——早期只有哭跟高興表情",[52,3336,3337],{},"六到十二個月——開始有其他情緒例如厭惡，害怕，憤怒",[52,3339,3340],{},"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",[52,3342,3343],{},"十八到二十四個月——能夠用語言表達情緒",[65,3345],{},[11,3347,3348],{},"依賴及獨立發展",[896,3350,3351,3354,3357],{},[52,3352,3353],{},"剛出生到十二個月——完全依賴照顧",[52,3355,3356],{},"十二到十八個月——知道自己是個體後，想自我尋求",[52,3358,3359,3360,3362],{},"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；",[15,3361],{},"\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":246,"searchDepth":247,"depth":247,"links":3364},[],"括約肌控制~依賴獨立發展","\u002Fimages\u002Fuploads\u002F1776052282656-EXjYORHUcAALULe.webp",{},"\u002Fblog\u002F小兒發展（四）",{"title":322,"description":3365},{"loc":3368},"blog\u002F小兒發展（四）","iCO6Xr2Vz0v9l6ulRBKlWBt93Dzu8k8I4HDGsX-Dbpc",{"id":3374,"title":323,"author":6,"body":3375,"date":1052,"description":3515,"draft":251,"edited_at":1052,"extension":253,"featured_image":3516,"meta":3517,"navigation":256,"path":3518,"pinned":251,"seo":3519,"sitemap":3520,"stem":3521,"tags":261,"__hash__":3522},"blog\u002Fblog\u002F小兒發展（五）.md",{"type":8,"value":3376,"toc":3513},[3377,3383,3397,3400,3420,3422,3425,3454,3456,3459,3479,3481,3484],[11,3378,3379,3380,3382],{},"接下來講到一個叫皮亞傑的人，他提出了發展理論",[15,3381],{},"\n先來講他說的四大認知階段",[896,3384,3385,3388,3391,3394],{},[52,3386,3387],{},"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",[52,3389,3390],{},"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）",[52,3392,3393],{},"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",[52,3395,3396],{},"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",[11,3398,3399],{},"接著是他提到的感覺運動期",[896,3401,3402,3405,3408,3411,3414,3417],{},[52,3403,3404],{},"反射期(0-2m)——對，就一堆反射",[52,3406,3407],{},"初級循環反應期(3-5m)——摸索自己身體",[52,3409,3410],{},"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）",[52,3412,3413],{},"兩個基模協調(9-12m)——透過兩種動作模式達成目的；理解因果",[52,3415,3416],{},"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",[52,3418,3419],{},"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",[65,3421],{},[11,3423,3424],{},"然後是個人與社會發展",[896,3426,3427,3430,3433,3436,3439,3442,3445,3448,3451],{},[52,3428,3429],{},"兩個月——會對別人笑",[52,3431,3432],{},"六個月——自己拿玩具玩",[52,3434,3435],{},"六到八個月——開始理解陌生，不讓陌生人抱",[52,3437,3438],{},"十個月——搖手bye bye（maybe是已經將動作與語言結合?）",[52,3440,3441],{},"一歲——拿杯子喝水",[52,3443,3444],{},"十五個月——拿湯匙、脫下外套、學刷牙",[52,3446,3447],{},"兩歲——會洗手",[52,3449,3450],{},"三歲——會穿脫鞋",[52,3452,3453],{},"四歲——穿衣服，扣鈕扣，刷牙",[65,3455],{},[11,3457,3458],{},"接下來講ASD的臨床徵象（即使動作發展正常，也會有語言delay）",[896,3460,3461,3464,3467,3470,3473,3476],{},[52,3462,3463],{},"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",[52,3465,3466],{},"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",[52,3468,3469],{},"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",[52,3471,3472],{},"注意力不集中——無法持久學習",[52,3474,3475],{},"衝動——人際關係緊張",[52,3477,3478],{},"好動——無法遵守規矩，破壞力強",[65,3480],{},[11,3482,3483],{},"吞嚥異常的臨床徵象",[896,3485,3486,3489,3492,3495,3498,3501,3504,3507,3510],{},[52,3487,3488],{},"反覆性肺炎",[52,3490,3491],{},"營養不良",[52,3493,3494],{},"抗拒食物",[52,3496,3497],{},"吞嚥困難",[52,3499,3500],{},"口中有異物感",[52,3502,3503],{},"嗆咳",[52,3505,3506],{},"口中有異味",[52,3508,3509],{},"經營嘔吐",[52,3511,3512],{},"流口水",{"title":246,"searchDepth":247,"depth":247,"links":3514},[],"皮亞傑~結束","\u002Fimages\u002Fuploads\u002F1776132158232-tHG70Gg.webp",{},"\u002Fblog\u002F小兒發展（五）",{"title":323,"description":3515},{"loc":3518},"blog\u002F小兒發展（五）","hzbfl2qpxvvTUq5Hn8aXvAKEpMa7oP19s8AD5xnz-1Q",{"id":3524,"title":324,"author":6,"body":3525,"date":3868,"description":3869,"draft":251,"edited_at":3868,"extension":253,"featured_image":3870,"meta":3871,"navigation":256,"path":3872,"pinned":251,"seo":3873,"sitemap":3874,"stem":3875,"tags":261,"__hash__":3876},"blog\u002Fblog\u002FGMFCS.md",{"type":8,"value":3526,"toc":3866},[3527,3530,3533,3550,3693,3696,3722,3724,3727,3744,3746,3749,3769,3771,3774,3794,3796,3799,3815,3817,3820,3837,3839,3842,3861,3863],[11,3528,3529],{},"寫完繼續趕神經 不然我會發神經",[11,3531,3532],{},"GMFCS分級定義",[896,3534,3535,3538,3541,3544,3547],{},[52,3536,3537],{},"一級——行走不受限",[52,3539,3540],{},"二級——行走受限",[52,3542,3543],{},"三級——使用手持輔具",[52,3545,3546],{},"四級——需要電動輪椅",[52,3548,3549],{},"五級——需要別人手推輪椅",[3551,3552,3553,3580],"table",{},[3554,3555,3556],"thead",{},[3557,3558,3559,3565,3568,3571,3574,3577],"tr",{},[3560,3561,3563],"th",{"align":3562},"left",[15,3564],{},[3560,3566,3567],{"align":3562},"0-2y",[3560,3569,3570],{"align":3562},"2-4y",[3560,3572,3573],{"align":3562},"4-6y",[3560,3575,3576],{"align":3562},"6-12y",[3560,3578,3579],{"align":3562},"12-18y",[3581,3582,3583,3607,3630,3653,3671],"tbody",{},[3557,3584,3585,3589,3592,3595,3599,3603],{},[3586,3587,3588],"td",{"align":3562},"I",[3586,3590,3591],{"align":3562},"1. Sitting free on the floor            2. Crawl on hands and knee 3. Pull to stand  4. Takes few step with support",[3586,3593,3594],{"align":3562},"Independent walking without assistance",[3586,3596,3597],{"align":3562},[15,3598],{},[3586,3600,3601],{"align":3562},[15,3602],{},[3586,3604,3605],{"align":3562},[15,3606],{},[3557,3608,3609,3612,3615,3618,3622,3626],{},[3586,3610,3611],{"align":3562},"II",[3586,3613,3614],{"align":3562},"1. Sitting may need support   2. Creep on stomach",[3586,3616,3617],{"align":3562},"but sitting with support",[3586,3619,3620],{"align":3562},[15,3621],{},[3586,3623,3624],{"align":3562},[15,3625],{},[3586,3627,3628],{"align":3562},[15,3629],{},[3557,3631,3632,3635,3638,3641,3645,3649],{},[3586,3633,3634],{"align":3562},"III",[3586,3636,3637],{"align":3562},"1. Low back supported        2. Roll or creep on stomach",[3586,3639,3640],{"align":3562},"1. W-sitting      2. Creep or crawl                3. Walking with walker indoor",[3586,3642,3643],{"align":3562},[15,3644],{},[3586,3646,3647],{"align":3562},[15,3648],{},[3586,3650,3651],{"align":3562},[15,3652],{},[3557,3654,3655,3658,3661,3664,3667,3669],{},[3586,3656,3657],{"align":3562},"IV",[3586,3659,3660],{"align":3562},"1. Head control  2. Roll to supine; may roll to prone",[3586,3662,3663],{"align":3562},"1. Sitting with support (cannot maintain in good alignment) 2. Roll or creep or crawl without reciprocal movements",[3586,3665,3666],{"align":3562},"Self mobility with powered W\u002FC",[3586,3668,3666],{"align":3562},[3586,3670,3666],{"align":3562},[3557,3672,3673,3676,3679,3681,3685,3689],{},[3586,3674,3675],{"align":3562},"V",[3586,3677,3678],{"align":3562},"Unable maintain antigravity head control",[3586,3680,3678],{"align":3562},[3586,3682,3683],{"align":3562},[15,3684],{},[3586,3686,3687],{"align":3562},[15,3688],{},[3586,3690,3691],{"align":3562},[15,3692],{},[11,3694,3695],{},"接著是操作的部份",[49,3697,3698,3701,3704,3707,3710,3713,3716,3719],{},[52,3699,3700],{},"軀幹支持行助行器——可以支撐pelvis trunk",[52,3702,3703],{},"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",[52,3705,3706],{},"肢體協助——需要別人協助移動",[52,3708,3709],{},"電動移動輔助——電動輪椅，代步車，等",[52,3711,3712],{},"手動輪椅自推——自己推",[52,3714,3715],{},"被動運送——被人推",[52,3717,3718],{},"行走——可以帶矯具但不能用輔具",[52,3720,3721],{},"輪式移動工具——包括電動輪椅，手動輪椅還有推車",[65,3723],{},[11,3725,3726],{},"兩歲前",[49,3728,3729,3732,3735,3738,3741],{},[52,3730,3731],{},"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",[52,3733,3734],{},"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",[52,3736,3737],{},"三級——下背部被支撐才能坐穩；會翻身、腹貼地爬",[52,3739,3740],{},"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",[52,3742,3743],{},"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",[65,3745],{},[11,3747,3748],{},"二到四歲",[49,3750,3751,3754,3757,3763,3766],{},[52,3752,3753],{},"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",[52,3755,3756],{},"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",[52,3758,3759,3760,3762],{},"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）",[15,3761],{},"\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",[52,3764,3765],{},"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",[52,3767,3768],{},"五級——幾乎不會動",[65,3770],{},[11,3772,3773],{},"四到六歲",[49,3775,3776,3779,3785,3788,3791],{},[52,3777,3778],{},"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",[52,3780,3781,3782,3784],{},"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；",[15,3783],{},"\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",[52,3786,3787],{},"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",[52,3789,3790],{},"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",[52,3792,3793],{},"五級——幾乎不動",[65,3795],{},[11,3797,3798],{},"六到十二歲",[49,3800,3801,3804,3807,3810,3813],{},[52,3802,3803],{},"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",[52,3805,3806],{},"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",[52,3808,3809],{},"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",[52,3811,3812],{},"四級——需他人協助或電動輪椅移動",[52,3814,3793],{},[65,3816],{},[11,3818,3819],{},"十二到十八歲",[49,3821,3822,3825,3828,3831,3834],{},[52,3823,3824],{},"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",[52,3826,3827],{},"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",[52,3829,3830],{},"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",[52,3832,3833],{},"四級——需輪式輔具移動；需肢體協助設備；常用電動輪椅移動",[52,3835,3836],{},"五級——被動協助移動",[65,3838],{},[11,3840,3841],{},"各分級比較",[49,3843,3844,3847,3850,3858],{},[52,3845,3846],{},"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",[52,3848,3849],{},"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",[52,3851,3852,3853],{},"三級VS四級——主要為坐姿及自動移動差異；",[49,3854,3855],{},[52,3856,3857],{},"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",[52,3859,3860],{},"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",[65,3862],{},[11,3864,3865],{},"還好內容不多也不難啃，嚇死我了",{"title":246,"searchDepth":247,"depth":247,"links":3867},[],"2026-04-19","好像是要自己看的補充","\u002Fimages\u002Fuploads\u002F1776579606728-El0Kc5OVMAEdbG5.webp",{},"\u002Fblog\u002FGMFCS",{"title":324,"description":3869},{"loc":3872},"blog\u002FGMFCS","G29aDr074P62Nd9uZoQMiZkkv7riTkIuliNENvcBRcI",{"id":4,"title":5,"author":6,"body":3878,"date":249,"description":250,"draft":251,"edited_at":252,"extension":253,"featured_image":254,"meta":4039,"navigation":256,"path":257,"pinned":251,"seo":4040,"sitemap":4041,"stem":260,"tags":261,"__hash__":262},{"type":8,"value":3879,"toc":4037},[3880,3884,3890,3896,3900,3904,3912,3914,3916,3918,3930,3932,3963,3965,3971,3975,4001,4003,4007,4012,4014,4024],[11,3881,13,3882,17],{},[15,3883],{},[11,3885,20,3886,23,3888,26],{},[15,3887],{},[15,3889],{},[11,3891,29,3892,32,3894,35],{},[15,3893],{},[15,3895],{},[11,3897,38,3898,41],{},[15,3899],{},[11,3901,44,3902,47],{},[15,3903],{},[49,3905,3906,3908,3910],{},[52,3907,54],{},[52,3909,57],{},[52,3911,60],{},[11,3913,63],{},[65,3915],{},[11,3917,69],{},[49,3919,3920,3922,3924,3926,3928],{},[52,3921,74],{},[52,3923,77],{},[52,3925,80],{},[52,3927,83],{},[52,3929,86],{},[11,3931,89],{},[49,3933,3934,3947,3959,3961],{},[52,3935,94,3936,102,3939],{},[96,3937,101],{"className":3938},[99,100],[49,3940,3941],{},[52,3942,107,3943],{},[49,3944,3945],{},[52,3946,112],{},[52,3948,115,3949,120,3952],{},[96,3950,119],{"className":3951},[100,99],[49,3953,3954],{},[52,3955,125,3956,131],{},[96,3957,130],{"className":3958},[129],[52,3960,134],{},[52,3962,137],{},[65,3964],{},[11,3966,142,3967,145,3969,148],{},[15,3968],{},[15,3970],{},[11,3972,151,3973,154],{},[15,3974],{},[49,3976,3977,3991],{},[52,3978,159,3979],{},[49,3980,3981,3983,3985,3987,3989],{},[52,3982,164],{},[52,3984,167],{},[52,3986,170],{},[52,3988,173],{},[52,3990,176],{},[52,3992,179,3993],{},[49,3994,3995,3997,3999],{},[52,3996,184],{},[52,3998,187],{},[52,4000,190],{},[11,4002,193],{},[11,4004,4005],{},[197,4006],{"alt":199,"src":200},[11,4008,4009],{},[204,4010,209],{"href":206,"rel":4011},[208],[11,4013,212],{},[49,4015,4016,4018,4020,4022],{},[52,4017,217],{},[52,4019,220],{},[52,4021,223],{},[52,4023,226],{},[11,4025,229,4026,232,4028,235,4030,238,4032,4034],{},[15,4027],{},[15,4029],{},[15,4031],{},[15,4033],{},[96,4035,244],{"className":4036},[100,99],{"title":246,"searchDepth":247,"depth":247,"links":4038},[],{},{"title":5,"description":250},{"loc":257},{"id":4043,"title":325,"author":6,"body":4044,"date":252,"description":4321,"draft":251,"edited_at":4322,"extension":253,"featured_image":4323,"meta":4324,"navigation":256,"path":4325,"pinned":251,"seo":4326,"sitemap":4327,"stem":4328,"tags":261,"__hash__":4329},"blog\u002Fblog\u002F先天性肌肉斜頸症CMT.md",{"type":8,"value":4045,"toc":4319},[4046,4064,4076,4082,4084,4087,4202,4204,4207],[11,4047,4048,4049,4051,4052,4054,4055,4057,4058,4060,4061,4063],{},"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）",[15,4050],{},"\n每1000個新生兒中就有3到20例",[15,4053],{},"\n病因包括：",[15,4056],{},"\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",[15,4059],{},"\n而斜頸的特徵為",[15,4062],{},"\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）",[11,4065,4066,4067,4069,4070,4072,4073,4075],{},"斜頸是表徵，不是診斷結果",[15,4068],{},"\n其中又有80%是天生的",[15,4071],{},"\n斜頸可以是慢性存在，也可以是急性發作",[15,4074],{},"\n可能伴隨不對稱的眼睛位置",[11,4077,4078,4079,4081],{},"通常PT可以做牽拉患側，增加健側肌肉力量，以及擺位",[15,4080],{},"\n假如有很嚴重的畸型，可以在1歲時進行手術",[65,4083],{},[11,4085,4086],{},"現在說一下可能會引發斜頸的問題",[49,4088,4089,4097,4105,4113,4121,4129,4152,4163,4171,4179,4194],{},[52,4090,4091,4092],{},"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",[49,4093,4094],{},[52,4095,4096],{},"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",[52,4098,4099,4100],{},"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",[49,4101,4102],{},[52,4103,4104],{},"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",[52,4106,4107,4108],{},"Clevical spine fractures and dislocations（頸椎骨折和脫臼）——有嚴重外傷史",[49,4109,4110],{},[52,4111,4112],{},"一般是車禍或高空墜落造成",[52,4114,4115,4116],{},"Chordomas（脊索瘤）——呈現下運動神經元問題，但小腦功能正常",[49,4117,4118],{},[52,4119,4120],{},"要看那顆瘤長在哪，才知道具體症狀",[52,4122,4123,4124],{},"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",[49,4125,4126],{},[52,4127,4128],{},"因體重超重，或胎位不正導致難產",[52,4130,4131,4132],{},"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",[49,4133,4134,4137,4140,4143,4146,4149],{},[52,4135,4136],{},"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",[52,4138,4139],{},"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）",[52,4141,4142],{},"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",[52,4144,4145],{},"反射檢查如X光不會照到異常",[52,4147,4148],{},"治療通常是運動為主",[52,4150,4151],{},"假如是出生之後幾年才被確診的小孩，需要做手術鬆開SCM",[52,4153,4154,4155],{},"Drug intoxication（藥物中毒）——服藥過量，如抗癲癇藥物",[49,4156,4157,4160],{},[52,4158,4159],{},"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",[52,4161,4162],{},"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",[52,4164,4165,4166],{},"Extraocular muscle Paresis（眼外肌麻痺）——無法讓眼睛全範圍運動",[49,4167,4168],{},[52,4169,4170],{},"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",[52,4172,4173,4174],{},"Juvenile Rheumatoid Arthritis（幼年型類風濕關節炎JRA）——在頭前傾姿勢十分常見",[49,4175,4176],{},[52,4177,4178],{},"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",[52,4180,4181,4182],{},"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",[49,4183,4184,4187],{},[52,4185,4186],{},"患者在40~50歲會有神經系統方面的問題",[52,4188,4189],{},[204,4190,4193],{"href":4191,"rel":4192},"https:\u002F\u002Fwww.tfrd.org.tw\u002Ftfrd\u002Frare_b\u002Fview\u002Fid\u002F266",[208],"這個中文名字翻譯我從這裡找的",[52,4195,4196,4197],{},"Muscle strain（肌肉拉傷）——有外傷史",[49,4198,4199],{},[52,4200,4201],{},"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",[65,4203],{},[11,4205,4206],{},"接下來講可能會導致斜頸的神經性運動障礙",[49,4208,4209,4217,4225,4233,4241,4249,4252,4260,4268,4276,4284,4292,4295,4303,4311],{},[52,4210,4211,4212],{},"Benign paroxysmal torticollis of infancy（良性陣發性嬰幼兒斜頸症）——類似於癲癇的症狀",[49,4213,4214],{},[52,4215,4216],{},"是多重原因導致",[52,4218,4219,4220],{},"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",[49,4221,4222],{},[52,4223,4224],{},"可以是顯性或隱性，原因不明",[52,4226,4227,4228],{},"Sandifer’s syndrome（桑迪弗氏症候群）——有胃食道逆流，突然斜頸的問題",[49,4229,4230],{},[52,4231,4232],{},"通常跟腦麻相關，有癲癇病史",[52,4234,4235,4236],{},"Pharyngeal abscess（咽後膿腫）——發炎時會有嚴重斜頸狀況",[49,4237,4238],{},[52,4239,4240],{},"口腔跟喉嚨會痠痛",[52,4242,4243,4244],{},"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",[49,4245,4246],{},[52,4247,4248],{},"機制不明，初期症狀與CMT容易被混淆",[52,4250,4251],{},"Psychogenic（心因性）——非典型的頸椎問題（例如發展遲緩）",[52,4253,4254,4255],{},"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",[49,4256,4257],{},[52,4258,4259],{},"會維持在同一方向傾斜和旋轉（跟CMT不同），可由X光確認",[52,4261,4262,4263],{},"Spastic Tordicollis（痙攣型斜頸）——頭會轉向一邊",[49,4264,4265],{},[52,4266,4267],{},"通常伴有呼吸道感染；好發在5~11歲；治療可靠熱敷及頸圈",[52,4269,4270,4271],{},"Spinal cord tumors（脊髓瘤）——出現下運動神經無力問題，但小腦功能正常",[49,4272,4273],{},[52,4274,4275],{},"具體要看腫瘤長在哪才知道狀況（感覺跟上面脊索瘤挺像）",[52,4277,4278,4279],{},"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",[49,4280,4281],{},[52,4282,4283],{},"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",[52,4285,4286,4287],{},"Syringomyelia（脊髓空洞症）——感覺喪失，肌肉萎縮，肌健反射消失",[49,4288,4289],{},[52,4290,4291],{},"病況取決於病灶level",[52,4293,4294],{},"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）",[52,4296,4297,4298],{},"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",[49,4299,4300],{},[52,4301,4302],{},"需手術切除",[52,4304,4305,4306],{},"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",[49,4307,4308],{},[52,4309,4310],{},"可使用抗生素治療",[52,4312,4313,4314],{},"Tuberculosis of the Cervical Spine（頸椎結核）——頸部和喉嚨會有疼痛，壓痛，腫脹",[49,4315,4316],{},[52,4317,4318],{},"通常是不對稱的傷害椎體，導致旋轉伴隨後凸",{"title":246,"searchDepth":247,"depth":247,"links":4320},[],"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":325,"description":4321},{"loc":4325},"blog\u002F先天性肌肉斜頸症CMT","1IZxGkst_bAVHix9u2lgPuJocdxwcKhvepyQjaOjwuM",{"id":4331,"title":326,"author":6,"body":4332,"date":4439,"description":4440,"draft":251,"edited_at":4439,"extension":253,"featured_image":4441,"meta":4442,"navigation":256,"path":4443,"pinned":251,"seo":4444,"sitemap":4445,"stem":4446,"tags":261,"__hash__":4447},"blog\u002Fblog\u002FMR智能不足.md",{"type":8,"value":4333,"toc":4437},[4334,4337,4340,4355,4364,4367,4425],[11,4335,4336],{},"先鬼轉來小兒好了 東西好像有點多",[11,4338,4339],{},"智能不足的定義是指IQ小於等於70以下的寶寶",[11,4341,4342,4343,4345,4346,4348,4349,4351,4352,4354],{},"那評估的表有",[15,4344],{},"\nStandford-Binet Intellectual Scale——適用於2.5歲",[15,4347],{},"\n中華智力發展量表——適用於6歲",[15,4350],{},"\nBayley Scale——適用於0~3歲",[15,4353],{},"\nWechsler Preschool and Primary scale of intelligence——適用於學齡前",[11,4356,4357,4358,4360,4361,4363],{},"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",[15,4359],{},"\n溝通，Self-care，居家生活，社交技巧，社區資源運用(community use)",[15,4362],{},"\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",[11,4365,4366],{},"從IQ範圍區分出",[49,4368,4369,4383,4397,4411],{},[52,4370,4371,4372],{},"輕度智能不足：IQ 50~70",[49,4373,4374,4377,4380],{},[52,4375,4376],{},"學齡期前：外表看起來正常",[52,4378,4379],{},"學齡期：在學業上需特殊教育（可達國小六年級程度）",[52,4381,4382],{},"成年人：可獨立生活",[52,4384,4385,4386],{},"中度：IQ 35~50",[49,4387,4388,4391,4394],{},[52,4389,4390],{},"學齡期前：社交技巧差",[52,4392,4393],{},"學齡期：需特殊訓練（可達國小四年級程度）",[52,4395,4396],{},"成年人：可從事非技術性職業",[52,4398,4399,4400],{},"重度：IQ 20~35",[49,4401,4402,4405,4408],{},[52,4403,4404],{},"學齡期前：缺乏溝通能力",[52,4406,4407],{},"學齡期：無法學習",[52,4409,4410],{},"成年人：日常活動需他人協助",[52,4412,4413,4414],{},"極嚴重：IQ\u003C20",[49,4415,4416,4419,4422],{},[52,4417,4418],{},"學齡期前：依賴他人照護",[52,4420,4421],{},"學齡期：依賴他人照護",[52,4423,4424],{},"成年人：依賴他人照護",[11,4426,4427,4428,4430,4431,4433,4434,4436],{},"從接受教育程度上，分成",[15,4429],{},"\nEducable：可被教育，可以上一般班級或資源班",[15,4432],{},"\nTrainable：可被訓練，學習一些謀生技巧",[15,4435],{},"\nDependent：依賴",{"title":246,"searchDepth":247,"depth":247,"links":4438},[],"2026-06-12","Intellectual disability","\u002Fimages\u002Fuploads\u002F1781247645586-145852080_p0_master1200.webp",{},"\u002Fblog\u002FMR智能不足",{"title":326,"description":4440},{"loc":4443},"blog\u002FMR智能不足","NZFChlk4JSzba5twGABUXtvtVQmu1tEvseZHqvvw_z4",{"id":4449,"title":4450,"author":6,"body":4451,"date":4439,"description":4613,"draft":251,"edited_at":4439,"extension":253,"featured_image":4614,"meta":4615,"navigation":256,"path":4616,"pinned":251,"seo":4617,"sitemap":4618,"stem":4619,"tags":261,"__hash__":4620},"blog\u002Fblog\u002FDown-Syndrome.md","Down Syndrome",{"type":8,"value":4452,"toc":4611},[4453,4459,4462,4473,4475,4478,4484,4496,4505,4515,4545,4554,4557,4560,4580,4589,4592],[11,4454,4455,4456,4458],{},"那唐氏症發生率是每1000個新生兒裡有1.3個",[15,4457],{},"\n母親是高齡產婦的話，風險會增加",[11,4460,4461],{},"這個不是遺傳疾病來的，起因有三",[49,4463,4464,4467,4470],{},[52,4465,4466],{},"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",[52,4468,4469],{},"第21對跟第22對染色體互換：4%的唐氏症是這類型",[52,4471,4472],{},"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",[65,4474],{},[11,4476,4477],{},"從病理學來看",[11,4479,4480,4481,4483],{},"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%",[15,4482],{},"\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",[11,4485,4486,4487,4489,4490,4492,4493,4495],{},"40%的唐氏症有先天性心臟病缺陷，常見的類型為",[15,4488],{},"\n房室通道缺損(Atrioventricular canal defects)",[15,4491],{},"\n心室中膈缺損(Ventriculoseptal defects)",[15,4494],{},"\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",[11,4497,4498,4499,4501,4502,4504],{},"感覺功能也會有缺失",[15,4500],{},"\n在107個受試者中，有64%的唐氏症有聽力喪失",[15,4503],{},"\n在75個受試者中，有41.3%有視覺缺陷",[11,4506,4507,4508,4510,4511],{},"肌肉骨骼系統上也會有差異",[15,4509],{},"\n低張力是主要原因，韌帶鬆馳，",[96,4512,4514],{"className":4513},[100,99],"第一二節頸椎半脫位",[11,4516,4517,4518,4520,4521,4523,4524,4526,4527,4529,4530,4532,4533,4535,4536,4538,4539],{},"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",[15,4519],{},"\n步態改變（踝關節不穩定）",[15,4522],{},"\n尿滯留",[15,4525],{},"\n斜頸",[15,4528],{},"\n不願意轉頭",[15,4531],{},"\n深層肌鍵反射增加",[15,4534],{},"\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",[15,4537],{},"\n所以，",[595,4540,4541],{},[96,4542,4544],{"className":4543},[100,99],"前庭刺激手法對於唐氏症來說是禁忌",[11,4546,4547,4548,4550,4551,4553],{},"從肌肉上，全身呈現低張力，尤其是肢體，頸部，軀幹較明顯",[15,4549],{},"\n也會有肌肉缺失問題，包括掌長肌（斷掌）和前臂屈肌",[15,4552],{},"\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",[11,4555,4556],{},"也會存在智力問題，通常IQ會小或等於70",[11,4558,4559],{},"在學習上的特徵有",[49,4561,4562,4565,4568,4571,4574,4577],{},[52,4563,4564],{},"能學的不多",[52,4566,4567],{},"要重複性學習",[52,4569,4570],{},"類化不好，無法順利轉化為技巧",[52,4572,4573],{},"容易忘記自己學過的技巧",[52,4575,4576],{},"反應慢",[52,4578,4579],{},"受刺激時，反應少",[11,4581,4582,4583,4585,4586,4588],{},"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",[15,4584],{},"\n一般有早期介入的唐氏症小孩在行走上是正常的",[15,4587],{},"\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",[11,4590,4591],{},"由於存在低張力問題，可以安排",[49,4593,4594,4597,4600,4608],{},[52,4595,4596],{},"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",[52,4598,4599],{},"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",[52,4601,4602,4603,4607],{},"且著重在早期的",[96,4604,4606],{"className":4605},[100,129],"動態探索","，而不是靜態探索",[52,4609,4610],{},"長大後，要去加強他的體適能及靈巧性（靈敏度）",{"title":246,"searchDepth":247,"depth":247,"links":4612},[],"唐氏症","\u002Fimages\u002Fuploads\u002F1781265657338-135232550_p0_master1200.webp",{},"\u002Fblog\u002FDown-Syndrome",{"title":4450,"description":4613},{"loc":4616},"blog\u002FDown-Syndrome","FOhG_wFbJIVxV3O-nKWt4g8KuD4rdC8E6Nyq7UBM67s",{"id":4622,"title":4623,"author":6,"body":4624,"date":4439,"description":4753,"draft":251,"edited_at":4754,"extension":253,"featured_image":4755,"meta":4756,"navigation":256,"path":4757,"pinned":251,"seo":4758,"sitemap":4759,"stem":4760,"tags":261,"__hash__":4761},"blog\u002Fblog\u002FRett-Syndrome.md","Rett Syndrome",{"type":8,"value":4625,"toc":4751},[4626,4629,4635,4643,4646,4649,4730,4733,4736,4742,4748],[11,4627,4628],{},"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",[11,4630,4631,4632,4634],{},"雷特氏症是一種發展性障礙疾病",[15,4633],{},"\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",[11,4636,4637,4638,4642],{},"主要的奇怪行為是常",[96,4639,4641],{"className":4640},[100,99],"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",[11,4644,4645],{},"雷特氏症的小孩在臨床上表現出四個時期的變化",[11,4647,4648],{},"RS的小孩雖然會合併自閉徵候，但RS合併MR更加明顯",[49,4650,4651,4665,4690,4710],{},[52,4652,4653,4654],{},"第一期（六個月到一歲半，早期）",[49,4655,4656,4662],{},[52,4657,4658,4659,4661],{},"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",[15,4660],{},"\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",[52,4663,4664],{},"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",[52,4666,4667,4668],{},"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）",[49,4669,4670,4687],{},[52,4671,4672,4673,4675,4676,4680,4681,4683,4684,4686],{},"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",[15,4674],{},"\n有反覆",[96,4677,4679],{"className":4678},[100,99],"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",[15,4682],{},"\n有的小孩還會吐舌，陣發喘氣，睡眠不安，或走路不穩",[15,4685],{},"\n頭圍成長趨緩",[52,4688,4689],{},"大段文字：會喪失已學習過的技巧；會癲癇",[52,4691,4692,4693],{},"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）",[49,4694,4695,4704],{},[52,4696,4697,4698,4700,4701,4703],{},"小孩呈失用症，不會正常使用肢體",[15,4699],{},"\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",[15,4702],{},"\n這個時期可以維持相當一段時間",[52,4705,4706,4707,4709],{},"大段文字：手部運動功能喪失逐漸明顯；逐漸喪失自主能力",[15,4708],{},"\n長達數年到數十年",[52,4711,4712,4713],{},"第四期（五到二十五歲，運動退化晚期）",[49,4714,4715,4724],{},[52,4716,4717,4718,4720,4721,4723],{},"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",[15,4719],{},"\n認知，溝通，手部動作較穩定，注視他人能力能維持",[15,4722],{},"\n有些會有脊椎側彎",[52,4725,4726,4727,4729],{},"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",[15,4728],{},"\n長達數十年",[11,4731,4732],{},"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",[11,4734,4735],{},"他們之前學會過的任務，卻會忘記自己學過",[11,4737,4738,4739,4741],{},"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",[15,4740],{},"\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",[11,4743,4744,4745,4747],{},"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",[15,4746],{},"\n即使時間很少，但也要著重訓練行走能力",[11,4749,4750],{},"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":246,"searchDepth":247,"depth":247,"links":4752},[],"雷特氏症","2026-06-13","\u002Fimages\u002Fuploads\u002F1781344227040-145949253_p0_master1200.webp",{},"\u002Fblog\u002FRett-Syndrome",{"title":4623,"description":4753},{"loc":4757},"blog\u002FRett-Syndrome","wp6UeSpNuWVzCMj8UKCOqphsSpW8MVmlDua_xz0r-Y0",1781450212023]