物理治療實習與臨床決策

神經物理治療

組員 : 賴冠穎 U107S146
游育瓏 U1080201
洪旻謙 U1080210
楊易達 U1080259
簡佳瑋 U1070164
謝文予 U1070139
 Introduction
Cerebral Cavernous Malformation
Cerebral cavernous malformations (CCMs) are vascular malformations in the
brain and spinal cord comprising closely clustered, enlarged capillary
channels (caverns) with a single layer of endothelium without mature vessel
wall elements or normal intervening brain parenchyma

Incidence 9% of individuals were symptomatic

before age ten years,
62%-72% between ages ten and
40 years
19% after age 40 years

Pathological due to mutations in one of three

genes, CCM1/KRIT1,
CCM2/malcavernin or
CCM3/PDCD10

https://www.ncbi.nlm.nih.gov/books/NBK1293/
 Clinical findings
• Seizure disorder with onset at any age, but most typically between the second and
fifth decades
• Focal neurologic deficits
• Nonspecific headaches
• Cerebral hemorrhage
• Vascular skin lesions (capillary malformations, hyperkeratotic cutaneous capillary
venous malformations, venous malformations, red macules, and/or nodular venous
malformations)
• Retinal cavernomas and rare choroidal hemangiomas

Histopathology
• Closely clustered enlarged capillary channels (caverns) ranging from two to 55 mm
(mean: 8 mm) with a single layer of endothelium without normal mature vessel wall
elements or intervening brain parenchyma
• Thrombosis and intra- and extralesional hemorrhage. Edema may surround lesions
with recent hemorrhage.

https://www.ncbi.nlm.nih.gov/books/NBK1293/
 Treatment of Manifestations

Recurrent hemorrhage or mass effect Surgical removal of lesions associated

with intractable seizures or focal deficits
from recurrent hemorrhage or mass effect
has traditionally been recommended
Gamma knife surgery or radiosurgery
Seizures Standard treatment for focal seizures
using anti-seizure medication with early
evaluation for surgical resection is
appropriate
Headaches
Neurologic deficits Rehabilitation is indicated for those with
temporary or permanent neurologic
deficits.

https://www.ncbi.nlm.nih.gov/books/NBK1293/
 Risk factor 、 Prognosis
with certain analgesic medications such as nonsteroidal anti-inflammatory drugs
(ibuprofen, naproxen) and aspirin 、 heparin, sodium warfarin

the prognosis for CCMs is variable, as the location, size and number of lesions
determine the severity of the disorder.

https://www.ncbi.nlm.nih.gov/books/NBK1293/
 Pontine hemorrhage

onset with fast developing coma, and show disturbance of vegetative

function (disturbance of respiration, cardiac dysrhythmias, hyperthermia,
hypertension), miosis and other neuroophthalmologic symptoms, flaccid
tetraparalysis and blood-stained cerebrospinal fluid

Pontine haemorrhage (PH) comprises approximately 10% of intracerebral

haemorrhages (ICH).1 With an estimated mortality rate ranging widely
from 30% to 90%, PH is the most pernicious form of ICH

https://pubmed-ncbi-nlm-nih-gov.translate.goog/31008342/
https://pubmed-ncbi-nlm-nih-gov.translate.goog/31008342/
 History taking
○Date of onset
○Chief complaint
○Admission assessment(X-ray, CT…etc)
○OP finding
○Rehabilitation intervention
○State before onset
○Medical history
○Rehabilitation Goal
PT program IICT
○Pick up paper: As functional graping with 5 to 10 min.
QID at a time and frequency would be 3 times per week,
the intensity would be 8-12 RPE.

○Yoga: As core muscle strength E’t with 30 to 45 min. at a

time and the frequency would be 3 times per week, the
intensity would be 8-12 RPE. but stopping before become
painful.

○Gait training with verbal cues for weight shift: walk 3

round on parallel bars at a time and the frequency would
be 3 times per week, the intensity would be 8-12 RPE.
Physical examination
○MMSE: Language item
○CN IX, X test: R/O dysphasia
○MMT: core, UE, LE muscle
○BBS: sit to stand
○FNF, Heel to shin: UE, LE cordination
○Line bisection: EOM
○MAS: UE, LE tension
○ROM
BRIDGE exercise 、 posture 、 sitting with back
unsupport 、 pick up object from the bed with
sitting(MMSE) 、 FINGER TO THERAPIS INGER
Posture control 、輔具使用、環境改造 ( 止滑墊 . 握把 ) 、
規律的生活習慣