缺血性脑卒中患者精神运动性障碍矫正的特点:心理方面

Y. Kharchenko, I. Vashchenko
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引用次数: 1

摘要

本文的目的是:提出作者对展现精神运动功能障碍全貌的生物力学规律的看法;对缺血性脑卒中“肢体无力+轻瘫”亚组患者的运动功能初始状态进行研究并分析已获得的数据;提出缺血性脑卒中患者肢体康复过程中患者一般代偿反应发展的心理学原理。研究方法。我们采用文献来源分析法;教学观察法;心理与教学实验;提供心理情绪状态的研究(采用M. Lucher’s test)。研究的结果。我们证明,无论障碍程度如何,精神运动功能障碍的图景都遵循一定的生物力学规律:1。受影响肢体功能重新分配的规律。患肢维持体重的功能明显减弱。这在单一支撑期内尤为明显:在单一支撑功能的时间间隔中,绝对和相对都减少,以及该支撑期的持续时间。但是这种对病侧的卸载是必须补偿的,因为健康腿的支撑期明显增加。支持周期的变化有一个明显的后果——患病一方的转移时间增加了,健康一方的转移时间也增加了——我们指的是它的减少。2. 模仿他人动作的规则。病理性不对称在能量或力学方面对身体不利。由于需要保持身体左右两侧功能的相对对称,因此得出以下结论:健康的身体(或肢体)比生病的肢体有相当大的功能储备,因此通过近似健康肢体的功能模式来减少功能不对称。3.确保精神运动活动达到最佳状态的法则。精神运动活动正常周期的所有要素的功能是个体生理最佳性的基础。任何与生理最优性的偏差都需要额外的适应性储备,这在受影响的一侧略有改变。由于健康侧的功能压力,为患者提供最佳功能是可能的。结论。在本研究中,我们提出了缺血性脑卒中患者身体康复中患者一般代偿反应发展的心理学原理。这些原则是:1)缺陷实现原则;2)精神运动性代偿机制的递进动员原理;3)人的心理代偿机制的连续反向集中原则;4)人的心理补偿机制的制裁原则;5)患者心理代偿机制的相对稳定性原则。研究证明,在缺血性中风的情况下,有一定的动态恢复的轨迹障碍。首先恢复反射功能和音调,然后出现精神运动动作(全局协调联动)和辅助动作,最后恢复任意动作。为了开始恢复肌腱反射和肌肉张力,有必要使脊髓功能正常化。我们强调,某些功能失调的补偿是基于旧刻板印象的重构和新的动态刻板印象的发展。在精神运动病理的情况下,对结构和功能障碍的补偿最重要的一点是积极参与康复过程和患者自己,他们应该寻求激活身体的系统,这些系统根本没有受到影响或受到轻微的影响。研究表明,由于新的未受影响的中枢神经系统部分,有可能重新安排拮抗剂之间的神经支配。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Peculiarities of the Correction of Psychomotor Disorders of Patients with Ischemic Stroke: the Psychological Aspect
The objectives of article are: to propose the author’s view on biomechanical laws which show the picture of disorders of psychomotor function; to make the research and to analyze obtained data on the initial state of motor function of patients with ischemic stroke of the subgroup «plesia + paresis»; to propose psychological principles of the development of general compensatory reactions of the patient in a case of physical rehabilitation of patients with ischemic stroke. Methods of the research. We used the method of the analysis of literature sources; the method of pedagogical observation; psychological and pedagogical experiment; providing the research of psycho-emotional state (M. Lucher’s test is used). The results of the research. We proved that regardless of the level of disorders, the picture of disorders of psychomotor function is subjected to certain biomechanical laws: 1. The rule of redistribution of functions of the affected limb. The functionality of the affected limb to maintain body weight is significantly reduced. This is especially noticeable in the period of single support: decreases both absolute and relative in time intervals of the function of single support, as well as the duration of the period of this support. But this kind of unloading of the sick side must be compensated, because the period of support of a healthy leg increases significantly. The change of periods of support has an obvious consequence – the increase of the sick side of the transfer time, also of the healthy side – we mean its reduction. 2. The rule of functional copying of another person’s movements. Pathological asymmetry is not beneficial to the body in terms of energy or mechanics. The need to maintain the relative symmetry of the function of the right and left sides of the body leads to the following conclusion: the healthy side of the body (or a limb) has a considerable functional reserve than a sick limb, so the reduction of functional asymmetry occurs by approximating the pattern of functioning of a healthy limb. 3. The rule of ensuring the optimum in psychomotor activity. The functioning of all elements of the normal cycle of psychomotor activity is the basis of physiological optimality of the individual. Any deviations from physiological optimality require the inclusion of additional adaptive reserves, which are slightly altered on the affected side. It is possible to provide the patient with optimal functioning due to the functional stress of a healthy side. Conclusions. We proposed psychological principles of the development of general compensatory reactions of the patient in a case of physical rehabilitation of patients with ischemic stroke were proposed in this research. These principles are: 1) the principle of actualization of the defect; 2) the principle of progressive mobilization of compensatory mechanisms of psychomotor activity; 3) the principle of continuous reverse of concentration of compensatory mechanisms of the psyche of the person; 4) the principle of sanctioning compensatory mechanisms of the psyche of the person; 5) the principle of relative stability of the compensatory mechanisms of the psyche of the patient. It was proved that in a case of ischemic strokes there is a certain dynamics of recovery of locus disorders. Firstly, reflex functions and tone are restored, then psychomotor actions (global and coordinating synkinesis) and auxiliary actions appear, and finally arbitrary movements are restored. In order to begin to restore tendon reflexes and muscle tone, it is necessary to normalize the functions of the spinal cord. We emphasized that compensation of certain function that had disorders is based on the restructuring of the old stereotype and the development of a new dynamic stereotype. The most important point of compensation for structural and functional disorders in the case of psychomotor pathology is active participation in the rehabilitation process and the patient himself/herself, who should seek to activate the body’s systems, which are not affected at all or suffered insignificantly. It has been shown that due to new unaffected parts of the central nervous system, it is possible to rearrange the innervation between the antagonists.
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