[{"data":1,"prerenderedAt":2297},["ShallowReactive",2],{"\u002Fblog\u002Fmotor-learning":3,"post-count":498,"series-global-data":499,"authors-all":569,"series-sidebar-小兒物治":761},{"id":4,"title":5,"author":6,"body":7,"date":484,"description":485,"draft":486,"edited_at":487,"extension":488,"featured_image":489,"meta":490,"navigation":491,"path":492,"pinned":486,"seo":493,"series":494,"seriesOrder":494,"sitemap":495,"stem":496,"tags":494,"__hash__":497},"blog\u002Fblog\u002FMotor-Learning.md","Motor Learning小兒（一）","hibiki12141132",{"type":8,"value":9,"toc":480},"minimark",[10,14,24,33,51,60,69,89,98,128,204,219,222,266,272,321,367,408,411,449,464],[11,12,13],"p",{},"那這一節課著重在動態模組理論，跟黃老師教的是互通的",[11,15,16,17,20,21,23],{},"那首先是講感覺統合的部份",[18,19],"br",{},"\n意思是指 知覺+大腦以往的經歷 結合成為認知的這麼一個過程",[18,22],{},"\n而感覺統合就是結合的過程 認知是結果這樣(這跟神經物治講的動作控制學雷同)",[11,25,26,27,29,30,32],{},"而接下來講到動作的發展",[18,28],{},"\n那老師用的理論是動態模組理論",[18,31],{},"\n假如還記得黃老師的Motor Control最後一課講的應該不難吃",[11,34,35,36,38,39,41,42,44,45,47,48,50],{},"不過我還是先列出來老師PPT裡的五個角度",[18,37],{},"\n第一 動作技巧的顯現",[18,40],{},"\n第二 動作型態的精準度",[18,43],{},"\n第三 動作成果(可從評估表推估) ",[18,46],{},"\n第四 組合技巧的獲得(次系統組合的結果)",[18,49],{},"\n第五 對環境適應力的增強",[11,52,53,54,56,57,59],{},"我們現在來講平衡系統的發展",[18,55],{},"\n1)平衡系統有三個人一起負責 迷路系統 本體覺與觸覺 視角",[18,58],{},"\n以站立來形容的話",[11,61,62,63,65,66,68],{},"2)人類的重心(COM)基本會在S2 ",[18,64],{},"\n那壓力中心(COP)是動態的 他會因應COM的改變而改變",[18,67],{},"\n那底面積(BOS)就是兩隻腳踩在地面的距離",[11,70,71,72,79,80,82,83,88],{},"3)那平衡的演化 在早期 小孩會",[73,74,78],"span",{"className":75},[76,77],"red-3","underline","極度依賴視角","來判斷",[18,81],{},"\n但在成熟的過程中 我們會",[73,84,87],{"className":85},[86],"bg-red-3","越來越傾向用本體感覺","去判斷",[11,90,91,92,94,95,97],{},"4)穩定極限(LOS) 他把我們人類想象成一個倒立的三角錐",[18,93],{},"\n在不移動的情況下身體能偏多少(前6度 側8度 後4度)",[18,96],{},"\n因為前面有腳趾輔助 而且側邊是比較寛 但後面甚麼都沒有 所以角度就變成這樣了(可以看游老師的講義)",[11,99,100,101,103,104,109,110,115,116,118,119,123,124],{},"5)承受外力時的反應時 人類會有兩種變化",[18,102],{},"\n第一種就是假如這",[73,105,108],{"className":106},[77,107],"green-3","外力少到一定範圍"," 就只會用",[73,111,114],{"className":112},[113],"bg-green-3","姿勢穩定反應","來做調整",[18,117],{},"\n另一種則是假如外力",[73,120,122],{"className":121},[77,76],"超過姿勢穩定反應可以調整的程度"," 就會產生",[73,125,127],{"className":126},[86],"保護性姿勢",[11,129,130,131,133,134,136,137,139,140,144,146,147,152,156,158,159,161,163,164,168,169,171,172,176,177,179,180,182,184,185,187,188,190,191,195,196,198,200,201,203],{},"6)",[18,132],{},"\ni) 我們在平衡反應上還有兩種策略可以選 一種是固定BOS的 一種是改變BOS的",[18,135],{},"\n首先是固定的一類 最熟悉的就是我們的踝策略和髖策略",[18,138],{},"\n那一般而言 越成熟的人 會越偏好用",[73,141,143],{"className":142},[76],"踝策略",[18,145],{},"\n而目前比較新的提出 就是",[73,148,151],{"className":149},[150,77],"yellow-3","抓握",[73,153,155],{"className":154},[150],"是一種不算策略(Strategy)的方法",[18,157],{},"\n例如老人在快摔倒時握緊拐仗穩定好自己 這也是一種功能性向的反應",[18,160],{},[18,162],{},"\nii) 而另一點則是改變BOS的 例子就有跨步策略 身體是",[73,165,167],{"className":166},[76],"被迫做出","的 伸手出去支撐也是如此",[18,170],{},"\n那在發展過程中 而在",[73,173,175],{"className":174},[76],"方向性上也是有順序","的",[18,178],{},"\n往前大概在6個月大才學會 而側向是8個月大 最後才是後向10個月大",[18,181],{},[18,183],{},"\niii) 那在臨床上 有些病人可能會因為關節或肌肉力量的原因 ",[18,186],{},"\n我們會教導他們去利用拐仗 來增加BOS的大小 這樣他的LOS也會變大",[18,189],{},"\n我們",[73,192,194],{"className":193},[77],"可以通過適度的給他們外力","訓練他們",[18,197],{},[18,199],{},"\niv) 目前 reach test 是最好用來測病人靜態以及半靜態平衡的方法",[18,202],{},"\n盡可能讓病人手伸出去多一點 那假如伸得遠出去 平衡就越好",[11,205,206,207,209,210,212,213,215,216,218],{},"那對於小兒的發展議題，主要有這幾個",[18,208],{},"\ni)——新形式的起源(The origin of new form)",[18,211],{},"\nii)——連續性與非連續性(Continuity vs discontinuity)",[18,214],{},"\niii)——變異性(Variability)",[18,217],{},"\niv)——生物與環境的影響(Biological vs. environmental influence)",[11,220,221],{},"那動態模組理論是經歷過以下發展而來的",[223,224,225,233,253],"ol",{},[226,227,228,229],"li",{},"那首先是小兒痲痺(1910s)——當年的理念是哪邊無力練哪邊",[73,230,232],{"className":231},[77,86],"(肌肉再教育 muscle re-education)",[226,234,235,236,240,241,243,244,246,247,249,250,252],{},"接著是1950s——當年他們開始著重以神經成熟理論為基礎學派，著重在",[73,237,239],{"className":238},[86,77],"感覺輸入","促進正常的動作以及動作發展",[18,242],{},"\n神經成熟理論(1945s)由Gesell和McGraw提出，他們的關鍵理念有如下",[18,245],{},"\nCNS髓鞘化(Increased myelination of CNS)",[18,248],{},"\n皮質抑制皮質下中心(Inhibition of the subcortical centers by the higher cerebral cortex)",[18,251],{},"\n層級控制(Hierarchical control)",[226,254,255,256,260,261,265],{},"最後來講到階層理論的雛型(1980s)——當年他們覺得動作發展",[73,257,259],{"className":258},[77],"不只單一的神經支配","，把",[73,262,264],{"className":263},[77,76],"其他的系統、環境","一併整合進來",[11,267,268,269,271],{},"那神經成熟理論貢獻有兩點，正常的發展與病理的進程，以及反射到動作里程碑的評估",[18,270],{},"\n那它有三個假設",[223,273,274,285,305],{},[226,275,276,277,279,280,284],{},"從反射到隨意動作——意思是剛出生只有原始反射，但隨著大腦成熟這些反射會被抑制",[18,278],{},"\n但在1979s有學者提出說，其實原始反射對於每個寶寶來說",[73,281,283],{"className":282},[76],"變異性","也很大",[226,286,287,288,290,291,295,296,300,301],{},"頭尾走向——意思是身體的發展一定是從頭到胸到骨盤再到下肢的發展",[18,289],{},"\n但在1976s有學者發現到，南非的寶寶被家長",[73,292,294],{"className":293},[77],"直立抱法或者練習坐","，會比美國寶寶",[73,297,299],{"className":298},[76],"更快發展出下肢動作","，但",[73,302,304],{"className":303},[107],"爬和翻身較慢",[226,306,307,308,310,311,315,316,320],{},"最後是近端到遠端——意思是身體發展要先學會控制近端(肩、軀幹)，而後才能控制遠端(手指)",[18,309],{},"\n但在1988s有學者提出，寶寶的",[73,312,314],{"className":313},[107],"伸手以及操作","的發展在近端遠端上是",[73,317,319],{"className":318},[77,76],"同時存在","的(同步進行發展，並沒有明確上下關係)",[11,322,323,324,326,327,331,332,336,338,339,343,344,346,347,351,352,356,357,361,363,364,366],{},"那每個人在做動作時一定會受到自身物理特性影響例如關節角度、肌肉長度等因素",[18,325],{},"\n那協調就是將這些複雜的東西，透過",[73,328,330],{"className":329},[76],"降低自由度","，來",[73,333,335],{"className":334},[107],"產生平滑的動作",[18,337],{},"\n那降低自由度的策略會牽涉到一個叫",[73,340,342],{"className":341},[86],"自我組織","的東西，那它的核心理念是說",[18,345],{},"\n動作是有",[73,348,350],{"className":349},[86],"適應性","的，次系統會根據",[73,353,355],{"className":354},[77,76],"環境任務","等因素做調整，",[73,358,360],{"className":359},[107],"再拼湊起來",[18,362],{},"\n(舉例來說，即使一樣是走路，在光亮的環境和在昏暗的環境下，也會做一些微調)（Bernstein提出）",[18,365],{},"\n有提到三個重點",[223,368,369,375,391],{},[226,370,371,372,374],{},"次序參數——它探討的是關節之間的協同",[18,373],{},"\n例如在同一個動作型態上，做不同的任務，力度或關節角度也稍微不同，但假如相對時間相同，就能利用次序參數說明",[226,376,377,378,382,383,385,386,390],{},"那個體在發展過程中會因應不同的任務去做動作調整，而通常會採取",[73,379,381],{"className":380},[77,86],"最省力、自然以及方便","的動作型態",[18,384],{},"\n那假如這個動作達到了上述說的型態，便是",[73,387,389],{"className":388},[76,77],"最穩定型態","，即使會因應任務去做改變也是十分穩定的",[226,392,393,394,396,397,401,402,404,405,407],{},"相移現象——意思就是說原本在做著一個穩定的動作型態",[18,395],{},"\n因為一些",[73,398,400],{"className":399},[76],"因素所干擾","，就會變成另一個動作型態",[18,403],{},"\n(例如速度的改變從走路變成跑步，相對時間不同，所以是另一個型態，不適應次序參數)",[18,406],{},"\n（對 黃老師教動態系統理論也提到過這個）",[11,409,410],{},"最後講兩個實驗",[223,412,413,435],{},[226,414,415,416,418,419,421,422,426,427,431,432,434],{},"第一個是關於踏步反射的實驗，那踏步反射在作原始反射，在第四周會消失，但在一歲時又會再次出現",[18,417],{},"\n而神經成熟理論認為，是因為大腦成熟了，讓高階抑制了低階",[18,420],{},"\n但動態模組理論發現，其實是因為在第四周寶寶",[73,423,425],{"className":424},[77,76],"長脂肪比長肌肉快","，導致",[73,428,430],{"className":429},[107],"力量不足","做不出來",[18,433],{},"\n將寶寶放在水中利用浮力降低脂肪重量，踏步反射就可以又被誘發出來",[226,436,437,438,440,441,443,444,448],{},"第二個實驗，是觀察青蛙生長的環境與發育的關係",[18,439],{},"\n青蛙需要水跟泥土的環境才能發育健全，假如只給水不給泥土的環境，就會讓發育有缺陷",[18,442],{},"\n所以神經成熟是可以讓動作型態形成，但必須得加上",[73,445,447],{"className":446},[77,76],"環境，時間以及個體本身條件","才能讓型態表現更好",[11,450,451,452,454,455,457,458,460,461,463],{},"那在臨床意義上有以下幾點",[18,453],{},"\n分散式控制(Distributed control)",[18,456],{},"\n控制參數可能來自兒童或者環境(Control parameter may be from the child or from the environment)",[18,459],{},"\n由兒童主導(Active role of the child)",[18,462],{},"\n個體差異的訊息(variability provides important information)",[11,465,466,467,471,472,476,477,479],{},"評估",[73,468,470],{"className":469},[77,113],"不應只侷限在探討神經發展過程","，而是要根據",[73,473,475],{"className":474},[86,77],"多個系統，家庭因素","等問題",[18,478],{},"\n(之前聽到的例子，有一個治療師說家長假如一直給小兒玩手機沒讓他們多動，確實會讓發展遲緩)",{"title":481,"searchDepth":482,"depth":482,"links":483},"",2,[],"2026-03-31","感覺統合~三個協調的重點",false,"2026-04-10","md","\u002Fimages\u002Fuploads\u002F1775795013607-141589321_p0.jpg",{},true,"\u002Fblog\u002Fmotor-learning",{"title":5,"description":485},null,{"loc":492},"blog\u002FMotor-Learning","WfAalY0VpEvjA4FEwqJIqFvJHZ0cmvKnrpM76PAKB1U",70,{"id":500,"extension":501,"meta":502,"series":503,"stem":567,"__hash__":568},"series\u002Fseries.json","json",{},{"微積分教學":504,"生活紀錄":507,"Motor Control":509,"生活隨筆":523,"Motor 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語言障礙",[18,899],{},[18,901],{},"\n對稱協調控制",[18,904],{},"\n雙側控制",[11,907,908,909,827,911,915,917,918,920,921,923,924,926,927,929,930,932,933,935],{},"最後來講失調型(Ataxia)",[18,910],{},[73,912,914],{"className":913},[86],"小腦",[18,916],{},"\n張力小",[18,919],{},"\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)",[18,922],{},"\n併發有 平衡 感覺統合 知覺都會較差",[18,925],{},"\n在治療重點上",[18,928],{},"\n會給他們穿加壓衣(增加感統知覺) ",[18,931],{},"\n穩定與張力提升",[18,934],{},"\n承重(增加感統知覺)",[11,937,938,939,941,942,944,945,947],{},"還有一些小分類 簡單帶過一下",[18,940],{},"\n首先是僵直型 這個是比痙攣型張力還要再強",[18,943],{},"\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",[18,946],{},"\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",[11,949,950,951,953,954,956,957,959,960,962,963,965,966,968,969,973],{},"接著來講治療原則 主要有五點",[18,952],{},"\n早期教育(早療 黃金期)",[18,955],{},"\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)",[18,958],{},"\n治療項目盡量以ADL為主",[18,961],{},"\n日常活動(結合孩子一天的作息去制定訓練 回家訓練)",[18,964],{},"\n感官輸入(如本體感覺 觸覺)",[18,967],{},"\n老師有圈了個重點 ",[73,970,972],{"className":971},[76],"張力 並不等於 肌力","(張力很大 但肌力通常低下 要控制張力同時訓練肌力)",[11,975,976,977,979,980,984,985,979,987,991,992,994,995,999],{},"最後來講預後",[18,978],{},"\n假如 ",[73,981,983],{"className":982},[77],"2歲前","的寶寶能自行坐起來 未來100%能夠自行走動",[18,986],{},[73,988,990],{"className":989},[77],"4歲的","寶寶還不會自行坐起來 未來不會走",[18,993],{},"\n假如 是",[73,996,998],{"className":997},[77],"偏癱","的寶寶 未來100%能夠自行走動",[11,1001,1002],{},[1003,1004],"img",{"alt":1005,"src":1006},"1.00","https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774841979537-Screenshot_20260330_100529_Gallery.png",[11,1008,1009],{},[1003,1010],{"alt":1005,"src":1011},"https:\u002F\u002Fraw.githubusercontent.com\u002FChinHongTan\u002Fblog\u002Fmain\u002Fpublic\u002Fimages\u002Fuploads\u002F1774842001784-Screenshot_20260330_100531_Gallery.png",[11,1013,1014,1015,1017],{},"一些講義的內容 我隨後會在另一篇裡加上 ",[18,1016],{},[73,1018,1020],{"className":1019},[86],"讀英文！！！",{"title":481,"searchDepth":482,"depth":482,"links":1022},[],"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":764,"description":1024},{"loc":1027},"blog\u002F腦性痲痺-CP",[1032],"小兒PT","VRwnEKZEYqmW7o2UAStJ5mCqG7YSqw_jRSxAkVYjn34",{"id":4,"title":5,"author":6,"body":1035,"date":484,"description":485,"draft":486,"edited_at":487,"extension":488,"featured_image":489,"meta":1343,"navigation":491,"path":492,"pinned":486,"seo":1344,"series":494,"seriesOrder":494,"sitemap":1345,"stem":496,"tags":494,"__hash__":497},{"type":8,"value":1036,"toc":1341},[1037,1039,1045,1051,1063,1069,1075,1085,1091,1109,1161,1171,1173,1201,1205,1237,1267,1294,1296,1321,1331],[11,1038,13],{},[11,1040,16,1041,20,1043,23],{},[18,1042],{},[18,1044],{},[11,1046,26,1047,29,1049,32],{},[18,1048],{},[18,1050],{},[11,1052,35,1053,38,1055,41,1057,44,1059,47,1061,50],{},[18,1054],{},[18,1056],{},[18,1058],{},[18,1060],{},[18,1062],{},[11,1064,53,1065,56,1067,59],{},[18,1066],{},[18,1068],{},[11,1070,62,1071,65,1073,68],{},[18,1072],{},[18,1074],{},[11,1076,71,1077,79,1080,82,1082,88],{},[73,1078,78],{"className":1079},[76,77],[18,1081],{},[73,1083,87],{"className":1084},[86],[11,1086,91,1087,94,1089,97],{},[18,1088],{},[18,1090],{},[11,1092,100,1093,103,1095,109,1098,115,1101,118,1103,123,1106],{},[18,1094],{},[73,1096,108],{"className":1097},[77,107],[73,1099,114],{"className":1100},[113],[18,1102],{},[73,1104,122],{"className":1105},[77,76],[73,1107,127],{"className":1108},[86],[11,1110,130,1111,133,1113,136,1115,139,1117,1120,146,1122,1125,1128,158,1130,1132,163,1134,168,1137,171,1139,176,1142,179,1144,1146,184,1148,187,1150,190,1152,195,1155,1157,200,1159,203],{},[18,1112],{},[18,1114],{},[18,1116],{},[73,1118,143],{"className":1119},[76],[18,1121],{},[73,1123,151],{"className":1124},[150,77],[73,1126,155],{"className":1127},[150],[18,1129],{},[18,1131],{},[18,1133],{},[73,1135,167],{"className":1136},[76],[18,1138],{},[73,1140,175],{"className":1141},[76],[18,1143],{},[18,1145],{},[18,1147],{},[18,1149],{},[18,1151],{},[73,1153,194],{"className":1154},[77],[18,1156],{},[18,1158],{},[18,1160],{},[11,1162,206,1163,209,1165,212,1167,215,1169,218],{},[18,1164],{},[18,1166],{},[18,1168],{},[18,1170],{},[11,1172,221],{},[223,1174,1175,1180,1193],{},[226,1176,228,1177],{},[73,1178,232],{"className":1179},[77,86],[226,1181,235,1182,240,1185,243,1187,246,1189,249,1191,252],{},[73,1183,239],{"className":1184},[86,77],[18,1186],{},[18,1188],{},[18,1190],{},[18,1192],{},[226,1194,255,1195,260,1198,265],{},[73,1196,259],{"className":1197},[77],[73,1199,264],{"className":1200},[77,76],[11,1202,268,1203,271],{},[18,1204],{},[223,1206,1207,1214,1227],{},[226,1208,276,1209,279,1211,284],{},[18,1210],{},[73,1212,283],{"className":1213},[76],[226,1215,287,1216,290,1218,295,1221,300,1224],{},[18,1217],{},[73,1219,294],{"className":1220},[77],[73,1222,299],{"className":1223},[76],[73,1225,304],{"className":1226},[107],[226,1228,307,1229,310,1231,315,1234,320],{},[18,1230],{},[73,1232,314],{"className":1233},[107],[73,1235,319],{"className":1236},[77,76],[11,1238,323,1239,326,1241,331,1244,1247,338,1249,343,1252,346,1254,351,1257,356,1260,1263,363,1265,366],{},[18,1240],{},[73,1242,330],{"className":1243},[76],[73,1245,335],{"className":1246},[107],[18,1248],{},[73,1250,342],{"className":1251},[86],[18,1253],{},[73,1255,350],{"className":1256},[86],[73,1258,355],{"className":1259},[77,76],[73,1261,360],{"className":1262},[107],[18,1264],{},[18,1266],{},[223,1268,1269,1273,1283],{},[226,1270,371,1271,374],{},[18,1272],{},[226,1274,377,1275,382,1278,385,1280,390],{},[73,1276,381],{"className":1277},[77,86],[18,1279],{},[73,1281,389],{"className":1282},[76,77],[226,1284,393,1285,396,1287,401,1290,404,1292,407],{},[18,1286],{},[73,1288,400],{"className":1289},[76],[18,1291],{},[18,1293],{},[11,1295,410],{},[223,1297,1298,1312],{},[226,1299,415,1300,418,1302,421,1304,426,1307,431,1310,434],{},[18,1301],{},[18,1303],{},[73,1305,425],{"className":1306},[77,76],[73,1308,430],{"className":1309},[107],[18,1311],{},[226,1313,437,1314,440,1316,443,1318,448],{},[18,1315],{},[18,1317],{},[73,1319,447],{"className":1320},[77,76],[11,1322,451,1323,454,1325,457,1327,460,1329,463],{},[18,1324],{},[18,1326],{},[18,1328],{},[18,1330],{},[11,1332,466,1333,471,1336,476,1339,479],{},[73,1334,470],{"className":1335},[77,113],[73,1337,475],{"className":1338},[86,77],[18,1340],{},{"title":481,"searchDepth":482,"depth":482,"links":1342},[],{},{"title":5,"description":485},{"loc":492},{"id":1347,"title":1348,"author":6,"body":1349,"date":487,"description":1561,"draft":486,"edited_at":1562,"extension":488,"featured_image":1563,"meta":1564,"navigation":491,"path":492,"pinned":486,"seo":1565,"series":494,"seriesOrder":494,"sitemap":1566,"stem":1567,"tags":494,"__hash__":1568},"blog\u002Fblog\u002FMotor-Learning小兒（二）.md","Motor Learning小兒（二）",{"type":8,"value":1350,"toc":1559},[1351,1354,1360,1369,1372,1392,1395],[11,1352,1353],{},"阿對的，又要來講動作學習的定義了，雖然之前就有講過",[11,1355,1356,1357,1359],{},"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)",[18,1358],{},"\n動作學習就是過程，而動作表現是動作做出來的結果。",[11,1361,1362,1363,1365,1366,1368],{},"而這邊講道Positive和Negative Sign",[18,1364],{},"\nPositive是指正常人沒有，但病人身上會出現的異常動作",[18,1367],{},"\nNegative則相反，正常人有的，但病人身上無法出現",[11,1370,1371],{},"對於動作學習有三大要素",[223,1373,1374,1377,1386],{},[226,1375,1376],{},"偵測練習——初期PT可以直接監測教導，而後讓病人自己監測自己動作，並且利用內在回饋方式，有利於long-term effect",[226,1378,1379,1380,1382,1383,1385],{},"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",[18,1381],{},"\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",[18,1384],{},"\n同儕競爭互相鼓勵、最後才是給予獎勵作為誘因激發動機",[226,1387,1388,1389,1391],{},"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",[18,1390],{},"\n而任務越具體，更能引導寶寶產生興趣",[11,1393,1394],{},"那動作學習有以下三個考量點",[223,1396,1397,1450,1498],{},[226,1398,1399,1400,1404,1405,1409,1410,1417,1418,1420,1421,1423,1424,1428,1429,1431,1432,1436,1437,1441,1442,1444,1445,1449],{},"轉移——意思是",[73,1401,1403],{"className":1402},[77,107],"相同相似的技巧","在不同情景下可以變化",[73,1406,1408],{"className":1407},[76,77],"產生新的","動作型態 (這裡也有說到 ",[1411,1412,1416],"a",{"href":1413,"rel":1414},"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",[1415],"nofollow","在最後一段",")",[18,1419],{},"\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",[18,1422],{},"\n所以我們可以借由",[73,1425,1427],{"className":1426},[107],"先學簡單","且技巧相同相似的動作，慢慢的去訓練到難的或具有功能性ADL等的動作",[18,1430],{},"\n也可以透過",[73,1433,1435],{"className":1434},[77,76],"環境改造","達成這一點，例如說寶寶的手還沒有能握住細筷子的能力，可以用",[73,1438,1440],{"className":1439},[77],"加粗","的方式讓寶寶更好握住",[18,1443],{},"\n但記得靠轉移來學習新的動作型態",[73,1446,1448],{"className":1447},[77,76],"不能一下子改太多太難","參數",[226,1451,1452,1453,1458,1459,1463,1464,1466,1467,1471,1472,1474,1475,1479,1481,1482,1486,1487,1489,1490,1494,1495,1497],{},"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（",[1411,1454,1457],{"href":1455,"rel":1456},"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",[1415],"一","，",[1411,1460,1462],{"href":1413,"rel":1461},[1415],"二","）",[18,1465],{},"\n集中VS分散，分散休息時間更長，對",[73,1468,1470],{"className":1469},[77],"學習較難或易疲勞病人","來說更佳",[18,1473],{},"\n段落VS隨機，隨機較難，但通常對",[73,1476,1478],{"className":1477},[107,77],"形成長期記憶以記轉移效果更有",[18,1480],{},"\n固定VS變異，變異在",[73,1483,1485],{"className":1484},[76,77],"轉移效果上","更佳",[18,1488],{},"\n全部VS分段，分段有",[73,1491,1493],{"className":1492},[77,76],"減負效果","，在學習較難動作時可以運用，將同一套動作數個技巧慢慢拆分練習",[18,1496],{},"\n心像練習，在腦中模擬動作型態",[226,1499,1500,1501,1458,1505,1458,1509,1458,1514,1417,1519,1521,1522,1524,1525,1527,1528,1463,1532,1534,1535,1539,1540,1542,1543,1547,1548,1550,1551,1553,1554,1558],{},"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(",[1411,1502,1457],{"href":1503,"rel":1504},"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",[1415],[1411,1506,1462],{"href":1507,"rel":1508},"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",[1415],[1411,1510,1513],{"href":1511,"rel":1512},"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",[1415],"三",[1411,1515,1518],{"href":1516,"rel":1517},"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",[1415],"四",[18,1520],{},"\nKR與KP，KR效度比KP更佳",[18,1523],{},"\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",[18,1526],{},"\n（",[1411,1529,1531],{"href":1516,"rel":1530},[1415],"這裡第一段有提到",[18,1533],{},"\n回饋的方法，",[1411,1536,1538],{"href":1507,"rel":1537},[1415],"這一篇的後半段","有提到，可以再複習一下",[18,1541],{},"\n先設定一個",[73,1544,1546],{"className":1545},[107],"區間","，達到的都算得分",[18,1549],{},"\n回饋也可以做遞減，逐漸減少依賴",[18,1552],{},"\n假如病人",[73,1555,1557],{"className":1556},[76,77],"主動要求回饋","，我們再給予，也會更佳",{"title":481,"searchDepth":482,"depth":482,"links":1560},[],"Motor Learning定義~結束","2026-04-11","\u002Fimages\u002Fuploads\u002F1775875520542-37128694_p0_master1200.jpg",{},{"title":1348,"description":1561},{"loc":492},"blog\u002FMotor-Learning小兒（二）","rQGIJJBG2JYTCd6jNzFlYufI482TpWmQ5YIfX_Gkt4s",{"id":1570,"title":1571,"author":6,"body":1572,"date":1562,"description":1772,"draft":486,"edited_at":1562,"extension":488,"featured_image":1773,"meta":1774,"navigation":491,"path":1775,"pinned":486,"seo":1776,"series":494,"seriesOrder":494,"sitemap":1777,"stem":1778,"tags":494,"__hash__":1779},"blog\u002Fblog\u002FGait-analysis小兒（一）.md","Gait analysis小兒（一）",{"type":8,"value":1573,"toc":1770},[1574,1577,1580,1597,1600,1611,1614,1631,1657,1663,1666,1684,1693,1704,1719,1725,1753,1756],[11,1575,1576],{},"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",[11,1578,1579],{},"那下肢雙關節肌肉有以下",[223,1581,1582,1585,1588,1591,1594],{},[226,1583,1584],{},"腰大肌——Hip Flexion, Trunk Flexion",[226,1586,1587],{},"腿後肌——Hip Extension, Knee Flexion",[226,1589,1590],{},"股直肌——Hip Flexion, Knee Extension",[226,1592,1593],{},"腓腸肌——Knee Flexion, PF",[226,1595,1596],{},"縫匠肌——Hip Flexion, Hip ER",[11,1598,1599],{},"那單關節的肌肉有",[223,1601,1602,1605,1608],{},[226,1603,1604],{},"臀大肌——Hip Extension, Hip ER",[226,1606,1607],{},"脛前肌——DF, inversion",[226,1609,1610],{},"腓骨長肌——PF, eversion",[11,1612,1613],{},"那以下動作的抗重力與無抗重力的擺位姿勢為",[223,1615,1616,1619,1622,1625,1628],{},[226,1617,1618],{},"Hip Extension——Prone 抗重力, side-lying 無抗重力",[226,1620,1621],{},"Hip Flexion——Sitting 抗重力, side-lying 無抗重力",[226,1623,1624],{},"Hip Abduction——Side-lying 抗重力, supine 無抗重力",[226,1626,1627],{},"Knee Extension——Sitting 抗重力, side-lying 無抗重力",[226,1629,1630],{},"PF——Standing 抗重力, prone 無抗重力",[11,1632,1633,1634,1636,1637,1641,1642,1646,1648,1649,1651,1652,1656],{},"接下來講一個異常步態——Crouch gait",[18,1635],{},"\n為甚麼他會呈現屈曲狀態，主要是因為",[73,1638,1640],{"className":1639},[77,76],"雙關節肌肉張力過強","，而",[73,1643,1645],{"className":1644},[77,107],"單關節肌肉力量不足",[18,1647],{},"\n不是單純的肌肉太緊，也是一種肌力失衡的表現",[18,1650],{},"\n其中，在",[73,1653,1655],{"className":1654},[77],"腿固定時(stand)，屈曲大腿的肌肉作用，會讓骨盤前傾","(像是髂腰肌)",[11,1658,1659,1660,1662],{},"接著來講步態的參數",[18,1661],{},"\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)",[11,1664,1665],{},"這邊提到一個中風後會出現的代償步態",[1667,1668,1669,1672,1675,1678,1681],"ul",{},[226,1670,1671],{},"步速下降",[226,1673,1674],{},"步距縮短或不對稱",[226,1676,1677],{},"步寬變大(BOS增加)",[226,1679,1680],{},"雙腳站立期變長",[226,1682,1683],{},"依賴手部支撐",[11,1685,1686,1687,1689,1690,1692],{},"接著講Gait cycle，分別為站立期以及擺盪期",[18,1688],{},"\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",[18,1691],{},"\n完成這三個任務又分成了這八個動作",[223,1694,1695,1698,1701],{},[226,1696,1697],{},"承重——Initial contact和Loading Response",[226,1699,1700],{},"單腳支撐——Mid-stance, Terminal Stance和Pre-swing",[226,1702,1703],{},"肢體向前——Pre-swing, Initial swing, Mid-swing和Terminal Swing",[11,1705,1706,1707,1711,1712,1714,1715],{},"而Pre-swing雖然腳尖還沒離地，但",[73,1708,1710],{"className":1709},[77,107],"重心其實已經轉移去另一隻腳","了",[18,1713],{},"\n其中 ",[73,1716,1718],{"className":1717},[77],"Initial contact和Pre-swing為雙腳承重期",[11,1720,1721,1722,1724],{},"我們現在攤開來看站立期和擺盪期下肢各關節變化",[18,1723],{},"\n首先是站立期",[223,1726,1727,1735,1738,1744,1750],{},[226,1728,1729,1730,1734],{},"在雙腳承重期，",[73,1731,1733],{"className":1732},[77,107],"足部會放平","，準備Push Off",[226,1736,1737],{},"Hip的話，在Initical Contact的Flexion到Terminal Stance的Hyperextension",[226,1739,1740,1741,1743],{},"Knee的話，會從Flexion姿勢，到Mid-stance的Extension，再變回Pre-swing的Flexion",[18,1742],{},"\n(Flexion>Extension>Flexion)",[226,1745,1746,1747,1749],{},"Ankle的話，在Initical Contact的Neutral姿勢，Loading Response的PF，",[18,1748],{},"\nMid-stance的DF，最後是Terminal Stance\u002FPre-swing的PF（Neutral>PF>DF>PF）",[226,1751,1752],{},"Pelvis的話，基本保持水平，但在Terminal stance會略微前傾",[11,1754,1755],{},"然後是擺盪期",[223,1757,1758,1761,1764,1767],{},[226,1759,1760],{},"Knee的話，在Initical swing時會呈現Flexion，在Terminal swing會Full-extension",[226,1762,1763],{},"Hip的話，從Initical swing的Hyperextension，在Terminal swing會變成Flexion",[226,1765,1766],{},"Ankle的話，保持DF狀態，使腳尖不會碰到地板",[226,1768,1769],{},"Pelvis的話，會Rotation",{"title":481,"searchDepth":482,"depth":482,"links":1771},[],"肌肉~步態各分期關節姿勢","\u002Fimages\u002Fuploads\u002F1775885400167-37100769_p0.png",{},"\u002Fblog\u002FGait-analysis小兒（一）",{"title":1571,"description":1772},{"loc":1775},"blog\u002FGait-analysis小兒（一）","IPE1YCLIHjaGM3K3t637opIC_UJyveODI_bALybZ_94",{"id":1781,"title":1782,"author":6,"body":1783,"date":1562,"description":1971,"draft":486,"edited_at":1562,"extension":488,"featured_image":1972,"meta":1973,"navigation":491,"path":1974,"pinned":486,"seo":1975,"series":494,"seriesOrder":494,"sitemap":1976,"stem":1977,"tags":494,"__hash__":1978},"blog\u002Fblog\u002FGait-analysis小兒（二）.md","Gait analysis小兒（二）",{"type":8,"value":1784,"toc":1969},[1785,1788,1902,1905,1940,1952,1958],[11,1786,1787],{},"現在我們將八個步態分期拆開了細看",[223,1789,1790,1814,1828,1846,1856,1877,1896,1899],{},[226,1791,1792,1793,1797,1801,1802,1806,1810,1811,1813],{},"Initical Contact——用",[73,1794,1796],{"className":1795},[77],"股四頭肌和脛前肌做",[73,1798,1800],{"className":1799},[77,76],"離心收縮","，這時",[73,1803,1805],{"className":1804},[77],"腿後肌做",[73,1807,1809],{"className":1808},[77,107],"向心收縮","協同加速穩定",[18,1812],{},"\n（減速與準備承重）",[226,1815,1816,1817,1821,1824,1825,1827],{},"Loading Response——",[73,1818,1820],{"className":1819},[77],"肌內側肌與脛前肌做",[73,1822,1800],{"className":1823},[77,76],"，而臀大肌以及腿後肌輔助Hip加速，將重心向前移動",[18,1826],{},"\n（避震）",[226,1829,1830,1831,1641,1835,1839,1842,1843,1845],{},"Mid-stance——膝蓋後方有關節囊結構的緣故，肌四頭肌幾乎",[73,1832,1834],{"className":1833},[107],"不需用力",[73,1836,1838],{"className":1837},[77],"比目魚肌此時做",[73,1840,1800],{"className":1841},[77,76],"控制脛骨速度",[18,1844],{},"\n（省力）",[226,1847,1848,1849,1853,1855],{},"Terminal stance——",[73,1850,1852],{"className":1851},[77,107],"腓腸肌與比目魚肌做向心收縮",[18,1854],{},"\n（產生推進力）",[226,1857,1858,1859,1863,1458,1866,1868,1869,1873],{},"Pre-swing——假如是慢速走路，會利用",[73,1860,1862],{"className":1861},[77],"縫匠肌(Sartorius)和肌薄肌(Graillis)做",[73,1864,1809],{"className":1865},[77,107],[18,1867],{},"\n快速行走則靠",[73,1870,1872],{"className":1871},[77],"肌直肌做",[73,1874,1876],{"className":1875},[77,150],"等長收縮",[226,1878,1879,1880,1884,1887,1889,1890,1893],{},"Initial swing——在慢速走路中，",[73,1881,1883],{"className":1882},[77],"股薄肌與縫匠肌會進行",[73,1885,1809],{"className":1886},[77,107],[18,1888],{},"\n而快速走路中，",[73,1891,1872],{"className":1892},[77],[73,1894,1876],{"className":1895},[77,150],[226,1897,1898],{},"Mid swing——靠慣性推進，基本沒有肌肉參與",[226,1900,1901],{},"Terminal swing——腿後肌做等長收縮，限制Knee extension速度",[11,1903,1904],{},"接著來講小腿後肌群無力的話會有甚麼問題",[1667,1906,1907,1917],{},[226,1908,1909,1910,1458,1914,1916],{},"Mid-stannce——比目魚肌無力的話，會讓",[73,1911,1913],{"className":1912},[76,77],"Ankle做DF",[18,1915],{},"\n那由於代償原因，Knee會做flexion來讓腳踩在地面，結果變成股四頭肌必須要加入收縮才能穩定站立",[226,1918,1919,1920,1924,1926,1927,1931,1932,426,1936],{},"Terminal stance和Pre-swing——腓腸肌力量不足的話，",[73,1921,1923],{"className":1922},[77,76],"沒辦法產生足夠的推進力",[18,1925],{},"\n只好讓",[73,1928,1930],{"className":1929},[76,77],"髖屈肌收縮","提起整段下肢，確保",[73,1933,1935],{"className":1934},[107],"腳尖離地",[73,1937,1939],{"className":1938},[86],"步距變短",[11,1941,1942,1943,1945,1946,1948,1949,1951],{},"最後講小孩的步態發展過程",[18,1944],{},"\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",[18,1947],{},"\n2歲的小孩懂得矢狀面(Sagittal-plane)關節旋轉",[18,1950],{},"\n7歲的小孩步態已經能達到成人標準了",[11,1953,1954,1955,1957],{},"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",[18,1956],{},"\n那CP小孩預測能力方面也分成了三個時段",[223,1959,1960,1963,1966],{},[226,1961,1962],{},"9~18個月——頭部控制能力",[226,1964,1965],{},"24個月——不需要支撐能獨自坐穩",[226,1967,1968],{},"30個月——做爬行",{"title":481,"searchDepth":482,"depth":482,"links":1970},[],"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",{"title":1782,"description":1971},{"loc":1974},"blog\u002FGait-analysis小兒（二）","b8ag1j-41EkcDyPxusedc-OHiManHuzgidmXxtyxgcc",{"id":1980,"title":551,"author":6,"body":1981,"date":1562,"description":2126,"draft":486,"edited_at":2127,"extension":488,"featured_image":2128,"meta":2129,"navigation":491,"path":2130,"pinned":486,"seo":2131,"series":494,"seriesOrder":494,"sitemap":2132,"stem":2133,"tags":494,"__hash__":2134},"blog\u002Fblog\u002F小兒發展（一）.md",{"type":8,"value":1982,"toc":2124},[1983,1986,2001,2007,2010,2036,2045,2048,2051,2068,2070,2073],[11,1984,1985],{},"（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）",[11,1987,1988,1989,1991,1992,1994,1995,1997,1998,2000],{},"那先來講發展遲緩的定義，它不單指運動層面上，還包括了",[18,1990],{},"\n知覺，語言，心理，社會，情緒等層面",[18,1993],{},"\n而這個動作遲緩有標準的",[18,1996],{},"\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",[18,1999],{},"\n根據WHO的數據，發生率為6~8%",[11,2002,2003,2004,2006],{},"那高危族群有以下",[18,2005],{},"\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",[11,2008,2009],{},"接下來講寶寶的正常發育過程，先從視角說起，如下",[223,2011,2012,2015,2018,2021,2024,2027,2030,2033],{},[226,2013,2014],{},"剛出生數天——眨眼反射",[226,2016,2017],{},"六周——注射物體",[226,2019,2020],{},"二到三個月——對明亮的東西感興趣",[226,2022,2023],{},"四個月——協調眼球轉動",[226,2025,2026],{},"一歲——影像認知發展完成，能看清輪廓",[226,2028,2029],{},"三歲——能分辨紅黃藍綠",[226,2031,2032],{},"五到六歲——可以分辨大多數顏色",[226,2034,2035],{},"八歲以前——有遠視現象（我問了Gemini也看不太懂就是了）",[11,2037,2038,2039,2041,2042,2044],{},"那關於視覺發展異常的問題包括了",[18,2040],{},"\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",[18,2043],{},"\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",[2046,2047],"hr",{},[11,2049,2050],{},"接著是聽覺發展，如下",[223,2052,2053,2056,2059,2062,2065],{},[226,2054,2055],{},"四個月——追尋聲音或說話來源",[226,2057,2058],{},"七到八個月——被叫名字有反應",[226,2060,2061],{},"十個月——仿說（無意義內容）",[226,2063,2064],{},"一到一歲半——初步聽懂簡單的話",[226,2066,2067],{},"兩歲以後——鸚鵡式學說話",[2046,2069],{},[11,2071,2072],{},"接下來是粗大動作的發展，如下",[223,2074,2075,2078,2081,2084,2087,2090,2093,2096,2099,2107,2115,2118,2121],{},[226,2076,2077],{},"兩個月——不穩定的抬頭控制",[226,2079,2080],{},"四個月——抬頭控制適當",[226,2082,2083],{},"五個月——翻身（先學會Prone to supine, 接著是supine to prone）",[226,2085,2086],{},"七個月——坐起來",[226,2088,2089],{},"八個月——爬行",[226,2091,2092],{},"九個月——需要支撐的站起來",[226,2094,2095],{},"十個月——僅需要極小輔助的從坐到站",[226,2097,2098],{},"一歲——獨立行走",[226,2100,2101,2102,2106],{},"兩歲——跑，",[73,2103,2105],{"className":2104},[107],"上樓梯","，踢球，投球，蹲下來",[226,2108,2109,2110,2114],{},"三歲——",[73,2111,2113],{"className":2112},[76],"下樓梯","，雙腳跳，騎三輪車",[226,2116,2117],{},"四歲——單腳跳",[226,2119,2120],{},"五歲——走直線",[226,2122,2123],{},"六歲——騎腳踏車",{"title":481,"searchDepth":482,"depth":482,"links":2125},[],"定義~粗大動作發展","2026-04-12","\u002Fimages\u002Fuploads\u002F1775957410970-EebbBUPUcAYSTE9.webp",{},"\u002Fblog",{"title":551,"description":2126},{"loc":2130},"blog\u002F小兒發展（一）","4ejiPQ8a9xnXVIFdzih8PoJrok3muVwRlBhhByq5HeI",{"id":2136,"title":552,"author":6,"body":2137,"date":2127,"description":2289,"draft":486,"edited_at":2127,"extension":488,"featured_image":2290,"meta":2291,"navigation":491,"path":2292,"pinned":486,"seo":2293,"series":494,"seriesOrder":494,"sitemap":2294,"stem":2295,"tags":494,"__hash__":2296},"blog\u002Fblog\u002F小兒發展（二）.md",{"type":8,"value":2138,"toc":2287},[2139,2142,2159,2161,2164,2192,2194,2197,2223,2225,2228,2242,2244,2247,2261,2263,2266,2274,2276,2279],[11,2140,2141],{},"那正常的寶寶下肢的生理變化也會按照一個叫鐘擺現象的過程發展",[223,2143,2144,2147,2150,2153,2156],{},[226,2145,2146],{},"新生兒——中度的膝內翻（O型腿）",[226,2148,2149],{},"六個月——輕度的O型腿",[226,2151,2152],{},"一歲半——直的",[226,2154,2155],{},"三歲半——輕度的膝外翻（X型腿）",[226,2157,2158],{},"五到七歲——直的",[2046,2160],{},[11,2162,2163],{},"而步態的發展會按照以下時期發展",[223,2165,2166,2169,2177,2180,2183,2186,2189],{},[226,2167,2168],{},"反射踏步（靠反射）",[226,2170,2171,2172,1463],{},"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—— ",[1411,2173,2176],{"href":2174,"rel":2175},"https:\u002F\u002Fblog.chinono.dev\u002Fblog\u002Fmotor-learning?series=%E5%B0%8F%E5%85%92%E7%89%A9%E6%B2%BB",[1415],"倒數第二段",[226,2178,2179],{},"過渡期",[226,2181,2182],{},"刻意跨步",[226,2184,2185],{},"獨立行走",[226,2187,2188],{},"Heell-toe步態",[226,2190,2191],{},"整合或直立行走成熟期",[2046,2193],{},[11,2195,2196],{},"接著來看不同系統的發展進程，從出生至九個月",[1667,2198,2199,2205,2211,2217],{},[226,2200,2201,2202,2204],{},"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）",[18,2203],{},"\n尤其是視覺發展遠大於粗大動作",[226,2206,2207,2208,2210],{},"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",[18,2209],{},"\n那關節部份——剛出生的寶寶：Hip會呈flexion contracture, ER>IR；膝內翻；假如承重時，會呈現旋前足",[226,2212,2213,2214,2216],{},"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)",[18,2215],{},"\nHip abduction(訓練方法是扶物側行)",[226,2218,2219,2220,2222],{},"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",[18,2221],{},"\n步寬外展；外轉(O型腿)；髖屈曲；足跟外翻",[2046,2224],{},[11,2226,2227],{},"時間來到了九個月到第十五個月之間的發展進程",[223,2229,2230,2233,2236],{},[226,2231,2232],{},"神經系統——開始能在視覺刺激或引導情況下行走，且開始具備有CPG的能力(反射抑或身體機能成熟以達成)",[226,2234,2235],{},"力學因素——重心較高(在下胸椎層級)，BOS左右積大前後面積小，直立姿勢下肌力尚有不足",[226,2237,2238,2239,2241],{},"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",[18,2240],{},"\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",[2046,2243],{},[11,2245,2246],{},"接下來時間來到了十八個月到二十四個月的發展進程",[223,2248,2249,2255],{},[226,2250,2251,2252,2254],{},"力學因素——重心下降(由於腿快速生長)，BOS減少",[18,2253],{},"\nROM的話O型腿消失，但有旋前足出現",[226,2256,2257,2258,2260],{},"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；",[18,2259],{},"\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)",[2046,2262],{},[11,2264,2265],{},"時間繼續來到了三歲到三歲半的發展進程",[223,2267,2268,2271],{},[226,2269,2270],{},"力學因素——ROM的話膝外翻(X型腿)，且有旋前足出現",[226,2272,2273],{},"功能性步態——足跟著地穩定，且出現Knee flexion",[2046,2275],{},[11,2277,2278],{},"最後時間來到了六歲到七歲的發展進程",[223,2280,2281,2284],{},[226,2282,2283],{},"力學因素——已經能直立行走，並且不在有旋前足",[226,2285,2286],{},"功能性步態——與成人一樣",{"title":481,"searchDepth":482,"depth":482,"links":2288},[],"步態~步態發展","\u002Fimages\u002Fuploads\u002F1775979234822-139196433_p0_master1200.webp",{},"\u002Fblog\u002F小兒發展（二）",{"title":552,"description":2289},{"loc":2292},"blog\u002F小兒發展（二）","ScVwjiCjwCAhdOVX_aORN11S38Xd5Fb_3-0haIKlezk",1775990610951]