נשים הריון ולידה גברים ילדים ונוער גיל הזהב שיניים רפואה-כללי
ספורט וכושר רפואה ומשפט דיאטה ותזונה מין וזוגיות רפואה משלימה

????? ?????? ?÷??

???? ??÷?????

?????? ????? ???????? ??? ??÷???? ??? ????? ??????? ???÷??? ?? ???? ???÷????? ???????? ?? ???? ??????? ??????? ???????, ????? ??????? ???? ??????? ?? ???? ????? ????? ??? ????? ??????? ??÷???? ??????? ???? ???? ???? ?? ???÷?? ??.

 ?"? ??? ?????,

 ????? ???÷?? ???????,
 ?????? ?????? ????? ??????? ?"? ????? ????? ???????;
 ???? ???????????, ?????????? ??-????

????

??????? ?÷????? ?? ???? ???÷????? ?????? ??????? ??-??? ?'???? ??÷????? ???? 1817. ???÷? ????? ???? ??? ??÷???? ????????????.

???????? ???????? ???÷????? ??? ?"???? ?????" ???? ?????? (Substancia Nigra), ???? ??? ?????? ????????? ??????????? (???????? ??????), ??? ?????? ?????? ?? ??????? ??÷???? Nigra-Striatal Ttracts. ?????? ??? ???? ??????? - ???? ???? ????? - ?"??????? ???????" (??????, 1986; ?????, 1982). ?? ???? ???÷????? ????? ????? ??-?? ???? ????? ??????? ?????? ???? ??????? ?????? ??????.



???? 1
?÷???? ??? ÷???? ????, ?????? ?????,
?????? ???????? ???? ????

??? ????? ?? ????????? ?? ?÷?? ?????? ???÷?????, ?? ????? ?? ??????? ?????:

  1. ?????? ??÷?? ????????? ?????? ???? ???÷??? ????? ????? ?? ????? ????. ??÷?? ???????? ????? ??????? ?????? ???? ??????? ?? ??? (???? ?????, ??????, ??????, ???????, ????÷???, ??????? ??????÷??).
  2. ???? ???÷?? ??????? ??? ???? ?? ????? ??? ??????? ?????: ???? ??????????? (???? ????? ?????? ???÷???), ?????????? (?? ?????), ???????÷? (?? ?????÷??) ????? ???????? (????????, ?????, ???, ???? ?????? ??????). ???? ?? ????? ??? ??? ?????????? ???÷????? ??????? ????? ??÷?? ???????? ????? ??÷?????.
  3. ?÷?? ?? ????? ??? ????? ????? ??????? ????????, ???? ??????? ??????? ??????.

?÷???????? ???÷????? ???????? ?? ??÷?? ???????? ?????? ???? ????? ?????÷??, ????? ??????, ??? ??????, ?????, ?????, ??????, ?????, ????? ??÷?, ??????? ????? ????. ??÷?? ???? ???????? ??? ???? ?????? ?????? ?? ??÷?? ??????. ?????? ???? ?????? ?????? ??? ????? ?÷??? ??????, ???????, ??????, ?????? ??? ?????????.

??-??-?? ?????? ???????? ??????? ??????? ???÷?? ???????, ???? ????? ?? ???????? ????? ÷????? ?????? ??????: ??? ?? ?????? ?? ????? ????? ???? (Orthostatic Hypotension), ??? ??????, ??? ?????? (???? ?????? ??? ?? ?????? ????), ÷???? ?????? ?? ???????? ????, ?????? ?????? ?? ??????? ???? ???????? ??? ??÷???? ???÷?? ?????. ????? ??÷????? ?????? ??????? (?????????) ???????? ??? ????? ???????, ??????? ?? ???? ?????? ????????, ?????, ??÷??? ?????? ????? ??????. ????? ?? ?????? ?? ?????? ?????? ??????? ??? ??? ???? ?????? ???÷? (??????÷, 1998; ???? ???????, 1988). ????? ???????? ?? ?÷?? ???? ?? ??????? ?????????? ???? ?????? (???????? ???', 1998), ???????, ??÷???? ??????? (??????) ?????? (?????? ???', 1997). ???? ?????? ?? ??????? ?? ??÷?? ????? ??? ??????? ?????????? ??? ??? ???? ?????? ??? ???? ????? ??????? ??????? ????? ??÷????? (???? ??????, 1989).

???? ?????? ????? ?? ????? ???????, ??????? ??? ???? ?????? ??????, ??????????, ?????? (÷????, 1998; ÷???? ???', 1995) ???????? (÷???? ??????÷, 1996).

???????? ???????? ????? ??÷?????

?????? ??????? ?? ???? ???÷????? ??? ???÷? "??? ?????" (Resting Tremor), ???????? ???? ?????? Pill Rolling; ?? ?? ÷????? ????? ???? Rigidity, ????? ?????? (Hypokinesia), ??????? ?????? ??????? ??÷? ??????? ??????. ?? ????? ?????? ÷????? ????? ?????? ??? ???? ??÷????? ??? "??? ????" (Intentional Tremor), ??? ???? ????? ???? ????? ????? ?????? ?? ÷????????????, ?"??? ??????" (Postural Tremor), ?????? ???? ?????? ???? ????? ?? ?????? (Posture) ?? ????? ?? ??? ???? (Position). ????? ??? ?????? ?????? ?????? ??÷???? ????? ??? ???? ?????? ?????, ????? ?? ????? ??÷? ??????. ???? ?????? ?? ??????? ???÷????:

÷????? ?????? (Rigidity)

?????? ?????? ??????? ?? ???? ????? ?????, ?? ?? ?????? ?? ???. ÷????? ?????? ???÷????? ????? ???????? ?????? ?????? ???? ????? ??????. ??????? ??? ?????? ?"???? ??????", ???? ??? ???? ????? ?÷????? ???? ?????? ?????? (???? ????? ??????) ?? ?????? ??? ????. ???? ?÷????? ????? ??? ??? ?????? ??????? ?????????? ??? ????? (???, ????, ????, ???), ??? ?????, ??????, ??? ?? ???. ????? ?÷????? ????? ?? ?÷ ?????? ?????, ?????? ???????? ?? ?÷??? ???? ??÷???? ?????? ???????, ??? ?? ????? ??????? ??????? ???????? ??? ?????? ??????? ????? "?? ????????" ??? ??????? (????? ????? "??????", ????? ?? ???? ??). ?? ??? ??????? ?? ???? ?÷????? ??÷??? ?? ???? ?? ?????? (??????? ???', 1983).

????? ????? ?????? (Hypokinesia)

????? ???÷????? ??????? ?"???? ??????", ??????, ????? ??????? ??? ??????. ????? ?? ??? ???? ??????? ???? ????? ????????? ?????? ???÷?????. ?????? ?????? ???? ???????? ????? ????? ?????? ?? ??÷?? ????????. ???? ??? ???????: ???? ??????? ?????????, ???? ???? ("??? ???? ?? "??? ??÷?"), ????? ?????? ?????? ?????? ??????? ????????, ????? ?????? ?????? (???? ???? ????? ÷????) ??? ????? ????? ?? ?????? ??????. ????? ?????? ????? ???÷????? ??? ?÷??? ?????? ?????. ??? ???? ??÷????? ???? ??? ?????? ???? ?????? ????? ?? ?????? ??? ????? (?????÷, 1998; ???÷??? ???', 1997; ???????? ???', 1997; ???? ???', 1983; ???'?? ??'??, 1988; ?????? ???', 1983).

??????? ????? (Gait)

????? ??÷????? ??? ???????? ???????? (??÷? ???????, 1998). ?????? ÷????, ?????? ??????? (Shuffing Steps), ?????? ???? ????, ?????? ?÷?????, ?÷??? ÷??? ?????? ?????? ?÷??? ????? (????? ???', 1997).

?????? ??????? ???? ????? ????? ?????? ??? ????÷? ???? ??????? ??? ???????, ?????? ???÷? ?????? ?????. ??? ?? ÷??? ???? ?????? ?????? ?????÷? ???? ????? (????? ?? ?÷? ÷????? ?? ÷???? ??÷??? ?? ?????? ???? ?????), ???? ?????? ???? ????? ?÷????, ????? ?????? ??????? ???? ?????-???? (??????? ???', 1988), ????? ??????? ?????? ?? ???? (???? ???? ?????? ???? ?? ???? ???? ??????) (÷??÷??? ???', 1987), ??? ?? ?????? ?? ?? ???? ??? ?????? ???? ????? ?? ?? ??? ???????.



???? 2
???? ??÷????? ???? ????? ?????? ??????,
??????? ?? ???? ?????? ???

???? ????? ?????? (Akinesia)

????? ?? ????? ?????? ????? ???? ??÷??? ?????÷ ???? ????? ??????? ?????? ????? ????? ?????? ?????, ??? ???? ????? ????? ?? ???? ?????? ?????? (??÷ ???', 1986; ??? ????'??, 1990). ??? ?????? ????? ???? ???? ??÷????? ???? ????? ?????? ?÷????????????. ????? ??? ???, ?????, ????? ?????? ?÷???? ?????? ?÷?? ??????, ????? ?????? ?? ??????? ????? ??????? ?? ?????? ??????? (???? - ??÷?? ?????? ??????).

???? ?????? (Bradykinesia)

?????? ?÷????? ????????? ??? ???? ??÷????? ?? ??? ?????? ???? (??? "?????") ??? ????? ??????. ???? ???÷????? ???? ????? ????? ??????? ??????, ?÷??? ????????, ???? ?????? ?????, ???????, ????? ????? ÷?? ????? ???? ????? ??? ??? ??????. ????? ?????? ???? ???÷?? ??÷?? ?????? ???? ??????? (?????? ??÷????-?????????) ????? ???÷??? ??? ???? ??????? ????? ???? ?? ????? ????? ?????????? ??? ????? ????????, ?????? (ReciprocalInhibition Mechanism). ?????? ???÷?????, ???????? ???????? ?? ???? ?? ??? ???????? ????? ????? ???? ????????????, ?????? ?? ??????? ?? ??? ???????. ?????? ??? "?????? ?÷????? ??????".

÷????? (Freezing Phenomenon)

????? ?÷????? ?????? ????÷? ??????? ?? ?????? ??????? ?? ????? ÷???? ??? ?????, ????? ??????. ????? ?? ÷???? ???? ?÷?????, ?? ??? ????? ?????? ??? ??? ????? ?? ?????? ??????. ?????? - ÷??? ???? "??, ??, ??, ??, ??" ?? ????? ??????? ???? ?????. ????? ?????? ???? ????? ?????? ?????? ????? ÷?? ???? ?????? ????. ????? ???, ???? ?????? ?? ?????? ?????? ?????? ??????- ?????? ?? ?????? - ??? ???? ????. ???, ???? ?? ???? ????? ?? ?????? ??? ????? ??? ?????? ???÷?? ?? ÷?? ?????? (????? ???', 1983; ????? ???', 1997).

÷???? ?????? ?????? ???÷?

????? ?? ????? ??÷? ??? ???÷??? ?? ?????? ???????? ????????? ????, ?? ???? ???? ??? ???? ???????? (?????? ???', 1982). ???÷????? ???? ????? ?????? ?????:

  • ????? ????? ?÷??????, ?????? ?????? ??????? ?????? ?????.
  • ????? ??????? ?????. ??????, ??????? ???? ???? ???? ??????.
  • ????? ????? ????? (Righting Reactions) ???? ?? ??? ???? ???? ??? ??????? ????? ???? ????? ??????. ??? ???? ??÷????? ???? ?? ?????? ???.
  • "÷???? ???" ?? ???? ????? ??? ???÷ ?÷??? (?????? ????÷?????) ???? ???÷ ?????÷ (?????? ???????) ???? ??????. ??????: ÷??? ?÷???? ?????? ????? ??????, ?????? ?? ?????? ??÷???. ÷???? ???? ????? ??????? ?÷?? ?? ????? ??÷? ??????, ?????? ???? ????? ????????. "÷???? ???" ???? ???÷???? ?????? ?? ????? ?????? ??÷?, ??????? ??????? ?????? (?????) ?????? ?? ?÷??????? ????????? (????? ?? ??????) ?? ???? ?????? ????????.

?÷????? ?? ?????? ?????? ????? ??÷?????

???? ???????? ???????? ??? ?????? ????? ??? ???? ??÷?????, ?? ??????? ??????? ?????? ????? ???? ????. ???? ??? ?÷????? ?? ?????? ?????? ????? ??÷?????:

  1. ??????? ????? ????? ????? ?????? ??????? ?? ?????? ???? ??????? ??? ??? ?????.
  2. ???? ??????? ????? ????? ?????? ???????? ÷????? ?????÷?? ????????. ???? ?? ????? ??????? ?????? ???????, ?????? ??????? ???????, ?????? ??????? ???????? ?? ??? ???????.
  3. ?? ?????? ???????? ??????? ?????:
    • ?????? ????? ?????? ????????? ????-???? ?????? ??????? ???? ?????? ?????? ????? ??????.
    • ?????? ????? ?????? ÷????? ?? ?÷??????.
    • ?????? ?????? ?????? ?? ?÷??? ???? ?????? ??÷?????? (÷????÷?????).
    • ?????? ????? ???????? ?????? ??? ????? (??? ?????, ???, ???, ?????, ??????, ????? ???) (????, 1997); ????? ?÷?? ????? (????? ??????, ?????? ?????) ?????? ????? ?????? (????, ?????, ???? ??? ??????, ???? ????); ????? ?????? ????? ????? ??? ?????. ??? ??? ?? - ????? ?????? ??? ????? (??????, ?÷?, ??? ?????? ????) (???????? ???', 1997).
  4. ?? ????? ????? ?? ??? ????? ?? ?????? ???????? ?????, ??? ????? ????? ?÷????? ????? ????? ????. ???? ??? ?????? ???÷? ??????? ????÷ ???????, ???????? ?????? ????? (÷???????) ???????? ????? ?? ?????? ???????? ???÷???????? ??÷? ?? ????, ??? ????? ????? ?????? ??? ?????.
  5. ????? ???? ?????? ?????? ?????? ????? ??? ??????, ?????, ??????, ?????? ??????, ??? ????? ????? ???? ?? ??????, ÷??, ???, ???÷ ?÷?? ???-??.
  6. ?? ????? ????? ??÷? ?????, ??? ????? ??÷????? ?????????, ÷?? ????? ????? ?????? ?? ???? ????? ????? ??????, ????? ??÷? ?????? ??÷?.
  7. ????? ?????? ?????? ?? ?????? ??????, ??? ????? ???????? ???????? ?? ???????? (????? ??????, 1988).
  8. ???? ??? ????? ?????? ?????÷? ???? ÷??, ???÷??? ÷??? ?? ???÷?? ?????? ??????.
  9. ??? ?÷??, ??? ????? ?? ????? - ????? ?? ??????.

?????

?? ???? ???? ????? ?? ??÷???? ???? ???÷?????, ???? ??????? ?????? ?? ?????? ????? ????? ??? ?? ???? ???????? ?? ?????, ???? ????? ???÷? ?? ??????? ????? ??????? ????????? ????. ??????? ????? ?????? ??÷?? ??? ?????, ??? ???? ?????? ??????.

÷????? ?????????? ?????? ?????? ????? ????? ???? ???????? ???????: www.medtronic.com/neuro/tremor/video.html

????? ?÷????

  1. Benecke, R. et al. (1986). Performance of Simultaneous 
        Movement in Parkinson?s Disease. Brain. 109:739.

  2. Beradelli, A., Sabra A., Hallett M. (1983). Physiological
        Mechanisms of Rigidity in Parkinson?s Disease. j.
        Neurosurg.
    Psychiatry. 46:45.

  3. Blaszyk, J. (1998). Motor Deficiency in Parkinson?s
        Disease. Acta Neurobiol. Exper. 58:79.

  4. Bloxham, C.A., Mindel, T.A., Firth, C.D. (1984). Initiation
        and Execution of Predictableand Unpredictable Movement
        in Parkinson?s Disease. Brain. 107:371.

  5. Brown, R.G., Marsden, C.D. (1988). Internal Versus
        External Cues and the Control of Attention in Parkinson?s
        Disease. Brain. 111:323.

  6. Chan, C.W.Y. (1986). Could Parkinsonian Akinesia be
        Attributable to a Disturbance in the Motor Preparatory
        Process? Brain Res. 386:183.

  7. Ciccone, C.D. (1998). Free Radical Toxicity and
        Antioxidant Medications in Parkinson?s Disease. Phys.
        Ther. 78:313.

  8. Cutson, T.M., Laub, K.C., Schenkman, M. (1995).
        Pharmacological and Nonpharmacological Interventions
        in the Treatment of Parkinson?s Disease. Phys. Ther.
        75:363.

  9. Gracia, R.E. (1986). The Basal Ganglia and the
        Locomotor Regions. Brain Res. Rev. 11:47.

  10. Haaland, K.Y. et al. (1997). Cognitive Motor Learning in
        Parkinson?s Disease. Neuropsychol. 11:180.

  11. Hasieh, S. et al. (1997). Object Based and Location Based
        Shifting of Attention Parkinson?s Disease. Perceptual and
        Motor Skills.
    85:1315.

  12. Koozekanani, S.H. et al. (1987). Ground Reaction Forces
        During Ambulation in Parkinsonism. Arch. Phys. Med.
       Rehabil.
    68:28.


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