作業(yè)治療身心功能基礎(chǔ)肌力評估教學(xué)課件

1、III. Kinesiologic conceptsB. Mobility- stabilityControlled movements occur within the framework of mobility and stability, or movement and posture (Cech & Martin, 1995 ).Postural control is about the relationship between stability (holding a posture) and mobility (moving).Random mobility occurs befo

2、re stability e.g. random hand and leg movements occur in newborns before deliberate 從容的 postures such as prone extension or prone-on-elbow Movement control can only be developed when a stable posture is established. e.g. infants learn to control movement by weight shifting in stable postures1Review第

3、1頁，共84頁。Review Motor control isThe processes involved in organizing and coordinating postures and movementsClassic reflexive hierarchy 經(jīng)典反射層次理論Motor control, in forms of reflex and reactions, are developed in correspondence to specific anatomic regions of Central Nervous System (CNS)Spinal cord 脊髓Br

4、ain stem 腦干Mid-brain 中腦Cortex 皮層At spinal cord level phasic short duration reciprocal inhibition Stepping & Placing Reflexes 牽張反射屈肌反射At brain stem level tonic long duration Con-contraction of agonist and antagonist muscles STNR ATNRAt mid-brain level At cortex level Righting reactions Neck Righting

5、Reaction Balance reactions Volition functionsMotor learning1: 2c01o4g/n9/i1t0ive (learning) phase 華 西 醫(yī) 2 院 : 康a 復(fù)ss 作o 業(yè)ci 治a 療tiv 張 e 玉 p 婷 hase(feedback) 3: 2autonomous phase第2頁，共84頁。第3頁，共84頁。知識要點(diǎn)肌張力的定義正常肌張力的形成神經(jīng)系統(tǒng)對肌張力的調(diào)節(jié)肌張力異常的常見原因肌張力的評定痙攣評定第4頁，共84頁。一、肌張力（Muscle Tone）無論是休息還是各種運(yùn)動活動中，肌肉都會處于不同程度的緊 張

6、狀態(tài)，肌肉的這種緊張度稱為肌張力(muscle tone, muscular tension)muscle toneis the continuous and passive partial contraction of the muscles, or the muscles resistance to passive stretch during resting state.正常肌張力是身體維持各種姿勢和正?；顒拥幕A(chǔ)正常的肌張力有賴于完整的外周和中樞系統(tǒng)功能和正常 的肌肉結(jié)構(gòu)與功能第5頁，共84頁。肌張力與肌力的區(qū)別肌力是主動收縮時產(chǎn)生的力量大小，或者主動 收縮肌肉的能力肌張力是一種無意識

7、的反射。主動的運(yùn)動可以改 變張力第6頁，共84頁。二、正常肌張力的產(chǎn)生肌張力的產(chǎn)生是一個非常復(fù)雜的發(fā)射活動牽張反射是肌張力產(chǎn)生的基礎(chǔ)，有腱反射 和肌緊張兩種類型其反射弧稱為“袢”：感受器（肌梭、腱梭）傳入神經(jīng)中樞（脊髓 前角a運(yùn)動神經(jīng)元） 傳出神經(jīng)效應(yīng)器（同一 肌肉的梭外?。５?頁，共84頁。肌梭（MuscleSpindle）肌梭是腱反射和肌緊張的主要感受器內(nèi)含6-12根肌纖維梭內(nèi)肌纖維（intrafusal fiber）對牽拉刺激和長度變化刺激敏感梭內(nèi)肌纖維收縮，梭內(nèi)肌感受裝置對牽拉刺激敏感性增高；梭 外肌纖維（extrafusal fiber）收縮，梭內(nèi)肌感受裝置所受牽 拉刺激減少第8頁

8、，共84頁。腱器官（TendonOrgan）分部于肌腱纖維之間的牽張感受器一種張力感受器傳入纖維對運(yùn)動神經(jīng)元產(chǎn)生抑制作用先興奮肌梭感受器，后興奮腱器官感受器，有利于避免肌肉牽拉傷第9頁，共84頁。牽張反射（myotatic reflex）指肌肉在外力或自身的其它肌肉收縮的作用 下而受到牽拉時，由于本身的感受器受到刺 激，誘發(fā)同一肌肉產(chǎn)生收縮的一類反射腱反射肌緊張第10頁，共84頁。一、肌緊張（muscletonus）是指緩慢持續(xù)牽拉肌腱時發(fā)生的牽張反射，其表 現(xiàn)為受牽拉的肌肉發(fā)生緊張性收縮，阻止被拉長。 肌緊張是維持軀體姿勢最基本的反射活動，是姿 勢反射的基礎(chǔ)。特點(diǎn)：多突出反射，潛伏期較長，經(jīng)

9、過多個突觸 傳遞第11頁，共84頁。二、腱反射（tendonreflex）是指快速牽拉肌腱時發(fā)生的牽張反射。如膝反射， 當(dāng)叩擊髕骨下方的股四頭肌肌腱時，可引起股四 頭肌發(fā)生一次收縮。此外，屬于腱反射的還有跟 腱反射和肘反射等特點(diǎn)：單突觸傳遞，潛伏期很短，約0.7秒第12頁，共84頁。肌張力產(chǎn)生的過程當(dāng)肌肉受到牽拉后，興奮肌梭感受器，興奮通過a纖維使支配 同一肌肉的運(yùn)動神經(jīng)元興奮，梭外肌收縮，形成張力第13頁，共84頁。肌張力的調(diào)節(jié)1外周因素：刺激的大小2中樞因素：中腦以上的許多結(jié)構(gòu)對肌張力產(chǎn)生 抑制作用，中腦以下的許多結(jié)構(gòu)，前庭系統(tǒng)對肌 張力產(chǎn)生易化作用第14頁，共84頁。三、神經(jīng)系統(tǒng)對肌張力

10、的控制與調(diào)節(jié)脊髓（spine）第15頁，共84頁。腦干（brainsteam）脊髓的牽張反射受到腦干調(diào)節(jié)具有易化和抑制作用延髓網(wǎng)狀結(jié)構(gòu)腹內(nèi)側(cè)部分 抑制區(qū)延髓網(wǎng)狀結(jié)構(gòu)腹背側(cè)部分、腦 橋、中腦灰質(zhì)即被蓋、下丘腦易化區(qū)三、神經(jīng)系統(tǒng)對肌張力的控制與調(diào)節(jié)第16頁，共84頁。舊小腦前葉區(qū)域抑制與易化的作用通過腦干網(wǎng)狀系統(tǒng)的易 化和抑制區(qū)來實(shí)現(xiàn)三、神經(jīng)系統(tǒng)對肌張力的控制與調(diào)節(jié)小腦（cerebellum）第17頁，共84頁。三、神經(jīng)系統(tǒng)對肌張力的控制與調(diào)節(jié)大腦（cerebrum）錐體系皮質(zhì)脊髓束皮質(zhì)腦干束錐體外系皮質(zhì)腦橋小腦途徑皮質(zhì)紋狀體途徑第18頁，共84頁。正常肌張力的特征近端關(guān)節(jié)周圍主動肌和拮抗肌可以進(jìn)

11、行有效的同 時收縮使關(guān)節(jié)固定具有完全抵抗重力和外來阻力的運(yùn)動能力能夠維持主動肌和拮抗肌的平衡第19頁，共84頁。正常肌張力的特征具有隨意使肢體由固定到運(yùn)動和在運(yùn)動過程中轉(zhuǎn) 換為固定姿勢的能力具有選擇性完成某一肌群協(xié)同運(yùn)動或某一肌肉獨(dú) 立運(yùn)動的能力被動運(yùn)動時，具有一定的彈性和輕度的抵抗感第20頁，共84頁。正常肌張力的分類靜止性肌張力在靜止?fàn)顟B(tài)下姿勢性肌張力在變換姿勢的過程中運(yùn)動性肌張力在完成某一運(yùn)動過程中第21頁，共84頁。正常肌張力的作用正常肌張力不僅僅是維持姿勢的基礎(chǔ)，而且也構(gòu) 成了肌體運(yùn)動時的良好背景，使得運(yùn)動更容易更 協(xié)調(diào)更準(zhǔn)確。第22頁，共84頁。影響肌張力的因素體位的影響精神因素的

12、影響并發(fā)癥的影響神經(jīng)狀態(tài)的影響局部壓力改變的影響疾病的影響藥物的影響外界環(huán)境的影響主觀因素的影響第23頁，共84頁。四、肌張力異常肌張力減低（遲緩）肌張力增高痙攣僵硬肌張力障礙第24頁，共84頁。（1）肌張力降低肌肉外觀平坦，貌似萎縮，肌肉松弛，柔軟，不能保持正常的彈力；被動活動阻力下降，關(guān)節(jié)活動度大于正常， 檢查過程中釋放肢體，肢體向重力方向落下；自主收縮時肌力下降第25頁，共84頁。（2）肌張力增高肌肉隆起明顯，肢體處于一種異常姿勢肌肉硬度增加被動活動阻力增大，甚至難以被動活動自主運(yùn)動困難，協(xié)調(diào)性降低，固定肌不穩(wěn)定，遠(yuǎn)端搖 晃痙攣:是一種由牽張反射高興奮性所致的、以速度依敕的緊張性牽張反射

13、增強(qiáng)伴腱反射逾常為特征的運(yùn)動障礙僵硬:主動肌和拮抗肌阻力一致性增加，使得身體相應(yīng)部位活動不便和固定不動的現(xiàn)象第26頁，共84頁。（3）肌張力障礙是唯一或主要以頸、軀干及四肢的近端肌肉 緩慢、持續(xù)、強(qiáng)烈扭轉(zhuǎn)樣不自主運(yùn)動為表現(xiàn) 的一種錐體外系疾患第27頁，共84頁。28肌張力評定痙攣評定（Ashworth, brunnstrom）第28頁，共84頁。痙攣（spasticity）在上運(yùn)動神經(jīng)元損傷后，由于腦干和脊髓反射 亢進(jìn)而使局部對被動運(yùn)動的阻力增大的一種狀 態(tài)。痙攣的評定，現(xiàn)在大多采用Ashworth痙攣量表（Ashworthscaleforspasticity，ASS） 或改良Ashworth

14、痙攣量表（modifiedAshworth scale，MAS）第29頁，共84頁。痙攣-評定量表（一）改良Ashworth分級法（二）Brunnstrom評定法（三）Fugl-Meyer評定法（四）股內(nèi)收肌張力量表（五）臨床痙攣指數(shù)（六）Oswestry 等級量表（七）改良Tardieu 量表（八）Rivermead運(yùn)動指數(shù)（九）Tufts運(yùn)動功能評定（十）九柱孔檢查（十一）改良Barthel指數(shù)（十二）功能獨(dú)立性評定第30頁，共84頁。痙攣-量表應(yīng)用注意事項(xiàng)（一）評定的影響因素.痙攣的神經(jīng)性因素 .痙攣的速度依賴 .患者的努力程度 .精神因素的影響 .環(huán)境變化的影響 .評定時患者的體位第3

15、1頁，共84頁。痙攣-量表應(yīng)用注意事項(xiàng)（二）評定紀(jì)錄需要記錄：測試的體位、是否存在異常反射、 是否存在影響評定的外在因素、痙攣分布的部 位、對患者ADL等功能活動的影響及所應(yīng)用的藥物、治療技術(shù)是否有效等第32頁，共84頁。級別評級標(biāo)準(zhǔn)0無張力異常增加肌張力輕度增加；被動屈伸時在活動末端出現(xiàn)輕的阻力肌張力輕度增加；被動屈伸時在活動范圍后50%內(nèi)出現(xiàn)輕的阻力肌張力明顯增加；被動屈伸時在活動范圍的大部分范圍內(nèi)50%以 上出現(xiàn)明顯的抵抗，但仍能容易進(jìn)行肌張力明顯增高，活動困難呈現(xiàn)僵直狀態(tài)，不能完成被動活動改良的Ashworth痙攣評價量表第33頁，共84頁。改良的Ashworth痙攣評價量表第34頁，

16、共84頁。brunnstromAssociated Reactions 聯(lián)合反應(yīng) Movement pattern typical in hemiplegiaUnable to isolate and control single muscle actionsMovement initiated in one joint results in automaticcontraction of other muscles linked in synergy with thatmovement Flexor and extensor synergy patterns協(xié)同第35頁，共84頁。級別評級標(biāo)

17、準(zhǔn)1Flaccidity2Spasticity appearing3Increase in spasticity (full synergy)4Decrease in spasticity (reduced synergy)5Spasticity reducing(synergy disappearing)6Movement near normal7Normal movementbrunnstrom評定量表第36頁，共84頁。brunnstrom評定量表I期馳緩型癱瘓，無隨 意活動II期：恢復(fù)開始，患 者出現(xiàn)聯(lián)合反應(yīng)，并 開始出現(xiàn)協(xié)同運(yùn)動和 痙攣，金鑾開始出 現(xiàn)，無隨意運(yùn)動。III期：肢體運(yùn)動

18、時能 隨意引發(fā)較典型的協(xié) 同運(yùn)動，痙攣進(jìn)一步 加重達(dá)到高峰。IV期，出現(xiàn)部分分離 運(yùn)動，協(xié)同運(yùn)動模式 逐漸減弱，痙攣減 輕，多種組合變得容 易V期，進(jìn)一步脫離協(xié)同 運(yùn)動模式，分離運(yùn)動 更充分，痙攣繼續(xù)減 少，可較好完成難度 更大的運(yùn)動組合第37頁，共84頁。brunnstrom評定量表第38頁，共84頁。brunnstrom評定量表第39頁，共84頁。brunnstrom評定量表Patients admitted at stages 1 and 2 are essentially nonfunctional, although patients in stage 2 are able to i

19、nitiate a pattern and have some traction responseStage 3 is a significant recovery stage because abnormal muscle tone starts to showsigns of normalization and voluntary control begins to take a distinct formStages 4 and 5 demonstrate phases of movement deviating from synergyFunctional recovery？第40頁，

20、共84頁。偏癱上肢功能測試-HKFunctional Test for the Hemiplegic Upper Extremity-HK versionbrunnstrom motor stage測試是根據(jù)Wilson, Baker, & Craddock 在1984年設(shè)計的Functional Test for the Hemiplegic Upper Extremity及根據(jù)brunnstrom之上 肢及手部功能康復(fù)理論及中國人的手部功能完成測試由12個測試活動按照復(fù)雜性（運(yùn)動技能、感覺、認(rèn)知能力、判斷 能力和一般偏癱上肢的復(fù)原趨勢）被排列成7個順序等級第41頁，共84頁。42階段項(xiàng)目動

21、作關(guān)鍵1沒有無2聯(lián)合反應(yīng)患手放在大腿上上肢開始漸漸活動肩膀和手肘活動的組合3C. 健手將衣服塞入褲里 時，提患側(cè)手臂D. 提著袋子(持15秒)肩部外展抓握中手指的彎曲度4E. 穩(wěn)定瓶蓋子 (用健手 打開瓶蓋)F. 將濕毛巾擰干手掌的抓握和腕關(guān)節(jié)的穩(wěn)定性肩膀和手肘的彎曲狀態(tài)5G. 拿起并搬移小木瑰H. 用匙子進(jìn)食肩膀和手肘的彎曲狀態(tài)、伸展和內(nèi)收；手肘的彎曲和延伸在抓 握和放松手指時肩膀關(guān)節(jié)的彎曲狀態(tài)和內(nèi)部的旋轉(zhuǎn)；手肘的彎曲和延伸；前臂手掌向下和反掌；腕關(guān)節(jié)的延伸和尺橈偏差；側(cè)捏/握力6I.提舉盒子J. 用膠杯喝水關(guān)節(jié)的彎曲狀態(tài)和伸展，手肘的彎曲當(dāng)抓握和放松時肩膀關(guān)節(jié)的彎曲狀態(tài)，伸展和內(nèi)收，手肘的

22、彎曲度和延伸，前 臂的反掌和手掌向下，對抓握和放松的控制7K. 用鑰匙開鎖頭L1. 操控筷子(強(qiáng)手) L2 操控夾子(非強(qiáng)手)肩膀關(guān)節(jié)的彎曲和延伸，手肘彎曲和延伸，反掌和手掌向下， 側(cè)捏三腳肌掌握和釋放，相互屈伸肘部和肩膀在同肱骨和肩胛骨議案旋轉(zhuǎn)起來的延伸。三腳肌掌握和釋放，相互屈伸肘部和肩膀在同肱骨和肩胛骨議 案旋轉(zhuǎn)起來的延伸第42頁，共84頁。四川大學(xué)華西醫(yī)院康復(fù)醫(yī)學(xué)科作業(yè)治第43頁，共84頁。Learning objective 學(xué)習(xí)目標(biāo)44At the end of the lecture, students will be able to:Know about clinical co

23、nditions that will affect muscle strength 掌握影響肌力的臨床條件Understand the aim of muscle strength testing掌握肌力評定的目的Describe the methodpositionreading of manual and instrumented muscle testing 描述徒手與器械肌力評估的方法、體位、度數(shù)Able to apply the grading of manual muscle strength in practice 掌握徒手肌力評估的分級標(biāo)準(zhǔn)Understand procedur

24、es and precautions of evaluating muscle strength掌握肌力評估的過程和注意事項(xiàng)第44頁，共84頁。DefinitionThe capacity of a muscle to produce the tension necessary for maintaining posture, initiating or controlling movements (Trombly, 1995) 肌肉產(chǎn)生張 力以維持姿勢、開啟或控制動作的能力機(jī)體隨意運(yùn)動時肌肉收縮的力量（康復(fù)醫(yī)學(xué)）Muscle strengthA lack or reduction of te

25、nsion-producing capacity of a muscle or a muscle group (Trombly,1995) 可產(chǎn)生張力的肌肉或 肌肉群缺失或減少M(fèi)uscle weakness45第45頁，共84頁。Direct disease: Muscular dystrophy 肌營養(yǎng)不良An injury to muscle itselfIndirect/misuse/immobilization: amputations截 肢, fracture骨折Some clinical causes of Muscle Weakness 肌肉無力的臨床成因第46頁，共84頁。Mu

26、sculoskeletal injuries 骨骼肌肉損傷Cumulative traumatic disease, fractures, arthritis, burns, amputation, hand trauma 累積創(chuàng)傷障礙，骨折，關(guān)節(jié)炎，燒傷，截肢，手外傷Some clinical causes of Muscle Weakness 肌肉無力的臨床成因47Tenosynovitis腱鞘炎Tendinous sheath of extensor/flexorCatabolic response分解代謝反應(yīng)Muscle wasting第47頁，共84頁。Neurological di

27、sease:Upper Motor Neuron Lesions上運(yùn)動神經(jīng)元損傷-spinal cord injury, stroke, congenital lesionsLower Motor Neuron Disorders下運(yùn)動神經(jīng)元損傷- peripheral nerve injuries, cranial nerve injuries48Some clinical causes of Muscle Weakness 肌肉無力的臨床成因Purpose of m華u西s醫(yī)c院l康e復(fù) 作p業(yè)o治w療e張r玉 婷evaluation？anterior horn cell of spina

28、l cord脊髓前角細(xì)胞第48頁，共84頁。Purposes of evaluating muscle strengthTo determine the amount of muscle power availableTo examine how muscle weakness limits functional performanceTo prevent deformitiesTo determine the need for assistive devicesmeaningful occupationsdeficit interferes with performance49第49頁，共8

29、4頁。Measuring Methods50Manual Muscle TestingInstrumented Muscle Testing第50頁，共84頁。Contraindications禁忌癥 for MMT51Inflammation of muscles and deposition of bone cells in muscles hard swellingPresence of pain broken bone, pain medicationNeuromuscular disease such as multiple sclerosis 多發(fā)性硬化 or post polio

30、 syndrome脊 髓灰質(zhì)炎DO not perform MMT on disorders related to tone?-message from brain arent being transmitted so they will not be able to control and isolate movement第51頁，共84頁。Gravity-related factors in MMT52Gravity-eliminated movementhorizontal planeMovement against gravity第52頁，共84頁。Scale of muscle st

31、rength Check PROMHorizontal planeNGFPTO53第53頁，共84頁。Scale of muscle strength 54第54頁，共84頁。Measurement procedures55Explain assessment proceduresPosition client, muscles to be tested and therapistCheck passive ROMStabilize the part proximal to the testing joint Ask client to perform movement, against gr

32、avity (grade 3)第55頁，共84頁。Measurement procedures56Observe quality of movementGently palpate muscle tendon or bellyIf AROM can be performed, continue the assessment by adding RESISTANCE (grade 4 or 5)If AROM cannot be performed, downgrade the assessment to grade 2 and below (i.e. assessing the movemen

33、t in gravity-eliminated position)第56頁，共84頁。Principles of Resistance ApplicationtonOpposite to movementMiddle to inner range of movemenOn distal end of moving boneClose to a perpendicular directiResistance application figure obtained from Clarkson & Gilewich (1898, p. 137)57第57頁，共84頁。Recommended posi

34、tioning for MMT58Begin assessment with movement Against Gravity-Tests for Fair (3) muscle grade during ROMBut when muscles are weak or when there are muscle tone problems, start with Gravity Eliminated Movements第58頁，共84頁。Manual Muscle TestingInstrumented Muscle Testing59第59頁，共84頁。Instrumented Muscle

35、 Testing60Better reliability and accuracy than MMTImproved intrarater, inter-rater, and inter-device reliabilityLimited in resisting muscle strength 第60頁，共84頁。Measurement proceduresElectronic Hand Dynamometer Hand Dynamometer61第61頁，共84頁。Instructions for lab sessions62Pair up for practiceWear short-s

36、leeve T-shirt第62頁，共84頁。四川大學(xué)華西醫(yī)院康復(fù)醫(yī)學(xué)科作業(yè)治第63頁，共84頁。ReviewClinical conditions that will affect muscle strength?Grading of MMT?Contraindication禁忌癥?損傷原因：Direct disease, injury to muscle itself, indirect/misuse/immobilization損傷系統(tǒng)：musculoskeletal injuries, Neurological diseaseThe aim of muscle strength tes

37、ting?amount of muscle power available, functional performance limitation, prevent deformities, need for assistive devices0 (0,O); 1 (10%, T); 2 (25%, P); 3 (50%, F)full ROM without R; 4 (75%, G); 5 (100%, N)Inflammation, pain, some neuromuscular disease(MS, post polio), tone, high blood pressure, ca

38、rdiac disease 1.History of cardiovascular problems or tight after abdominal surgery 2.Patients with malnutrition, malignancy, and severe chronic obstructive pulmonary disease. These patients may not have the energy to carry out strenuous testing64第64頁，共84頁。Definition 1. Types of muscle contraction:I

39、sotonic contraction 等張收縮Lifting an object at a constant speed is an example of isotonic contractions肌肉的收縮只是長度的縮短而張力保持不變，這是在肌肉收縮時所承受的負(fù)荷小于肌肉收縮力的情況下產(chǎn)生Concentric contraction 向心收縮 肌纖維長度變短時肌肉所處的收縮狀態(tài)-Tension is developed in the muscle in which it is shortened and produces a movement.-The origin and inserti

40、on of the muscle move closer togetherActivity: flexes the elbow joint and feels the contraction of bicepsEccentric contraction 離心收縮肌肉在阻力下逐漸被拉長，使運(yùn)動環(huán)節(jié)向肌肉拉力相反的方向運(yùn)動的收縮方式-If the tension developed in the muscle is less than the load acting against it, the muscle will lengthen while active.Activity: gradua

41、lly moves the abducted arm to the side of the body and feels the action of the deltoid.65第65頁，共84頁。Definition 1. Types of muscle contraction:Isometric contraction 肌肉在收縮時其長度不變而只有張力增加66eg.體位保持-tension developed by a muscle=load againstorigin and insertion of the muscle do not change position and lengt

42、h of the muscle does not change. Muscle tone increasesActivity: sits on a chair and hold the lower leg in extension. pushing against a fence第66頁，共84頁。Definition 1. Classification of muscles:Prime mover (Agonist)Prime movers is the chief muscle and/or a muscle group that is responsible for a particul

43、ar movement at a joint. eg. Hamstrings縫匠肌 are the prime movers of knee flexionAntagonistAntagonist refers to a muscle and/or a muscle group that opposes the action of the prime mover. Before a prime mover contracts, there must be an equal relaxation of the antagonist.eg. Knee extension requires the

44、contraction of quadriceps (prime mover) and the relaxation of hamstrings (antagonist)67第67頁，共84頁。Measurement procedures68Explain assessment proceduresPosition client, muscles to be tested and therapistCheck passive ROMStabilize the part proximal to the testing joint Ask client to perform movement, a

45、gainst gravity (grade 3)第68頁，共84頁。Measurement procedures69Observe quality of movementGently palpate muscle tendon or bellyIf AROM can be performed, continue the assessment by adding RESISTANCE (grade 4 or 5)If AROM cannot be performed, downgrade the assessment to grade 2 and below (i.e. assessing th

46、e movement in gravity-eliminated position)Bilateral comparison第69頁，共84頁。Group presentation70肩關(guān)節(jié)以及肩頸部肌肉張嘉祺、康有存肘關(guān)節(jié)及前臂，膝關(guān)節(jié)及踝關(guān)節(jié)毛貝尼、張夢杰腕關(guān)節(jié)及手指谷尚、余佳丹髖關(guān)節(jié)及骨盆附近肌肉馬迪、李熠第70頁，共84頁。Upper extremity71髁 踝尺偏 橈偏 掌屈 背伸第71頁，共84頁。Upper extremityShoulder flexionPrime movers: Anterior fibres of deltoid 三角肌前部Accessory muscl

47、es: Coracobrachialis喙肱肌, Clavicular head of pectoralis major, Biceps Resistance: The therapists hand is placed over the distal end of the humerus and pushes down toward extensionGravity eliminated position: side lying on the non-test side. The therapist support the weight of the test arm throughout

48、the assessment.Pic from Learning Package of Department of rehabilitation Science, PolyU72第72頁，共84頁。Upper extremityShoulder extensionPrime movers: Latissimus dorsi 背闊肌 Teres major 大圓肌Accessory muscles: Posterior deltoid三角肌后束, long head of tricepsResistance: The therapists hand is placed over the dist

49、al end of the humerus and pushes forward toward flexionGravity eliminated position: Side lying on the non-test side. The therapist support the weight of the test arm throughout the assessment.Pic from Learning Package of Department of rehabilitation Science, PolyU73第73頁，共84頁。Upper extremityShoulder

50、abductionPrime movers: Middle deltoid 肱二頭肌中束 supraspinatus 岡上肌Resistance: The therapists hand is placed over the distal end of the humerus and pushes down toward the bodyGravity eliminated position: Supine lying. The therapist support the weight of the test arm throughout the assessment.Pic from Lea

51、rning Package of Department of rehabilitation Science, PolyU74第74頁，共84頁。Upper extremityShoulder internal rotationPrime movers: Subscapularis 肩胛下肌Accessory muscles: Teres major, pectoralis major 胸大肌, latissimus dorsi, anterior deltoidResistance: The therapists hand is placed on the volar掌側(cè) surface of

52、 the distal end of the forearm and pushes towards the floor, keeping the elbow supported and flexed to 90Gravity eliminated position: The patient is sitting. The shoulder is slightly abducted, elbow flexed to 90, with forearm in midposition. The therapist stabilizes the humerus and supports the weig

53、ht of the forearm.Pic from Learning Package of Department of rehabilitation Science, PolyU75第75頁，共84頁。Upper extremityShoulder external rotationPrime movers: infraspinatus岡下肌 Teres major 大圓肌Accessory muscles: Posterior deltoid三角肌后束Resistance: The therapists hand is placed on the posterior surface of

54、the distal end of the forearm and pushes towards the floor, keeping the elbow supported and flexed to 90Gravity eliminated position: The patient is sitting. The shoulder is slightly abducted, elbow flexed to 90, with forearm in midposition. The therapist stabilizes the humerus and supports the weigh

55、t of the forearm.Pic from Learning Package of Department of rehabilitation Science, PolyU76第76頁，共84頁。Upper extremityElbow flexion Elbow extensionForearm supination旋后/pronation旋前Wrist extensionPic from Learning Package of Department Wrist flexion of r eh a b il i t at i on Science, PolyU77第77頁，共84頁。L

56、ower extremity78第78頁，共84頁。Lower extremityHip flexionPrime movers: lliopsoas 髂腰肌Accessory muscles: Rectus femoris 股直肌, sartorius 縫匠肌, tensor fascia latae闊筋膜張肌, Pectineus恥骨肌Resistance: Resistance is applied over the anterior aspect of the thigh proximal to the knee in the direction of hip extensionGra

57、vity eliminated position: The patient is side lying on the non-test side and holds the non-tested leg in maximal hip and knee flexion. The therapist stands behind the patient and supports the weight of the test leg. The hip is extended and the knee is flexed.Pic from Learning Package of Department of rehabilitation Science, PolyU79第79頁，共84頁。Lower extremityHip extensionPrime movers: Gluteus maximus 臀大肌, biceps femoris, sem