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我們來讀CVA",[11,476,477,478,480,481,483,484,486,487,489,490,492,493,495],{},"從成因上能分成 梗塞性(Infarction) 和出血性(hemorrhage)",[15,479],{},"\n那主要徵狀有",[15,482],{},"\n偏癱",[15,485],{},"\n感覺異常",[15,488],{},"\n失語症\u002F構音困難",[15,491],{},"\n視野缺損",[15,494],{},"\n認知及智力受損",[11,497,498,499,501,502,504,505,507,508,510,511,513,514,516],{},"流行病學上 ",[15,500],{},"\nCVA在美國都排第三第四名 台灣排第二第三名",[15,503],{},"\n年齡也是重要因素 大多數CVA都在65歲以上",[15,506],{},"\n而到了55歲 那麼每十年 患CVA的機率就會翻一倍",[15,509],{},"\n男性比女性更容易患上",[15,512],{},"\n黑人比白人更容易患上",[15,515],{},"\n梗塞性佔所有類型70~85%",[11,518,519,520,522],{},"然後有三種高風險因素",[15,521],{},"\n高血壓 糖尿病 心臟病",[524,525],"hr",{},[11,527,528],{},"以下補充一下來自物治精選神經的內容 可看可不看",[11,530,531,532,534,535,537],{},"除了這些還有其他高危因子",[15,533],{},"\n膽固醇過高 運動量不足 過重 抽煙 或有CVA家族史",[15,536],{},"\n上述八種有其三 屬高危族群",[11,539,540],{},"在國民健康署給了六項建議預防中風",[11,542,543],{},"定期健檢",[11,545,546,547,549],{},"血壓測量722原則--18歲以上每年至少在家量一次血壓 並按照以下組數測量",[15,548],{},"\n7天連續量 一天早晚量一次共2次 每次量2遍取平均值 (建議血壓值在120\u002F80mmHg)",[11,551,552,553,555],{},"三高異常辨識--血壓在120\u002F80mmHg以下 ",[15,554],{},"\n空腹血糖值在70~99mg\u002FdL LDL(低密度膽固醇)維持在130mg\u002FdL以下",[11,557,558],{},"科學算病管評估中心--利用 科學算病館 網站",[11,560,561],{},"維持良好習慣--如作息 運動 飲食(三低一高) 及情緒穩定",[11,563,564],{},"中風跡象--看微笑 看舉手 說你好",{"title":187,"searchDepth":188,"depth":188,"links":566},[],"2026-03-24","CVACVACVACVA~(路人可只看底下橫線的內容)","2026-03-26","\u002Fimages\u002Fuploads\u002F1774504345861-IMG_20200706_025803.jpg",{},"\u002Fblog\u002F腦血管病變（CVA）（中風）(一)",{"title":260,"description":568},{"loc":572},"blog\u002F腦血管病變（CVA）（中風）(一)","WAWJvtEAtJQSFAIChqC7ABykN4jeGw5TIvYG1DaHZLM",{"id":578,"title":261,"author":6,"body":579,"date":569,"description":742,"draft":192,"edited_at":190,"extension":194,"featured_image":743,"meta":744,"navigation":197,"path":745,"pinned":192,"seo":746,"series":200,"seriesOrder":200,"sitemap":747,"stem":748,"tags":200,"__hash__":749},"blog\u002Fblog\u002FCVA（二）.md",{"type":8,"value":580,"toc":740},[581,593,614,617,644,659,677,692,695,707,724],[11,582,583,584,586,587,589,590,592],{},"現在我們來講分類 從病理上分成了三種",[15,585],{},"\n血栓型(60%) 栓塞型(20%) 出血型(5%)",[15,588],{},"\n而從發展進程來看又分成了三種(15%)",[15,591],{},"\n完全型 發展型 短暫性腦缺血發作(TIA)",[11,594,595,596,598,599,601,602,604,605,607,608,610,611,613],{},"我們首先來講血栓型(Thrombotic Infarction)",[15,597],{},"\n主要由粥狀動脈硬化斑塊和高血壓交互形成",[15,600],{},"\n多發生在血管彎曲處積累班塊(多數為腦動脈第一主要分支處)",[15,603],{},"\n而它是進行式的 所以在中風之前 多數患者都不清楚斑塊積累已深",[15,606],{},"\n關於TIA這個前置警訊 它會誘發兩個機制",[15,609],{},"\n腦血管痙攣--因血管突然收縮 導致原本就狹窄的血管完全被阻斷",[15,612],{},"\n暫時性全身血壓過低--原本就狹窄 血壓還突然下降 導致血液供給不足",[11,615,616],{},"那來講機制 簡單就是血塊在斑塊中破開 觸發凝血因子 導致血栓(新民老師有專門講過 maybe重要)",[11,618,619,620,622,623,625,626,628,629,631,632,634,635,640,641,643],{},"接著講栓塞型(Embolic Infarction)",[15,621],{},"\n栓塞型是說有栓子在血液中流血最終塞到血管",[15,624],{},"\n通常栓子有三種來源",[15,627],{},"\n心臟 頸內動脈血栓 頸動脈竇的粥狀斑塊",[15,630],{},"\n而最常發生在MCA處",[15,633],{},"\n而比起血栓型 栓塞型",[22,636,639],{"className":637},[638],"bg-red-3","更加致命"," ",[15,642],{},"\n因為血栓型是發展型的(慢慢堵住) 而栓塞型是完全型的(突然有一塊東西堵住)",[11,645,646,647,649,650,652,653,655,656,658],{},"然後講有一個比較特殊的變體 叫空隙性中風(小洞中風 Lacunar Infarction)",[15,648],{},"\n是一些近乎90度分出來的微小管血處發生 通常影響這三個部位",[15,651],{},"\n基底核--在MCA的M1處 ",[15,654],{},"\n腦幹--在基底動脈處",[15,657],{},"\n視丘--在PCA的P1\u002FP2處",[11,660,661,662,664,665,667,668,670,671,673,674,676],{},"最後我們來講出血型(Hemorrhage)",[15,663],{},"\n分成腦內出血跟蜘蛛膜下腔出血",[15,666],{},"\n腦內出血就是指血管破裂 血跑到並壓迫腦實質空間",[15,669],{},"\n而蜘蛛膜下腔出血通常是腦動脈瘤破裂",[15,672],{},"\n而患者通常會說有以下徵狀",[15,675],{},"\n劇烈頭痛(這輩子最痛的) 噁心嘔吐 脖子僵硬 意識昏迷",[11,678,679,680,682,683,685,686,688,689,691],{},"而出血型通常有這四種損傷機制",[15,681],{},"\n第一點 血會被噴出來 擠壓到周邊神經組織",[15,684],{},"\n第二點 腦內壓升高(ICP)",[15,687],{},"\n第三點 腦疝脫 是指血塊搶佔了空間 把正常腦組織推走(mass effect)",[15,690],{},"\n第四點 周圍血流減少 意思是不只佔了腦組織空間 還從血管外壓到血管 導致供血不能",[11,693,694],{},"通常有這三種原因導致腦中風",[11,696,697,698,700,701,703,704,706],{},"第一種 高血壓 分成了三個要點",[15,699],{},"\n長期的高血壓會對血管管壁造成損傷(因長期承受高壓力沖刷導致管壁失去彈性)",[15,702],{},"\n跟小洞中風一樣 都是微小血管問題(區別在一個堵住一個破開)",[15,705],{},"\n高血壓性小腦出血",[11,708,709,710,712,713,715,716,721,723],{},"第二種 囊狀動脈瘤",[15,711],{},"\n也是因為長期被沖刷 導致內壁被過度拉伸",[15,714],{},"\n好發在威氏環",[22,717,720],{"className":718},[719],"underline","前半部",[15,722],{},"\n通常為8~10mm",[11,725,726,727,729,730,732,733,735,736],{},"最後一種是 AVM 動靜脈畸型",[15,728],{},"\n這一個是天生的 比較難辦 意思是動靜脈直接對接 中間並沒有微血管",[15,731],{},"\n而靜脈沒有辦法承受來自動脈的血壓 導致破裂",[15,734],{},"\n好發在大腦",[22,737,739],{"className":738},[719],"後半部",{"title":187,"searchDepth":188,"depth":188,"links":741},[],"CVA分類","\u002Fimages\u002Fuploads\u002F1774515663816-IMG_20200709_193107.jpg",{},"\u002Fblog\u002FCVA（二）",{"title":261,"description":742},{"loc":745},"blog\u002FCVA（二）","apEyOXViAqwKG6XZaxqVBHM60bPSkudeJMWzzy-eIXM",{"id":751,"title":752,"author":6,"body":753,"date":190,"description":852,"draft":192,"edited_at":190,"extension":194,"featured_image":853,"meta":854,"navigation":197,"path":855,"pinned":192,"seo":856,"series":200,"seriesOrder":200,"sitemap":857,"stem":858,"tags":200,"__hash__":859},"blog\u002Fblog\u002FCVA（三）血管症候群-i.md","CVA（三）血管症候群 (i)",{"type":8,"value":754,"toc":850},[755,764,773,791,809,825,828,833],[11,756,757,758,760,761,763],{},"決定受損程度有兩個因素",[15,759],{},"\n第一 受傷區域的大小還有位置，等下會重點說明這一塊",[15,762],{},"\n第二 側支循環的量：就是備用小路，假如這條路徑良好 可以減少神經系統受損程度",[11,765,766,767,769,770,772],{},"假如以血管來看",[15,768],{},"\n頸動脈堵住的話，會呈現單側偏癱，因為頸動脈分左右，堵住一邊，另一住還能流通",[15,771],{},"\n但基底動脈的話，因為它是由兩條椎動脈匯流而程一條 再從這裡分出包括PCA在內的一堆血管 所以會呈現雙側偏癱",[11,774,775,776,778,779,781,782,784,785,787,788,790],{},"接下來講一下威氏環",[15,777],{},"\n先來講由頸內動脈分出來的血管它們分別是",[15,780],{},"\nMCA、ACA、還有連接ACA之間的前交通支、最後就是後交通支",[15,783],{},"\n接著來講椎動脈出來的，包括了",[15,786],{},"\n基底動脈及PCA",[15,789],{},"\n（僅講義重點標注 不代表沒有其他）",[11,792,793,794,796,797,799,800,802,803,805,806,808],{},"那從以上這些血管假如出狀況了，會演變到以下的症候群",[15,795],{},"\nACA症候群",[15,798],{},"\nMCA症候群",[15,801],{},"\n內頸動脈症候群",[15,804],{},"\nPCA症候群",[15,807],{},"\n椎動脈症候群",[11,810,811,812,814,815,817,818,821,822,824],{},"先來講ACA Syndromes ",[15,813],{},"\nACA的血主要供應兩個區域",[15,816],{},"\n首先是大腦半球內側，會供應額葉（",[450,819,820],{},"初級運動皮層","）以及頂葉（初級本體感覺皮質區）",[15,823],{},"\n接著也會往裡面跑，供應基底核（前內囊以及尾狀核下部）、穹隆前部、胼胝體前4\u002F5",[11,826,827],{},"那假如ACA出狀況了 會有以下癥狀",[37,829,830],{},[40,831,832],{},"對側偏癱（下肢比上肢嚴重）————初級運動區域受影響",[37,834,835,838,841,844,847],{},[40,836,837],{},"對側感覺喪失（下肢比下肢嚴重）——初級感覺區域受影響",[40,839,840],{},"尿失禁————額葉的後內側受影響",[40,842,843],{},"失用症及雙手協調問題————胼胝體受影響",[40,845,846],{},"意志喪失\u002F動作遲緩（冷漠）————額葉內側受影響",[40,848,849],{},"一些原始反射如抓握\u002F吸吮反射再現——額葉受影響",{"title":187,"searchDepth":188,"depth":188,"links":851},[],"臨床表現與病灶位置的關係~ACA","\u002Fimages\u002Fuploads\u002F1775007735475-127888519_p0_master1200.jpg",{},"\u002Fblog\u002FCVA（三）血管症候群-i",{"title":752,"description":852},{"loc":855},"blog\u002FCVA（三）血管症候群-i","LmlGapSdVYDl0s3SusHWhzCgok2UmU776EQkVj7y-pw",{"id":4,"title":5,"author":6,"body":861,"date":190,"description":191,"draft":192,"edited_at":193,"extension":194,"featured_image":195,"meta":982,"navigation":197,"path":198,"pinned":192,"seo":983,"series":200,"seriesOrder":200,"sitemap":984,"stem":202,"tags":200,"__hash__":203},{"type":8,"value":862,"toc":980},[863,876,878,900,906,910,926,928,942,946,950,954,968,970],[11,864,13,865,17,867,20,869,872,29,874,32],{},[15,866],{},[15,868],{},[22,870,26],{"className":871},[25],[15,873],{},[15,875],{},[11,877,35],{},[37,879,880,882,884,886,888,890,892,894,896,898],{},[40,881,42],{},[40,883,45],{},[40,885,48],{},[40,887,51],{},[40,889,54],{},[40,891,57],{},[40,893,60],{},[40,895,63],{},[40,897,66],{},[40,899,69],{},[11,901,72,902,75,904,78],{},[15,903],{},[15,905],{},[11,907,81,908,84],{},[15,909],{},[37,911,912,914,916,918,920,922,924],{},[40,913,89],{},[40,915,92],{},[40,917,95],{},[40,919,98],{},[40,921,101],{},[40,923,104],{},[40,925,107],{},[11,927,110],{},[37,929,930,934,936,938,940],{},[40,931,115,932,118],{},[15,933],{},[40,935,121],{},[40,937,124],{},[40,939,127],{},[40,941,130],{},[11,943,133,944,136],{},[15,945],{},[11,947,139,948,142],{},[15,949],{},[11,951,145,952,148],{},[15,953],{},[37,955,956,958,960,962,964,966],{},[40,957,153],{},[40,959,156],{},[40,961,159],{},[40,963,162],{},[40,965,165],{},[40,967,168],{},[11,969,171],{},[37,971,972,974,976,978],{},[40,973,176],{},[40,975,179],{},[40,977,182],{},[40,979,185],{},{"title":187,"searchDepth":188,"depth":188,"links":981},[],{},{"title":5,"description":191},{"loc":198},{"id":986,"title":987,"author":6,"body":988,"date":193,"description":1242,"draft":192,"edited_at":1243,"extension":194,"featured_image":1244,"meta":1245,"navigation":197,"path":1246,"pinned":192,"seo":1247,"series":200,"seriesOrder":200,"sitemap":1248,"stem":1249,"tags":200,"__hash__":1250},"blog\u002Fblog\u002FCVA（四）.md","CVA（五）",{"type":8,"value":989,"toc":1240},[990,996,1010,1019,1034,1040,1062,1082,1110,1112,1115,1134,1152,1155,1178,1184,1201,1222,1231],[11,991,992,993,995],{},"在急性期我們能做甚麼呢，首先要看類型",[15,994],{},"\n先來講血栓型跟TIA，接著要看的是缺血部位",[11,997,998,999,1001,1002,1006,1007,1009],{},"一般來說缺血有分兩種變體 ",[15,1000],{},"\n一個叫中心區（80%～100%缺血），那這個區域細胞會在",[22,1003,1005],{"className":1004},[638],"幾分鐘內死亡","（梗塞）",[15,1008],{},"\n一個叫半影區（50%～80%缺血），這個區域的話，假如趕緊搶救，是能救得回來的（手術上也是專門搶救這個區域）",[11,1011,1012,1013,1015,1016,1018],{},"接著來看做甚麼處置 ",[15,1014],{},"\n首先是預防 預防勝於治療這是肯定的了",[15,1017],{},"\n能做的是維持血壓及血流",[11,1020,1021,1022,1024,1025,1027,1028,1030,1031,1033],{},"但假如不幸的話，有兩種手段",[15,1023],{},"\n首先是藥物 有三種類型的藥物",[15,1026],{},"\n第一類是Tissue plasminogen activator（老師給翻譯是組織性血栓溶解因子,t-PA）：在90-180分鐘內最有效",[15,1029],{},"\n第二類是抗凝血藥：有肝素，華法林",[15,1032],{},"\n第三類是抗血小板藥：有著名的阿斯匹靈",[11,1035,1036,1037,1039],{},"第二種手段就是手術，有兩種手術類型",[15,1038],{},"\n血栓內膜切開術（直接對堵住區域的斑塊\u002F血栓清理）和血管移植",[11,1041,1042,1043,1045,1046,1050,1051,1053,1054,1058,1059,1061],{},"然後來看栓塞型 雖然他跟血栓型類似",[15,1044],{},"\n但主因是因為",[22,1047,1049],{"className":1048},[638],"別的地方的東西經血流漂到腦血管並堵住","了",[15,1052],{},"\n所以治療目的應主要放在",[22,1055,1057],{"className":1056},[638],"源頭上","例如心臟或大血管",[15,1060],{},"\n也有三種是高危險問題：心房震顫，心肌梗塞，人工瓣膜",[11,1063,1064,1065,1067,1068,1073,1074,1078,1079,1081],{},"接著是高血壓性的出血型",[15,1066],{},"\n一般來說，其實",[22,1069,1072],{"className":1070},[1071],"bg-green-3","手術跟降壓","都",[22,1075,1077],{"className":1076},[638],"沒有很好","的對這個類型做處置",[15,1080],{},"\n所以能做得只有預防和長期控制（長期吃降血壓藥）",[11,1083,1084,1085,1087,1088,1090,1091,1100,1101,1103,1104,1106,1107,1109],{},"最後來講動脈瘤破裂的出血型 有以下幾種措施",[15,1086],{},"\n手術",[15,1089],{},"\n床上休養（",[1092,1093,1094],"em",{},[450,1095,1096],{},[22,1097,1099],{"className":1098},[638],"絕對的床上休息","）4~6weeks",[15,1102],{},"\n降低動脈血壓",[15,1105],{},"\n抗癲癇藥物",[15,1108],{},"\n系統性抗纖維蛋白溶解劑",[524,1111],{},[11,1113,1114],{},"接著講併發症的相關處置，總得來說有七個大類",[11,1116,1117,1118,1120,1121,1126,1127,1131,1133],{},"肯定得先來講最大問題的痙攣了，也就是高張力",[15,1119],{},"\n那關於，管不管高張這個問題，其實吵了很久，因為，高張他",[22,1122,1125],{"className":1123},[1124],"green-3","沒辦法做動作","，低張又軟癱也沒法",[22,1128,1130],{"className":1129},[1124],"維持姿勢",[15,1132],{},"\n所以普遍會從這兩個方向去看待，影不影響動作，以及影不影響功能性（ADL）",[11,1135,1136,1137,1139,1140,1142,1143,1145,1146,1148,1149,1151],{},"那抑制痙攣有兩種手段，吃藥以及做手術",[15,1138],{},"\n首先講吃藥，用藥也分成了對周邊抑或者對中樞去作用",[15,1141],{},"\n這部份我只介紹老師打星的藥物",[15,1144],{},"\n首先對中樞的，藥名叫Diazepam，可以抑制掉整個中樞系統，但副作用有嗜睡，焦慮或者全身無力",[15,1147],{},"\n接著是周邊的，有兩種手段",[15,1150],{},"\n一種名字叫肉毒桿菌，另一種叫做脊髓內注射貝可芬（這個量極需要極小且不易嗜，效果也極佳）",[11,1153,1154],{},"手術的部份有三種，肌腱切開術，神經切除術，以後選擇性後神經根切除術",[11,1156,1157,1158,1160,1161,1165,1166,1168,1169,1171,1172,1174,1175,1177],{},"接著講第二大類，癲癇",[15,1159],{},"\n癲癇也是最麻煩的一個問題，我們給病人教導了一些東西後，遇到癲癇，教過的東西他都會",[22,1162,1164],{"className":1163},[638],"全部忘記","，相當於reset掉",[15,1167],{},"\n機率上來看，57%的病人會在第一周發生癲癇，而88%的病人會在第一年內發生癲癇",[15,1170],{},"\n類型上，血栓或者栓塞這兩個會比較早發生，而出血型會比較晚發生",[15,1173],{},"\n那治療癲癇當然就是用抗癲癇藥物了",[15,1176],{},"\n副作用的話會有：嗜睡，運動失調，注意力不集中，記憶力變差",[11,1179,1180,1181,1183],{},"第三大類，呼吸系統也會有影響",[15,1182],{},"\n主因有兩種，因為癱瘓導致的功能不全，以及因為痙攣導致的需氧增加（或者異常動作模式）",[11,1185,1186,1187,1189,1190,1192,1193,1195,1196,1200],{},"第四大類，創傷",[15,1188],{},"\n這很容易理解，中風了嘛，肯定有不穩定不平衡，抑或者不對稱姿勢導致跌導",[15,1191],{},"\n那常見的骨折部位有：肱骨，手腕，髖部",[15,1194],{},"\n這邊有小補充，偏癱病人的",[22,1197,1199],{"className":1198},[1071],"偏癱側肢體","會高機率有骨質疏鬆症（因為不常用\u002F廢用）",[11,1202,1203,1204,1206,1207,1209,1210,1212,1213,1215,1216,1218,1219,1221],{},"第五大類，血栓性靜脈炎跟深層靜脈栓塞",[15,1205],{},"\n這個問題其實在復健早期階段就會被發現了（而中風病人在中風前血管就已經有硬化或者狹窄問題）",[15,1208],{},"\n那深層靜脈栓塞成因有這幾點",[15,1211],{},"\n血流改變：流速變慢",[15,1214],{},"\n血管壁受損",[15,1217],{},"\n血流凝固時間改變：血液變稠",[15,1220],{},"\n患側姿體的不活動與垂放姿勢：不活動肌肉不收縮就沒法回流；垂放加上重力影響也沒法回流",[11,1223,1224,1225,1227,1228,1230],{},"第六大類，反射性交感神經失養症",[15,1226],{},"\n症狀有灼燒感",[15,1229],{},"\n處置上可以用交感神經阻斷劑，或者利用類固醇",[11,1232,1233,1234,1236,1237,1239],{},"最後一類，疼痛",[15,1235],{},"\n病人經常抱怨肩膀痛",[15,1238],{},"\n處置上是局部注射類固醇",{"title":187,"searchDepth":188,"depth":188,"links":1241},[],"急性期醫生能幹嘛以及併發症的相關處置","2026-04-07","\u002Fimages\u002Fuploads\u002F1775193545170-142911098_p0_master1200.jpg",{},"\u002Fblog\u002FCVA（四）",{"title":987,"description":1242},{"loc":1246},"blog\u002FCVA（四）","r6jrmqGHVdbIelVQZGp41itZnx8LxnparGf1IWVe11k",{"id":1252,"title":265,"author":6,"body":1253,"date":193,"description":1492,"draft":192,"edited_at":1243,"extension":194,"featured_image":1493,"meta":1494,"navigation":197,"path":1495,"pinned":192,"seo":1496,"series":200,"seriesOrder":200,"sitemap":1497,"stem":1498,"tags":200,"__hash__":1499},"blog\u002Fblog\u002FCVA（六）.md",{"type":8,"value":1254,"toc":1490},[1255,1271,1305,1325,1327,1330,1342,1360,1369,1372,1435,1469],[11,1256,1257,1258,1260,1261,1263,1264,1266,1267],{},"那從時期來分PT能幹嘛 分成了",[15,1259],{},"\n急性期，復健期，回歸社會環境",[15,1262],{},"\n那CVA運動功能恢復時長需要數月到數年",[15,1265],{},"\n而復健黃金期只有",[22,1268,1270],{"className":1269},[638],"三到六個月",[11,1272,1273,1274,1276,1277,1281,1282,1284,1285,1289,1290,1292,1293,1297,1298,1300,1301],{},"CVA有相關的復健指標來預測",[15,1275],{},"\n第一點，假如復健期",[22,1278,1280],{"className":1279},[1071],"第一個月","表現很差，那中風後的半年的進步空間也會有限（86%）",[15,1283],{},"\n第二點，假如",[22,1286,1288],{"className":1287},[638],"前兩周內","病人上肢有回復，那代表那個病人以後上肢功能性一定會完全康復",[15,1291],{},"\n第三點，假如",[22,1294,1296],{"className":1295},[1071],"中風後24天","內沒有回復握力，這樣上肢的功能性恢復一定很差",[15,1299],{},"\n第四點，假如第一周內腿沒動作，第四周內手沒有動作，那病人預後",[22,1302,1304],{"className":1303},[638],"極差",[11,1306,1307,1308,1310,1311,1313,1314,1316,1317,1319,1320,1324],{},"從預後結果來看",[15,1309],{},"\n功能性是完全有機會康復的（只不能多次中風的話，難度會增大）",[15,1312],{},"\n就算是嚴重受損者例如包括認知功能受損，依然有機會讓他們功能性變好",[15,1315],{},"\n而且年齡不是決定預後的因素，主要要看動機以及受損程度",[15,1318],{},"\n尤其是",[22,1321,1323],{"className":1322},[1071],"年輕人","，因為年輕人在CVA上偏向出血型，出血型致死率更高",[524,1326],{},[11,1328,1329],{},"接著講損傷導致的限制跟失能部份",[11,1331,1332,1333,1335,1336,1338,1339,1341],{},"主要的損傷會以以下三點呈現",[15,1334],{},"\n第一點，癱瘓（MMT0分）或者無力",[15,1337],{},"\n第二點，高張力或低張力",[15,1340],{},"\n第三點，肌肉的啟動也有所改變",[11,1343,1344,1345,1347,1348,1350,1351,1353,1354,1356,1357,1359],{},"接著來講次級傷害，包括但不限於",[15,1346],{},"\n生理曲線與活動度改變",[15,1349],{},"\n肌肉與軟組織長度改變",[15,1352],{},"\n疼痛",[15,1355],{},"\n水腫",[15,1358],{},"\n等等等等.........",[11,1361,1362,1363,1365,1366,1368],{},"然後講動作上的問題，主要能觀察到這三種問題",[15,1364],{},"\n首先是動作喪失，異常動作模式，以及代償",[15,1367],{},"\n那這三個會漸漸影響ADL的獨立性，變得要別人來照顧",[11,1370,1371],{},"那中風病人會在復原中出現協同動作，可以分成上下肢以及屈曲伸直來看",[37,1373,1374,1387,1399,1412],{},[40,1375,1376,1377,1381,1382,1386],{},"那首先是上肢的屈曲協同動作——肩胛骨後縮和上提，",[22,1378,1380],{"className":1379},[1071],"肩外轉外旋","，",[22,1383,1385],{"className":1384},[638],"肘屈曲","，前臂旋後，手指手腕屈曲",[40,1388,1389,1390,1381,1394,1398],{},"接著是上肢的伸展協同動作——肩胛骨前伸，",[22,1391,1393],{"className":1392},[638],"肩內收內旋",[22,1395,1397],{"className":1396},[1071],"肘伸直","，前臂旋前，手腕手指屈曲",[40,1400,1401,1402,1406,1407,1411],{},"然後是下肢的屈曲協同動作——骨盤後縮上提(？)，髖",[22,1403,1405],{"className":1404},[638],"彎曲外展外旋","，膝",[22,1408,1410],{"className":1409},[1071],"彎曲90度","，踝背曲內翻，腳趾背屈",[40,1413,1414,1415,1419,1420,1381,1425,1429,1430,1434],{},"最後是下肢的伸展協同動作——髖",[22,1416,1418],{"className":1417},[1071],"伸直","內旋",[22,1421,1424],{"className":1422},[1423],"bg-yellow-2","內收",[22,1426,1428],{"className":1427},[638],"膝伸直","，踝",[22,1431,1433],{"className":1432},[638],"蹠曲","內收，腳趾蹠曲",[11,1436,1437,1438,1440,1441,1445,1446,1448,1449,1453,1455,1456,1458,1459,1463,1465,1466,1468],{},"在中風病人身上還能看到聯合反應，簡單來說是病人健側用力，患側也會不自主用力",[15,1439],{},"\n上肢的話這個聯合反應是",[22,1442,1444],{"className":1443},[1071],"相同方向","的（例如我健側肘用力屈曲，患側也會肘屈曲）",[15,1447],{},"\n而下肢的則",[22,1450,1452],{"className":1451},[638],"相反（內收、外展除外",[15,1454],{},"\n也會有這三種特殊反應",[15,1457],{},"\n那打哈欠、打噴嚏、咳嗽的話，它們的",[22,1460,1462],{"className":1461},[638],"吸氣期會產生屈曲的協同動作",[15,1464],{},"\n而假如患側上肢有動作，那麼同側的下肢也會有動作（可以反過來，下肢先有動作讓上肢也有動作）(Homolateral Synkinesis)",[15,1467],{},"\n那結合剛剛上面說的因為下肢內收外展是同向，所以健側內收或外展，患側一樣是內收或外展",[11,1470,1471,1472,1474,1475,1477,1478,1480,1481,1483,1484,1486,1487,1489],{},"最後來講功能性限制，主要有以下六點",[15,1473],{},"\nADL",[15,1476],{},"\n床上活動能力",[15,1479],{},"\n轉移位",[15,1482],{},"\n平衡與姿勢控制",[15,1485],{},"\n移動能力",[15,1488],{},"\n上肢的功能性動作",{"title":187,"searchDepth":188,"depth":188,"links":1491},[],"PT能幹嘛；受損導致的限制或失能","\u002Fimages\u002Fuploads\u002F1775208758679-138277104_p0_master1200.jpg",{},"\u002Fblog\u002FCVA（六）",{"title":265,"description":1492},{"loc":1495},"blog\u002FCVA（六）","30KL8AqkEnXvxygyaPZNtTIGb4_AjMnXMhv1vHZd6bI",{"id":1501,"title":1502,"author":6,"body":1503,"date":1760,"description":1761,"draft":192,"edited_at":1760,"extension":194,"featured_image":1762,"meta":1763,"navigation":197,"path":1764,"pinned":192,"seo":1765,"series":200,"seriesOrder":200,"sitemap":1766,"stem":1767,"tags":200,"__hash__":1768},"blog\u002Fblog\u002FCVA（七）評估-(i).md","CVA（七）評估 (i)",{"type":8,"value":1504,"toc":1758},[1505,1512,1515,1531,1540,1543,1562,1581,1604,1646,1653,1656,1704,1731,1746],[11,1506,1507,1511],{},[1508,1509,1510],"del",{},"CVA好像有點多 看不到頭哦","  目前進度計量 76\u002F292頁",[11,1513,1514],{},"那CVA評估方向有分這幾種",[11,1516,1517,1518,1520,1524,1525,1527,1528,1530],{},"首先是評估認知跟意識的量表，包括了",[15,1519],{},[22,1521,1523],{"className":1522},[719,638],"JOMAC","——Judgment(常識\u002F判斷)、Orientation(定向感)、Memory、Abstract thinking(抽象思考)、Calculation(計算)",[15,1526],{},"\nMMSE",[15,1529],{},"\nGCS",[11,1532,1533,1534,1536,1537,1539],{},"接著是功能量表，包括了",[15,1535],{},"\nBarthel index(巴氏量表)",[15,1538],{},"\nFuntional Independent measure(FIM)——這個比巴氏量表測得還要更精細",[11,1541,1542],{},"肌張力評估，有Modified Ashworth Scale(MAS)",[11,1544,1545,1546,1548,1552,1553,1555,1556,1558,1559,1561],{},"動作功能整合測試，包括了",[15,1547],{},[22,1549,1551],{"className":1550},[719,638],"Brunnstorm Method","——分了六期 而第二期會開始出現協同動作(區分)",[15,1554],{},"\nFugl-Meyer Assessment——這個是根據布朗斯壯量表改良的",[15,1557],{},"\nMotor Assessment Scale",[15,1560],{},"\nNIH Stroke Scale",[11,1563,1564,1565,640,1572,1577,1578,1580],{},"我們先來講布朗斯壯（跑台要跑哦）（可以再複習一下這兩份 ",[1566,1567,1571],"a",{"href":1568,"rel":1569},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002F%E5%91%A8%E5%9C%8D%E7%90%86%E8%AB%96%E5%AD%B8%E6%B4%BE%EF%BC%88%E4%BA%8C%EF%BC%89%E9%9A%8E%E5%B1%A4%E7%90%86%E8%AB%96?series=Motor%20Control",[1570],"nofollow","一",[1566,1573,1576],{"href":1574,"rel":1575},"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%89%EF%BC%89%E8%87%A8%E5%BA%8A%E6%87%89%E7%94%A8?series=Motor%20learning",[1570],"二"," 的階層理論跟布朗斯壯的描述）",[15,1579],{},"\n首先來測的是感覺，分了四種測試方向",[37,1582,1583,1589,1595,1601],{},[40,1584,1585,1586,1588],{},"被動運動覺（本體感覺）——蒙住病人眼，分別移動病人的肩、肘、前臂、腕、手指、下肢",[15,1587],{},"\n（這樣才可以知道病人需不需要一直專注看著自己腳來移動）（患測）",[40,1590,1591,1592,1594],{},"指尖辨識——蒙住病人眼，碰病人的指尖看他分不分得出來是碰哪根",[15,1593],{},"\n（測解覺跟大腦皮層的整合能力）（患測）",[40,1596,1597,1598,1600],{},"足底感覺——拿毛巾分別放在病人的前足，後足，內足，外足測他看能不能分不分得出",[15,1599],{},"\n（這跟平衡有關）（患測）",[40,1602,1603],{},"動態運動覺——蒙住病人眼，PT手抓患測帶著移動，讓病人的好手跟著這個速度跟方向跟著動",[11,1605,1606,1607,1609,1610,1612,1613,1617,1618,1622,1623,1625,1626,1631,1632,1634,1635,1637,1638,1642,1643,1645],{},"然後就是布朗斯壯的運動測試，它分成了六期，稍微解釋一下",[15,1608],{},"\n首先是第一期，沒有張力也沒有動作的",[15,1611],{},"\n第二期，它有",[22,1614,1616],{"className":1615},[638],"聯合動作出現","(伴隨協同動作)（是用來",[22,1619,1621],{"className":1620},[638],"區分第一期跟第二期","的指標），而且開始有痙攣出現，但還沒有主動動作",[15,1624],{},"\n第三期，痙攣是",[22,1627,1630],{"className":1628},[1629],"bg-yellow-3","最強","的，雖然開始有主動動作，但還是被協同動作主導",[15,1633],{},"\n第四期，這時痙攣開始下降，而且動作也開始偏離協同動作模式",[15,1636],{},"\n第五期，痙攣",[22,1639,1641],{"className":1640},[1071],"最弱","，基本上也沒有協同動作出現",[15,1644],{},"\n第六期，無痙攣，並且可以做到單關節動作，動作開始是協調的(雖然還有些笨拙)",[11,1647,1648],{},[1649,1650],"img",{"alt":1651,"src":1652},"1.00","https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1775437999044-Gemini_Generated_Image_5mnz195mnz195mnz.png",[11,1654,1655],{},"emmm，跑台的話看後面要不要再開一章做整理好了",[11,1657,1658,1659,1661,1662,1664,1665,1669,1670,1672,1673,1677,1678,1680,1681,1685,1686,1688,1689,1691,1692,1694,1695,1697,1698,1703],{},"接著講測試張力的MAS(Modified Ashworth Scale)，它分成了六個等級",[15,1660],{},"\nGrade 0  ——正常人",[15,1663],{},"\nGrade 1  ——到關節活動度",[22,1666,1668],{"className":1667},[638],"末端","才有張力出現",[15,1671],{},"\nGrade 1+  ——",[22,1674,1676],{"className":1675},[1629],"後半段","關節活動度出現張力",[15,1679],{},"\nGrade 2  ——",[22,1682,1684],{"className":1683},[1071],"大半段","活動度都有出現張力",[15,1687],{},"\nGrade 3  ——很難拉得動，但還是能拉",[15,1690],{},"\nGrade 4  ——拉不動了",[15,1693],{},"\n（補充，因為張力會受到速度影響(速度相依)，而另一個表MTS是MAS再把速度整合進去的版本）",[15,1696],{},"\n（Clasp-knife Response(摺刀反應)意思是在測試張力過程中，阻力突然消失了，代表上運動神經元受損——",[1566,1699,1702],{"href":1700,"rel":1701},"https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=JJ9Hg1hZS9Q",[1570],"補一條影片","）",[11,1705,1706,1707,1709,1710,1712,1713,1715,1716,1718,1719,1723,1724,1726,1727,1730],{},"然後來講FMA，它主要看五大面向加起來113個測試項目",[15,1708],{},"\n動作功能——包括了上下肢",[15,1711],{},"\n感覺功能——分為了Light touch兩面(輕觸覺)和Position Sense八個(位置覺)",[15,1714],{},"\n平衡——七個測試（坐姿三個，站姿四個）",[15,1717],{},"\n關節活動度——",[22,1720,1722],{"className":1721},[25],"九個","關節測ROM",[15,1725],{},"\n關節疼痛——一樣是",[22,1728,1722],{"className":1729},[25],"關節",[11,1732,1733,1734,1736,1737,1739,1740,1742,1743,1745],{},"單論上肢就總分126分，包括了",[15,1735],{},"\nMotor(66)",[15,1738],{},"\nSensation(12)",[15,1741],{},"\nROM(24)",[15,1744],{},"\nPain(24)",[11,1747,1748,1749,1751,1752,1754,1755,1757],{},"那FMA的評分是0~2分來看的",[15,1750],{},"\n0分是完全沒有動作",[15,1753],{},"\n1分是能做到一部份抑或者不完美",[15,1756],{},"\n2分是流暢完美的完成",{"title":187,"searchDepth":188,"depth":188,"links":1759},[],"2026-04-06","評估 Brunnstrom~FMA","\u002Fimages\u002Fuploads\u002F1775441596804-HE-2PhpbAAAPbL6.png",{},"\u002Fblog\u002FCVA（七）評估-(i)",{"title":1502,"description":1761},{"loc":1764},"blog\u002FCVA（七）評估-(i)","5VjlOMhJesoVA8qOO4VQLSc8-Dn-LDih6bguuuMPLJE",{"id":1770,"title":1771,"author":6,"body":1772,"date":1760,"description":1972,"draft":192,"edited_at":1760,"extension":194,"featured_image":1973,"meta":1974,"navigation":197,"path":1975,"pinned":192,"seo":1976,"series":200,"seriesOrder":200,"sitemap":1977,"stem":1978,"tags":200,"__hash__":1979},"blog\u002Fblog\u002FCVA（八）評估-(ii).md","CVA（八）評估 (ii)",{"type":8,"value":1773,"toc":1970},[1774,1777,1810,1831,1867,1876,1881,1929,1944,1964],[11,1775,1776],{},"繼續講評估",[11,1778,1779,1780,1782,1783,1785,1786,1788,1789,1791,1792,1794,1795,1797,1798,1800,1801,1803,1804,1806,1807,1809],{},"首先是Motor Assessment Scale",[15,1781],{},"\n它這個表比起上一份說的布朗斯壯（粗大動作）以及FMA（精細動作）不同",[15,1784],{},"\n這個更著重於功能性部份(ADL)，更加臨床，它分成了八個項目",[15,1787],{},"\nSupine to side lying",[15,1790],{},"\nSupine to sitting over the edge of a bed(仰躺到床緣再坐起)",[15,1793],{},"\nBalanced sitting",[15,1796],{},"\nSitting to Standing",[15,1799],{},"\nWalking",[15,1802],{},"\nUpper-arm function",[15,1805],{},"\nHand movements",[15,1808],{},"\nAdvance hand activites",[11,1811,1812,1813,1815,1816,1818,1819,1821,1822,1824,1825,1827,1828,1830],{},"接著講NIHSS的部份，它分成了11評估項目，一共42分，越高分越嚴重",[15,1814],{},"\n0分就是正常",[15,1817],{},"\n1~4分是輕度中風",[15,1820],{},"\n5~14分是中度中風",[15,1823],{},"\n15~24分是中重度重風",[15,1826],{},"\n24分以上是十分嚴重的中風",[15,1829],{},"\n（而10分以下的預後會有60%~70%機會恢復很好，20分以上預後會變十分差）",[11,1832,1833,1834,1836,1837,1839,1840,1842,1843,1845,1846,1848,1849,1851,1852,1854,1855,1857,1858,1860,1861,1863,1864,1866],{},"那十一項評分項目包括了",[15,1835],{},"\n意識——意識的評分又分成了三類（水準，問題，指令）",[15,1838],{},"\n眼球運動",[15,1841],{},"\n視野",[15,1844],{},"\n面部肌肉",[15,1847],{},"\n上肢運動",[15,1850],{},"\n下肢運動",[15,1853],{},"\n肢體運動失調",[15,1856],{},"\n感覺功能",[15,1859],{},"\n語言功能",[15,1862],{},"\n構音困難",[15,1865],{},"\n忽略症",[11,1868,1869,1870,1875],{},"下圖是來自網上抓的台中榮民總醫院的",[1566,1871,1874],{"href":1872,"rel":1873},"https:\u002F\u002Fwww.vghtc.gov.tw\u002FUploadFiles\u002FWebFiles\u002FWebPagesFiles\u002FFiles\u002Ff3802ff1-0016-44af-939f-fb045f9d5a4a\u002F20190419%20NIHSS%E4%BB%8B%E7%B4%B9%E5%8F%8A%E6%87%89%E7%94%A8.pdf",[1570],"NIHSS 中風量表之介紹與應用"," 雖然它這邊有分了左右的上下肢體運動 但總分一樣是42",[11,1877,1878],{},[1649,1879],{"alt":1651,"src":1880},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1775443710135-Screenshot_2026-04-06_103756.png",[11,1882,1883,1884,1886,1887,1889,1890,1892,1893,1895,1896,1898,1899,1901,1902,1904,1905,1907,1908,1910,1911,1913,1914,1916,1917,1919,1920,1922,1923,1925,1926,1928],{},"然後來講伯格氏平衡量表Berg Balance Scale，它原本是來預測老人的跌倒風險的，但發現用在CVA上也不錯",[15,1885],{},"\n有以下十四點",[15,1888],{},"\nSitting unsupported——不支撐坐著",[15,1891],{},"\nChange of position--sitting to standing——坐到站",[15,1894],{},"\nChange of position--standing to sitting——站到坐",[15,1897],{},"\nTransfers——轉移位",[15,1900],{},"\nStanding unsupported——不支撐站著",[15,1903],{},"\nStanding with eyes closed——閉眼站著",[15,1906],{},"\nStanding with feet together——雙腳拼攏站著",[15,1909],{},"\nTandem standing——腳尖碰腳跟站著",[15,1912],{},"\nStanding on one leg——單腳站",[15,1915],{},"\nTurning Trunk(feet fix)——轉軀幹但腳不動",[15,1918],{},"\nRetrieving objects from floor——從地上撿東西",[15,1921],{},"\nTurning 360 degrees——轉身360度",[15,1924],{},"\nStool stepping——用一個踏板輪流讓左右腳上去下來（重量轉移）",[15,1927],{},"\nReaching forward while standing——站立前往伸手",[11,1930,1931,1932,1934,1935,1937,1938,1940,1941,1943],{},"而這個表的得分會長這樣",[15,1933],{},"\n0~20分——一定會跌倒，建議坐輪椅",[15,1936],{},"\n21~40分——中度跌倒風險，建議用輔具",[15,1939],{},"\n41~56分——低跌倒風險，可以獨立行走",[15,1942],{},"\n（而老師有補充低於36分就一定會跌倒，45分以內也會高機率跌倒）",[11,1945,1946,1947,1949,1950,1954,1955,1957,1958,1960,1961,1963],{},"最後講的是Functional Reach Test，這是一個可以快速中風或者老人的跌倒風險測試",[15,1948],{},"\n那最基本測試對象",[22,1951,1953],{"className":1952},[638],"需要這兩點能力","（獨立站立30秒，肩至少能平舉90度）",[15,1956],{},"\n然後是判讀的部分",[15,1959],{},"\n假如病人能向前伸6inch(15cm)以下，代表他跌倒風險高",[15,1962],{},"\n假如病人能向前伸6~10inch(25cm)，代表跌倒風險是中",[11,1965,1966,1967,1969],{},"接下來有一大堆跑台的東西了 我之後再整理（啊好多啊~",[15,1968],{},"\n目前進度50\u002F292頁",{"title":187,"searchDepth":188,"depth":188,"links":1971},[],"Motor Assessment Scale~Functional Reach Test","\u002Fimages\u002Fuploads\u002F1775445542448-135083397_p0.png",{},"\u002Fblog\u002FCVA（八）評估-(ii)",{"title":1771,"description":1972},{"loc":1975},"blog\u002FCVA（八）評估-(ii)","F5NsFqBo4w2dGUO_7yvNf7hwpR_kEvHtkzGNRa6YWlo",{"id":1981,"title":1982,"author":6,"body":1983,"date":2241,"description":2242,"draft":192,"edited_at":2241,"extension":194,"featured_image":2243,"meta":2244,"navigation":197,"path":2245,"pinned":192,"seo":2246,"series":200,"seriesOrder":200,"sitemap":2247,"stem":2248,"tags":200,"__hash__":2249},"blog\u002Fblog\u002FCVA（九）復健—手部-(i).md","CVA（九）復健—手部 (i)",{"type":8,"value":1984,"toc":2239},[1985,1988,2006,2056,2120,2125,2160,2167,2185,2198,2210,2213,2236],[11,1986,1987],{},"有跑台的內容我先跳過",[11,1989,1990,1991,1993,1994,1996,1997,1999,2000,2002,2003,2005],{},"Brunnstrom說手部在中風後早期會有這五種反應",[15,1992],{},"\n本體覺牽引反應(Proprioceptive traction response)",[15,1995],{},"\n真正的抓握反射(True grasp reflex)",[15,1998],{},"\n本能性抓握反射(Instinctive grasp reaction)",[15,2001],{},"\n本能性規避反應(Instinctive avoiding reaction)",[15,2004],{},"\n索格氏手指現象(Sougue's finger phenomenon)",[11,2007,2008,2009,2011,2012,2015,2016,2020,2022,2023,2027,2031,2032,2036,2037,2039,2040,2044,2046,2047,2049,2050,2052],{},"先來講本體覺牽引反應",[15,2010],{},"\n他的機制是說，假如對上肢或者下肢的其中一個",[22,2013,1730],{"className":2014},[719,1124],"的屈肌肌群做",[22,2017,2019],{"className":2018},[638],"快速的牽拉或者伸展",[15,2021],{},"\n會使被",[22,2024,2026],{"className":2025},[25],"同一個肢體",[22,2028,2030],{"className":2029},[638,719],"所有關節的屈肌","一起",[22,2033,2035],{"className":2034},[1124,719],"被誘發收縮","，讓整段肢體一起縮短",[15,2038],{},"\n主要會被這兩種反射",[22,2041,2043],{"className":2042},[719,1071],"促進或者抑制",[15,2045],{},"\nTNR(Tonic neck reflexes)——尤其是ATNR",[15,2048],{},"\n翻正反射(Body-righting reflexes)",[15,2051],{},[22,2053,2055],{"className":2054},[25],"（利用本體感覺進行誘發）",[11,2057,2058,2059,2061,2062,2066,2067,2071,2072,2077,2078,2082,2083,2085,2086,2088,2089,2091,2092,2096,2097,2099,2100,2104,2105,2109,2110,2114,2115,2119],{},"接著是真正的抓握反射",[15,2060],{},"\n它的誘發方式是，",[22,2063,2065],{"className":2064},[1124],"必須要","從",[22,2068,2070],{"className":2069},[719,25],"近端到遠端","並經過",[22,2073,2076],{"className":2074},[2075],"yellow-3","掌心橈側部","給予",[22,2079,2081],{"className":2080},[719],"深層壓力","（利用觸覺誘發）",[15,2084],{},"\n這個反射有兩個過程",[15,2087],{},"\n首先是捕捉期，手指的屈曲會快速出現，試圖抓住物體",[15,2090],{},"\n接著是持續抓握期，這個時候屈曲會持續用力收縮，假如物體",[22,2093,2095],{"className":2094},[1124],"試圖掙脫","，會讓抓握力度繼續增加（反射變強）",[15,2098],{},"\n那",[22,2101,2103],{"className":2102},[719],"掌指關節","(MP)以及",[22,2106,2108],{"className":2107},[719],"指間關節","(IP)會一起收縮並且呈現",[22,2111,2113],{"className":2112},[25],"內收(Add)","，但",[22,2116,2118],{"className":2117},[1124,719],"拇指的力量是最弱","的",[11,2121,2122],{},[1649,2123],{"alt":1651,"src":2124},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1775725402541-Screenshot_2026-04-09_170119.png",[11,2126,2127,2128,2130,2131,2135,2139,2143,2144,2146,2147,2151,2153,2154,2156,2157,2159],{},"現在講的是本能性抓握反射",[15,2129],{},"\n那它的機制跟剛剛的真正抓握不同，不需要從近到遠，只需要",[22,2132,2134],{"className":2133},[719,25],"靜止讓",[22,2136,2138],{"className":2137},[719,2075],"手掌",[22,2140,2142],{"className":2141},[719,25],"碰到","就能觸",[15,2145],{},"\n手指會不自主的握成拳頭，假如物體不拿開手是張不開的",[22,2148,2150],{"className":2149},[719],"（即使像Brunnstrom4 5期的病人能自主張開手也一樣）",[15,2152],{},"\n那有兩種方法可以釋放這個抓握",[15,2155],{},"\n刺激手背（誘發拮抗肌）",[15,2158],{},"\n腕屈曲+放在大腿上休息（因為手指在flex的情況下被帶到wrist flex, 伸肌會被拉到, 借由這個原理讓被動張力來拉開手指）",[11,2161,2162,2163],{},"那Brunnstrom覺得抓握反射也有幾個發展分期",[22,2164,2166],{"className":2165},[638],"(低階到高階)",[2168,2169,2170,2173,2176,2179,2182],"ol",{},[40,2171,2172],{},"牽張反射（最原始的）——在脊髓，並且是單節段的",[40,2174,2175],{},"本體感覺牽引反射——高於脊髓，並且為多節段的（像剛說到的牽拉一個關節可以連帶誘發同一肢段的關節一起收縮）",[40,2177,2178],{},"真正的抓握反射——皮層下反應（subcortical response）",[40,2180,2181],{},"本能性抓握反射——有部份皮層使用（這裡是恢復過程重要的指標，比起真正抓握還要有功能性--by gemini）",[40,2183,2184],{},"抑制本能性抓握反射——高階皮層",[11,2186,2187,2188,2190,2191,2195,2197],{},"然後講本能性規避反應",[15,2189],{},"\n雖然它一樣從近到遠去滑動誘發，但他的前提是將手向前抬高到一定高度，這樣誘發出來的型態會變成手指拇指",[22,2192,2194],{"className":2193},[25],"hyperextension",[15,2196],{},"\n而這種反應會體現在頂葉受損的病人上",[11,2199,2200,2201,2206,2207,2209],{},"最後講的是索格氏手指現象 (",[1566,2202,2205],{"href":2203,"rel":2204},"https:\u002F\u002Fwww.youtube.com\u002Fshorts\u002Fk9i59cNYq5E",[1570],"這是影片","，雖然看起來沒有想象中的一下子就鬆開，但看起來也已經是不像上面第二第三點說的抓死)",[15,2208],{},"\n他提到，假如將手臂整個抬高到90度以上，可以讓手指自動出現伸展（對癱瘓的手指也有用）",[11,2211,2212],{},"Brunnstrom對於手部的功能恢復分成了七個階段",[2168,2214,2215,2218,2221,2224,2227,2230,2233],{},[40,2216,2217],{},"肌腱反射回歸並且亢奮(Tendon reflexes return and become hyperactive)",[40,2219,2220],{},"痙攣與阻力增加(Spasticity and resistance develop)",[40,2222,2223],{},"借由本體覺刺激誘發手指主動屈曲(Voluntary finger flexion occurs by proprioceptive stimuli)",[40,2225,2226],{},"本體覺牽引反射出現(Proprioceptive traction response appear)",[40,2228,2229],{},"脫離本體覺刺激的手部控制(Control of hand movement without proprioceptive stimuli)",[40,2231,2232],{},"刺激掌心誘發屈曲，痙攣下降(Grasp is greatly reinforced by tactile stimuli in palm, spasticity is declining)",[40,2234,2235],{},"真正的抓握反射出現(True grasp reflex appear)",[11,2237,2238],{},"後面的我留給跑台寫好了",{"title":187,"searchDepth":188,"depth":188,"links":2240},[],"2026-04-09","講brunnstrom手指五個反應~功能恢復","\u002Fimages\u002Fuploads\u002F1775730146879-139326331_p1.png",{},"\u002Fblog\u002FCVA（九）復健—手部-(i)",{"title":1982,"description":2242},{"loc":2245},"blog\u002FCVA（九）復健—手部-(i)","iYpfITqz8NPRepIaYnPwgqVG-PFltjVz6OncktPo9X4",{"id":2251,"title":269,"author":6,"body":2252,"date":2549,"description":2550,"draft":192,"edited_at":2549,"extension":194,"featured_image":2551,"meta":2552,"navigation":197,"path":2553,"pinned":192,"seo":2554,"series":200,"seriesOrder":200,"sitemap":2555,"stem":2556,"tags":200,"__hash__":2557},"blog\u002Fblog\u002FCVA跑台（一）.md",{"type":8,"value":2253,"toc":2547},[2254,2289,2334,2353,2374,2393,2417,2435,2465,2495,2508,2524],[11,2255,2256,2259,2261,2263,2264,2267,2268,2272,2273,2275,2276,2280,2281,2283,2284,2288],{},[450,2257,2258],{},"如何測試上下肢Brunnstrom stage 是否為Stage 2（第1\u002F2期區分是有無聯合動作）",[15,2260],{},[15,2262],{},"\n說話：主要是測有沒有聯合動作來區分一期或者第二期，聯合動作",[450,2265,2266],{},"上肢方向","相同，下肢除了",[22,2269,2271],{"className":2270},[719],"內收外展","其他都相反",[15,2274],{},"\n那上肢要先從",[22,2277,2279],{"className":2278},[719,25],"Extensor","測到再Flexor，讓好手用力抵抗阻力誘發壞手的動作",[15,2282],{},"\n下肢就先從",[22,2285,2287],{"className":2286},[719,1124],"Flexor","先測再到Extensor，一樣是用好腳用力抵抗阻力誘發壞腳動作",[11,2290,2291,2294,2296,2298,2299,2302,2303,2305,2306,2310,2311,2315,2316,2320,2321,2325,2326,2328,2329,2333],{},[450,2292,2293],{},"測試上肢Brunnstrom stage是否為Stage 3的各項動作（紀錄角度）",[15,2295],{},[15,2297],{},"\n說話：因為要先測弱的協同動作，以及從好邊先測，所以要先從",[22,2300,2279],{"className":2301},[719],"的協同動作開始測",[15,2304],{},"\nExtensor的動作的話：患者",[22,2307,2309],{"className":2308},[719],"同側手","放在",[22,2312,2314],{"className":2313},[719],"同側大腿","上，碰",[22,2317,2319],{"className":2318},[719],"對側","膝蓋內側（",[22,2322,2324],{"className":2323},[719],"雙膝中間","）並記錄各關節角度",[15,2327],{},"\n而Flexor的動作的話：患者同側手放在同側大腿上，往上碰同側",[22,2330,2332],{"className":2331},[719],"耳垂","，並記錄各關節角度",[11,2335,2336,2339,2341,2343,2344,2346,2347,2349,2350,2352],{},[450,2337,2338],{},"測試上肢Brunnstrom stage是否為Stage 4的各項動作",[15,2340],{},[15,2342],{},"\n說話：",[15,2345],{},"\n第一個動作——手動到下背",[15,2348],{},"\n第二個動作——手向前平舉，掌心朝下",[15,2351],{},"\n第三個動作——Elbow Flex並且前臂做旋前和旋後",[11,2354,2355,2358,2360,2343,2362,2364,2365,2367,2368,2370,2371,2373],{},[450,2356,2357],{},"測試上肢Brunnstrom stage是否為Stage 5的各項動作",[15,2359],{},[15,2361],{},[15,2363],{},"\n第一個動作——手側向平舉（掌心朝下）",[15,2366],{},"\n第二個動作——手側向平舉後（掌心朝下）-->前臂旋後（掌心朝上）",[15,2369],{},"\n第三個動作——手向前平舉再往前伸（Protraction）",[15,2372],{},"\n第四個動作——手向前高舉過頭",[11,2375,2376,2379,2381,2298,2383,2386,2387,2389,2390,2392],{},[450,2377,2378],{},"測試下肢Brunnstrom stage是否為Stage 3的各項動作",[15,2380],{},[15,2382],{},[22,2384,2287],{"className":2385},[719],"協同動作開始測",[15,2388],{},"\nFlexor的動作的話——請病人supine，並嘗試讓病人膝碰胸",[15,2391],{},"\n而Extensor的話——讓病人側躺，並用Hip Knee Flex的姿勢，做Knee Extend",[11,2394,2395,2398,2400,2343,2402,2404,2405,2407,2408,2410,2411,2413,2414,2416],{},[450,2396,2397],{},"測試下肢Brunnstrom stage是否為Stage 4的各項動作",[15,2399],{},[15,2401],{},[15,2403],{},"\n第一個動作——在supine的姿勢下做hip abd",[15,2406],{},"\n第二個動作——坐姿下膝碰胸，那這個動作先測好邊再測壞邊",[15,2409],{},"\n第三個動作——坐姿下，腳踩在地上，向後滑，這個動作一樣先測好邊再測壞邊",[15,2412],{},"\n第四個動作——坐姿下，knee flex，做ankle dorsiflexion",[15,2415],{},"\n第五個動作——坐姿下，knee extend",[11,2418,2419,2422,2424,2343,2426,2428,2429,2431,2432,2434],{},[450,2420,2421],{},"測試下肢Brunnstrom stage是否為Stage 5的各項動作",[15,2423],{},[15,2425],{},[15,2427],{},"\n第一個動作——坐姿下，要knee extend到腳跟離地下，做PF\u002FDF",[15,2430],{},"\n第二個動作——坐姿下，僅腳跟碰地情況下，做eversion\u002Finversion",[15,2433],{},"\n第三個動作——站姿下，一隻腳flex並且用後跟碰臀部",[11,2436,2437,2440,2442,2444,2445,2449,2450,2452,2453,2457,2458,2460,2461,2457],{},[450,2438,2439],{},"Brunnstrom測試肩、肘、腕關節的被動動作感覺檢查",[15,2441],{},[15,2443],{},"\n說話：那等下請你",[22,2446,2448],{"className":2447},[719],"閉上眼睛","，然後我要動你的壞手，你的好手也要跟著做一樣的動作",[15,2451],{},"\n肩、肘的話——一手托住手肘，一手用兩指托住",[22,2454,2456],{"className":2455},[719],"掌心","去移動",[15,2459],{},"\n腕的話——一手托住前臂，一手用二指抓",[22,2462,2464],{"className":2463},[719],"第二及第五掌骨",[11,2466,2467,2470,2472,2474,2475,2478,2479,2483,2484,2486,2488,2489,2491,2492,2494],{},[450,2468,2469],{},"Brunnstrom測試手指Fingertip Recognition 及上肢之速度測試",[15,2471],{},[15,2473],{},"\n說話：讓病人坐著，請病人",[22,2476,2448],{"className":2477},[719],"，手放大腿上，用鉛筆的橡皮擦去碰病人的",[22,2480,2482],{"className":2481},[719],"壞側指尖","，讓他說出是碰哪一根",[15,2485],{},[15,2487],{},"\n而速度測試的話：",[15,2490],{},"\n第一個——手放大腿靠近膝蓋的地方，然後去碰下巴再回到大腿，測五秒內能來回多少次",[15,2493],{},"\n第二個——手放大腿靠近髖部的地方，然後去碰對側膝蓋再回來，測五秒內能來回多少次",[11,2496,2497,2500,2502,2504,2505,2507],{},[450,2498,2499],{},"Brunnstrom 測試足底 Sole sensation 檢查",[15,2501],{},[15,2503],{},"\n說話：坐著，將壓舌板放在足下，測",[15,2506],{},"\n不放、放腳掌（橫）、放腳跟（橫）、放小趾側（竪）、放大腳趾側（竪）",[11,2509,2510,2513,2515,2517,2518,2520,2521,2523],{},[450,2511,2512],{},"如何評估肘屈肌之肌肉痙攣（利用MAS）",[15,2514],{},[15,2516],{},"\n說話：先將手放在extend，隨後慢慢的移動到Flex再慢慢回來，之後快速的將手拉動做Flex\u002Fextend三次感受阻力",[15,2519],{},"\n0分的話無阻力、1分的話只有末端有阻力、1+的話只有後半段有阻力",[15,2522],{},"\n2的話大半段都有阻力、3分的話很難拉動要用力才能拉開、4分的話完全拉不開",[11,2525,2526,2529,2531,2533,2534,2536,2537,2541,2543,2544,2546],{},[450,2527,2528],{},"請說明如何執行及判斷Functional Reach Test",[15,2530],{},[15,2532],{},"\n說話：那首先病人要俱備這兩種能力，第一能不能獨自站立30秒以上，第二手能平舉起過90度",[15,2535],{},"\n接著就是身體直立，雙腳平行站立，握拳，手向前平舉90度，盡量讓病人向前伸，",[22,2538,2540],{"className":2539},[719],"測三次取平均值",[15,2542],{},"\n假如少於6inch的話，代表跌倒風險高",[15,2545],{},"\n假如6~10inch的話，代表跌倒風險中",{"title":187,"searchDepth":188,"depth":188,"links":2548},[],"2026-04-08","僅收錄期中李老師跑台內容 Brunnstrom~functional reach test","\u002Fimages\u002Fuploads\u002F1775616855750-143269515_p0_master1200.jpg",{},"\u002Fblog\u002FCVA跑台（一）",{"title":269,"description":2550},{"loc":2553},"blog\u002FCVA跑台（一）","V2tMy4Ah7CXxbABDHqNIYd8xqcDM1ev6P-8O4ZJBsGU",1775990611437]