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CP",{"type":8,"value":493,"toc":748},[494,497,534,546,549,601,633,663,675,701,727,734,739],[11,495,496],{},"以下根據余老師做的總結來編寫",[11,498,499,500,502,503,507,508,512,513,515,516,520,521,525,527,528,530,531,533],{},"首先是定義 ",[44,501],{},"\n在大腦",[22,504,506],{"className":505},[177],"未成熟","的階段 因為",[22,509,511],{"className":510},[177],"腦傷而導致的動作障礙","為主的症候群",[44,514],{},"\n而CP有",[22,517,519],{"className":518},[30],"三個非","合併導致",[22,522,524],{"className":523},[30],"發展遲緩",[44,526],{},"\n非進行性(傷口不會再惡化) ",[44,529],{},"\n非暫時性(腦傷不會好)",[44,532],{},"\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)",[11,535,536,537,539,540,542,543,545],{},"影響區域有三種區分",[44,538],{},"\n單側麻痺(Hemiplegia)(患側手腳無力)",[44,541],{},"\n雙側麻痺(Diplegia)(通常雙腿影響比雙手明顯)",[44,544],{},"\n四肢麻痺(Quadriplegia)(四肢 但上肢影響程度比下肢大)",[11,547,548],{},"我們現在來講三大分類",[11,550,551,552,554,555,559,560,562,563,567,568,570,574,575,577,578,583,584,588,589,591,592,594,595,597,598,600],{},"首先是痙攣型(Spasticity) 也是最大宗的一類(70%)",[44,553],{},"\n傷到了",[22,556,558],{"className":557},[177],"錐狀束","(錐體路徑 Pyramidal Tract)",[44,561],{},"\n而四肢張力都會變大 ",[22,564,566],{"className":565},[177],"上肢比下肢","還要嚴重",[44,569],{},[22,571,573],{"className":572},[25],"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)",[44,576],{},"\n併發症有 ",[22,579,582],{"className":580},[581],"green-5","斜視","(70%) ",[22,585,587],{"className":586},[581],"癲癇","(50%)",[44,590],{},"\n治療重點有",[44,593],{},"\n增加中軸張力(核心穩定)",[44,596],{},"\n降低肢體張力",[44,599],{},"\n提升抗重力能力",[11,602,603,604,554,606,610,611,613,614,618,619,621,622,624,625,591,627,629,630,632],{},"接著講徐動型(Athethoid)",[44,605],{},[22,607,609],{"className":608},[177],"基底核黃核","部位",[44,612],{},"\n張力",[22,615,617],{"className":616},[30],"時大時小","(有時候很硬 有時候很軟)",[44,620],{},"\n而頭部控制差 上肢較下肢嚴重 且有不隨意扭動",[44,623],{},"\n併發症有 聽覺障礙(高頻聽不見) 語言障礙",[44,626],{},[44,628],{},"\n對稱協調控制",[44,631],{},"\n雙側控制",[11,634,635,636,554,638,642,644,645,647,648,650,651,653,654,656,657,659,660,662],{},"最後來講失調型(Ataxia)",[44,637],{},[22,639,641],{"className":640},[177],"小腦",[44,643],{},"\n張力小",[44,646],{},"\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)",[44,649],{},"\n併發有 平衡 感覺統合 知覺都會較差",[44,652],{},"\n在治療重點上",[44,655],{},"\n會給他們穿加壓衣(增加感統知覺) ",[44,658],{},"\n穩定與張力提升",[44,661],{},"\n承重(增加感統知覺)",[11,664,665,666,668,669,671,672,674],{},"還有一些小分類 簡單帶過一下",[44,667],{},"\n首先是僵直型 這個是比痙攣型張力還要再強",[44,670],{},"\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",[44,673],{},"\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",[11,676,677,678,680,681,683,684,686,687,689,690,692,693,695,696,700],{},"接著來講治療原則 主要有五點",[44,679],{},"\n早期教育(早療 黃金期)",[44,682],{},"\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)",[44,685],{},"\n治療項目盡量以ADL為主",[44,688],{},"\n日常活動(結合孩子一天的作息去制定訓練 回家訓練)",[44,691],{},"\n感官輸入(如本體感覺 觸覺)",[44,694],{},"\n老師有圈了個重點 ",[22,697,699],{"className":698},[30],"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)",[11,702,703,704,706,707,711,712,706,714,718,719,721,722,726],{},"最後來講預後",[44,705],{},"\n假如 ",[22,708,710],{"className":709},[25],"2歲前","的寶寶能自行坐起來 未來100%能夠自行走動",[44,713],{},[22,715,717],{"className":716},[25],"4歲的","寶寶還不會自行坐起來 未來不會走",[44,720],{},"\n假如 是",[22,723,725],{"className":724},[25],"偏癱","的寶寶 未來100%能夠自行走動",[11,728,729],{},[730,731],"img",{"alt":732,"src":733},"1.00","https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774841979537-Screenshot_20260330_100529_Gallery.png",[11,735,736],{},[730,737],{"alt":732,"src":738},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774842001784-Screenshot_20260330_100531_Gallery.png",[11,740,741,742,744],{},"一些講義的內容 我隨後會在另一篇裡加上 ",[44,743],{},[22,745,747],{"className":746},[177],"讀英文！！！",{"title":209,"searchDepth":210,"depth":210,"links":749},[],"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":491,"description":751},{"loc":754},"blog\u002F腦性痲痺-CP",[759],"小兒PT","VRwnEKZEYqmW7o2UAStJ5mCqG7YSqw_jRSxAkVYjn34",{"id":762,"title":763,"author":6,"body":764,"date":1227,"description":1228,"draft":214,"edited_at":1229,"extension":215,"featured_image":1230,"meta":1231,"navigation":218,"path":1232,"pinned":214,"seo":1233,"series":221,"seriesOrder":221,"sitemap":1234,"stem":1235,"tags":221,"__hash__":1236},"blog\u002Fblog\u002FMotor-Learning.md","Motor Learning小兒（一）",{"type":8,"value":765,"toc":1225},[766,769,778,787,805,814,823,839,848,877,952,967,970,1012,1018,1067,1113,1154,1157,1194,1209],[11,767,768],{},"那這一節課著重在動態模組理論，跟黃老師教的是互通的",[11,770,771,772,774,775,777],{},"那首先是講感覺統合的部份",[44,773],{},"\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",[44,776],{},"\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)",[11,779,780,781,783,784,786],{},"而接下來講到動作的發展",[44,782],{},"\n那老師用的理論是動態模組理論",[44,785],{},"\n假如還記得黃老師的Motor Control最後一課講的應該不難吃",[11,788,789,790,792,793,795,796,798,799,801,802,804],{},"不過我還是先列出來老師PPT裡的五個角度",[44,791],{},"\n第一 動作技巧的顯現",[44,794],{},"\n第二 動作型態的精準度",[44,797],{},"\n第三 動作成果(可從評估表推估) ",[44,800],{},"\n第四 組合技巧的獲得(次系統組合的結果)",[44,803],{},"\n第五 對環境適應力的增強",[11,806,807,808,810,811,813],{},"我們現在來講平衡系統的發展",[44,809],{},"\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",[44,812],{},"\n以站立來形容的話",[11,815,816,817,819,820,822],{},"2)人類的重心(COM)基本會在S2 ",[44,818],{},"\n那壓力中心(COP)是動態的 他會因應COM的改變而改變",[44,821],{},"\n那底面積(BOS)就是兩隻腳踩在地面的距離",[11,824,825,826,830,831,833,834,838],{},"3)那平衡的演化 在早期 小孩會",[22,827,829],{"className":828},[30,25],"極度依賴視角","來判斷",[44,832],{},"\n但在成熟的過程中 我們會",[22,835,837],{"className":836},[177],"越來越傾向用本體感覺","去判斷",[11,840,841,842,844,845,847],{},"4)穩定極限(LOS) 他把我們人類想象成一個倒立的三角錐",[44,843],{},"\n在不移動的情況下身體能偏多少(前6度 側8度 後4度)",[44,846],{},"\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)",[11,849,850,851,853,854,858,859,864,865,867,868,872,873],{},"5)承受外力時的反應時 人類會有兩種變化",[44,852],{},"\n第一種就是假如這",[22,855,857],{"className":856},[25,40],"外力少到一定範圍"," 就只會用",[22,860,863],{"className":861},[862],"bg-green-3","姿勢穩定反應","來做調整",[44,866],{},"\n另一種則是假如外力",[22,869,871],{"className":870},[25,30],"超過姿勢穩定反應可以調整的程度"," 就會產生",[22,874,876],{"className":875},[177],"保護性姿勢",[11,878,879,880,882,883,885,886,888,889,893,895,896,900,904,906,907,909,911,912,916,917,919,920,924,925,927,928,930,932,933,935,936,938,939,943,944,946,948,949,951],{},"6)",[44,881],{},"\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",[44,884],{},"\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",[44,887],{},"\n那一般而言 越成熟的人 會越偏好用",[22,890,892],{"className":891},[30],"踝策略",[44,894],{},"\n而目前比較新的提出 就是",[22,897,899],{"className":898},[111,25],"抓握",[22,901,903],{"className":902},[111],"是一種不算策略(Strategy)的方法",[44,905],{},"\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",[44,908],{},[44,910],{},"\nii) 而另一點則是改變BOS的 例子就有跨步策略 身體是",[22,913,915],{"className":914},[30],"被迫做出","的 伸手出去支撐也是如此",[44,918],{},"\n那在發展過程中 而在",[22,921,923],{"className":922},[30],"方向性上也是有順序","的",[44,926],{},"\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",[44,929],{},[44,931],{},"\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 ",[44,934],{},"\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",[44,937],{},"\n我們",[22,940,942],{"className":941},[25],"可以通過適度的給他們外力","訓練他們",[44,945],{},[44,947],{},"\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",[44,950],{},"\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",[11,953,954,955,957,958,960,961,963,964,966],{},"那對於小兒的發展議題，主要有這幾個",[44,956],{},"\ni)——新形式的起源(The origin of new form)",[44,959],{},"\nii)——連續性與非連續性(Continuity vs discontinuity)",[44,962],{},"\niii)——變異性(Variability)",[44,965],{},"\niv)——生物與環境的影響(Biological vs. environmental influence)",[11,968,969],{},"那動態模組理論是經歷過以下發展而來的",[15,971,972,979,999],{},[18,973,974,975],{},"那首先是小兒痲痺(1910s)——當年的理念是哪邊無力練哪邊",[22,976,978],{"className":977},[25,177],"(肌肉再教育 muscle re-education)",[18,980,981,982,986,987,989,990,992,993,995,996,998],{},"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",[22,983,985],{"className":984},[177,25],"感覺輸入","促進正常的動作以及動作發展",[44,988],{},"\n神經成熟理論(1945s)由Gesell和McGraw提出，他們的關鍵理念有如下",[44,991],{},"\nCNS髓鞘化(Increased myelination of CNS)",[44,994],{},"\n皮質抑制皮質下中心(Inhibition of the subcortical centers by the higher cerebral cortex)",[44,997],{},"\n層級控制(Hierarchical control)",[18,1000,1001,1002,1006,1007,1011],{},"最後來講到階層理論的雛型(1980s)——當年他們覺得動作發展",[22,1003,1005],{"className":1004},[25],"不只單一的神經支配","，把",[22,1008,1010],{"className":1009},[25,30],"其他的系統、環境","一併整合進來",[11,1013,1014,1015,1017],{},"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",[44,1016],{},"\n那它有三個假設",[15,1019,1020,1031,1051],{},[18,1021,1022,1023,1025,1026,1030],{},"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",[44,1024],{},"\n但在1979s有學者提出說，其實原始反射對於每個寶寶來說",[22,1027,1029],{"className":1028},[30],"變異性","也很大",[18,1032,1033,1034,1036,1037,1041,1042,1046,1047],{},"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",[44,1035],{},"\n但在1976s有學者發現到，南非的寶寶被家長",[22,1038,1040],{"className":1039},[25],"直立抱法或者練習坐","，會比美國寶寶",[22,1043,1045],{"className":1044},[30],"更快發展出下肢動作","，但",[22,1048,1050],{"className":1049},[40],"爬和翻身較慢",[18,1052,1053,1054,1056,1057,1061,1062,1066],{},"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)",[44,1055],{},"\n但在1988s有學者提出，寶寶的",[22,1058,1060],{"className":1059},[40],"伸手以及操作","的發展在近端遠端上是",[22,1063,1065],{"className":1064},[25,30],"同時存在","的(同步進行發展，並沒有明確上下關係)",[11,1068,1069,1070,1072,1073,1077,1078,1082,1084,1085,1089,1090,1092,1093,1097,1098,1102,1103,1107,1109,1110,1112],{},"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",[44,1071],{},"\n那協調就是將這些複雜的東西，透過",[22,1074,1076],{"className":1075},[30],"降低自由度","，來",[22,1079,1081],{"className":1080},[40],"產生平滑的動作",[44,1083],{},"\n那降低自由度的策略會牽涉到一個叫",[22,1086,1088],{"className":1087},[177],"自我組織","的東西，那它的核心理念是說",[44,1091],{},"\n動作是有",[22,1094,1096],{"className":1095},[177],"適應性","的，次系統會根據",[22,1099,1101],{"className":1100},[25,30],"環境任務","等因素做調整，",[22,1104,1106],{"className":1105},[40],"再拼湊起來",[44,1108],{},"\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）",[44,1111],{},"\n有提到三個重點",[15,1114,1115,1121,1137],{},[18,1116,1117,1118,1120],{},"次序參數——它探討的是關節之間的協同",[44,1119],{},"\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",[18,1122,1123,1124,1128,1129,1131,1132,1136],{},"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",[22,1125,1127],{"className":1126},[25,177],"最省力、自然以及方便","的動作型態",[44,1130],{},"\n那假如這個動作達到了上述說的型態，便是",[22,1133,1135],{"className":1134},[30,25],"最穩定型態","，即使會因應任務去做改變也是十分穩定的",[18,1138,1139,1140,1142,1143,1147,1148,1150,1151,1153],{},"相移現象——意思就是說原本在做著一個穩定的動作型態",[44,1141],{},"\n因為一些",[22,1144,1146],{"className":1145},[30],"因素所干擾","，就會變成另一個動作型態",[44,1149],{},"\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)",[44,1152],{},"\n（對 黃老師教動態系統理論也提到過這個）",[11,1155,1156],{},"最後講兩個實驗",[15,1158,1159,1180],{},[18,1160,1161,1162,1164,1165,1167,1168,173,1172,1176,1177,1179],{},"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",[44,1163],{},"\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",[44,1166],{},"\n但動態模組理論發現，其實是因為在第四周寶寶",[22,1169,1171],{"className":1170},[25,30],"長脂肪比長肌肉快",[22,1173,1175],{"className":1174},[40],"力量不足","做不出來",[44,1178],{},"\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",[18,1181,1182,1183,1185,1186,1188,1189,1193],{},"第二個實驗，是觀察青蛙生長的環境與發育的關係",[44,1184],{},"\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",[44,1187],{},"\n所以神經成熟是可以讓動作型態形成，但必須得加上",[22,1190,1192],{"className":1191},[25,30],"環境，時間以及個體本身條件","才能讓型態表現更好",[11,1195,1196,1197,1199,1200,1202,1203,1205,1206,1208],{},"那在臨床意義上有以下幾點",[44,1198],{},"\n分散式控制(Distributed control)",[44,1201],{},"\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)",[44,1204],{},"\n由兒童主導(Active role of the child)",[44,1207],{},"\n個體差異的訊息(variability provides important information)",[11,1210,1211,1212,1216,1217,1221,1222,1224],{},"評估",[22,1213,1215],{"className":1214},[25,862],"不應只侷限在探討神經發展過程","，而是要根據",[22,1218,1220],{"className":1219},[177,25],"多個系統，家庭因素","等問題",[44,1223],{},"\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":209,"searchDepth":210,"depth":210,"links":1226},[],"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":763,"description":1228},{"loc":1232},"blog\u002FMotor-Learning","WfAalY0VpEvjA4FEwqJIqFvJHZ0cmvKnrpM76PAKB1U",{"id":1238,"title":1239,"author":6,"body":1240,"date":1229,"description":1451,"draft":214,"edited_at":212,"extension":215,"featured_image":1452,"meta":1453,"navigation":218,"path":1232,"pinned":214,"seo":1454,"series":221,"seriesOrder":221,"sitemap":1455,"stem":1456,"tags":221,"__hash__":1457},"blog\u002Fblog\u002FMotor-Learning小兒（二）.md","Motor Learning小兒（二）",{"type":8,"value":1241,"toc":1449},[1242,1245,1251,1260,1263,1283,1286],[11,1243,1244],{},"阿對的，又要來講動作學習的定義了，雖然之前就有講過",[11,1246,1247,1248,1250],{},"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)",[44,1249],{},"\n動作學習就是過程，而動作表現是動作做出來的結果。",[11,1252,1253,1254,1256,1257,1259],{},"而這邊講道Positive和Negative Sign",[44,1255],{},"\nPositive是指正常人沒有，但病人身上會出現的異常動作",[44,1258],{},"\nNegative則相反，正常人有的，但病人身上無法出現",[11,1261,1262],{},"對於動作學習有三大要素",[15,1264,1265,1268,1277],{},[18,1266,1267],{},"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",[18,1269,1270,1271,1273,1274,1276],{},"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",[44,1272],{},"\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",[44,1275],{},"\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",[18,1278,1279,1280,1282],{},"對於目標的清淅程度——就是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",[44,1281],{},"\n而任務越具體，更能引導寶寶產生興趣",[11,1284,1285],{},"那動作學習有以下三個考量點",[15,1287,1288,1341,1388],{},[18,1289,1290,1291,1295,1296,1300,1301,1308,1309,1311,1312,1314,1315,1319,1320,1322,1323,1327,1328,1332,1333,1335,1336,1340],{},"轉移——意思是",[22,1292,1294],{"className":1293},[25,40],"相同相似的技巧","在不同情景下可以變化",[22,1297,1299],{"className":1298},[30,25],"產生新的","動作型態 (這裡也有說到 ",[1302,1303,1307],"a",{"href":1304,"rel":1305},"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",[1306],"nofollow","在最後一段",")",[44,1310],{},"\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",[44,1313],{},"\n所以我們可以借由",[22,1316,1318],{"className":1317},[40],"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",[44,1321],{},"\n也可以透過",[22,1324,1326],{"className":1325},[25,30],"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",[22,1329,1331],{"className":1330},[25],"加粗","的方式讓寶寶更好握住",[44,1334],{},"\n但記得靠轉移來學習新的動作型態",[22,1337,1339],{"className":1338},[25,30],"不能一下子改太多太難","參數",[18,1342,1343,1344,100,1349,1353,1354,1356,1357,1361,1362,1364,1365,1369,1371,1372,1376,1377,1379,1380,1384,1385,1387],{},"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（",[1302,1345,1348],{"href":1346,"rel":1347},"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",[1306],"一",[1302,1350,1352],{"href":1304,"rel":1351},[1306],"二","）",[44,1355],{},"\n集中VS分散，分散休息時間更長，對",[22,1358,1360],{"className":1359},[25],"學習較難或易疲勞病人","來說更佳",[44,1363],{},"\n段落VS隨機，隨機較難，但通常對",[22,1366,1368],{"className":1367},[40,25],"形成長期記憶以記轉移效果更有",[44,1370],{},"\n固定VS變異，變異在",[22,1373,1375],{"className":1374},[30,25],"轉移效果上","更佳",[44,1378],{},"\n全部VS分段，分段有",[22,1381,1383],{"className":1382},[25,30],"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",[44,1386],{},"\n心像練習，在腦中模擬動作型態",[18,1389,1390,1391,100,1395,100,1399,100,1404,1308,1409,1411,1412,1414,1415,1417,1418,1353,1422,1424,1425,1429,1430,1432,1433,1437,1438,1440,1441,1443,1444,1448],{},"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(",[1302,1392,1348],{"href":1393,"rel":1394},"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",[1306],[1302,1396,1352],{"href":1397,"rel":1398},"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",[1306],[1302,1400,1403],{"href":1401,"rel":1402},"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",[1306],"三",[1302,1405,1408],{"href":1406,"rel":1407},"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",[1306],"四",[44,1410],{},"\nKR與KP，KR效度比KP更佳",[44,1413],{},"\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",[44,1416],{},"\n（",[1302,1419,1421],{"href":1406,"rel":1420},[1306],"這裡第一段有提到",[44,1423],{},"\n回饋的方法，",[1302,1426,1428],{"href":1397,"rel":1427},[1306],"這一篇的後半段","有提到，可以再複習一下",[44,1431],{},"\n先設定一個",[22,1434,1436],{"className":1435},[40],"區間","，達到的都算得分",[44,1439],{},"\n回饋也可以做遞減，逐漸減少依賴",[44,1442],{},"\n假如病人",[22,1445,1447],{"className":1446},[30,25],"主動要求回饋","，我們再給予，也會更佳",{"title":209,"searchDepth":210,"depth":210,"links":1450},[],"Motor Learning定義~結束","\u002Fimages\u002Fuploads\u002F1775875520542-37128694_p0_master1200.jpg",{},{"title":1239,"description":1451},{"loc":1232},"blog\u002FMotor-Learning小兒（二）","rQGIJJBG2JYTCd6jNzFlYufI482TpWmQ5YIfX_Gkt4s",{"id":1459,"title":1460,"author":6,"body":1461,"date":212,"description":1659,"draft":214,"edited_at":212,"extension":215,"featured_image":1660,"meta":1661,"navigation":218,"path":1662,"pinned":214,"seo":1663,"series":221,"seriesOrder":221,"sitemap":1664,"stem":1665,"tags":221,"__hash__":1666},"blog\u002Fblog\u002FGait-analysis小兒（一）.md","Gait analysis小兒（一）",{"type":8,"value":1462,"toc":1657},[1463,1466,1469,1486,1489,1500,1503,1520,1545,1551,1554,1571,1580,1591,1606,1612,1640,1643],[11,1464,1465],{},"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",[11,1467,1468],{},"那下肢雙關節肌肉有以下",[15,1470,1471,1474,1477,1480,1483],{},[18,1472,1473],{},"腰大肌——Hip Flexion, Trunk Flexion",[18,1475,1476],{},"腿後肌——Hip Extension, Knee Flexion",[18,1478,1479],{},"股直肌——Hip Flexion, Knee Extension",[18,1481,1482],{},"腓腸肌——Knee Flexion, PF",[18,1484,1485],{},"縫匠肌——Hip Flexion, Hip ER",[11,1487,1488],{},"那單關節的肌肉有",[15,1490,1491,1494,1497],{},[18,1492,1493],{},"臀大肌——Hip Extension, Hip ER",[18,1495,1496],{},"脛前肌——DF, inversion",[18,1498,1499],{},"腓骨長肌——PF, eversion",[11,1501,1502],{},"那以下動作的抗重力與無抗重力的擺位姿勢為",[15,1504,1505,1508,1511,1514,1517],{},[18,1506,1507],{},"Hip Extension——Prone 抗重力, side-lying 無抗重力",[18,1509,1510],{},"Hip Flexion——Sitting 抗重力, side-lying 無抗重力",[18,1512,1513],{},"Hip Abduction——Side-lying 抗重力, supine 無抗重力",[18,1515,1516],{},"Knee Extension——Sitting 抗重力, side-lying 無抗重力",[18,1518,1519],{},"PF——Standing 抗重力, prone 無抗重力",[11,1521,1522,1523,1525,1526,68,1530,1534,1536,1537,1539,1540,1544],{},"接下來講一個異常步態——Crouch gait",[44,1524],{},"\n為甚麼他會呈現屈曲狀態，主要是因為",[22,1527,1529],{"className":1528},[25,30],"雙關節肌肉張力過強",[22,1531,1533],{"className":1532},[25,40],"單關節肌肉力量不足",[44,1535],{},"\n不是單純的肌肉太緊，也是一種肌力失衡的表現",[44,1538],{},"\n其中，在",[22,1541,1543],{"className":1542},[25],"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)",[11,1546,1547,1548,1550],{},"接著來講步態的參數",[44,1549],{},"\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)",[11,1552,1553],{},"這邊提到一個中風後會出現的代償步態",[142,1555,1556,1559,1562,1565,1568],{},[18,1557,1558],{},"步速下降",[18,1560,1561],{},"步距縮短或不對稱",[18,1563,1564],{},"步寬變大(BOS增加)",[18,1566,1567],{},"雙腳站立期變長",[18,1569,1570],{},"依賴手部支撐",[11,1572,1573,1574,1576,1577,1579],{},"接著講Gait cycle，分別為站立期以及擺盪期",[44,1575],{},"\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",[44,1578],{},"\n完成這三個任務又分成了這八個動作",[15,1581,1582,1585,1588],{},[18,1583,1584],{},"承重——Initial contact和Loading Response",[18,1586,1587],{},"單腳支撐——Mid-stance, Terminal Stance和Pre-swing",[18,1589,1590],{},"肢體向前——Pre-swing, Initial swing, Mid-swing和Terminal Swing",[11,1592,1593,1594,1598,1599,1601,1602],{},"而Pre-swing雖然腳尖還沒離地，但",[22,1595,1597],{"className":1596},[25,40],"重心其實已經轉移去另一隻腳","了",[44,1600],{},"\n其中 ",[22,1603,1605],{"className":1604},[25],"Initial contact和Pre-swing為雙腳承重期",[11,1607,1608,1609,1611],{},"我們現在攤開來看站立期和擺盪期下肢各關節變化",[44,1610],{},"\n首先是站立期",[15,1613,1614,1622,1625,1631,1637],{},[18,1615,1616,1617,1621],{},"在雙腳承重期，",[22,1618,1620],{"className":1619},[25,40],"足部會放平","，準備Push Off",[18,1623,1624],{},"Hip的話，在Initical Contact的Flexion到Terminal Stance的Hyperextension",[18,1626,1627,1628,1630],{},"Knee的話，會從Flexion姿勢，到Mid-stance的Extension，再變回Pre-swing的Flexion",[44,1629],{},"\n(Flexion>Extension>Flexion)",[18,1632,1633,1634,1636],{},"Ankle的話，在Initical Contact的Neutral姿勢，Loading Response的PF，",[44,1635],{},"\nMid-stance的DF，最後是Terminal Stance\u002FPre-swing的PF（Neutral>PF>DF>PF）",[18,1638,1639],{},"Pelvis的話，基本保持水平，但在Terminal stance會略微前傾",[11,1641,1642],{},"然後是擺盪期",[15,1644,1645,1648,1651,1654],{},[18,1646,1647],{},"Knee的話，在Initical swing時會呈現Flexion，在Terminal swing會Full-extension",[18,1649,1650],{},"Hip的話，從Initical swing的Hyperextension，在Terminal swing會變成Flexion",[18,1652,1653],{},"Ankle的話，保持DF狀態，使腳尖不會碰到地板",[18,1655,1656],{},"Pelvis的話，會Rotation",{"title":209,"searchDepth":210,"depth":210,"links":1658},[],"肌肉~步態各分期關節姿勢","\u002Fimages\u002Fuploads\u002F1775885400167-37100769_p0.png",{},"\u002Fblog\u002FGait-analysis小兒（一）",{"title":1460,"description":1659},{"loc":1662},"blog\u002FGait-analysis小兒（一）","IPE1YCLIHjaGM3K3t637opIC_UJyveODI_bALybZ_94",{"id":4,"title":5,"author":6,"body":1668,"date":212,"description":213,"draft":214,"edited_at":212,"extension":215,"featured_image":216,"meta":1805,"navigation":218,"path":219,"pinned":214,"seo":1806,"series":221,"seriesOrder":221,"sitemap":1807,"stem":223,"tags":221,"__hash__":224},{"type":8,"value":1669,"toc":1803},[1670,1672,1756,1758,1783,1791,1795],[11,1671,13],{},[15,1673,1674,1690,1700,1713,1720,1736,1752,1754],{},[18,1675,20,1676,1679,32,1682,1685,42,1688,46],{},[22,1677,26],{"className":1678},[25],[22,1680,31],{"className":1681},[25,30],[22,1683,36],{"className":1684},[25],[22,1686,41],{"className":1687},[25,40],[44,1689],{},[18,1691,49,1692,1695,57,1698,60],{},[22,1693,53],{"className":1694},[25],[22,1696,31],{"className":1697},[25,30],[44,1699],{},[18,1701,63,1702,68,1705,1708,76,1711,79],{},[22,1703,67],{"className":1704},[40],[22,1706,72],{"className":1707},[25],[22,1709,31],{"className":1710},[25,30],[44,1712],{},[18,1714,82,1715,1718,89],{},[22,1716,86],{"className":1717},[25,40],[44,1719],{},[18,1721,92,1722,1725,100,1728,103,1730,1733],{},[22,1723,96],{"className":1724},[25],[22,1726,41],{"className":1727},[25,40],[44,1729],{},[22,1731,107],{"className":1732},[25],[22,1734,112],{"className":1735},[25,111],[18,1737,115,1738,1741,1744,125,1746,1749],{},[22,1739,119],{"className":1740},[25],[22,1742,41],{"className":1743},[25,40],[44,1745],{},[22,1747,107],{"className":1748},[25],[22,1750,112],{"className":1751},[25,111],[18,1753,134],{},[18,1755,137],{},[11,1757,140],{},[142,1759,1760,1767],{},[18,1761,146,1762,100,1765,153],{},[22,1763,150],{"className":1764},[30,25],[44,1766],{},[18,1768,156,1769,1772,163,1774,168,1777,173,1780],{},[22,1770,160],{"className":1771},[25,30],[44,1773],{},[22,1775,167],{"className":1776},[30,25],[22,1778,172],{"className":1779},[40],[22,1781,178],{"className":1782},[177],[11,1784,181,1785,184,1787,187,1789,190],{},[44,1786],{},[44,1788],{},[44,1790],{},[11,1792,193,1793,196],{},[44,1794],{},[15,1796,1797,1799,1801],{},[18,1798,201],{},[18,1800,204],{},[18,1802,207],{},{"title":209,"searchDepth":210,"depth":210,"links":1804},[],{},{"title":5,"description":213},{"loc":219},{"id":1809,"title":278,"author":6,"body":1810,"date":212,"description":1955,"draft":214,"edited_at":1956,"extension":215,"featured_image":1957,"meta":1958,"navigation":218,"path":1959,"pinned":214,"seo":1960,"series":221,"seriesOrder":221,"sitemap":1961,"stem":1962,"tags":221,"__hash__":1963},"blog\u002Fblog\u002F小兒發展（一）.md",{"type":8,"value":1811,"toc":1953},[1812,1815,1830,1836,1839,1865,1874,1877,1880,1897,1899,1902],[11,1813,1814],{},"（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）",[11,1816,1817,1818,1820,1821,1823,1824,1826,1827,1829],{},"那先來講發展遲緩的定義，它不單指運動層面上，還包括了",[44,1819],{},"\n知覺，語言，心理，社會，情緒等層面",[44,1822],{},"\n而這個動作遲緩有標準的",[44,1825],{},"\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",[44,1828],{},"\n根據WHO的數據，發生率為6~8%",[11,1831,1832,1833,1835],{},"那高危族群有以下",[44,1834],{},"\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",[11,1837,1838],{},"接下來講寶寶的正常發育過程，先從視角說起，如下",[15,1840,1841,1844,1847,1850,1853,1856,1859,1862],{},[18,1842,1843],{},"剛出生數天——眨眼反射",[18,1845,1846],{},"六周——注射物體",[18,1848,1849],{},"二到三個月——對明亮的東西感興趣",[18,1851,1852],{},"四個月——協調眼球轉動",[18,1854,1855],{},"一歲——影像認知發展完成，能看清輪廓",[18,1857,1858],{},"三歲——能分辨紅黃藍綠",[18,1860,1861],{},"五到六歲——可以分辨大多數顏色",[18,1863,1864],{},"八歲以前——有遠視現象（我問了Gemini也看不太懂就是了）",[11,1866,1867,1868,1870,1871,1873],{},"那關於視覺發展異常的問題包括了",[44,1869],{},"\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",[44,1872],{},"\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",[1875,1876],"hr",{},[11,1878,1879],{},"接著是聽覺發展，如下",[15,1881,1882,1885,1888,1891,1894],{},[18,1883,1884],{},"四個月——追尋聲音或說話來源",[18,1886,1887],{},"七到八個月——被叫名字有反應",[18,1889,1890],{},"十個月——仿說（無意義內容）",[18,1892,1893],{},"一到一歲半——初步聽懂簡單的話",[18,1895,1896],{},"兩歲以後——鸚鵡式學說話",[1875,1898],{},[11,1900,1901],{},"接下來是粗大動作的發展，如下",[15,1903,1904,1907,1910,1913,1916,1919,1922,1925,1928,1936,1944,1947,1950],{},[18,1905,1906],{},"兩個月——不穩定的抬頭控制",[18,1908,1909],{},"四個月——抬頭控制適當",[18,1911,1912],{},"五個月——翻身（先學會Prone to supine, 接著是supine to prone）",[18,1914,1915],{},"七個月——坐起來",[18,1917,1918],{},"八個月——爬行",[18,1920,1921],{},"九個月——需要支撐的站起來",[18,1923,1924],{},"十個月——僅需要極小輔助的從坐到站",[18,1926,1927],{},"一歲——獨立行走",[18,1929,1930,1931,1935],{},"兩歲——跑，",[22,1932,1934],{"className":1933},[40],"上樓梯","，踢球，投球，蹲下來",[18,1937,1938,1939,1943],{},"三歲——",[22,1940,1942],{"className":1941},[30],"下樓梯","，雙腳跳，騎三輪車",[18,1945,1946],{},"四歲——單腳跳",[18,1948,1949],{},"五歲——走直線",[18,1951,1952],{},"六歲——騎腳踏車",{"title":209,"searchDepth":210,"depth":210,"links":1954},[],"定義~粗大動作發展","2026-04-12","\u002Fimages\u002Fuploads\u002F1775957410970-EebbBUPUcAYSTE9.webp",{},"\u002Fblog",{"title":278,"description":1955},{"loc":1959},"blog\u002F小兒發展（一）","4ejiPQ8a9xnXVIFdzih8PoJrok3muVwRlBhhByq5HeI",{"id":1965,"title":279,"author":6,"body":1966,"date":1956,"description":2118,"draft":214,"edited_at":1956,"extension":215,"featured_image":2119,"meta":2120,"navigation":218,"path":2121,"pinned":214,"seo":2122,"series":221,"seriesOrder":221,"sitemap":2123,"stem":2124,"tags":221,"__hash__":2125},"blog\u002Fblog\u002F小兒發展（二）.md",{"type":8,"value":1967,"toc":2116},[1968,1971,1988,1990,1993,2021,2023,2026,2052,2054,2057,2071,2073,2076,2090,2092,2095,2103,2105,2108],[11,1969,1970],{},"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",[15,1972,1973,1976,1979,1982,1985],{},[18,1974,1975],{},"新生兒——中度的膝內翻（O型腿）",[18,1977,1978],{},"六個月——輕度的O型腿",[18,1980,1981],{},"一歲半——直的",[18,1983,1984],{},"三歲半——輕度的膝外翻（X型腿）",[18,1986,1987],{},"五到七歲——直的",[1875,1989],{},[11,1991,1992],{},"而步態的發展會按照以下時期發展",[15,1994,1995,1998,2006,2009,2012,2015,2018],{},[18,1996,1997],{},"反射踏步（靠反射）",[18,1999,2000,2001,1353],{},"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—— ",[1302,2002,2005],{"href":2003,"rel":2004},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002Fmotor-learning?series=%E5%B0%8F%E5%85%92%E7%89%A9%E6%B2%BB",[1306],"倒數第二段",[18,2007,2008],{},"過渡期",[18,2010,2011],{},"刻意跨步",[18,2013,2014],{},"獨立行走",[18,2016,2017],{},"Heell-toe步態",[18,2019,2020],{},"整合或直立行走成熟期",[1875,2022],{},[11,2024,2025],{},"接著來看不同系統的發展進程，從出生至九個月",[142,2027,2028,2034,2040,2046],{},[18,2029,2030,2031,2033],{},"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）",[44,2032],{},"\n尤其是視覺發展遠大於粗大動作",[18,2035,2036,2037,2039],{},"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",[44,2038],{},"\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",[18,2041,2042,2043,2045],{},"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)",[44,2044],{},"\nHip abduction(訓練方法是扶物側行)",[18,2047,2048,2049,2051],{},"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",[44,2050],{},"\n步寬外展；外轉(O型腿)；髖屈曲；足跟外翻",[1875,2053],{},[11,2055,2056],{},"時間來到了九個月到第十五個月之間的發展進程",[15,2058,2059,2062,2065],{},[18,2060,2061],{},"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)",[18,2063,2064],{},"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",[18,2066,2067,2068,2070],{},"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",[44,2069],{},"\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",[1875,2072],{},[11,2074,2075],{},"接下來時間來到了十八個月到二十四個月的發展進程",[15,2077,2078,2084],{},[18,2079,2080,2081,2083],{},"力學因素——重心下降(由於腿快速生長)，BOS減少",[44,2082],{},"\nROM的話O型腿消失，但有旋前足出現",[18,2085,2086,2087,2089],{},"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；",[44,2088],{},"\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)",[1875,2091],{},[11,2093,2094],{},"時間繼續來到了三歲到三歲半的發展進程",[15,2096,2097,2100],{},[18,2098,2099],{},"力學因素——ROM的話膝外翻(X型腿)，且有旋前足出現",[18,2101,2102],{},"功能性步態——足跟著地穩定，且出現Knee flexion",[1875,2104],{},[11,2106,2107],{},"最後時間來到了六歲到七歲的發展進程",[15,2109,2110,2113],{},[18,2111,2112],{},"力學因素——已經能直立行走，並且不在有旋前足",[18,2114,2115],{},"功能性步態——與成人一樣",{"title":209,"searchDepth":210,"depth":210,"links":2117},[],"步態~步態發展","\u002Fimages\u002Fuploads\u002F1775979234822-139196433_p0_master1200.webp",{},"\u002Fblog\u002F小兒發展（二）",{"title":279,"description":2118},{"loc":2121},"blog\u002F小兒發展（二）","ScVwjiCjwCAhdOVX_aORN11S38Xd5Fb_3-0haIKlezk",1775990610992]