neurorehabilitation in stroke 腦中風復健

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Neurorehabilitation in stroke腦中風復健

蔡森蔚醫師

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前言bull 中風是由於腦血管阻塞或腦部出血造成腦

組織的缺氧而導致壞死中風後因腦組織壞死造成的後遺症可分為以下幾部分認知及記憶力空間方向感肢體力量半邊無力不正常張力吞嚥功能障礙大小便障礙等復健專科醫師診視病人障礙程度後會依病患問題開立不同的治療處方並與治療師共同組成團隊以進行中風後的復健

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Medical DX VS Rehab DX

bull Medical diagnosis ndash pathplogy (eg Infarction) ----neurological defi

cits (eg hemiplegia)

bull Rehabilitaiton diagnosis ndash Impairment (eg hemiplegia) ----- disability (e

g inablility to walk)

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中風後需不需要復健bull 大部分病患在中風 30 天內都會有自然恢復

現象bull successful rehabilitation depends on

ndash how early rehabilitation begins ndash the extent of the brain injury ndash the survivors attitude ndash the rehabilitation teams skill ndash the cooperation of family and friends

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中風後運動功能障礙bull Weakness (paralysis paresis plegia)

bull Spastic hypertonia

bull Incoordination

bull Loss of fine motor control

bull Abnormal involuntary movement

bull Sallowing impairment

bull Spatial defect - neglect

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中風治療bull 中風復健大家比較熟悉的部份包括物理治療職能治療及

語言治療但每一種治療到底包含哪些部分則一般民眾並不清楚

bull 物理治療主要著重於肢體運動困難包括動作誘發維持關節活動度大動作運動功能重新訓練（例如肌耐力行走坐立站立功能訓練等）步態矯正平衡訓練等

bull 職能治療著重於日常生活及回復工作能力訓練包括手部肌肉及精細動作訓練認知功能訓練副木支架製作輔具穿戴訓練及居家無障礙設施的評估等

bull 語言治療包括口語發聲訓練吞嚥訓練認知訓練等bull 除了以上三種治療完整的復建計畫尚包括中風後心理調

適治療等

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中風復健治療介入時機

bull 腦血管阻塞所導致的中風病人的復健在中風後第一天就必須開始而腦部出血所造成出血性中風必須等 7-10 天或病況穩定才開始進行復健

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中風復健初步分類bull 若病患恢復良好且無特別後遺症復健則著重於病房指導居家復健運動治療與衛教

bull 雖然病患明顯殘留後遺症例如半側偏癱運動困難認知及空間方向感障礙不正常張力吞嚥功能障礙大小便障礙等但有積極復健潛能者則依病況安排積極復健治療包括癱瘓肢體動作誘發行走坐立站立等功能訓練步態矯正手部肌肉及精細動作訓練平衡訓練語言治療包括口語發聲訓練等

bull 有些病患若肢體完全無力或張力不正常則視狀況幫病患製作副木支架防止關節攣縮

bull 對於嚴重障礙的病患例如可能須長期臥床照顧者則協助殘障鑑定與居家輔具評估以進行長期照護

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NIHSS ndash initial assessment

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運動功能的復原ndash Early recovery

bull Except TIA good recovery within 24 hoursbull initial hours -no substantial neurological recovery

ndash First month most of the motor improvementndash Up to 6 months some motor improvementndash Some patients considerable recovery in later

phases

Biller J Stroke 1990 Bonita R Stroke 1988 Duncan P Stroke 1992

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中風復健大致上可分為三個階段

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急性期bull 中風發生一週內治療重點在於維持血壓心跳等生命徵

象的穩定初期會讓病患血壓維持在比較高的範圍以幫助腦血液循環因意識不清或吞嚥東能障礙有些病人在此時期需要靠鼻胃管幫助灌食以預防肺炎或嗆咳的發生在此時期治療目標以床邊復健為主治療師會施以被動性關節運動以維持關節活動度並教導照護者正確擺位以免臥床導致褥瘡在中風急性期依國外對於 319位在急性期即將轉入復健病房的中風病患研究統計指出約有百分之七的病患需要插導尿管以幫助排尿而另外 297位病患中有 21 病患其膀胱中的餘尿超過 150ml 這些病患存在泌尿道感染的危險

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急性期之復健項目 bull 適當之床邊擺位bull 協助翻身及移位bull 床邊運動治療bull 夾板預防關節變形bull 預防嗆到bull 協助排痰及增加心肺功能

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Dysphagia

bull CAV is the most common medical condition associated with dysphagia

bull 30 of people who experienced a CVA have significant dysphagia

bull Dysphagia team ndash decrease length of stay

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亞急性期bull 若病患恢復良好且無行走困難一般在急性期後

並不需特別復健若病患能明顯殘留如半側偏癱失語症等後遺症則需要持續復健治療對於有積極復健潛力的病患復健醫師將安排這些病患轉入復健病房接受每天 2-3次更積極的復健患者生命徵象在此時逐漸穩定因此復健醫師會依病況調整藥物復健治療目標則在於促進腦神經重新整合日常生活功能訓練增加患者自我照顧能力在此時期為病患功能恢復最多且運動訓練成效也較明顯的時期大多數病患必須把握這1-3個月的黃金期接受復健

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恢復期之復健項目

bull傾斜床訓練bull墊上運動訓練bull平衡移位床外活動訓練bull步行訓練bull輪椅輔助用具之使用bull手功能訓練bull日常生活訓練

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亞急性bull 在這三個月的住院復健中第一個月的訓練著重

在移位上廁所增加患者自我照顧能力及教導照顧者如何幫助患者執行日常生活並預防跌倒

bull 第二個月的復健訓練目標在於讓患者開始站立並在輔具幫助下行走

bull 第三個月的復健訓練目標則在於使患者能獨立行走並降依賴他人照護的需求降至最低

bull 三個月後病況更趨穩定絕大部分患者不需住院照護此時復健醫師會建議病患接受門診復健治療在此時期病患仍會持續進步對於少數病況不穩定的病患例如接受氣管插管或反覆性肺炎或泌尿道感染等則可能必須住院照護

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Impairment evaluation

bull 1 Higher mental function ndash recognition and interpretation of sensory info

with intact sensory input system

bull 2 Communication disordersndash Aphasia ndash language disorderndash Dysphasia and dysarthria ndash speech disorder

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bull 3 Cranial nervesbull 4 Motor Impairment

ndash Medical Research Council 0-5 system used in early stroke

ndash Brunnstrom stage correlate with functional recoveryndash Bohannon ndash objective dynamometer correlates with p

erformance in functional tasksndash Fugl-Meyer movement and disabilityndash Tone ndash Modified Ashworth Scale

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bull 5 Sensory impairmentndash Frequently with motor impairment distributionndash Thalamic leisonndash Parietal lobe perceptual deficits

bull 6 Balance coordination and posturendash Secondary to deficits in motor and sensory fu

nction cerebellar lesion vestibular dysfunction ataxia

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Natural History Of Recovery of Gait

bull Walking is the outcome most desired by stroke survivors

bull The Copenhagen Stroke Studyndash Gait impaired in 63ndash Initially

bull 51 -no walking functionbull 37 -independent walking

ndash After rehabbull 22 -still no walking function

bull 66 -independent walkingJorgensen H Arch Phys Med Rehabil 1995 Francisco 2006

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bull Walking Function95 of patients reached their best level of walking function within 11 weeks from stroke onset (Jorgensen H Arch Phys Med Rehabil 1995)

bull How many more of these patients have the potential for further recovery if recovery is enhanced or if complications are treated

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body-weight supported treadmill training in post-stroke rehabilitation

bull Unloads up to about 30-40 of body weight

bull 1048697Start at 025 msbull 1048697Need help of 1-2 therapists initiallybull 1048697Benefits

ndash Improves balancendash Improves symmetryndash Decreases plantarflexor spasticity

bull More regular muscle activation pattern

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electrical stimulation in facilitating post-stroke gait

bull Delivery of electrical stimulation to an intact lower motor neuron to activate paralyzed or paretic muscles and directly accomplish a functional task

bull 1048697Therapeutic effect achieved throughndash Active repetitive-movement trainingndash Motor re-learning

bull 1048697Typesndash Transcutaneous (surface)

bull Implanted (percutaneous epimysial epineural intraneural)

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慢性期bull 大約中風 3-6個月後大多數病人病況穩定

病患的障礙情況也大致固定因此大多以門診方式接受復健復健進步不理想的病患則居家或於安養機構進行照護治療目標則在於維持功能避免併發症

bull 有些中風患者患側會有痙攣高張力現象復健醫師將在此時依病況進行肉毒桿菌素注射協助患者降低張力配合門診復健已獲得更好的功能進步

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electrical stimulation

bull Stimulates over a nerve or a motor pointbull Manipulate pulse width amplitude and frequenc

y of current to achieve desired muscle contraction

bull Superior to ankle-foot orthosisndash Challenges

bull Painbull Tissue injurybull Skin Impedancebull Inconsistent placement of electrodes

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botulinum toxin enhancing motor recovery by treating the common

complication spasticity

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TREATMENT OF COMPLICATIONS Focus on Spasticity

bull Definition

bull A motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks resulting from hyperexcitability of the stretch reflex as one component of the upper motor neuron syndrome

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Spasticity 健保給付bull )限 20歲以上中風發生

後經復健輔具或藥物治療至少 6個月以上仍有手臂痙攣影響其日常活動 ( 如飲食衛生穿衣等 )者痙攣程度符合Modified Ashworth Scale 評估 2 或 3級且關節活動度（ R1R2 ）顯示顯著痙攣並排除臥床手臂攣縮或關節固定不可逆攣縮者

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Ocupational therapybull Hand functional trai

ngbull hand function shou

lder stablization- elbow reaching- hand grasp and release- pinch - opposition- finger prehension

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ITB TherapyEvidence of Efficacy

ndash At the impairment level ITB Therapy is effective inDecreasing spastic hypertonia

ndash Reducing spasms and clonus

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語言障礙bull 大多數中風病患所殘留的後遺症都為肢體

障礙有少數中風患者則合併有語言障礙在三個月後若仍無改善復健醫師則會依病況給予 bromocriptine　或　 levodopa 等藥物治療但這些藥物並非對於每位患者都有效必須依病況調整

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言治療 Speech Therapy (ST)bull Oral motor functionbull Impairment of swall

owingbull Drollingbull Impairment of tongu

e movementbull Dysarthria

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Speech therapy

bull Vebral command simple complex

bull Namingbull Repititionbull Communication plat

ebull Reading and singing

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Neglect

bull 更少數病患則殘留空間方向感障礙例如左側忽略 (left spatial neglect) 這種病症會使中風病患忽略掉他們左側的空間例如頭一直轉到右側吃飯只吃右邊食物甚至畫圖只劃出病患看到的右側空間 ( 如圖 )

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NeglectNeuropsychological Rehab

bull Monopatching

bull Patching in the right-half field

bull Prism goggle (right shift) with the effect of post adaptation (PA) (Rossetti et al 1998)

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Robotic Devices

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前言bull 中風是由於腦血管阻塞或腦部出血造成腦

組織的缺氧而導致壞死中風後因腦組織壞死造成的後遺症可分為以下幾部分認知及記憶力空間方向感肢體力量半邊無力不正常張力吞嚥功能障礙大小便障礙等復健專科醫師診視病人障礙程度後會依病患問題開立不同的治療處方並與治療師共同組成團隊以進行中風後的復健

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bull Incoordination





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適治療等

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phases


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Dysphagia




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bull Definition


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Speech therapy




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Neglect


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bull Monopatching



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Robotic Devices

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bull Incoordination





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適治療等

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phases


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Dysphagia




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bull Definition


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Speech therapy




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Neglect


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bull Monopatching



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Robotic Devices

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bull Incoordination





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適治療等

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phases


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Dysphagia




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bull Definition


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Speech therapy




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Neglect


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bull Monopatching



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Robotic Devices

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bull Incoordination





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適治療等

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phases


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Dysphagia




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bull Definition


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Speech therapy




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Neglect


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bull Monopatching



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Robotic Devices

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適治療等

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Dysphagia




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bull Definition


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Speech therapy




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Neglect


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bull Monopatching



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Robotic Devices

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bull Definition


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Neglect


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bull Monopatching



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Robotic Devices

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bull Definition


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Speech therapy




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Neglect


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bull Monopatching



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Robotic Devices

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bull Definition


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Speech therapy




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Neglect


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bull Monopatching



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Robotic Devices

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phases


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bull Definition


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Speech therapy




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Neglect


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bull Monopatching



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Robotic Devices

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bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

12



13


14

Dysphagia




15



16



17






18





19






20





21







22




23






24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

13


14

Dysphagia




15



16



17






18





19






20





21







22




23






24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

14

Dysphagia




15



16



17






18





19






20





21







22




23






24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

15



16



17






18





19






20





21







22




23






24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

16



17






18





19






20





21







22




23






24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

17






18





19






20





21







22




23






24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

18





19






20





21







22




23






24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

19






20





21







22




23






24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

20





21







22




23






24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

21







22




23






24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

22




23






24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

23






24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

24






25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

25




26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

26






27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

27



28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

28


bull Definition


29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

29



30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

30




31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

31




32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

32

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

33



34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

34




35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

35

Speech therapy




36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

36

Neglect


37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

37


bull Monopatching



38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

38

Robotic Devices

Slide 1

Slide 2

Slide 3

Slide 4

Slide 5

Slide 6

Slide 7

Slide 8

Slide 9

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Slide 16

Slide 17

Slide 18

Slide 19

Slide 20

Slide 21

Slide 22

Slide 23

Slide 24

Slide 25

Slide 26

Slide 27

Slide 28

Slide 29

Slide 30

Slide 31

Slide 32

Slide 33

Slide 34

Slide 35

Slide 36

Slide 37

Slide 38

neurorehabilitation in stroke 腦中風復健

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