前饋控制與康復(fù)

1、中樞控制指令肢體運(yùn)動(dòng)姿勢(shì)干擾姿勢(shì)調(diào)節(jié)APAs+CPAs預(yù)期姿勢(shì)調(diào)節(jié)補(bǔ)償姿勢(shì)調(diào)節(jié) 姿勢(shì)控制是機(jī)體運(yùn)動(dòng)控制的基礎(chǔ)，是機(jī)體保持重心穩(wěn)定、維持身體平衡和維系肢體空間定位的基本身體能力。Germany:Germany: 德國德國30%30%以上的以上的6565歲以上老人每年至少歲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歲以上的老年人歲以上的老年人：跌倒：跌倒的的風(fēng)險(xiǎn)性風(fēng)險(xiǎn)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：英國：英國大約大約30%30%以上的以上的6565歲以上生活在社區(qū)的老人每年會(huì)歲以上生活在社區(qū)的老人每年會(huì)跌倒跌倒一次。一次。20082008年的研究年的研究：9090歲以上的老年人，歲以上的老年人，58%58%的人的人在過去的一年中在過去的一年中曾經(jīng)曾經(jīng)跌倒至少跌倒至少一次，一次，60%60%的人的人在一年的隨訪中發(fā)生過跌倒在一年的隨訪中發(fā)生過跌倒（女性（女性9090人人，男性，男性2020人人）USAUSA：美國：美國20082008年的研究年的研究：疾病控制與預(yù)防中心（疾病控制與預(yù)防中

3、心（CDCCDC）580580萬的萬的6565歲和歲和6565歲以上的人，歲以上的人，或者美國同年齡段所有人群的或者美國同年齡段所有人群的15.9%15.9%的人的人，在在過去過去3 3個(gè)月中至少個(gè)月中至少跌跌倒過倒過1 1次。次。這些人中的這些人中的180180萬人萬人 （31.3%31.3%），由于），由于跌倒跌倒造成造成了了損傷。損傷。China: China: 中國中國 在中國，據(jù)報(bào)道每年大約有在中國，據(jù)報(bào)道每年大約有25002500萬次跌倒的發(fā)生。與跌倒相關(guān)的花銷是巨大的，萬次跌倒的發(fā)生。與跌倒相關(guān)的花銷是巨大的，直接醫(yī)療消費(fèi)算起來大約有直接醫(yī)療消費(fèi)算起來大約有5050億元，與其相關(guān)

4、的社會(huì)花銷為億元，與其相關(guān)的社會(huì)花銷為600-800600-800億元。億元。跌倒是我國傷害死亡的第四位原因，而在跌倒是我國傷害死亡的第四位原因，而在6565歲以上的老年人中則為首位。歲以上的老年人中則為首位。 我國我國6565歲以上老年人跌倒死亡率男性為歲以上老年人跌倒死亡率男性為49.56/1049.56/10萬，女性為萬，女性為52.80/1052.80/10萬萬因此防跌倒風(fēng)險(xiǎn)戰(zhàn)略對(duì)于社會(huì)和經(jīng)濟(jì)效益有著深遠(yuǎn)的影響。因此防跌倒風(fēng)險(xiǎn)戰(zhàn)略對(duì)于社會(huì)和經(jīng)濟(jì)效益有著深遠(yuǎn)的影響。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力量訓(xùn)練力量訓(xùn)練神經(jīng)肌肉控制神經(jīng)肌肉控制訓(xùn)練訓(xùn)練平衡訓(xùn)練平衡訓(xùn)練肢體運(yùn)動(dòng)控制肢體運(yùn)動(dòng)控制反饋訓(xùn)練反饋訓(xùn)練本體感覺訓(xùn)練本體感覺訓(xùn)練應(yīng)激訓(xùn)練應(yīng)激訓(xùn)練MFT S3 動(dòng)態(tài)平衡測(cè)試訓(xùn)練系統(tǒng)動(dòng)態(tài)平衡測(cè)試訓(xùn)練系統(tǒng) 感覺統(tǒng)合臨床站立平衡測(cè)試（感覺統(tǒng)合臨床站立平衡測(cè)試（CTSIBCTSIB）本體感覺訓(xùn)練本體感覺訓(xùn)練PosturomedPosturomed本體感

6、覺測(cè)試訓(xùn)練系統(tǒng)本體感覺測(cè)試訓(xùn)練系統(tǒng)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.浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院康復(fù)