WFU

2020年8月18日 星期二

中風及帕金森氏症與駝背




        駝背,不只影響一般人的動作表現,同時也是影響中風和帕金森氏症(Parkinson’s Disease, PD)者動作問題的主因之一。單單來說,如果能改善駝背,對肩膀痛、上肢動作不良及預防跌倒也會有幫助!



為什麼駝背




        身體的姿勢靠關節活動、肌肉收縮、神經回饋、腦部整合等共同維持與調整,一但其中一個環節出了問題,姿勢調整自然也會跟著被影響。


       中風和帕金森氏症看似不相關,卻都有個共通點:肌肉張力調整異常


中風    中風後因為軀幹肌肉無力、身體兩側張力獲力量不對稱或左右邊感覺異常,進而讓人容易出現駝背的姿勢。隨著駝背的習慣養成,胸椎的活動就減少,導致日後想挺胸也困難。


帕金森氏症    這是一種因為腦部變化造成動作功能異常的疾病。由於腦部變化,會造成肌肉長時間收縮無法放鬆,因此出現肌肉僵硬(Rigidity) ,進而導致動作及駝背、側彎的情況。



駝背會怎樣?




        駝背就是胸椎太彎曲,除了不好看以外,也會造成肩頸關節活動變差和肌肉、關節疼痛問題。


關節活動    不論是手抬不高或是抬高會痛,都是因為肩胛骨沒辦法在抬手過程跟著轉動,導致肩膀附近肌肉要更用力或軟組織被擠壓,進而出現類似『五十肩』的症狀。


疼痛    最大的原因,是在駝背的姿勢之下,頸椎和肩膀附近的肌肉需要用更大的力量才能讓我們抬頭或抬手, 長時間 下來自然會造成肌肉、關節痠痛!



要怎麼自救?


       雖然駝背發生在胸椎,但是抬高肩膀的同時,胸椎也會跟著挺直。所以伸懶腰這個動作,就是改善駝背很理想的動作之一。     

       但是有中風或帕金森氏症的人,常常伴隨有平衡不佳或肩膀、軀幹肌肉無力的問題,所以躺著抬手就是個不錯的選擇!


註:若肩膀有疼痛或其他活動問題者,建議與專業醫療人員討論後再做會比較安全!

        





參考文獻


  1. Anna Fehér-Kiss, Edit Nagy, Andrea Domján, Katalin Jakab, János Kránicz & Gyöngyi Horváth (2018) Trunk alignment in different standing positions in healthy subjects and stroke patients -a comparative study with a simple method for the everyday practice.: Trunk alignment in healthy and stroke subjects, Topics in Stroke Rehabilitation, 25:8, 561-568, DOI: 10.1080/10749357.2018.1517490
  2. Verheyden, Geert, PhD; Ruesen, Carolien, MSc; Gorissen, Monique, MSc; Brumby, Victoria, MSc; Moran, Rachel, MSc; Burnett, Malcolm, MSc; Ashburn, Ann, PhD Postural Alignment Is Altered in People With Chronic Stroke and Related to Motor and Functional Performance, Journal of Neurologic Physical Therapy: October 2014 - Volume 38 - Issue 4 - p 239-245 doi: 10.1097/NPT.0000000000000054Barbosa, 
  3. Alessandra Ferreira et al. “Gait, posture and cognition in Parkinson's disease.” Dementia & neuropsychologia vol. 10,4 (2016): 280-286. doi:10.1590/s1980-5764-2016dn1004005
  4. Magrinelli F, Picelli A, Tocco P, et al. Pathophysiology of Motor Dysfunction in Parkinson's Disease as the Rationale for Drug Treatment and Rehabilitation. Parkinsons Dis. 2016;2016:9832839. doi:10.1155/2016/9832839
  5. Kim EJ, Lee KB, Hwang BY. Effects of upper extremity training in a standing position on trunk alignment in stroke patients. J Phys Ther Sci. 2016;28(9):2426-2429. doi:10.1589/jpts.28.2426
  6. Khallaf ME, Fayed EE. Early postural changes in individuals with idiopathic Parkinson's disease. Parkinsons Dis. 2015;2015:369454. doi:10.1155/2015/369454
  7. Oliveira de Carvalho, Alessandro et al. “Physical Exercise For Parkinson's Disease: Clinical And Experimental Evidence.” Clinical practice and epidemiology in mental health : CP & EMH vol. 14 89-98. 30 Mar. 2018, doi:10.2174/1745017901814010089
  8. Baradaran, Nazanin et al. “Parkinson's disease rigidity: relation to brain connectivity and motor performance.” Frontiers in neurology vol. 4 67. 5 Jun. 2013, doi:10.3389/fneur.2013.00067
  9. Ponche, Sophie & Yelnik, A.P. & Bonan, I.. (2015). Motor strategies of postural control after hemispheric stroke. Neurophysiologie Clinique/Clinical Neurophysiology. 45. 10.1016/j.neucli.2015.09.003
  10. Theodoridis D, Ruston S. The effect of shoulder movements on thoracic spine 3D motion. Clin Biomech (Bristol, Avon). 2002;17(5):418-421. doi:10.1016/s0268-0033(02)00026-8
  11. Eum, Regina et al. “Is kyphosis related to mobility, balance, and disability?.” American journal of physical medicine & rehabilitation vol. 92,11 (2013): 980-9. doi:10.1097/PHM.0b013e31829233ee
  12. Edmondston SJ, Ferguson A, Ippersiel P, Ronningen L, Sodeland S, Barclay L. Clinical and radiological investigation of thoracic spine extension motion during bilateral arm elevation. J Orthop Sports Phys Ther. 2012;42(10):861-869. doi:10.2519/jospt.2012.4164
  13. Margaret L Schenkman, Kevin Clark, Tony Xie, Maggie Kuchibhatla, Mindi Shinberg, Laurie Ray, Spinal Movement and Performance of a Standing Reach Task in Participants With and Without Parkinson Disease, Physical Therapy, Volume 81, Issue 8, 1 August 2001, Pages 1400–1411,