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CP",{"type":8,"value":550,"toc":806},[551,554,592,604,607,659,691,721,733,759,785,792,797],[11,552,553],{},"以下根據余老師做的總結來編寫",[11,555,556,557,559,560,565,566,570,571,573,574,578,579,583,585,586,588,589,591],{},"首先是定義 ",[15,558],{},"\n在大腦",[74,561,564],{"className":562},[563],"bg-red-3","未成熟","的階段 因為",[74,567,569],{"className":568},[563],"腦傷而導致的動作障礙","為主的症候群",[15,572],{},"\n而CP有",[74,575,577],{"className":576},[78],"三個非","合併導致",[74,580,582],{"className":581},[78],"發展遲緩",[15,584],{},"\n非進行性(傷口不會再惡化) ",[15,587],{},"\n非暫時性(腦傷不會好)",[15,590],{},"\n非單純性(有機會響影到多個區域 症狀會有例如智能不足等)",[11,593,594,595,597,598,600,601,603],{},"影響區域有三種區分",[15,596],{},"\n單側麻痺(Hemiplegia)(患側手腳無力)",[15,599],{},"\n雙側麻痺(Diplegia)(通常雙腿影響比雙手明顯)",[15,602],{},"\n四肢麻痺(Quadriplegia)(四肢 但上肢影響程度比下肢大)",[11,605,606],{},"我們現在來講三大分類",[11,608,609,610,612,613,617,618,620,621,625,626,628,632,633,635,636,641,642,646,647,649,650,652,653,655,656,658],{},"首先是痙攣型(Spasticity) 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tone強+pronation，下肢Extenor tone強",[15,902],{},"\n徐動型——佔比一成五，傷到基底核，皮質無影響，所以智力正",[15,905],{},"\n僵直型——傷到皮質，比",[74,908,910],{"className":909},[77,78],"痙攣型張力還大",[15,912],{},"\n運動失調型——佔比一成三，傷到小腦，",[74,915,917],{"className":916},[77,78],"協調能力差","且尤其是",[74,920,923],{"className":921},[922],"yellow-3","下肢","特別明顯，步寬大，走路搖晃",[15,926],{},"\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",[15,929],{},"\n顫抖型——較徐動型有節奏，在遠端顫抖",[15,932],{},"\n混合型",[15,935],{},"\n無法分類型",[11,938,939],{},"類別——2（P8）",[11,941,942],{},"他提到了按照ICF思路去想各個層級寶寶的問題",[830,944,945,948,956,963,971],{},[25,946,947],{},"首先是健康問題，受了甚麼傷",[25,949,950,951],{},"其次是受限，這個傷會讓寶寶",[74,952,955],{"className":953},[77,954],"blue-3","做不了哪些動作",[25,957,958,959],{},"再來是侷限，這些做不了的動作會讓寶寶",[74,960,962],{"className":961},[77,78],"失去甚麼功能性",[25,964,965,966,970],{},"然後是環境因素，例如失去了這些功能性的話，與",[74,967,969],{"className":968},[77,172],"環境的互動","有甚麼障礙",[25,972,973,974,978],{},"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",[74,975,977],{"className":976},[77,922],"動機","等因素",[11,980,981],{},[788,982],{"alt":790,"src":983},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776135419925-Screenshot_2026-04-14_105040.png",{"title":179,"searchDepth":180,"depth":180,"links":985},[],"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":244,"description":987},{"loc":990},"blog\u002FCP補充（一）","8cDECsO9Ab18dGecDdRUOUB4ETPPEAjd1AS3dqL2ii4",{"id":996,"title":997,"author":6,"body":998,"date":986,"description":1354,"draft":184,"edited_at":986,"extension":185,"featured_image":1355,"meta":1356,"navigation":188,"path":1357,"pinned":184,"seo":1358,"sitemap":1359,"stem":1360,"tags":193,"__hash__":1361},"blog\u002Fblog\u002FCP—Rood-&-Bobath.md","CP—Rood & Bobath（一）",{"type":8,"value":999,"toc":1352},[1000,1003,1006,1022,1040,1072,1075,1121,1123,1126,1202,1210,1292,1294,1297],[11,1001,1002],{},"(就先只寫余老師有在上課做註記的版書，讀不完啦)",[11,1004,1005],{},"1940前肌能教再育>1950年後神經成熟理論>1990年動態系統理論",[11,1007,1008,1009,1011,1012,1016,1017,1021],{},"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）",[15,1010],{},"\n手法有RIP(",[74,1013,1015],{"className":1014},[77,172],"異常reflex抑制",")，接著誘發動作(",[74,1018,1020],{"className":1019},[78,77],"翻正反應,平衡反應)","，再加一些本體覺和觸覺輸入",[11,1023,1024,1025,1027,1028,1030,1031,1035,1036],{},"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",[15,1026],{},"\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",[15,1029],{},"\n主要是",[74,1032,1034],{"className":1033},[77,78],"打破錯的感覺運動經驗","，",[74,1037,1039],{"className":1038},[77,922],"重新教寶寶正確的動作形態",[11,1041,1042,1043,1045,1046,1048,1049,1051,1052,1056,1057,1059,1060,1062,1063,1067,1068],{},"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",[15,1044],{},"\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",[15,1047],{},"\n那像是這裡提到的flexor tone過大，我們就幫他做extension",[15,1050],{},"\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",[74,1053,1055],{"className":1054},[922],"反方向","，誘發GTO關閉tone",[15,1058],{},"\n(著重在擺位)",[15,1061],{},"\n現在的RIP是改為",[74,1064,1066],{"className":1065},[172],"partial RIP","，只利用",[74,1069,1071],{"className":1070},[77,78],"Key point來達到抑制與誘發",[11,1073,1074],{},"那RIP的注意事項有如下",[22,1076,1077,1089,1101,1109,1112,1115],{},[25,1078,1079,1080,1084,1085],{},"RIP只做在",[74,1081,1083],{"className":1082},[77,78],"有痙攣","的地方，",[74,1086,1088],{"className":1087},[172],"hypotone則不需要做",[25,1090,1091,1092,1096,1097],{},"力度需",[74,1093,1095],{"className":1094},[922,77],"緩慢施加","，因為痙攣的部位容易",[74,1098,1100],{"className":1099},[78],"contracture",[25,1102,1103,1104,1108],{},"從近端開始做，並且做",[74,1105,1107],{"className":1106},[563,77],"旋轉以及Protraction(shoulder)是最容易打破張力","的手段",[25,1110,1111],{},"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",[25,1113,1114],{},"新的Bobath目的是做ADL動作",[25,1116,1117,1118,1120],{},"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",[15,1119],{},"\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",[35,1122],{},[11,1124,1125],{},"接下來講抑制Extensor的技巧，先來講第一個",[830,1127,1128,1131,1137,1162,1170,1191,1199],{},[25,1129,1130],{},"首先PT要坐在有靠背的椅子上保護好PT的背",[25,1132,1133,1134,1136],{},"將小孩的身體放在PT大腿上，腿面向PT，呈現total flexion姿勢",[15,1135],{},"\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",[25,1138,1139,1140,1142,1143,1147,1148,1152,1156,1157,1161],{},"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",[15,1141],{},"\n可以在剛提到的姿勢下順便訓練旋轉，PT一手將",[74,1144,1146],{"className":1145},[77,78],"小孩的腳轉","到一側，另一手轉動寶寶的",[74,1149,1151],{"className":1150},[77,563],"身體",[74,1153,1155],{"className":1154},[77],"到對側","（",[74,1158,1160],{"className":1159},[563],"是身體，不是頭","）",[25,1163,1164,1165,1169],{},"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",[74,1166,1168],{"className":1167},[78,77],"肩胛骨內緣","後主推做protraction",[25,1171,1172,1173,1175,1176,1180,1181,1183,1184,1188,1190],{},"那小孩也因為extensor張力太大，可能沒有意識到有手的存在",[15,1174],{},"\n我們就得將他的手帶到胸前",[74,1177,1179],{"className":1178},[78,77],"進入視野範圍","，讓他開始吃或者自己的手",[15,1182],{},"\n而有些小孩會緊張會保持抓握姿勢，我們可以從",[74,1185,1187],{"className":1186},[77,78],"大拇指開始扳開慢慢張手打開",[15,1189],{},"\n讓他去做手碰手、手碰嘴、手碰腳、嘴碰嘴",[25,1192,1193,1194,1198],{},"而在抑制的過程中也可以做一些",[74,1195,1197],{"className":1196},[78,77],"誘發flexion動作","的手法，訓練屈肌，這樣也能降低extensor tone",[25,1200,1201],{},"習慣了以上姿勢後，就可以放寶寶在地上自己玩了",[11,1203,1204,1205,1209],{},"接著來講第二個，這個是",[74,1206,1208],{"className":1207},[563,77],"利用滾筒","的方式，結合了誘發動作的方式",[830,1211,1212,1239,1268],{},[25,1213,1214,1215,1219,1221,1222,1226,1228,1229,1233,1234,1238],{},"首先讓小孩在滾筒上side-lying，",[74,1216,1218],{"className":1217},[77,172],"手抬高將滾筒卡在腋下",[15,1220],{},"\n這時候PT要對小孩上方的髖做",[74,1223,1225],{"className":1224},[77,78],"Abd，extension和external rotation",[15,1227],{},"\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",[74,1230,1232],{"className":1231},[78,77],"extension","姿勢(",[74,1235,1237],{"className":1236},[77],"正常站立角度",")",[25,1240,1241,1242,1244,1245,1247,1248,1250,1251,1255,1259,1263,1264,1161],{},"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",[15,1243],{},"\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",[15,1246],{},"\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",[15,1249],{},"\n而這時候會想要去訓練他的抬頭（雖然",[74,1252,1254],{"className":1253},[77,78],"抬頭是extension姿勢",[74,1256,1258],{"className":1257},[77],"但這個跟",[74,1260,1262],{"className":1261},[77,922],"extensor muscle tone不一樣","，還是得教導",[74,1265,1267],{"className":1266},[78],"正確方式",[25,1269,1270,1271,1273,1274,1276,1277,1279,1280,1284,1286,1287,1291],{},"剛剛講的是從side-lying到prone，現在講反過來的從prone到side-lying",[15,1272],{},"\n一手放在pelvis，一手固定shoulder，",[15,1275],{},"\n這次先將pelvis，翻回side-lying，然後慢慢協助將shoulder帶到side-lying",[15,1278],{},"\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",[74,1281,1283],{"className":1282},[77,78],"retraction",[15,1285],{},"\n對於CP小兒而言",[74,1288,1290],{"className":1289},[78,77],"誘發出extensor tone","，所以要先將pelvis帶走）",[35,1293],{},[11,1295,1296],{},"然後來介紹到抑制Flexor的技巧，核心是利用重力去抑制",[830,1298,1299,1319,1334,1349],{},[25,1300,1301,1302,1306,1307,1311,1313,1314,1318],{},"讓小孩supine在球上，這過程要",[74,1303,1305],{"className":1304},[78,77],"緩慢以及穩","，不要讓小孩感到害怕，假如",[74,1308,1310],{"className":1309},[563,77],"小孩恐懼就不要做這個",[15,1312],{},"\n因為flexor tone 高的小孩比較少動，所以",[74,1315,1317],{"className":1316},[77,78],"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",[25,1320,1321,1322,1326,1327,1331,1333],{},"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",[74,1323,1325],{"className":1324},[172,77],"逐漸放鬆","，同時也能",[74,1328,1330],{"className":1329},[77,78],"靠重力牽拉flexor肌肉",[15,1332],{},"\n再進階就遠端例如hip去做同樣的事",[25,1335,1336,1337,1339,1340,1344,1345],{},"進一步的做法是，抓住小孩的小肢，將球往小孩的頭側推",[15,1338],{},"\n這樣因為滾動的原因變成頭反而靠近地面，呈",[74,1341,1343],{"className":1342},[172,77],"頭靠近地面","，這樣也能讓",[74,1346,1348],{"className":1347},[78,77],"extensor tone上升",[25,1350,1351],{},"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":179,"searchDepth":180,"depth":180,"links":1353},[],"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":997,"description":1354},{"loc":1357},"blog\u002FCP—Rood-&-Bobath","hbxSp87ZZts-QV-3eWuNwBK9q66v8uar73myHqp0-sQ",{"id":1363,"title":1364,"author":6,"body":1365,"date":986,"description":1475,"draft":184,"edited_at":1476,"extension":185,"featured_image":1477,"meta":1478,"navigation":188,"path":1479,"pinned":184,"seo":1480,"sitemap":1481,"stem":1482,"tags":193,"__hash__":1483},"blog\u002Fblog\u002FCP—Rood-&-Bobath（二）.md","CP—Rood & Bobath（二）",{"type":8,"value":1366,"toc":1473},[1367,1370,1376,1381,1384],[11,1368,1369],{},"那剛剛一篇講的都Bobath的手法，那現在講Rood的",[11,1371,1372,1373,1375],{},"那Rood 提到說，人類有發展次序，mobility>stability>mobility on stability>skill movement",[15,1374],{},"\n也強調了可以利用感覺輸入誘發動作",[11,1377,1378],{},[788,1379],{"alt":790,"src":1380},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776217678571-Screenshot_2026-04-15_094736.png",[11,1382,1383],{},"那感覺刺激的部份根據強度及頻率而有這四種變化",[22,1385,1386,1392,1431,1437],{},[25,1387,1388,1389,1391],{},"快速且短暫的刺激",[15,1390],{},"\n可以用心智狀態提高，全身muscle tone 增高，反應力上升（喚醒）",[25,1393,1394,1395,1397,1398,1400,1401,1403,1405,1406,1410,1411,1413,1414,1416,1417,1421,1423,1427,1428,1430],{},"快速且重複的刺激",[15,1396],{},"\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",[15,1399],{},"\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",[15,1402],{},[15,1404],{},"\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",[74,1407,1409],{"className":1408},[78,77],"頸部開始訓練","(inversion在GA26~29就出現)",[15,1412],{},"\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",[15,1415],{},"\n治療師採坐姿，而且不是用手在帶動，是",[74,1418,1420],{"className":1419},[77,78],"利用治療師身體帶動",[15,1422],{},[74,1424,1426],{"className":1425},[563],"注意","：要給小孩安全感，inversion不能過久，保持頭部的正確位置",[15,1429],{},"\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",[25,1432,1433,1434,1436],{},"緩慢且規律重覆的刺激",[15,1435],{},"\n通常用來減敏",[25,1438,1439,1440,1442,1443,1445,1447,1448,1452,1453,1457,1458,1460,1462,1463,1467,1468,1472],{},"持續性的刺激",[15,1441],{},"\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",[15,1444],{},[15,1446],{},"\n對於",[74,1449,1451],{"className":1450},[77,78],"痙攣","的小孩，先從",[74,1454,1456],{"className":1455},[78,77],"不敏感的地方開始","，再往較敏感的位慢慢刺激，嘴巴也一樣",[15,1459],{},[15,1461],{},"\n但對於",[74,1464,1466],{"className":1465},[77,922],"低張","的小孩，則相反，從",[74,1469,1471],{"className":1470},[77,922],"最敏感的地方開始","刺激",{"title":179,"searchDepth":180,"depth":180,"links":1474},[],"Rood 到結尾","2026-04-15","\u002Fimages\u002Fuploads\u002F1776222460274-Ee4ldTMUcAEiPzF.webp",{},"\u002Fblog\u002FCP—Rood-&-Bobath（二）",{"title":1364,"description":1475},{"loc":1479},"blog\u002FCP—Rood-&-Bobath（二）","56_IFu2CIimvGKbXPweMAs8MdVF91nlzrjRw9LcNlb0",{"id":1485,"title":1486,"author":6,"body":1487,"date":1951,"description":1952,"draft":184,"edited_at":1953,"extension":185,"featured_image":1954,"meta":1955,"navigation":188,"path":1956,"pinned":184,"seo":1957,"sitemap":1958,"stem":1959,"tags":193,"__hash__":1960},"blog\u002Fblog\u002FMotor-Learning.md","Motor Learning小兒（一）",{"type":8,"value":1488,"toc":1949},[1489,1492,1501,1510,1528,1537,1546,1562,1571,1600,1675,1690,1693,1735,1741,1790,1836,1877,1880,1918,1933],[11,1490,1491],{},"那這一節課著重在動態模組理論，跟黃老師教的是互通的",[11,1493,1494,1495,1497,1498,1500],{},"那首先是講感覺統合的部份",[15,1496],{},"\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",[15,1499],{},"\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)",[11,1502,1503,1504,1506,1507,1509],{},"而接下來講到動作的發展",[15,1505],{},"\n那老師用的理論是動態模組理論",[15,1508],{},"\n假如還記得黃老師的Motor Control最後一課講的應該不難吃",[11,1511,1512,1513,1515,1516,1518,1519,1521,1522,1524,1525,1527],{},"不過我還是先列出來老師PPT裡的五個角度",[15,1514],{},"\n第一 動作技巧的顯現",[15,1517],{},"\n第二 動作型態的精準度",[15,1520],{},"\n第三 動作成果(可從評估表推估) ",[15,1523],{},"\n第四 組合技巧的獲得(次系統組合的結果)",[15,1526],{},"\n第五 對環境適應力的增強",[11,1529,1530,1531,1533,1534,1536],{},"我們現在來講平衡系統的發展",[15,1532],{},"\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",[15,1535],{},"\n以站立來形容的話",[11,1538,1539,1540,1542,1543,1545],{},"2)人類的重心(COM)基本會在S2 ",[15,1541],{},"\n那壓力中心(COP)是動態的 他會因應COM的改變而改變",[15,1544],{},"\n那底面積(BOS)就是兩隻腳踩在地面的距離",[11,1547,1548,1549,1553,1554,1556,1557,1561],{},"3)那平衡的演化 在早期 小孩會",[74,1550,1552],{"className":1551},[78,77],"極度依賴視角","來判斷",[15,1555],{},"\n但在成熟的過程中 我們會",[74,1558,1560],{"className":1559},[563],"越來越傾向用本體感覺","去判斷",[11,1563,1564,1565,1567,1568,1570],{},"4)穩定極限(LOS) 他把我們人類想象成一個倒立的三角錐",[15,1566],{},"\n在不移動的情況下身體能偏多少(前6度 側8度 後4度)",[15,1569],{},"\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)",[11,1572,1573,1574,1576,1577,1581,1582,1587,1588,1590,1591,1595,1596],{},"5)承受外力時的反應時 人類會有兩種變化",[15,1575],{},"\n第一種就是假如這",[74,1578,1580],{"className":1579},[77,172],"外力少到一定範圍"," 就只會用",[74,1583,1586],{"className":1584},[1585],"bg-green-3","姿勢穩定反應","來做調整",[15,1589],{},"\n另一種則是假如外力",[74,1592,1594],{"className":1593},[77,78],"超過姿勢穩定反應可以調整的程度"," 就會產生",[74,1597,1599],{"className":1598},[563],"保護性姿勢",[11,1601,1602,1603,1605,1606,1608,1609,1611,1612,1616,1618,1619,1623,1627,1629,1630,1632,1634,1635,1639,1640,1642,1643,1647,1648,1650,1651,1653,1655,1656,1658,1659,1661,1662,1666,1667,1669,1671,1672,1674],{},"6)",[15,1604],{},"\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",[15,1607],{},"\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",[15,1610],{},"\n那一般而言 越成熟的人 會越偏好用",[74,1613,1615],{"className":1614},[78],"踝策略",[15,1617],{},"\n而目前比較新的提出 就是",[74,1620,1622],{"className":1621},[922,77],"抓握",[74,1624,1626],{"className":1625},[922],"是一種不算策略(Strategy)的方法",[15,1628],{},"\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",[15,1631],{},[15,1633],{},"\nii) 而另一點則是改變BOS的 例子就有跨步策略 身體是",[74,1636,1638],{"className":1637},[78],"被迫做出","的 伸手出去支撐也是如此",[15,1641],{},"\n那在發展過程中 而在",[74,1644,1646],{"className":1645},[78],"方向性上也是有順序","的",[15,1649],{},"\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",[15,1652],{},[15,1654],{},"\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 ",[15,1657],{},"\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",[15,1660],{},"\n我們",[74,1663,1665],{"className":1664},[77],"可以通過適度的給他們外力","訓練他們",[15,1668],{},[15,1670],{},"\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",[15,1673],{},"\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",[11,1676,1677,1678,1680,1681,1683,1684,1686,1687,1689],{},"那對於小兒的發展議題，主要有這幾個",[15,1679],{},"\ni)——新形式的起源(The origin of new form)",[15,1682],{},"\nii)——連續性與非連續性(Continuity vs discontinuity)",[15,1685],{},"\niii)——變異性(Variability)",[15,1688],{},"\niv)——生物與環境的影響(Biological vs. environmental influence)",[11,1691,1692],{},"那動態模組理論是經歷過以下發展而來的",[830,1694,1695,1702,1722],{},[25,1696,1697,1698],{},"那首先是小兒痲痺(1910s)——當年的理念是哪邊無力練哪邊",[74,1699,1701],{"className":1700},[77,563],"(肌肉再教育 muscle re-education)",[25,1703,1704,1705,1709,1710,1712,1713,1715,1716,1718,1719,1721],{},"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",[74,1706,1708],{"className":1707},[563,77],"感覺輸入","促進正常的動作以及動作發展",[15,1711],{},"\n神經成熟理論(1945s)由Gesell和McGraw提出，他們的關鍵理念有如下",[15,1714],{},"\nCNS髓鞘化(Increased myelination of CNS)",[15,1717],{},"\n皮質抑制皮質下中心(Inhibition of the subcortical centers by the higher cerebral cortex)",[15,1720],{},"\n層級控制(Hierarchical control)",[25,1723,1724,1725,1729,1730,1734],{},"最後來講到階層理論的雛型(1980s)——當年他們覺得動作發展",[74,1726,1728],{"className":1727},[77],"不只單一的神經支配","，把",[74,1731,1733],{"className":1732},[77,78],"其他的系統、環境","一併整合進來",[11,1736,1737,1738,1740],{},"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",[15,1739],{},"\n那它有三個假設",[830,1742,1743,1754,1774],{},[25,1744,1745,1746,1748,1749,1753],{},"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",[15,1747],{},"\n但在1979s有學者提出說，其實原始反射對於每個寶寶來說",[74,1750,1752],{"className":1751},[78],"變異性","也很大",[25,1755,1756,1757,1759,1760,1764,1765,1769,1770],{},"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",[15,1758],{},"\n但在1976s有學者發現到，南非的寶寶被家長",[74,1761,1763],{"className":1762},[77],"直立抱法或者練習坐","，會比美國寶寶",[74,1766,1768],{"className":1767},[78],"更快發展出下肢動作","，但",[74,1771,1773],{"className":1772},[172],"爬和翻身較慢",[25,1775,1776,1777,1779,1780,1784,1785,1789],{},"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)",[15,1778],{},"\n但在1988s有學者提出，寶寶的",[74,1781,1783],{"className":1782},[172],"伸手以及操作","的發展在近端遠端上是",[74,1786,1788],{"className":1787},[77,78],"同時存在","的(同步進行發展，並沒有明確上下關係)",[11,1791,1792,1793,1795,1796,1800,1801,1805,1807,1808,1812,1813,1815,1816,1820,1821,1825,1826,1830,1832,1833,1835],{},"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",[15,1794],{},"\n那協調就是將這些複雜的東西，透過",[74,1797,1799],{"className":1798},[78],"降低自由度","，來",[74,1802,1804],{"className":1803},[172],"產生平滑的動作",[15,1806],{},"\n那降低自由度的策略會牽涉到一個叫",[74,1809,1811],{"className":1810},[563],"自我組織","的東西，那它的核心理念是說",[15,1814],{},"\n動作是有",[74,1817,1819],{"className":1818},[563],"適應性","的，次系統會根據",[74,1822,1824],{"className":1823},[77,78],"環境任務","等因素做調整，",[74,1827,1829],{"className":1828},[172],"再拼湊起來",[15,1831],{},"\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）",[15,1834],{},"\n有提到三個重點",[830,1837,1838,1844,1860],{},[25,1839,1840,1841,1843],{},"次序參數——它探討的是關節之間的協同",[15,1842],{},"\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",[25,1845,1846,1847,1851,1852,1854,1855,1859],{},"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",[74,1848,1850],{"className":1849},[77,563],"最省力、自然以及方便","的動作型態",[15,1853],{},"\n那假如這個動作達到了上述說的型態，便是",[74,1856,1858],{"className":1857},[78,77],"最穩定型態","，即使會因應任務去做改變也是十分穩定的",[25,1861,1862,1863,1865,1866,1870,1871,1873,1874,1876],{},"相移現象——意思就是說原本在做著一個穩定的動作型態",[15,1864],{},"\n因為一些",[74,1867,1869],{"className":1868},[78],"因素所干擾","，就會變成另一個動作型態",[15,1872],{},"\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)",[15,1875],{},"\n（對 黃老師教動態系統理論也提到過這個）",[11,1878,1879],{},"最後講兩個實驗",[830,1881,1882,1904],{},[25,1883,1884,1885,1887,1888,1890,1891,1895,1896,1900,1901,1903],{},"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",[15,1886],{},"\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",[15,1889],{},"\n但動態模組理論發現，其實是因為在第四周寶寶",[74,1892,1894],{"className":1893},[77,78],"長脂肪比長肌肉快","，導致",[74,1897,1899],{"className":1898},[172],"力量不足","做不出來",[15,1902],{},"\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",[25,1905,1906,1907,1909,1910,1912,1913,1917],{},"第二個實驗，是觀察青蛙生長的環境與發育的關係",[15,1908],{},"\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",[15,1911],{},"\n所以神經成熟是可以讓動作型態形成，但必須得加上",[74,1914,1916],{"className":1915},[77,78],"環境，時間以及個體本身條件","才能讓型態表現更好",[11,1919,1920,1921,1923,1924,1926,1927,1929,1930,1932],{},"那在臨床意義上有以下幾點",[15,1922],{},"\n分散式控制(Distributed control)",[15,1925],{},"\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)",[15,1928],{},"\n由兒童主導(Active role of the child)",[15,1931],{},"\n個體差異的訊息(variability provides important information)",[11,1934,1935,1936,1940,1941,1945,1946,1948],{},"評估",[74,1937,1939],{"className":1938},[77,1585],"不應只侷限在探討神經發展過程","，而是要根據",[74,1942,1944],{"className":1943},[563,77],"多個系統，家庭因素","等問題",[15,1947],{},"\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":179,"searchDepth":180,"depth":180,"links":1950},[],"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":1486,"description":1952},{"loc":1956},"blog\u002FMotor-Learning","EmOKsVRjY6Fz-rmd5PiPG83wEP6j59SCfF75Y1WnFNU",{"id":1962,"title":1963,"author":6,"body":1964,"date":1953,"description":2187,"draft":184,"edited_at":2188,"extension":185,"featured_image":2189,"meta":2190,"navigation":188,"path":2191,"pinned":184,"seo":2192,"sitemap":2193,"stem":2194,"tags":193,"__hash__":2195},"blog\u002Fblog\u002FMotor-Learning小兒（二）.md","Motor Learning小兒（二）",{"type":8,"value":1965,"toc":2185},[1966,1969,1975,1984,1987,2021,2024],[11,1967,1968],{},"阿對的，又要來講動作學習的定義了，雖然之前就有講過",[11,1970,1971,1972,1974],{},"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)",[15,1973],{},"\n動作學習就是過程，而動作表現是動作做出來的結果。",[11,1976,1977,1978,1980,1981,1983],{},"而這邊講道Positive和Negative Sign",[15,1979],{},"\nPositive是指正常人沒有，但病人身上會出現的異常動作 ",[15,1982],{},"\nNegative則相反，正常人有的，但病人身上無法出現",[11,1985,1986],{},"對於動作學習有三大要素",[830,1988,1989,1992,2001],{},[25,1990,1991],{},"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",[25,1993,1994,1995,1997,1998,2000],{},"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",[15,1996],{},"\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",[15,1999],{},"\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",[25,2002,2003,2004,2008,2009,2011,2012,2016,2017],{},"對於目標的清淅程度——就是",[74,2005,2007],{"className":2006},[172],"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",[15,2010],{},"\n而任務",[74,2013,2015],{"className":2014},[78],"越具體","，更能",[74,2018,2020],{"className":2019},[78,77],"引導寶寶產生興趣",[11,2022,2023],{},"那動作學習有以下三個考量點",[830,2025,2026,2078,2124],{},[25,2027,2028,2029,2033,2034,2038,2039,1238,2046,2048,2049,2051,2052,2056,2057,2059,2060,2064,2065,2069,2070,2072,2073,2077],{},"轉移——意思是",[74,2030,2032],{"className":2031},[77,172],"相同相似的技巧","在不同情景下可以變化",[74,2035,2037],{"className":2036},[78,77],"產生新的","動作型態 (這裡也有說到 ",[2040,2041,2045],"a",{"href":2042,"rel":2043},"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",[2044],"nofollow","在最後一段",[15,2047],{},"\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",[15,2050],{},"\n所以我們可以借由",[74,2053,2055],{"className":2054},[172],"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",[15,2058],{},"\n也可以透過",[74,2061,2063],{"className":2062},[77,78],"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",[74,2066,2068],{"className":2067},[77],"加粗","的方式讓寶寶更好握住",[15,2071],{},"\n但記得靠轉移來學習新的動作型態",[74,2074,2076],{"className":2075},[77,78],"不能一下子改太多太難","參數",[25,2079,2080,2081,1035,2086,1161,2090,2092,2093,2097,2098,2100,2101,2105,2107,2108,2112,2113,2115,2116,2120,2121,2123],{},"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（",[2040,2082,2085],{"href":2083,"rel":2084},"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",[2044],"一",[2040,2087,2089],{"href":2042,"rel":2088},[2044],"二",[15,2091],{},"\n集中VS分散，分散休息時間更長，對",[74,2094,2096],{"className":2095},[77],"學習較難或易疲勞病人","來說更佳",[15,2099],{},"\n段落VS隨機，隨機較難，但通常對",[74,2102,2104],{"className":2103},[172,77],"形成長期記憶以記轉移效果更有",[15,2106],{},"\n固定VS變異，變異在",[74,2109,2111],{"className":2110},[78,77],"轉移效果上","更佳",[15,2114],{},"\n全部VS分段，分段有",[74,2117,2119],{"className":2118},[77,78],"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",[15,2122],{},"\n心像練習，在腦中模擬動作型態",[25,2125,2126,2127,1035,2131,1035,2135,1035,2140,1238,2145,2147,2148,2150,2151,2153,2154,1161,2158,2160,2161,2165,2166,2168,2169,2173,2174,2176,2177,2179,2180,2184],{},"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(",[2040,2128,2085],{"href":2129,"rel":2130},"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",[2044],[2040,2132,2089],{"href":2133,"rel":2134},"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",[2044],[2040,2136,2139],{"href":2137,"rel":2138},"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",[2044],"三",[2040,2141,2144],{"href":2142,"rel":2143},"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",[2044],"四",[15,2146],{},"\nKR與KP，KR效度比KP更佳",[15,2149],{},"\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",[15,2152],{},"\n（",[2040,2155,2157],{"href":2142,"rel":2156},[2044],"這裡第一段有提到",[15,2159],{},"\n回饋的方法，",[2040,2162,2164],{"href":2133,"rel":2163},[2044],"這一篇的後半段","有提到，可以再複習一下",[15,2167],{},"\n先設定一個",[74,2170,2172],{"className":2171},[172],"區間","，達到的都算得分",[15,2175],{},"\n回饋也可以做遞減，逐漸減少依賴",[15,2178],{},"\n假如病人",[74,2181,2183],{"className":2182},[78,77],"主動要求回饋","，我們再給予，也會更佳",{"title":179,"searchDepth":180,"depth":180,"links":2186},[],"Motor Learning定義~結束","2026-04-13","\u002Fimages\u002Fuploads\u002F1775875520542-37128694_p0_master1200.jpg",{},"\u002Fblog\u002FMotor-Learning小兒（二）",{"title":1963,"description":2187},{"loc":2191},"blog\u002FMotor-Learning小兒（二）","vCmIeebtfGfHQk7UoNr_yn1XC2gwpWX_B8fsdXmUsJc",{"id":2197,"title":2198,"author":6,"body":2199,"date":2398,"description":2399,"draft":184,"edited_at":2398,"extension":185,"featured_image":2400,"meta":2401,"navigation":188,"path":2402,"pinned":184,"seo":2403,"sitemap":2404,"stem":2405,"tags":193,"__hash__":2406},"blog\u002Fblog\u002FGait-analysis小兒（一）.md","Gait analysis小兒（一）",{"type":8,"value":2200,"toc":2396},[2201,2204,2207,2224,2227,2238,2241,2258,2284,2290,2293,2310,2319,2330,2345,2351,2379,2382],[11,2202,2203],{},"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",[11,2205,2206],{},"那下肢雙關節肌肉有以下",[830,2208,2209,2212,2215,2218,2221],{},[25,2210,2211],{},"腰大肌——Hip Flexion, Trunk Flexion",[25,2213,2214],{},"腿後肌——Hip Extension, Knee Flexion",[25,2216,2217],{},"股直肌——Hip Flexion, Knee Extension",[25,2219,2220],{},"腓腸肌——Knee Flexion, PF",[25,2222,2223],{},"縫匠肌——Hip Flexion, Hip ER",[11,2225,2226],{},"那單關節的肌肉有",[830,2228,2229,2232,2235],{},[25,2230,2231],{},"臀大肌——Hip Extension, Hip ER",[25,2233,2234],{},"脛前肌——DF, inversion",[25,2236,2237],{},"腓骨長肌——PF, eversion",[11,2239,2240],{},"那以下動作的抗重力與無抗重力的擺位姿勢為",[830,2242,2243,2246,2249,2252,2255],{},[25,2244,2245],{},"Hip Extension——Prone 抗重力, side-lying 無抗重力",[25,2247,2248],{},"Hip Flexion——Sitting 抗重力, side-lying 無抗重力",[25,2250,2251],{},"Hip Abduction——Side-lying 抗重力, supine 無抗重力",[25,2253,2254],{},"Knee Extension——Sitting 抗重力, side-lying 無抗重力",[25,2256,2257],{},"PF——Standing 抗重力, prone 無抗重力",[11,2259,2260,2261,2263,2264,2268,2269,2273,2275,2276,2278,2279,2283],{},"接下來講一個異常步態——Crouch gait",[15,2262],{},"\n為甚麼他會呈現屈曲狀態，主要是因為",[74,2265,2267],{"className":2266},[77,78],"雙關節肌肉張力過強","，而",[74,2270,2272],{"className":2271},[77,172],"單關節肌肉力量不足",[15,2274],{},"\n不是單純的肌肉太緊，也是一種肌力失衡的表現",[15,2277],{},"\n其中，在",[74,2280,2282],{"className":2281},[77],"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)",[11,2285,2286,2287,2289],{},"接著來講步態的參數",[15,2288],{},"\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)",[11,2291,2292],{},"這邊提到一個中風後會出現的代償步態",[22,2294,2295,2298,2301,2304,2307],{},[25,2296,2297],{},"步速下降",[25,2299,2300],{},"步距縮短或不對稱",[25,2302,2303],{},"步寬變大(BOS增加)",[25,2305,2306],{},"雙腳站立期變長",[25,2308,2309],{},"依賴手部支撐",[11,2311,2312,2313,2315,2316,2318],{},"接著講Gait cycle，分別為站立期以及擺盪期",[15,2314],{},"\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",[15,2317],{},"\n完成這三個任務又分成了這八個動作",[830,2320,2321,2324,2327],{},[25,2322,2323],{},"承重——Initial contact和Loading Response",[25,2325,2326],{},"單腳支撐——Mid-stance, Terminal Stance和Pre-swing",[25,2328,2329],{},"肢體向前——Pre-swing, Initial swing, Mid-swing和Terminal Swing",[11,2331,2332,2333,2337,2338,2340,2341],{},"而Pre-swing雖然腳尖還沒離地，但",[74,2334,2336],{"className":2335},[77,172],"重心其實已經轉移去另一隻腳","了",[15,2339],{},"\n其中 ",[74,2342,2344],{"className":2343},[77],"Initial contact和Pre-swing為雙腳承重期",[11,2346,2347,2348,2350],{},"我們現在攤開來看站立期和擺盪期下肢各關節變化",[15,2349],{},"\n首先是站立期",[830,2352,2353,2361,2364,2370,2376],{},[25,2354,2355,2356,2360],{},"在雙腳承重期，",[74,2357,2359],{"className":2358},[77,172],"足部會放平","，準備Push Off",[25,2362,2363],{},"Hip的話，在Initical Contact的Flexion到Terminal Stance的Hyperextension",[25,2365,2366,2367,2369],{},"Knee的話，會從Flexion姿勢，到Mid-stance的Extension，再變回Pre-swing的Flexion",[15,2368],{},"\n(Flexion>Extension>Flexion)",[25,2371,2372,2373,2375],{},"Ankle的話，在Initical Contact的Neutral姿勢，Loading Response的PF，",[15,2374],{},"\nMid-stance的DF，最後是Terminal Stance\u002FPre-swing的PF（Neutral>PF>DF>PF）",[25,2377,2378],{},"Pelvis的話，基本保持水平，但在Terminal stance會略微前傾",[11,2380,2381],{},"然後是擺盪期",[830,2383,2384,2387,2390,2393],{},[25,2385,2386],{},"Knee的話，在Initical swing時會呈現Flexion，在Terminal swing會Full-extension",[25,2388,2389],{},"Hip的話，從Initical swing的Hyperextension，在Terminal swing會變成Flexion",[25,2391,2392],{},"Ankle的話，保持DF狀態，使腳尖不會碰到地板",[25,2394,2395],{},"Pelvis的話，會Rotation",{"title":179,"searchDepth":180,"depth":180,"links":2397},[],"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":2198,"description":2399},{"loc":2402},"blog\u002FGait-analysis小兒（一）","twQeon3uGQlDYDjG3t_oGlDC93CraJNGOOTRTTxdazk",{"id":2408,"title":2409,"author":6,"body":2410,"date":2398,"description":2598,"draft":184,"edited_at":2398,"extension":185,"featured_image":2599,"meta":2600,"navigation":188,"path":2601,"pinned":184,"seo":2602,"sitemap":2603,"stem":2604,"tags":193,"__hash__":2605},"blog\u002Fblog\u002FGait-analysis小兒（二）.md","Gait analysis小兒（二）",{"type":8,"value":2411,"toc":2596},[2412,2415,2529,2532,2567,2579,2585],[11,2413,2414],{},"現在我們將八個步態分期拆開了細看",[830,2416,2417,2441,2455,2473,2483,2504,2523,2526],{},[25,2418,2419,2420,2424,2428,2429,2433,2437,2438,2440],{},"Initical Contact——用",[74,2421,2423],{"className":2422},[77],"股四頭肌和脛前肌做",[74,2425,2427],{"className":2426},[77,78],"離心收縮","，這時",[74,2430,2432],{"className":2431},[77],"腿後肌做",[74,2434,2436],{"className":2435},[77,172],"向心收縮","協同加速穩定",[15,2439],{},"\n（減速與準備承重）",[25,2442,2443,2444,2448,2451,2452,2454],{},"Loading Response——",[74,2445,2447],{"className":2446},[77],"肌內側肌與脛前肌做",[74,2449,2427],{"className":2450},[77,78],"，而臀大肌以及腿後肌輔助Hip加速，將重心向前移動",[15,2453],{},"\n（避震）",[25,2456,2457,2458,2268,2462,2466,2469,2470,2472],{},"Mid-stance——膝蓋後方有關節囊結構的緣故，肌四頭肌幾乎",[74,2459,2461],{"className":2460},[172],"不需用力",[74,2463,2465],{"className":2464},[77],"比目魚肌此時做",[74,2467,2427],{"className":2468},[77,78],"控制脛骨速度",[15,2471],{},"\n（省力）",[25,2474,2475,2476,2480,2482],{},"Terminal stance——",[74,2477,2479],{"className":2478},[77,172],"腓腸肌與比目魚肌做向心收縮",[15,2481],{},"\n（產生推進力）",[25,2484,2485,2486,2490,1035,2493,2495,2496,2500],{},"Pre-swing——假如是慢速走路，會利用",[74,2487,2489],{"className":2488},[77],"縫匠肌(Sartorius)和肌薄肌(Graillis)做",[74,2491,2436],{"className":2492},[77,172],[15,2494],{},"\n快速行走則靠",[74,2497,2499],{"className":2498},[77],"肌直肌做",[74,2501,2503],{"className":2502},[77,922],"等長收縮",[25,2505,2506,2507,2511,2514,2516,2517,2520],{},"Initial swing——在慢速走路中，",[74,2508,2510],{"className":2509},[77],"股薄肌與縫匠肌會進行",[74,2512,2436],{"className":2513},[77,172],[15,2515],{},"\n而快速走路中，",[74,2518,2499],{"className":2519},[77],[74,2521,2503],{"className":2522},[77,922],[25,2524,2525],{},"Mid swing——靠慣性推進，基本沒有肌肉參與",[25,2527,2528],{},"Terminal swing——腿後肌做等長收縮，限制Knee extension速度",[11,2530,2531],{},"接著來講小腿後肌群無力的話會有甚麼問題",[22,2533,2534,2544],{},[25,2535,2536,2537,1035,2541,2543],{},"Mid-stannce——比目魚肌無力的話，會讓",[74,2538,2540],{"className":2539},[78,77],"Ankle做DF",[15,2542],{},"\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",[25,2545,2546,2547,2551,2553,2554,2558,2559,1895,2563],{},"Terminal stance和Pre-swing——腓腸肌力量不足的話，",[74,2548,2550],{"className":2549},[77,78],"沒辦法產生足夠的推進力",[15,2552],{},"\n只好讓",[74,2555,2557],{"className":2556},[78,77],"髖屈肌收縮","提起整段下肢，確保",[74,2560,2562],{"className":2561},[172],"腳尖離地",[74,2564,2566],{"className":2565},[563],"步距變短",[11,2568,2569,2570,2572,2573,2575,2576,2578],{},"最後講小孩的步態發展過程",[15,2571],{},"\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",[15,2574],{},"\n2歲的小孩懂得矢狀面(Sagittal-plane)關節旋轉",[15,2577],{},"\n7歲的小孩步態已經能達到成人標準了",[11,2580,2581,2582,2584],{},"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",[15,2583],{},"\n那CP小孩預測能力方面也分成了三個時段",[830,2586,2587,2590,2593],{},[25,2588,2589],{},"9~18個月——頭部控制能力",[25,2591,2592],{},"24個月——不需要支撐能獨自坐穩",[25,2594,2595],{},"30個月——做爬行",{"title":179,"searchDepth":180,"depth":180,"links":2597},[],"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":2409,"description":2598},{"loc":2601},"blog\u002FGait-analysis小兒（二）","x7y-Smp4poLa_EJUkNUpEi-ow03rff_xJb4B-xlHN1k",{"id":2607,"title":251,"author":6,"body":2608,"date":2398,"description":2752,"draft":184,"edited_at":2753,"extension":185,"featured_image":2754,"meta":2755,"navigation":188,"path":2756,"pinned":184,"seo":2757,"sitemap":2758,"stem":2759,"tags":193,"__hash__":2760},"blog\u002Fblog\u002F小兒發展（一）.md",{"type":8,"value":2609,"toc":2750},[2610,2613,2628,2634,2637,2663,2672,2674,2677,2694,2696,2699],[11,2611,2612],{},"（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）",[11,2614,2615,2616,2618,2619,2621,2622,2624,2625,2627],{},"那先來講發展遲緩的定義，它不單指運動層面上，還包括了",[15,2617],{},"\n知覺，語言，心理，社會，情緒等層面",[15,2620],{},"\n而這個動作遲緩有標準的",[15,2623],{},"\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",[15,2626],{},"\n根據WHO的數據，發生率為6~8%",[11,2629,2630,2631,2633],{},"那高危族群有以下",[15,2632],{},"\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",[11,2635,2636],{},"接下來講寶寶的正常發育過程，先從視角說起，如下",[830,2638,2639,2642,2645,2648,2651,2654,2657,2660],{},[25,2640,2641],{},"剛出生數天——眨眼反射",[25,2643,2644],{},"六周——注射物體",[25,2646,2647],{},"二到三個月——對明亮的東西感興趣",[25,2649,2650],{},"四個月——協調眼球轉動",[25,2652,2653],{},"一歲——影像認知發展完成，能看清輪廓",[25,2655,2656],{},"三歲——能分辨紅黃藍綠",[25,2658,2659],{},"五到六歲——可以分辨大多數顏色",[25,2661,2662],{},"八歲以前——有遠視現象（我問了Gemini也看不太懂就是了）",[11,2664,2665,2666,2668,2669,2671],{},"那關於視覺發展異常的問題包括了",[15,2667],{},"\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",[15,2670],{},"\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",[35,2673],{},[11,2675,2676],{},"接著是聽覺發展，如下",[830,2678,2679,2682,2685,2688,2691],{},[25,2680,2681],{},"四個月——追尋聲音或說話來源",[25,2683,2684],{},"七到八個月——被叫名字有反應",[25,2686,2687],{},"十個月——仿說（無意義內容）",[25,2689,2690],{},"一到一歲半——初步聽懂簡單的話",[25,2692,2693],{},"兩歲以後——鸚鵡式學說話",[35,2695],{},[11,2697,2698],{},"接下來是粗大動作的發展，如下",[830,2700,2701,2704,2707,2710,2713,2716,2719,2722,2725,2733,2741,2744,2747],{},[25,2702,2703],{},"兩個月——不穩定的抬頭控制",[25,2705,2706],{},"四個月——抬頭控制適當",[25,2708,2709],{},"五個月——翻身（先學會Prone to supine, 接著是supine to prone）",[25,2711,2712],{},"七個月——坐起來",[25,2714,2715],{},"八個月——爬行",[25,2717,2718],{},"九個月——需要支撐的站起來",[25,2720,2721],{},"十個月——僅需要極小輔助的從坐到站",[25,2723,2724],{},"一歲——獨立行走",[25,2726,2727,2728,2732],{},"兩歲——跑，",[74,2729,2731],{"className":2730},[172],"上樓梯","，踢球，投球，蹲下來",[25,2734,2735,2736,2740],{},"三歲——",[74,2737,2739],{"className":2738},[78],"下樓梯","，雙腳跳，騎三輪車",[25,2742,2743],{},"四歲——單腳跳",[25,2745,2746],{},"五歲——走直線",[25,2748,2749],{},"六歲——騎腳踏車",{"title":179,"searchDepth":180,"depth":180,"links":2751},[],"定義~粗大動作發展","2026-04-12","\u002Fimages\u002Fuploads\u002F1775957410970-EebbBUPUcAYSTE9.webp",{},"\u002Fblog\u002F小兒發展（一）",{"title":251,"description":2752},{"loc":2756},"blog\u002F小兒發展（一）","PRBPkkWsOaM11PriYRM9bPFgTo_bGZSIOZZuLMzA1sk",{"id":2762,"title":252,"author":6,"body":2763,"date":2753,"description":2915,"draft":184,"edited_at":2753,"extension":185,"featured_image":2916,"meta":2917,"navigation":188,"path":2918,"pinned":184,"seo":2919,"sitemap":2920,"stem":2921,"tags":193,"__hash__":2922},"blog\u002Fblog\u002F小兒發展（二）.md",{"type":8,"value":2764,"toc":2913},[2765,2768,2785,2787,2790,2818,2820,2823,2849,2851,2854,2868,2870,2873,2887,2889,2892,2900,2902,2905],[11,2766,2767],{},"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",[830,2769,2770,2773,2776,2779,2782],{},[25,2771,2772],{},"新生兒——中度的膝內翻（O型腿）",[25,2774,2775],{},"六個月——輕度的O型腿",[25,2777,2778],{},"一歲半——直的",[25,2780,2781],{},"三歲半——輕度的膝外翻（X型腿）",[25,2783,2784],{},"五到七歲——直的",[35,2786],{},[11,2788,2789],{},"而步態的發展會按照以下時期發展",[830,2791,2792,2795,2803,2806,2809,2812,2815],{},[25,2793,2794],{},"反射踏步（靠反射）",[25,2796,2797,2798,1161],{},"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—— ",[2040,2799,2802],{"href":2800,"rel":2801},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002Fmotor-learning?series=%E5%B0%8F%E5%85%92%E7%89%A9%E6%B2%BB",[2044],"倒數第二段",[25,2804,2805],{},"過渡期",[25,2807,2808],{},"刻意跨步",[25,2810,2811],{},"獨立行走",[25,2813,2814],{},"Heell-toe步態",[25,2816,2817],{},"整合或直立行走成熟期",[35,2819],{},[11,2821,2822],{},"接著來看不同系統的發展進程，從出生至九個月",[22,2824,2825,2831,2837,2843],{},[25,2826,2827,2828,2830],{},"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）",[15,2829],{},"\n尤其是視覺發展遠大於粗大動作",[25,2832,2833,2834,2836],{},"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",[15,2835],{},"\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",[25,2838,2839,2840,2842],{},"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)",[15,2841],{},"\nHip abduction(訓練方法是扶物側行)",[25,2844,2845,2846,2848],{},"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",[15,2847],{},"\n步寬外展；外轉(O型腿)；髖屈曲；足跟外翻",[35,2850],{},[11,2852,2853],{},"時間來到了九個月到第十五個月之間的發展進程",[830,2855,2856,2859,2862],{},[25,2857,2858],{},"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)",[25,2860,2861],{},"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",[25,2863,2864,2865,2867],{},"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",[15,2866],{},"\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",[35,2869],{},[11,2871,2872],{},"接下來時間來到了十八個月到二十四個月的發展進程",[830,2874,2875,2881],{},[25,2876,2877,2878,2880],{},"力學因素——重心下降(由於腿快速生長)，BOS減少",[15,2879],{},"\nROM的話O型腿消失，但有旋前足出現",[25,2882,2883,2884,2886],{},"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；",[15,2885],{},"\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)",[35,2888],{},[11,2890,2891],{},"時間繼續來到了三歲到三歲半的發展進程",[830,2893,2894,2897],{},[25,2895,2896],{},"力學因素——ROM的話膝外翻(X型腿)，且有旋前足出現",[25,2898,2899],{},"功能性步態——足跟著地穩定，且出現Knee flexion",[35,2901],{},[11,2903,2904],{},"最後時間來到了六歲到七歲的發展進程",[830,2906,2907,2910],{},[25,2908,2909],{},"力學因素——已經能直立行走，並且不在有旋前足",[25,2911,2912],{},"功能性步態——與成人一樣",{"title":179,"searchDepth":180,"depth":180,"links":2914},[],"步態~步態發展","\u002Fimages\u002Fuploads\u002F1775979234822-139196433_p0_master1200.webp",{},"\u002Fblog\u002F小兒發展（二）",{"title":252,"description":2915},{"loc":2918},"blog\u002F小兒發展（二）","tgAyAngzwVGZGqD2GsTT7J1O1RchC3cKRE-f381-bqo",{"id":2924,"title":253,"author":6,"body":2925,"date":2753,"description":3149,"draft":184,"edited_at":2188,"extension":185,"featured_image":3150,"meta":3151,"navigation":188,"path":3152,"pinned":184,"seo":3153,"sitemap":3154,"stem":3155,"tags":193,"__hash__":3156},"blog\u002Fblog\u002F小兒發展（三）.md",{"type":8,"value":2926,"toc":3147},[2927,2930,2933,2962,2964,2967,2984,2986,2989,3015,3017,3020,3053,3059,3078,3084,3110,3113,3116,3139,3142],[11,2928,2929],{},"寫著寫著發現這一課東西好多（悲",[11,2931,2932],{},"接著講精細動作的發展過程",[830,2934,2935,2938,2941,2944,2947,2950,2953,2956,2959],{},[25,2936,2937],{},"四個月——可以合掌",[25,2939,2940],{},"五個月——手可以向前伸並抓東西",[25,2942,2943],{},"七個月——握緊奶瓶",[25,2945,2946],{},"十個月——拍手",[25,2948,2949],{},"一歲——亂塗鴉",[25,2951,2952],{},"一歲半——疊兩到四個積木",[25,2954,2955],{},"兩歲——疊四到八個積木；畫直線",[25,2957,2958],{},"三歲——畫圓圈",[25,2960,2961],{},"五歲——畫出人形",[35,2963],{},[11,2965,2966],{},"假如有發展遲緩的問題，會有以下徵候",[22,2968,2969,2972,2975,2978,2981],{},[25,2970,2971],{},"以翻身作為移動方式",[25,2973,2974],{},"手腳不協調的爬行方式",[25,2976,2977],{},"W坐姿",[25,2979,2980],{},"兔子跳",[25,2982,2983],{},"一歲前出現明顯慣用手(因為一歲前大多為雙手並用)",[35,2985],{},[11,2987,2988],{},"而寶寶出現以下徵候，可能他有CP問題",[22,2990,2991,2994,2997,3000,3003,3006,3009,3012],{},[25,2992,2993],{},"躁動",[25,2995,2996],{},"缺乏精力",[25,2998,2999],{},"吸吮無力伴隨舌頭往前突",[25,3001,3002],{},"六個月大頭部控制不佳",[25,3004,3005],{},"口腔過度敏感",[25,3007,3008],{},"強直性咬合反射",[25,3010,3011],{},"不對稱動作形態",[25,3013,3014],{},"異常姿勢",[35,3016],{},[11,3018,3019],{},"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",[11,3021,3022,3023,3025,3026,3030,3031,3035,3037,3038,3042,3043,3047,3048,3052],{},"首先是語言準備期，分成了表達跟理解兩個面向",[15,3024],{},"\n這時候寶寶還小，表達還只能靠",[74,3027,3029],{"className":3028},[77],"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",[74,3032,3034],{"className":3033},[77],"學身邊的人咿咿呀呀",[15,3036],{},"\n而這個時候",[74,3039,3041],{"className":3040},[77,172],"理解能力比表達能力還要發展得快","，知覺部份開始分得出",[74,3044,3046],{"className":3045},[172],"語氣快慢聲源","等，也能",[74,3049,3051],{"className":3050},[172],"理解一些簡單的短語","例如yes or no等",[11,3054,3055,3056,3058],{},"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",[15,3057],{},"\n而語法構造則分為以下部份",[22,3060,3061,3069],{},[25,3062,3063,3064,3068],{},"句子表達能力——分成剛開始學的不完整句子，",[74,3065,3067],{"className":3066},[77,172],"只講關鍵的詞","；和發展到後面的會講完整句子",[25,3070,3071,3072,3074,3075,3077],{},"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",[15,3073],{},"\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",[15,3076],{},"\n最後也能理解對哪個人說甚麼樣的話",[11,3079,3080,3081,3083],{},"然後講一下正常語言發展能力，雖然跟聽覺有部份重合，",[15,3082],{},"\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(?)",[830,3085,3086,3089,3092,3095,3098,3101,3104,3107],{},[25,3087,3088],{},"四個月——頭尋找聲源",[25,3090,3091],{},"六到七個月——仿說",[25,3093,3094],{},"九到十二個月——叫爸爸媽媽",[25,3096,3097],{},"一歲到一歲半——只會講一兩個字且沒有意義",[25,3099,3100],{},"兩歲到兩歲半——講片語（例如像鸚鵡般學大人說啥）",[25,3102,3103],{},"三歲——開始能講句子，講顏色，倒數十，說出身體部位",[25,3105,3106],{},"四歲——能說出數種顏色",[25,3108,3109],{},"五歲——計算五個積木",[11,3111,3112],{},"(所以看起來三歲已經具備認知能力?)",[11,3114,3115],{},"那假如語言發展異常會有以下徵象",[22,3117,3118,3121,3124,3127,3130,3133,3136],{},[25,3119,3120],{},"一歲前——太安靜",[25,3122,3123],{},"兩歲——還沒有出現有意思的字詞",[25,3125,3126],{},"三歲——沒有出現任何句子",[25,3128,3129],{},"四歲——有構音困難",[25,3131,3132],{},"五歲——說話結巴",[25,3134,3135],{},"年紀越大話越少",[25,3137,3138],{},"鼻音重，說話小聲，不當的臉部表情，說話會喘",[11,3140,3141],{},"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",[11,3143,3144],{},[788,3145],{"alt":790,"src":3146},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776047406679-Screenshot_2026-04-13_102943.png",{"title":179,"searchDepth":180,"depth":180,"links":3148},[],"精細動作~語言發展","\u002Fimages\u002Fuploads\u002F1776047258825-ElqW51yVoAI09Jg.webp",{},"\u002Fblog\u002F小兒發展（三）",{"title":253,"description":3149},{"loc":3152},"blog\u002F小兒發展（三）","cGrD26dwyUjVzawlHZHH_OnTqXRpbSPGvcZEZluSbRk",{"id":3158,"title":254,"author":6,"body":3159,"date":2188,"description":3302,"draft":184,"edited_at":2188,"extension":185,"featured_image":3303,"meta":3304,"navigation":188,"path":3305,"pinned":184,"seo":3306,"sitemap":3307,"stem":3308,"tags":193,"__hash__":3309},"blog\u002Fblog\u002F小兒發展（四）.md",{"type":8,"value":3160,"toc":3300},[3161,3164,3187,3189,3192,3218,3220,3223,3243,3245,3248,3262,3264,3267,3281,3283,3286],[11,3162,3163],{},"接下來講到括約肌控制發展（大小便控制）",[830,3165,3166,3169,3178,3184],{},[25,3167,3168],{},"十五個月——能告訴爸媽想上廁所或者褲子濕了",[25,3170,3171,3172,3174,3175,3177],{},"十八個月——白天褲子不太會濕，當然也有意外；",[15,3173],{},"\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；",[15,3176],{},"\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",[25,3179,3180,3181,3183],{},"兩到三歲——半夜讓小孩上廁所就整晚不會尿床",[15,3182],{},"\n有研究表明，晚上會叫尿床的都比較神經質(講義原句XD)",[25,3185,3186],{},"三歲——能自己上廁所但擦不乾淨，要到六歲才能擦乾淨",[35,3188],{},[11,3190,3191],{},"接著講ADL的發展",[830,3193,3194,3197,3200,3206,3209,3212,3215],{},[25,3195,3196],{},"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",[25,3198,3199],{},"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",[25,3201,3202,3203,3205],{},"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；",[15,3204],{},"\n也開始可以脫襪子和鞋子",[25,3207,3208],{},"十八個月——會脫襪子鞋子，將拉鏈拉開，不需要轉動湯匙進食",[25,3210,3211],{},"兩歲——可以穿脫襪子鞋子褲子",[25,3213,3214],{},"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",[25,3216,3217],{},"五歲——會綁鞋子",[35,3219],{},[11,3221,3222],{},"社會性情緒發展部份",[830,3224,3225,3228,3234,3237,3240],{},[25,3226,3227],{},"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",[25,3229,3230,3231,3233],{},"六到十二個月——十分依賴，認得且會得媽媽",[15,3232],{},"\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",[25,3235,3236],{},"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",[25,3238,3239],{},"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",[25,3241,3242],{},"二十四到三十六個月——越來越適應陌生環境，上托兒所",[35,3244],{},[11,3246,3247],{},"自我概念發展部份",[830,3249,3250,3253,3256,3259],{},[25,3251,3252],{},"剛出生到六個月——動作控制不佳；稍微分得出自我跟非自我",[25,3254,3255],{},"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",[25,3257,3258],{},"十八到二十四個月——對自己名字敏感",[25,3260,3261],{},"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",[35,3263],{},[11,3265,3266],{},"情緒發展部份",[830,3268,3269,3272,3275,3278],{},[25,3270,3271],{},"剛出生到六個月——早期只有哭跟高興表情",[25,3273,3274],{},"六到十二個月——開始有其他情緒例如厭惡，害怕，憤怒",[25,3276,3277],{},"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",[25,3279,3280],{},"十八到二十四個月——能夠用語言表達情緒",[35,3282],{},[11,3284,3285],{},"依賴及獨立發展",[830,3287,3288,3291,3294],{},[25,3289,3290],{},"剛出生到十二個月——完全依賴照顧",[25,3292,3293],{},"十二到十八個月——知道自己是個體後，想自我尋求",[25,3295,3296,3297,3299],{},"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；",[15,3298],{},"\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":179,"searchDepth":180,"depth":180,"links":3301},[],"括約肌控制~依賴獨立發展","\u002Fimages\u002Fuploads\u002F1776052282656-EXjYORHUcAALULe.webp",{},"\u002Fblog\u002F小兒發展（四）",{"title":254,"description":3302},{"loc":3305},"blog\u002F小兒發展（四）","iCO6Xr2Vz0v9l6ulRBKlWBt93Dzu8k8I4HDGsX-Dbpc",{"id":3311,"title":255,"author":6,"body":3312,"date":986,"description":3452,"draft":184,"edited_at":986,"extension":185,"featured_image":3453,"meta":3454,"navigation":188,"path":3455,"pinned":184,"seo":3456,"sitemap":3457,"stem":3458,"tags":193,"__hash__":3459},"blog\u002Fblog\u002F小兒發展（五）.md",{"type":8,"value":3313,"toc":3450},[3314,3320,3334,3337,3357,3359,3362,3391,3393,3396,3416,3418,3421],[11,3315,3316,3317,3319],{},"接下來講到一個叫皮亞傑的人，他提出了發展理論",[15,3318],{},"\n先來講他說的四大認知階段",[830,3321,3322,3325,3328,3331],{},[25,3323,3324],{},"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",[25,3326,3327],{},"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）",[25,3329,3330],{},"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",[25,3332,3333],{},"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",[11,3335,3336],{},"接著是他提到的感覺運動期",[830,3338,3339,3342,3345,3348,3351,3354],{},[25,3340,3341],{},"反射期(0-2m)——對，就一堆反射",[25,3343,3344],{},"初級循環反應期(3-5m)——摸索自己身體",[25,3346,3347],{},"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）",[25,3349,3350],{},"兩個基模協調(9-12m)——透過兩種動作模式達成目的；理解因果",[25,3352,3353],{},"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",[25,3355,3356],{},"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",[35,3358],{},[11,3360,3361],{},"然後是個人與社會發展",[830,3363,3364,3367,3370,3373,3376,3379,3382,3385,3388],{},[25,3365,3366],{},"兩個月——會對別人笑",[25,3368,3369],{},"六個月——自己拿玩具玩",[25,3371,3372],{},"六到八個月——開始理解陌生，不讓陌生人抱",[25,3374,3375],{},"十個月——搖手bye bye（maybe是已經將動作與語言結合?）",[25,3377,3378],{},"一歲——拿杯子喝水",[25,3380,3381],{},"十五個月——拿湯匙、脫下外套、學刷牙",[25,3383,3384],{},"兩歲——會洗手",[25,3386,3387],{},"三歲——會穿脫鞋",[25,3389,3390],{},"四歲——穿衣服，扣鈕扣，刷牙",[35,3392],{},[11,3394,3395],{},"接下來講ASD的臨床徵象（即使動作發展正常，也會有語言delay）",[830,3397,3398,3401,3404,3407,3410,3413],{},[25,3399,3400],{},"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",[25,3402,3403],{},"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",[25,3405,3406],{},"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",[25,3408,3409],{},"注意力不集中——無法持久學習",[25,3411,3412],{},"衝動——人際關係緊張",[25,3414,3415],{},"好動——無法遵守規矩，破壞力強",[35,3417],{},[11,3419,3420],{},"吞嚥異常的臨床徵象",[830,3422,3423,3426,3429,3432,3435,3438,3441,3444,3447],{},[25,3424,3425],{},"反覆性肺炎",[25,3427,3428],{},"營養不良",[25,3430,3431],{},"抗拒食物",[25,3433,3434],{},"吞嚥困難",[25,3436,3437],{},"口中有異物感",[25,3439,3440],{},"嗆咳",[25,3442,3443],{},"口中有異味",[25,3445,3446],{},"經營嘔吐",[25,3448,3449],{},"流口水",{"title":179,"searchDepth":180,"depth":180,"links":3451},[],"皮亞傑~結束","\u002Fimages\u002Fuploads\u002F1776132158232-tHG70Gg.webp",{},"\u002Fblog\u002F小兒發展（五）",{"title":255,"description":3452},{"loc":3455},"blog\u002F小兒發展（五）","hzbfl2qpxvvTUq5Hn8aXvAKEpMa7oP19s8AD5xnz-1Q",{"id":3461,"title":256,"author":6,"body":3462,"date":3805,"description":3806,"draft":184,"edited_at":3805,"extension":185,"featured_image":3807,"meta":3808,"navigation":188,"path":3809,"pinned":184,"seo":3810,"sitemap":3811,"stem":3812,"tags":193,"__hash__":3813},"blog\u002Fblog\u002FGMFCS.md",{"type":8,"value":3463,"toc":3803},[3464,3467,3470,3487,3630,3633,3659,3661,3664,3681,3683,3686,3706,3708,3711,3731,3733,3736,3752,3754,3757,3774,3776,3779,3798,3800],[11,3465,3466],{},"寫完繼續趕神經 不然我會發神經",[11,3468,3469],{},"GMFCS分級定義",[830,3471,3472,3475,3478,3481,3484],{},[25,3473,3474],{},"一級——行走不受限",[25,3476,3477],{},"二級——行走受限",[25,3479,3480],{},"三級——使用手持輔具",[25,3482,3483],{},"四級——需要電動輪椅",[25,3485,3486],{},"五級——需要別人手推輪椅",[3488,3489,3490,3517],"table",{},[3491,3492,3493],"thead",{},[3494,3495,3496,3502,3505,3508,3511,3514],"tr",{},[3497,3498,3500],"th",{"align":3499},"left",[15,3501],{},[3497,3503,3504],{"align":3499},"0-2y",[3497,3506,3507],{"align":3499},"2-4y",[3497,3509,3510],{"align":3499},"4-6y",[3497,3512,3513],{"align":3499},"6-12y",[3497,3515,3516],{"align":3499},"12-18y",[3518,3519,3520,3544,3567,3590,3608],"tbody",{},[3494,3521,3522,3526,3529,3532,3536,3540],{},[3523,3524,3525],"td",{"align":3499},"I",[3523,3527,3528],{"align":3499},"1. Sitting free on the floor            2. Crawl on hands and knee 3. Pull to stand  4. Takes few step with support",[3523,3530,3531],{"align":3499},"Independent walking without assistance",[3523,3533,3534],{"align":3499},[15,3535],{},[3523,3537,3538],{"align":3499},[15,3539],{},[3523,3541,3542],{"align":3499},[15,3543],{},[3494,3545,3546,3549,3552,3555,3559,3563],{},[3523,3547,3548],{"align":3499},"II",[3523,3550,3551],{"align":3499},"1. Sitting may need support   2. Creep on stomach",[3523,3553,3554],{"align":3499},"but sitting with support",[3523,3556,3557],{"align":3499},[15,3558],{},[3523,3560,3561],{"align":3499},[15,3562],{},[3523,3564,3565],{"align":3499},[15,3566],{},[3494,3568,3569,3572,3575,3578,3582,3586],{},[3523,3570,3571],{"align":3499},"III",[3523,3573,3574],{"align":3499},"1. Low back supported        2. Roll or creep on stomach",[3523,3576,3577],{"align":3499},"1. W-sitting      2. Creep or crawl                3. Walking with walker indoor",[3523,3579,3580],{"align":3499},[15,3581],{},[3523,3583,3584],{"align":3499},[15,3585],{},[3523,3587,3588],{"align":3499},[15,3589],{},[3494,3591,3592,3595,3598,3601,3604,3606],{},[3523,3593,3594],{"align":3499},"IV",[3523,3596,3597],{"align":3499},"1. Head control  2. Roll to supine; may roll to prone",[3523,3599,3600],{"align":3499},"1. Sitting with support (cannot maintain in good alignment) 2. Roll or creep or crawl without reciprocal movements",[3523,3602,3603],{"align":3499},"Self mobility with powered W\u002FC",[3523,3605,3603],{"align":3499},[3523,3607,3603],{"align":3499},[3494,3609,3610,3613,3616,3618,3622,3626],{},[3523,3611,3612],{"align":3499},"V",[3523,3614,3615],{"align":3499},"Unable maintain antigravity head control",[3523,3617,3615],{"align":3499},[3523,3619,3620],{"align":3499},[15,3621],{},[3523,3623,3624],{"align":3499},[15,3625],{},[3523,3627,3628],{"align":3499},[15,3629],{},[11,3631,3632],{},"接著是操作的部份",[22,3634,3635,3638,3641,3644,3647,3650,3653,3656],{},[25,3636,3637],{},"軀幹支持行助行器——可以支撐pelvis trunk",[25,3639,3640],{},"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",[25,3642,3643],{},"肢體協助——需要別人協助移動",[25,3645,3646],{},"電動移動輔助——電動輪椅，代步車，等",[25,3648,3649],{},"手動輪椅自推——自己推",[25,3651,3652],{},"被動運送——被人推",[25,3654,3655],{},"行走——可以帶矯具但不能用輔具",[25,3657,3658],{},"輪式移動工具——包括電動輪椅，手動輪椅還有推車",[35,3660],{},[11,3662,3663],{},"兩歲前",[22,3665,3666,3669,3672,3675,3678],{},[25,3667,3668],{},"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",[25,3670,3671],{},"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",[25,3673,3674],{},"三級——下背部被支撐才能坐穩；會翻身、腹貼地爬",[25,3676,3677],{},"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",[25,3679,3680],{},"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",[35,3682],{},[11,3684,3685],{},"二到四歲",[22,3687,3688,3691,3694,3700,3703],{},[25,3689,3690],{},"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",[25,3692,3693],{},"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",[25,3695,3696,3697,3699],{},"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）",[15,3698],{},"\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",[25,3701,3702],{},"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",[25,3704,3705],{},"五級——幾乎不會動",[35,3707],{},[11,3709,3710],{},"四到六歲",[22,3712,3713,3716,3722,3725,3728],{},[25,3714,3715],{},"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",[25,3717,3718,3719,3721],{},"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；",[15,3720],{},"\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",[25,3723,3724],{},"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",[25,3726,3727],{},"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",[25,3729,3730],{},"五級——幾乎不動",[35,3732],{},[11,3734,3735],{},"六到十二歲",[22,3737,3738,3741,3744,3747,3750],{},[25,3739,3740],{},"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",[25,3742,3743],{},"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",[25,3745,3746],{},"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",[25,3748,3749],{},"四級——需他人協助或電動輪椅移動",[25,3751,3730],{},[35,3753],{},[11,3755,3756],{},"十二到十八歲",[22,3758,3759,3762,3765,3768,3771],{},[25,3760,3761],{},"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",[25,3763,3764],{},"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",[25,3766,3767],{},"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",[25,3769,3770],{},"四級——需輪式輔具移動；需肢體協助設備；常用電動輪椅移動",[25,3772,3773],{},"五級——被動協助移動",[35,3775],{},[11,3777,3778],{},"各分級比較",[22,3780,3781,3784,3787,3795],{},[25,3782,3783],{},"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",[25,3785,3786],{},"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",[25,3788,3789,3790],{},"三級VS四級——主要為坐姿及自動移動差異；",[22,3791,3792],{},[25,3793,3794],{},"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",[25,3796,3797],{},"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",[35,3799],{},[11,3801,3802],{},"還好內容不多也不難啃，嚇死我了",{"title":179,"searchDepth":180,"depth":180,"links":3804},[],"2026-04-19","好像是要自己看的補充","\u002Fimages\u002Fuploads\u002F1776579606728-El0Kc5OVMAEdbG5.webp",{},"\u002Fblog\u002FGMFCS",{"title":256,"description":3806},{"loc":3809},"blog\u002FGMFCS","G29aDr074P62Nd9uZoQMiZkkv7riTkIuliNENvcBRcI",{"id":3815,"title":257,"author":6,"body":3816,"date":4041,"description":4042,"draft":184,"edited_at":4043,"extension":185,"featured_image":4044,"meta":4045,"navigation":188,"path":4046,"pinned":184,"seo":4047,"sitemap":4048,"stem":4049,"tags":193,"__hash__":4050},"blog\u002Fblog\u002FBPI.md",{"type":8,"value":3817,"toc":4039},[3818,3824,3833,3842,3848,3854,3865,3868,3870,3873,3890,3893,3936,3938,3947,3953,3989,3992,3997,4004,4007,4021],[11,3819,3820,3821,3823],{},"BPI，臂叢傷害，在1768年在英國第一次被提出來",[15,3822],{},"\n臂叢包括了從C5到T1的五條神經",[11,3825,3826,3827,3829,3830,3832],{},"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",[15,3828],{},"\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",[15,3831],{},"\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",[11,3834,3835,3836,3838,3839,3841],{},"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",[15,3837],{},"\n在剛出生第一年恢復會很快，但肌肉無力還是會存在",[15,3840],{},"\n（大概每個月長1 inch\u002F每天1 mm）",[11,3843,3844,3845,3847],{},"會造成臂叢傷害，可能是因為嬰兒太大",[15,3846],{},"\n在自然分娩時頭出來但嬰兒肩膀還卡在骨盤裡",[11,3849,3850,3851,3853],{},"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",[15,3852],{},"\n手臂無力在剛出生就可以被觀察到，相關併發症有",[22,3855,3856,3859,3862],{},[25,3857,3858],{},"鎖骨骨折",[25,3860,3861],{},"肱骨骨折",[25,3863,3864],{},"霍納氏症候群：眼瞼下垂，較小的瞳孔",[11,3866,3867],{},"發生率在每1000個裡有0.6~3個",[35,3869],{},[11,3871,3872],{},"按照神經受傷類型分成",[22,3874,3875,3878,3881,3884,3887],{},[25,3876,3877],{},"Avulsion撕脫——神經跟脊髓連接斷開，無法靠再生或開刀修復",[25,3879,3880],{},"Rupture斷裂——斷裂處不在脊髓，可靠開刀修復",[25,3882,3883],{},"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",[25,3885,3886],{},"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",[25,3888,3889],{},"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",[11,3891,3892],{},"按照傷到的哪一條神經又分成",[22,3894,3895,3913,3930,3933],{},[25,3896,3897,3898,3902,3903],{},"Erb’s Palsy or upper-plexus type（",[74,3899,3901],{"className":3900},[78,77],"最常見","）——傷到C5和C6",[22,3904,3905],{},[25,3906,3907,3908],{},"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",[22,3909,3910],{},[25,3911,3912],{},"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",[25,3914,3915,3916,3920,3921],{},"Klumpke’s Palsy or lower-plexus type（",[74,3917,3919],{"className":3918},[77,78],"少見","）——C7到T1",[22,3922,3923],{},[25,3924,3925,3926,1161],{},"手部內在肌無力（特別是",[74,3927,3929],{"className":3928},[172],"尺側",[25,3931,3932],{},"Duchennes Palsy——C7",[25,3934,3935],{},"Whole arm type——C5到T1",[35,3937],{},[11,3939,3940,3941,3943,3944,3946],{},"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",[15,3942],{},"\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）",[15,3945],{},"\n（通常在一歲前肩部問題要處理好）",[11,3948,3949,3950,3952],{},"那這邊老師給了一張叫Hospital for Sick Children Active Movement Scale的量表（AMS）",[15,3951],{},"\n評分一共七個，是按照MMT改過來的（我感覺是）",[22,3954,3955,3975],{},[25,3956,3957,3958],{},"非抗重力",[22,3959,3960,3963,3966,3969,3972],{},[25,3961,3962],{},"0——沒有任何反應",[25,3964,3965],{},"1——有肌肉收縮，無動作",[25,3967,3968],{},"2——能活動範圍\u003C1\u002F2",[25,3970,3971],{},"3——能活動範圍>1\u002F2",[25,3973,3974],{},"4——full range",[25,3976,3977,3978],{},"抗重力",[22,3979,3980,3983,3986],{},[25,3981,3982],{},"5——能活動範圍\u003C1\u002F2",[25,3984,3985],{},"6——能活動範圍>1\u002F2",[25,3987,3988],{},"7——full range",[11,3990,3991],{},"這一個是Mallet classification(Mallet Scale) 錄肩部和手臂功能變化的評分系統",[11,3993,3994],{},[788,3995],{"alt":790,"src":3996},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1780284740177-malletslace_full.gif",[11,3998,3999],{},[2040,4000,4003],{"href":4001,"rel":4002},"https:\u002F\u002Fwww.stlouischildrens.org\u002Fconditions-treatments\u002Fneurosurgery-services\u002Fbrachial-plexus-center\u002Ftreatment-goals\u002Fmedical-treatment",[2044],"此圖我從這裡找的",[11,4005,4006],{},"評估反射的內容包括",[22,4008,4009,4012,4015,4018],{},[25,4010,4011],{},"Moro",[25,4013,4014],{},"Galant",[25,4016,4017],{},"Neck righting, hand placing",[25,4019,4020],{},"Visual tracking",[11,4022,4023,4024,4026,4027,4029,4030,4032,4033,4035],{},"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",[15,4025],{},"\n提供對恢復有利的環境",[15,4028],{},"\n將攣縮問題降到最低",[15,4031],{},"\n以及著手運動訓練",[15,4034],{},[74,4036,4038],{"className":4037},[77,78],"（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":179,"searchDepth":180,"depth":180,"links":4040},[],"2026-05-29","BPI，斜頸等下再寫","2026-06-01","\u002Fimages\u002Fuploads\u002F1780287451942-138768698_p0_master1200.webp",{},"\u002Fblog\u002FBPI",{"title":257,"description":4042},{"loc":4046},"blog\u002FBPI","BKiUvsIFaniao4lSrn5PHOXgLG4FS10Qmaqzt74VOCs",{"id":4052,"title":258,"author":6,"body":4053,"date":4043,"description":4330,"draft":184,"edited_at":4331,"extension":185,"featured_image":4332,"meta":4333,"navigation":188,"path":4334,"pinned":184,"seo":4335,"sitemap":4336,"stem":4337,"tags":193,"__hash__":4338},"blog\u002Fblog\u002F先天性肌肉斜頸症CMT.md",{"type":8,"value":4054,"toc":4328},[4055,4073,4085,4091,4093,4096,4211,4213,4216],[11,4056,4057,4058,4060,4061,4063,4064,4066,4067,4069,4070,4072],{},"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）",[15,4059],{},"\n每1000個新生兒中就有3到20例",[15,4062],{},"\n病因包括：",[15,4065],{},"\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",[15,4068],{},"\n而斜頸的特徵為",[15,4071],{},"\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）",[11,4074,4075,4076,4078,4079,4081,4082,4084],{},"斜頸是表徵，不是診斷結果",[15,4077],{},"\n其中又有80%是天生的",[15,4080],{},"\n斜頸可以是慢性存在，也可以是急性發作",[15,4083],{},"\n可能伴隨不對稱的眼睛位置",[11,4086,4087,4088,4090],{},"通常PT可以做牽拉患側，增加健側肌肉力量，以及擺位",[15,4089],{},"\n假如有很嚴重的畸型，可以在1歲時進行手術",[35,4092],{},[11,4094,4095],{},"現在說一下可能會引發斜頸的問題",[22,4097,4098,4106,4114,4122,4130,4138,4161,4172,4180,4188,4203],{},[25,4099,4100,4101],{},"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",[22,4102,4103],{},[25,4104,4105],{},"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",[25,4107,4108,4109],{},"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",[22,4110,4111],{},[25,4112,4113],{},"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",[25,4115,4116,4117],{},"Clevical spine fractures and dislocations（頸椎骨折和脫臼）——有嚴重外傷史",[22,4118,4119],{},[25,4120,4121],{},"一般是車禍或高空墜落造成",[25,4123,4124,4125],{},"Chordomas（脊索瘤）——呈現下運動神經元問題，但小腦功能正常",[22,4126,4127],{},[25,4128,4129],{},"要看那顆瘤長在哪，才知道具體症狀",[25,4131,4132,4133],{},"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",[22,4134,4135],{},[25,4136,4137],{},"因體重超重，或胎位不正導致難產",[25,4139,4140,4141],{},"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",[22,4142,4143,4146,4149,4152,4155,4158],{},[25,4144,4145],{},"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",[25,4147,4148],{},"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）",[25,4150,4151],{},"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",[25,4153,4154],{},"反射檢查如X光不會照到異常",[25,4156,4157],{},"治療通常是運動為主",[25,4159,4160],{},"假如是出生之後幾年才被確診的小孩，需要做手術鬆開SCM",[25,4162,4163,4164],{},"Drug intoxication（藥物中毒）——服藥過量，如抗癲癇藥物",[22,4165,4166,4169],{},[25,4167,4168],{},"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",[25,4170,4171],{},"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",[25,4173,4174,4175],{},"Extraocular muscle Paresis（眼外肌麻痺）——無法讓眼睛全範圍運動",[22,4176,4177],{},[25,4178,4179],{},"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",[25,4181,4182,4183],{},"Juvenile Rheumatoid Arthritis（幼年型類風濕關節炎JRA）——在頭前傾姿勢十分常見",[22,4184,4185],{},[25,4186,4187],{},"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",[25,4189,4190,4191],{},"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",[22,4192,4193,4196],{},[25,4194,4195],{},"患者在40~50歲會有神經系統方面的問題",[25,4197,4198],{},[2040,4199,4202],{"href":4200,"rel":4201},"https:\u002F\u002Fwww.tfrd.org.tw\u002Ftfrd\u002Frare_b\u002Fview\u002Fid\u002F266",[2044],"這個中文名字翻譯我從這裡找的",[25,4204,4205,4206],{},"Muscle strain（肌肉拉傷）——有外傷史",[22,4207,4208],{},[25,4209,4210],{},"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",[35,4212],{},[11,4214,4215],{},"接下來講可能會導致斜頸的神經性運動障礙",[22,4217,4218,4226,4234,4242,4250,4258,4261,4269,4277,4285,4293,4301,4304,4312,4320],{},[25,4219,4220,4221],{},"Benign paroxysmal torticollis of infancy（良性陣發性嬰幼兒斜頸症）——類似於癲癇的症狀",[22,4222,4223],{},[25,4224,4225],{},"是多重原因導致",[25,4227,4228,4229],{},"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",[22,4230,4231],{},[25,4232,4233],{},"可以是顯性或隱性，原因不明",[25,4235,4236,4237],{},"Sandifer’s syndrome（桑迪弗氏症候群）——有胃食道逆流，突然斜頸的問題",[22,4238,4239],{},[25,4240,4241],{},"通常跟腦麻相關，有癲癇病史",[25,4243,4244,4245],{},"Pharyngeal abscess（咽後膿腫）——發炎時會有嚴重斜頸狀況",[22,4246,4247],{},[25,4248,4249],{},"口腔跟喉嚨會痠痛",[25,4251,4252,4253],{},"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",[22,4254,4255],{},[25,4256,4257],{},"機制不明，初期症狀與CMT容易被混淆",[25,4259,4260],{},"Psychogenic（心因性）——非典型的頸椎問題（例如發展遲緩）",[25,4262,4263,4264],{},"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",[22,4265,4266],{},[25,4267,4268],{},"會維持在同一方向傾斜和旋轉（跟CMT不同），可由X光確認",[25,4270,4271,4272],{},"Spastic Tordicollis（痙攣型斜頸）——頭會轉向一邊",[22,4273,4274],{},[25,4275,4276],{},"通常伴有呼吸道感染；好發在5~11歲；治療可靠熱敷及頸圈",[25,4278,4279,4280],{},"Spinal cord tumors（脊髓瘤）——出現下運動神經無力問題，但小腦功能正常",[22,4281,4282],{},[25,4283,4284],{},"具體要看腫瘤長在哪才知道狀況（感覺跟上面脊索瘤挺像）",[25,4286,4287,4288],{},"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",[22,4289,4290],{},[25,4291,4292],{},"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",[25,4294,4295,4296],{},"Syringomyelia（脊髓空洞症）——感覺喪失，肌肉萎縮，肌健反射消失",[22,4297,4298],{},[25,4299,4300],{},"病況取決於病灶level",[25,4302,4303],{},"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）",[25,4305,4306,4307],{},"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",[22,4308,4309],{},[25,4310,4311],{},"需手術切除",[25,4313,4314,4315],{},"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",[22,4316,4317],{},[25,4318,4319],{},"可使用抗生素治療",[25,4321,4322,4323],{},"Tuberculosis of the Cervical Spine（頸椎結核）——頸部和喉嚨會有疼痛，壓痛，腫脹",[22,4324,4325],{},[25,4326,4327],{},"通常是不對稱的傷害椎體，導致旋轉伴隨後凸",{"title":179,"searchDepth":180,"depth":180,"links":4329},[],"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":258,"description":4330},{"loc":4334},"blog\u002F先天性肌肉斜頸症CMT","1IZxGkst_bAVHix9u2lgPuJocdxwcKhvepyQjaOjwuM",{"id":4340,"title":259,"author":6,"body":4341,"date":182,"description":4448,"draft":184,"edited_at":182,"extension":185,"featured_image":4449,"meta":4450,"navigation":188,"path":4451,"pinned":184,"seo":4452,"sitemap":4453,"stem":4454,"tags":193,"__hash__":4455},"blog\u002Fblog\u002FMR智能不足.md",{"type":8,"value":4342,"toc":4446},[4343,4346,4349,4364,4373,4376,4434],[11,4344,4345],{},"先鬼轉來小兒好了 東西好像有點多",[11,4347,4348],{},"智能不足的定義是指IQ小於等於70以下的寶寶",[11,4350,4351,4352,4354,4355,4357,4358,4360,4361,4363],{},"那評估的表有",[15,4353],{},"\nStandford-Binet Intellectual Scale——適用於2.5歲",[15,4356],{},"\n中華智力發展量表——適用於6歲",[15,4359],{},"\nBayley Scale——適用於0~3歲",[15,4362],{},"\nWechsler Preschool and Primary scale of intelligence——適用於學齡前",[11,4365,4366,4367,4369,4370,4372],{},"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",[15,4368],{},"\n溝通，Self-care，居家生活，社交技巧，社區資源運用(community use)",[15,4371],{},"\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",[11,4374,4375],{},"從IQ範圍區分出",[22,4377,4378,4392,4406,4420],{},[25,4379,4380,4381],{},"輕度智能不足：IQ 50~70",[22,4382,4383,4386,4389],{},[25,4384,4385],{},"學齡期前：外表看起來正常",[25,4387,4388],{},"學齡期：在學業上需特殊教育（可達國小六年級程度）",[25,4390,4391],{},"成年人：可獨立生活",[25,4393,4394,4395],{},"中度：IQ 35~50",[22,4396,4397,4400,4403],{},[25,4398,4399],{},"學齡期前：社交技巧差",[25,4401,4402],{},"學齡期：需特殊訓練（可達國小四年級程度）",[25,4404,4405],{},"成年人：可從事非技術性職業",[25,4407,4408,4409],{},"重度：IQ 20~35",[22,4410,4411,4414,4417],{},[25,4412,4413],{},"學齡期前：缺乏溝通能力",[25,4415,4416],{},"學齡期：無法學習",[25,4418,4419],{},"成年人：日常活動需他人協助",[25,4421,4422,4423],{},"極嚴重：IQ\u003C20",[22,4424,4425,4428,4431],{},[25,4426,4427],{},"學齡期前：依賴他人照護",[25,4429,4430],{},"學齡期：依賴他人照護",[25,4432,4433],{},"成年人：依賴他人照護",[11,4435,4436,4437,4439,4440,4442,4443,4445],{},"從接受教育程度上，分成",[15,4438],{},"\nEducable：可被教育，可以上一般班級或資源班",[15,4441],{},"\nTrainable：可被訓練，學習一些謀生技巧",[15,4444],{},"\nDependent：依賴",{"title":179,"searchDepth":180,"depth":180,"links":4447},[],"Intellectual disability","\u002Fimages\u002Fuploads\u002F1781247645586-145852080_p0_master1200.webp",{},"\u002Fblog\u002FMR智能不足",{"title":259,"description":4448},{"loc":4451},"blog\u002FMR智能不足","NZFChlk4JSzba5twGABUXtvtVQmu1tEvseZHqvvw_z4",{"id":4,"title":5,"author":6,"body":4457,"date":182,"description":183,"draft":184,"edited_at":182,"extension":185,"featured_image":186,"meta":4570,"navigation":188,"path":189,"pinned":184,"seo":4571,"sitemap":4572,"stem":192,"tags":193,"__hash__":194},{"type":8,"value":4458,"toc":4568},[4459,4463,4465,4473,4475,4477,4481,4489,4495,4502,4523,4529,4531,4533,4547,4553,4555],[11,4460,13,4461,17],{},[15,4462],{},[11,4464,20],{},[22,4466,4467,4469,4471],{},[25,4468,27],{},[25,4470,30],{},[25,4472,33],{},[35,4474],{},[11,4476,39],{},[11,4478,42,4479,45],{},[15,4480],{},[11,4482,48,4483,51,4485,54,4487,57],{},[15,4484],{},[15,4486],{},[15,4488],{},[11,4490,60,4491,63,4493,66],{},[15,4492],{},[15,4494],{},[11,4496,69,4497,72,4499],{},[15,4498],{},[74,4500,79],{"className":4501},[77,78],[11,4503,82,4504,85,4506,88,4508,91,4510,94,4512,97,4514,100,4516,103,4518],{},[15,4505],{},[15,4507],{},[15,4509],{},[15,4511],{},[15,4513],{},[15,4515],{},[15,4517],{},[105,4519,4520],{},[74,4521,110],{"className":4522},[77,78],[11,4524,113,4525,116,4527,119],{},[15,4526],{},[15,4528],{},[11,4530,122],{},[11,4532,125],{},[22,4534,4535,4537,4539,4541,4543,4545],{},[25,4536,130],{},[25,4538,133],{},[25,4540,136],{},[25,4542,139],{},[25,4544,142],{},[25,4546,145],{},[11,4548,148,4549,151,4551,154],{},[15,4550],{},[15,4552],{},[11,4554,157],{},[22,4556,4557,4559,4561,4566],{},[25,4558,162],{},[25,4560,165],{},[25,4562,168,4563,174],{},[74,4564,173],{"className":4565},[77,172],[25,4567,177],{},{"title":179,"searchDepth":180,"depth":180,"links":4569},[],{},{"title":5,"description":183},{"loc":189},{"id":4574,"title":4575,"author":6,"body":4576,"date":182,"description":4705,"draft":184,"edited_at":4706,"extension":185,"featured_image":4707,"meta":4708,"navigation":188,"path":4709,"pinned":184,"seo":4710,"sitemap":4711,"stem":4712,"tags":193,"__hash__":4713},"blog\u002Fblog\u002FRett-Syndrome.md","Rett Syndrome",{"type":8,"value":4577,"toc":4703},[4578,4581,4587,4595,4598,4601,4682,4685,4688,4694,4700],[11,4579,4580],{},"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",[11,4582,4583,4584,4586],{},"雷特氏症是一種發展性障礙疾病",[15,4585],{},"\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",[11,4588,4589,4590,4594],{},"主要的奇怪行為是常",[74,4591,4593],{"className":4592},[77,78],"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",[11,4596,4597],{},"雷特氏症的小孩在臨床上表現出四個時期的變化",[11,4599,4600],{},"RS的小孩雖然會合併自閉徵候，但RS合併MR更加明顯",[22,4602,4603,4617,4642,4662],{},[25,4604,4605,4606],{},"第一期（六個月到一歲半，早期）",[22,4607,4608,4614],{},[25,4609,4610,4611,4613],{},"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",[15,4612],{},"\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",[25,4615,4616],{},"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",[25,4618,4619,4620],{},"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）",[22,4621,4622,4639],{},[25,4623,4624,4625,4627,4628,4632,4633,4635,4636,4638],{},"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",[15,4626],{},"\n有反覆",[74,4629,4631],{"className":4630},[77,78],"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",[15,4634],{},"\n有的小孩還會吐舌，陣發喘氣，睡眠不安，或走路不穩",[15,4637],{},"\n頭圍成長趨緩",[25,4640,4641],{},"大段文字：會喪失已學習過的技巧；會癲癇",[25,4643,4644,4645],{},"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）",[22,4646,4647,4656],{},[25,4648,4649,4650,4652,4653,4655],{},"小孩呈失用症，不會正常使用肢體",[15,4651],{},"\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",[15,4654],{},"\n這個時期可以維持相當一段時間",[25,4657,4658,4659,4661],{},"大段文字：手部運動功能喪失逐漸明顯；逐漸喪失自主能力",[15,4660],{},"\n長達數年到數十年",[25,4663,4664,4665],{},"第四期（五到二十五歲，運動退化晚期）",[22,4666,4667,4676],{},[25,4668,4669,4670,4672,4673,4675],{},"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",[15,4671],{},"\n認知，溝通，手部動作較穩定，注視他人能力能維持",[15,4674],{},"\n有些會有脊椎側彎",[25,4677,4678,4679,4681],{},"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",[15,4680],{},"\n長達數十年",[11,4683,4684],{},"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",[11,4686,4687],{},"他們之前學會過的任務，卻會忘記自己學過",[11,4689,4690,4691,4693],{},"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",[15,4692],{},"\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",[11,4695,4696,4697,4699],{},"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",[15,4698],{},"\n即使時間很少，但也要著重訓練行走能力",[11,4701,4702],{},"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":179,"searchDepth":180,"depth":180,"links":4704},[],"雷特氏症","2026-06-13","\u002Fimages\u002Fuploads\u002F1781344227040-145949253_p0_master1200.webp",{},"\u002Fblog\u002FRett-Syndrome",{"title":4575,"description":4705},{"loc":4709},"blog\u002FRett-Syndrome","wp6UeSpNuWVzCMj8UKCOqphsSpW8MVmlDua_xz0r-Y0",1781450212209]