【Controlholic控制狂的碎碎念:D】
記得Mark曾說過一句話:「教給病人一百種運動,然後十指交扣祈禱,希望他們可以從中好起來。這不叫做運動治療,這叫碰運氣。」
那該怎麼辦呢?
的確自古以來,介入方式的療效,是「try & error」試出來的,像大家都很熟的神農。不過現代醫學,為了降低偏誤且同時提升療效,實證醫學的診療模式應運而生。David Sackett醫師於1997年發表了Evidence-Based Medicine一文,文中提到應將好的文獻證據、醫療人員的臨床經驗、以及患者的期望三者相結合:
1. 好的文獻證據:藉由可驗證的臨床研究實驗以及統計方法,能夠補足個人傾向或是既成印的偏差。
2. 醫療人員的臨床經驗:藉由臨床邏輯推理,與累積的直覺,能夠補足當某些臨床問題,尚未有足量研究提供佐證的狀況。
3. 患者的期望:例如一樣是接受髖關節置換手術後,年輕且活動需求高的患者 V.S. 年長活動需求不高的患者,對自己的期望,以及想要的恢復程度是不同的。
也許對某些人來說,恢復個六成,能從家裡走到便利商店來回即可;但有些人想要旅遊、爬山。因此術後要轉介到什麼程度,也會有不同的需求。每個人對自己負責的決心,也有很大一部分影響。
所以什麼叫做不碰運氣的運動治療呢?
按照實證醫學的架構,文獻佐證自不必說,而若患者也很有動力,接下來,醫療人員的「臨床邏輯推理」,就是關鍵之一。
盡可能收集患者的病歷資訊、有技巧的問診與檢查、將患者的症狀或蛛絲馬跡與我們懷疑的真正原因進行假設與驗證,最後查明真兇——就像偵探在做的事情——這就是臨床邏輯推理。當找到造成疼痛問題的真兇,就等於得到「診斷」。
只是,如果要處理的是跟「動作」相關的問題,在一般解剖結構診斷之外,更會需要動作系統診斷。
動作系統診斷的概念,出自Kinesiopathological model,中文可以理解為「動作病理模型」。 Ludewig等人在2013年發表的文章中,曾比較Making a movement system diagnosis vs a patho-anatomical diagnosis:找出動作系統的診斷,和找出解剖病理結構診斷有何不同?
兩者本質上的差異,就是「標的不同」。簡而言之,看問題的角度是不一樣的,那就需要「不同類型」的標籤方式。一類是找出「什麼動作」造成疼痛,一類是找出「哪個身體結構/組織」在喊痛。
例如,同樣AB兩位解剖結構診斷為「腰椎椎間盤突出」的病人,A在彎腰的時候會引發症狀,但B則是在後仰的時候才會引發症狀。可能這兩位患者受到破壞的結構:椎間盤,需要的治療一樣都是手術,但是這兩個人所需要的「運動治療動作」,一定會是不一樣的。
邏輯是這樣:對於運動治療來說,因為主體是動作,所以必須得找出「動作診斷」。有了「動作診斷」,再依據「動作診斷」設計出個人化動作來進行治療,如此可算得上盡人事,聽天命的解答了。
因此 Movement is medicine 這句話我超級同意。但是否所有Movement都可以算得上medicine?
有些運動設計邏輯,屬於給予「維他命」,整體的增加身體適能。而運動設計邏輯,若是包含經由一連串的臨床邏輯推理獲得的結論,其「針對性」非常明顯,那才能歸類是「藥物」等級的運動。
「有用到」「有練到」 跟「針對性」是不一樣的。這沒有好壞之差,看要處理的問題不同,就用適合的方式。
「動作系統診斷」的內容,包含標示出:出問題的身體部位、出問題的動作方向、在哪種閾值/負荷量出問題、互為協同肌中的一群肌肉組合中,誰代償了誰?互為拮抗肌中的一群肌肉組合中,誰抑制了誰?沒有拮抗肌的那類肌肉中,誰失去了前饋收縮的正常神經生理角色?埋藏在動作系統中造成失控代償的結構(可能是跟關節相關的、可能跟肌筋膜相關的、可能跟神經滑動相關的...)有哪些?
當把這些來龍去脈搞清楚,找到「動作診斷」,並且依據這些診斷設計出來的運動,對我來說才稱得上是movement medicine。這也是身為一個物理治療師,希望能無愧於教我的前輩,一直努力在堅持的事。
#KineticControl #movementismedicine #movementcontrol #Mark是KC的其中一位創辦人
同時也有1部Youtube影片,追蹤數超過6萬的網紅大人的玩具,也在其Youtube影片中提到,跪求有空的朋友 為影片加上字幕(中文即可) 萬分感謝 https://www.youtube.com/timedtext_cs_panel?tab=2&c=UC1FmA48qj1YOYQ5I6j4l6YA 如果覺得我介紹的不錯,歡迎贊助我的開箱影片(Please support my video ...
「mark醫學中文」的推薦目錄:
- 關於mark醫學中文 在 林維萱 物理治療師 Tina Lin PhysioTherapist Facebook 的最讚貼文
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- 關於mark醫學中文 在 Queenie Chan 莉敏 Facebook 的最讚貼文
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mark醫學中文 在 赤米 Nereus Facebook 的最讚貼文
希望大家可以幫吓可仁啦😢 我希望個個小朋友都可以健康快樂咁成長,可以一齊去公園玩
【最新消息:募捐行動已於2018年12月3日結束】中大校友慈善基金感謝各界慷慨支持,募捐行動已結束。所得善款將支持張可仁及患上相類疾病需免疫治療的其他6位病童。
詳情請參閱中大校友慈善基金網頁:https://www.facebook.com/cuhkacf.org/posts/589827338133781
-------------------------------------------------------------------------------------
(2018/11/22)
中大醫學院向大家作出緊急呼籲,支持我們2000年的醫科畢業生張俊傑醫生,拯救他只有17個月大的兒子張可仁的性命。
可仁早於出生第4天時已被診斷罹患一種罕有心臟病「主動脈狹窄」(Coarctation of Aorta),需要接受緊急手術。極之不幸的是,可仁最近再被確診患上「第四期神經母腫瘤」(Stage IV Neuroblastoma),目前可仁的頭骨至腰椎和盆骨均受到癌細胞擴散,脊髓神經線受到癌細胞壓住,痛楚非常,並有癱瘓的危機,癌細胞更正轉移至骨髓。
可仁現時正住在威爾斯親王醫院兒童癌症中心隔離病房,極容易受到感染。他已開始接受化療,而治療方案將包括化療、手術、放射治療、骨髓移植、免疫治療,治療時間約一年至一年半。他完成化療、手術和放射治療後,會進行骨髓移植,之後需要免疫療法,這可大大提高存活率,由20%升至50%。
然而,免疫治療需要病人自費,所需費用高達港幣200萬元。張醫生另一兒子患有自閉症,太太辭掉小學主任一職,全職照顧兩位小朋友,並要照顧父母親,經濟上未能承擔高昂的醫療費用。
中大醫學院2000年畢業同學會發起是次籌款,目的包括:
1. 為可仁進行骨髓移植後的免疫治療;
2. 引發社會人士及政府對兒童罕有癌症治療的關注。
查詢:
香港中文大學校友慈善基金
電郵:info@cuhkacf.org
電話:2180 4316
-------------------------------------------------------------------------------------
【Fundraising Campaign Completed on 3 December 2018】According to CUHK Alumni Charity Foundation, the fundraising campaign for Mark CHEUNG Ho Yan has completed. The fund raised will be used to support the immunotherapy of Mark and 6 other patients who are suffered from the same disease. Thank you for all your kind-hearted support and generosity.
-------------------------------------------------------------------------------------
(2018/11/22)
This is an urgent appeal for your generosity to save the life of the 17-month-old son of Dr. CHEUNG Chun Kit, our medical alumnus of Class 2000.
Dr. Cheung Chun Kit is a CUHK medical graduate of Year 2000. His younger son, Cheung Ho Yan Mark, has recently been diagnosed to have Stage IV Neuroblastoma in November 2018, and is in an emergency need of donation to provide the necessary funding to support the life-saving yet expensive immunotherapy.
Mark was presented to his paediatrician for fever and cough in late October 2018. His cough resolved with treatment but his fever never completely went away. Two days prior to his diagnosis, Mark was more clingy than usual and did not like to walk. On a video clip, Mark was noted to have foot drop, a very significant red flag which may indicate a compression on the spinal cord. Emergency scans were immediately performed that night, and Mark was found to have a large tumour on the left side of his abdomen. The aggressive tumour had already spread silently to the back of his skull, his spine, his hips and had compressed his nerves which control his lower limbs, resulting in pain on standing and difficulty in walking. Mark is facing an imminent risk of paralysis.
Mark is diagnosed to have a rare childhood cancer which is called Stage IV neuroblastoma, a cancer which typically presents at late stage because it arises deep in the abdomen. To cure his aggressive cancer, Mark needs to survive through rounds of intensive chemotherapy, radiotherapy, surgery, bone marrow transplant, and finally, immunotherapy. The whole treatment duration lasts 1.5 to 2 years. To completely eradicate all cancer cells, immunotherapy will be needed to boost Mark’s survival from 20% to 50%. However, immunotherapy is a self-financed treatment in the public hospital and the treatment costs could be up to 2 million.
Such close encounter with death is not the first time for Mark. At the first week of life, Mark was diagnosed to have a rare heart problem called “Coarctation of Aorta”. Mark had received life-saving surgery to reestablish the blood flow across his aorta, the major blood vessel that allows blood to go from the heart to the brain and the rest of the body. In a report published in 2002, only 67 cases with dual heart condition and neuroblastoma were reported, giving an odd of 1 in 100 million for a child to be hit by these two rare diseases. Scientists have not yet completely understood the mechanisms that may cause the two conditions to appear in a single child.
It never rains but pours that Mark’s elder brother, now 5 years old, was diagnosed to have autism at around age 2. To enable the elder brother to have intensive training to improve his outcome and development, Mark’s mommy quit her job as a primary school teacher since the diagnosis of autism was made for his elder brother. Dr. Cheung, who is a medical doctor for the elderly, became the sole bread-winner of his family.
CUHK Medical Graduates of Year 2000 have initiated a fund-raising campaign for Mark and his family with the following two objectives:
1. To appeal for donation to support the costs of immunotherapy for Mark
2. To increase the public awareness on the grave needs of children with cancers
Enquiries:
CUHK Alumni Charity Foundation Limited
Email: info@cuhkacf.org
Telephone: 2180 4316
mark醫學中文 在 Queenie Chan 莉敏 Facebook 的最讚貼文
🙏🏻🙏🏻🙏🏻
【最新消息:募捐行動已於2018年12月3日結束】中大校友慈善基金感謝各界慷慨支持,募捐行動已結束。所得善款將支持張可仁及患上相類疾病需免疫治療的其他6位病童。
詳情請參閱中大校友慈善基金網頁:https://www.facebook.com/cuhkacf.org/posts/589827338133781
-------------------------------------------------------------------------------------
(2018/11/22)
中大醫學院向大家作出緊急呼籲,支持我們2000年的醫科畢業生張俊傑醫生,拯救他只有17個月大的兒子張可仁的性命。
可仁早於出生第4天時已被診斷罹患一種罕有心臟病「主動脈狹窄」(Coarctation of Aorta),需要接受緊急手術。極之不幸的是,可仁最近再被確診患上「第四期神經母腫瘤」(Stage IV Neuroblastoma),目前可仁的頭骨至腰椎和盆骨均受到癌細胞擴散,脊髓神經線受到癌細胞壓住,痛楚非常,並有癱瘓的危機,癌細胞更正轉移至骨髓。
可仁現時正住在威爾斯親王醫院兒童癌症中心隔離病房,極容易受到感染。他已開始接受化療,而治療方案將包括化療、手術、放射治療、骨髓移植、免疫治療,治療時間約一年至一年半。他完成化療、手術和放射治療後,會進行骨髓移植,之後需要免疫療法,這可大大提高存活率,由20%升至50%。
然而,免疫治療需要病人自費,所需費用高達港幣200萬元。張醫生另一兒子患有自閉症,太太辭掉小學主任一職,全職照顧兩位小朋友,並要照顧父母親,經濟上未能承擔高昂的醫療費用。
中大醫學院2000年畢業同學會發起是次籌款,目的包括:
1. 為可仁進行骨髓移植後的免疫治療;
2. 引發社會人士及政府對兒童罕有癌症治療的關注。
查詢:
香港中文大學校友慈善基金
電郵:info@cuhkacf.org
電話:2180 4316
-------------------------------------------------------------------------------------
【Fundraising Campaign Completed on 3 December 2018】According to CUHK Alumni Charity Foundation, the fundraising campaign for Mark CHEUNG Ho Yan has completed. The fund raised will be used to support the immunotherapy of Mark and 6 other patients who are suffered from the same disease. Thank you for all your kind-hearted support and generosity.
-------------------------------------------------------------------------------------
(2018/11/22)
This is an urgent appeal for your generosity to save the life of the 17-month-old son of Dr. CHEUNG Chun Kit, our medical alumnus of Class 2000.
Dr. Cheung Chun Kit is a CUHK medical graduate of Year 2000. His younger son, Cheung Ho Yan Mark, has recently been diagnosed to have Stage IV Neuroblastoma in November 2018, and is in an emergency need of donation to provide the necessary funding to support the life-saving yet expensive immunotherapy.
Mark was presented to his paediatrician for fever and cough in late October 2018. His cough resolved with treatment but his fever never completely went away. Two days prior to his diagnosis, Mark was more clingy than usual and did not like to walk. On a video clip, Mark was noted to have foot drop, a very significant red flag which may indicate a compression on the spinal cord. Emergency scans were immediately performed that night, and Mark was found to have a large tumour on the left side of his abdomen. The aggressive tumour had already spread silently to the back of his skull, his spine, his hips and had compressed his nerves which control his lower limbs, resulting in pain on standing and difficulty in walking. Mark is facing an imminent risk of paralysis.
Mark is diagnosed to have a rare childhood cancer which is called Stage IV neuroblastoma, a cancer which typically presents at late stage because it arises deep in the abdomen. To cure his aggressive cancer, Mark needs to survive through rounds of intensive chemotherapy, radiotherapy, surgery, bone marrow transplant, and finally, immunotherapy. The whole treatment duration lasts 1.5 to 2 years. To completely eradicate all cancer cells, immunotherapy will be needed to boost Mark’s survival from 20% to 50%. However, immunotherapy is a self-financed treatment in the public hospital and the treatment costs could be up to 2 million.
Such close encounter with death is not the first time for Mark. At the first week of life, Mark was diagnosed to have a rare heart problem called “Coarctation of Aorta”. Mark had received life-saving surgery to reestablish the blood flow across his aorta, the major blood vessel that allows blood to go from the heart to the brain and the rest of the body. In a report published in 2002, only 67 cases with dual heart condition and neuroblastoma were reported, giving an odd of 1 in 100 million for a child to be hit by these two rare diseases. Scientists have not yet completely understood the mechanisms that may cause the two conditions to appear in a single child.
It never rains but pours that Mark’s elder brother, now 5 years old, was diagnosed to have autism at around age 2. To enable the elder brother to have intensive training to improve his outcome and development, Mark’s mommy quit her job as a primary school teacher since the diagnosis of autism was made for his elder brother. Dr. Cheung, who is a medical doctor for the elderly, became the sole bread-winner of his family.
CUHK Medical Graduates of Year 2000 have initiated a fund-raising campaign for Mark and his family with the following two objectives:
1. To appeal for donation to support the costs of immunotherapy for Mark
2. To increase the public awareness on the grave needs of children with cancers
Enquiries:
CUHK Alumni Charity Foundation Limited
Email: info@cuhkacf.org
Telephone: 2180 4316
mark醫學中文 在 大人的玩具 Youtube 的最讚貼文
跪求有空的朋友
為影片加上字幕(中文即可)
萬分感謝
https://www.youtube.com/timedtext_cs_panel?tab=2&c=UC1FmA48qj1YOYQ5I6j4l6YA
如果覺得我介紹的不錯,歡迎贊助我的開箱影片(Please support my video Channel) PayPal : jkc1974@gmail.com
開箱介紹:Hot Toys – MMS387 – 奇異博士【史蒂芬.史傳奇】Doctor Strange 1/6 比例人偶作品~ by 大人的玩具
賣場
http://class.ruten.com.tw/user/index00.php?s=18xtoys
FB
https://www.facebook.com/18Xtoys
MMS387 奇異博士 奇異博士
建議售價:7,200元
參考預購價:6,500元
預計到貨日: 2017年 第三季
預購截止日:2016年9月28日
商品介紹:
國際狂熱話題性玩具品牌Hot Toys 隆重推出來自漫威電影最新力作《奇異博士》1/6高端收藏可動人偶。
不同於漫威中前幾位大家已經非常熟悉的英雄人物故事,《奇異博士》充滿了魔法奇幻的風格,並利用這些魔法打擊罪惡。
此次由台灣知名頭雕師Viva,及Hot Toys韓國專業設計團隊操刀製作 班尼迪克•康柏拜區的1/6頭雕,完整重現班尼迪克•康柏拜區於電影中的神態,
完全不放過角色的任何一個細節,精細製作其服裝及披風,為方便批風穿脫,特別設計以磁鐵方式吸附,並以特殊特效零件重現《奇異博士》的魔法效果。
漫威電影最新超級英雄,請來把它納入收藏吧! 想更深入了解這位英雄,請期待10/27搶先全美上映的《奇異博士》
商品內容:
全新雕刻頭雕充分表現出國際巨星 班尼迪克•康柏拜區 (Benedict Cumberbatch)於《奇異博士》電影中的面部輪廓及表情
- 高擬真的塗裝技術以突顯出其皮膚紋理及鬍鬚
- 全新打造多達30個可動關節素體
- 約31cm高
- 9隻可替換手掌包括
- 一對拳頭
- 一對打開手掌
- 一對握緊狀態手掌
- 一對使用魔法狀態手掌
- 一隻示意手勢右手掌
- 頭雕均由手工塗裝
服飾造型:
- 一件獨特剪裁設計的紅色披肩連內置磁石及迷陣圖案
- 一套獨特剪裁的多層次深藍色調道服
- 一條棕色交疊式腰帶
- 一對黑色藍色長靴
配件:
- 一本魔法書
- 兩條魔法鏈墜(分別為開或關模式)
- 兩個橙色光環魔法陣配件
- 三個不同大小的綠色光環魔法陣配件
- 特別設計《奇異博士》主題地台連電影logo及一個金色的角色名牌
造型師:
- 頭雕師: Viva Lai
- 塗裝師: JC. Hong
- 頭雕美術指導: JC. Hong
(Doctor Strange)的本名為史蒂芬·文森·史傳奇(Stephen Vincent Strange),從小就對於醫學非常的有興趣,而後長大也成為了一名醫生,不過因為了家人的過世與一場意外再也無法拿起手術刀。失去一切的 奇異博士 四處的找尋秘方想辦法要治療好自己的雙手。而最後,因為一個神祕的古老傳說,他來到了一個西藏神祕場所,見到了至尊魔法師 古一 (Ancient One),經過了不斷的訓練之後成為至尊魔法師。除了擁有強大的魔法能力之外, 奇異博士
也找回了自己失去的靈魂,而後在不同的MARVEL 大事件中,
奇異博士 都扮演著很重要的角色。
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