[{"data":1,"prerenderedAt":3862},["ShallowReactive",2],{"\u002Fblog\u002FGMFCS":3,"post-count":372,"series-global-data":373,"authors-all":482,"series-sidebar-小兒物治":678},{"id":4,"title":5,"author":6,"body":7,"date":359,"description":360,"draft":361,"edited_at":359,"extension":362,"featured_image":363,"meta":364,"navigation":365,"path":366,"pinned":361,"seo":367,"sitemap":368,"stem":369,"tags":370,"__hash__":371},"blog\u002Fblog\u002FGMFCS.md","GMFCS","hibiki12141132",{"type":8,"value":9,"toc":355},"minimark",[10,14,17,36,180,183,210,213,216,233,235,238,258,260,263,283,285,288,304,306,309,326,328,331,350,352],[11,12,13],"p",{},"寫完繼續趕神經 不然我會發神經",[11,15,16],{},"GMFCS分級定義",[18,19,20,24,27,30,33],"ol",{},[21,22,23],"li",{},"一級——行走不受限",[21,25,26],{},"二級——行走受限",[21,28,29],{},"三級——使用手持輔具",[21,31,32],{},"四級——需要電動輪椅",[21,34,35],{},"五級——需要別人手推輪椅",[37,38,39,67],"table",{},[40,41,42],"thead",{},[43,44,45,52,55,58,61,64],"tr",{},[46,47,49],"th",{"align":48},"left",[50,51],"br",{},[46,53,54],{"align":48},"0-2y",[46,56,57],{"align":48},"2-4y",[46,59,60],{"align":48},"4-6y",[46,62,63],{"align":48},"6-12y",[46,65,66],{"align":48},"12-18y",[68,69,70,94,117,140,158],"tbody",{},[43,71,72,76,79,82,86,90],{},[73,74,75],"td",{"align":48},"I",[73,77,78],{"align":48},"1. Sitting free on the floor            2. Crawl on hands and knee 3. Pull to stand  4. Takes few step with support",[73,80,81],{"align":48},"Independent walking without assistance",[73,83,84],{"align":48},[50,85],{},[73,87,88],{"align":48},[50,89],{},[73,91,92],{"align":48},[50,93],{},[43,95,96,99,102,105,109,113],{},[73,97,98],{"align":48},"II",[73,100,101],{"align":48},"1. Sitting may need support   2. Creep on stomach",[73,103,104],{"align":48},"but sitting with support",[73,106,107],{"align":48},[50,108],{},[73,110,111],{"align":48},[50,112],{},[73,114,115],{"align":48},[50,116],{},[43,118,119,122,125,128,132,136],{},[73,120,121],{"align":48},"III",[73,123,124],{"align":48},"1. Low back supported        2. Roll or creep on stomach",[73,126,127],{"align":48},"1. W-sitting      2. Creep or crawl                3. Walking with walker indoor",[73,129,130],{"align":48},[50,131],{},[73,133,134],{"align":48},[50,135],{},[73,137,138],{"align":48},[50,139],{},[43,141,142,145,148,151,154,156],{},[73,143,144],{"align":48},"IV",[73,146,147],{"align":48},"1. Head control  2. Roll to supine; may roll to prone",[73,149,150],{"align":48},"1. Sitting with support (cannot maintain in good alignment) 2. Roll or creep or crawl without reciprocal movements",[73,152,153],{"align":48},"Self mobility with powered W\u002FC",[73,155,153],{"align":48},[73,157,153],{"align":48},[43,159,160,163,166,168,172,176],{},[73,161,162],{"align":48},"V",[73,164,165],{"align":48},"Unable maintain antigravity head control",[73,167,165],{"align":48},[73,169,170],{"align":48},[50,171],{},[73,173,174],{"align":48},[50,175],{},[73,177,178],{"align":48},[50,179],{},[11,181,182],{},"接著是操作的部份",[184,185,186,189,192,195,198,201,204,207],"ul",{},[21,187,188],{},"軀幹支持行助行器——可以支撐pelvis trunk",[21,190,191],{},"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",[21,193,194],{},"肢體協助——需要別人協助移動",[21,196,197],{},"電動移動輔助——電動輪椅，代步車，等",[21,199,200],{},"手動輪椅自推——自己推",[21,202,203],{},"被動運送——被人推",[21,205,206],{},"行走——可以帶矯具但不能用輔具",[21,208,209],{},"輪式移動工具——包括電動輪椅，手動輪椅還有推車",[211,212],"hr",{},[11,214,215],{},"兩歲前",[184,217,218,221,224,227,230],{},[21,219,220],{},"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",[21,222,223],{},"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",[21,225,226],{},"三級——下背部被支撐才能坐穩；會翻身、腹貼地爬",[21,228,229],{},"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",[21,231,232],{},"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",[211,234],{},[11,236,237],{},"二到四歲",[184,239,240,243,246,252,255],{},[21,241,242],{},"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",[21,244,245],{},"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",[21,247,248,249,251],{},"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）",[50,250],{},"\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",[21,253,254],{},"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",[21,256,257],{},"五級——幾乎不會動",[211,259],{},[11,261,262],{},"四到六歲",[184,264,265,268,274,277,280],{},[21,266,267],{},"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",[21,269,270,271,273],{},"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；",[50,272],{},"\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",[21,275,276],{},"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",[21,278,279],{},"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",[21,281,282],{},"五級——幾乎不動",[211,284],{},[11,286,287],{},"六到十二歲",[184,289,290,293,296,299,302],{},[21,291,292],{},"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",[21,294,295],{},"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",[21,297,298],{},"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",[21,300,301],{},"四級——需他人協助或電動輪椅移動",[21,303,282],{},[211,305],{},[11,307,308],{},"十二到十八歲",[184,310,311,314,317,320,323],{},[21,312,313],{},"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",[21,315,316],{},"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",[21,318,319],{},"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",[21,321,322],{},"四級——需輪式輔具移動；需肢體協助設備；常用電動輪椅移動",[21,324,325],{},"五級——被動協助移動",[211,327],{},[11,329,330],{},"各分級比較",[184,332,333,336,339,347],{},[21,334,335],{},"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",[21,337,338],{},"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",[21,340,341,342],{},"三級VS四級——主要為坐姿及自動移動差異；",[184,343,344],{},[21,345,346],{},"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",[21,348,349],{},"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",[211,351],{},[11,353,354],{},"還好內容不多也不難啃，嚇死我了",{"title":356,"searchDepth":357,"depth":357,"links":358},"",2,[],"2026-04-19","好像是要自己看的補充",false,"md","\u002Fimages\u002Fuploads\u002F1776579606728-El0Kc5OVMAEdbG5.webp",{},true,"\u002Fblog\u002FGMFCS",{"title":5,"description":360},{"loc":366},"blog\u002FGMFCS",null,"G29aDr074P62Nd9uZoQMiZkkv7riTkIuliNENvcBRcI",102,{"id":374,"extension":375,"meta":376,"series":377,"stem":480,"__hash__":481},"series\u002Fseries.json","json",{},{"微積分教學":378,"生活紀錄":381,"Motor 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語言障礙",[50,820],{},[50,822],{},"\n對稱協調控制",[50,825],{},"\n雙側控制",[11,828,829,830,747,832,836,838,839,841,842,844,845,847,848,850,851,853,854,856],{},"最後來講失調型(Ataxia)",[50,831],{},[694,833,835],{"className":834},[697],"小腦",[50,837],{},"\n張力小",[50,840],{},"\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)",[50,843],{},"\n併發有 平衡 感覺統合 知覺都會較差",[50,846],{},"\n在治療重點上",[50,849],{},"\n會給他們穿加壓衣(增加感統知覺) ",[50,852],{},"\n穩定與張力提升",[50,855],{},"\n承重(增加感統知覺)",[11,858,859,860,862,863,865,866,868],{},"還有一些小分類 簡單帶過一下",[50,861],{},"\n首先是僵直型 這個是比痙攣型張力還要再強",[50,864],{},"\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",[50,867],{},"\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",[11,870,871,872,874,875,877,878,880,881,883,884,886,887,889,890,894],{},"接著來講治療原則 主要有五點",[50,873],{},"\n早期教育(早療 黃金期)",[50,876],{},"\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)",[50,879],{},"\n治療項目盡量以ADL為主",[50,882],{},"\n日常活動(結合孩子一天的作息去制定訓練 回家訓練)",[50,885],{},"\n感官輸入(如本體感覺 觸覺)",[50,888],{},"\n老師有圈了個重點 ",[694,891,893],{"className":892},[711],"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)",[11,896,897,898,900,901,905,906,900,908,912,913,915,916,920],{},"最後來講預後",[50,899],{},"\n假如 ",[694,902,904],{"className":903},[766],"2歲前","的寶寶能自行坐起來 未來100%能夠自行走動",[50,907],{},[694,909,911],{"className":910},[766],"4歲的","寶寶還不會自行坐起來 未來不會走",[50,914],{},"\n假如 是",[694,917,919],{"className":918},[766],"偏癱","的寶寶 未來100%能夠自行走動",[11,922,923],{},[924,925],"img",{"alt":926,"src":927},"1.00","https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774841979537-Screenshot_20260330_100529_Gallery.png",[11,929,930],{},[924,931],{"alt":926,"src":932},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774842001784-Screenshot_20260330_100531_Gallery.png",[11,934,935,936,938],{},"一些講義的內容 我隨後會在另一篇裡加上 ",[50,937],{},[694,939,941],{"className":940},[697],"讀英文！！！",{"title":356,"searchDepth":357,"depth":357,"links":943},[],"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":681,"description":945},{"loc":948},"blog\u002F腦性痲痺-CP",[953],"小兒PT","Oa9L6eaO1VoQayD-z7Id8c20dDInqUv2J9f4wkCkC9g",{"id":956,"title":421,"author":6,"body":957,"date":1122,"description":1123,"draft":361,"edited_at":1122,"extension":362,"featured_image":1124,"meta":1125,"navigation":365,"path":1126,"pinned":361,"seo":1127,"sitemap":1128,"stem":1129,"tags":370,"__hash__":1130},"blog\u002Fblog\u002FCP補充（一）.md",{"type":8,"value":958,"toc":1120},[959,962,965,993,995,1001,1024,1029,1073,1076,1079,1115],[11,960,961],{},"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",[11,963,964],{},"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",[18,966,967,973,990],{},[21,968,969,970,972],{},"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",[50,971],{},"\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",[21,974,975,976,981,983,984,986,987,989],{},"產中——主要為",[694,977,980],{"className":978},[766,979],"green-3","胎兒中毒以及產時窒息",[50,982],{},"\n血液樣本顯示為代謝性酸中毒，pH\u003C7以及鹼剩餘>12mmol\u002FL",[50,985],{},"\n妊娠周數>34周，早期會出現中度或重度腦病變",[50,988],{},"\n低血糖，未經治療的黃疽，嚴重的新生兒感染亦會導致CP",[21,991,992],{},"產後——感染，外傷，腦膜炎，敗血症",[211,994],{},[11,996,997,998,1000],{},"腦型麻痺類別——1（雖然總結有提到，但還是再寫一次好了）",[50,999],{},"\n分成了",[18,1002,1003],{},[21,1004,1005,1006,1008,1009,1011,1012,1014,1015,1017,1018,1020,1021,1023],{},"肢體受影響的分佈模式——",[50,1007],{},"\n雙側痲痺(腳比手影響嚴重)",[50,1010],{},"\n單側痲痺(單側受影響)",[50,1013],{},"\n四肢痲痺（手比腳嚴重）",[50,1016],{},"\n單肢痲痺",[50,1019],{},"\n三肢痲痺",[50,1022],{},"\n下肢痲痺",[11,1025,1026],{},[924,1027],{"alt":926,"src":1028},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776134449314-Screenshot_2026-04-14_104024.png",[18,1030,1031],{},[21,1032,1033,1034,1036,1037,1039,1040,1042,1043,1047,1049,1050,1054,1055,1060,1061,1063,1064,1066,1067,1069,1070,1072],{},"根據張力與動作異常形態區分——",[50,1035],{},"\n痙攣型——佔比七成，傷到錐狀束，上肢Flexor tone強+pronation，下肢Extenor tone強",[50,1038],{},"\n徐動型——佔比一成五，傷到基底核，皮質無影響，所以智力正",[50,1041],{},"\n僵直型——傷到皮質，比",[694,1044,1046],{"className":1045},[766,711],"痙攣型張力還大",[50,1048],{},"\n運動失調型——佔比一成三，傷到小腦，",[694,1051,1053],{"className":1052},[766,711],"協調能力差","且尤其是",[694,1056,1059],{"className":1057},[1058],"yellow-3","下肢","特別明顯，步寬大，走路搖晃",[50,1062],{},"\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",[50,1065],{},"\n顫抖型——較徐動型有節奏，在遠端顫抖",[50,1068],{},"\n混合型",[50,1071],{},"\n無法分類型",[11,1074,1075],{},"類別——2（P8）",[11,1077,1078],{},"他提到了按照ICF思路去想各個層級寶寶的問題",[18,1080,1081,1084,1092,1099,1107],{},[21,1082,1083],{},"首先是健康問題，受了甚麼傷",[21,1085,1086,1087],{},"其次是受限，這個傷會讓寶寶",[694,1088,1091],{"className":1089},[766,1090],"blue-3","做不了哪些動作",[21,1093,1094,1095],{},"再來是侷限，這些做不了的動作會讓寶寶",[694,1096,1098],{"className":1097},[766,711],"失去甚麼功能性",[21,1100,1101,1102,1106],{},"然後是環境因素，例如失去了這些功能性的話，與",[694,1103,1105],{"className":1104},[766,979],"環境的互動","有甚麼障礙",[21,1108,1109,1110,1114],{},"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",[694,1111,1113],{"className":1112},[766,1058],"動機","等因素",[11,1116,1117],{},[924,1118],{"alt":926,"src":1119},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776135419925-Screenshot_2026-04-14_105040.png",{"title":356,"searchDepth":357,"depth":357,"links":1121},[],"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":421,"description":1123},{"loc":1126},"blog\u002FCP補充（一）","8cDECsO9Ab18dGecDdRUOUB4ETPPEAjd1AS3dqL2ii4",{"id":1132,"title":1133,"author":6,"body":1134,"date":1122,"description":1490,"draft":361,"edited_at":1122,"extension":362,"featured_image":1491,"meta":1492,"navigation":365,"path":1493,"pinned":361,"seo":1494,"sitemap":1495,"stem":1496,"tags":370,"__hash__":1497},"blog\u002Fblog\u002FCP—Rood-&-Bobath.md","CP—Rood & Bobath（一）",{"type":8,"value":1135,"toc":1488},[1136,1139,1142,1158,1176,1208,1211,1257,1259,1262,1338,1346,1428,1430,1433],[11,1137,1138],{},"(就先只寫余老師有在上課做註記的版書，讀不完啦)",[11,1140,1141],{},"1940前肌能教再育>1950年後神經成熟理論>1990年動態系統理論",[11,1143,1144,1145,1147,1148,1152,1153,1157],{},"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）",[50,1146],{},"\n手法有RIP(",[694,1149,1151],{"className":1150},[766,979],"異常reflex抑制",")，接著誘發動作(",[694,1154,1156],{"className":1155},[711,766],"翻正反應,平衡反應)","，再加一些本體覺和觸覺輸入",[11,1159,1160,1161,1163,1164,1166,1167,1171,1172],{},"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",[50,1162],{},"\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",[50,1165],{},"\n主要是",[694,1168,1170],{"className":1169},[766,711],"打破錯的感覺運動經驗","，",[694,1173,1175],{"className":1174},[766,1058],"重新教寶寶正確的動作形態",[11,1177,1178,1179,1181,1182,1184,1185,1187,1188,1192,1193,1195,1196,1198,1199,1203,1204],{},"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",[50,1180],{},"\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",[50,1183],{},"\n那像是這裡提到的flexor tone過大，我們就幫他做extension",[50,1186],{},"\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",[694,1189,1191],{"className":1190},[1058],"反方向","，誘發GTO關閉tone",[50,1194],{},"\n(著重在擺位)",[50,1197],{},"\n現在的RIP是改為",[694,1200,1202],{"className":1201},[979],"partial RIP","，只利用",[694,1205,1207],{"className":1206},[766,711],"Key point來達到抑制與誘發",[11,1209,1210],{},"那RIP的注意事項有如下",[184,1212,1213,1225,1237,1245,1248,1251],{},[21,1214,1215,1216,1220,1221],{},"RIP只做在",[694,1217,1219],{"className":1218},[766,711],"有痙攣","的地方，",[694,1222,1224],{"className":1223},[979],"hypotone則不需要做",[21,1226,1227,1228,1232,1233],{},"力度需",[694,1229,1231],{"className":1230},[1058,766],"緩慢施加","，因為痙攣的部位容易",[694,1234,1236],{"className":1235},[711],"contracture",[21,1238,1239,1240,1244],{},"從近端開始做，並且做",[694,1241,1243],{"className":1242},[697,766],"旋轉以及Protraction(shoulder)是最容易打破張力","的手段",[21,1246,1247],{},"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",[21,1249,1250],{},"新的Bobath目的是做ADL動作",[21,1252,1253,1254,1256],{},"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",[50,1255],{},"\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",[211,1258],{},[11,1260,1261],{},"接下來講抑制Extensor的技巧，先來講第一個",[18,1263,1264,1267,1273,1298,1306,1327,1335],{},[21,1265,1266],{},"首先PT要坐在有靠背的椅子上保護好PT的背",[21,1268,1269,1270,1272],{},"將小孩的身體放在PT大腿上，腿面向PT，呈現total flexion姿勢",[50,1271],{},"\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",[21,1274,1275,1276,1278,1279,1283,1284,1288,1292,1293,1297],{},"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",[50,1277],{},"\n可以在剛提到的姿勢下順便訓練旋轉，PT一手將",[694,1280,1282],{"className":1281},[766,711],"小孩的腳轉","到一側，另一手轉動寶寶的",[694,1285,1287],{"className":1286},[766,697],"身體",[694,1289,1291],{"className":1290},[766],"到對側","（",[694,1294,1296],{"className":1295},[697],"是身體，不是頭","）",[21,1299,1300,1301,1305],{},"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",[694,1302,1304],{"className":1303},[711,766],"肩胛骨內緣","後主推做protraction",[21,1307,1308,1309,1311,1312,1316,1317,1319,1320,1324,1326],{},"那小孩也因為extensor張力太大，可能沒有意識到有手的存在",[50,1310],{},"\n我們就得將他的手帶到胸前",[694,1313,1315],{"className":1314},[711,766],"進入視野範圍","，讓他開始吃或者自己的手",[50,1318],{},"\n而有些小孩會緊張會保持抓握姿勢，我們可以從",[694,1321,1323],{"className":1322},[766,711],"大拇指開始扳開慢慢張手打開",[50,1325],{},"\n讓他去做手碰手、手碰嘴、手碰腳、嘴碰嘴",[21,1328,1329,1330,1334],{},"而在抑制的過程中也可以做一些",[694,1331,1333],{"className":1332},[711,766],"誘發flexion動作","的手法，訓練屈肌，這樣也能降低extensor tone",[21,1336,1337],{},"習慣了以上姿勢後，就可以放寶寶在地上自己玩了",[11,1339,1340,1341,1345],{},"接著來講第二個，這個是",[694,1342,1344],{"className":1343},[697,766],"利用滾筒","的方式，結合了誘發動作的方式",[18,1347,1348,1375,1404],{},[21,1349,1350,1351,1355,1357,1358,1362,1364,1365,1369,1370,1374],{},"首先讓小孩在滾筒上side-lying，",[694,1352,1354],{"className":1353},[766,979],"手抬高將滾筒卡在腋下",[50,1356],{},"\n這時候PT要對小孩上方的髖做",[694,1359,1361],{"className":1360},[766,711],"Abd，extension和external rotation",[50,1363],{},"\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",[694,1366,1368],{"className":1367},[711,766],"extension","姿勢(",[694,1371,1373],{"className":1372},[766],"正常站立角度",")",[21,1376,1377,1378,1380,1381,1383,1384,1386,1387,1391,1395,1399,1400,1297],{},"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",[50,1379],{},"\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",[50,1382],{},"\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",[50,1385],{},"\n而這時候會想要去訓練他的抬頭（雖然",[694,1388,1390],{"className":1389},[766,711],"抬頭是extension姿勢",[694,1392,1394],{"className":1393},[766],"但這個跟",[694,1396,1398],{"className":1397},[766,1058],"extensor muscle tone不一樣","，還是得教導",[694,1401,1403],{"className":1402},[711],"正確方式",[21,1405,1406,1407,1409,1410,1412,1413,1415,1416,1420,1422,1423,1427],{},"剛剛講的是從side-lying到prone，現在講反過來的從prone到side-lying",[50,1408],{},"\n一手放在pelvis，一手固定shoulder，",[50,1411],{},"\n這次先將pelvis，翻回side-lying，然後慢慢協助將shoulder帶到side-lying",[50,1414],{},"\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",[694,1417,1419],{"className":1418},[766,711],"retraction",[50,1421],{},"\n對於CP小兒而言",[694,1424,1426],{"className":1425},[711,766],"誘發出extensor tone","，所以要先將pelvis帶走）",[211,1429],{},[11,1431,1432],{},"然後來介紹到抑制Flexor的技巧，核心是利用重力去抑制",[18,1434,1435,1455,1470,1485],{},[21,1436,1437,1438,1442,1443,1447,1449,1450,1454],{},"讓小孩supine在球上，這過程要",[694,1439,1441],{"className":1440},[711,766],"緩慢以及穩","，不要讓小孩感到害怕，假如",[694,1444,1446],{"className":1445},[697,766],"小孩恐懼就不要做這個",[50,1448],{},"\n因為flexor tone 高的小孩比較少動，所以",[694,1451,1453],{"className":1452},[766,711],"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",[21,1456,1457,1458,1462,1463,1467,1469],{},"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",[694,1459,1461],{"className":1460},[979,766],"逐漸放鬆","，同時也能",[694,1464,1466],{"className":1465},[766,711],"靠重力牽拉flexor肌肉",[50,1468],{},"\n再進階就遠端例如hip去做同樣的事",[21,1471,1472,1473,1475,1476,1480,1481],{},"進一步的做法是，抓住小孩的小肢，將球往小孩的頭側推",[50,1474],{},"\n這樣因為滾動的原因變成頭反而靠近地面，呈",[694,1477,1479],{"className":1478},[979,766],"頭靠近地面","，這樣也能讓",[694,1482,1484],{"className":1483},[711,766],"extensor tone上升",[21,1486,1487],{},"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":356,"searchDepth":357,"depth":357,"links":1489},[],"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":1133,"description":1490},{"loc":1493},"blog\u002FCP—Rood-&-Bobath","hbxSp87ZZts-QV-3eWuNwBK9q66v8uar73myHqp0-sQ",{"id":1499,"title":1500,"author":6,"body":1501,"date":1122,"description":1611,"draft":361,"edited_at":1612,"extension":362,"featured_image":1613,"meta":1614,"navigation":365,"path":1615,"pinned":361,"seo":1616,"sitemap":1617,"stem":1618,"tags":370,"__hash__":1619},"blog\u002Fblog\u002FCP—Rood-&-Bobath（二）.md","CP—Rood & Bobath（二）",{"type":8,"value":1502,"toc":1609},[1503,1506,1512,1517,1520],[11,1504,1505],{},"那剛剛一篇講的都Bobath的手法，那現在講Rood的",[11,1507,1508,1509,1511],{},"那Rood 提到說，人類有發展次序，mobility>stability>mobility on stability>skill movement",[50,1510],{},"\n也強調了可以利用感覺輸入誘發動作",[11,1513,1514],{},[924,1515],{"alt":926,"src":1516},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776217678571-Screenshot_2026-04-15_094736.png",[11,1518,1519],{},"那感覺刺激的部份根據強度及頻率而有這四種變化",[184,1521,1522,1528,1567,1573],{},[21,1523,1524,1525,1527],{},"快速且短暫的刺激",[50,1526],{},"\n可以用心智狀態提高，全身muscle tone 增高，反應力上升（喚醒）",[21,1529,1530,1531,1533,1534,1536,1537,1539,1541,1542,1546,1547,1549,1550,1552,1553,1557,1559,1563,1564,1566],{},"快速且重複的刺激",[50,1532],{},"\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",[50,1535],{},"\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",[50,1538],{},[50,1540],{},"\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",[694,1543,1545],{"className":1544},[711,766],"頸部開始訓練","(inversion在GA26~29就出現)",[50,1548],{},"\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",[50,1551],{},"\n治療師採坐姿，而且不是用手在帶動，是",[694,1554,1556],{"className":1555},[766,711],"利用治療師身體帶動",[50,1558],{},[694,1560,1562],{"className":1561},[697],"注意","：要給小孩安全感，inversion不能過久，保持頭部的正確位置",[50,1565],{},"\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",[21,1568,1569,1570,1572],{},"緩慢且規律重覆的刺激",[50,1571],{},"\n通常用來減敏",[21,1574,1575,1576,1578,1579,1581,1583,1584,1588,1589,1593,1594,1596,1598,1599,1603,1604,1608],{},"持續性的刺激",[50,1577],{},"\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",[50,1580],{},[50,1582],{},"\n對於",[694,1585,1587],{"className":1586},[766,711],"痙攣","的小孩，先從",[694,1590,1592],{"className":1591},[711,766],"不敏感的地方開始","，再往較敏感的位慢慢刺激，嘴巴也一樣",[50,1595],{},[50,1597],{},"\n但對於",[694,1600,1602],{"className":1601},[766,1058],"低張","的小孩，則相反，從",[694,1605,1607],{"className":1606},[766,1058],"最敏感的地方開始","刺激",{"title":356,"searchDepth":357,"depth":357,"links":1610},[],"Rood 到結尾","2026-04-15","\u002Fimages\u002Fuploads\u002F1776222460274-Ee4ldTMUcAEiPzF.webp",{},"\u002Fblog\u002FCP—Rood-&-Bobath（二）",{"title":1500,"description":1611},{"loc":1615},"blog\u002FCP—Rood-&-Bobath（二）","56_IFu2CIimvGKbXPweMAs8MdVF91nlzrjRw9LcNlb0",{"id":1621,"title":1622,"author":6,"body":1623,"date":2087,"description":2088,"draft":361,"edited_at":2089,"extension":362,"featured_image":2090,"meta":2091,"navigation":365,"path":2092,"pinned":361,"seo":2093,"sitemap":2094,"stem":2095,"tags":370,"__hash__":2096},"blog\u002Fblog\u002FMotor-Learning.md","Motor Learning小兒（一）",{"type":8,"value":1624,"toc":2085},[1625,1628,1637,1646,1664,1673,1682,1698,1707,1736,1811,1826,1829,1871,1877,1926,1972,2013,2016,2054,2069],[11,1626,1627],{},"那這一節課著重在動態模組理論，跟黃老師教的是互通的",[11,1629,1630,1631,1633,1634,1636],{},"那首先是講感覺統合的部份",[50,1632],{},"\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",[50,1635],{},"\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)",[11,1638,1639,1640,1642,1643,1645],{},"而接下來講到動作的發展",[50,1641],{},"\n那老師用的理論是動態模組理論",[50,1644],{},"\n假如還記得黃老師的Motor Control最後一課講的應該不難吃",[11,1647,1648,1649,1651,1652,1654,1655,1657,1658,1660,1661,1663],{},"不過我還是先列出來老師PPT裡的五個角度",[50,1650],{},"\n第一 動作技巧的顯現",[50,1653],{},"\n第二 動作型態的精準度",[50,1656],{},"\n第三 動作成果(可從評估表推估) ",[50,1659],{},"\n第四 組合技巧的獲得(次系統組合的結果)",[50,1662],{},"\n第五 對環境適應力的增強",[11,1665,1666,1667,1669,1670,1672],{},"我們現在來講平衡系統的發展",[50,1668],{},"\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",[50,1671],{},"\n以站立來形容的話",[11,1674,1675,1676,1678,1679,1681],{},"2)人類的重心(COM)基本會在S2 ",[50,1677],{},"\n那壓力中心(COP)是動態的 他會因應COM的改變而改變",[50,1680],{},"\n那底面積(BOS)就是兩隻腳踩在地面的距離",[11,1683,1684,1685,1689,1690,1692,1693,1697],{},"3)那平衡的演化 在早期 小孩會",[694,1686,1688],{"className":1687},[711,766],"極度依賴視角","來判斷",[50,1691],{},"\n但在成熟的過程中 我們會",[694,1694,1696],{"className":1695},[697],"越來越傾向用本體感覺","去判斷",[11,1699,1700,1701,1703,1704,1706],{},"4)穩定極限(LOS) 他把我們人類想象成一個倒立的三角錐",[50,1702],{},"\n在不移動的情況下身體能偏多少(前6度 側8度 後4度)",[50,1705],{},"\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)",[11,1708,1709,1710,1712,1713,1717,1718,1723,1724,1726,1727,1731,1732],{},"5)承受外力時的反應時 人類會有兩種變化",[50,1711],{},"\n第一種就是假如這",[694,1714,1716],{"className":1715},[766,979],"外力少到一定範圍"," 就只會用",[694,1719,1722],{"className":1720},[1721],"bg-green-3","姿勢穩定反應","來做調整",[50,1725],{},"\n另一種則是假如外力",[694,1728,1730],{"className":1729},[766,711],"超過姿勢穩定反應可以調整的程度"," 就會產生",[694,1733,1735],{"className":1734},[697],"保護性姿勢",[11,1737,1738,1739,1741,1742,1744,1745,1747,1748,1752,1754,1755,1759,1763,1765,1766,1768,1770,1771,1775,1776,1778,1779,1783,1784,1786,1787,1789,1791,1792,1794,1795,1797,1798,1802,1803,1805,1807,1808,1810],{},"6)",[50,1740],{},"\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",[50,1743],{},"\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",[50,1746],{},"\n那一般而言 越成熟的人 會越偏好用",[694,1749,1751],{"className":1750},[711],"踝策略",[50,1753],{},"\n而目前比較新的提出 就是",[694,1756,1758],{"className":1757},[1058,766],"抓握",[694,1760,1762],{"className":1761},[1058],"是一種不算策略(Strategy)的方法",[50,1764],{},"\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",[50,1767],{},[50,1769],{},"\nii) 而另一點則是改變BOS的 例子就有跨步策略 身體是",[694,1772,1774],{"className":1773},[711],"被迫做出","的 伸手出去支撐也是如此",[50,1777],{},"\n那在發展過程中 而在",[694,1780,1782],{"className":1781},[711],"方向性上也是有順序","的",[50,1785],{},"\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",[50,1788],{},[50,1790],{},"\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 ",[50,1793],{},"\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",[50,1796],{},"\n我們",[694,1799,1801],{"className":1800},[766],"可以通過適度的給他們外力","訓練他們",[50,1804],{},[50,1806],{},"\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",[50,1809],{},"\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",[11,1812,1813,1814,1816,1817,1819,1820,1822,1823,1825],{},"那對於小兒的發展議題，主要有這幾個",[50,1815],{},"\ni)——新形式的起源(The origin of new form)",[50,1818],{},"\nii)——連續性與非連續性(Continuity vs discontinuity)",[50,1821],{},"\niii)——變異性(Variability)",[50,1824],{},"\niv)——生物與環境的影響(Biological vs. environmental influence)",[11,1827,1828],{},"那動態模組理論是經歷過以下發展而來的",[18,1830,1831,1838,1858],{},[21,1832,1833,1834],{},"那首先是小兒痲痺(1910s)——當年的理念是哪邊無力練哪邊",[694,1835,1837],{"className":1836},[766,697],"(肌肉再教育 muscle re-education)",[21,1839,1840,1841,1845,1846,1848,1849,1851,1852,1854,1855,1857],{},"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",[694,1842,1844],{"className":1843},[697,766],"感覺輸入","促進正常的動作以及動作發展",[50,1847],{},"\n神經成熟理論(1945s)由Gesell和McGraw提出，他們的關鍵理念有如下",[50,1850],{},"\nCNS髓鞘化(Increased myelination of CNS)",[50,1853],{},"\n皮質抑制皮質下中心(Inhibition of the subcortical centers by the higher cerebral cortex)",[50,1856],{},"\n層級控制(Hierarchical control)",[21,1859,1860,1861,1865,1866,1870],{},"最後來講到階層理論的雛型(1980s)——當年他們覺得動作發展",[694,1862,1864],{"className":1863},[766],"不只單一的神經支配","，把",[694,1867,1869],{"className":1868},[766,711],"其他的系統、環境","一併整合進來",[11,1872,1873,1874,1876],{},"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",[50,1875],{},"\n那它有三個假設",[18,1878,1879,1890,1910],{},[21,1880,1881,1882,1884,1885,1889],{},"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",[50,1883],{},"\n但在1979s有學者提出說，其實原始反射對於每個寶寶來說",[694,1886,1888],{"className":1887},[711],"變異性","也很大",[21,1891,1892,1893,1895,1896,1900,1901,1905,1906],{},"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",[50,1894],{},"\n但在1976s有學者發現到，南非的寶寶被家長",[694,1897,1899],{"className":1898},[766],"直立抱法或者練習坐","，會比美國寶寶",[694,1902,1904],{"className":1903},[711],"更快發展出下肢動作","，但",[694,1907,1909],{"className":1908},[979],"爬和翻身較慢",[21,1911,1912,1913,1915,1916,1920,1921,1925],{},"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)",[50,1914],{},"\n但在1988s有學者提出，寶寶的",[694,1917,1919],{"className":1918},[979],"伸手以及操作","的發展在近端遠端上是",[694,1922,1924],{"className":1923},[766,711],"同時存在","的(同步進行發展，並沒有明確上下關係)",[11,1927,1928,1929,1931,1932,1936,1937,1941,1943,1944,1948,1949,1951,1952,1956,1957,1961,1962,1966,1968,1969,1971],{},"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",[50,1930],{},"\n那協調就是將這些複雜的東西，透過",[694,1933,1935],{"className":1934},[711],"降低自由度","，來",[694,1938,1940],{"className":1939},[979],"產生平滑的動作",[50,1942],{},"\n那降低自由度的策略會牽涉到一個叫",[694,1945,1947],{"className":1946},[697],"自我組織","的東西，那它的核心理念是說",[50,1950],{},"\n動作是有",[694,1953,1955],{"className":1954},[697],"適應性","的，次系統會根據",[694,1958,1960],{"className":1959},[766,711],"環境任務","等因素做調整，",[694,1963,1965],{"className":1964},[979],"再拼湊起來",[50,1967],{},"\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）",[50,1970],{},"\n有提到三個重點",[18,1973,1974,1980,1996],{},[21,1975,1976,1977,1979],{},"次序參數——它探討的是關節之間的協同",[50,1978],{},"\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",[21,1981,1982,1983,1987,1988,1990,1991,1995],{},"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",[694,1984,1986],{"className":1985},[766,697],"最省力、自然以及方便","的動作型態",[50,1989],{},"\n那假如這個動作達到了上述說的型態，便是",[694,1992,1994],{"className":1993},[711,766],"最穩定型態","，即使會因應任務去做改變也是十分穩定的",[21,1997,1998,1999,2001,2002,2006,2007,2009,2010,2012],{},"相移現象——意思就是說原本在做著一個穩定的動作型態",[50,2000],{},"\n因為一些",[694,2003,2005],{"className":2004},[711],"因素所干擾","，就會變成另一個動作型態",[50,2008],{},"\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)",[50,2011],{},"\n（對 黃老師教動態系統理論也提到過這個）",[11,2014,2015],{},"最後講兩個實驗",[18,2017,2018,2040],{},[21,2019,2020,2021,2023,2024,2026,2027,2031,2032,2036,2037,2039],{},"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",[50,2022],{},"\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",[50,2025],{},"\n但動態模組理論發現，其實是因為在第四周寶寶",[694,2028,2030],{"className":2029},[766,711],"長脂肪比長肌肉快","，導致",[694,2033,2035],{"className":2034},[979],"力量不足","做不出來",[50,2038],{},"\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",[21,2041,2042,2043,2045,2046,2048,2049,2053],{},"第二個實驗，是觀察青蛙生長的環境與發育的關係",[50,2044],{},"\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",[50,2047],{},"\n所以神經成熟是可以讓動作型態形成，但必須得加上",[694,2050,2052],{"className":2051},[766,711],"環境，時間以及個體本身條件","才能讓型態表現更好",[11,2055,2056,2057,2059,2060,2062,2063,2065,2066,2068],{},"那在臨床意義上有以下幾點",[50,2058],{},"\n分散式控制(Distributed control)",[50,2061],{},"\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)",[50,2064],{},"\n由兒童主導(Active role of the child)",[50,2067],{},"\n個體差異的訊息(variability provides important information)",[11,2070,2071,2072,2076,2077,2081,2082,2084],{},"評估",[694,2073,2075],{"className":2074},[766,1721],"不應只侷限在探討神經發展過程","，而是要根據",[694,2078,2080],{"className":2079},[697,766],"多個系統，家庭因素","等問題",[50,2083],{},"\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":356,"searchDepth":357,"depth":357,"links":2086},[],"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":1622,"description":2088},{"loc":2092},"blog\u002FMotor-Learning","EmOKsVRjY6Fz-rmd5PiPG83wEP6j59SCfF75Y1WnFNU",{"id":2098,"title":2099,"author":6,"body":2100,"date":2089,"description":2323,"draft":361,"edited_at":2324,"extension":362,"featured_image":2325,"meta":2326,"navigation":365,"path":2327,"pinned":361,"seo":2328,"sitemap":2329,"stem":2330,"tags":370,"__hash__":2331},"blog\u002Fblog\u002FMotor-Learning小兒（二）.md","Motor Learning小兒（二）",{"type":8,"value":2101,"toc":2321},[2102,2105,2111,2120,2123,2157,2160],[11,2103,2104],{},"阿對的，又要來講動作學習的定義了，雖然之前就有講過",[11,2106,2107,2108,2110],{},"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)",[50,2109],{},"\n動作學習就是過程，而動作表現是動作做出來的結果。",[11,2112,2113,2114,2116,2117,2119],{},"而這邊講道Positive和Negative Sign",[50,2115],{},"\nPositive是指正常人沒有，但病人身上會出現的異常動作 ",[50,2118],{},"\nNegative則相反，正常人有的，但病人身上無法出現",[11,2121,2122],{},"對於動作學習有三大要素",[18,2124,2125,2128,2137],{},[21,2126,2127],{},"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",[21,2129,2130,2131,2133,2134,2136],{},"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",[50,2132],{},"\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",[50,2135],{},"\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",[21,2138,2139,2140,2144,2145,2147,2148,2152,2153],{},"對於目標的清淅程度——就是",[694,2141,2143],{"className":2142},[979],"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",[50,2146],{},"\n而任務",[694,2149,2151],{"className":2150},[711],"越具體","，更能",[694,2154,2156],{"className":2155},[711,766],"引導寶寶產生興趣",[11,2158,2159],{},"那動作學習有以下三個考量點",[18,2161,2162,2214,2260],{},[21,2163,2164,2165,2169,2170,2174,2175,1374,2182,2184,2185,2187,2188,2192,2193,2195,2196,2200,2201,2205,2206,2208,2209,2213],{},"轉移——意思是",[694,2166,2168],{"className":2167},[766,979],"相同相似的技巧","在不同情景下可以變化",[694,2171,2173],{"className":2172},[711,766],"產生新的","動作型態 (這裡也有說到 ",[2176,2177,2181],"a",{"href":2178,"rel":2179},"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",[2180],"nofollow","在最後一段",[50,2183],{},"\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",[50,2186],{},"\n所以我們可以借由",[694,2189,2191],{"className":2190},[979],"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",[50,2194],{},"\n也可以透過",[694,2197,2199],{"className":2198},[766,711],"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",[694,2202,2204],{"className":2203},[766],"加粗","的方式讓寶寶更好握住",[50,2207],{},"\n但記得靠轉移來學習新的動作型態",[694,2210,2212],{"className":2211},[766,711],"不能一下子改太多太難","參數",[21,2215,2216,2217,1171,2222,1297,2226,2228,2229,2233,2234,2236,2237,2241,2243,2244,2248,2249,2251,2252,2256,2257,2259],{},"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（",[2176,2218,2221],{"href":2219,"rel":2220},"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",[2180],"一",[2176,2223,2225],{"href":2178,"rel":2224},[2180],"二",[50,2227],{},"\n集中VS分散，分散休息時間更長，對",[694,2230,2232],{"className":2231},[766],"學習較難或易疲勞病人","來說更佳",[50,2235],{},"\n段落VS隨機，隨機較難，但通常對",[694,2238,2240],{"className":2239},[979,766],"形成長期記憶以記轉移效果更有",[50,2242],{},"\n固定VS變異，變異在",[694,2245,2247],{"className":2246},[711,766],"轉移效果上","更佳",[50,2250],{},"\n全部VS分段，分段有",[694,2253,2255],{"className":2254},[766,711],"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",[50,2258],{},"\n心像練習，在腦中模擬動作型態",[21,2261,2262,2263,1171,2267,1171,2271,1171,2276,1374,2281,2283,2284,2286,2287,2289,2290,1297,2294,2296,2297,2301,2302,2304,2305,2309,2310,2312,2313,2315,2316,2320],{},"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(",[2176,2264,2221],{"href":2265,"rel":2266},"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",[2180],[2176,2268,2225],{"href":2269,"rel":2270},"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",[2180],[2176,2272,2275],{"href":2273,"rel":2274},"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",[2180],"三",[2176,2277,2280],{"href":2278,"rel":2279},"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",[2180],"四",[50,2282],{},"\nKR與KP，KR效度比KP更佳",[50,2285],{},"\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",[50,2288],{},"\n（",[2176,2291,2293],{"href":2278,"rel":2292},[2180],"這裡第一段有提到",[50,2295],{},"\n回饋的方法，",[2176,2298,2300],{"href":2269,"rel":2299},[2180],"這一篇的後半段","有提到，可以再複習一下",[50,2303],{},"\n先設定一個",[694,2306,2308],{"className":2307},[979],"區間","，達到的都算得分",[50,2311],{},"\n回饋也可以做遞減，逐漸減少依賴",[50,2314],{},"\n假如病人",[694,2317,2319],{"className":2318},[711,766],"主動要求回饋","，我們再給予，也會更佳",{"title":356,"searchDepth":357,"depth":357,"links":2322},[],"Motor Learning定義~結束","2026-04-13","\u002Fimages\u002Fuploads\u002F1775875520542-37128694_p0_master1200.jpg",{},"\u002Fblog\u002FMotor-Learning小兒（二）",{"title":2099,"description":2323},{"loc":2327},"blog\u002FMotor-Learning小兒（二）","vCmIeebtfGfHQk7UoNr_yn1XC2gwpWX_B8fsdXmUsJc",{"id":2333,"title":2334,"author":6,"body":2335,"date":2534,"description":2535,"draft":361,"edited_at":2534,"extension":362,"featured_image":2536,"meta":2537,"navigation":365,"path":2538,"pinned":361,"seo":2539,"sitemap":2540,"stem":2541,"tags":370,"__hash__":2542},"blog\u002Fblog\u002FGait-analysis小兒（一）.md","Gait analysis小兒（一）",{"type":8,"value":2336,"toc":2532},[2337,2340,2343,2360,2363,2374,2377,2394,2420,2426,2429,2446,2455,2466,2481,2487,2515,2518],[11,2338,2339],{},"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",[11,2341,2342],{},"那下肢雙關節肌肉有以下",[18,2344,2345,2348,2351,2354,2357],{},[21,2346,2347],{},"腰大肌——Hip Flexion, Trunk Flexion",[21,2349,2350],{},"腿後肌——Hip Extension, Knee Flexion",[21,2352,2353],{},"股直肌——Hip Flexion, Knee Extension",[21,2355,2356],{},"腓腸肌——Knee Flexion, PF",[21,2358,2359],{},"縫匠肌——Hip Flexion, Hip ER",[11,2361,2362],{},"那單關節的肌肉有",[18,2364,2365,2368,2371],{},[21,2366,2367],{},"臀大肌——Hip Extension, Hip ER",[21,2369,2370],{},"脛前肌——DF, inversion",[21,2372,2373],{},"腓骨長肌——PF, eversion",[11,2375,2376],{},"那以下動作的抗重力與無抗重力的擺位姿勢為",[18,2378,2379,2382,2385,2388,2391],{},[21,2380,2381],{},"Hip Extension——Prone 抗重力, side-lying 無抗重力",[21,2383,2384],{},"Hip Flexion——Sitting 抗重力, side-lying 無抗重力",[21,2386,2387],{},"Hip Abduction——Side-lying 抗重力, supine 無抗重力",[21,2389,2390],{},"Knee Extension——Sitting 抗重力, side-lying 無抗重力",[21,2392,2393],{},"PF——Standing 抗重力, prone 無抗重力",[11,2395,2396,2397,2399,2400,2404,2405,2409,2411,2412,2414,2415,2419],{},"接下來講一個異常步態——Crouch gait",[50,2398],{},"\n為甚麼他會呈現屈曲狀態，主要是因為",[694,2401,2403],{"className":2402},[766,711],"雙關節肌肉張力過強","，而",[694,2406,2408],{"className":2407},[766,979],"單關節肌肉力量不足",[50,2410],{},"\n不是單純的肌肉太緊，也是一種肌力失衡的表現",[50,2413],{},"\n其中，在",[694,2416,2418],{"className":2417},[766],"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)",[11,2421,2422,2423,2425],{},"接著來講步態的參數",[50,2424],{},"\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)",[11,2427,2428],{},"這邊提到一個中風後會出現的代償步態",[184,2430,2431,2434,2437,2440,2443],{},[21,2432,2433],{},"步速下降",[21,2435,2436],{},"步距縮短或不對稱",[21,2438,2439],{},"步寬變大(BOS增加)",[21,2441,2442],{},"雙腳站立期變長",[21,2444,2445],{},"依賴手部支撐",[11,2447,2448,2449,2451,2452,2454],{},"接著講Gait cycle，分別為站立期以及擺盪期",[50,2450],{},"\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",[50,2453],{},"\n完成這三個任務又分成了這八個動作",[18,2456,2457,2460,2463],{},[21,2458,2459],{},"承重——Initial contact和Loading Response",[21,2461,2462],{},"單腳支撐——Mid-stance, Terminal Stance和Pre-swing",[21,2464,2465],{},"肢體向前——Pre-swing, Initial swing, Mid-swing和Terminal Swing",[11,2467,2468,2469,2473,2474,2476,2477],{},"而Pre-swing雖然腳尖還沒離地，但",[694,2470,2472],{"className":2471},[766,979],"重心其實已經轉移去另一隻腳","了",[50,2475],{},"\n其中 ",[694,2478,2480],{"className":2479},[766],"Initial contact和Pre-swing為雙腳承重期",[11,2482,2483,2484,2486],{},"我們現在攤開來看站立期和擺盪期下肢各關節變化",[50,2485],{},"\n首先是站立期",[18,2488,2489,2497,2500,2506,2512],{},[21,2490,2491,2492,2496],{},"在雙腳承重期，",[694,2493,2495],{"className":2494},[766,979],"足部會放平","，準備Push Off",[21,2498,2499],{},"Hip的話，在Initical Contact的Flexion到Terminal Stance的Hyperextension",[21,2501,2502,2503,2505],{},"Knee的話，會從Flexion姿勢，到Mid-stance的Extension，再變回Pre-swing的Flexion",[50,2504],{},"\n(Flexion>Extension>Flexion)",[21,2507,2508,2509,2511],{},"Ankle的話，在Initical Contact的Neutral姿勢，Loading Response的PF，",[50,2510],{},"\nMid-stance的DF，最後是Terminal Stance\u002FPre-swing的PF（Neutral>PF>DF>PF）",[21,2513,2514],{},"Pelvis的話，基本保持水平，但在Terminal stance會略微前傾",[11,2516,2517],{},"然後是擺盪期",[18,2519,2520,2523,2526,2529],{},[21,2521,2522],{},"Knee的話，在Initical swing時會呈現Flexion，在Terminal swing會Full-extension",[21,2524,2525],{},"Hip的話，從Initical swing的Hyperextension，在Terminal swing會變成Flexion",[21,2527,2528],{},"Ankle的話，保持DF狀態，使腳尖不會碰到地板",[21,2530,2531],{},"Pelvis的話，會Rotation",{"title":356,"searchDepth":357,"depth":357,"links":2533},[],"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":2334,"description":2535},{"loc":2538},"blog\u002FGait-analysis小兒（一）","twQeon3uGQlDYDjG3t_oGlDC93CraJNGOOTRTTxdazk",{"id":2544,"title":2545,"author":6,"body":2546,"date":2534,"description":2734,"draft":361,"edited_at":2534,"extension":362,"featured_image":2735,"meta":2736,"navigation":365,"path":2737,"pinned":361,"seo":2738,"sitemap":2739,"stem":2740,"tags":370,"__hash__":2741},"blog\u002Fblog\u002FGait-analysis小兒（二）.md","Gait analysis小兒（二）",{"type":8,"value":2547,"toc":2732},[2548,2551,2665,2668,2703,2715,2721],[11,2549,2550],{},"現在我們將八個步態分期拆開了細看",[18,2552,2553,2577,2591,2609,2619,2640,2659,2662],{},[21,2554,2555,2556,2560,2564,2565,2569,2573,2574,2576],{},"Initical Contact——用",[694,2557,2559],{"className":2558},[766],"股四頭肌和脛前肌做",[694,2561,2563],{"className":2562},[766,711],"離心收縮","，這時",[694,2566,2568],{"className":2567},[766],"腿後肌做",[694,2570,2572],{"className":2571},[766,979],"向心收縮","協同加速穩定",[50,2575],{},"\n（減速與準備承重）",[21,2578,2579,2580,2584,2587,2588,2590],{},"Loading Response——",[694,2581,2583],{"className":2582},[766],"肌內側肌與脛前肌做",[694,2585,2563],{"className":2586},[766,711],"，而臀大肌以及腿後肌輔助Hip加速，將重心向前移動",[50,2589],{},"\n（避震）",[21,2592,2593,2594,2404,2598,2602,2605,2606,2608],{},"Mid-stance——膝蓋後方有關節囊結構的緣故，肌四頭肌幾乎",[694,2595,2597],{"className":2596},[979],"不需用力",[694,2599,2601],{"className":2600},[766],"比目魚肌此時做",[694,2603,2563],{"className":2604},[766,711],"控制脛骨速度",[50,2607],{},"\n（省力）",[21,2610,2611,2612,2616,2618],{},"Terminal stance——",[694,2613,2615],{"className":2614},[766,979],"腓腸肌與比目魚肌做向心收縮",[50,2617],{},"\n（產生推進力）",[21,2620,2621,2622,2626,1171,2629,2631,2632,2636],{},"Pre-swing——假如是慢速走路，會利用",[694,2623,2625],{"className":2624},[766],"縫匠肌(Sartorius)和肌薄肌(Graillis)做",[694,2627,2572],{"className":2628},[766,979],[50,2630],{},"\n快速行走則靠",[694,2633,2635],{"className":2634},[766],"肌直肌做",[694,2637,2639],{"className":2638},[766,1058],"等長收縮",[21,2641,2642,2643,2647,2650,2652,2653,2656],{},"Initial swing——在慢速走路中，",[694,2644,2646],{"className":2645},[766],"股薄肌與縫匠肌會進行",[694,2648,2572],{"className":2649},[766,979],[50,2651],{},"\n而快速走路中，",[694,2654,2635],{"className":2655},[766],[694,2657,2639],{"className":2658},[766,1058],[21,2660,2661],{},"Mid swing——靠慣性推進，基本沒有肌肉參與",[21,2663,2664],{},"Terminal swing——腿後肌做等長收縮，限制Knee extension速度",[11,2666,2667],{},"接著來講小腿後肌群無力的話會有甚麼問題",[184,2669,2670,2680],{},[21,2671,2672,2673,1171,2677,2679],{},"Mid-stannce——比目魚肌無力的話，會讓",[694,2674,2676],{"className":2675},[711,766],"Ankle做DF",[50,2678],{},"\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",[21,2681,2682,2683,2687,2689,2690,2694,2695,2031,2699],{},"Terminal stance和Pre-swing——腓腸肌力量不足的話，",[694,2684,2686],{"className":2685},[766,711],"沒辦法產生足夠的推進力",[50,2688],{},"\n只好讓",[694,2691,2693],{"className":2692},[711,766],"髖屈肌收縮","提起整段下肢，確保",[694,2696,2698],{"className":2697},[979],"腳尖離地",[694,2700,2702],{"className":2701},[697],"步距變短",[11,2704,2705,2706,2708,2709,2711,2712,2714],{},"最後講小孩的步態發展過程",[50,2707],{},"\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",[50,2710],{},"\n2歲的小孩懂得矢狀面(Sagittal-plane)關節旋轉",[50,2713],{},"\n7歲的小孩步態已經能達到成人標準了",[11,2716,2717,2718,2720],{},"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",[50,2719],{},"\n那CP小孩預測能力方面也分成了三個時段",[18,2722,2723,2726,2729],{},[21,2724,2725],{},"9~18個月——頭部控制能力",[21,2727,2728],{},"24個月——不需要支撐能獨自坐穩",[21,2730,2731],{},"30個月——做爬行",{"title":356,"searchDepth":357,"depth":357,"links":2733},[],"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":2545,"description":2734},{"loc":2737},"blog\u002FGait-analysis小兒（二）","x7y-Smp4poLa_EJUkNUpEi-ow03rff_xJb4B-xlHN1k",{"id":2743,"title":428,"author":6,"body":2744,"date":2534,"description":2888,"draft":361,"edited_at":2889,"extension":362,"featured_image":2890,"meta":2891,"navigation":365,"path":2892,"pinned":361,"seo":2893,"sitemap":2894,"stem":2895,"tags":370,"__hash__":2896},"blog\u002Fblog\u002F小兒發展（一）.md",{"type":8,"value":2745,"toc":2886},[2746,2749,2764,2770,2773,2799,2808,2810,2813,2830,2832,2835],[11,2747,2748],{},"（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）",[11,2750,2751,2752,2754,2755,2757,2758,2760,2761,2763],{},"那先來講發展遲緩的定義，它不單指運動層面上，還包括了",[50,2753],{},"\n知覺，語言，心理，社會，情緒等層面",[50,2756],{},"\n而這個動作遲緩有標準的",[50,2759],{},"\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",[50,2762],{},"\n根據WHO的數據，發生率為6~8%",[11,2765,2766,2767,2769],{},"那高危族群有以下",[50,2768],{},"\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",[11,2771,2772],{},"接下來講寶寶的正常發育過程，先從視角說起，如下",[18,2774,2775,2778,2781,2784,2787,2790,2793,2796],{},[21,2776,2777],{},"剛出生數天——眨眼反射",[21,2779,2780],{},"六周——注射物體",[21,2782,2783],{},"二到三個月——對明亮的東西感興趣",[21,2785,2786],{},"四個月——協調眼球轉動",[21,2788,2789],{},"一歲——影像認知發展完成，能看清輪廓",[21,2791,2792],{},"三歲——能分辨紅黃藍綠",[21,2794,2795],{},"五到六歲——可以分辨大多數顏色",[21,2797,2798],{},"八歲以前——有遠視現象（我問了Gemini也看不太懂就是了）",[11,2800,2801,2802,2804,2805,2807],{},"那關於視覺發展異常的問題包括了",[50,2803],{},"\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",[50,2806],{},"\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",[211,2809],{},[11,2811,2812],{},"接著是聽覺發展，如下",[18,2814,2815,2818,2821,2824,2827],{},[21,2816,2817],{},"四個月——追尋聲音或說話來源",[21,2819,2820],{},"七到八個月——被叫名字有反應",[21,2822,2823],{},"十個月——仿說（無意義內容）",[21,2825,2826],{},"一到一歲半——初步聽懂簡單的話",[21,2828,2829],{},"兩歲以後——鸚鵡式學說話",[211,2831],{},[11,2833,2834],{},"接下來是粗大動作的發展，如下",[18,2836,2837,2840,2843,2846,2849,2852,2855,2858,2861,2869,2877,2880,2883],{},[21,2838,2839],{},"兩個月——不穩定的抬頭控制",[21,2841,2842],{},"四個月——抬頭控制適當",[21,2844,2845],{},"五個月——翻身（先學會Prone to supine, 接著是supine to prone）",[21,2847,2848],{},"七個月——坐起來",[21,2850,2851],{},"八個月——爬行",[21,2853,2854],{},"九個月——需要支撐的站起來",[21,2856,2857],{},"十個月——僅需要極小輔助的從坐到站",[21,2859,2860],{},"一歲——獨立行走",[21,2862,2863,2864,2868],{},"兩歲——跑，",[694,2865,2867],{"className":2866},[979],"上樓梯","，踢球，投球，蹲下來",[21,2870,2871,2872,2876],{},"三歲——",[694,2873,2875],{"className":2874},[711],"下樓梯","，雙腳跳，騎三輪車",[21,2878,2879],{},"四歲——單腳跳",[21,2881,2882],{},"五歲——走直線",[21,2884,2885],{},"六歲——騎腳踏車",{"title":356,"searchDepth":357,"depth":357,"links":2887},[],"定義~粗大動作發展","2026-04-12","\u002Fimages\u002Fuploads\u002F1775957410970-EebbBUPUcAYSTE9.webp",{},"\u002Fblog\u002F小兒發展（一）",{"title":428,"description":2888},{"loc":2892},"blog\u002F小兒發展（一）","PRBPkkWsOaM11PriYRM9bPFgTo_bGZSIOZZuLMzA1sk",{"id":2898,"title":429,"author":6,"body":2899,"date":2889,"description":3051,"draft":361,"edited_at":2889,"extension":362,"featured_image":3052,"meta":3053,"navigation":365,"path":3054,"pinned":361,"seo":3055,"sitemap":3056,"stem":3057,"tags":370,"__hash__":3058},"blog\u002Fblog\u002F小兒發展（二）.md",{"type":8,"value":2900,"toc":3049},[2901,2904,2921,2923,2926,2954,2956,2959,2985,2987,2990,3004,3006,3009,3023,3025,3028,3036,3038,3041],[11,2902,2903],{},"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",[18,2905,2906,2909,2912,2915,2918],{},[21,2907,2908],{},"新生兒——中度的膝內翻（O型腿）",[21,2910,2911],{},"六個月——輕度的O型腿",[21,2913,2914],{},"一歲半——直的",[21,2916,2917],{},"三歲半——輕度的膝外翻（X型腿）",[21,2919,2920],{},"五到七歲——直的",[211,2922],{},[11,2924,2925],{},"而步態的發展會按照以下時期發展",[18,2927,2928,2931,2939,2942,2945,2948,2951],{},[21,2929,2930],{},"反射踏步（靠反射）",[21,2932,2933,2934,1297],{},"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—— ",[2176,2935,2938],{"href":2936,"rel":2937},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002Fmotor-learning?series=%E5%B0%8F%E5%85%92%E7%89%A9%E6%B2%BB",[2180],"倒數第二段",[21,2940,2941],{},"過渡期",[21,2943,2944],{},"刻意跨步",[21,2946,2947],{},"獨立行走",[21,2949,2950],{},"Heell-toe步態",[21,2952,2953],{},"整合或直立行走成熟期",[211,2955],{},[11,2957,2958],{},"接著來看不同系統的發展進程，從出生至九個月",[184,2960,2961,2967,2973,2979],{},[21,2962,2963,2964,2966],{},"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）",[50,2965],{},"\n尤其是視覺發展遠大於粗大動作",[21,2968,2969,2970,2972],{},"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",[50,2971],{},"\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",[21,2974,2975,2976,2978],{},"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)",[50,2977],{},"\nHip abduction(訓練方法是扶物側行)",[21,2980,2981,2982,2984],{},"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",[50,2983],{},"\n步寬外展；外轉(O型腿)；髖屈曲；足跟外翻",[211,2986],{},[11,2988,2989],{},"時間來到了九個月到第十五個月之間的發展進程",[18,2991,2992,2995,2998],{},[21,2993,2994],{},"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)",[21,2996,2997],{},"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",[21,2999,3000,3001,3003],{},"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",[50,3002],{},"\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",[211,3005],{},[11,3007,3008],{},"接下來時間來到了十八個月到二十四個月的發展進程",[18,3010,3011,3017],{},[21,3012,3013,3014,3016],{},"力學因素——重心下降(由於腿快速生長)，BOS減少",[50,3015],{},"\nROM的話O型腿消失，但有旋前足出現",[21,3018,3019,3020,3022],{},"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；",[50,3021],{},"\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)",[211,3024],{},[11,3026,3027],{},"時間繼續來到了三歲到三歲半的發展進程",[18,3029,3030,3033],{},[21,3031,3032],{},"力學因素——ROM的話膝外翻(X型腿)，且有旋前足出現",[21,3034,3035],{},"功能性步態——足跟著地穩定，且出現Knee flexion",[211,3037],{},[11,3039,3040],{},"最後時間來到了六歲到七歲的發展進程",[18,3042,3043,3046],{},[21,3044,3045],{},"力學因素——已經能直立行走，並且不在有旋前足",[21,3047,3048],{},"功能性步態——與成人一樣",{"title":356,"searchDepth":357,"depth":357,"links":3050},[],"步態~步態發展","\u002Fimages\u002Fuploads\u002F1775979234822-139196433_p0_master1200.webp",{},"\u002Fblog\u002F小兒發展（二）",{"title":429,"description":3051},{"loc":3054},"blog\u002F小兒發展（二）","tgAyAngzwVGZGqD2GsTT7J1O1RchC3cKRE-f381-bqo",{"id":3060,"title":430,"author":6,"body":3061,"date":2889,"description":3285,"draft":361,"edited_at":2324,"extension":362,"featured_image":3286,"meta":3287,"navigation":365,"path":3288,"pinned":361,"seo":3289,"sitemap":3290,"stem":3291,"tags":370,"__hash__":3292},"blog\u002Fblog\u002F小兒發展（三）.md",{"type":8,"value":3062,"toc":3283},[3063,3066,3069,3098,3100,3103,3120,3122,3125,3151,3153,3156,3189,3195,3214,3220,3246,3249,3252,3275,3278],[11,3064,3065],{},"寫著寫著發現這一課東西好多（悲",[11,3067,3068],{},"接著講精細動作的發展過程",[18,3070,3071,3074,3077,3080,3083,3086,3089,3092,3095],{},[21,3072,3073],{},"四個月——可以合掌",[21,3075,3076],{},"五個月——手可以向前伸並抓東西",[21,3078,3079],{},"七個月——握緊奶瓶",[21,3081,3082],{},"十個月——拍手",[21,3084,3085],{},"一歲——亂塗鴉",[21,3087,3088],{},"一歲半——疊兩到四個積木",[21,3090,3091],{},"兩歲——疊四到八個積木；畫直線",[21,3093,3094],{},"三歲——畫圓圈",[21,3096,3097],{},"五歲——畫出人形",[211,3099],{},[11,3101,3102],{},"假如有發展遲緩的問題，會有以下徵候",[184,3104,3105,3108,3111,3114,3117],{},[21,3106,3107],{},"以翻身作為移動方式",[21,3109,3110],{},"手腳不協調的爬行方式",[21,3112,3113],{},"W坐姿",[21,3115,3116],{},"兔子跳",[21,3118,3119],{},"一歲前出現明顯慣用手(因為一歲前大多為雙手並用)",[211,3121],{},[11,3123,3124],{},"而寶寶出現以下徵候，可能他有CP問題",[184,3126,3127,3130,3133,3136,3139,3142,3145,3148],{},[21,3128,3129],{},"躁動",[21,3131,3132],{},"缺乏精力",[21,3134,3135],{},"吸吮無力伴隨舌頭往前突",[21,3137,3138],{},"六個月大頭部控制不佳",[21,3140,3141],{},"口腔過度敏感",[21,3143,3144],{},"強直性咬合反射",[21,3146,3147],{},"不對稱動作形態",[21,3149,3150],{},"異常姿勢",[211,3152],{},[11,3154,3155],{},"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",[11,3157,3158,3159,3161,3162,3166,3167,3171,3173,3174,3178,3179,3183,3184,3188],{},"首先是語言準備期，分成了表達跟理解兩個面向",[50,3160],{},"\n這時候寶寶還小，表達還只能靠",[694,3163,3165],{"className":3164},[766],"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",[694,3168,3170],{"className":3169},[766],"學身邊的人咿咿呀呀",[50,3172],{},"\n而這個時候",[694,3175,3177],{"className":3176},[766,979],"理解能力比表達能力還要發展得快","，知覺部份開始分得出",[694,3180,3182],{"className":3181},[979],"語氣快慢聲源","等，也能",[694,3185,3187],{"className":3186},[979],"理解一些簡單的短語","例如yes or no等",[11,3190,3191,3192,3194],{},"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",[50,3193],{},"\n而語法構造則分為以下部份",[184,3196,3197,3205],{},[21,3198,3199,3200,3204],{},"句子表達能力——分成剛開始學的不完整句子，",[694,3201,3203],{"className":3202},[766,979],"只講關鍵的詞","；和發展到後面的會講完整句子",[21,3206,3207,3208,3210,3211,3213],{},"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",[50,3209],{},"\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",[50,3212],{},"\n最後也能理解對哪個人說甚麼樣的話",[11,3215,3216,3217,3219],{},"然後講一下正常語言發展能力，雖然跟聽覺有部份重合，",[50,3218],{},"\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(?)",[18,3221,3222,3225,3228,3231,3234,3237,3240,3243],{},[21,3223,3224],{},"四個月——頭尋找聲源",[21,3226,3227],{},"六到七個月——仿說",[21,3229,3230],{},"九到十二個月——叫爸爸媽媽",[21,3232,3233],{},"一歲到一歲半——只會講一兩個字且沒有意義",[21,3235,3236],{},"兩歲到兩歲半——講片語（例如像鸚鵡般學大人說啥）",[21,3238,3239],{},"三歲——開始能講句子，講顏色，倒數十，說出身體部位",[21,3241,3242],{},"四歲——能說出數種顏色",[21,3244,3245],{},"五歲——計算五個積木",[11,3247,3248],{},"(所以看起來三歲已經具備認知能力?)",[11,3250,3251],{},"那假如語言發展異常會有以下徵象",[184,3253,3254,3257,3260,3263,3266,3269,3272],{},[21,3255,3256],{},"一歲前——太安靜",[21,3258,3259],{},"兩歲——還沒有出現有意思的字詞",[21,3261,3262],{},"三歲——沒有出現任何句子",[21,3264,3265],{},"四歲——有構音困難",[21,3267,3268],{},"五歲——說話結巴",[21,3270,3271],{},"年紀越大話越少",[21,3273,3274],{},"鼻音重，說話小聲，不當的臉部表情，說話會喘",[11,3276,3277],{},"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",[11,3279,3280],{},[924,3281],{"alt":926,"src":3282},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776047406679-Screenshot_2026-04-13_102943.png",{"title":356,"searchDepth":357,"depth":357,"links":3284},[],"精細動作~語言發展","\u002Fimages\u002Fuploads\u002F1776047258825-ElqW51yVoAI09Jg.webp",{},"\u002Fblog\u002F小兒發展（三）",{"title":430,"description":3285},{"loc":3288},"blog\u002F小兒發展（三）","cGrD26dwyUjVzawlHZHH_OnTqXRpbSPGvcZEZluSbRk",{"id":3294,"title":431,"author":6,"body":3295,"date":2324,"description":3438,"draft":361,"edited_at":2324,"extension":362,"featured_image":3439,"meta":3440,"navigation":365,"path":3441,"pinned":361,"seo":3442,"sitemap":3443,"stem":3444,"tags":370,"__hash__":3445},"blog\u002Fblog\u002F小兒發展（四）.md",{"type":8,"value":3296,"toc":3436},[3297,3300,3323,3325,3328,3354,3356,3359,3379,3381,3384,3398,3400,3403,3417,3419,3422],[11,3298,3299],{},"接下來講到括約肌控制發展（大小便控制）",[18,3301,3302,3305,3314,3320],{},[21,3303,3304],{},"十五個月——能告訴爸媽想上廁所或者褲子濕了",[21,3306,3307,3308,3310,3311,3313],{},"十八個月——白天褲子不太會濕，當然也有意外；",[50,3309],{},"\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；",[50,3312],{},"\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",[21,3315,3316,3317,3319],{},"兩到三歲——半夜讓小孩上廁所就整晚不會尿床",[50,3318],{},"\n有研究表明，晚上會叫尿床的都比較神經質(講義原句XD)",[21,3321,3322],{},"三歲——能自己上廁所但擦不乾淨，要到六歲才能擦乾淨",[211,3324],{},[11,3326,3327],{},"接著講ADL的發展",[18,3329,3330,3333,3336,3342,3345,3348,3351],{},[21,3331,3332],{},"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",[21,3334,3335],{},"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",[21,3337,3338,3339,3341],{},"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；",[50,3340],{},"\n也開始可以脫襪子和鞋子",[21,3343,3344],{},"十八個月——會脫襪子鞋子，將拉鏈拉開，不需要轉動湯匙進食",[21,3346,3347],{},"兩歲——可以穿脫襪子鞋子褲子",[21,3349,3350],{},"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",[21,3352,3353],{},"五歲——會綁鞋子",[211,3355],{},[11,3357,3358],{},"社會性情緒發展部份",[18,3360,3361,3364,3370,3373,3376],{},[21,3362,3363],{},"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",[21,3365,3366,3367,3369],{},"六到十二個月——十分依賴，認得且會得媽媽",[50,3368],{},"\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",[21,3371,3372],{},"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",[21,3374,3375],{},"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",[21,3377,3378],{},"二十四到三十六個月——越來越適應陌生環境，上托兒所",[211,3380],{},[11,3382,3383],{},"自我概念發展部份",[18,3385,3386,3389,3392,3395],{},[21,3387,3388],{},"剛出生到六個月——動作控制不佳；稍微分得出自我跟非自我",[21,3390,3391],{},"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",[21,3393,3394],{},"十八到二十四個月——對自己名字敏感",[21,3396,3397],{},"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",[211,3399],{},[11,3401,3402],{},"情緒發展部份",[18,3404,3405,3408,3411,3414],{},[21,3406,3407],{},"剛出生到六個月——早期只有哭跟高興表情",[21,3409,3410],{},"六到十二個月——開始有其他情緒例如厭惡，害怕，憤怒",[21,3412,3413],{},"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",[21,3415,3416],{},"十八到二十四個月——能夠用語言表達情緒",[211,3418],{},[11,3420,3421],{},"依賴及獨立發展",[18,3423,3424,3427,3430],{},[21,3425,3426],{},"剛出生到十二個月——完全依賴照顧",[21,3428,3429],{},"十二到十八個月——知道自己是個體後，想自我尋求",[21,3431,3432,3433,3435],{},"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；",[50,3434],{},"\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":356,"searchDepth":357,"depth":357,"links":3437},[],"括約肌控制~依賴獨立發展","\u002Fimages\u002Fuploads\u002F1776052282656-EXjYORHUcAALULe.webp",{},"\u002Fblog\u002F小兒發展（四）",{"title":431,"description":3438},{"loc":3441},"blog\u002F小兒發展（四）","iCO6Xr2Vz0v9l6ulRBKlWBt93Dzu8k8I4HDGsX-Dbpc",{"id":3447,"title":432,"author":6,"body":3448,"date":1122,"description":3588,"draft":361,"edited_at":1122,"extension":362,"featured_image":3589,"meta":3590,"navigation":365,"path":3591,"pinned":361,"seo":3592,"sitemap":3593,"stem":3594,"tags":370,"__hash__":3595},"blog\u002Fblog\u002F小兒發展（五）.md",{"type":8,"value":3449,"toc":3586},[3450,3456,3470,3473,3493,3495,3498,3527,3529,3532,3552,3554,3557],[11,3451,3452,3453,3455],{},"接下來講到一個叫皮亞傑的人，他提出了發展理論",[50,3454],{},"\n先來講他說的四大認知階段",[18,3457,3458,3461,3464,3467],{},[21,3459,3460],{},"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",[21,3462,3463],{},"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）",[21,3465,3466],{},"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",[21,3468,3469],{},"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",[11,3471,3472],{},"接著是他提到的感覺運動期",[18,3474,3475,3478,3481,3484,3487,3490],{},[21,3476,3477],{},"反射期(0-2m)——對，就一堆反射",[21,3479,3480],{},"初級循環反應期(3-5m)——摸索自己身體",[21,3482,3483],{},"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）",[21,3485,3486],{},"兩個基模協調(9-12m)——透過兩種動作模式達成目的；理解因果",[21,3488,3489],{},"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",[21,3491,3492],{},"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",[211,3494],{},[11,3496,3497],{},"然後是個人與社會發展",[18,3499,3500,3503,3506,3509,3512,3515,3518,3521,3524],{},[21,3501,3502],{},"兩個月——會對別人笑",[21,3504,3505],{},"六個月——自己拿玩具玩",[21,3507,3508],{},"六到八個月——開始理解陌生，不讓陌生人抱",[21,3510,3511],{},"十個月——搖手bye bye（maybe是已經將動作與語言結合?）",[21,3513,3514],{},"一歲——拿杯子喝水",[21,3516,3517],{},"十五個月——拿湯匙、脫下外套、學刷牙",[21,3519,3520],{},"兩歲——會洗手",[21,3522,3523],{},"三歲——會穿脫鞋",[21,3525,3526],{},"四歲——穿衣服，扣鈕扣，刷牙",[211,3528],{},[11,3530,3531],{},"接下來講ASD的臨床徵象（即使動作發展正常，也會有語言delay）",[18,3533,3534,3537,3540,3543,3546,3549],{},[21,3535,3536],{},"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",[21,3538,3539],{},"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",[21,3541,3542],{},"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",[21,3544,3545],{},"注意力不集中——無法持久學習",[21,3547,3548],{},"衝動——人際關係緊張",[21,3550,3551],{},"好動——無法遵守規矩，破壞力強",[211,3553],{},[11,3555,3556],{},"吞嚥異常的臨床徵象",[18,3558,3559,3562,3565,3568,3571,3574,3577,3580,3583],{},[21,3560,3561],{},"反覆性肺炎",[21,3563,3564],{},"營養不良",[21,3566,3567],{},"抗拒食物",[21,3569,3570],{},"吞嚥困難",[21,3572,3573],{},"口中有異物感",[21,3575,3576],{},"嗆咳",[21,3578,3579],{},"口中有異味",[21,3581,3582],{},"經營嘔吐",[21,3584,3585],{},"流口水",{"title":356,"searchDepth":357,"depth":357,"links":3587},[],"皮亞傑~結束","\u002Fimages\u002Fuploads\u002F1776132158232-tHG70Gg.webp",{},"\u002Fblog\u002F小兒發展（五）",{"title":432,"description":3588},{"loc":3591},"blog\u002F小兒發展（五）","hzbfl2qpxvvTUq5Hn8aXvAKEpMa7oP19s8AD5xnz-1Q",{"id":4,"title":5,"author":6,"body":3597,"date":359,"description":360,"draft":361,"edited_at":359,"extension":362,"featured_image":363,"meta":3859,"navigation":365,"path":366,"pinned":361,"seo":3860,"sitemap":3861,"stem":369,"tags":370,"__hash__":371},{"type":8,"value":3598,"toc":3857},[3599,3601,3603,3615,3731,3733,3751,3753,3755,3767,3769,3771,3785,3787,3789,3803,3805,3807,3819,3821,3823,3835,3837,3839,3853,3855],[11,3600,13],{},[11,3602,16],{},[18,3604,3605,3607,3609,3611,3613],{},[21,3606,23],{},[21,3608,26],{},[21,3610,29],{},[21,3612,32],{},[21,3614,35],{},[37,3616,3617,3635],{},[40,3618,3619],{},[43,3620,3621,3625,3627,3629,3631,3633],{},[46,3622,3623],{"align":48},[50,3624],{},[46,3626,54],{"align":48},[46,3628,57],{"align":48},[46,3630,60],{"align":48},[46,3632,63],{"align":48},[46,3634,66],{"align":48},[68,3636,3637,3657,3677,3697,3711],{},[43,3638,3639,3641,3643,3645,3649,3653],{},[73,3640,75],{"align":48},[73,3642,78],{"align":48},[73,3644,81],{"align":48},[73,3646,3647],{"align":48},[50,3648],{},[73,3650,3651],{"align":48},[50,3652],{},[73,3654,3655],{"align":48},[50,3656],{},[43,3658,3659,3661,3663,3665,3669,3673],{},[73,3660,98],{"align":48},[73,3662,101],{"align":48},[73,3664,104],{"align":48},[73,3666,3667],{"align":48},[50,3668],{},[73,3670,3671],{"align":48},[50,3672],{},[73,3674,3675],{"align":48},[50,3676],{},[43,3678,3679,3681,3683,3685,3689,3693],{},[73,3680,121],{"align":48},[73,3682,124],{"align":48},[73,3684,127],{"align":48},[73,3686,3687],{"align":48},[50,3688],{},[73,3690,3691],{"align":48},[50,3692],{},[73,3694,3695],{"align":48},[50,3696],{},[43,3698,3699,3701,3703,3705,3707,3709],{},[73,3700,144],{"align":48},[73,3702,147],{"align":48},[73,3704,150],{"align":48},[73,3706,153],{"align":48},[73,3708,153],{"align":48},[73,3710,153],{"align":48},[43,3712,3713,3715,3717,3719,3723,3727],{},[73,3714,162],{"align":48},[73,3716,165],{"align":48},[73,3718,165],{"align":48},[73,3720,3721],{"align":48},[50,3722],{},[73,3724,3725],{"align":48},[50,3726],{},[73,3728,3729],{"align":48},[50,3730],{},[11,3732,182],{},[184,3734,3735,3737,3739,3741,3743,3745,3747,3749],{},[21,3736,188],{},[21,3738,191],{},[21,3740,194],{},[21,3742,197],{},[21,3744,200],{},[21,3746,203],{},[21,3748,206],{},[21,3750,209],{},[211,3752],{},[11,3754,215],{},[184,3756,3757,3759,3761,3763,3765],{},[21,3758,220],{},[21,3760,223],{},[21,3762,226],{},[21,3764,229],{},[21,3766,232],{},[211,3768],{},[11,3770,237],{},[184,3772,3773,3775,3777,3781,3783],{},[21,3774,242],{},[21,3776,245],{},[21,3778,248,3779,251],{},[50,3780],{},[21,3782,254],{},[21,3784,257],{},[211,3786],{},[11,3788,262],{},[184,3790,3791,3793,3797,3799,3801],{},[21,3792,267],{},[21,3794,270,3795,273],{},[50,3796],{},[21,3798,276],{},[21,3800,279],{},[21,3802,282],{},[211,3804],{},[11,3806,287],{},[184,3808,3809,3811,3813,3815,3817],{},[21,3810,292],{},[21,3812,295],{},[21,3814,298],{},[21,3816,301],{},[21,3818,282],{},[211,3820],{},[11,3822,308],{},[184,3824,3825,3827,3829,3831,3833],{},[21,3826,313],{},[21,3828,316],{},[21,3830,319],{},[21,3832,322],{},[21,3834,325],{},[211,3836],{},[11,3838,330],{},[184,3840,3841,3843,3845,3851],{},[21,3842,335],{},[21,3844,338],{},[21,3846,341,3847],{},[184,3848,3849],{},[21,3850,346],{},[21,3852,349],{},[211,3854],{},[11,3856,354],{},{"title":356,"searchDepth":357,"depth":357,"links":3858},[],{},{"title":5,"description":360},{"loc":366},1776857462078]