[{"data":1,"prerenderedAt":4691},["ShallowReactive",2],{"\u002Fblog\u002FRett-Syndrome":3,"post-count":160,"series-global-data":161,"authors-all":315,"series-sidebar-小兒物治":511},{"id":4,"title":5,"author":6,"body":7,"date":146,"description":147,"draft":148,"edited_at":149,"extension":150,"featured_image":151,"meta":152,"navigation":153,"path":154,"pinned":148,"seo":155,"sitemap":156,"stem":157,"tags":158,"__hash__":159},"blog\u002Fblog\u002FRett-Syndrome.md","Rett Syndrome","hibiki12141132",{"type":8,"value":9,"toc":142},"minimark",[10,14,21,32,35,38,121,124,127,133,139],[11,12,13],"p",{},"接下來講雷特氏症，先來整理一下老師給的兩頁雷特氏症的特徵",[11,15,16,17,20],{},"雷特氏症是一種發展性障礙疾病",[18,19],"br",{},"\n好發於女性，因為是X染色體出問題導致的，有75%的典型跟非典型RS會有這個叫MECP2的異常，最新的研究這個也跟FXYD1有關係",[11,22,23,24,31],{},"主要的奇怪行為是常",[25,26,30],"span",{"className":27},[28,29],"underline","red-3","搓自己的手，拍自己的手，玩自己的手","，以及其他身體的怪異動作",[11,33,34],{},"雷特氏症的小孩在臨床上表現出四個時期的變化",[11,36,37],{},"RS的小孩雖然會合併自閉徵候，但RS合併MR更加明顯",[39,40,41,56,81,101],"ul",{},[42,43,44,45],"li",{},"第一期（六個月到一歲半，早期）",[39,46,47,53],{},[42,48,49,50,52],{},"發展通常正常，這個病在這個時期會被父母忽略；父母可能會覺得小孩目光不太注視外人",[18,51],{},"\n對玩具逐漸不感興趣，較安靜乖巧，會喜歡搓手，而且頭圍成長趨緩",[42,54,55],{},"大段文字：會有一些發展遲緩問題，例如雙手協調動作未出現，臀部位移等",[42,57,58,59],{},"第二期（一歲到四歲，發展明顯遲緩及退化期，那大段文字叫快速退化期）",[39,60,61,78],{},[42,62,63,64,66,67,71,72,74,75,77],{},"小孩會顯現快速退化跟發展遲緩現象，包括語言表達逐漸喪失",[18,65],{},"\n有反覆",[25,68,70],{"className":69},[28,29],"洗手，捻手，搓手","等刻板動作，偶爾手會無理由放在背後觸摸，握緊手，張手",[18,73],{},"\n有的小孩還會吐舌，陣發喘氣，睡眠不安，或走路不穩",[18,76],{},"\n頭圍成長趨緩",[42,79,80],{},"大段文字：會喪失已學習過的技巧；會癲癇",[42,82,83,84],{},"第三期（兩歲到十歲，幼兒園到國小穩定期；那大段文字叫假性穩定期）",[39,85,86,95],{},[42,87,88,89,91,92,94],{},"小孩呈失用症，不會正常使用肢體",[18,90],{},"\n躁動，愛哭，自閉程度比之前好，會對外界事物感興趣，語言溝通較進步",[18,93],{},"\n這個時期可以維持相當一段時間",[42,96,97,98,100],{},"大段文字：手部運動功能喪失逐漸明顯；逐漸喪失自主能力",[18,99],{},"\n長達數年到數十年",[42,102,103,104],{},"第四期（五到二十五歲，運動退化晚期）",[39,105,106,115],{},[42,107,108,109,111,112,114],{},"通常會在十歲左右出現運動失能現象，逐漸不能走路，有的下肢還會強直，所以要坐輪椅",[18,110],{},"\n認知，溝通，手部動作較穩定，注視他人能力能維持",[18,113],{},"\n有些會有脊椎側彎",[42,116,117,118,120],{},"大段文字：全身性肌肉萎縮，骨骼變形，對外界無反應；最終因細菌感染，敗血病或肺炎去世",[18,119],{},"\n長達數十年",[11,122,123],{},"情緒上也會有波動，例如早上很安靜，中午很容易生氣，下午會突然很穩重，晚上會變活潑與好奇",[11,125,126],{},"他們之前學會過的任務，卻會忘記自己學過",[11,128,129,130,132],{},"在做一件任務時，興奮的動機才是誘發出正常動作的方法，他們能夠自己做出來，但假如由別人要求他再多一次出來，他就會失敗",[18,131],{},"\n所以情緒上的照顧尤為要注意，假如他不開心，就該立即停止要求他去做",[11,134,135,136,138],{},"行走能力是最關鍵的，假如喪失行走能力，會導致脊椎側彎，骨質疏鬆，甚至會影響呼吸與消化功能",[18,137],{},"\n即使時間很少，但也要著重訓練行走能力",[11,140,141],{},"學者認為，他們不是真的退化，他們還是能學到新的技巧的",{"title":143,"searchDepth":144,"depth":144,"links":145},"",2,[],"2026-06-12","雷特氏症",false,"2026-06-13","md","\u002Fimages\u002Fuploads\u002F1781344227040-145949253_p0_master1200.webp",{},true,"\u002Fblog\u002FRett-Syndrome",{"title":5,"description":147},{"loc":154},"blog\u002FRett-Syndrome",null,"wp6UeSpNuWVzCMj8UKCOqphsSpW8MVmlDua_xz0r-Y0",142,{"id":162,"extension":163,"meta":164,"series":165,"stem":313,"__hash__":314},"series\u002Fseries.json","json",{},{"微積分教學":166,"生活紀錄":169,"Motor Control":171,"生活隨筆":185,"Motor learning":189,"小兒物治":207,"中風":227,"平衡":240,"Network Communication":250,"CSA":257,"機器學習":263,"小腦":267,"SCI脊髓損傷":276,"Machine Learning":292,"Data Structure":297,"基底核失調":304},[167,168],"微積分隨筆-未完成版","2025數學回顧",[170],"一個漂流到地球的故事",[172,173,174,175,176,177,178,179,180,181,182,183,184],"控制自己-Be-water-my-friend","控制自己-Be-water-my-friend（二）","控制自己-Be-water-my-friend（三）","控制自己-Be-water-my-friend（四）","控制自己-Be-water-my-friend（五）","進階控制制制制","周圍理論學派（一）反射理論","周圍理論學派（二）階層理論","中樞理論學派（一）CPG","中樞理論學派（二）Motor-Program","模組理論","系統理論","動態模組理論",[186,187,188],"你好，世界。","根本沒人在乎你的部落格","早安-午安-晚安",[190,191,192,193,194,195,196,197,198,199,200,201,202,203,204,205,206],"動作學習（一）介紹","動作學習（二）form-of-learning","動作學習（三）Measurement-of-learning","動作學習（四）理論","動作學習（五）理論-2","動作學習（六）理論-3","動作學習（七）練習方式-1","動作學習（八）練習方式-2","動作學習（九）回饋-1","動作學習（十）回饋-2-擴增性(KR)","動作學習（十一）回饋-3-擴增性(KP)","動作學習（十一）回饋-4-(間隔+物理引導)","動作學習（十二）神經可塑性","動作學習（十二）神經可塑性2","動作學習（十三）臨床應用","動作學習（十四）記憶","動作學習（十五）影響表現的因素",[208,209,210,211,212,213,214,215,216,217,218,219,220,221,222,223,224,225,226],"腦性痲痺-CP","CP補充（一）","CP—Rood-&-Bobath","CP—Rood-&-Bobath（二）","Motor-Learning","Motor-Learning小兒（二）","Gait-analysis小兒（一）","Gait-analysis小兒（二）","小兒發展（一）","小兒發展（二）","小兒發展（三）","小兒發展（四）","小兒發展（五）","GMFCS","BPI","先天性肌肉斜頸症CMT","MR智能不足","Down-Syndrome","Rett-Syndrome",[228,229,230,231,232,233,234,235,236,237,238,239],"腦血管病變（CVA）（中風）(一)","CVA（二）","CVA（三）血管症候群-i","CVA（四）血管症候群-(ii)","CVA（四）","CVA（六）","CVA（七）評估-(i)","CVA（八）評估-(ii)","CVA（九）復健—手部-(i)","CVA（十）功能性走路","CVA（十一）功能性走路ii","CVA（十二）輔助用品",[241,242,243,244,245,246,247,248,249],"平衡與前庭失調（一）","Balance（二）前庭覺-(i)","Balance（三）","Balance（四）評估","Balance（五）復健","Balance（六）功能恢復","Balance（七）前庭障礙","Balance（八）檢查","Balance（九）干預",[251,252,253,254,255,256],"Network-Communication,-Chapter-1","Network-Communication,-Chapter-2","Network-Communication,-Chapter-3","Network-Communication-Chapter-4","Network-Communications,-Chapter-5","Network-Communication,-Chapter-6",[258,259,260,261,262],"Week-1-—-Introduction-to-Computer-Systems","Computer-Systems-Architecture-Understanding-Performance","A-Top-Level-View-of-Computer-Function-and-Interconnection","The-Memory-Hierarchy-Understanding-Cache-Memory","Internal-Memory-How-Your-Computer-Remembers-Things",[264,265,266],"機器學習導論","資料前處理與迴歸分析","決策樹",[268,269,270,271,272,273,274,275],"小腦（一）","小腦（二）","小腦（三）功能","小腦（四）損傷","小腦（五）各功能障礙","小腦（六）評估","小腦（七）評估(ii)","小腦（八）治療",[277,278,279,280,281,282,283,284,285,286,287,288,289,290,291],"脊髓損傷SCI（一）","SCI（二）受傷機制——創傷性（頸椎）","SCI（三）受傷機制--ii","SCI（四）病理","SCI（五）類型--病症","SCI（六）分類--ASIA","SCI（七）感覺和運動檢查","SCI（八）相關症狀","SCI（九）預後和早期照護","SCI（十）物理治療介入-呼吸功能","SCI（十一）物理治療介入-動作策略","SCI（十二）墊上運動","SCI-（十三）墊上運動-ii","SCI（十四）轉位","SCI（十五）輪椅",[293,294,295,296],"Introduction-to-Machine-Learning","Data-Preprocessing-&-Regression-Analysis","Artificial-Neural-Networks-and-Backpropagation","Decision-Trees",[298,299,300,301,302,303],"Data-Structure-Concept-Revision","Java-Generics","Abstract-Data-Types-&-The-Bag","Stack","Linked-Lists-&-Doubly-Linked-Lists","Queues",[305,306,307,308,309,310,311,312],"基底核失調（一）解剖","基底核失調（二）帕金森氏症-i","基底核失調（三）帕金森氏症-ii","基底核失調（四）帕金森氏症-iii","基底核失調（五）帕金森氏症-iv","基底核失調（六）亨丁頓氏症","基底核失調（七）其他的病","基底核失調（補充）","series","87PwXcehfP8SscoXIlJrje28xWViVXF31SvaCht5wf4",[316,335,355,374,391,408,423,440,458,480],{"id":317,"title":318,"avatar":319,"banner":158,"bio":320,"body":321,"description":143,"extension":150,"meta":325,"name":318,"navigation":153,"path":326,"seo":327,"sitemap":328,"social":329,"stem":333,"__hash__":334},"authors\u002Fauthors\u002Fautomata.md","Automata","\u002Fimages\u002Fuploads\u002Fnier-automata-2b.jpg","一隻吐司天喵，漂浮在銀河星辰中",{"type":8,"value":322,"toc":323},[],{"title":143,"searchDepth":144,"depth":144,"links":324},[],{},"\u002Fauthors\u002Fautomata",{"description":143},{"loc":326},{"website":330,"twitter":331,"github":332},"https:\u002F\u002Freurl.cc\u002FWOeM29","https:\u002F\u002Freurl.cc\u002FLnvLEy","https:\u002F\u002Fgithub.com\u002FAutomata-0","authors\u002Fautomata","IkVbO2zA7revgYq624iVWpSZQUyMmWa82tw_EbWXViE",{"id":336,"title":337,"avatar":338,"banner":339,"bio":340,"body":341,"description":143,"extension":150,"meta":345,"name":346,"navigation":153,"path":347,"seo":348,"sitemap":349,"social":350,"stem":353,"__hash__":354},"authors\u002Fauthors\u002Fchinono.md","Chinono","\u002Fimages\u002Fuploads\u002F103467998_p0 copy.png","\u002Fimages\u002Fbackground_light.jpg","我不是女生！",{"type":8,"value":342,"toc":343},[],{"title":143,"searchDepth":144,"depth":144,"links":344},[],{},"七糯糯","\u002Fauthors\u002Fchinono",{"description":143},{"loc":347},{"github":351,"twitter":143,"website":352},"https:\u002F\u002Fgithub.com\u002FChinHongTan","https:\u002F\u002Fchinono.dev","authors\u002Fchinono","jj1J9mFh3InZFL6XtCzGBQ5jPip0EwBDE3mjGvnN6jE",{"id":356,"title":357,"avatar":358,"banner":359,"bio":360,"body":361,"description":143,"extension":150,"meta":365,"name":366,"navigation":153,"path":367,"seo":368,"sitemap":369,"social":370,"stem":372,"__hash__":373},"authors\u002Fauthors\u002Fhibiki12141132.md","Hibiki12141132","https:\u002F\u002Favatars.githubusercontent.com\u002Fu\u002F265822020?v=4","\u002Fimages\u002Fuploads\u002F1773978423557-___.jpg","享受著知識強姦大腦的過程 (內文含個人發癲 不要再意)",{"type":8,"value":362,"toc":363},[],{"title":143,"searchDepth":144,"depth":144,"links":364},[],{},"HiBiKi","\u002Fauthors\u002Fhibiki12141132",{"description":143},{"loc":367},{"github":371,"twitter":143},"https:\u002F\u002Fgithub.com\u002FHiBiKi12141132","authors\u002Fhibiki12141132","dbRnKEcYeCH_faD8R7AUmPPcwgc26s_fR4Q_lu4qtA4",{"id":375,"title":376,"avatar":377,"banner":158,"bio":378,"body":379,"description":143,"extension":150,"meta":383,"name":376,"navigation":153,"path":384,"seo":385,"sitemap":386,"social":387,"stem":389,"__hash__":390},"authors\u002Fauthors\u002Fmahiro.md","Mahiro","https:\u002F\u002Ftruth.bahamut.com.tw\u002Fs01\u002F202601\u002F2a29b047d341f840b2ce89f7d65b2ba3.JPG","一個致力於逃離新竹的電機系小雜魚",{"type":8,"value":380,"toc":381},[],{"title":143,"searchDepth":144,"depth":144,"links":382},[],{},"\u002Fauthors\u002Fmahiro",{"description":143},{"loc":384},{"github":388},"https:\u002F\u002Fgithub.com\u002Fwifekurumi","authors\u002Fmahiro","b435tdWu9eXUf06WroCge0I405cqA0FhLlUUhoPk14k",{"id":392,"title":393,"avatar":394,"banner":158,"bio":395,"body":396,"description":143,"extension":150,"meta":400,"name":393,"navigation":153,"path":401,"seo":402,"sitemap":403,"social":404,"stem":406,"__hash__":407},"authors\u002Fauthors\u002Fosborrrrn.md","Osborrrrn","\u002Fimages\u002Fuploads\u002Frectangle_large_type_2_c516437ed713e5de1f7d2dca8a20cd81.jpg","別人笑我太瘋癲，我笑他人看不穿。\n不見五陵豪傑墓，無花無酒鋤就田",{"type":8,"value":397,"toc":398},[],{"title":143,"searchDepth":144,"depth":144,"links":399},[],{},"\u002Fauthors\u002Fosborrrrn",{"description":143},{"loc":401},{"github":405},"https:\u002F\u002Fgithub.com\u002FOsborrrrn","authors\u002Fosborrrrn","w6VWZKPUwvXn5i7MKXOpU2Jeqr3BrdTKVCeDOF2jZlU",{"id":409,"title":410,"avatar":158,"banner":158,"bio":411,"body":412,"description":143,"extension":150,"meta":416,"name":410,"navigation":153,"path":417,"seo":418,"sitemap":419,"social":420,"stem":421,"__hash__":422},"authors\u002Fauthors\u002F法法.md","法法","123",{"type":8,"value":413,"toc":414},[],{"title":143,"searchDepth":144,"depth":144,"links":415},[],{},"\u002Fauthors\u002F法法",{"description":143},{"loc":417},{"github":143},"authors\u002F法法","o5pdVuPCfTmhkDCpvgy4YmAP0CGdvFluPvjhgvQVbsI",{"id":424,"title":425,"avatar":426,"banner":158,"bio":427,"body":428,"description":143,"extension":150,"meta":432,"name":425,"navigation":153,"path":433,"seo":434,"sitemap":435,"social":436,"stem":438,"__hash__":439},"authors\u002Fauthors\u002F灰海獅.md","灰海獅","\u002Fimages\u002Fuploads\u002Fimg_3279.jpeg","守夜人",{"type":8,"value":429,"toc":430},[],{"title":143,"searchDepth":144,"depth":144,"links":431},[],{},"\u002Fauthors\u002F灰海獅",{"description":143},{"loc":433},{"github":437},"https:\u002F\u002Fgithub.com\u002Fyuiri333","authors\u002F灰海獅","iZoSIFbQdS-6v3LiK1txgxnIMKy-d2CyZXQk9CMua_s",{"id":441,"title":442,"avatar":443,"banner":444,"bio":445,"body":446,"description":143,"extension":150,"meta":450,"name":442,"navigation":153,"path":451,"seo":452,"sitemap":453,"social":454,"stem":456,"__hash__":457},"authors\u002Fauthors\u002F花夜.md","花夜","\u002Fimages\u002Fuploads\u002F1772719470518-791_20260218161129.png","\u002Fimages\u002Fuploads\u002Fimg_2446.png","無論你身在何處，我都會在這裡等你",{"type":8,"value":447,"toc":448},[],{"title":143,"searchDepth":144,"depth":144,"links":449},[],{},"\u002Fauthors\u002F花夜",{"description":143},{"loc":451},{"github":455,"twitter":143},"https:\u002F\u002Fgithub.com\u002Fflowernight0709","authors\u002F花夜","a7jeQiF_JkawgYIR-aYSGceJdDP6Z-OWydsICvgSIzs",{"id":459,"title":460,"avatar":461,"banner":462,"bio":463,"body":464,"description":468,"extension":150,"meta":471,"name":460,"navigation":153,"path":472,"seo":473,"sitemap":474,"social":475,"stem":478,"__hash__":479},"authors\u002Fauthors\u002F輝月.md","輝月","\u002Fimages\u002Fuploads\u002Ffb_img_1771085634823.jpg","\u002Fimages\u002Fuploads\u002Fimg_1751.jpg","天下布魔好好玩",{"type":8,"value":465,"toc":469},[466],[11,467,468],{},"準大學生，目前正在製作TFR模組",{"title":143,"searchDepth":144,"depth":144,"links":470},[],{},"\u002Fauthors\u002F輝月",{"description":468},{"loc":472},{"twitter":476,"github":477},"https:\u002F\u002Fx.com\u002Fhuiyue945","https:\u002F\u002Fgithub.com\u002Fhuiyueyea","authors\u002F輝月","koUocBihphDy3453-nAcolM7JJYwI7UMBpVkf1JQrMQ",{"id":481,"title":482,"avatar":483,"banner":158,"bio":484,"body":485,"description":489,"extension":150,"meta":503,"name":482,"navigation":153,"path":504,"seo":505,"sitemap":506,"social":507,"stem":509,"__hash__":510},"authors\u002Fauthors\u002F阿西狄亞.md","阿西狄亞","\u002Fimages\u002Fuploads\u002Fimg_20251215_121849_589.jpg","君は実に馬鹿だな",{"type":8,"value":486,"toc":501},[487,490],[11,488,489],{},"我是阿西狄亞，阿西狄亞的阿，阿西狄亞的西，阿西狄亞的狄，阿西狄亞的亞，你可以叫我阿西。",[11,491,492,496,497,500],{},[493,494,495],"strong",{},"我說的所有事情都抱有極度主觀的看法以及意見","，如果你有其他想法，",[493,498,499],{},"你是對的","。",{"title":143,"searchDepth":144,"depth":144,"links":502},[],{},"\u002Fauthors\u002F阿西狄亞",{"description":489},{"loc":504},{"github":508},"https:\u002F\u002Fgithub.com\u002FAcedia0130","authors\u002F阿西狄亞","q5ECEDl8-0Y33tPck0lYZnzPjFdJkrOnBN7HkAO3pls",[512,785,963,1330,1452,1929,2164,2375,2574,2729,2891,3125,3278,3428,3782,4019,4307,4424,4597],{"id":513,"title":514,"author":6,"body":515,"date":774,"description":775,"draft":148,"edited_at":774,"extension":150,"featured_image":776,"meta":777,"navigation":153,"path":778,"pinned":148,"seo":779,"sitemap":780,"stem":781,"tags":782,"__hash__":784},"blog\u002Fblog\u002F腦性痲痺-CP.md","腦性痲痺 CP",{"type":8,"value":516,"toc":772},[517,520,558,570,573,625,657,687,699,725,751,758,763],[11,518,519],{},"以下根據余老師做的總結來編寫",[11,521,522,523,525,526,531,532,536,537,539,540,544,545,549,551,552,554,555,557],{},"首先是定義 ",[18,524],{},"\n在大腦",[25,527,530],{"className":528},[529],"bg-red-3","未成熟","的階段 因為",[25,533,535],{"className":534},[529],"腦傷而導致的動作障礙","為主的症候群",[18,538],{},"\n而CP有",[25,541,543],{"className":542},[29],"三個非","合併導致",[25,546,548],{"className":547},[29],"發展遲緩",[18,550],{},"\n非進行性(傷口不會再惡化) ",[18,553],{},"\n非暫時性(腦傷不會好)",[18,556],{},"\n非單純性(有機會響影到多個區域 症狀會有例如智能不足等)",[11,559,560,561,563,564,566,567,569],{},"影響區域有三種區分",[18,562],{},"\n單側麻痺(Hemiplegia)(患側手腳無力)",[18,565],{},"\n雙側麻痺(Diplegia)(通常雙腿影響比雙手明顯)",[18,568],{},"\n四肢麻痺(Quadriplegia)(四肢 但上肢影響程度比下肢大)",[11,571,572],{},"我們現在來講三大分類",[11,574,575,576,578,579,583,584,586,587,591,592,594,598,599,601,602,607,608,612,613,615,616,618,619,621,622,624],{},"首先是痙攣型(Spasticity) 也是最大宗的一類(70%)",[18,577],{},"\n傷到了",[25,580,582],{"className":581},[529],"錐狀束","(錐體路徑 Pyramidal Tract)",[18,585],{},"\n而四肢張力都會變大 ",[25,588,590],{"className":589},[529],"上肢比下肢","還要嚴重",[18,593],{},[25,595,597],{"className":596},[28],"上肢為Flex協同動作 下肢為Exten協同動作","(詳細請見李老師CVA中的表)",[18,600],{},"\n併發症有 ",[25,603,606],{"className":604},[605],"green-5","斜視","(70%) ",[25,609,611],{"className":610},[605],"癲癇","(50%)",[18,614],{},"\n治療重點有",[18,617],{},"\n增加中軸張力(核心穩定)",[18,620],{},"\n降低肢體張力",[18,623],{},"\n提升抗重力能力",[11,626,627,628,578,630,634,635,637,638,642,643,645,646,648,649,615,651,653,654,656],{},"接著講徐動型(Athethoid)",[18,629],{},[25,631,633],{"className":632},[529],"基底核黃核","部位",[18,636],{},"\n張力",[25,639,641],{"className":640},[29],"時大時小","(有時候很硬 有時候很軟)",[18,644],{},"\n而頭部控制差 上肢較下肢嚴重 且有不隨意扭動",[18,647],{},"\n併發症有 聽覺障礙(高頻聽不見) 語言障礙",[18,650],{},[18,652],{},"\n對稱協調控制",[18,655],{},"\n雙側控制",[11,658,659,660,578,662,666,668,669,671,672,674,675,677,678,680,681,683,684,686],{},"最後來講失調型(Ataxia)",[18,661],{},[25,663,665],{"className":664},[529],"小腦",[18,667],{},"\n張力小",[18,670],{},"\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)",[18,673],{},"\n併發有 平衡 感覺統合 知覺都會較差",[18,676],{},"\n在治療重點上",[18,679],{},"\n會給他們穿加壓衣(增加感統知覺) ",[18,682],{},"\n穩定與張力提升",[18,685],{},"\n承重(增加感統知覺)",[11,688,689,690,692,693,695,696,698],{},"還有一些小分類 簡單帶過一下",[18,691],{},"\n首先是僵直型 這個是比痙攣型張力還要再強",[18,694],{},"\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",[18,697],{},"\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",[11,700,701,702,704,705,707,708,710,711,713,714,716,717,719,720,724],{},"接著來講治療原則 主要有五點",[18,703],{},"\n早期教育(早療 黃金期)",[18,706],{},"\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)",[18,709],{},"\n治療項目盡量以ADL為主",[18,712],{},"\n日常活動(結合孩子一天的作息去制定訓練 回家訓練)",[18,715],{},"\n感官輸入(如本體感覺 觸覺)",[18,718],{},"\n老師有圈了個重點 ",[25,721,723],{"className":722},[29],"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)",[11,726,727,728,730,731,735,736,730,738,742,743,745,746,750],{},"最後來講預後",[18,729],{},"\n假如 ",[25,732,734],{"className":733},[28],"2歲前","的寶寶能自行坐起來 未來100%能夠自行走動",[18,737],{},[25,739,741],{"className":740},[28],"4歲的","寶寶還不會自行坐起來 未來不會走",[18,744],{},"\n假如 是",[25,747,749],{"className":748},[28],"偏癱","的寶寶 未來100%能夠自行走動",[11,752,753],{},[754,755],"img",{"alt":756,"src":757},"1.00","https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774841979537-Screenshot_20260330_100529_Gallery.png",[11,759,760],{},[754,761],{"alt":756,"src":762},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774842001784-Screenshot_20260330_100531_Gallery.png",[11,764,765,766,768],{},"一些講義的內容 我隨後會在另一篇裡加上 ",[18,767],{},[25,769,771],{"className":770},[529],"讀英文！！！",{"title":143,"searchDepth":144,"depth":144,"links":773},[],"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":514,"description":775},{"loc":778},"blog\u002F腦性痲痺-CP",[783],"小兒PT","Oa9L6eaO1VoQayD-z7Id8c20dDInqUv2J9f4wkCkC9g",{"id":786,"title":209,"author":6,"body":787,"date":954,"description":955,"draft":148,"edited_at":954,"extension":150,"featured_image":956,"meta":957,"navigation":153,"path":958,"pinned":148,"seo":959,"sitemap":960,"stem":961,"tags":158,"__hash__":962},"blog\u002Fblog\u002FCP補充（一）.md",{"type":8,"value":788,"toc":952},[789,792,795,824,827,833,856,861,905,908,911,947],[11,790,791],{},"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",[11,793,794],{},"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",[796,797,798,804,821],"ol",{},[42,799,800,801,803],{},"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",[18,802],{},"\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",[42,805,806,807,812,814,815,817,818,820],{},"產中——主要為",[25,808,811],{"className":809},[28,810],"green-3","胎兒中毒以及產時窒息",[18,813],{},"\n血液樣本顯示為代謝性酸中毒，pH\u003C7以及鹼剩餘>12mmol\u002FL",[18,816],{},"\n妊娠周數>34周，早期會出現中度或重度腦病變",[18,819],{},"\n低血糖，未經治療的黃疽，嚴重的新生兒感染亦會導致CP",[42,822,823],{},"產後——感染，外傷，腦膜炎，敗血症",[825,826],"hr",{},[11,828,829,830,832],{},"腦型麻痺類別——1（雖然總結有提到，但還是再寫一次好了）",[18,831],{},"\n分成了",[796,834,835],{},[42,836,837,838,840,841,843,844,846,847,849,850,852,853,855],{},"肢體受影響的分佈模式——",[18,839],{},"\n雙側痲痺(腳比手影響嚴重)",[18,842],{},"\n單側痲痺(單側受影響)",[18,845],{},"\n四肢痲痺（手比腳嚴重）",[18,848],{},"\n單肢痲痺",[18,851],{},"\n三肢痲痺",[18,854],{},"\n下肢痲痺",[11,857,858],{},[754,859],{"alt":756,"src":860},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776134449314-Screenshot_2026-04-14_104024.png",[796,862,863],{},[42,864,865,866,868,869,871,872,874,875,879,881,882,886,887,892,893,895,896,898,899,901,902,904],{},"根據張力與動作異常形態區分——",[18,867],{},"\n痙攣型——佔比七成，傷到錐狀束，上肢Flexor tone強+pronation，下肢Extenor tone強",[18,870],{},"\n徐動型——佔比一成五，傷到基底核，皮質無影響，所以智力正",[18,873],{},"\n僵直型——傷到皮質，比",[25,876,878],{"className":877},[28,29],"痙攣型張力還大",[18,880],{},"\n運動失調型——佔比一成三，傷到小腦，",[25,883,885],{"className":884},[28,29],"協調能力差","且尤其是",[25,888,891],{"className":889},[890],"yellow-3","下肢","特別明顯，步寬大，走路搖晃",[18,894],{},"\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",[18,897],{},"\n顫抖型——較徐動型有節奏，在遠端顫抖",[18,900],{},"\n混合型",[18,903],{},"\n無法分類型",[11,906,907],{},"類別——2（P8）",[11,909,910],{},"他提到了按照ICF思路去想各個層級寶寶的問題",[796,912,913,916,924,931,939],{},[42,914,915],{},"首先是健康問題，受了甚麼傷",[42,917,918,919],{},"其次是受限，這個傷會讓寶寶",[25,920,923],{"className":921},[28,922],"blue-3","做不了哪些動作",[42,925,926,927],{},"再來是侷限，這些做不了的動作會讓寶寶",[25,928,930],{"className":929},[28,29],"失去甚麼功能性",[42,932,933,934,938],{},"然後是環境因素，例如失去了這些功能性的話，與",[25,935,937],{"className":936},[28,810],"環境的互動","有甚麼障礙",[42,940,941,942,946],{},"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",[25,943,945],{"className":944},[28,890],"動機","等因素",[11,948,949],{},[754,950],{"alt":756,"src":951},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776135419925-Screenshot_2026-04-14_105040.png",{"title":143,"searchDepth":144,"depth":144,"links":953},[],"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":209,"description":955},{"loc":958},"blog\u002FCP補充（一）","8cDECsO9Ab18dGecDdRUOUB4ETPPEAjd1AS3dqL2ii4",{"id":964,"title":965,"author":6,"body":966,"date":954,"description":1322,"draft":148,"edited_at":954,"extension":150,"featured_image":1323,"meta":1324,"navigation":153,"path":1325,"pinned":148,"seo":1326,"sitemap":1327,"stem":1328,"tags":158,"__hash__":1329},"blog\u002Fblog\u002FCP—Rood-&-Bobath.md","CP—Rood & Bobath（一）",{"type":8,"value":967,"toc":1320},[968,971,974,990,1008,1040,1043,1089,1091,1094,1170,1178,1260,1262,1265],[11,969,970],{},"(就先只寫余老師有在上課做註記的版書，讀不完啦)",[11,972,973],{},"1940前肌能教再育>1950年後神經成熟理論>1990年動態系統理論",[11,975,976,977,979,980,984,985,989],{},"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）",[18,978],{},"\n手法有RIP(",[25,981,983],{"className":982},[28,810],"異常reflex抑制",")，接著誘發動作(",[25,986,988],{"className":987},[29,28],"翻正反應,平衡反應)","，再加一些本體覺和觸覺輸入",[11,991,992,993,995,996,998,999,1003,1004],{},"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",[18,994],{},"\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",[18,997],{},"\n主要是",[25,1000,1002],{"className":1001},[28,29],"打破錯的感覺運動經驗","，",[25,1005,1007],{"className":1006},[28,890],"重新教寶寶正確的動作形態",[11,1009,1010,1011,1013,1014,1016,1017,1019,1020,1024,1025,1027,1028,1030,1031,1035,1036],{},"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",[18,1012],{},"\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",[18,1015],{},"\n那像是這裡提到的flexor tone過大，我們就幫他做extension",[18,1018],{},"\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",[25,1021,1023],{"className":1022},[890],"反方向","，誘發GTO關閉tone",[18,1026],{},"\n(著重在擺位)",[18,1029],{},"\n現在的RIP是改為",[25,1032,1034],{"className":1033},[810],"partial RIP","，只利用",[25,1037,1039],{"className":1038},[28,29],"Key point來達到抑制與誘發",[11,1041,1042],{},"那RIP的注意事項有如下",[39,1044,1045,1057,1069,1077,1080,1083],{},[42,1046,1047,1048,1052,1053],{},"RIP只做在",[25,1049,1051],{"className":1050},[28,29],"有痙攣","的地方，",[25,1054,1056],{"className":1055},[810],"hypotone則不需要做",[42,1058,1059,1060,1064,1065],{},"力度需",[25,1061,1063],{"className":1062},[890,28],"緩慢施加","，因為痙攣的部位容易",[25,1066,1068],{"className":1067},[29],"contracture",[42,1070,1071,1072,1076],{},"從近端開始做，並且做",[25,1073,1075],{"className":1074},[529,28],"旋轉以及Protraction(shoulder)是最容易打破張力","的手段",[42,1078,1079],{},"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",[42,1081,1082],{},"新的Bobath目的是做ADL動作",[42,1084,1085,1086,1088],{},"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",[18,1087],{},"\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",[825,1090],{},[11,1092,1093],{},"接下來講抑制Extensor的技巧，先來講第一個",[796,1095,1096,1099,1105,1130,1138,1159,1167],{},[42,1097,1098],{},"首先PT要坐在有靠背的椅子上保護好PT的背",[42,1100,1101,1102,1104],{},"將小孩的身體放在PT大腿上，腿面向PT，呈現total flexion姿勢",[18,1103],{},"\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",[42,1106,1107,1108,1110,1111,1115,1116,1120,1124,1125,1129],{},"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",[18,1109],{},"\n可以在剛提到的姿勢下順便訓練旋轉，PT一手將",[25,1112,1114],{"className":1113},[28,29],"小孩的腳轉","到一側，另一手轉動寶寶的",[25,1117,1119],{"className":1118},[28,529],"身體",[25,1121,1123],{"className":1122},[28],"到對側","（",[25,1126,1128],{"className":1127},[529],"是身體，不是頭","）",[42,1131,1132,1133,1137],{},"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",[25,1134,1136],{"className":1135},[29,28],"肩胛骨內緣","後主推做protraction",[42,1139,1140,1141,1143,1144,1148,1149,1151,1152,1156,1158],{},"那小孩也因為extensor張力太大，可能沒有意識到有手的存在",[18,1142],{},"\n我們就得將他的手帶到胸前",[25,1145,1147],{"className":1146},[29,28],"進入視野範圍","，讓他開始吃或者自己的手",[18,1150],{},"\n而有些小孩會緊張會保持抓握姿勢，我們可以從",[25,1153,1155],{"className":1154},[28,29],"大拇指開始扳開慢慢張手打開",[18,1157],{},"\n讓他去做手碰手、手碰嘴、手碰腳、嘴碰嘴",[42,1160,1161,1162,1166],{},"而在抑制的過程中也可以做一些",[25,1163,1165],{"className":1164},[29,28],"誘發flexion動作","的手法，訓練屈肌，這樣也能降低extensor tone",[42,1168,1169],{},"習慣了以上姿勢後，就可以放寶寶在地上自己玩了",[11,1171,1172,1173,1177],{},"接著來講第二個，這個是",[25,1174,1176],{"className":1175},[529,28],"利用滾筒","的方式，結合了誘發動作的方式",[796,1179,1180,1207,1236],{},[42,1181,1182,1183,1187,1189,1190,1194,1196,1197,1201,1202,1206],{},"首先讓小孩在滾筒上side-lying，",[25,1184,1186],{"className":1185},[28,810],"手抬高將滾筒卡在腋下",[18,1188],{},"\n這時候PT要對小孩上方的髖做",[25,1191,1193],{"className":1192},[28,29],"Abd，extension和external rotation",[18,1195],{},"\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",[25,1198,1200],{"className":1199},[29,28],"extension","姿勢(",[25,1203,1205],{"className":1204},[28],"正常站立角度",")",[42,1208,1209,1210,1212,1213,1215,1216,1218,1219,1223,1227,1231,1232,1129],{},"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",[18,1211],{},"\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",[18,1214],{},"\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",[18,1217],{},"\n而這時候會想要去訓練他的抬頭（雖然",[25,1220,1222],{"className":1221},[28,29],"抬頭是extension姿勢",[25,1224,1226],{"className":1225},[28],"但這個跟",[25,1228,1230],{"className":1229},[28,890],"extensor muscle tone不一樣","，還是得教導",[25,1233,1235],{"className":1234},[29],"正確方式",[42,1237,1238,1239,1241,1242,1244,1245,1247,1248,1252,1254,1255,1259],{},"剛剛講的是從side-lying到prone，現在講反過來的從prone到side-lying",[18,1240],{},"\n一手放在pelvis，一手固定shoulder，",[18,1243],{},"\n這次先將pelvis，翻回side-lying，然後慢慢協助將shoulder帶到side-lying",[18,1246],{},"\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",[25,1249,1251],{"className":1250},[28,29],"retraction",[18,1253],{},"\n對於CP小兒而言",[25,1256,1258],{"className":1257},[29,28],"誘發出extensor tone","，所以要先將pelvis帶走）",[825,1261],{},[11,1263,1264],{},"然後來介紹到抑制Flexor的技巧，核心是利用重力去抑制",[796,1266,1267,1287,1302,1317],{},[42,1268,1269,1270,1274,1275,1279,1281,1282,1286],{},"讓小孩supine在球上，這過程要",[25,1271,1273],{"className":1272},[29,28],"緩慢以及穩","，不要讓小孩感到害怕，假如",[25,1276,1278],{"className":1277},[529,28],"小孩恐懼就不要做這個",[18,1280],{},"\n因為flexor tone 高的小孩比較少動，所以",[25,1283,1285],{"className":1284},[28,29],"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",[42,1288,1289,1290,1294,1295,1299,1301],{},"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",[25,1291,1293],{"className":1292},[810,28],"逐漸放鬆","，同時也能",[25,1296,1298],{"className":1297},[28,29],"靠重力牽拉flexor肌肉",[18,1300],{},"\n再進階就遠端例如hip去做同樣的事",[42,1303,1304,1305,1307,1308,1312,1313],{},"進一步的做法是，抓住小孩的小肢，將球往小孩的頭側推",[18,1306],{},"\n這樣因為滾動的原因變成頭反而靠近地面，呈",[25,1309,1311],{"className":1310},[810,28],"頭靠近地面","，這樣也能讓",[25,1314,1316],{"className":1315},[29,28],"extensor tone上升",[42,1318,1319],{},"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":143,"searchDepth":144,"depth":144,"links":1321},[],"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":965,"description":1322},{"loc":1325},"blog\u002FCP—Rood-&-Bobath","hbxSp87ZZts-QV-3eWuNwBK9q66v8uar73myHqp0-sQ",{"id":1331,"title":1332,"author":6,"body":1333,"date":954,"description":1443,"draft":148,"edited_at":1444,"extension":150,"featured_image":1445,"meta":1446,"navigation":153,"path":1447,"pinned":148,"seo":1448,"sitemap":1449,"stem":1450,"tags":158,"__hash__":1451},"blog\u002Fblog\u002FCP—Rood-&-Bobath（二）.md","CP—Rood & Bobath（二）",{"type":8,"value":1334,"toc":1441},[1335,1338,1344,1349,1352],[11,1336,1337],{},"那剛剛一篇講的都Bobath的手法，那現在講Rood的",[11,1339,1340,1341,1343],{},"那Rood 提到說，人類有發展次序，mobility>stability>mobility on stability>skill movement",[18,1342],{},"\n也強調了可以利用感覺輸入誘發動作",[11,1345,1346],{},[754,1347],{"alt":756,"src":1348},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776217678571-Screenshot_2026-04-15_094736.png",[11,1350,1351],{},"那感覺刺激的部份根據強度及頻率而有這四種變化",[39,1353,1354,1360,1399,1405],{},[42,1355,1356,1357,1359],{},"快速且短暫的刺激",[18,1358],{},"\n可以用心智狀態提高，全身muscle tone 增高，反應力上升（喚醒）",[42,1361,1362,1363,1365,1366,1368,1369,1371,1373,1374,1378,1379,1381,1382,1384,1385,1389,1391,1395,1396,1398],{},"快速且重複的刺激",[18,1364],{},"\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",[18,1367],{},"\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",[18,1370],{},[18,1372],{},"\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",[25,1375,1377],{"className":1376},[29,28],"頸部開始訓練","(inversion在GA26~29就出現)",[18,1380],{},"\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",[18,1383],{},"\n治療師採坐姿，而且不是用手在帶動，是",[25,1386,1388],{"className":1387},[28,29],"利用治療師身體帶動",[18,1390],{},[25,1392,1394],{"className":1393},[529],"注意","：要給小孩安全感，inversion不能過久，保持頭部的正確位置",[18,1397],{},"\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",[42,1400,1401,1402,1404],{},"緩慢且規律重覆的刺激",[18,1403],{},"\n通常用來減敏",[42,1406,1407,1408,1410,1411,1413,1415,1416,1420,1421,1425,1426,1428,1430,1431,1435,1436,1440],{},"持續性的刺激",[18,1409],{},"\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",[18,1412],{},[18,1414],{},"\n對於",[25,1417,1419],{"className":1418},[28,29],"痙攣","的小孩，先從",[25,1422,1424],{"className":1423},[29,28],"不敏感的地方開始","，再往較敏感的位慢慢刺激，嘴巴也一樣",[18,1427],{},[18,1429],{},"\n但對於",[25,1432,1434],{"className":1433},[28,890],"低張","的小孩，則相反，從",[25,1437,1439],{"className":1438},[28,890],"最敏感的地方開始","刺激",{"title":143,"searchDepth":144,"depth":144,"links":1442},[],"Rood 到結尾","2026-04-15","\u002Fimages\u002Fuploads\u002F1776222460274-Ee4ldTMUcAEiPzF.webp",{},"\u002Fblog\u002FCP—Rood-&-Bobath（二）",{"title":1332,"description":1443},{"loc":1447},"blog\u002FCP—Rood-&-Bobath（二）","56_IFu2CIimvGKbXPweMAs8MdVF91nlzrjRw9LcNlb0",{"id":1453,"title":1454,"author":6,"body":1455,"date":1919,"description":1920,"draft":148,"edited_at":1921,"extension":150,"featured_image":1922,"meta":1923,"navigation":153,"path":1924,"pinned":148,"seo":1925,"sitemap":1926,"stem":1927,"tags":158,"__hash__":1928},"blog\u002Fblog\u002FMotor-Learning.md","Motor Learning小兒（一）",{"type":8,"value":1456,"toc":1917},[1457,1460,1469,1478,1496,1505,1514,1530,1539,1568,1643,1658,1661,1703,1709,1758,1804,1845,1848,1886,1901],[11,1458,1459],{},"那這一節課著重在動態模組理論，跟黃老師教的是互通的",[11,1461,1462,1463,1465,1466,1468],{},"那首先是講感覺統合的部份",[18,1464],{},"\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",[18,1467],{},"\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)",[11,1470,1471,1472,1474,1475,1477],{},"而接下來講到動作的發展",[18,1473],{},"\n那老師用的理論是動態模組理論",[18,1476],{},"\n假如還記得黃老師的Motor Control最後一課講的應該不難吃",[11,1479,1480,1481,1483,1484,1486,1487,1489,1490,1492,1493,1495],{},"不過我還是先列出來老師PPT裡的五個角度",[18,1482],{},"\n第一 動作技巧的顯現",[18,1485],{},"\n第二 動作型態的精準度",[18,1488],{},"\n第三 動作成果(可從評估表推估) ",[18,1491],{},"\n第四 組合技巧的獲得(次系統組合的結果)",[18,1494],{},"\n第五 對環境適應力的增強",[11,1497,1498,1499,1501,1502,1504],{},"我們現在來講平衡系統的發展",[18,1500],{},"\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",[18,1503],{},"\n以站立來形容的話",[11,1506,1507,1508,1510,1511,1513],{},"2)人類的重心(COM)基本會在S2 ",[18,1509],{},"\n那壓力中心(COP)是動態的 他會因應COM的改變而改變",[18,1512],{},"\n那底面積(BOS)就是兩隻腳踩在地面的距離",[11,1515,1516,1517,1521,1522,1524,1525,1529],{},"3)那平衡的演化 在早期 小孩會",[25,1518,1520],{"className":1519},[29,28],"極度依賴視角","來判斷",[18,1523],{},"\n但在成熟的過程中 我們會",[25,1526,1528],{"className":1527},[529],"越來越傾向用本體感覺","去判斷",[11,1531,1532,1533,1535,1536,1538],{},"4)穩定極限(LOS) 他把我們人類想象成一個倒立的三角錐",[18,1534],{},"\n在不移動的情況下身體能偏多少(前6度 側8度 後4度)",[18,1537],{},"\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)",[11,1540,1541,1542,1544,1545,1549,1550,1555,1556,1558,1559,1563,1564],{},"5)承受外力時的反應時 人類會有兩種變化",[18,1543],{},"\n第一種就是假如這",[25,1546,1548],{"className":1547},[28,810],"外力少到一定範圍"," 就只會用",[25,1551,1554],{"className":1552},[1553],"bg-green-3","姿勢穩定反應","來做調整",[18,1557],{},"\n另一種則是假如外力",[25,1560,1562],{"className":1561},[28,29],"超過姿勢穩定反應可以調整的程度"," 就會產生",[25,1565,1567],{"className":1566},[529],"保護性姿勢",[11,1569,1570,1571,1573,1574,1576,1577,1579,1580,1584,1586,1587,1591,1595,1597,1598,1600,1602,1603,1607,1608,1610,1611,1615,1616,1618,1619,1621,1623,1624,1626,1627,1629,1630,1634,1635,1637,1639,1640,1642],{},"6)",[18,1572],{},"\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",[18,1575],{},"\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",[18,1578],{},"\n那一般而言 越成熟的人 會越偏好用",[25,1581,1583],{"className":1582},[29],"踝策略",[18,1585],{},"\n而目前比較新的提出 就是",[25,1588,1590],{"className":1589},[890,28],"抓握",[25,1592,1594],{"className":1593},[890],"是一種不算策略(Strategy)的方法",[18,1596],{},"\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",[18,1599],{},[18,1601],{},"\nii) 而另一點則是改變BOS的 例子就有跨步策略 身體是",[25,1604,1606],{"className":1605},[29],"被迫做出","的 伸手出去支撐也是如此",[18,1609],{},"\n那在發展過程中 而在",[25,1612,1614],{"className":1613},[29],"方向性上也是有順序","的",[18,1617],{},"\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",[18,1620],{},[18,1622],{},"\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 ",[18,1625],{},"\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",[18,1628],{},"\n我們",[25,1631,1633],{"className":1632},[28],"可以通過適度的給他們外力","訓練他們",[18,1636],{},[18,1638],{},"\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",[18,1641],{},"\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",[11,1644,1645,1646,1648,1649,1651,1652,1654,1655,1657],{},"那對於小兒的發展議題，主要有這幾個",[18,1647],{},"\ni)——新形式的起源(The origin of new form)",[18,1650],{},"\nii)——連續性與非連續性(Continuity vs discontinuity)",[18,1653],{},"\niii)——變異性(Variability)",[18,1656],{},"\niv)——生物與環境的影響(Biological vs. environmental influence)",[11,1659,1660],{},"那動態模組理論是經歷過以下發展而來的",[796,1662,1663,1670,1690],{},[42,1664,1665,1666],{},"那首先是小兒痲痺(1910s)——當年的理念是哪邊無力練哪邊",[25,1667,1669],{"className":1668},[28,529],"(肌肉再教育 muscle re-education)",[42,1671,1672,1673,1677,1678,1680,1681,1683,1684,1686,1687,1689],{},"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",[25,1674,1676],{"className":1675},[529,28],"感覺輸入","促進正常的動作以及動作發展",[18,1679],{},"\n神經成熟理論(1945s)由Gesell和McGraw提出，他們的關鍵理念有如下",[18,1682],{},"\nCNS髓鞘化(Increased myelination of CNS)",[18,1685],{},"\n皮質抑制皮質下中心(Inhibition of the subcortical centers by the higher cerebral cortex)",[18,1688],{},"\n層級控制(Hierarchical control)",[42,1691,1692,1693,1697,1698,1702],{},"最後來講到階層理論的雛型(1980s)——當年他們覺得動作發展",[25,1694,1696],{"className":1695},[28],"不只單一的神經支配","，把",[25,1699,1701],{"className":1700},[28,29],"其他的系統、環境","一併整合進來",[11,1704,1705,1706,1708],{},"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",[18,1707],{},"\n那它有三個假設",[796,1710,1711,1722,1742],{},[42,1712,1713,1714,1716,1717,1721],{},"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",[18,1715],{},"\n但在1979s有學者提出說，其實原始反射對於每個寶寶來說",[25,1718,1720],{"className":1719},[29],"變異性","也很大",[42,1723,1724,1725,1727,1728,1732,1733,1737,1738],{},"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",[18,1726],{},"\n但在1976s有學者發現到，南非的寶寶被家長",[25,1729,1731],{"className":1730},[28],"直立抱法或者練習坐","，會比美國寶寶",[25,1734,1736],{"className":1735},[29],"更快發展出下肢動作","，但",[25,1739,1741],{"className":1740},[810],"爬和翻身較慢",[42,1743,1744,1745,1747,1748,1752,1753,1757],{},"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)",[18,1746],{},"\n但在1988s有學者提出，寶寶的",[25,1749,1751],{"className":1750},[810],"伸手以及操作","的發展在近端遠端上是",[25,1754,1756],{"className":1755},[28,29],"同時存在","的(同步進行發展，並沒有明確上下關係)",[11,1759,1760,1761,1763,1764,1768,1769,1773,1775,1776,1780,1781,1783,1784,1788,1789,1793,1794,1798,1800,1801,1803],{},"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",[18,1762],{},"\n那協調就是將這些複雜的東西，透過",[25,1765,1767],{"className":1766},[29],"降低自由度","，來",[25,1770,1772],{"className":1771},[810],"產生平滑的動作",[18,1774],{},"\n那降低自由度的策略會牽涉到一個叫",[25,1777,1779],{"className":1778},[529],"自我組織","的東西，那它的核心理念是說",[18,1782],{},"\n動作是有",[25,1785,1787],{"className":1786},[529],"適應性","的，次系統會根據",[25,1790,1792],{"className":1791},[28,29],"環境任務","等因素做調整，",[25,1795,1797],{"className":1796},[810],"再拼湊起來",[18,1799],{},"\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）",[18,1802],{},"\n有提到三個重點",[796,1805,1806,1812,1828],{},[42,1807,1808,1809,1811],{},"次序參數——它探討的是關節之間的協同",[18,1810],{},"\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",[42,1813,1814,1815,1819,1820,1822,1823,1827],{},"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",[25,1816,1818],{"className":1817},[28,529],"最省力、自然以及方便","的動作型態",[18,1821],{},"\n那假如這個動作達到了上述說的型態，便是",[25,1824,1826],{"className":1825},[29,28],"最穩定型態","，即使會因應任務去做改變也是十分穩定的",[42,1829,1830,1831,1833,1834,1838,1839,1841,1842,1844],{},"相移現象——意思就是說原本在做著一個穩定的動作型態",[18,1832],{},"\n因為一些",[25,1835,1837],{"className":1836},[29],"因素所干擾","，就會變成另一個動作型態",[18,1840],{},"\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)",[18,1843],{},"\n（對 黃老師教動態系統理論也提到過這個）",[11,1846,1847],{},"最後講兩個實驗",[796,1849,1850,1872],{},[42,1851,1852,1853,1855,1856,1858,1859,1863,1864,1868,1869,1871],{},"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",[18,1854],{},"\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",[18,1857],{},"\n但動態模組理論發現，其實是因為在第四周寶寶",[25,1860,1862],{"className":1861},[28,29],"長脂肪比長肌肉快","，導致",[25,1865,1867],{"className":1866},[810],"力量不足","做不出來",[18,1870],{},"\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",[42,1873,1874,1875,1877,1878,1880,1881,1885],{},"第二個實驗，是觀察青蛙生長的環境與發育的關係",[18,1876],{},"\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",[18,1879],{},"\n所以神經成熟是可以讓動作型態形成，但必須得加上",[25,1882,1884],{"className":1883},[28,29],"環境，時間以及個體本身條件","才能讓型態表現更好",[11,1887,1888,1889,1891,1892,1894,1895,1897,1898,1900],{},"那在臨床意義上有以下幾點",[18,1890],{},"\n分散式控制(Distributed control)",[18,1893],{},"\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)",[18,1896],{},"\n由兒童主導(Active role of the child)",[18,1899],{},"\n個體差異的訊息(variability provides important information)",[11,1902,1903,1904,1908,1909,1913,1914,1916],{},"評估",[25,1905,1907],{"className":1906},[28,1553],"不應只侷限在探討神經發展過程","，而是要根據",[25,1910,1912],{"className":1911},[529,28],"多個系統，家庭因素","等問題",[18,1915],{},"\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":143,"searchDepth":144,"depth":144,"links":1918},[],"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":1454,"description":1920},{"loc":1924},"blog\u002FMotor-Learning","EmOKsVRjY6Fz-rmd5PiPG83wEP6j59SCfF75Y1WnFNU",{"id":1930,"title":1931,"author":6,"body":1932,"date":1921,"description":2155,"draft":148,"edited_at":2156,"extension":150,"featured_image":2157,"meta":2158,"navigation":153,"path":2159,"pinned":148,"seo":2160,"sitemap":2161,"stem":2162,"tags":158,"__hash__":2163},"blog\u002Fblog\u002FMotor-Learning小兒（二）.md","Motor Learning小兒（二）",{"type":8,"value":1933,"toc":2153},[1934,1937,1943,1952,1955,1989,1992],[11,1935,1936],{},"阿對的，又要來講動作學習的定義了，雖然之前就有講過",[11,1938,1939,1940,1942],{},"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)",[18,1941],{},"\n動作學習就是過程，而動作表現是動作做出來的結果。",[11,1944,1945,1946,1948,1949,1951],{},"而這邊講道Positive和Negative Sign",[18,1947],{},"\nPositive是指正常人沒有，但病人身上會出現的異常動作 ",[18,1950],{},"\nNegative則相反，正常人有的，但病人身上無法出現",[11,1953,1954],{},"對於動作學習有三大要素",[796,1956,1957,1960,1969],{},[42,1958,1959],{},"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",[42,1961,1962,1963,1965,1966,1968],{},"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",[18,1964],{},"\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",[18,1967],{},"\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",[42,1970,1971,1972,1976,1977,1979,1980,1984,1985],{},"對於目標的清淅程度——就是",[25,1973,1975],{"className":1974},[810],"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",[18,1978],{},"\n而任務",[25,1981,1983],{"className":1982},[29],"越具體","，更能",[25,1986,1988],{"className":1987},[29,28],"引導寶寶產生興趣",[11,1990,1991],{},"那動作學習有以下三個考量點",[796,1993,1994,2046,2092],{},[42,1995,1996,1997,2001,2002,2006,2007,1206,2014,2016,2017,2019,2020,2024,2025,2027,2028,2032,2033,2037,2038,2040,2041,2045],{},"轉移——意思是",[25,1998,2000],{"className":1999},[28,810],"相同相似的技巧","在不同情景下可以變化",[25,2003,2005],{"className":2004},[29,28],"產生新的","動作型態 (這裡也有說到 ",[2008,2009,2013],"a",{"href":2010,"rel":2011},"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",[2012],"nofollow","在最後一段",[18,2015],{},"\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",[18,2018],{},"\n所以我們可以借由",[25,2021,2023],{"className":2022},[810],"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",[18,2026],{},"\n也可以透過",[25,2029,2031],{"className":2030},[28,29],"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",[25,2034,2036],{"className":2035},[28],"加粗","的方式讓寶寶更好握住",[18,2039],{},"\n但記得靠轉移來學習新的動作型態",[25,2042,2044],{"className":2043},[28,29],"不能一下子改太多太難","參數",[42,2047,2048,2049,1003,2054,1129,2058,2060,2061,2065,2066,2068,2069,2073,2075,2076,2080,2081,2083,2084,2088,2089,2091],{},"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（",[2008,2050,2053],{"href":2051,"rel":2052},"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",[2012],"一",[2008,2055,2057],{"href":2010,"rel":2056},[2012],"二",[18,2059],{},"\n集中VS分散，分散休息時間更長，對",[25,2062,2064],{"className":2063},[28],"學習較難或易疲勞病人","來說更佳",[18,2067],{},"\n段落VS隨機，隨機較難，但通常對",[25,2070,2072],{"className":2071},[810,28],"形成長期記憶以記轉移效果更有",[18,2074],{},"\n固定VS變異，變異在",[25,2077,2079],{"className":2078},[29,28],"轉移效果上","更佳",[18,2082],{},"\n全部VS分段，分段有",[25,2085,2087],{"className":2086},[28,29],"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",[18,2090],{},"\n心像練習，在腦中模擬動作型態",[42,2093,2094,2095,1003,2099,1003,2103,1003,2108,1206,2113,2115,2116,2118,2119,2121,2122,1129,2126,2128,2129,2133,2134,2136,2137,2141,2142,2144,2145,2147,2148,2152],{},"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(",[2008,2096,2053],{"href":2097,"rel":2098},"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",[2012],[2008,2100,2057],{"href":2101,"rel":2102},"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",[2012],[2008,2104,2107],{"href":2105,"rel":2106},"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",[2012],"三",[2008,2109,2112],{"href":2110,"rel":2111},"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",[2012],"四",[18,2114],{},"\nKR與KP，KR效度比KP更佳",[18,2117],{},"\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",[18,2120],{},"\n（",[2008,2123,2125],{"href":2110,"rel":2124},[2012],"這裡第一段有提到",[18,2127],{},"\n回饋的方法，",[2008,2130,2132],{"href":2101,"rel":2131},[2012],"這一篇的後半段","有提到，可以再複習一下",[18,2135],{},"\n先設定一個",[25,2138,2140],{"className":2139},[810],"區間","，達到的都算得分",[18,2143],{},"\n回饋也可以做遞減，逐漸減少依賴",[18,2146],{},"\n假如病人",[25,2149,2151],{"className":2150},[29,28],"主動要求回饋","，我們再給予，也會更佳",{"title":143,"searchDepth":144,"depth":144,"links":2154},[],"Motor Learning定義~結束","2026-04-13","\u002Fimages\u002Fuploads\u002F1775875520542-37128694_p0_master1200.jpg",{},"\u002Fblog\u002FMotor-Learning小兒（二）",{"title":1931,"description":2155},{"loc":2159},"blog\u002FMotor-Learning小兒（二）","vCmIeebtfGfHQk7UoNr_yn1XC2gwpWX_B8fsdXmUsJc",{"id":2165,"title":2166,"author":6,"body":2167,"date":2366,"description":2367,"draft":148,"edited_at":2366,"extension":150,"featured_image":2368,"meta":2369,"navigation":153,"path":2370,"pinned":148,"seo":2371,"sitemap":2372,"stem":2373,"tags":158,"__hash__":2374},"blog\u002Fblog\u002FGait-analysis小兒（一）.md","Gait analysis小兒（一）",{"type":8,"value":2168,"toc":2364},[2169,2172,2175,2192,2195,2206,2209,2226,2252,2258,2261,2278,2287,2298,2313,2319,2347,2350],[11,2170,2171],{},"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",[11,2173,2174],{},"那下肢雙關節肌肉有以下",[796,2176,2177,2180,2183,2186,2189],{},[42,2178,2179],{},"腰大肌——Hip Flexion, Trunk Flexion",[42,2181,2182],{},"腿後肌——Hip Extension, Knee Flexion",[42,2184,2185],{},"股直肌——Hip Flexion, Knee Extension",[42,2187,2188],{},"腓腸肌——Knee Flexion, PF",[42,2190,2191],{},"縫匠肌——Hip Flexion, Hip ER",[11,2193,2194],{},"那單關節的肌肉有",[796,2196,2197,2200,2203],{},[42,2198,2199],{},"臀大肌——Hip Extension, Hip ER",[42,2201,2202],{},"脛前肌——DF, inversion",[42,2204,2205],{},"腓骨長肌——PF, eversion",[11,2207,2208],{},"那以下動作的抗重力與無抗重力的擺位姿勢為",[796,2210,2211,2214,2217,2220,2223],{},[42,2212,2213],{},"Hip Extension——Prone 抗重力, side-lying 無抗重力",[42,2215,2216],{},"Hip Flexion——Sitting 抗重力, side-lying 無抗重力",[42,2218,2219],{},"Hip Abduction——Side-lying 抗重力, supine 無抗重力",[42,2221,2222],{},"Knee Extension——Sitting 抗重力, side-lying 無抗重力",[42,2224,2225],{},"PF——Standing 抗重力, prone 無抗重力",[11,2227,2228,2229,2231,2232,2236,2237,2241,2243,2244,2246,2247,2251],{},"接下來講一個異常步態——Crouch gait",[18,2230],{},"\n為甚麼他會呈現屈曲狀態，主要是因為",[25,2233,2235],{"className":2234},[28,29],"雙關節肌肉張力過強","，而",[25,2238,2240],{"className":2239},[28,810],"單關節肌肉力量不足",[18,2242],{},"\n不是單純的肌肉太緊，也是一種肌力失衡的表現",[18,2245],{},"\n其中，在",[25,2248,2250],{"className":2249},[28],"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)",[11,2253,2254,2255,2257],{},"接著來講步態的參數",[18,2256],{},"\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)",[11,2259,2260],{},"這邊提到一個中風後會出現的代償步態",[39,2262,2263,2266,2269,2272,2275],{},[42,2264,2265],{},"步速下降",[42,2267,2268],{},"步距縮短或不對稱",[42,2270,2271],{},"步寬變大(BOS增加)",[42,2273,2274],{},"雙腳站立期變長",[42,2276,2277],{},"依賴手部支撐",[11,2279,2280,2281,2283,2284,2286],{},"接著講Gait cycle，分別為站立期以及擺盪期",[18,2282],{},"\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",[18,2285],{},"\n完成這三個任務又分成了這八個動作",[796,2288,2289,2292,2295],{},[42,2290,2291],{},"承重——Initial contact和Loading Response",[42,2293,2294],{},"單腳支撐——Mid-stance, Terminal Stance和Pre-swing",[42,2296,2297],{},"肢體向前——Pre-swing, Initial swing, Mid-swing和Terminal Swing",[11,2299,2300,2301,2305,2306,2308,2309],{},"而Pre-swing雖然腳尖還沒離地，但",[25,2302,2304],{"className":2303},[28,810],"重心其實已經轉移去另一隻腳","了",[18,2307],{},"\n其中 ",[25,2310,2312],{"className":2311},[28],"Initial contact和Pre-swing為雙腳承重期",[11,2314,2315,2316,2318],{},"我們現在攤開來看站立期和擺盪期下肢各關節變化",[18,2317],{},"\n首先是站立期",[796,2320,2321,2329,2332,2338,2344],{},[42,2322,2323,2324,2328],{},"在雙腳承重期，",[25,2325,2327],{"className":2326},[28,810],"足部會放平","，準備Push Off",[42,2330,2331],{},"Hip的話，在Initical Contact的Flexion到Terminal Stance的Hyperextension",[42,2333,2334,2335,2337],{},"Knee的話，會從Flexion姿勢，到Mid-stance的Extension，再變回Pre-swing的Flexion",[18,2336],{},"\n(Flexion>Extension>Flexion)",[42,2339,2340,2341,2343],{},"Ankle的話，在Initical Contact的Neutral姿勢，Loading Response的PF，",[18,2342],{},"\nMid-stance的DF，最後是Terminal Stance\u002FPre-swing的PF（Neutral>PF>DF>PF）",[42,2345,2346],{},"Pelvis的話，基本保持水平，但在Terminal stance會略微前傾",[11,2348,2349],{},"然後是擺盪期",[796,2351,2352,2355,2358,2361],{},[42,2353,2354],{},"Knee的話，在Initical swing時會呈現Flexion，在Terminal swing會Full-extension",[42,2356,2357],{},"Hip的話，從Initical swing的Hyperextension，在Terminal swing會變成Flexion",[42,2359,2360],{},"Ankle的話，保持DF狀態，使腳尖不會碰到地板",[42,2362,2363],{},"Pelvis的話，會Rotation",{"title":143,"searchDepth":144,"depth":144,"links":2365},[],"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":2166,"description":2367},{"loc":2370},"blog\u002FGait-analysis小兒（一）","twQeon3uGQlDYDjG3t_oGlDC93CraJNGOOTRTTxdazk",{"id":2376,"title":2377,"author":6,"body":2378,"date":2366,"description":2566,"draft":148,"edited_at":2366,"extension":150,"featured_image":2567,"meta":2568,"navigation":153,"path":2569,"pinned":148,"seo":2570,"sitemap":2571,"stem":2572,"tags":158,"__hash__":2573},"blog\u002Fblog\u002FGait-analysis小兒（二）.md","Gait analysis小兒（二）",{"type":8,"value":2379,"toc":2564},[2380,2383,2497,2500,2535,2547,2553],[11,2381,2382],{},"現在我們將八個步態分期拆開了細看",[796,2384,2385,2409,2423,2441,2451,2472,2491,2494],{},[42,2386,2387,2388,2392,2396,2397,2401,2405,2406,2408],{},"Initical Contact——用",[25,2389,2391],{"className":2390},[28],"股四頭肌和脛前肌做",[25,2393,2395],{"className":2394},[28,29],"離心收縮","，這時",[25,2398,2400],{"className":2399},[28],"腿後肌做",[25,2402,2404],{"className":2403},[28,810],"向心收縮","協同加速穩定",[18,2407],{},"\n（減速與準備承重）",[42,2410,2411,2412,2416,2419,2420,2422],{},"Loading Response——",[25,2413,2415],{"className":2414},[28],"肌內側肌與脛前肌做",[25,2417,2395],{"className":2418},[28,29],"，而臀大肌以及腿後肌輔助Hip加速，將重心向前移動",[18,2421],{},"\n（避震）",[42,2424,2425,2426,2236,2430,2434,2437,2438,2440],{},"Mid-stance——膝蓋後方有關節囊結構的緣故，肌四頭肌幾乎",[25,2427,2429],{"className":2428},[810],"不需用力",[25,2431,2433],{"className":2432},[28],"比目魚肌此時做",[25,2435,2395],{"className":2436},[28,29],"控制脛骨速度",[18,2439],{},"\n（省力）",[42,2442,2443,2444,2448,2450],{},"Terminal stance——",[25,2445,2447],{"className":2446},[28,810],"腓腸肌與比目魚肌做向心收縮",[18,2449],{},"\n（產生推進力）",[42,2452,2453,2454,2458,1003,2461,2463,2464,2468],{},"Pre-swing——假如是慢速走路，會利用",[25,2455,2457],{"className":2456},[28],"縫匠肌(Sartorius)和肌薄肌(Graillis)做",[25,2459,2404],{"className":2460},[28,810],[18,2462],{},"\n快速行走則靠",[25,2465,2467],{"className":2466},[28],"肌直肌做",[25,2469,2471],{"className":2470},[28,890],"等長收縮",[42,2473,2474,2475,2479,2482,2484,2485,2488],{},"Initial swing——在慢速走路中，",[25,2476,2478],{"className":2477},[28],"股薄肌與縫匠肌會進行",[25,2480,2404],{"className":2481},[28,810],[18,2483],{},"\n而快速走路中，",[25,2486,2467],{"className":2487},[28],[25,2489,2471],{"className":2490},[28,890],[42,2492,2493],{},"Mid swing——靠慣性推進，基本沒有肌肉參與",[42,2495,2496],{},"Terminal swing——腿後肌做等長收縮，限制Knee extension速度",[11,2498,2499],{},"接著來講小腿後肌群無力的話會有甚麼問題",[39,2501,2502,2512],{},[42,2503,2504,2505,1003,2509,2511],{},"Mid-stannce——比目魚肌無力的話，會讓",[25,2506,2508],{"className":2507},[29,28],"Ankle做DF",[18,2510],{},"\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",[42,2513,2514,2515,2519,2521,2522,2526,2527,1863,2531],{},"Terminal stance和Pre-swing——腓腸肌力量不足的話，",[25,2516,2518],{"className":2517},[28,29],"沒辦法產生足夠的推進力",[18,2520],{},"\n只好讓",[25,2523,2525],{"className":2524},[29,28],"髖屈肌收縮","提起整段下肢，確保",[25,2528,2530],{"className":2529},[810],"腳尖離地",[25,2532,2534],{"className":2533},[529],"步距變短",[11,2536,2537,2538,2540,2541,2543,2544,2546],{},"最後講小孩的步態發展過程",[18,2539],{},"\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",[18,2542],{},"\n2歲的小孩懂得矢狀面(Sagittal-plane)關節旋轉",[18,2545],{},"\n7歲的小孩步態已經能達到成人標準了",[11,2548,2549,2550,2552],{},"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",[18,2551],{},"\n那CP小孩預測能力方面也分成了三個時段",[796,2554,2555,2558,2561],{},[42,2556,2557],{},"9~18個月——頭部控制能力",[42,2559,2560],{},"24個月——不需要支撐能獨自坐穩",[42,2562,2563],{},"30個月——做爬行",{"title":143,"searchDepth":144,"depth":144,"links":2565},[],"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":2377,"description":2566},{"loc":2569},"blog\u002FGait-analysis小兒（二）","x7y-Smp4poLa_EJUkNUpEi-ow03rff_xJb4B-xlHN1k",{"id":2575,"title":216,"author":6,"body":2576,"date":2366,"description":2720,"draft":148,"edited_at":2721,"extension":150,"featured_image":2722,"meta":2723,"navigation":153,"path":2724,"pinned":148,"seo":2725,"sitemap":2726,"stem":2727,"tags":158,"__hash__":2728},"blog\u002Fblog\u002F小兒發展（一）.md",{"type":8,"value":2577,"toc":2718},[2578,2581,2596,2602,2605,2631,2640,2642,2645,2662,2664,2667],[11,2579,2580],{},"（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）",[11,2582,2583,2584,2586,2587,2589,2590,2592,2593,2595],{},"那先來講發展遲緩的定義，它不單指運動層面上，還包括了",[18,2585],{},"\n知覺，語言，心理，社會，情緒等層面",[18,2588],{},"\n而這個動作遲緩有標準的",[18,2591],{},"\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",[18,2594],{},"\n根據WHO的數據，發生率為6~8%",[11,2597,2598,2599,2601],{},"那高危族群有以下",[18,2600],{},"\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",[11,2603,2604],{},"接下來講寶寶的正常發育過程，先從視角說起，如下",[796,2606,2607,2610,2613,2616,2619,2622,2625,2628],{},[42,2608,2609],{},"剛出生數天——眨眼反射",[42,2611,2612],{},"六周——注射物體",[42,2614,2615],{},"二到三個月——對明亮的東西感興趣",[42,2617,2618],{},"四個月——協調眼球轉動",[42,2620,2621],{},"一歲——影像認知發展完成，能看清輪廓",[42,2623,2624],{},"三歲——能分辨紅黃藍綠",[42,2626,2627],{},"五到六歲——可以分辨大多數顏色",[42,2629,2630],{},"八歲以前——有遠視現象（我問了Gemini也看不太懂就是了）",[11,2632,2633,2634,2636,2637,2639],{},"那關於視覺發展異常的問題包括了",[18,2635],{},"\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",[18,2638],{},"\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",[825,2641],{},[11,2643,2644],{},"接著是聽覺發展，如下",[796,2646,2647,2650,2653,2656,2659],{},[42,2648,2649],{},"四個月——追尋聲音或說話來源",[42,2651,2652],{},"七到八個月——被叫名字有反應",[42,2654,2655],{},"十個月——仿說（無意義內容）",[42,2657,2658],{},"一到一歲半——初步聽懂簡單的話",[42,2660,2661],{},"兩歲以後——鸚鵡式學說話",[825,2663],{},[11,2665,2666],{},"接下來是粗大動作的發展，如下",[796,2668,2669,2672,2675,2678,2681,2684,2687,2690,2693,2701,2709,2712,2715],{},[42,2670,2671],{},"兩個月——不穩定的抬頭控制",[42,2673,2674],{},"四個月——抬頭控制適當",[42,2676,2677],{},"五個月——翻身（先學會Prone to supine, 接著是supine to prone）",[42,2679,2680],{},"七個月——坐起來",[42,2682,2683],{},"八個月——爬行",[42,2685,2686],{},"九個月——需要支撐的站起來",[42,2688,2689],{},"十個月——僅需要極小輔助的從坐到站",[42,2691,2692],{},"一歲——獨立行走",[42,2694,2695,2696,2700],{},"兩歲——跑，",[25,2697,2699],{"className":2698},[810],"上樓梯","，踢球，投球，蹲下來",[42,2702,2703,2704,2708],{},"三歲——",[25,2705,2707],{"className":2706},[29],"下樓梯","，雙腳跳，騎三輪車",[42,2710,2711],{},"四歲——單腳跳",[42,2713,2714],{},"五歲——走直線",[42,2716,2717],{},"六歲——騎腳踏車",{"title":143,"searchDepth":144,"depth":144,"links":2719},[],"定義~粗大動作發展","2026-04-12","\u002Fimages\u002Fuploads\u002F1775957410970-EebbBUPUcAYSTE9.webp",{},"\u002Fblog\u002F小兒發展（一）",{"title":216,"description":2720},{"loc":2724},"blog\u002F小兒發展（一）","PRBPkkWsOaM11PriYRM9bPFgTo_bGZSIOZZuLMzA1sk",{"id":2730,"title":217,"author":6,"body":2731,"date":2721,"description":2883,"draft":148,"edited_at":2721,"extension":150,"featured_image":2884,"meta":2885,"navigation":153,"path":2886,"pinned":148,"seo":2887,"sitemap":2888,"stem":2889,"tags":158,"__hash__":2890},"blog\u002Fblog\u002F小兒發展（二）.md",{"type":8,"value":2732,"toc":2881},[2733,2736,2753,2755,2758,2786,2788,2791,2817,2819,2822,2836,2838,2841,2855,2857,2860,2868,2870,2873],[11,2734,2735],{},"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",[796,2737,2738,2741,2744,2747,2750],{},[42,2739,2740],{},"新生兒——中度的膝內翻（O型腿）",[42,2742,2743],{},"六個月——輕度的O型腿",[42,2745,2746],{},"一歲半——直的",[42,2748,2749],{},"三歲半——輕度的膝外翻（X型腿）",[42,2751,2752],{},"五到七歲——直的",[825,2754],{},[11,2756,2757],{},"而步態的發展會按照以下時期發展",[796,2759,2760,2763,2771,2774,2777,2780,2783],{},[42,2761,2762],{},"反射踏步（靠反射）",[42,2764,2765,2766,1129],{},"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—— ",[2008,2767,2770],{"href":2768,"rel":2769},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002Fmotor-learning?series=%E5%B0%8F%E5%85%92%E7%89%A9%E6%B2%BB",[2012],"倒數第二段",[42,2772,2773],{},"過渡期",[42,2775,2776],{},"刻意跨步",[42,2778,2779],{},"獨立行走",[42,2781,2782],{},"Heell-toe步態",[42,2784,2785],{},"整合或直立行走成熟期",[825,2787],{},[11,2789,2790],{},"接著來看不同系統的發展進程，從出生至九個月",[39,2792,2793,2799,2805,2811],{},[42,2794,2795,2796,2798],{},"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）",[18,2797],{},"\n尤其是視覺發展遠大於粗大動作",[42,2800,2801,2802,2804],{},"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",[18,2803],{},"\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",[42,2806,2807,2808,2810],{},"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)",[18,2809],{},"\nHip abduction(訓練方法是扶物側行)",[42,2812,2813,2814,2816],{},"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",[18,2815],{},"\n步寬外展；外轉(O型腿)；髖屈曲；足跟外翻",[825,2818],{},[11,2820,2821],{},"時間來到了九個月到第十五個月之間的發展進程",[796,2823,2824,2827,2830],{},[42,2825,2826],{},"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)",[42,2828,2829],{},"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",[42,2831,2832,2833,2835],{},"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",[18,2834],{},"\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",[825,2837],{},[11,2839,2840],{},"接下來時間來到了十八個月到二十四個月的發展進程",[796,2842,2843,2849],{},[42,2844,2845,2846,2848],{},"力學因素——重心下降(由於腿快速生長)，BOS減少",[18,2847],{},"\nROM的話O型腿消失，但有旋前足出現",[42,2850,2851,2852,2854],{},"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；",[18,2853],{},"\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)",[825,2856],{},[11,2858,2859],{},"時間繼續來到了三歲到三歲半的發展進程",[796,2861,2862,2865],{},[42,2863,2864],{},"力學因素——ROM的話膝外翻(X型腿)，且有旋前足出現",[42,2866,2867],{},"功能性步態——足跟著地穩定，且出現Knee flexion",[825,2869],{},[11,2871,2872],{},"最後時間來到了六歲到七歲的發展進程",[796,2874,2875,2878],{},[42,2876,2877],{},"力學因素——已經能直立行走，並且不在有旋前足",[42,2879,2880],{},"功能性步態——與成人一樣",{"title":143,"searchDepth":144,"depth":144,"links":2882},[],"步態~步態發展","\u002Fimages\u002Fuploads\u002F1775979234822-139196433_p0_master1200.webp",{},"\u002Fblog\u002F小兒發展（二）",{"title":217,"description":2883},{"loc":2886},"blog\u002F小兒發展（二）","tgAyAngzwVGZGqD2GsTT7J1O1RchC3cKRE-f381-bqo",{"id":2892,"title":218,"author":6,"body":2893,"date":2721,"description":3117,"draft":148,"edited_at":2156,"extension":150,"featured_image":3118,"meta":3119,"navigation":153,"path":3120,"pinned":148,"seo":3121,"sitemap":3122,"stem":3123,"tags":158,"__hash__":3124},"blog\u002Fblog\u002F小兒發展（三）.md",{"type":8,"value":2894,"toc":3115},[2895,2898,2901,2930,2932,2935,2952,2954,2957,2983,2985,2988,3021,3027,3046,3052,3078,3081,3084,3107,3110],[11,2896,2897],{},"寫著寫著發現這一課東西好多（悲",[11,2899,2900],{},"接著講精細動作的發展過程",[796,2902,2903,2906,2909,2912,2915,2918,2921,2924,2927],{},[42,2904,2905],{},"四個月——可以合掌",[42,2907,2908],{},"五個月——手可以向前伸並抓東西",[42,2910,2911],{},"七個月——握緊奶瓶",[42,2913,2914],{},"十個月——拍手",[42,2916,2917],{},"一歲——亂塗鴉",[42,2919,2920],{},"一歲半——疊兩到四個積木",[42,2922,2923],{},"兩歲——疊四到八個積木；畫直線",[42,2925,2926],{},"三歲——畫圓圈",[42,2928,2929],{},"五歲——畫出人形",[825,2931],{},[11,2933,2934],{},"假如有發展遲緩的問題，會有以下徵候",[39,2936,2937,2940,2943,2946,2949],{},[42,2938,2939],{},"以翻身作為移動方式",[42,2941,2942],{},"手腳不協調的爬行方式",[42,2944,2945],{},"W坐姿",[42,2947,2948],{},"兔子跳",[42,2950,2951],{},"一歲前出現明顯慣用手(因為一歲前大多為雙手並用)",[825,2953],{},[11,2955,2956],{},"而寶寶出現以下徵候，可能他有CP問題",[39,2958,2959,2962,2965,2968,2971,2974,2977,2980],{},[42,2960,2961],{},"躁動",[42,2963,2964],{},"缺乏精力",[42,2966,2967],{},"吸吮無力伴隨舌頭往前突",[42,2969,2970],{},"六個月大頭部控制不佳",[42,2972,2973],{},"口腔過度敏感",[42,2975,2976],{},"強直性咬合反射",[42,2978,2979],{},"不對稱動作形態",[42,2981,2982],{},"異常姿勢",[825,2984],{},[11,2986,2987],{},"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",[11,2989,2990,2991,2993,2994,2998,2999,3003,3005,3006,3010,3011,3015,3016,3020],{},"首先是語言準備期，分成了表達跟理解兩個面向",[18,2992],{},"\n這時候寶寶還小，表達還只能靠",[25,2995,2997],{"className":2996},[28],"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",[25,3000,3002],{"className":3001},[28],"學身邊的人咿咿呀呀",[18,3004],{},"\n而這個時候",[25,3007,3009],{"className":3008},[28,810],"理解能力比表達能力還要發展得快","，知覺部份開始分得出",[25,3012,3014],{"className":3013},[810],"語氣快慢聲源","等，也能",[25,3017,3019],{"className":3018},[810],"理解一些簡單的短語","例如yes or no等",[11,3022,3023,3024,3026],{},"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",[18,3025],{},"\n而語法構造則分為以下部份",[39,3028,3029,3037],{},[42,3030,3031,3032,3036],{},"句子表達能力——分成剛開始學的不完整句子，",[25,3033,3035],{"className":3034},[28,810],"只講關鍵的詞","；和發展到後面的會講完整句子",[42,3038,3039,3040,3042,3043,3045],{},"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",[18,3041],{},"\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",[18,3044],{},"\n最後也能理解對哪個人說甚麼樣的話",[11,3047,3048,3049,3051],{},"然後講一下正常語言發展能力，雖然跟聽覺有部份重合，",[18,3050],{},"\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(?)",[796,3053,3054,3057,3060,3063,3066,3069,3072,3075],{},[42,3055,3056],{},"四個月——頭尋找聲源",[42,3058,3059],{},"六到七個月——仿說",[42,3061,3062],{},"九到十二個月——叫爸爸媽媽",[42,3064,3065],{},"一歲到一歲半——只會講一兩個字且沒有意義",[42,3067,3068],{},"兩歲到兩歲半——講片語（例如像鸚鵡般學大人說啥）",[42,3070,3071],{},"三歲——開始能講句子，講顏色，倒數十，說出身體部位",[42,3073,3074],{},"四歲——能說出數種顏色",[42,3076,3077],{},"五歲——計算五個積木",[11,3079,3080],{},"(所以看起來三歲已經具備認知能力?)",[11,3082,3083],{},"那假如語言發展異常會有以下徵象",[39,3085,3086,3089,3092,3095,3098,3101,3104],{},[42,3087,3088],{},"一歲前——太安靜",[42,3090,3091],{},"兩歲——還沒有出現有意思的字詞",[42,3093,3094],{},"三歲——沒有出現任何句子",[42,3096,3097],{},"四歲——有構音困難",[42,3099,3100],{},"五歲——說話結巴",[42,3102,3103],{},"年紀越大話越少",[42,3105,3106],{},"鼻音重，說話小聲，不當的臉部表情，說話會喘",[11,3108,3109],{},"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",[11,3111,3112],{},[754,3113],{"alt":756,"src":3114},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1776047406679-Screenshot_2026-04-13_102943.png",{"title":143,"searchDepth":144,"depth":144,"links":3116},[],"精細動作~語言發展","\u002Fimages\u002Fuploads\u002F1776047258825-ElqW51yVoAI09Jg.webp",{},"\u002Fblog\u002F小兒發展（三）",{"title":218,"description":3117},{"loc":3120},"blog\u002F小兒發展（三）","cGrD26dwyUjVzawlHZHH_OnTqXRpbSPGvcZEZluSbRk",{"id":3126,"title":219,"author":6,"body":3127,"date":2156,"description":3270,"draft":148,"edited_at":2156,"extension":150,"featured_image":3271,"meta":3272,"navigation":153,"path":3273,"pinned":148,"seo":3274,"sitemap":3275,"stem":3276,"tags":158,"__hash__":3277},"blog\u002Fblog\u002F小兒發展（四）.md",{"type":8,"value":3128,"toc":3268},[3129,3132,3155,3157,3160,3186,3188,3191,3211,3213,3216,3230,3232,3235,3249,3251,3254],[11,3130,3131],{},"接下來講到括約肌控制發展（大小便控制）",[796,3133,3134,3137,3146,3152],{},[42,3135,3136],{},"十五個月——能告訴爸媽想上廁所或者褲子濕了",[42,3138,3139,3140,3142,3143,3145],{},"十八個月——白天褲子不太會濕，當然也有意外；",[18,3141],{},"\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；",[18,3144],{},"\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",[42,3147,3148,3149,3151],{},"兩到三歲——半夜讓小孩上廁所就整晚不會尿床",[18,3150],{},"\n有研究表明，晚上會叫尿床的都比較神經質(講義原句XD)",[42,3153,3154],{},"三歲——能自己上廁所但擦不乾淨，要到六歲才能擦乾淨",[825,3156],{},[11,3158,3159],{},"接著講ADL的發展",[796,3161,3162,3165,3168,3174,3177,3180,3183],{},[42,3163,3164],{},"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",[42,3166,3167],{},"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",[42,3169,3170,3171,3173],{},"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；",[18,3172],{},"\n也開始可以脫襪子和鞋子",[42,3175,3176],{},"十八個月——會脫襪子鞋子，將拉鏈拉開，不需要轉動湯匙進食",[42,3178,3179],{},"兩歲——可以穿脫襪子鞋子褲子",[42,3181,3182],{},"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",[42,3184,3185],{},"五歲——會綁鞋子",[825,3187],{},[11,3189,3190],{},"社會性情緒發展部份",[796,3192,3193,3196,3202,3205,3208],{},[42,3194,3195],{},"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",[42,3197,3198,3199,3201],{},"六到十二個月——十分依賴，認得且會得媽媽",[18,3200],{},"\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",[42,3203,3204],{},"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",[42,3206,3207],{},"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",[42,3209,3210],{},"二十四到三十六個月——越來越適應陌生環境，上托兒所",[825,3212],{},[11,3214,3215],{},"自我概念發展部份",[796,3217,3218,3221,3224,3227],{},[42,3219,3220],{},"剛出生到六個月——動作控制不佳；稍微分得出自我跟非自我",[42,3222,3223],{},"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",[42,3225,3226],{},"十八到二十四個月——對自己名字敏感",[42,3228,3229],{},"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",[825,3231],{},[11,3233,3234],{},"情緒發展部份",[796,3236,3237,3240,3243,3246],{},[42,3238,3239],{},"剛出生到六個月——早期只有哭跟高興表情",[42,3241,3242],{},"六到十二個月——開始有其他情緒例如厭惡，害怕，憤怒",[42,3244,3245],{},"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",[42,3247,3248],{},"十八到二十四個月——能夠用語言表達情緒",[825,3250],{},[11,3252,3253],{},"依賴及獨立發展",[796,3255,3256,3259,3262],{},[42,3257,3258],{},"剛出生到十二個月——完全依賴照顧",[42,3260,3261],{},"十二到十八個月——知道自己是個體後，想自我尋求",[42,3263,3264,3265,3267],{},"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；",[18,3266],{},"\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":143,"searchDepth":144,"depth":144,"links":3269},[],"括約肌控制~依賴獨立發展","\u002Fimages\u002Fuploads\u002F1776052282656-EXjYORHUcAALULe.webp",{},"\u002Fblog\u002F小兒發展（四）",{"title":219,"description":3270},{"loc":3273},"blog\u002F小兒發展（四）","iCO6Xr2Vz0v9l6ulRBKlWBt93Dzu8k8I4HDGsX-Dbpc",{"id":3279,"title":220,"author":6,"body":3280,"date":954,"description":3420,"draft":148,"edited_at":954,"extension":150,"featured_image":3421,"meta":3422,"navigation":153,"path":3423,"pinned":148,"seo":3424,"sitemap":3425,"stem":3426,"tags":158,"__hash__":3427},"blog\u002Fblog\u002F小兒發展（五）.md",{"type":8,"value":3281,"toc":3418},[3282,3288,3302,3305,3325,3327,3330,3359,3361,3364,3384,3386,3389],[11,3283,3284,3285,3287],{},"接下來講到一個叫皮亞傑的人，他提出了發展理論",[18,3286],{},"\n先來講他說的四大認知階段",[796,3289,3290,3293,3296,3299],{},[42,3291,3292],{},"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",[42,3294,3295],{},"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）",[42,3297,3298],{},"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",[42,3300,3301],{},"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",[11,3303,3304],{},"接著是他提到的感覺運動期",[796,3306,3307,3310,3313,3316,3319,3322],{},[42,3308,3309],{},"反射期(0-2m)——對，就一堆反射",[42,3311,3312],{},"初級循環反應期(3-5m)——摸索自己身體",[42,3314,3315],{},"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）",[42,3317,3318],{},"兩個基模協調(9-12m)——透過兩種動作模式達成目的；理解因果",[42,3320,3321],{},"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",[42,3323,3324],{},"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",[825,3326],{},[11,3328,3329],{},"然後是個人與社會發展",[796,3331,3332,3335,3338,3341,3344,3347,3350,3353,3356],{},[42,3333,3334],{},"兩個月——會對別人笑",[42,3336,3337],{},"六個月——自己拿玩具玩",[42,3339,3340],{},"六到八個月——開始理解陌生，不讓陌生人抱",[42,3342,3343],{},"十個月——搖手bye bye（maybe是已經將動作與語言結合?）",[42,3345,3346],{},"一歲——拿杯子喝水",[42,3348,3349],{},"十五個月——拿湯匙、脫下外套、學刷牙",[42,3351,3352],{},"兩歲——會洗手",[42,3354,3355],{},"三歲——會穿脫鞋",[42,3357,3358],{},"四歲——穿衣服，扣鈕扣，刷牙",[825,3360],{},[11,3362,3363],{},"接下來講ASD的臨床徵象（即使動作發展正常，也會有語言delay）",[796,3365,3366,3369,3372,3375,3378,3381],{},[42,3367,3368],{},"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",[42,3370,3371],{},"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",[42,3373,3374],{},"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",[42,3376,3377],{},"注意力不集中——無法持久學習",[42,3379,3380],{},"衝動——人際關係緊張",[42,3382,3383],{},"好動——無法遵守規矩，破壞力強",[825,3385],{},[11,3387,3388],{},"吞嚥異常的臨床徵象",[796,3390,3391,3394,3397,3400,3403,3406,3409,3412,3415],{},[42,3392,3393],{},"反覆性肺炎",[42,3395,3396],{},"營養不良",[42,3398,3399],{},"抗拒食物",[42,3401,3402],{},"吞嚥困難",[42,3404,3405],{},"口中有異物感",[42,3407,3408],{},"嗆咳",[42,3410,3411],{},"口中有異味",[42,3413,3414],{},"經營嘔吐",[42,3416,3417],{},"流口水",{"title":143,"searchDepth":144,"depth":144,"links":3419},[],"皮亞傑~結束","\u002Fimages\u002Fuploads\u002F1776132158232-tHG70Gg.webp",{},"\u002Fblog\u002F小兒發展（五）",{"title":220,"description":3420},{"loc":3423},"blog\u002F小兒發展（五）","hzbfl2qpxvvTUq5Hn8aXvAKEpMa7oP19s8AD5xnz-1Q",{"id":3429,"title":221,"author":6,"body":3430,"date":3773,"description":3774,"draft":148,"edited_at":3773,"extension":150,"featured_image":3775,"meta":3776,"navigation":153,"path":3777,"pinned":148,"seo":3778,"sitemap":3779,"stem":3780,"tags":158,"__hash__":3781},"blog\u002Fblog\u002FGMFCS.md",{"type":8,"value":3431,"toc":3771},[3432,3435,3438,3455,3598,3601,3627,3629,3632,3649,3651,3654,3674,3676,3679,3699,3701,3704,3720,3722,3725,3742,3744,3747,3766,3768],[11,3433,3434],{},"寫完繼續趕神經 不然我會發神經",[11,3436,3437],{},"GMFCS分級定義",[796,3439,3440,3443,3446,3449,3452],{},[42,3441,3442],{},"一級——行走不受限",[42,3444,3445],{},"二級——行走受限",[42,3447,3448],{},"三級——使用手持輔具",[42,3450,3451],{},"四級——需要電動輪椅",[42,3453,3454],{},"五級——需要別人手推輪椅",[3456,3457,3458,3485],"table",{},[3459,3460,3461],"thead",{},[3462,3463,3464,3470,3473,3476,3479,3482],"tr",{},[3465,3466,3468],"th",{"align":3467},"left",[18,3469],{},[3465,3471,3472],{"align":3467},"0-2y",[3465,3474,3475],{"align":3467},"2-4y",[3465,3477,3478],{"align":3467},"4-6y",[3465,3480,3481],{"align":3467},"6-12y",[3465,3483,3484],{"align":3467},"12-18y",[3486,3487,3488,3512,3535,3558,3576],"tbody",{},[3462,3489,3490,3494,3497,3500,3504,3508],{},[3491,3492,3493],"td",{"align":3467},"I",[3491,3495,3496],{"align":3467},"1. Sitting free on the floor            2. Crawl on hands and knee 3. Pull to stand  4. Takes few step with support",[3491,3498,3499],{"align":3467},"Independent walking without assistance",[3491,3501,3502],{"align":3467},[18,3503],{},[3491,3505,3506],{"align":3467},[18,3507],{},[3491,3509,3510],{"align":3467},[18,3511],{},[3462,3513,3514,3517,3520,3523,3527,3531],{},[3491,3515,3516],{"align":3467},"II",[3491,3518,3519],{"align":3467},"1. Sitting may need support   2. Creep on stomach",[3491,3521,3522],{"align":3467},"but sitting with support",[3491,3524,3525],{"align":3467},[18,3526],{},[3491,3528,3529],{"align":3467},[18,3530],{},[3491,3532,3533],{"align":3467},[18,3534],{},[3462,3536,3537,3540,3543,3546,3550,3554],{},[3491,3538,3539],{"align":3467},"III",[3491,3541,3542],{"align":3467},"1. Low back supported        2. Roll or creep on stomach",[3491,3544,3545],{"align":3467},"1. W-sitting      2. Creep or crawl                3. Walking with walker indoor",[3491,3547,3548],{"align":3467},[18,3549],{},[3491,3551,3552],{"align":3467},[18,3553],{},[3491,3555,3556],{"align":3467},[18,3557],{},[3462,3559,3560,3563,3566,3569,3572,3574],{},[3491,3561,3562],{"align":3467},"IV",[3491,3564,3565],{"align":3467},"1. Head control  2. Roll to supine; may roll to prone",[3491,3567,3568],{"align":3467},"1. Sitting with support (cannot maintain in good alignment) 2. Roll or creep or crawl without reciprocal movements",[3491,3570,3571],{"align":3467},"Self mobility with powered W\u002FC",[3491,3573,3571],{"align":3467},[3491,3575,3571],{"align":3467},[3462,3577,3578,3581,3584,3586,3590,3594],{},[3491,3579,3580],{"align":3467},"V",[3491,3582,3583],{"align":3467},"Unable maintain antigravity head control",[3491,3585,3583],{"align":3467},[3491,3587,3588],{"align":3467},[18,3589],{},[3491,3591,3592],{"align":3467},[18,3593],{},[3491,3595,3596],{"align":3467},[18,3597],{},[11,3599,3600],{},"接著是操作的部份",[39,3602,3603,3606,3609,3612,3615,3618,3621,3624],{},[42,3604,3605],{},"軀幹支持行助行器——可以支撐pelvis trunk",[42,3607,3608],{},"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",[42,3610,3611],{},"肢體協助——需要別人協助移動",[42,3613,3614],{},"電動移動輔助——電動輪椅，代步車，等",[42,3616,3617],{},"手動輪椅自推——自己推",[42,3619,3620],{},"被動運送——被人推",[42,3622,3623],{},"行走——可以帶矯具但不能用輔具",[42,3625,3626],{},"輪式移動工具——包括電動輪椅，手動輪椅還有推車",[825,3628],{},[11,3630,3631],{},"兩歲前",[39,3633,3634,3637,3640,3643,3646],{},[42,3635,3636],{},"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",[42,3638,3639],{},"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",[42,3641,3642],{},"三級——下背部被支撐才能坐穩；會翻身、腹貼地爬",[42,3644,3645],{},"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",[42,3647,3648],{},"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",[825,3650],{},[11,3652,3653],{},"二到四歲",[39,3655,3656,3659,3662,3668,3671],{},[42,3657,3658],{},"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",[42,3660,3661],{},"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",[42,3663,3664,3665,3667],{},"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）",[18,3666],{},"\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",[42,3669,3670],{},"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",[42,3672,3673],{},"五級——幾乎不會動",[825,3675],{},[11,3677,3678],{},"四到六歲",[39,3680,3681,3684,3690,3693,3696],{},[42,3682,3683],{},"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",[42,3685,3686,3687,3689],{},"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；",[18,3688],{},"\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",[42,3691,3692],{},"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",[42,3694,3695],{},"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",[42,3697,3698],{},"五級——幾乎不動",[825,3700],{},[11,3702,3703],{},"六到十二歲",[39,3705,3706,3709,3712,3715,3718],{},[42,3707,3708],{},"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",[42,3710,3711],{},"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",[42,3713,3714],{},"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",[42,3716,3717],{},"四級——需他人協助或電動輪椅移動",[42,3719,3698],{},[825,3721],{},[11,3723,3724],{},"十二到十八歲",[39,3726,3727,3730,3733,3736,3739],{},[42,3728,3729],{},"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",[42,3731,3732],{},"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",[42,3734,3735],{},"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",[42,3737,3738],{},"四級——需輪式輔具移動；需肢體協助設備；常用電動輪椅移動",[42,3740,3741],{},"五級——被動協助移動",[825,3743],{},[11,3745,3746],{},"各分級比較",[39,3748,3749,3752,3755,3763],{},[42,3750,3751],{},"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",[42,3753,3754],{},"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",[42,3756,3757,3758],{},"三級VS四級——主要為坐姿及自動移動差異；",[39,3759,3760],{},[42,3761,3762],{},"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",[42,3764,3765],{},"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",[825,3767],{},[11,3769,3770],{},"還好內容不多也不難啃，嚇死我了",{"title":143,"searchDepth":144,"depth":144,"links":3772},[],"2026-04-19","好像是要自己看的補充","\u002Fimages\u002Fuploads\u002F1776579606728-El0Kc5OVMAEdbG5.webp",{},"\u002Fblog\u002FGMFCS",{"title":221,"description":3774},{"loc":3777},"blog\u002FGMFCS","G29aDr074P62Nd9uZoQMiZkkv7riTkIuliNENvcBRcI",{"id":3783,"title":222,"author":6,"body":3784,"date":4009,"description":4010,"draft":148,"edited_at":4011,"extension":150,"featured_image":4012,"meta":4013,"navigation":153,"path":4014,"pinned":148,"seo":4015,"sitemap":4016,"stem":4017,"tags":158,"__hash__":4018},"blog\u002Fblog\u002FBPI.md",{"type":8,"value":3785,"toc":4007},[3786,3792,3801,3810,3816,3822,3833,3836,3838,3841,3858,3861,3904,3906,3915,3921,3957,3960,3965,3972,3975,3989],[11,3787,3788,3789,3791],{},"BPI，臂叢傷害，在1768年在英國第一次被提出來",[18,3790],{},"\n臂叢包括了從C5到T1的五條神經",[11,3793,3794,3795,3797,3798,3800],{},"功能包括了接收來自手臂和手的訊號、傳送大腦發出的訊號",[18,3796],{},"\n那假如這條路徑受傷，訊號就傳不到大腦，反過來也傳不到手臂跟手",[18,3799],{},"\n感覺會退化，肌肉也會逐漸萎縮，進一步的變成肌肉和關節攣縮",[11,3802,3803,3804,3806,3807,3809],{},"假如神經裡面的nerve covering沒有受損，這樣的話神經是可以再生的",[18,3805],{},"\n在剛出生第一年恢復會很快，但肌肉無力還是會存在",[18,3808],{},"\n（大概每個月長1 inch\u002F每天1 mm）",[11,3811,3812,3813,3815],{},"會造成臂叢傷害，可能是因為嬰兒太大",[18,3814],{},"\n在自然分娩時頭出來但嬰兒肩膀還卡在骨盤裡",[11,3817,3818,3819,3821],{},"那為了避免頭部傷害，都會將頭部往下拉，可能會使臂叢被拉傷",[18,3820],{},"\n手臂無力在剛出生就可以被觀察到，相關併發症有",[39,3823,3824,3827,3830],{},[42,3825,3826],{},"鎖骨骨折",[42,3828,3829],{},"肱骨骨折",[42,3831,3832],{},"霍納氏症候群：眼瞼下垂，較小的瞳孔",[11,3834,3835],{},"發生率在每1000個裡有0.6~3個",[825,3837],{},[11,3839,3840],{},"按照神經受傷類型分成",[39,3842,3843,3846,3849,3852,3855],{},[42,3844,3845],{},"Avulsion撕脫——神經跟脊髓連接斷開，無法靠再生或開刀修復",[42,3847,3848],{},"Rupture斷裂——斷裂處不在脊髓，可靠開刀修復",[42,3850,3851],{},"Neuroma神經瘤——神經再生時會長出疤痕組織，會阻斷傳導，需開刀移除疤痕組織",[42,3853,3854],{},"Axonotmesis軸突斷裂——傷到了fiber，但nerve covering還在，能再生，但速度慢慢的長回支配的肌肉",[42,3856,3857],{},"Neuropraxis神經失用症——輕度傷害，沒有撕裂，在出生後三個月後才能看出明顯不同",[11,3859,3860],{},"按照傷到的哪一條神經又分成",[39,3862,3863,3881,3898,3901],{},[42,3864,3865,3866,3870,3871],{},"Erb’s Palsy or upper-plexus type（",[25,3867,3869],{"className":3868},[29,28],"最常見","）——傷到C5和C6",[39,3872,3873],{},[42,3874,3875,3876],{},"功能喪失包括：肩外展，肩屈曲，肘屈曲，腕伸展；手臂無法從身側抬高",[39,3877,3878],{},[42,3879,3880],{},"呈現下垂姿勢，在肩內收，肩內旋，前臂旋前，手指屈曲的姿勢——類似小費手",[42,3882,3883,3884,3888,3889],{},"Klumpke’s Palsy or lower-plexus type（",[25,3885,3887],{"className":3886},[28,29],"少見","）——C7到T1",[39,3890,3891],{},[42,3892,3893,3894,1129],{},"手部內在肌無力（特別是",[25,3895,3897],{"className":3896},[810],"尺側",[42,3899,3900],{},"Duchennes Palsy——C7",[42,3902,3903],{},"Whole arm type——C5到T1",[825,3905],{},[11,3907,3908,3909,3911,3912,3914],{},"手術處置的話，假如在出生後九個月沒有任何進步就會開刀，抑或者有些嚴重的會在出生約3到4個月就會開刀",[18,3910],{},"\n第一次開刀主要是移除疤痕組織，或者神經移植（會用不那麼重要的感覺神經做移植）",[18,3913],{},"\n（通常在一歲前肩部問題要處理好）",[11,3916,3917,3918,3920],{},"那這邊老師給了一張叫Hospital for Sick Children Active Movement Scale的量表（AMS）",[18,3919],{},"\n評分一共七個，是按照MMT改過來的（我感覺是）",[39,3922,3923,3943],{},[42,3924,3925,3926],{},"非抗重力",[39,3927,3928,3931,3934,3937,3940],{},[42,3929,3930],{},"0——沒有任何反應",[42,3932,3933],{},"1——有肌肉收縮，無動作",[42,3935,3936],{},"2——能活動範圍\u003C1\u002F2",[42,3938,3939],{},"3——能活動範圍>1\u002F2",[42,3941,3942],{},"4——full range",[42,3944,3945,3946],{},"抗重力",[39,3947,3948,3951,3954],{},[42,3949,3950],{},"5——能活動範圍\u003C1\u002F2",[42,3952,3953],{},"6——能活動範圍>1\u002F2",[42,3955,3956],{},"7——full range",[11,3958,3959],{},"這一個是Mallet classification(Mallet Scale) 錄肩部和手臂功能變化的評分系統",[11,3961,3962],{},[754,3963],{"alt":756,"src":3964},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1780284740177-malletslace_full.gif",[11,3966,3967],{},[2008,3968,3971],{"href":3969,"rel":3970},"https:\u002F\u002Fwww.stlouischildrens.org\u002Fconditions-treatments\u002Fneurosurgery-services\u002Fbrachial-plexus-center\u002Ftreatment-goals\u002Fmedical-treatment",[2012],"此圖我從這裡找的",[11,3973,3974],{},"評估反射的內容包括",[39,3976,3977,3980,3983,3986],{},[42,3978,3979],{},"Moro",[42,3981,3982],{},"Galant",[42,3984,3985],{},"Neck righting, hand placing",[42,3987,3988],{},"Visual tracking",[11,3990,3991,3992,3994,3995,3997,3998,4000,4001,4003],{},"那我們介入的時間，在出血跟水腫都消退後就可以開始了，當然是越早越好",[18,3993],{},"\n提供對恢復有利的環境",[18,3996],{},"\n將攣縮問題降到最低",[18,3999],{},"\n以及著手運動訓練",[18,4002],{},[25,4004,4006],{"className":4005},[28,29],"（那PT介入是無法使神經再生加快，目的是處理減少無力，攣縮等問題，還有動作訓練）",{"title":143,"searchDepth":144,"depth":144,"links":4008},[],"2026-05-29","BPI，斜頸等下再寫","2026-06-01","\u002Fimages\u002Fuploads\u002F1780287451942-138768698_p0_master1200.webp",{},"\u002Fblog\u002FBPI",{"title":222,"description":4010},{"loc":4014},"blog\u002FBPI","BKiUvsIFaniao4lSrn5PHOXgLG4FS10Qmaqzt74VOCs",{"id":4020,"title":223,"author":6,"body":4021,"date":4011,"description":4298,"draft":148,"edited_at":4299,"extension":150,"featured_image":4300,"meta":4301,"navigation":153,"path":4302,"pinned":148,"seo":4303,"sitemap":4304,"stem":4305,"tags":158,"__hash__":4306},"blog\u002Fblog\u002F先天性肌肉斜頸症CMT.md",{"type":8,"value":4022,"toc":4296},[4023,4041,4053,4059,4061,4064,4179,4181,4184],[11,4024,4025,4026,4028,4029,4031,4032,4034,4035,4037,4038,4040],{},"那顧名思義，就是歪脖子，他是SCM過緊導致的（這條肌肉從耳後連到了鎖骨）",[18,4027],{},"\n每1000個新生兒中就有3到20例",[18,4030],{},"\n病因包括：",[18,4033],{},"\n胎位不正，難產，任何外傷引發斜頸，可能有腫瘤的神經學徵象",[18,4036],{},"\n而斜頸的特徵為",[18,4039],{},"\n頸向患側傾，頭向健側看；頭部跟臉部不對稱；SCM有腫塊，通常出生四周會被發現，八個月後消退（但假如沒摸到腫塊也不代表不是先天性斜頸）",[11,4042,4043,4044,4046,4047,4049,4050,4052],{},"斜頸是表徵，不是診斷結果",[18,4045],{},"\n其中又有80%是天生的",[18,4048],{},"\n斜頸可以是慢性存在，也可以是急性發作",[18,4051],{},"\n可能伴隨不對稱的眼睛位置",[11,4054,4055,4056,4058],{},"通常PT可以做牽拉患側，增加健側肌肉力量，以及擺位",[18,4057],{},"\n假如有很嚴重的畸型，可以在1歲時進行手術",[825,4060],{},[11,4062,4063],{},"現在說一下可能會引發斜頸的問題",[39,4065,4066,4074,4082,4090,4098,4106,4129,4140,4148,4156,4171],{},[42,4067,4068,4069],{},"Arnold-Chiari Malformation（小腦扁桃體下疝畸形）——特徵有頸痛（咳嗽或打噴嚏時會加劇），可能會出現視力模糊，吞嚥困難，嘔吐反射，眼球震顫",[39,4070,4071],{},[42,4072,4073],{},"原因因為小腦與第四腦室向下移位至頸椎管；可以用MRI診斷；可能需要手術擴大後顱窩",[42,4075,4076,4077],{},"Brucellosis——脖子跟喉部會有痛，壓痛，腫脹；可能是頸椎感染了布魯氏菌而引起的",[39,4078,4079],{},[42,4080,4081],{},"跟結核一樣是細菌感染；要用培養確認菌種；可利用抗生素，偶爾需要手術",[42,4083,4084,4085],{},"Clevical spine fractures and dislocations（頸椎骨折和脫臼）——有嚴重外傷史",[39,4086,4087],{},[42,4088,4089],{},"一般是車禍或高空墜落造成",[42,4091,4092,4093],{},"Chordomas（脊索瘤）——呈現下運動神經元問題，但小腦功能正常",[39,4094,4095],{},[42,4096,4097],{},"要看那顆瘤長在哪，才知道具體症狀",[42,4099,4100,4101],{},"Clavical fracture with or without BPI（鎖骨骨折伴隨或不伴隨BPI）——在Moro反射中，患側手不會動，而且移動患側手嬰兒會哭鬧",[39,4102,4103],{},[42,4104,4105],{},"因體重超重，或胎位不正導致難產",[42,4107,4108,4109],{},"Congenital muscular torticollis（先天性肌肉斜頸症CMT）——就上面提到的，頸向患側傾，頭向健側看，SCM有腫塊且緊繃，頸部活動度減少",[39,4110,4111,4114,4117,4120,4123,4126],{},[42,4112,4113],{},"SCM會處於緊繃狀態；屬慢性問題，假如不去處理會導置臉部和顱骨不對稱",[42,4115,4116],{},"SCM摸到腫塊，在二到三個月內會消退（但講義上面寫八個月內）",[42,4118,4119],{},"那跟C1C2半脫位引發的斜頸不同，這個是頭頸同向，跟CMT的頭頸反向不同",[42,4121,4122],{},"反射檢查如X光不會照到異常",[42,4124,4125],{},"治療通常是運動為主",[42,4127,4128],{},"假如是出生之後幾年才被確診的小孩，需要做手術鬆開SCM",[42,4130,4131,4132],{},"Drug intoxication（藥物中毒）——服藥過量，如抗癲癇藥物",[39,4133,4134,4137],{},[42,4135,4136],{},"那兒童的肌張力不全，一般會在腿部足部開始發作，再慢慢影響到全身",[42,4138,4139],{},"而後天性的肌張力不全，頭部可能會前傾或後仰，不會偏向特定一側",[42,4141,4142,4143],{},"Extraocular muscle Paresis（眼外肌麻痺）——無法讓眼睛全範圍運動",[39,4144,4145],{},[42,4146,4147],{},"所以小孩需要透過傾斜頭跟脖子來看清；接受了眼科矯正手術之後斜頸也會消失",[42,4149,4150,4151],{},"Juvenile Rheumatoid Arthritis（幼年型類風濕關節炎JRA）——在頭前傾姿勢十分常見",[39,4152,4153],{},[42,4154,4155],{},"單關節和少關節類型的JRA裡不太會出現斜頸；多關節類型侵犯過多之後才會累及，造成斜頸",[42,4157,4158,4159],{},"Multiple congenital cervical spine anomalies（先天性頸椎病變Klipel-Feil Disorder）——脖子短且寬，髮際線靠低，頸部活動度受損",[39,4160,4161,4164],{},[42,4162,4163],{},"患者在40~50歲會有神經系統方面的問題",[42,4165,4166],{},[2008,4167,4170],{"href":4168,"rel":4169},"https:\u002F\u002Fwww.tfrd.org.tw\u002Ftfrd\u002Frare_b\u002Fview\u002Fid\u002F266",[2012],"這個中文名字翻譯我從這裡找的",[42,4172,4173,4174],{},"Muscle strain（肌肉拉傷）——有外傷史",[39,4175,4176],{},[42,4177,4178],{},"會造成暫時性的斜頸，且沒有固定型態，要看是傷了哪一條肌肉",[825,4180],{},[11,4182,4183],{},"接下來講可能會導致斜頸的神經性運動障礙",[39,4185,4186,4194,4202,4210,4218,4226,4229,4237,4245,4253,4261,4269,4272,4280,4288],{},[42,4187,4188,4189],{},"Benign paroxysmal torticollis of infancy（良性陣發性嬰幼兒斜頸症）——類似於癲癇的症狀",[39,4190,4191],{},[42,4192,4193],{},"是多重原因導致",[42,4195,4196,4197],{},"Dystonia musculorum deformans（畸型性肌張力不全）——許多腦部疾病，如腦炎後遺症，亨丁頓氏症",[39,4198,4199],{},[42,4200,4201],{},"可以是顯性或隱性，原因不明",[42,4203,4204,4205],{},"Sandifer’s syndrome（桑迪弗氏症候群）——有胃食道逆流，突然斜頸的問題",[39,4206,4207],{},[42,4208,4209],{},"通常跟腦麻相關，有癲癇病史",[42,4211,4212,4213],{},"Pharyngeal abscess（咽後膿腫）——發炎時會有嚴重斜頸狀況",[39,4214,4215],{},[42,4216,4217],{},"口腔跟喉嚨會痠痛",[42,4219,4220,4221],{},"Posterior fossa tumor（後顱窩腫瘤）——出現小腦功能障礙問題，可以觀察到斜視，動暈症，嘔吐",[39,4222,4223],{},[42,4224,4225],{},"機制不明，初期症狀與CMT容易被混淆",[42,4227,4228],{},"Psychogenic（心因性）——非典型的頸椎問題（例如發展遲緩）",[42,4230,4231,4232],{},"Rotary subluxation of C1-C2（C1C2半脫位）——是原本正常的小孩，突然間出現斜頸狀況",[39,4233,4234],{},[42,4235,4236],{},"會維持在同一方向傾斜和旋轉（跟CMT不同），可由X光確認",[42,4238,4239,4240],{},"Spastic Tordicollis（痙攣型斜頸）——頭會轉向一邊",[39,4241,4242],{},[42,4243,4244],{},"通常伴有呼吸道感染；好發在5~11歲；治療可靠熱敷及頸圈",[42,4246,4247,4248],{},"Spinal cord tumors（脊髓瘤）——出現下運動神經無力問題，但小腦功能正常",[39,4249,4250],{},[42,4251,4252],{},"具體要看腫瘤長在哪才知道狀況（感覺跟上面脊索瘤挺像）",[42,4254,4255,4256],{},"Sprengel’s deformity（先天性肩胛骨高位症）——肩胛骨上移，頭部動作通常不受限",[39,4257,4258],{},[42,4259,4260],{},"從胚胎裡，肩胛骨會在C4長出，並在胚胎慢慢長大而下降，高位應該就是下降出問題",[42,4262,4263,4264],{},"Syringomyelia（脊髓空洞症）——感覺喪失，肌肉萎縮，肌健反射消失",[39,4265,4266],{},[42,4267,4268],{},"病況取決於病灶level",[42,4270,4271],{},"Systematic fungal infection（全身性真菌感染）——頸部和喉嚨會有疼痛，壓痛，腫脹（感覺跟上面布魯氏菌像）",[42,4273,4274,4275],{},"Thyroglossal duct cyst（甲狀舌骨囊腫）——頸部正中央會長出一塊柔軟的腫塊，而不是長在SCM上，且比起SCM的腫塊要更表淺",[39,4276,4277],{},[42,4278,4279],{},"需手術切除",[42,4281,4282,4283],{},"Tonsillitis\u002FAdenitis（扁桃腺炎）——嚴重發炎並引起斜頸，造成口腔與喉嚨發炎，可能會導致吞嚥與呼吸困難",[39,4284,4285],{},[42,4286,4287],{},"可使用抗生素治療",[42,4289,4290,4291],{},"Tuberculosis of the Cervical Spine（頸椎結核）——頸部和喉嚨會有疼痛，壓痛，腫脹",[39,4292,4293],{},[42,4294,4295],{},"通常是不對稱的傷害椎體，導致旋轉伴隨後凸",{"title":143,"searchDepth":144,"depth":144,"links":4297},[],"Congenital Muscular Torticollis","2026-06-03","\u002Fimages\u002Fuploads\u002F1780462622920-121146410_p0_master1200.webp",{},"\u002Fblog\u002F先天性肌肉斜頸症CMT",{"title":223,"description":4298},{"loc":4302},"blog\u002F先天性肌肉斜頸症CMT","1IZxGkst_bAVHix9u2lgPuJocdxwcKhvepyQjaOjwuM",{"id":4308,"title":224,"author":6,"body":4309,"date":146,"description":4416,"draft":148,"edited_at":146,"extension":150,"featured_image":4417,"meta":4418,"navigation":153,"path":4419,"pinned":148,"seo":4420,"sitemap":4421,"stem":4422,"tags":158,"__hash__":4423},"blog\u002Fblog\u002FMR智能不足.md",{"type":8,"value":4310,"toc":4414},[4311,4314,4317,4332,4341,4344,4402],[11,4312,4313],{},"先鬼轉來小兒好了 東西好像有點多",[11,4315,4316],{},"智能不足的定義是指IQ小於等於70以下的寶寶",[11,4318,4319,4320,4322,4323,4325,4326,4328,4329,4331],{},"那評估的表有",[18,4321],{},"\nStandford-Binet Intellectual Scale——適用於2.5歲",[18,4324],{},"\n中華智力發展量表——適用於6歲",[18,4327],{},"\nBayley Scale——適用於0~3歲",[18,4330],{},"\nWechsler Preschool and Primary scale of intelligence——適用於學齡前",[11,4333,4334,4335,4337,4338,4340],{},"跟據美國智能不足協會(AAMR)定義，將適應能力分成十個項目，包括了",[18,4336],{},"\n溝通，Self-care，居家生活，社交技巧，社區資源運用(community use)",[18,4339],{},"\n自我導向(self-direction)，健康安全(healthy and safely)，功能性學業(functional academic)，休閒娛樂(leisure)，work",[11,4342,4343],{},"從IQ範圍區分出",[39,4345,4346,4360,4374,4388],{},[42,4347,4348,4349],{},"輕度智能不足：IQ 50~70",[39,4350,4351,4354,4357],{},[42,4352,4353],{},"學齡期前：外表看起來正常",[42,4355,4356],{},"學齡期：在學業上需特殊教育（可達國小六年級程度）",[42,4358,4359],{},"成年人：可獨立生活",[42,4361,4362,4363],{},"中度：IQ 35~50",[39,4364,4365,4368,4371],{},[42,4366,4367],{},"學齡期前：社交技巧差",[42,4369,4370],{},"學齡期：需特殊訓練（可達國小四年級程度）",[42,4372,4373],{},"成年人：可從事非技術性職業",[42,4375,4376,4377],{},"重度：IQ 20~35",[39,4378,4379,4382,4385],{},[42,4380,4381],{},"學齡期前：缺乏溝通能力",[42,4383,4384],{},"學齡期：無法學習",[42,4386,4387],{},"成年人：日常活動需他人協助",[42,4389,4390,4391],{},"極嚴重：IQ\u003C20",[39,4392,4393,4396,4399],{},[42,4394,4395],{},"學齡期前：依賴他人照護",[42,4397,4398],{},"學齡期：依賴他人照護",[42,4400,4401],{},"成年人：依賴他人照護",[11,4403,4404,4405,4407,4408,4410,4411,4413],{},"從接受教育程度上，分成",[18,4406],{},"\nEducable：可被教育，可以上一般班級或資源班",[18,4409],{},"\nTrainable：可被訓練，學習一些謀生技巧",[18,4412],{},"\nDependent：依賴",{"title":143,"searchDepth":144,"depth":144,"links":4415},[],"Intellectual disability","\u002Fimages\u002Fuploads\u002F1781247645586-145852080_p0_master1200.webp",{},"\u002Fblog\u002FMR智能不足",{"title":224,"description":4416},{"loc":4419},"blog\u002FMR智能不足","NZFChlk4JSzba5twGABUXtvtVQmu1tEvseZHqvvw_z4",{"id":4425,"title":4426,"author":6,"body":4427,"date":146,"description":4589,"draft":148,"edited_at":146,"extension":150,"featured_image":4590,"meta":4591,"navigation":153,"path":4592,"pinned":148,"seo":4593,"sitemap":4594,"stem":4595,"tags":158,"__hash__":4596},"blog\u002Fblog\u002FDown-Syndrome.md","Down Syndrome",{"type":8,"value":4428,"toc":4587},[4429,4435,4438,4449,4451,4454,4460,4472,4481,4491,4521,4530,4533,4536,4556,4565,4568],[11,4430,4431,4432,4434],{},"那唐氏症發生率是每1000個新生兒裡有1.3個",[18,4433],{},"\n母親是高齡產婦的話，風險會增加",[11,4436,4437],{},"這個不是遺傳疾病來的，起因有三",[39,4439,4440,4443,4446],{},[42,4441,4442],{},"第21對染色體多了一條小的染色體：91%的唐氏症都是這種類型",[42,4444,4445],{},"第21對跟第22對染色體互換：4%的唐氏症是這類型",[42,4447,4448],{},"嵌合體：智力正常，只有外觀有特徵，臨床工作者一般會建議孩子整形",[825,4450],{},[11,4452,4453],{},"從病理學來看",[11,4455,4456,4457,4459],{},"唐氏症的大腦比一般正常孩子的大腦重量小，大概只有正常的76%",[18,4458],{},"\n形狀呈圓，短，前後較窄，外側較寬——對應了最常見的唐氏症頭形：短頭畸形",[11,4461,4462,4463,4465,4466,4468,4469,4471],{},"40%的唐氏症有先天性心臟病缺陷，常見的類型為",[18,4464],{},"\n房室通道缺損(Atrioventricular canal defects)",[18,4467],{},"\n心室中膈缺損(Ventriculoseptal defects)",[18,4470],{},"\n情況良好的唐氏症小孩都會建議開刀，才能進行後續訓練，所以一般我們PT接到的都已經是開過刀的小孩了",[11,4473,4474,4475,4477,4478,4480],{},"感覺功能也會有缺失",[18,4476],{},"\n在107個受試者中，有64%的唐氏症有聽力喪失",[18,4479],{},"\n在75個受試者中，有41.3%有視覺缺陷",[11,4482,4483,4484,4486,4487],{},"肌肉骨骼系統上也會有差異",[18,4485],{},"\n低張力是主要原因，韌帶鬆馳，",[25,4488,4490],{"className":4489},[28,29],"第一二節頸椎半脫位",[11,4492,4493,4494,4496,4497,4499,4500,4502,4503,4505,4506,4508,4509,4511,4512,4514,4515],{},"那寰樞椎脫位是唐氏症最大問題的點，我們PT也要十分注意，症狀包括",[18,4495],{},"\n步態改變（踝關節不穩定）",[18,4498],{},"\n尿滯留",[18,4501],{},"\n斜頸",[18,4504],{},"\n不願意轉頭",[18,4507],{},"\n深層肌鍵反射增加",[18,4510],{},"\n2歲可以用X光進行檢查，有12~20%發現脫位，原因是齒突韌帶過鬆，所以C1C2會有十分大的活動度",[18,4513],{},"\n所以，",[493,4516,4517],{},[25,4518,4520],{"className":4519},[28,29],"前庭刺激手法對於唐氏症來說是禁忌",[11,4522,4523,4524,4526,4527,4529],{},"從肌肉上，全身呈現低張力，尤其是肢體，頸部，軀幹較明顯",[18,4525],{},"\n也會有肌肉缺失問題，包括掌長肌（斷掌）和前臂屈肌",[18,4528],{},"\n顴大小肌和提上唇肌這三條臉部肌肉缺乏明顯的肌腹分化",[11,4531,4532],{},"也會存在智力問題，通常IQ會小或等於70",[11,4534,4535],{},"在學習上的特徵有",[39,4537,4538,4541,4544,4547,4550,4553],{},[42,4539,4540],{},"能學的不多",[42,4542,4543],{},"要重複性學習",[42,4545,4546],{},"類化不好，無法順利轉化為技巧",[42,4548,4549],{},"容易忘記自己學過的技巧",[42,4551,4552],{},"反應慢",[42,4554,4555],{},"受刺激時，反應少",[11,4557,4558,4559,4561,4562,4564],{},"所以早期介入對於唐氏症小孩是最好的，整體表現會呈現輕度跟中度，很少會演變成重度",[18,4560],{},"\n一般有早期介入的唐氏症小孩在行走上是正常的",[18,4563],{},"\n且因應他的智力再安排他進入不同的班級，例如資源班或者特教班",[11,4566,4567],{},"由於存在低張力問題，可以安排",[39,4569,4570,4573,4576,4584],{},[42,4571,4572],{},"在幼兒期，利用抱姿或擺位，增加抗地心引力適應力和承重能力",[42,4574,4575],{},"也要加強抗地心引力的伸直與屈曲肌，促進關節周圍肌肉的共同收縮",[42,4577,4578,4579,4583],{},"且著重在早期的",[25,4580,4582],{"className":4581},[28,810],"動態探索","，而不是靜態探索",[42,4585,4586],{},"長大後，要去加強他的體適能及靈巧性（靈敏度）",{"title":143,"searchDepth":144,"depth":144,"links":4588},[],"唐氏症","\u002Fimages\u002Fuploads\u002F1781265657338-135232550_p0_master1200.webp",{},"\u002Fblog\u002FDown-Syndrome",{"title":4426,"description":4589},{"loc":4592},"blog\u002FDown-Syndrome","FOhG_wFbJIVxV3O-nKWt4g8KuD4rdC8E6Nyq7UBM67s",{"id":4,"title":5,"author":6,"body":4598,"date":146,"description":147,"draft":148,"edited_at":149,"extension":150,"featured_image":151,"meta":4688,"navigation":153,"path":154,"pinned":148,"seo":4689,"sitemap":4690,"stem":157,"tags":158,"__hash__":159},{"type":8,"value":4599,"toc":4686},[4600,4602,4606,4611,4613,4615,4672,4674,4676,4680,4684],[11,4601,13],{},[11,4603,16,4604,20],{},[18,4605],{},[11,4607,23,4608,31],{},[25,4609,30],{"className":4610},[28,29],[11,4612,34],{},[11,4614,37],{},[39,4616,4617,4627,4644,4658],{},[42,4618,44,4619],{},[39,4620,4621,4625],{},[42,4622,49,4623,52],{},[18,4624],{},[42,4626,55],{},[42,4628,58,4629],{},[39,4630,4631,4642],{},[42,4632,63,4633,66,4635,71,4638,74,4640,77],{},[18,4634],{},[25,4636,70],{"className":4637},[28,29],[18,4639],{},[18,4641],{},[42,4643,80],{},[42,4645,83,4646],{},[39,4647,4648,4654],{},[42,4649,88,4650,91,4652,94],{},[18,4651],{},[18,4653],{},[42,4655,97,4656,100],{},[18,4657],{},[42,4659,103,4660],{},[39,4661,4662,4668],{},[42,4663,108,4664,111,4666,114],{},[18,4665],{},[18,4667],{},[42,4669,117,4670,120],{},[18,4671],{},[11,4673,123],{},[11,4675,126],{},[11,4677,129,4678,132],{},[18,4679],{},[11,4681,135,4682,138],{},[18,4683],{},[11,4685,141],{},{"title":143,"searchDepth":144,"depth":144,"links":4687},[],{},{"title":5,"description":147},{"loc":154},1781450212618]