前馈控制与康复

1、中枢控制指令肢体运动姿势干扰姿势调节APAs+CPAs预期姿势调节补偿姿势调节 姿势控制是机体运动控制的基础，是机体保持重心稳定、维持身体平衡和维系肢体空间定位的基本身体能力。Germany:Germany: 德国德国30%30%以上的以上的6565岁以上老人每年至少岁以上老人每年至少跌倒跌倒1 1次次，15%15%的老人的老人跌倒跌倒2 2次或更多次或更多8080岁以上的老年人岁以上的老年人：跌倒：跌倒的的风险性风险性提高提高50%50%Source: BSource: B rge 2002; Runge 2000, 1998; Specht-Leible et al. 1997rge 20

2、02; Runge 2000, 1998; Specht-Leible et al. 1997UKUK：英国：英国大约大约30%30%以上的以上的6565岁以上生活在社区的老人每年会岁以上生活在社区的老人每年会跌倒跌倒一次。一次。20082008年的研究年的研究：9090岁以上的老年人，岁以上的老年人，58%58%的人的人在过去的一年中在过去的一年中曾经曾经跌倒至少跌倒至少一次，一次，60%60%的人的人在一年的随访中发生过跌倒在一年的随访中发生过跌倒（女性（女性9090人人，男性，男性2020人人）USAUSA：美国：美国20082008年的研究年的研究：疾病控制与预防中心（疾病控制与预防中

3、心（CDCCDC）580580万的万的6565岁和岁和6565岁以上的人，岁以上的人，或者美国同年龄段所有人群的或者美国同年龄段所有人群的15.9%15.9%的人的人，在在过去过去3 3个月中至少个月中至少跌跌倒过倒过1 1次。次。这些人中的这些人中的180180万人万人 （31.3%31.3%），由于），由于跌倒跌倒造成造成了了损伤。损伤。China: China: 中国中国 在中国，据报道每年大约有在中国，据报道每年大约有25002500万次跌倒的发生。与跌倒相关的花销是巨大的，万次跌倒的发生。与跌倒相关的花销是巨大的，直接医疗消费算起来大约有直接医疗消费算起来大约有5050亿元，与其相关

4、的社会花销为亿元，与其相关的社会花销为600-800600-800亿元。亿元。跌倒是我国伤害死亡的第四位原因，而在跌倒是我国伤害死亡的第四位原因，而在6565岁以上的老年人中则为首位。岁以上的老年人中则为首位。 我国我国6565岁以上老年人跌倒死亡率男性为岁以上老年人跌倒死亡率男性为49.56/1049.56/10万，女性为万，女性为52.80/1052.80/10万万因此防跌倒风险战略对于社会和经济效益有着深远的影响。因此防跌倒风险战略对于社会和经济效益有着深远的影响。Wang et al. 2010, Institute for Geriatric Clinic and Rehabilit

5、ation, Beijing Geriatric Wang et al. 2010, Institute for Geriatric Clinic and Rehabilitation, Beijing Geriatric HospitalHospital力量训练力量训练神经肌肉控制神经肌肉控制训练训练平衡训练平衡训练肢体运动控制肢体运动控制反馈训练反馈训练本体感觉训练本体感觉训练应激训练应激训练MFT S3 动态平衡测试训练系统动态平衡测试训练系统 感觉统合临床站立平衡测试（感觉统合临床站立平衡测试（CTSIBCTSIB）本体感觉训练本体感觉训练PosturomedPosturomed本体感

6、觉测试训练系统本体感觉测试训练系统Ilan Kurz Ilan Kurz et al,et al, Unexpected perturbations training improves Unexpected perturbations training improves balance control and voluntary stepping times in older adults balance control and voluntary stepping times in older adults a a double blind randomized control triald

7、ouble blind randomized control trial；BMC Geriatrics (2016) 16:58BMC Geriatrics (2016) 16:58ShimadaShimada et al, et al, New Intervention Program for Preventing Falls among New Intervention Program for Preventing Falls among Frail Elderly People: The Effects of Perturbed Walking Exercise Frail Elderl

8、y People: The Effects of Perturbed Walking Exercise Using a Bilateral Separated TreadmillUsing a Bilateral Separated Treadmill；PhysMed Rehabil PhysMed Rehabil (2004);83:493(2004);83:493499499MichaelMichael et al, Age Influences the Outcome of a Slipping et al, Age Influences the Outcome of a Slippin

9、g Perturbation during Initial But Not Repeated Exposures, Biol Sci Perturbation during Initial But Not Repeated Exposures, Biol Sci Med SciMed Sci (2002);57(8)(2002);57(8)AvrilAvril et al, Effect of a Perturbation-Based Balance Training et al, Effect of a Perturbation-Based Balance Training Program

10、on Compensatory Stepping and Grasping Reactions in Older Program on Compensatory Stepping and Grasping Reactions in Older Adults: A Randomized Controlled Trial, Physical Therapy, April Adults: A Randomized Controlled Trial, Physical Therapy, April (2010); 90 (4) 476-49.(2010); 90 (4) 476-49.AvrilAvr

11、il et al, Does Perturbation-Based Balance Training Prevent et al, Does Perturbation-Based Balance Training Prevent Falls? Systematic Review and Meta-Analysis of Preliminary Falls? Systematic Review and Meta-Analysis of Preliminary Randomized Controlled Trials, Physical Therapy (2015); 95 (5) 700-Ran

12、domized Controlled Trials, Physical Therapy (2015); 95 (5) 700-709.709.Avril et al, Is Impaired Control of Reactive Stepping Related to Avril et al, Is Impaired Control of Reactive Stepping Related to Falls During Inpatient Stroke Rehabilitation? Neural Repair Falls During Inpatient Stroke Rehabilit

13、ation? Neural Repair (2013); 27 (6) 526-533(2013); 27 (6) 526-533Avril et al, Training Rapid Stepping Responses in an Individual Avril et al, Training Rapid Stepping Responses in an Individual with Strokewith Stroke， Physical TherapyPhysical Therapy (2011)(2011) 9191 (6)(6) 958-969958-969Ilan et al,

14、 Perturbation Training while Walking Improves Balance Ilan et al, Perturbation Training while Walking Improves Balance Control and Voluntary Stepping Parameters in Community Dwelling Control and Voluntary Stepping Parameters in Community Dwelling Elders: A Randomized Control Trial,Elders: A Randomiz

15、ed Control Trial, Movement Analysis and Movement Analysis and Rehabilitation LaboratoryRehabilitation LaboratoryPavol et al, Young and Older Adults Exhibit Proactive and Reactive Pavol et al, Young and Older Adults Exhibit Proactive and Reactive Adaptations to Repeated Slip Exposure, A Biol Sci Med

16、Sci.Adaptations to Repeated Slip Exposure, A Biol Sci Med Sci. (2004); (2004); 59(5):494-50259(5):494-502Mansfield et al, Do Measures of Reactive Balance Control Predict Mansfield et al, Do Measures of Reactive Balance Control Predict Falls in People with Stroke Returning to the Community,Falls in P

17、eople with Stroke Returning to the Community, Physiotherapy (2015); 101 (4) 373 Physiotherapy (2015); 101 (4) 373 380 380Radzinski MRadzinski M et al, The Incidence and Risk Factors of fall in et al, The Incidence and Risk Factors of fall in Parkinson Disease: Prospective Study, Parkinson Disease: Prospective Study, Neurol Neurochir Neurol Neurochir Pol.Pol.(2013);47(5):431-7.(2013);47(5):431-7.浙江大学医学院附属邵逸夫医院康复