Rehabilitation國考題cva - SlideShare

腦中風病人半側偏癱及感覺受損，患側下肢動作明顯比上肢靈活，則病灶最可能在? ... 半邊忽略現象（ hemineglect）是最常出現於腦部何處之病變？ SlideShareusescookiestoimprovefunctionalityandperformance,andtoprovideyouwithrelevantadvertising.Ifyoucontinuebrowsingthesite,youagreetotheuseofcookiesonthiswebsite.SeeourUserAgreementandPrivacyPolicy. SlideShareusescookiestoimprovefunctionalityandperformance,andtoprovideyouwithrelevantadvertising.Ifyoucontinuebrowsingthesite,youagreetotheuseofcookiesonthiswebsite.SeeourPrivacyPolicyandUserAgreementfordetails. Home Explore Login Signup Successfullyreportedthisslideshow. WeuseyourLinkedInprofileandactivitydatatopersonalizeadsandtoshowyoumorerelevantads.Youcanchangeyouradpreferencesanytime. Rehabilitation國考題cva UpcomingSlideShare Loadingin…5 × 1 1of46 Likethispresentation?Whynotshare! Share Email     Rehabilitation國考題tbi by Yi-ChengWu 620 views Facebook Twitter LinkedIn Size(px) Starton ShowrelatedSlideSharesatend of PrevSlideShare NextSlideShares UpcomingSlideShare Rehabilitation國考題tbi Next Education Sep.01,2014 1,254views 0Likes Share Rehabilitation國考題cva Education Sep.01,2014 1,254views 醫師國考(復健科) Readmore Yi-ChengWu Follow Working at 長庚醫院 Rehabilitation國考題tbi Yi-ChengWu Rehabilitation國考題scicomplications Yi-ChengWu Rehabilitation國考題modalities Yi-ChengWu Rehabilitation國考題speech Yi-ChengWu Rehabilitation國考題_SCI Yi-ChengWu WhattoUploadtoSlideShare SlideShare BeAGreatProductLeader(Amplify,Oct2019) AdamNash TrillionDollarCoachBook(BillCampbell) EricSchmidt APIdaysParis2019-Innovation@scale,APIsasDigitalFactories'NewMachi... apidays Afewthoughtsonworklife-balance WimVanderbauwhede RelatedBooks Freewitha30daytrialfromScribd Seeall FightingForward:YourNitty-GrittyGuidetoBeatingtheLiesThatHoldYouBack HannahBrencher (0/5) Free NoOneSucceedsAlone:LearnEverythingYouCanfromEveryoneYouCan RobertReffkin (4/5) Free Dedicated:TheCaseforCommitmentinanAgeofInfiniteBrowsing PeteDavis (5/5) Free Let'sTalkAboutHardThings AnnaSale (4/5) Free HappinessBecomesYou:AGuidetoChangingYourLifeforGood TinaTurner (4.5/5) Free KeepSharp:BuildaBetterBrainatAnyAge SanjayGupta (4/5) Free AverageExpectations:LessonsinLoweringtheBar ShepRose (3/5) Free HighConflict:WhyWeGetTrappedandHowWeGetOut AmandaRipley (5/5) Free Girl,StopApologizing:AShame-FreePlanforEmbracingandAchievingYourGoals RachelHollis (3.5/5) Free LessFret,MoreFaith:An11-WeekActionPlantoOvercomeAnxiety MaxLucado (4.5/5) Free Dry:AMemoir AugustenBurroughs (4.5/5) Free The7HabitsofHighlyEffectivePeoplePersonalWorkbook StephenR.Covey (4/5) Free NeverSplittheDifference:NegotiatingAsIfYourLifeDependedOnIt ChrisVoss (4.5/5) Free BoundariesUpdatedandExpandedEdition:WhentoSayYes,HowtoSayNoToTakeControlofYourLife HenryCloud (4/5) Free Girl,WashYourFace:StopBelievingtheLiesAboutWhoYouAresoYouCanBecomeWhoYouWereMeanttoBe RachelHollis (3.5/5) Free Uninvited:LivingLovedWhenYouFeelLessThan,LeftOut,andLonely LysaTerKeurst (4.5/5) Free RelatedAudiobooks Freewitha30daytrialfromScribd Seeall FeedingtheSoul(BecauseIt'sMyBusiness):FindingOurWaytoJoy,Love,andFreedom TabithaBrown (5/5) Free TheBookofHope:ASurvivalGuideforTryingTimes JaneGoodall (4.5/5) Free ExtraordinaryAwakenings:WhenTraumaLeadstoTransformation SteveTaylor (3.5/5) Free MyFriendFear:HowtoMoveThroughSocialAnxietyandEmbracetheLifeYouWant RoseBerry (5/5) Free FearlessLeadership:HowtoEmbodytheStrengthandConfidenceofGreatLeaders KimMartin (4/5) Free GettingMoreDone:WieldingIntentionandPlanningtoAchieveYourMostAmbitiousGoals MichelleLoucadoux (4.5/5) Free TheAuthenticLeader:FiveEssentialTraitsofEffective,InspiringLeaders MerindaSmith (5/5) Free EmpathUp!:HowtoEmbracetheGiftofEmpathy CherylHutchinson (4.5/5) Free OutwiththeOld,InwiththeYou TessBrigham (5/5) Free 10RulesforResilience:MentalToughnessforFamilies JoeDeSena (0/5) Free Winning:TheUnforgivingRacetoGreatness TimS.Grover (5/5) Free ThePowerofYourAttitude:7ChoicesforaHappyandSuccessfulLife StanToler (4.5/5) Free MinimalFinance:ForgingYourOwnPathtoFinancialFreedom SamDixonBrown (3.5/5) Free TheArtofStopping:HowtoBeStillWhenYouHavetoKeepGoing DavidKundtz (4.5/5) Free LiveYourLife:MyStoryofLovingandLosingNickCordero AmandaKloots (4.5/5) Free CheckingIn:HowGettingRealaboutDepressionSavedMyLife---andCanSaveYours MichelleWilliams (4.5/5) Free 0Likes Statistics Notes Bethefirsttolikethis Views Totalviews 1,254 OnSlideShare 0 FromEmbeds 0 NumberofEmbeds 8 Actions Shares 0 Downloads 1 Comments 0 Likes 0 Nonotesforslide Rehabilitation國考題cva 1. Rehabilitation國考題_CVA R吳易澄 2. 腦中風 Stroke 3. 腦中風 期末考最後一名， 我爸氣到中風… 4. •一位56歲的病人在吃午餐時，突然發生頭痛 ，隨即有嘔吐現象，送到醫院時發現其右側上 下肢無力，左側顏面神經麻痺，經臨床診斷為 腦中風，其最可能的病變位置在下列何處？ (101-2-65,100-2-56) 1.基底核（basalganglion） 2.視丘（thalamus） 3.小腦（cerebellum） 4.橋腦（pons） 5. •腦中風病人半側偏癱及感覺受損，患側下 肢動作明顯比上肢靈活，則病灶最可能在? (95-1-55) 1.前大腦動脈（anteriorcerebralartery) 2.中大腦動脈（middlecerebralartery） 3.後大腦動脈（posteriorcerebralartery） 4.脊椎動脈（vertebralartery） 6. •一位55歲男性病人，突然發生右側肢體無力，小 便失禁，經診斷為梗塞性腦中風。

經過兩個月後， 右上肢恢復到幾乎正常，但右下肢仍明顯無力，在 診斷上最可能是那一條血管梗塞？(95-2-46) •前腦動脈（anteriorcerebralartery） •內頸動脈（internalcarotidartery） •基底動脈（basilarartery） •中腦動脈（middlecerebralartery） 7. •圖中病人在復健科被教導依ABCD順序穿 上衣，病人最可能罹患下列何種疾病？(98- 1-67) •左側大腦梗塞 •右側大腦出血 •左側腦幹出血 •右側小腦腫瘤 8. •49歲男性，平時有高血壓， 突然右側肢體無力， 根據此緊急CT，則其診斷是：(95-1-96) •視丘出血性中風（Thalamichemorrhage） •被殼出血性中風（Putaminalhemorrhage） •橋腦出血性中風（Pontinehemorrhage） •內囊出血性中風（Internalcapsularhemorrhage） 9. 中風評估 10. •下列何者不是常用來評估個人日常生活功 能之工具?(103-1-70) 1.布朗氏等級表(Brunnstromstage) 2.功能獨立評估表(functionalindependence measure) 3.巴氏量表(Barthelindex) 4.肯尼自我照顧評估表(Kennyselfcare evaluation) 11. •腦中風半側偏癱的患者，其患側肢的手部 可以做出掌面抓握（palmarprehension） 的動作，依照布朗氏分期（Brunnstrom’s stage）來判定，應該屬於第幾期？(96-2- 57) •StageII •StageIII •SatgeIV •StageV 12. •下列何者不是腦中風病人發病半年內常見 的預後不佳因子？(103-2-64) 1.坐姿不穩（poorsittingbalance） 2.尿失禁（incontinence） 3.心智改變（mentalchange） 4.肢肌肉張力增強（spasticity） 13. •Poorprognosisassociatedalsowith: –Nomeasurablegraspstrengthby4weeks –Severeproximalspasticity –Prolonged“flaccidity”period –Latereturnofproprioceptivefacilitation (tapping)response>9days –Latereturnofproximaltractionresponse (shoulderflexors/adductors)>13days 14. •Brunnstrom(1966,1970)andSawner(1992)alsodescribedtheprocessof recoveryfollowingstroke-inducedhemiplegia.Theprocesswasdivided intoanumberofstages: •1.Flaccidity(immediatelyaftertheonset) No“voluntary”movementsontheaffectedsidecanbe initiated. •2.Spasticityappears. Basicsynergypatternsappear. Minimalvoluntarymovementsmaybepresent. •3.Patientgainsvoluntarycontroloversynergies. Increaseinspasticity. 15. •4.Somemovementpatternsoutofsynergyaremastered(synergy patternsstillpredominate). Decreaseinspasticity. •5.Ifprogresscontinues,morecomplexmovement combinationsarelearnedasthebasic synergieslosetheirdominanceovermotoracts. Furtherdecreaseinspasticity. •6.Disappearanceofspasticity. Individualjointmovementsbecomepossibleand coordinationapproachesnormal. •7.Normalfunctionisrestored. 16. UpperLowerHand Iflaccid II spasticitydeveloping Associated movement/reaction •Littleornoactive fingerflexion III Synergypattern Muscletone •Triple extension(lock knee、tip toe、ankle inversion) •Massgrasp •Usehookgraspbut norelease •Novoluntary extension 17. UpperLowerHand IV Blocksynergy pattern •Placingthehand behindthebody •Elevatedthe armto水平 •屈肘可做 supination 坐著時 •Ankledorsiflexed •Kneeisolated extened •Lateral prehension(夾虎口 動作)，releaseby thumbmovement •Semivoluntary fingerextension V Blocksynergy pattern •Arm-raised forwardand overhead •伸肘可做 supination-pronation 站著 •Ankledorsiflexion •Kneeisolatedflexed •Ankle Inversion/eversion •Palmarprehension 掌面抓握 VI 只在RAMor交替 動作異常 可以只動一隻手指 18. •一位2歲的小女孩下肢肌肉有明顯的高張力痙攣 （spasticity），將踝關節作被動式背屈運動 （passivedorsiflexion）時，在大於50%的關節活動 度（rangeofmotion,ROM）之中，肌肉張力有明 顯的增加，但是這些張力可以很容易被移除，根據 modifiedAshworthscale，分數大約為幾分？(103- 1-55) 1.1 2.1+ 3.2 4.4 19. 中風併發症 20. •我們請某腦中風病人在每條橫線的中間點標示 記號（bisectiontest），結果如圖所示，這位 病人罹患什麼症狀？(100-1-55) •左側偏盲 •左眼眼盲 •右側斜視 •左側忽略 21. •右側大腦中風的病人除了會造成左側肢體無力及左 側感覺鈍化(hypesthetic)之外，也常常併發其他的 症狀，諸如左側忽略(leftneglect)和左側偏盲(left hemianopia) •目前評估是否合併忽略症狀可使用 –confrontationtest –仿畫測試(copytest) –spontaneousdrawingtest –behavioralinattentiontest –線二等分測驗(linebisectiontest) –刪除測驗(cancel-lationtest) 22. •忽略是對受傷大腦對側的刺激察覺能力降低，罹患該症 的病人無法察覺左側物體的存在。

•右側大腦中風的病人其視覺運用能力降低，除了忽略之 外尚有偏盲。

•偏盲一般成因是由於眼睛視神經到視皮質的病變而造成 視野縮小或缺損的情況。

•只有偏盲未合併忽略的病人可能以轉頭或轉動眼球的方 式代償來看見左側物品，病人若合併忽略症狀就沒有代 償能力。

23. •有文獻指出，中大腦動脈支配區域發生病 灶會產生純忽略症(pureneglect) •後大腦動脈支配的區域受損會產生純偏盲 症(purehemianopia) •中大腦動脈及後大腦動脈支配區域皆發生 病灶者即會產生兩種病症。

24. •半邊忽略現象（hemineglect）是最常出現 於腦部何處之病變？(97-1-55) •基底核（basalganglion） •額葉（frontallobe） •顳頂葉（temporoparietallobe） •枕葉（occipitallobe） 25. •下圖所示是病人在紙上畫出的房子、花和 時鐘，此病人有何種問題？(96-1-58) •左側偏盲（lefthemianopsia） •左側忽略（lefthemineglect） •左側失用症（leftsideapraxia） •左眼眼盲（lefteyeblindness） 26. •腦中風病人常發生患側肩關節疼痛僵硬等問題 ，下列敘述何者錯誤？(100-2-59) •腦中風病人約70-80%有肩關節問題 •維持被動性關節活動與肩外展運動最為重要 •急性期不可使用肩帶或吊帶，以免僵硬惡化 •肩關節問題發生在病人痙攣期（spastic phase）比無力期（flaccidphase）多 27. POSTSTROKESHOULDERPAIN •70–84%ofstrokepatientswithhemiplegiahave shoulderpainwithvaryingdegreesofseverity. •Themajority(85%)willdevelopitduringthe spasticphaseofrecovery. •Themostcommoncausesofhemiplegicshoulder painarecomplexregionalpainsyndrometypeI (seebelow)andsofttissuelesions(including plexuslesions). 28. •腦中風病人容易併發反射性交感神經失養 症（Reflexsympatheticdystrophy），下列 何者不是其典型的症狀？(100-2-57) •肩痛 •手肘活動度受限 •手腕水腫 •手背皮膚變薄 29. ComplexRegionalPainSyndrome TypeI(CRPSTypeI) •Alsoknownasreflexsympatheticdystrophy [RSD],shoulder-handsyndrome,orSudeck atrophy. •Disordercharacterizedby –sympathetic-maintainedpain –relatedsensoryabnormalities –abnormalbloodflow –abnormalitiesinthemotorsystem –andchangesinbothsuperficialanddeepstructures withtrophicchanges. 30. Stages •Stage1(acute):Lasts3to6months. –burningpain –diffuseswelling/edema –exquisitetenderness –hyperpathiaand/orallodynia –vasomotorchangesinhand/fingers(increasednail andhairgrowth,hyperthermiaorhypothermia, sweating). 31. Stages •Stage2(dystrophic):Lasts3to6months –painbecomesmoreintenseandspreadsproximally –skin/muscleatrophy –brawnyedema –coldinsensitivity –brittlenails/nailatrophy,decreasedROM, –mottledskin –earlyatrophy,andosteopenia(late) 32. Stages •Stage3(atrophic): –paindecreases –trophicchangesoccur:hand/skinappearpaleand cyanoticwithasmooth,shinyappearance,feeling coolanddry –bonedemineralizationprogresseswithmuscula weakness/atrophy,contractures/flexion deformitiesofshoulder/hand,taperingdigits –novasomotorchanges. 33. •一位中風患者在復健過程中主訴肩關節疼痛，理學 檢查顯示肩關節半脫位（subluxation），下列相關 敘述何者最為正確？(99-2-56) •使用三角巾將肩關節固定於內轉（internal rotation）角度 •常伴隨複雜性區域疼痛症候群第二型（complex regionalpainsyndrometype2）的發生 •可使用功能性電刺激於三角肌（deltoid）與棘上肌 （supraspinatus） •步行訓練時須將手臂置於身體背後 34. ShoulderSubluxation Treatment •Shoulderslinguseiscontroversial. –Pros:maybeusedwhenpatientambulatestosupportextremity(mayprevent upperextremitytrauma,whichinturnmaycauseincreasepainorpredispose todevelopmentofRSD). –Cons:mayencouragecontracturesinshoulderadduction/internalrotation, elbowflexion(flexorsynergypattern). •Otherwidelyusedtreatmentsforshouldersubluxation: –Functionalelectricalstimulation(FES) –Armboard,armtrough,lapboard—usedinpoorupper-extremityrecovery, primarywheelchairusers. –Armboardmayovercorrectsubluxation. –Overheadslings—preventshandedema(mayusefoamwedgeonarm board). 35. •因慢性腦中風或腦性麻痺所引起的偏癱步 態（hemipareticgait）不會有下列何項特 徵？(101-1-56) •膝部外翻（genuvalgum） •髖部環繞動作（circumduction） •上肢協同收縮（co-contraction） •足部內翻（inversion） Rehabilitation國考題tbi Yi-ChengWu Rehabilitation國考題scicomplications Yi-ChengWu Rehabilitation國考題modalities Yi-ChengWu Rehabilitation國考題speech Yi-ChengWu Rehabilitation國考題_SCI Yi-ChengWu WhattoUploadtoSlideShare SlideShare BeAGreatProductLeader(Amplify,Oct2019) AdamNash TrillionDollarCoachBook(BillCampbell) EricSchmidt APIdaysParis2019-Innovation@scale,APIsasDigitalFactories'NewMachi... apidays Afewthoughtsonworklife-balance WimVanderbauwhede 醫師國考(復健科) Views Totalviews 1,254 OnSlideshare 0 Fromembeds 0 Numberofembeds 8 Actions Downloads 1 Shares 0 Comments 0 Likes 0 0Likes Statistics Notes × ShareClipboard × Facebook Twitter LinkedIn Link Publicclipboardsfeaturingthisslide × Nopublicclipboardsfoundforthisslide Selectanotherclipboard × Lookslikeyou’veclippedthisslidetoalready. Createaclipboard Youjustclippedyourfirstslide! Clippingisahandywaytocollectimportantslidesyouwanttogobacktolater.Nowcustomizethenameofaclipboardtostoreyourclips. Name* Description Visibility OtherscanseemyClipboard Cancel Save SpecialOffertoSlideShareReaders × TheSlideSharefamilyjustgotbigger.Younowhaveunlimited*accesstobooks,audiobooks,magazines,andmorefromScribd. Activateyourfree60daytrial Cancelanytime.