**Add on**

Dynamic Ball Activities

Dynamic ball activities should be attempted only after the patient achieves static control. As
previously discussed, the addition of trunk and limb movements requires anticipatory balance
control as well as reactive control.

P.113-120

P.113(續)Dynamic Ball Activities

5.24~5.27

5.24 Sitting on ball, head and trunk rotation The patient practices head and trunk rotation to the left
while holding a small ball and maintaining sitting stability. The patient then twists to the other side,
moving the ball as far as possible in the new direction.

(續)Lower Extremity Movements

Knee extension. The patient straightens the knee and holds the foot out in front for three counts and
then returns (Fig. 5.29). This activity can progress to reciprocal opposite knee and elbow extension
(Fig. 5.30).
Knee extension with ankle movements (circles, or writing letters of the alphabet in space with the
dynamic foot).

Side steps. The patient moves the LE out to the side into hip abduction and knee extension (Fig.
5.31), holds briefly, and then returns. This activity can progress to hip abduction with the knee
flexed, moving down into unilateral kneeling while half-sitting on the ball (a modified half-kneeling
position).

Heel lifts and toe-offs. The patient lifts both heels off the floor while keeping the toes in contact,
and then reverses and lifts both toes off the floor while keeping the heels in contact with the floor.
Activity can be progressed to reciprocal lifts.

Kicking a ball. A small ball is rolled toward the patient, who then kicks it back to the therapist.

Four-Limb Activities
Jumping jacks. The patient raises both UEs overhead, claps the hands, and returns hands to the start
position (along sides of ball). This activity is combined with bouncing on the ball and alternating
reciprocal knee extension and flexion (Fig. 5.32)

P.114(續)Dynamic Ball Activities

5.28 Sitting on ball, marching
病人坐在球上一邊保持平衡一邊做行軍動作(交替著做髖膝屈曲和對側的肩屈肩伸)。這個四
肢共同參與的動作要求在球上保持動態平衡。

5.29 Sitting on ball, knee extension

病患試著坐在球上保持平衡的同時舉起單邊的腳並保持膝關節伸直，雙上肢在兩側保持平
衡；這項活動可以再進階為讓病人用舉起的腳畫字母或是數字。

5.30 Sitting on ball, LE lifts with reciprocal UE lifts

病患試著伸出單膝並合併抬高對側的上肢，或是做髖屈曲時將腳放在不穩定平面上合併抬高
對側的上肢。

P.115(續)Dynamic Ball Activities

5.31 Sitting on ball, side steps

The patient practices stepping out to the side, moving one LE into hip abduction with knee
extension while maintaining stable sitting on the ball. The UEs are held with both hands clasped
together in a forward position (elbows extended and shoulders flexed).
病人練習在球上保持坐姿平衡的同時，將一隻下肢做髖外展和膝伸；而雙上肢則是

5.32 Sitting on ball, jumping jacks

The patient practices jumping jacks, raising both UEs overhead and clapping hands while
performing alternate reciprocal hip abduction/adduction of both LEs.

病人練習在球上做開合跳，雙手過頭拍手的同時，雙下肢做髖外展內收。

P.115 Promoting Adaptive Balance Control

适应性平衡控制可以通过修改或 改变任务或环境的要求来加强适应性平衡控制。參考 BOX
5.7

BOX 5.7 Strategies to Promote Adaptive Balance Control

1. 改變支撐底面積和本體覺輸入: 從坐在墊上改為坐在，再到不穩定的球上。底面積從一塊
瑜珈墊縮減到一塊瓷磚，再到
Modify the support surface and somatosensory inputs: Change from sitting on a platform mat to
sitting on a dense foam pad to an inflatable disc to a ball; change surface under feet from a sticky
mat (yoga mat) to a tile floor to an inflatable disc to both feet on a small ball.

2. 視覺輸入: 從睜眼到閉眼
Modify visual input: Change from eyes open to eyes closed.

3. 調整 BOS: 底面積從兩腳打開到兩腳併攏，到兩腳一前一後站；再到站在不穩定平面(平衡
球)；雙手從扶扶手改為抱胸。
Modify the BOS: Change from feet wide apart to feet together to one leg crossed to feet on a mobile
surface (inflated disc or ball); change from UEs supporting to no support (e.g., UEs held in front,
out to the sides, or folded across the chest).

4. 調整肢體動作:從單側到雙側動作，再到合併四肢的動作；可以調整動作的方向、ROM，
增加或是變化阻力。
Modify limb movements: Progress from unilateral to bilateral limb movements to combinations of
limb movements (e.g., four-limb activities); modify the direction and range of movements);
add/vary the amount of resistance.

5. 調整活動: 調高速度, 活動範圍或反覆次數。

Modify the activity: Increase the speed, range, number of repetitions.

6. 為活動加節律: 使用外部裝置打節拍，例如節拍器或是用播放器
Pace the activity: Use an external rhythmic timing device (e.g., a metronome or personal listening
device with a specific music beat).

7. 使用雙重任務: 額外加入第二個動作或是認知上的任務，像是坐姿時手托著上面有杯水的
盤子；或是從 100 開始以 3 個數字為 1 個單位做倒數)
Use dual-tasking: Add a secondary motor or cognitive task (e.g., sitting while holding a tray with a
glass of water on it or counting backward by 3s from 100).

8. 調整環境: 最開始從封閉的空間(例如 TBI 病人會需要靜室來避免分散注意)，到開放的空

間(例如運動治療室)，再到近似於居家的環境。
Modify the environment: Progress from a closed environment (e.g., quiet room with no distractions
needed for some patients with TBI) to an open environment (busy treatment area or gym) to
simulated home environment.

坐姿下的整合療法運動
** 整合療法(Integrative medicine)是將標準醫學與輔助及另類療法(CAM)相互結合，並通過科學證明是安
全有效的醫學。這種醫學強調依據病人的喜好，解決他們生理、心理和精神方面的問題。

整合医学将古老的智慧和当前的最佳实践结合起来，提供以病人为中心的护理。的最佳实
践，提供以病人为中心的护理。思考整个人的健康，包括精神、思想和身体。着重强调健康
和预防医学。

整合医学被整合医学学术中心联盟定义为 "重申医生和病人之间关系的重要性的医学实践。
医学实践重申了医生和病人之间关系的重要性，关注整个人，以证据为依托，并在此基础上
进行治疗。医学实践重申医生和病人之间关系的重要性，关注整个人，以证据为依据，并利
用所有
适当的治疗方法、卫生保健专业人员和学科，以实现最佳的健康和治疗"。
心灵/身体锻炼的临床益处已被充分证实。有据可查。

太极拳和瑜伽是可以在康复环境中使用的参与性和趣味性综合运动的例子。这些运动可以在
临床医生与患者 1:1 的比例下进行，也可以在团体课程中进行。个体化治疗可以根据病人的
具体需要进行人工提示和 VC，并允许对有跌倒风险的病人进行严密保护。

团体课程提供了一个丰富的社交和支持机会的环境。

坐姿下的太極

太极拳是一种古老的中国武术形式，由缓慢、有意识的动作和姿势组成，强调身体意识、灵
活性、力量和平衡。目前和新出现的研究表明，这种运动方式对病人的功能和社会心理有深
刻的影响。这种运动方式对运动障碍患者有深刻的功能和社会心理影响。运动障碍的病人产
生深远的功能和社会心理影响。太极拳的功能益处包括改善平衡，提高功能活动能力。和增
加步行耐力。
太极拳有许多社会心理方面的好处，包括减轻疼痛和压力。
众所周知，慢性衰弱性疾病会给病人以及家庭成员和护理人员带来疾病负担。以及家庭成员
和照顾者。
鼓励社会参与和家人、朋友和照顾者参与的项目与改善病人和支持伙伴的健康和福祉有关，
此外，在结构化锻炼项目完成后，病人的依从性和持续锻炼的坚持性也得到了改善。

一个为帕金森病患者和他们的支持伙伴（通常是家人或朋友）提供联合课程的太极拳 "伙伴
"计划，使患者和支持伙伴都报告了身体、心理和社会方面的改善。

附录 5A：坐着打太极拳的顺序提供了一个太极拳运动的样本
太极拳练习样本，适合于因关节疼痛、无力而无法进行站立练习的患者。
因为关节疼痛、虚弱或平衡问题而无法进行站立练习的病人提供了一套太极拳练习的样本。
这套动作强调坐着的重心转移、平衡、灵活性和力量训练。这套动作可以作为
可以作为个人治疗课程或家庭锻炼计划（HEP）的一部分进行。
锻炼计划的一部分，或者在小组环境中进行，以促进社交活动。

P.116 坐姿瑜伽
瑜伽的练习是在印度发展起来的，是连接身体、心理和精神的一种手段。
瑜伽有许多不同的风格。大多数结合了一系列的身体姿势（称为体位法）和受控的呼吸（称
为调息法），强调对齐、灵活、力量、平衡和呼吸意识。瑜伽运动的好处已经在各种病人的
病情中得到证实。

附录 5B：晚期帕金森病的坐姿瑜伽练习，提供了一个坐姿瑜伽练习的样本，旨在改善患者
的姿势、灵活性和呼吸。

这套动作可以作为个人治疗课程的一部分进行
或 HEP 的一部分，或在小组环境中进行，以促进社交活动。

Outcome Measures of Sitting Ability

坐姿能力的结果测量
使用标准化的结果测量来记录病人的坐姿能力和护理计划的结果是很重要的。有些措施是针
对残疾的，例如，急性中风患者的移动量表和中风患者的姿势评估。
还有一些是通用的，也是普遍使用的。
康复中最常用的测量方法之一是功能独立测量。
在评估使用哪种工具时，重要的是要了解被测量的参数，其中包括。
- 描述性参数：病人的依赖性或独立性水平（病人需要的援助量）；困难、疲劳或疼痛；一
天中不同时间的波动；用药水平；环境 影响因素
- 定量参数：病人能够保持坐姿的时间和完成坐姿活动所需的时间（例如，躯干或四肢的运
动）
- 定性参数：保持姿势的稳定性；对改变 BOS 的反应的稳定性；使用手扶支撑物来保持姿
势；对改变 BOS 的反应的稳定性。
姿势的稳定性；对改变 BOS 的反应的稳定性；使用手掌的支撑来保持姿势；重量转移和四
肢运动的便利性；动作的整体协调性；接受挑战的能力和对四肢运动
动作的整体协调性；接受挑战和保持姿势的能力
姿态
表 5.1 列出了坐姿能力的标准化结果测量。
It is important to use standardized outcome measures to document the patient’s sitting ability and
outcomes of the plan of care. Some measures are disability specific, for example, the Mobility Scale
for Acute Stroke Patients,27 and the Postural Assessment for Stroke Patients.28,29 Others are
generic and in general use; one of the most commonly used measures in rehabilitation is the
Functional Independence Measure. 30,31 In evaluating which instruments to use, it is important to
understand the parameters being measured, which can include: • Descriptive parameters: the
patient’s level of dependence or independence (the amount of assistance the patient requires);
difficulty, fatigue, or pain; fluctuations by time of day; level of medication; environmental
influences • Quantitative parameters: the amount of time the patient is able to maintain the sitting
posture and the time required to complete an activity in sitting (e.g., trunk or extremity movements)
• Qualitative parameters: steadiness in maintaining posture; steadiness in response to altering the
BOS; use of handhold support to maintain posture; ease in weight shifting and extremity
movements; overall coordination of movements; ability to accept challenges and maintain posture
Table 5.1 presents standardized outcome measures of sitting ability.

P.117 坐姿能力的結果測量

Measure Specific items

BBT Sit to stand
Sitting unsupported
Trunk control test Sitting edge of bed
Feet off floor
supine to sit
Duke mobility skill profile Sitting unsupported
Sitting reach to take object
Rising from chair
Bed to chair
Postural Assessment for stroke Sitting without support, feet on floor
patients(PASS) Supine-to-sit
Sit-to-supine
Sit-to-stand
 Stand-to-sit
Mobility Scale for Acute Stroke Supine-to-sit
Patients Sitting unsupported
Sit-to-stand
Fugl-Meyer Assessment- Sitting unsupported
Balance Subscale
Rivermead Mobility Index Supine-to-sit
Sitting unsupported
Sit-to-stand
Motor Assessment Scale UE activities in supported sitting
Modified Functional Reach Distance of forward reach in sitting
Performance Oriented Mobility UE activities in supported sitting
Assessment-Balance Subscale Distance of forward reach in sitting
(POMA)
Function in Sitting Test (FIST) Static sit
Reach forward
Pick item up off floor
Lateral reach with uninvolved UE
Lateral reach with involved UE
Pick up item from behind with
uninvolved UE
Sit with eyes closed
Anterior nudge
Posterior nudge
Anterior scooting
Lateral nudge
Pick up item from behind with involved
UE
Lift involved foot off floor
Posterior scooting (2 in.)
Lateral scooting (2 in.)
Shake head “no”
Functional Independence Bathing
Measure (FIM) Dressing
Toileting
Transfers: bed chair, wheelchair, toilet,
tub, shower
Barthel Index Bathing
Dressing
Toilet
transfers
Bed-to-chair transfers

P.118
BOX 5.8 STUDENT PRACTICE ACTIVITY

Task Analysis of Sitting 坐姿任務分析

OBJECTIVE: To provide practice opportunities for developing skill in task analysis of sitting
EQUIPMENT NEEDS: Adjustable-height platform mat or treatment table and a dome-shaped
wobble board
目的: 提供機會來發展坐姿任務
器材需求: 治療床和平衡板

DIRECTIONS: Work in groups of two or three. Begin by having each person in the group sit on the
mat, first in short-sitting (knees flexed, feet flat on the floor) and then in long-sitting (knees
extended).

Then have each person practice weight shifts to the LOS 穩定限度(limits of stability；LOS) in both
postures. Finally, have each person sit on a dome-shaped wobble board placed on a hard sitting
surface. Have each person practice sitting centered on the board (no tilts); then have each person sit
on the wobble board with reduced BOS (one leg crossed over the other; sitting on a high seat
without contact of the feet on the floor).

P.119
BOX 5.9 STUDENT PRACTICE ACTIVITY
增進坐姿和坐姿平衡控制的技巧與策略
Sitting, holding
• Stabilizing reversals //等張: 讓病人去推你
• Rhythmic stabilization //等長: 固定在原地，不要動
Sitting, weight shifts, cone stacking
Sitting, weight shifts, dynamic reversals
Sitting, application of PNF UE patterns, using dynamic reversals
• Chop and reverse chop
• Lift and reverse lift
• Bilateral symmetrical thrust and withdrawal
• Bilateral symmetrical flex/abdomen (abd)/external rotation (ER), rhythmic initiation
Sitting, manual perturbations
Sitting, ball activities
•Pelvic shifts (anterior-posterior, side to side, pelvic clock)
• UE lifts (unilateral, bilateral symmetrical, bilateral asymmetrical, reciprocal with marching)
• LE lifts (hip flexion, knee extension, with ankle circles or writing letters, side steps, heel lifts, toe-
offs)
• Head and trunk rotation (lateral rotations, diagonal rotations)
• Marching in place (contralateral UE and LE lifts)
• Jumping jacks (bouncing with UE lifts overhead) :開合跳
• Catching and throwing a ball (inflated ball, weighted ball); batting a balloon
• Kicking a rolling ball

使用不穩定平面增進平衡 Promoting Balance Control Using Mobile and Compliant Surfaces

平衡板和平衡盤 Rocker Board or Inflated Disc
使用平衡板、平衡盤或是治療球來改變病患的底面積以及 engage postural mechanisms

P.120 總結
這個章節介紹了坐姿和坐姿平衡控制的要求，
這些介入除了當 PT program 外 有些難度低的也可以當 home program

也可以再 modify 之後衛教給病家