衡性的机制和训练课件

平衡性的机制和训练唐戎

PT，DPT，PhDDOCTOROFPHYSICALTHERAPYREHABCAREINC平衡性的机制和训练唐戎PT，DPT，PhD1自我介绍出生和成长于四川省江油市临床医学专科广元职工医学院运动人体科学硕士成都体育学院生物医学工程学博士华西医科大学DPT（DoctorofPhysicalTherapy）临床康复物理治疗学博士ConcordiaUniversityWisconsin(美国协和大学威斯康辛分校)PostdoctoralResearchAssociate（博士后助理研究员）UniversityofMinnesota（美国明尼苏达大学）SupervisingPhysicalTherapist（主管物理治疗师）AegisTherapies（美国易捷康复集团）SupervisingPhysicalTherapist（主管物理治疗师）RehabCare（美国RehabCare康复集团）医学总监上海医知网络科技有限公司自我介绍出生和成长于四川省江油市2平衡的定义以及几个重要概念Balance:Controlofcenterofmassoverbaseofsupport(Shumway–Cook,2001)Centerofmass:thepointthatisatthecenterofthetotalbodymassBaseofsupport:Areaofobjectthatisincontactwiththeground平衡的定义以及几个重要概念Balance:Control3平衡的定义以及几个重要概念Centerofmass:CenterpointofeachbodysegmentcombinedCOM平衡的定义以及几个重要概念COM4平衡的定义以及几个重要概念Baseofsupport:Areaofobjectthatisincontactwiththeground平衡的定义以及几个重要概念5平衡的定义以及几个重要概念Balance:Controlofcenterofmassoverbaseofsupport平衡的定义以及几个重要概念Balance:Control6平衡的分类Steadystate(static)balance:MaintainstablepositioninstandingorsittingReactivebalance:RecoveringfromanunexpectedperturbationProactive(anticipatory)balance:Activatingbalanceinadvance平衡的分类Steadystate(static)bal7平衡的分类Steadystate(static)balance:Maintainstablepositioninstandingorsitting平衡的分类Steadystate(static)bal8平衡的分类Reactivebalanceabilitytorecoverfromanunexpectedperturbation(beingnudgedbysomeone)平衡的分类Reactivebalanceability9平衡的分类Proactive(Anticipatory)Balance：Abilitytoactivatemusclesforbalanceinadvanceofapotentiallydestabilizingmovementinordertoavoidinstability.Reaching,leaning,pulling平衡的分类Proactive(Anticipatory)10平衡的分类BalanceisacomplexcompositeofmultiplebodysystemsMotorSensoryCognition平衡的分类Balanceisacomplexcomp11MotorSystemsMusculoskeletalsystem:strengthandflexibilityNeuromuscularsystem:coordinationofmovementMotorSystemsMusculoskeletals12SensorySystemsPeripheralinput:Visual,vestibular(innerear),somatosensory(inputfromjointandmusclereceptors,auditory(hearing)Centralprocessing:Receivesinformationfromperipheryinterpretsit,andsendscommandstomotorsystemsSensorySystemsPeripheralinpu13CognitionMultitaskingandfilteringoutdistractionswhilemaintainingbalanceCognitionMultitaskingandfilt14平衡的系统模型平衡的系统模型15平衡性的评定平衡性的评定16平衡性的评定平衡性的评定17平衡性的评定平衡性的评定18平衡性的评定

TheTUGwasfoundtohave:

87%sensitivityforpredictingfallswithascore>14seconds

TheBergBalanceTest:83%ofsubjectswerecorrectly

identifiedasfallers(thegoldstandard)baseduponthedichotomousruletoclassifyfallersatacut-offpointof<40(BBTScore).

平衡性的评定TheTUGwasfoundto19平衡性的评定Timedupandgotest(TUG)Getupfromseatedposition,walk3meters,turnaround,walkbacktochairAdultswhotook>30secweredependentinactivitiesofdailyliving平衡性的评定Timedupandgotest(TU20平衡性的评定BergBalancescale:DiscriminatesolderadultsatriskforfallsSinglebestpredictoroffallstatusincommunitydwellingadultsSoundtestwithgoodreliabilityMainlytestsstaticandanticipatorybalance平衡性的评定BergBalancescale:21平衡性的评定BergBalancescale:SittingtostandingStandingunsupportedStandingtosittingStandingunsupportedwitheyesclosedStandingunsupportedwithfeettogetherReachingforwardwithoutstretchedarmPickupobjectfromfloorTurningtolookoverrightandleftshoulderTurn360dgSteponstepstool(#timesin20seconds)Tandemstance;Standingononefoot平衡性的评定BergBalancescale:22平衡性的评定14itemscaleforpossible56pointstotalDecreaseinBergscore=increasedfallriskScoreof56-54,1pointdrop=3-4%inc.fallriskEachpointdropfrom54-46,=6-8%increaseBelow36,fallrisk=100%Limitations:doesnottestreactivebalance;ceilingeffect平衡性的评定14itemscaleforpossib23平衡性的训练平衡性的训练24平衡性的训练EXERCISE!!!!Standing-ontwo

feetandoneStandincornerandmoveshoulders/hipsWalkandturnhead平衡性的训练EXERCISE!!!!25平衡性的训练Walkheeltotoe,walkontoes,walkonheelsWalkbackwards,walksidewaysStandupandsitdownwithouthandsFocusonLE,Core,TricepsUE-scapularretraction,rowing平衡性的训练Walkheeltotoe,walko26平衡性的训练Improveflexibility-stretching,TaiChi,YogaDeepbreathingFloortransfersImprovepostureMedicationreview-4+meds,sideeffectsVisionscreening平衡性的训练Improveflexibility-stre27平衡性的训练AquaticprogramsStrategies-ankle,hip,stepEyesopenandclosedReaching/bending/weightshifts/lifting/carryingBalls/BAPSboard平衡性的训练Aquaticprograms28平衡性的训练ObstaclecoursesJointmobilizationstothespineDancingDoADLsononefootBeginwalkingprogramsElectricalstimulationConsiderDME/AE-hipprotectors,walkers,canes,etc平衡性的训练Obstaclecourses29平衡性的训练Dothingsduringbalanceexercises:AddmusicChangesurface-unlevelChangefootwearAdjustlighting-includelowlightingDomathCategorize平衡性的训练Dothingsduringbalance30平衡性的训练NintendoWiiFitSystem平衡性的训练NintendoWiiFitSystem31FallUnintentionalinjuriesExternalcausesoftheinjuryMultifactorialcauses e.g.fallsduetointrinsicfactorsvs.extrinsicfactors

FallUnintentionalinjuries32Intrinsic(Personal)factorsforFallsAged(over65years)FemaleLowmobilityorfragility–lowerextremityweakness,andpoorgripstrengthFunctionalimpairments-limitedActivitiesofDailyliving(ADL)PoorgaitandbalanceLowbodyweightIntrinsic(Personal)factorsf33Intrinsic(Personal)factorsforFalls

CognitiveimpairmentordementiaChronicillness-Parkinsondisease,visualdifficulties,stroke,hypertension,orurinaryincontinencePsychoactivemedication-tranquilizersorantidepressantsPreviousfallsHeavydrinkingIntrinsic(Personal)factorsf34ExtrinsicorEnvironmentalFactorsPerson’senvironment:UnevensurfacesObstacles,stairs,curbsPoorlighting,suddenchangesinlightingSlipperysurfacesPoorfootwearPoorlyfittedassistivedevicesforwalkingExtrinsicorEnvironmentalFac35IncidenceratesofFallsinU.S.Oneofeverythreeadultsover65yearsfallineveryyear

Mostcommoncauseofinjurydeathfor65+90%ofhipfracturesinolderadultsMostcommoncauseofnon-fatalinjuriesIncidenceratesofFallsinU.36恶性循环Fall↗

↘Imbalance

←

Inactive

恶性循环Fall37Wherearepeoplelikelytofall?

Forpeople65yearsoldorolder…..NursingHome10%Home60%

PublicPlaces30%Wherearepeoplelikelytofal38ConsequencesofFallsMortalityMorbidityFractures

SofttissueinjuriesHeadtraumaJointdistortionsanddislocationsLossofconfidence-fearoffallingRestrictedactivityIn1994,estimatedfall-relatedinjurycostwas$20.2billion.ConsequencesofFallsMortality39ConsequencesofFallsFractures3%ofallfallscausefractures.Approx.95%ofhipfracturesinolderpeopleagedover65yearsaretheresultofafallPeoplewhohaveahipfactureare5~20%morelikelytodieinthefirstyearfollowingtheinjurythananyotherreasoninthesameagegroupsConsequencesofFallsFractures40ConsequencesofFalls

Forearm(Wrist)FractureSpineFractureHipFracture(pelvis,hip,femur)AnkleFractureUpperarm,forearms,handConsequencesofFallsForearm41HowtoPreventFallsCDCPreventionPlanFallPreventionstrategies:Exerciseregularly,TaiChi(strength/balance)Medicationreview-sideeffectsandinteractionsYearlyeyeexamsReducefallhazardsintheh