文档介绍：痉挛( Spasticity) 中国康复研究中心徐基民?痉挛是临床上很常见但处理起来却又颇不容易的一个难题。?因为对痉挛的概念还不是十分的清楚。?“ spasticity ”是来源于希腊语的“ spastikos ”, 意思是“ draw in ”,即“收”、“紧缩”的意思。??目前国际上对痉挛还没有一个统一的定义。?以下是在外文文献中经常被引用的 3位学者提出的有关痉挛( Spasticity )的定义。 Nathan(1973) 对痉挛的描述: ?“Spasticity is a condition in which stretch reflexes that are normally latent e obvious. The tendon reflexes have a lowered threshold to tap, the response of the tapped muscle is increased, and usually muscles besides the tapped one respond; tonic stretch reflexes are affected in the same way. ”?“痉挛是正常时处于潜伏状态的牵张反射显露出来的一种状态。腱反射对叩击的阈值降低,被叩击肌肉的反应性增加,其相邻肌肉也发生反应,张力性牵张反射也出现类似的现象。”?Nathan 对痉挛的定义强调牵张反射的中枢性作用,包括位相性牵张反射(phasic stretch reflexes )和张力性牵张反射( tonic stretch reflexes ) 增加。–位相性牵张反射增加表现为腱反射活跃或亢进–张力性反射增加表现为检查者被动活动牵拉肌肉时的抵抗(肌张力)增加。 Lance (1980 )对痉挛的描述是目前国际上普遍采用的痉挛定义: ?. “A motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome ”?“痉挛是属于上运动神经元综合症的运动障碍表现之一,其特征为肌张力随肌肉牵张反射的速度增加而增高,伴随着由于牵张反射过度兴奋导致的腱反射亢强。”?显然,临床上所指的痉挛是检查者被动牵拉肌群诱发肌肉张力增加的主观感受, 所谓“肌张力随肌肉牵张反射的速度增加而增高”是指当牵拉痉挛肌肉时,缓慢牵拉所感受到的阻力小于快速牵拉。 Gans 和 Glenn (1990) 对痉挛的描述包含以下四个特征? Velocity-dependent resistance to passive range of motion, in which slow passive movements meet with little resistance but faster movements encounter more resistance (something like the response of a bicycle tire pump) ? Hyperactive reflex actions ? Spread of reflexes beyond the joint being tested ? Clonus