[{"data":1,"prerenderedAt":3039},["ShallowReactive",2],{"\u002Fblog\u002FMotor-Learning":3,"post-count":498,"series-global-data":499,"authors-all":580,"series-sidebar-小兒物治":776},{"id":4,"title":5,"author":6,"body":7,"date":484,"description":485,"draft":486,"edited_at":487,"extension":488,"featured_image":489,"meta":490,"navigation":491,"path":492,"pinned":486,"seo":493,"series":494,"seriesOrder":494,"sitemap":495,"stem":496,"tags":494,"__hash__":497},"blog\u002Fblog\u002FMotor-Learning.md","Motor Learning小兒（一）","hibiki12141132",{"type":8,"value":9,"toc":480},"minimark",[10,14,24,33,51,60,69,89,98,128,204,219,222,266,272,321,367,408,411,449,464],[11,12,13],"p",{},"那這一節課著重在動態模組理論，跟黃老師教的是互通的",[11,15,16,17,20,21,23],{},"那首先是講感覺統合的部份",[18,19],"br",{},"\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",[18,22],{},"\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)",[11,25,26,27,29,30,32],{},"而接下來講到動作的發展",[18,28],{},"\n那老師用的理論是動態模組理論",[18,31],{},"\n假如還記得黃老師的Motor Control最後一課講的應該不難吃",[11,34,35,36,38,39,41,42,44,45,47,48,50],{},"不過我還是先列出來老師PPT裡的五個角度",[18,37],{},"\n第一 動作技巧的顯現",[18,40],{},"\n第二 動作型態的精準度",[18,43],{},"\n第三 動作成果(可從評估表推估) ",[18,46],{},"\n第四 組合技巧的獲得(次系統組合的結果)",[18,49],{},"\n第五 對環境適應力的增強",[11,52,53,54,56,57,59],{},"我們現在來講平衡系統的發展",[18,55],{},"\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",[18,58],{},"\n以站立來形容的話",[11,61,62,63,65,66,68],{},"2)人類的重心(COM)基本會在S2 ",[18,64],{},"\n那壓力中心(COP)是動態的 他會因應COM的改變而改變",[18,67],{},"\n那底面積(BOS)就是兩隻腳踩在地面的距離",[11,70,71,72,79,80,82,83,88],{},"3)那平衡的演化 在早期 小孩會",[73,74,78],"span",{"className":75},[76,77],"red-3","underline","極度依賴視角","來判斷",[18,81],{},"\n但在成熟的過程中 我們會",[73,84,87],{"className":85},[86],"bg-red-3","越來越傾向用本體感覺","去判斷",[11,90,91,92,94,95,97],{},"4)穩定極限(LOS) 他把我們人類想象成一個倒立的三角錐",[18,93],{},"\n在不移動的情況下身體能偏多少(前6度 側8度 後4度)",[18,96],{},"\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)",[11,99,100,101,103,104,109,110,115,116,118,119,123,124],{},"5)承受外力時的反應時 人類會有兩種變化",[18,102],{},"\n第一種就是假如這",[73,105,108],{"className":106},[77,107],"green-3","外力少到一定範圍"," 就只會用",[73,111,114],{"className":112},[113],"bg-green-3","姿勢穩定反應","來做調整",[18,117],{},"\n另一種則是假如外力",[73,120,122],{"className":121},[77,76],"超過姿勢穩定反應可以調整的程度"," 就會產生",[73,125,127],{"className":126},[86],"保護性姿勢",[11,129,130,131,133,134,136,137,139,140,144,146,147,152,156,158,159,161,163,164,168,169,171,172,176,177,179,180,182,184,185,187,188,190,191,195,196,198,200,201,203],{},"6)",[18,132],{},"\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",[18,135],{},"\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",[18,138],{},"\n那一般而言 越成熟的人 會越偏好用",[73,141,143],{"className":142},[76],"踝策略",[18,145],{},"\n而目前比較新的提出 就是",[73,148,151],{"className":149},[150,77],"yellow-3","抓握",[73,153,155],{"className":154},[150],"是一種不算策略(Strategy)的方法",[18,157],{},"\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",[18,160],{},[18,162],{},"\nii) 而另一點則是改變BOS的 例子就有跨步策略 身體是",[73,165,167],{"className":166},[76],"被迫做出","的 伸手出去支撐也是如此",[18,170],{},"\n那在發展過程中 而在",[73,173,175],{"className":174},[76],"方向性上也是有順序","的",[18,178],{},"\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",[18,181],{},[18,183],{},"\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 ",[18,186],{},"\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",[18,189],{},"\n我們",[73,192,194],{"className":193},[77],"可以通過適度的給他們外力","訓練他們",[18,197],{},[18,199],{},"\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",[18,202],{},"\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",[11,205,206,207,209,210,212,213,215,216,218],{},"那對於小兒的發展議題，主要有這幾個",[18,208],{},"\ni)——新形式的起源(The origin of new form)",[18,211],{},"\nii)——連續性與非連續性(Continuity vs discontinuity)",[18,214],{},"\niii)——變異性(Variability)",[18,217],{},"\niv)——生物與環境的影響(Biological vs. environmental influence)",[11,220,221],{},"那動態模組理論是經歷過以下發展而來的",[223,224,225,233,253],"ol",{},[226,227,228,229],"li",{},"那首先是小兒痲痺(1910s)——當年的理念是哪邊無力練哪邊",[73,230,232],{"className":231},[77,86],"(肌肉再教育 muscle re-education)",[226,234,235,236,240,241,243,244,246,247,249,250,252],{},"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",[73,237,239],{"className":238},[86,77],"感覺輸入","促進正常的動作以及動作發展",[18,242],{},"\n神經成熟理論(1945s)由Gesell和McGraw提出，他們的關鍵理念有如下",[18,245],{},"\nCNS髓鞘化(Increased myelination of CNS)",[18,248],{},"\n皮質抑制皮質下中心(Inhibition of the subcortical centers by the higher cerebral cortex)",[18,251],{},"\n層級控制(Hierarchical control)",[226,254,255,256,260,261,265],{},"最後來講到階層理論的雛型(1980s)——當年他們覺得動作發展",[73,257,259],{"className":258},[77],"不只單一的神經支配","，把",[73,262,264],{"className":263},[77,76],"其他的系統、環境","一併整合進來",[11,267,268,269,271],{},"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",[18,270],{},"\n那它有三個假設",[223,273,274,285,305],{},[226,275,276,277,279,280,284],{},"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",[18,278],{},"\n但在1979s有學者提出說，其實原始反射對於每個寶寶來說",[73,281,283],{"className":282},[76],"變異性","也很大",[226,286,287,288,290,291,295,296,300,301],{},"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",[18,289],{},"\n但在1976s有學者發現到，南非的寶寶被家長",[73,292,294],{"className":293},[77],"直立抱法或者練習坐","，會比美國寶寶",[73,297,299],{"className":298},[76],"更快發展出下肢動作","，但",[73,302,304],{"className":303},[107],"爬和翻身較慢",[226,306,307,308,310,311,315,316,320],{},"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)",[18,309],{},"\n但在1988s有學者提出，寶寶的",[73,312,314],{"className":313},[107],"伸手以及操作","的發展在近端遠端上是",[73,317,319],{"className":318},[77,76],"同時存在","的(同步進行發展，並沒有明確上下關係)",[11,322,323,324,326,327,331,332,336,338,339,343,344,346,347,351,352,356,357,361,363,364,366],{},"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",[18,325],{},"\n那協調就是將這些複雜的東西，透過",[73,328,330],{"className":329},[76],"降低自由度","，來",[73,333,335],{"className":334},[107],"產生平滑的動作",[18,337],{},"\n那降低自由度的策略會牽涉到一個叫",[73,340,342],{"className":341},[86],"自我組織","的東西，那它的核心理念是說",[18,345],{},"\n動作是有",[73,348,350],{"className":349},[86],"適應性","的，次系統會根據",[73,353,355],{"className":354},[77,76],"環境任務","等因素做調整，",[73,358,360],{"className":359},[107],"再拼湊起來",[18,362],{},"\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）",[18,365],{},"\n有提到三個重點",[223,368,369,375,391],{},[226,370,371,372,374],{},"次序參數——它探討的是關節之間的協同",[18,373],{},"\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",[226,376,377,378,382,383,385,386,390],{},"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",[73,379,381],{"className":380},[77,86],"最省力、自然以及方便","的動作型態",[18,384],{},"\n那假如這個動作達到了上述說的型態，便是",[73,387,389],{"className":388},[76,77],"最穩定型態","，即使會因應任務去做改變也是十分穩定的",[226,392,393,394,396,397,401,402,404,405,407],{},"相移現象——意思就是說原本在做著一個穩定的動作型態",[18,395],{},"\n因為一些",[73,398,400],{"className":399},[76],"因素所干擾","，就會變成另一個動作型態",[18,403],{},"\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)",[18,406],{},"\n（對 黃老師教動態系統理論也提到過這個）",[11,409,410],{},"最後講兩個實驗",[223,412,413,435],{},[226,414,415,416,418,419,421,422,426,427,431,432,434],{},"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",[18,417],{},"\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",[18,420],{},"\n但動態模組理論發現，其實是因為在第四周寶寶",[73,423,425],{"className":424},[77,76],"長脂肪比長肌肉快","，導致",[73,428,430],{"className":429},[107],"力量不足","做不出來",[18,433],{},"\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",[226,436,437,438,440,441,443,444,448],{},"第二個實驗，是觀察青蛙生長的環境與發育的關係",[18,439],{},"\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",[18,442],{},"\n所以神經成熟是可以讓動作型態形成，但必須得加上",[73,445,447],{"className":446},[77,76],"環境，時間以及個體本身條件","才能讓型態表現更好",[11,450,451,452,454,455,457,458,460,461,463],{},"那在臨床意義上有以下幾點",[18,453],{},"\n分散式控制(Distributed control)",[18,456],{},"\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)",[18,459],{},"\n由兒童主導(Active role of the child)",[18,462],{},"\n個體差異的訊息(variability provides important information)",[11,465,466,467,471,472,476,477,479],{},"評估",[73,468,470],{"className":469},[77,113],"不應只侷限在探討神經發展過程","，而是要根據",[73,473,475],{"className":474},[86,77],"多個系統，家庭因素","等問題",[18,478],{},"\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":481,"searchDepth":482,"depth":482,"links":483},"",2,[],"2026-03-31","感覺統合~三個協調的重點",false,"2026-04-10","md","\u002Fimages\u002Fuploads\u002F1775795013607-141589321_p0.jpg",{},true,"\u002Fblog\u002FMotor-Learning",{"title":5,"description":485},null,{"loc":492},"blog\u002FMotor-Learning","obavLX0YE8S5ZdJePeKeB95Xv_paOfh3iXMyeyjVjCA",79,{"id":500,"extension":501,"meta":502,"series":503,"stem":578,"__hash__":579},"series\u002Fseries.json","json",{},{"微積分教學":504,"生活紀錄":507,"Motor Control":509,"生活隨筆":523,"Motor learning":527,"小兒物治":545,"中風":557,"平衡":568,"Network 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語言障礙",[18,914],{},[18,916],{},"\n對稱協調控制",[18,919],{},"\n雙側控制",[11,922,923,924,842,926,930,932,933,935,936,938,939,941,942,944,945,947,948,950],{},"最後來講失調型(Ataxia)",[18,925],{},[73,927,929],{"className":928},[86],"小腦",[18,931],{},"\n張力小",[18,934],{},"\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)",[18,937],{},"\n併發有 平衡 感覺統合 知覺都會較差",[18,940],{},"\n在治療重點上",[18,943],{},"\n會給他們穿加壓衣(增加感統知覺) ",[18,946],{},"\n穩定與張力提升",[18,949],{},"\n承重(增加感統知覺)",[11,952,953,954,956,957,959,960,962],{},"還有一些小分類 簡單帶過一下",[18,955],{},"\n首先是僵直型 這個是比痙攣型張力還要再強",[18,958],{},"\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",[18,961],{},"\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",[11,964,965,966,968,969,971,972,974,975,977,978,980,981,983,984,988],{},"接著來講治療原則 主要有五點",[18,967],{},"\n早期教育(早療 黃金期)",[18,970],{},"\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)",[18,973],{},"\n治療項目盡量以ADL為主",[18,976],{},"\n日常活動(結合孩子一天的作息去制定訓練 回家訓練)",[18,979],{},"\n感官輸入(如本體感覺 觸覺)",[18,982],{},"\n老師有圈了個重點 ",[73,985,987],{"className":986},[76],"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)",[11,990,991,992,994,995,999,1000,994,1002,1006,1007,1009,1010,1014],{},"最後來講預後",[18,993],{},"\n假如 ",[73,996,998],{"className":997},[77],"2歲前","的寶寶能自行坐起來 未來100%能夠自行走動",[18,1001],{},[73,1003,1005],{"className":1004},[77],"4歲的","寶寶還不會自行坐起來 未來不會走",[18,1008],{},"\n假如 是",[73,1011,1013],{"className":1012},[77],"偏癱","的寶寶 未來100%能夠自行走動",[11,1016,1017],{},[1018,1019],"img",{"alt":1020,"src":1021},"1.00","https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774841979537-Screenshot_20260330_100529_Gallery.png",[11,1023,1024],{},[1018,1025],{"alt":1020,"src":1026},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774842001784-Screenshot_20260330_100531_Gallery.png",[11,1028,1029,1030,1032],{},"一些講義的內容 我隨後會在另一篇裡加上 ",[18,1031],{},[73,1033,1035],{"className":1034},[86],"讀英文！！！",{"title":481,"searchDepth":482,"depth":482,"links":1037},[],"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":779,"description":1039},{"loc":1042},"blog\u002F腦性痲痺-CP",[1047],"小兒PT","VRwnEKZEYqmW7o2UAStJ5mCqG7YSqw_jRSxAkVYjn34",{"id":1050,"title":547,"author":6,"body":1051,"date":1215,"description":1216,"draft":486,"edited_at":1215,"extension":488,"featured_image":1217,"meta":1218,"navigation":491,"path":1219,"pinned":486,"seo":1220,"series":494,"seriesOrder":494,"sitemap":1221,"stem":1222,"tags":494,"__hash__":1223},"blog\u002Fblog\u002FCP補充（一）.md",{"type":8,"value":1052,"toc":1213},[1053,1056,1059,1086,1089,1095,1118,1123,1166,1169,1172,1208],[11,1054,1055],{},"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",[11,1057,1058],{},"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",[223,1060,1061,1067,1083],{},[226,1062,1063,1064,1066],{},"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",[18,1065],{},"\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",[226,1068,1069,1070,1074,1076,1077,1079,1080,1082],{},"產中——主要為",[73,1071,1073],{"className":1072},[77,107],"胎兒中毒以及產時窒息",[18,1075],{},"\n血液樣本顯示為代謝性酸中毒，pH\u003C7以及鹼剩餘>12mmol\u002FL",[18,1078],{},"\n妊娠周數>34周，早期會出現中度或重度腦病變",[18,1081],{},"\n低血糖，未經治療的黃疽，嚴重的新生兒感染亦會導致CP",[226,1084,1085],{},"產後——感染，外傷，腦膜炎，敗血症",[1087,1088],"hr",{},[11,1090,1091,1092,1094],{},"腦型麻痺類別——1（雖然總結有提到，但還是再寫一次好了）",[18,1093],{},"\n分成了",[223,1096,1097],{},[226,1098,1099,1100,1102,1103,1105,1106,1108,1109,1111,1112,1114,1115,1117],{},"肢體受影響的分佈模式——",[18,1101],{},"\n雙側痲痺(腳比手影響嚴重)",[18,1104],{},"\n單側痲痺(單側受影響)",[18,1107],{},"\n四肢痲痺（手比腳嚴重）",[18,1110],{},"\n單肢痲痺",[18,1113],{},"\n三肢痲痺",[18,1116],{},"\n下肢痲痺",[11,1119,1120],{},[1018,1121],{"alt":1020,"src":1122},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776134449314-Screenshot_2026-04-14_104024.png",[223,1124,1125],{},[226,1126,1127,1128,1130,1131,1133,1134,1136,1137,1141,1143,1144,1148,1149,1153,1154,1156,1157,1159,1160,1162,1163,1165],{},"根據張力與動作異常形態區分——",[18,1129],{},"\n痙攣型——佔比七成，傷到錐狀束，上肢Flexor tone強+pronation，下肢Extenor tone強",[18,1132],{},"\n徐動型——佔比一成五，傷到基底核，皮質無影響，所以智力正",[18,1135],{},"\n僵直型——傷到皮質，比",[73,1138,1140],{"className":1139},[77,76],"痙攣型張力還大",[18,1142],{},"\n運動失調型——佔比一成三，傷到小腦，",[73,1145,1147],{"className":1146},[77,76],"協調能力差","且尤其是",[73,1150,1152],{"className":1151},[150],"下肢","特別明顯，步寬大，走路搖晃",[18,1155],{},"\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",[18,1158],{},"\n顫抖型——較徐動型有節奏，在遠端顫抖",[18,1161],{},"\n混合型",[18,1164],{},"\n無法分類型",[11,1167,1168],{},"類別——2（P8）",[11,1170,1171],{},"他提到了按照ICF思路去想各個層級寶寶的問題",[223,1173,1174,1177,1185,1192,1200],{},[226,1175,1176],{},"首先是健康問題，受了甚麼傷",[226,1178,1179,1180],{},"其次是受限，這個傷會讓寶寶",[73,1181,1184],{"className":1182},[77,1183],"blue-3","做不了哪些動作",[226,1186,1187,1188],{},"再來是侷限，這些做不了的動作會讓寶寶",[73,1189,1191],{"className":1190},[77,76],"失去甚麼功能性",[226,1193,1194,1195,1199],{},"然後是環境因素，例如失去了這些功能性的話，與",[73,1196,1198],{"className":1197},[77,107],"環境的互動","有甚麼障礙",[226,1201,1202,1203,1207],{},"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",[73,1204,1206],{"className":1205},[77,150],"動機","等因素",[11,1209,1210],{},[1018,1211],{"alt":1020,"src":1212},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776135419925-Screenshot_2026-04-14_105040.png",{"title":481,"searchDepth":482,"depth":482,"links":1214},[],"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":547,"description":1216},{"loc":1219},"blog\u002FCP補充（一）","MVDRBJhtJrUF5RgWPNWhW-ndIgxVG35Nlwm4ejBv78c",{"id":4,"title":5,"author":6,"body":1225,"date":484,"description":485,"draft":486,"edited_at":487,"extension":488,"featured_image":489,"meta":1533,"navigation":491,"path":492,"pinned":486,"seo":1534,"series":494,"seriesOrder":494,"sitemap":1535,"stem":496,"tags":494,"__hash__":497},{"type":8,"value":1226,"toc":1531},[1227,1229,1235,1241,1253,1259,1265,1275,1281,1299,1351,1361,1363,1391,1395,1427,1457,1484,1486,1511,1521],[11,1228,13],{},[11,1230,16,1231,20,1233,23],{},[18,1232],{},[18,1234],{},[11,1236,26,1237,29,1239,32],{},[18,1238],{},[18,1240],{},[11,1242,35,1243,38,1245,41,1247,44,1249,47,1251,50],{},[18,1244],{},[18,1246],{},[18,1248],{},[18,1250],{},[18,1252],{},[11,1254,53,1255,56,1257,59],{},[18,1256],{},[18,1258],{},[11,1260,62,1261,65,1263,68],{},[18,1262],{},[18,1264],{},[11,1266,71,1267,79,1270,82,1272,88],{},[73,1268,78],{"className":1269},[76,77],[18,1271],{},[73,1273,87],{"className":1274},[86],[11,1276,91,1277,94,1279,97],{},[18,1278],{},[18,1280],{},[11,1282,100,1283,103,1285,109,1288,115,1291,118,1293,123,1296],{},[18,1284],{},[73,1286,108],{"className":1287},[77,107],[73,1289,114],{"className":1290},[113],[18,1292],{},[73,1294,122],{"className":1295},[77,76],[73,1297,127],{"className":1298},[86],[11,1300,130,1301,133,1303,136,1305,139,1307,1310,146,1312,1315,1318,158,1320,1322,163,1324,168,1327,171,1329,176,1332,179,1334,1336,184,1338,187,1340,190,1342,195,1345,1347,200,1349,203],{},[18,1302],{},[18,1304],{},[18,1306],{},[73,1308,143],{"className":1309},[76],[18,1311],{},[73,1313,151],{"className":1314},[150,77],[73,1316,155],{"className":1317},[150],[18,1319],{},[18,1321],{},[18,1323],{},[73,1325,167],{"className":1326},[76],[18,1328],{},[73,1330,175],{"className":1331},[76],[18,1333],{},[18,1335],{},[18,1337],{},[18,1339],{},[18,1341],{},[73,1343,194],{"className":1344},[77],[18,1346],{},[18,1348],{},[18,1350],{},[11,1352,206,1353,209,1355,212,1357,215,1359,218],{},[18,1354],{},[18,1356],{},[18,1358],{},[18,1360],{},[11,1362,221],{},[223,1364,1365,1370,1383],{},[226,1366,228,1367],{},[73,1368,232],{"className":1369},[77,86],[226,1371,235,1372,240,1375,243,1377,246,1379,249,1381,252],{},[73,1373,239],{"className":1374},[86,77],[18,1376],{},[18,1378],{},[18,1380],{},[18,1382],{},[226,1384,255,1385,260,1388,265],{},[73,1386,259],{"className":1387},[77],[73,1389,264],{"className":1390},[77,76],[11,1392,268,1393,271],{},[18,1394],{},[223,1396,1397,1404,1417],{},[226,1398,276,1399,279,1401,284],{},[18,1400],{},[73,1402,283],{"className":1403},[76],[226,1405,287,1406,290,1408,295,1411,300,1414],{},[18,1407],{},[73,1409,294],{"className":1410},[77],[73,1412,299],{"className":1413},[76],[73,1415,304],{"className":1416},[107],[226,1418,307,1419,310,1421,315,1424,320],{},[18,1420],{},[73,1422,314],{"className":1423},[107],[73,1425,319],{"className":1426},[77,76],[11,1428,323,1429,326,1431,331,1434,1437,338,1439,343,1442,346,1444,351,1447,356,1450,1453,363,1455,366],{},[18,1430],{},[73,1432,330],{"className":1433},[76],[73,1435,335],{"className":1436},[107],[18,1438],{},[73,1440,342],{"className":1441},[86],[18,1443],{},[73,1445,350],{"className":1446},[86],[73,1448,355],{"className":1449},[77,76],[73,1451,360],{"className":1452},[107],[18,1454],{},[18,1456],{},[223,1458,1459,1463,1473],{},[226,1460,371,1461,374],{},[18,1462],{},[226,1464,377,1465,382,1468,385,1470,390],{},[73,1466,381],{"className":1467},[77,86],[18,1469],{},[73,1471,389],{"className":1472},[76,77],[226,1474,393,1475,396,1477,401,1480,404,1482,407],{},[18,1476],{},[73,1478,400],{"className":1479},[76],[18,1481],{},[18,1483],{},[11,1485,410],{},[223,1487,1488,1502],{},[226,1489,415,1490,418,1492,421,1494,426,1497,431,1500,434],{},[18,1491],{},[18,1493],{},[73,1495,425],{"className":1496},[77,76],[73,1498,430],{"className":1499},[107],[18,1501],{},[226,1503,437,1504,440,1506,443,1508,448],{},[18,1505],{},[18,1507],{},[73,1509,447],{"className":1510},[77,76],[11,1512,451,1513,454,1515,457,1517,460,1519,463],{},[18,1514],{},[18,1516],{},[18,1518],{},[18,1520],{},[11,1522,466,1523,471,1526,476,1529,479],{},[73,1524,470],{"className":1525},[77,113],[73,1527,475],{"className":1528},[86,77],[18,1530],{},{"title":481,"searchDepth":482,"depth":482,"links":1532},[],{},{"title":5,"description":485},{"loc":492},{"id":1537,"title":1538,"author":6,"body":1539,"date":487,"description":1765,"draft":486,"edited_at":1766,"extension":488,"featured_image":1767,"meta":1768,"navigation":491,"path":1769,"pinned":486,"seo":1770,"series":494,"seriesOrder":494,"sitemap":1771,"stem":1772,"tags":494,"__hash__":1773},"blog\u002Fblog\u002FMotor-Learning小兒（二）.md","Motor Learning小兒（二）",{"type":8,"value":1540,"toc":1763},[1541,1544,1550,1559,1562,1596,1599],[11,1542,1543],{},"阿對的，又要來講動作學習的定義了，雖然之前就有講過",[11,1545,1546,1547,1549],{},"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)",[18,1548],{},"\n動作學習就是過程，而動作表現是動作做出來的結果。",[11,1551,1552,1553,1555,1556,1558],{},"而這邊講道Positive和Negative Sign",[18,1554],{},"\nPositive是指正常人沒有，但病人身上會出現的異常動作 ",[18,1557],{},"\nNegative則相反，正常人有的，但病人身上無法出現",[11,1560,1561],{},"對於動作學習有三大要素",[223,1563,1564,1567,1576],{},[226,1565,1566],{},"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",[226,1568,1569,1570,1572,1573,1575],{},"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",[18,1571],{},"\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",[18,1574],{},"\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",[226,1577,1578,1579,1583,1584,1586,1587,1591,1592],{},"對於目標的清淅程度——就是",[73,1580,1582],{"className":1581},[107],"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",[18,1585],{},"\n而任務",[73,1588,1590],{"className":1589},[76],"越具體","，更能",[73,1593,1595],{"className":1594},[76,77],"引導寶寶產生興趣",[11,1597,1598],{},"那動作學習有以下三個考量點",[223,1600,1601,1654,1702],{},[226,1602,1603,1604,1608,1609,1613,1614,1621,1622,1624,1625,1627,1628,1632,1633,1635,1636,1640,1641,1645,1646,1648,1649,1653],{},"轉移——意思是",[73,1605,1607],{"className":1606},[77,107],"相同相似的技巧","在不同情景下可以變化",[73,1610,1612],{"className":1611},[76,77],"產生新的","動作型態 (這裡也有說到 ",[1615,1616,1620],"a",{"href":1617,"rel":1618},"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",[1619],"nofollow","在最後一段",")",[18,1623],{},"\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",[18,1626],{},"\n所以我們可以借由",[73,1629,1631],{"className":1630},[107],"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",[18,1634],{},"\n也可以透過",[73,1637,1639],{"className":1638},[77,76],"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",[73,1642,1644],{"className":1643},[77],"加粗","的方式讓寶寶更好握住",[18,1647],{},"\n但記得靠轉移來學習新的動作型態",[73,1650,1652],{"className":1651},[77,76],"不能一下子改太多太難","參數",[226,1655,1656,1657,1662,1663,1667,1668,1670,1671,1675,1676,1678,1679,1683,1685,1686,1690,1691,1693,1694,1698,1699,1701],{},"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（",[1615,1658,1661],{"href":1659,"rel":1660},"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",[1619],"一","，",[1615,1664,1666],{"href":1617,"rel":1665},[1619],"二","）",[18,1669],{},"\n集中VS分散，分散休息時間更長，對",[73,1672,1674],{"className":1673},[77],"學習較難或易疲勞病人","來說更佳",[18,1677],{},"\n段落VS隨機，隨機較難，但通常對",[73,1680,1682],{"className":1681},[107,77],"形成長期記憶以記轉移效果更有",[18,1684],{},"\n固定VS變異，變異在",[73,1687,1689],{"className":1688},[76,77],"轉移效果上","更佳",[18,1692],{},"\n全部VS分段，分段有",[73,1695,1697],{"className":1696},[77,76],"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",[18,1700],{},"\n心像練習，在腦中模擬動作型態",[226,1703,1704,1705,1662,1709,1662,1713,1662,1718,1621,1723,1725,1726,1728,1729,1731,1732,1667,1736,1738,1739,1743,1744,1746,1747,1751,1752,1754,1755,1757,1758,1762],{},"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(",[1615,1706,1661],{"href":1707,"rel":1708},"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",[1619],[1615,1710,1666],{"href":1711,"rel":1712},"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",[1619],[1615,1714,1717],{"href":1715,"rel":1716},"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",[1619],"三",[1615,1719,1722],{"href":1720,"rel":1721},"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",[1619],"四",[18,1724],{},"\nKR與KP，KR效度比KP更佳",[18,1727],{},"\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",[18,1730],{},"\n（",[1615,1733,1735],{"href":1720,"rel":1734},[1619],"這裡第一段有提到",[18,1737],{},"\n回饋的方法，",[1615,1740,1742],{"href":1711,"rel":1741},[1619],"這一篇的後半段","有提到，可以再複習一下",[18,1745],{},"\n先設定一個",[73,1748,1750],{"className":1749},[107],"區間","，達到的都算得分",[18,1753],{},"\n回饋也可以做遞減，逐漸減少依賴",[18,1756],{},"\n假如病人",[73,1759,1761],{"className":1760},[76,77],"主動要求回饋","，我們再給予，也會更佳",{"title":481,"searchDepth":482,"depth":482,"links":1764},[],"Motor Learning定義~結束","2026-04-13","\u002Fimages\u002Fuploads\u002F1775875520542-37128694_p0_master1200.jpg",{},"\u002Fblog\u002FMotor-Learning小兒（二）",{"title":1538,"description":1765},{"loc":1769},"blog\u002FMotor-Learning小兒（二）","beZCqHWkr0UlT1MH3L844jBiQoKx5V56TVWNmGkjw0I",{"id":1775,"title":1776,"author":6,"body":1777,"date":1977,"description":1978,"draft":486,"edited_at":1977,"extension":488,"featured_image":1979,"meta":1980,"navigation":491,"path":1981,"pinned":486,"seo":1982,"series":494,"seriesOrder":494,"sitemap":1983,"stem":1984,"tags":494,"__hash__":1985},"blog\u002Fblog\u002FGait-analysis小兒（一）.md","Gait analysis小兒（一）",{"type":8,"value":1778,"toc":1975},[1779,1782,1785,1802,1805,1816,1819,1836,1862,1868,1871,1889,1898,1909,1924,1930,1958,1961],[11,1780,1781],{},"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",[11,1783,1784],{},"那下肢雙關節肌肉有以下",[223,1786,1787,1790,1793,1796,1799],{},[226,1788,1789],{},"腰大肌——Hip Flexion, Trunk Flexion",[226,1791,1792],{},"腿後肌——Hip Extension, Knee Flexion",[226,1794,1795],{},"股直肌——Hip Flexion, Knee Extension",[226,1797,1798],{},"腓腸肌——Knee Flexion, PF",[226,1800,1801],{},"縫匠肌——Hip Flexion, Hip ER",[11,1803,1804],{},"那單關節的肌肉有",[223,1806,1807,1810,1813],{},[226,1808,1809],{},"臀大肌——Hip Extension, Hip ER",[226,1811,1812],{},"脛前肌——DF, inversion",[226,1814,1815],{},"腓骨長肌——PF, eversion",[11,1817,1818],{},"那以下動作的抗重力與無抗重力的擺位姿勢為",[223,1820,1821,1824,1827,1830,1833],{},[226,1822,1823],{},"Hip Extension——Prone 抗重力, side-lying 無抗重力",[226,1825,1826],{},"Hip Flexion——Sitting 抗重力, side-lying 無抗重力",[226,1828,1829],{},"Hip Abduction——Side-lying 抗重力, supine 無抗重力",[226,1831,1832],{},"Knee Extension——Sitting 抗重力, side-lying 無抗重力",[226,1834,1835],{},"PF——Standing 抗重力, prone 無抗重力",[11,1837,1838,1839,1841,1842,1846,1847,1851,1853,1854,1856,1857,1861],{},"接下來講一個異常步態——Crouch gait",[18,1840],{},"\n為甚麼他會呈現屈曲狀態，主要是因為",[73,1843,1845],{"className":1844},[77,76],"雙關節肌肉張力過強","，而",[73,1848,1850],{"className":1849},[77,107],"單關節肌肉力量不足",[18,1852],{},"\n不是單純的肌肉太緊，也是一種肌力失衡的表現",[18,1855],{},"\n其中，在",[73,1858,1860],{"className":1859},[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)",[11,1863,1864,1865,1867],{},"接著來講步態的參數",[18,1866],{},"\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)",[11,1869,1870],{},"這邊提到一個中風後會出現的代償步態",[1872,1873,1874,1877,1880,1883,1886],"ul",{},[226,1875,1876],{},"步速下降",[226,1878,1879],{},"步距縮短或不對稱",[226,1881,1882],{},"步寬變大(BOS增加)",[226,1884,1885],{},"雙腳站立期變長",[226,1887,1888],{},"依賴手部支撐",[11,1890,1891,1892,1894,1895,1897],{},"接著講Gait cycle，分別為站立期以及擺盪期",[18,1893],{},"\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",[18,1896],{},"\n完成這三個任務又分成了這八個動作",[223,1899,1900,1903,1906],{},[226,1901,1902],{},"承重——Initial contact和Loading Response",[226,1904,1905],{},"單腳支撐——Mid-stance, Terminal Stance和Pre-swing",[226,1907,1908],{},"肢體向前——Pre-swing, Initial swing, Mid-swing和Terminal Swing",[11,1910,1911,1912,1916,1917,1919,1920],{},"而Pre-swing雖然腳尖還沒離地，但",[73,1913,1915],{"className":1914},[77,107],"重心其實已經轉移去另一隻腳","了",[18,1918],{},"\n其中 ",[73,1921,1923],{"className":1922},[77],"Initial contact和Pre-swing為雙腳承重期",[11,1925,1926,1927,1929],{},"我們現在攤開來看站立期和擺盪期下肢各關節變化",[18,1928],{},"\n首先是站立期",[223,1931,1932,1940,1943,1949,1955],{},[226,1933,1934,1935,1939],{},"在雙腳承重期，",[73,1936,1938],{"className":1937},[77,107],"足部會放平","，準備Push Off",[226,1941,1942],{},"Hip的話，在Initical Contact的Flexion到Terminal Stance的Hyperextension",[226,1944,1945,1946,1948],{},"Knee的話，會從Flexion姿勢，到Mid-stance的Extension，再變回Pre-swing的Flexion",[18,1947],{},"\n(Flexion>Extension>Flexion)",[226,1950,1951,1952,1954],{},"Ankle的話，在Initical Contact的Neutral姿勢，Loading Response的PF，",[18,1953],{},"\nMid-stance的DF，最後是Terminal Stance\u002FPre-swing的PF（Neutral>PF>DF>PF）",[226,1956,1957],{},"Pelvis的話，基本保持水平，但在Terminal stance會略微前傾",[11,1959,1960],{},"然後是擺盪期",[223,1962,1963,1966,1969,1972],{},[226,1964,1965],{},"Knee的話，在Initical swing時會呈現Flexion，在Terminal swing會Full-extension",[226,1967,1968],{},"Hip的話，從Initical swing的Hyperextension，在Terminal swing會變成Flexion",[226,1970,1971],{},"Ankle的話，保持DF狀態，使腳尖不會碰到地板",[226,1973,1974],{},"Pelvis的話，會Rotation",{"title":481,"searchDepth":482,"depth":482,"links":1976},[],"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":1776,"description":1978},{"loc":1981},"blog\u002FGait-analysis小兒（一）","IPE1YCLIHjaGM3K3t637opIC_UJyveODI_bALybZ_94",{"id":1987,"title":1988,"author":6,"body":1989,"date":1977,"description":2177,"draft":486,"edited_at":1977,"extension":488,"featured_image":2178,"meta":2179,"navigation":491,"path":2180,"pinned":486,"seo":2181,"series":494,"seriesOrder":494,"sitemap":2182,"stem":2183,"tags":494,"__hash__":2184},"blog\u002Fblog\u002FGait-analysis小兒（二）.md","Gait analysis小兒（二）",{"type":8,"value":1990,"toc":2175},[1991,1994,2108,2111,2146,2158,2164],[11,1992,1993],{},"現在我們將八個步態分期拆開了細看",[223,1995,1996,2020,2034,2052,2062,2083,2102,2105],{},[226,1997,1998,1999,2003,2007,2008,2012,2016,2017,2019],{},"Initical Contact——用",[73,2000,2002],{"className":2001},[77],"股四頭肌和脛前肌做",[73,2004,2006],{"className":2005},[77,76],"離心收縮","，這時",[73,2009,2011],{"className":2010},[77],"腿後肌做",[73,2013,2015],{"className":2014},[77,107],"向心收縮","協同加速穩定",[18,2018],{},"\n（減速與準備承重）",[226,2021,2022,2023,2027,2030,2031,2033],{},"Loading Response——",[73,2024,2026],{"className":2025},[77],"肌內側肌與脛前肌做",[73,2028,2006],{"className":2029},[77,76],"，而臀大肌以及腿後肌輔助Hip加速，將重心向前移動",[18,2032],{},"\n（避震）",[226,2035,2036,2037,1846,2041,2045,2048,2049,2051],{},"Mid-stance——膝蓋後方有關節囊結構的緣故，肌四頭肌幾乎",[73,2038,2040],{"className":2039},[107],"不需用力",[73,2042,2044],{"className":2043},[77],"比目魚肌此時做",[73,2046,2006],{"className":2047},[77,76],"控制脛骨速度",[18,2050],{},"\n（省力）",[226,2053,2054,2055,2059,2061],{},"Terminal stance——",[73,2056,2058],{"className":2057},[77,107],"腓腸肌與比目魚肌做向心收縮",[18,2060],{},"\n（產生推進力）",[226,2063,2064,2065,2069,1662,2072,2074,2075,2079],{},"Pre-swing——假如是慢速走路，會利用",[73,2066,2068],{"className":2067},[77],"縫匠肌(Sartorius)和肌薄肌(Graillis)做",[73,2070,2015],{"className":2071},[77,107],[18,2073],{},"\n快速行走則靠",[73,2076,2078],{"className":2077},[77],"肌直肌做",[73,2080,2082],{"className":2081},[77,150],"等長收縮",[226,2084,2085,2086,2090,2093,2095,2096,2099],{},"Initial swing——在慢速走路中，",[73,2087,2089],{"className":2088},[77],"股薄肌與縫匠肌會進行",[73,2091,2015],{"className":2092},[77,107],[18,2094],{},"\n而快速走路中，",[73,2097,2078],{"className":2098},[77],[73,2100,2082],{"className":2101},[77,150],[226,2103,2104],{},"Mid swing——靠慣性推進，基本沒有肌肉參與",[226,2106,2107],{},"Terminal swing——腿後肌做等長收縮，限制Knee extension速度",[11,2109,2110],{},"接著來講小腿後肌群無力的話會有甚麼問題",[1872,2112,2113,2123],{},[226,2114,2115,2116,1662,2120,2122],{},"Mid-stannce——比目魚肌無力的話，會讓",[73,2117,2119],{"className":2118},[76,77],"Ankle做DF",[18,2121],{},"\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",[226,2124,2125,2126,2130,2132,2133,2137,2138,426,2142],{},"Terminal stance和Pre-swing——腓腸肌力量不足的話，",[73,2127,2129],{"className":2128},[77,76],"沒辦法產生足夠的推進力",[18,2131],{},"\n只好讓",[73,2134,2136],{"className":2135},[76,77],"髖屈肌收縮","提起整段下肢，確保",[73,2139,2141],{"className":2140},[107],"腳尖離地",[73,2143,2145],{"className":2144},[86],"步距變短",[11,2147,2148,2149,2151,2152,2154,2155,2157],{},"最後講小孩的步態發展過程",[18,2150],{},"\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",[18,2153],{},"\n2歲的小孩懂得矢狀面(Sagittal-plane)關節旋轉",[18,2156],{},"\n7歲的小孩步態已經能達到成人標準了",[11,2159,2160,2161,2163],{},"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",[18,2162],{},"\n那CP小孩預測能力方面也分成了三個時段",[223,2165,2166,2169,2172],{},[226,2167,2168],{},"9~18個月——頭部控制能力",[226,2170,2171],{},"24個月——不需要支撐能獨自坐穩",[226,2173,2174],{},"30個月——做爬行",{"title":481,"searchDepth":482,"depth":482,"links":2176},[],"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":1988,"description":2177},{"loc":2180},"blog\u002FGait-analysis小兒（二）","2dJ_hurzNJqXlMLpT5WOSh7fqYamFHergs61a_W4aGQ",{"id":2186,"title":552,"author":6,"body":2187,"date":1977,"description":2331,"draft":486,"edited_at":2332,"extension":488,"featured_image":2333,"meta":2334,"navigation":491,"path":2335,"pinned":486,"seo":2336,"series":494,"seriesOrder":494,"sitemap":2337,"stem":2338,"tags":494,"__hash__":2339},"blog\u002Fblog\u002F小兒發展（一）.md",{"type":8,"value":2188,"toc":2329},[2189,2192,2207,2213,2216,2242,2251,2253,2256,2273,2275,2278],[11,2190,2191],{},"（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）",[11,2193,2194,2195,2197,2198,2200,2201,2203,2204,2206],{},"那先來講發展遲緩的定義，它不單指運動層面上，還包括了",[18,2196],{},"\n知覺，語言，心理，社會，情緒等層面",[18,2199],{},"\n而這個動作遲緩有標準的",[18,2202],{},"\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",[18,2205],{},"\n根據WHO的數據，發生率為6~8%",[11,2208,2209,2210,2212],{},"那高危族群有以下",[18,2211],{},"\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",[11,2214,2215],{},"接下來講寶寶的正常發育過程，先從視角說起，如下",[223,2217,2218,2221,2224,2227,2230,2233,2236,2239],{},[226,2219,2220],{},"剛出生數天——眨眼反射",[226,2222,2223],{},"六周——注射物體",[226,2225,2226],{},"二到三個月——對明亮的東西感興趣",[226,2228,2229],{},"四個月——協調眼球轉動",[226,2231,2232],{},"一歲——影像認知發展完成，能看清輪廓",[226,2234,2235],{},"三歲——能分辨紅黃藍綠",[226,2237,2238],{},"五到六歲——可以分辨大多數顏色",[226,2240,2241],{},"八歲以前——有遠視現象（我問了Gemini也看不太懂就是了）",[11,2243,2244,2245,2247,2248,2250],{},"那關於視覺發展異常的問題包括了",[18,2246],{},"\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",[18,2249],{},"\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",[1087,2252],{},[11,2254,2255],{},"接著是聽覺發展，如下",[223,2257,2258,2261,2264,2267,2270],{},[226,2259,2260],{},"四個月——追尋聲音或說話來源",[226,2262,2263],{},"七到八個月——被叫名字有反應",[226,2265,2266],{},"十個月——仿說（無意義內容）",[226,2268,2269],{},"一到一歲半——初步聽懂簡單的話",[226,2271,2272],{},"兩歲以後——鸚鵡式學說話",[1087,2274],{},[11,2276,2277],{},"接下來是粗大動作的發展，如下",[223,2279,2280,2283,2286,2289,2292,2295,2298,2301,2304,2312,2320,2323,2326],{},[226,2281,2282],{},"兩個月——不穩定的抬頭控制",[226,2284,2285],{},"四個月——抬頭控制適當",[226,2287,2288],{},"五個月——翻身（先學會Prone to supine, 接著是supine to prone）",[226,2290,2291],{},"七個月——坐起來",[226,2293,2294],{},"八個月——爬行",[226,2296,2297],{},"九個月——需要支撐的站起來",[226,2299,2300],{},"十個月——僅需要極小輔助的從坐到站",[226,2302,2303],{},"一歲——獨立行走",[226,2305,2306,2307,2311],{},"兩歲——跑，",[73,2308,2310],{"className":2309},[107],"上樓梯","，踢球，投球，蹲下來",[226,2313,2314,2315,2319],{},"三歲——",[73,2316,2318],{"className":2317},[76],"下樓梯","，雙腳跳，騎三輪車",[226,2321,2322],{},"四歲——單腳跳",[226,2324,2325],{},"五歲——走直線",[226,2327,2328],{},"六歲——騎腳踏車",{"title":481,"searchDepth":482,"depth":482,"links":2330},[],"定義~粗大動作發展","2026-04-12","\u002Fimages\u002Fuploads\u002F1775957410970-EebbBUPUcAYSTE9.webp",{},"\u002Fblog\u002F小兒發展（一）",{"title":552,"description":2331},{"loc":2335},"blog\u002F小兒發展（一）","hNnn9x-HHmutraT7_l-tIOpotpXuOIbXclzk460F-js",{"id":2341,"title":553,"author":6,"body":2342,"date":2332,"description":2494,"draft":486,"edited_at":2332,"extension":488,"featured_image":2495,"meta":2496,"navigation":491,"path":2497,"pinned":486,"seo":2498,"series":494,"seriesOrder":494,"sitemap":2499,"stem":2500,"tags":494,"__hash__":2501},"blog\u002Fblog\u002F小兒發展（二）.md",{"type":8,"value":2343,"toc":2492},[2344,2347,2364,2366,2369,2397,2399,2402,2428,2430,2433,2447,2449,2452,2466,2468,2471,2479,2481,2484],[11,2345,2346],{},"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",[223,2348,2349,2352,2355,2358,2361],{},[226,2350,2351],{},"新生兒——中度的膝內翻（O型腿）",[226,2353,2354],{},"六個月——輕度的O型腿",[226,2356,2357],{},"一歲半——直的",[226,2359,2360],{},"三歲半——輕度的膝外翻（X型腿）",[226,2362,2363],{},"五到七歲——直的",[1087,2365],{},[11,2367,2368],{},"而步態的發展會按照以下時期發展",[223,2370,2371,2374,2382,2385,2388,2391,2394],{},[226,2372,2373],{},"反射踏步（靠反射）",[226,2375,2376,2377,1667],{},"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—— ",[1615,2378,2381],{"href":2379,"rel":2380},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002Fmotor-learning?series=%E5%B0%8F%E5%85%92%E7%89%A9%E6%B2%BB",[1619],"倒數第二段",[226,2383,2384],{},"過渡期",[226,2386,2387],{},"刻意跨步",[226,2389,2390],{},"獨立行走",[226,2392,2393],{},"Heell-toe步態",[226,2395,2396],{},"整合或直立行走成熟期",[1087,2398],{},[11,2400,2401],{},"接著來看不同系統的發展進程，從出生至九個月",[1872,2403,2404,2410,2416,2422],{},[226,2405,2406,2407,2409],{},"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）",[18,2408],{},"\n尤其是視覺發展遠大於粗大動作",[226,2411,2412,2413,2415],{},"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",[18,2414],{},"\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",[226,2417,2418,2419,2421],{},"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)",[18,2420],{},"\nHip abduction(訓練方法是扶物側行)",[226,2423,2424,2425,2427],{},"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",[18,2426],{},"\n步寬外展；外轉(O型腿)；髖屈曲；足跟外翻",[1087,2429],{},[11,2431,2432],{},"時間來到了九個月到第十五個月之間的發展進程",[223,2434,2435,2438,2441],{},[226,2436,2437],{},"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)",[226,2439,2440],{},"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",[226,2442,2443,2444,2446],{},"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",[18,2445],{},"\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",[1087,2448],{},[11,2450,2451],{},"接下來時間來到了十八個月到二十四個月的發展進程",[223,2453,2454,2460],{},[226,2455,2456,2457,2459],{},"力學因素——重心下降(由於腿快速生長)，BOS減少",[18,2458],{},"\nROM的話O型腿消失，但有旋前足出現",[226,2461,2462,2463,2465],{},"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；",[18,2464],{},"\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)",[1087,2467],{},[11,2469,2470],{},"時間繼續來到了三歲到三歲半的發展進程",[223,2472,2473,2476],{},[226,2474,2475],{},"力學因素——ROM的話膝外翻(X型腿)，且有旋前足出現",[226,2477,2478],{},"功能性步態——足跟著地穩定，且出現Knee flexion",[1087,2480],{},[11,2482,2483],{},"最後時間來到了六歲到七歲的發展進程",[223,2485,2486,2489],{},[226,2487,2488],{},"力學因素——已經能直立行走，並且不在有旋前足",[226,2490,2491],{},"功能性步態——與成人一樣",{"title":481,"searchDepth":482,"depth":482,"links":2493},[],"步態~步態發展","\u002Fimages\u002Fuploads\u002F1775979234822-139196433_p0_master1200.webp",{},"\u002Fblog\u002F小兒發展（二）",{"title":553,"description":2494},{"loc":2497},"blog\u002F小兒發展（二）","ScVwjiCjwCAhdOVX_aORN11S38Xd5Fb_3-0haIKlezk",{"id":2503,"title":554,"author":6,"body":2504,"date":2332,"description":2728,"draft":486,"edited_at":1766,"extension":488,"featured_image":2729,"meta":2730,"navigation":491,"path":2731,"pinned":486,"seo":2732,"series":494,"seriesOrder":494,"sitemap":2733,"stem":2734,"tags":494,"__hash__":2735},"blog\u002Fblog\u002F小兒發展（三）.md",{"type":8,"value":2505,"toc":2726},[2506,2509,2512,2541,2543,2546,2563,2565,2568,2594,2596,2599,2632,2638,2657,2663,2689,2692,2695,2718,2721],[11,2507,2508],{},"寫著寫著發現這一課東西好多（悲",[11,2510,2511],{},"接著講精細動作的發展過程",[223,2513,2514,2517,2520,2523,2526,2529,2532,2535,2538],{},[226,2515,2516],{},"四個月——可以合掌",[226,2518,2519],{},"五個月——手可以向前伸並抓東西",[226,2521,2522],{},"七個月——握緊奶瓶",[226,2524,2525],{},"十個月——拍手",[226,2527,2528],{},"一歲——亂塗鴉",[226,2530,2531],{},"一歲半——疊兩到四個積木",[226,2533,2534],{},"兩歲——疊四到八個積木；畫直線",[226,2536,2537],{},"三歲——畫圓圈",[226,2539,2540],{},"五歲——畫出人形",[1087,2542],{},[11,2544,2545],{},"假如有發展遲緩的問題，會有以下徵候",[1872,2547,2548,2551,2554,2557,2560],{},[226,2549,2550],{},"以翻身作為移動方式",[226,2552,2553],{},"手腳不協調的爬行方式",[226,2555,2556],{},"W坐姿",[226,2558,2559],{},"兔子跳",[226,2561,2562],{},"一歲前出現明顯慣用手(因為一歲前大多為雙手並用)",[1087,2564],{},[11,2566,2567],{},"而寶寶出現以下徵候，可能他有CP問題",[1872,2569,2570,2573,2576,2579,2582,2585,2588,2591],{},[226,2571,2572],{},"躁動",[226,2574,2575],{},"缺乏精力",[226,2577,2578],{},"吸吮無力伴隨舌頭往前突",[226,2580,2581],{},"六個月大頭部控制不佳",[226,2583,2584],{},"口腔過度敏感",[226,2586,2587],{},"強直性咬合反射",[226,2589,2590],{},"不對稱動作形態",[226,2592,2593],{},"異常姿勢",[1087,2595],{},[11,2597,2598],{},"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",[11,2600,2601,2602,2604,2605,2609,2610,2614,2616,2617,2621,2622,2626,2627,2631],{},"首先是語言準備期，分成了表達跟理解兩個面向",[18,2603],{},"\n這時候寶寶還小，表達還只能靠",[73,2606,2608],{"className":2607},[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",[73,2611,2613],{"className":2612},[77],"學身邊的人咿咿呀呀",[18,2615],{},"\n而這個時候",[73,2618,2620],{"className":2619},[77,107],"理解能力比表達能力還要發展得快","，知覺部份開始分得出",[73,2623,2625],{"className":2624},[107],"語氣快慢聲源","等，也能",[73,2628,2630],{"className":2629},[107],"理解一些簡單的短語","例如yes or no等",[11,2633,2634,2635,2637],{},"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",[18,2636],{},"\n而語法構造則分為以下部份",[1872,2639,2640,2648],{},[226,2641,2642,2643,2647],{},"句子表達能力——分成剛開始學的不完整句子，",[73,2644,2646],{"className":2645},[77,107],"只講關鍵的詞","；和發展到後面的會講完整句子",[226,2649,2650,2651,2653,2654,2656],{},"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",[18,2652],{},"\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",[18,2655],{},"\n最後也能理解對哪個人說甚麼樣的話",[11,2658,2659,2660,2662],{},"然後講一下正常語言發展能力，雖然跟聽覺有部份重合，",[18,2661],{},"\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(?)",[223,2664,2665,2668,2671,2674,2677,2680,2683,2686],{},[226,2666,2667],{},"四個月——頭尋找聲源",[226,2669,2670],{},"六到七個月——仿說",[226,2672,2673],{},"九到十二個月——叫爸爸媽媽",[226,2675,2676],{},"一歲到一歲半——只會講一兩個字且沒有意義",[226,2678,2679],{},"兩歲到兩歲半——講片語（例如像鸚鵡般學大人說啥）",[226,2681,2682],{},"三歲——開始能講句子，講顏色，倒數十，說出身體部位",[226,2684,2685],{},"四歲——能說出數種顏色",[226,2687,2688],{},"五歲——計算五個積木",[11,2690,2691],{},"(所以看起來三歲已經具備認知能力?)",[11,2693,2694],{},"那假如語言發展異常會有以下徵象",[1872,2696,2697,2700,2703,2706,2709,2712,2715],{},[226,2698,2699],{},"一歲前——太安靜",[226,2701,2702],{},"兩歲——還沒有出現有意思的字詞",[226,2704,2705],{},"三歲——沒有出現任何句子",[226,2707,2708],{},"四歲——有構音困難",[226,2710,2711],{},"五歲——說話結巴",[226,2713,2714],{},"年紀越大話越少",[226,2716,2717],{},"鼻音重，說話小聲，不當的臉部表情，說話會喘",[11,2719,2720],{},"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",[11,2722,2723],{},[1018,2724],{"alt":1020,"src":2725},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776047406679-Screenshot_2026-04-13_102943.png",{"title":481,"searchDepth":482,"depth":482,"links":2727},[],"精細動作~語言發展","\u002Fimages\u002Fuploads\u002F1776047258825-ElqW51yVoAI09Jg.webp",{},"\u002Fblog\u002F小兒發展（三）",{"title":554,"description":2728},{"loc":2731},"blog\u002F小兒發展（三）","fWW5FGWeFOguN6l_xnyfcdE-obaq-taTZA3JJhpNgzQ",{"id":2737,"title":555,"author":6,"body":2738,"date":1766,"description":2881,"draft":486,"edited_at":1766,"extension":488,"featured_image":2882,"meta":2883,"navigation":491,"path":2884,"pinned":486,"seo":2885,"series":494,"seriesOrder":494,"sitemap":2886,"stem":2887,"tags":494,"__hash__":2888},"blog\u002Fblog\u002F小兒發展（四）.md",{"type":8,"value":2739,"toc":2879},[2740,2743,2766,2768,2771,2797,2799,2802,2822,2824,2827,2841,2843,2846,2860,2862,2865],[11,2741,2742],{},"接下來講到括約肌控制發展（大小便控制）",[223,2744,2745,2748,2757,2763],{},[226,2746,2747],{},"十五個月——能告訴爸媽想上廁所或者褲子濕了",[226,2749,2750,2751,2753,2754,2756],{},"十八個月——白天褲子不太會濕，當然也有意外；",[18,2752],{},"\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；",[18,2755],{},"\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",[226,2758,2759,2760,2762],{},"兩到三歲——半夜讓小孩上廁所就整晚不會尿床",[18,2761],{},"\n有研究表明，晚上會叫尿床的都比較神經質(講義原句XD)",[226,2764,2765],{},"三歲——能自己上廁所但擦不乾淨，要到六歲才能擦乾淨",[1087,2767],{},[11,2769,2770],{},"接著講ADL的發展",[223,2772,2773,2776,2779,2785,2788,2791,2794],{},[226,2774,2775],{},"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",[226,2777,2778],{},"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",[226,2780,2781,2782,2784],{},"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；",[18,2783],{},"\n也開始可以脫襪子和鞋子",[226,2786,2787],{},"十八個月——會脫襪子鞋子，將拉鏈拉開，不需要轉動湯匙進食",[226,2789,2790],{},"兩歲——可以穿脫襪子鞋子褲子",[226,2792,2793],{},"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",[226,2795,2796],{},"五歲——會綁鞋子",[1087,2798],{},[11,2800,2801],{},"社會性情緒發展部份",[223,2803,2804,2807,2813,2816,2819],{},[226,2805,2806],{},"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",[226,2808,2809,2810,2812],{},"六到十二個月——十分依賴，認得且會得媽媽",[18,2811],{},"\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",[226,2814,2815],{},"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",[226,2817,2818],{},"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",[226,2820,2821],{},"二十四到三十六個月——越來越適應陌生環境，上托兒所",[1087,2823],{},[11,2825,2826],{},"自我概念發展部份",[223,2828,2829,2832,2835,2838],{},[226,2830,2831],{},"剛出生到六個月——動作控制不佳；稍微分得出自我跟非自我",[226,2833,2834],{},"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",[226,2836,2837],{},"十八到二十四個月——對自己名字敏感",[226,2839,2840],{},"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",[1087,2842],{},[11,2844,2845],{},"情緒發展部份",[223,2847,2848,2851,2854,2857],{},[226,2849,2850],{},"剛出生到六個月——早期只有哭跟高興表情",[226,2852,2853],{},"六到十二個月——開始有其他情緒例如厭惡，害怕，憤怒",[226,2855,2856],{},"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",[226,2858,2859],{},"十八到二十四個月——能夠用語言表達情緒",[1087,2861],{},[11,2863,2864],{},"依賴及獨立發展",[223,2866,2867,2870,2873],{},[226,2868,2869],{},"剛出生到十二個月——完全依賴照顧",[226,2871,2872],{},"十二到十八個月——知道自己是個體後，想自我尋求",[226,2874,2875,2876,2878],{},"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；",[18,2877],{},"\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":481,"searchDepth":482,"depth":482,"links":2880},[],"括約肌控制~依賴獨立發展","\u002Fimages\u002Fuploads\u002F1776052282656-EXjYORHUcAALULe.webp",{},"\u002Fblog\u002F小兒發展（四）",{"title":555,"description":2881},{"loc":2884},"blog\u002F小兒發展（四）","DJaCMsTP4CUgNTT9jIJJG3_DBmMSQrwM99wp0S7GQq0",{"id":2890,"title":556,"author":6,"body":2891,"date":1215,"description":3031,"draft":486,"edited_at":1215,"extension":488,"featured_image":3032,"meta":3033,"navigation":491,"path":3034,"pinned":486,"seo":3035,"series":494,"seriesOrder":494,"sitemap":3036,"stem":3037,"tags":494,"__hash__":3038},"blog\u002Fblog\u002F小兒發展（五）.md",{"type":8,"value":2892,"toc":3029},[2893,2899,2913,2916,2936,2938,2941,2970,2972,2975,2995,2997,3000],[11,2894,2895,2896,2898],{},"接下來講到一個叫皮亞傑的人，他提出了發展理論",[18,2897],{},"\n先來講他說的四大認知階段",[223,2900,2901,2904,2907,2910],{},[226,2902,2903],{},"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",[226,2905,2906],{},"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）",[226,2908,2909],{},"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",[226,2911,2912],{},"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",[11,2914,2915],{},"接著是他提到的感覺運動期",[223,2917,2918,2921,2924,2927,2930,2933],{},[226,2919,2920],{},"反射期(0-2m)——對，就一堆反射",[226,2922,2923],{},"初級循環反應期(3-5m)——摸索自己身體",[226,2925,2926],{},"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）",[226,2928,2929],{},"兩個基模協調(9-12m)——透過兩種動作模式達成目的；理解因果",[226,2931,2932],{},"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",[226,2934,2935],{},"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",[1087,2937],{},[11,2939,2940],{},"然後是個人與社會發展",[223,2942,2943,2946,2949,2952,2955,2958,2961,2964,2967],{},[226,2944,2945],{},"兩個月——會對別人笑",[226,2947,2948],{},"六個月——自己拿玩具玩",[226,2950,2951],{},"六到八個月——開始理解陌生，不讓陌生人抱",[226,2953,2954],{},"十個月——搖手bye bye（maybe是已經將動作與語言結合?）",[226,2956,2957],{},"一歲——拿杯子喝水",[226,2959,2960],{},"十五個月——拿湯匙、脫下外套、學刷牙",[226,2962,2963],{},"兩歲——會洗手",[226,2965,2966],{},"三歲——會穿脫鞋",[226,2968,2969],{},"四歲——穿衣服，扣鈕扣，刷牙",[1087,2971],{},[11,2973,2974],{},"接下來講ASD的臨床徵象（即使動作發展正常，也會有語言delay）",[223,2976,2977,2980,2983,2986,2989,2992],{},[226,2978,2979],{},"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",[226,2981,2982],{},"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",[226,2984,2985],{},"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",[226,2987,2988],{},"注意力不集中——無法持久學習",[226,2990,2991],{},"衝動——人際關係緊張",[226,2993,2994],{},"好動——無法遵守規矩，破壞力強",[1087,2996],{},[11,2998,2999],{},"吞嚥異常的臨床徵象",[223,3001,3002,3005,3008,3011,3014,3017,3020,3023,3026],{},[226,3003,3004],{},"反覆性肺炎",[226,3006,3007],{},"營養不良",[226,3009,3010],{},"抗拒食物",[226,3012,3013],{},"吞嚥困難",[226,3015,3016],{},"口中有異物感",[226,3018,3019],{},"嗆咳",[226,3021,3022],{},"口中有異味",[226,3024,3025],{},"經營嘔吐",[226,3027,3028],{},"流口水",{"title":481,"searchDepth":482,"depth":482,"links":3030},[],"皮亞傑~結束","\u002Fimages\u002Fuploads\u002F1776132158232-tHG70Gg.webp",{},"\u002Fblog\u002F小兒發展（五）",{"title":556,"description":3031},{"loc":3034},"blog\u002F小兒發展（五）","RKnQlk0r42ngZg40xiD1WidamW2DaZqPZc7ocSVVK-Y",1776152764613]