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腦袋的功能 Brain Functions

translated with the courtesy of Robert P. Lehr Jr., Ph.D.
Professor Emeritus, Department of Anatomy,School of Medicine,Southern Illinois University and
Centre for Neuro Skills® ,Bakersfield California, USA

(感謝東華醫院腦神經臨床心理學家梁國強博士審閱本頁內容)

羅拔萊爾博士
醫學院解剖學系 名譽退休教授
南伊利諾伊大學 		Robert P. Lehr Jr., Ph.D.
Professor Emeritus, Department of Anatomy, School of Medicine,
Southern Illinois University
創傷性腦損患者可能只是傷及腦部某一個特定位置，或同時傷及腦部許多不同的部份，正是這種不確定的性質 ， 治療腦損患者必須因應不同患者的情況設計不同而獨特的治療方案。在過去的二十年，我們對大腦功能認識得愈來愈多，我們可以從患者腦部損傷的位置，猜測出患者將會出現的問題。 先進的診斷技術， 如電腦掃描和磁力共振，固然也可以提供有關大腦損傷程度的資料，但作為一個復康專家，我們也可以從患者的日常生活中了解到患者的受傷情況。 我們的日常活動，無論是身體或思維上的，都是由腦部不同地方控制的。 重要的是當你熟悉腦袋的功能後 ， 你便可以更了解專業復康人員對你施予各項治療的因由。 為了讓你能夠更好地了解復康療程如何產生作用，我們將引導你認識腦部不同位置及其功能 ， 並說明一些因腦損傷後所產生的問題。

腦部大致可區分為大腦皮層，腦幹和小腦。 我們將概略地敍述各種因應不同腦部受損部位所造成的問題。 我們必須明白到腦功能是整體的，各部份的特定功能是相互關連的。 腦部某一部位受損可能只會破壞一項活動中的一個特定步驟；因此，當一項活動中的任何特定步驟出現問題，便可能跟腦部損傷所引致的問題有關。 以下詳列腦袋各部份的功能和因受損後而產生的問題， 括號中的詞彙是用來描述腦功能缺損病症的專業術語。

 In traumatic brain injury the brain may be injured in a specific location or the injury may be diffused to many different parts of the brain. It is this indefinite nature of brain injury that makes treatment unique for each individual patient. In the past twenty years, a great deal has been learned about brain function, and we learn more everyday. We can make guesses about the nature of the problems an individual may have from knowing the location of a lesion. Diagnostic procedures such as CT scans and MRI's can also provide information about a brain injury.As rehabilitation specialists, however, we can also learn about an injury by observing the day to day activities of the patient. All the activities we perform each day, whether physical or mental, are directed by different parts of our brains. It is important that you become familiar with brain function to better understand how therapies, created by rehabilitation professionals, help brain injured patients. In order for you to better understand how the rehabilitation process works we will guide you through the different parts of the brain and indicate some of the functions and problems resulting from injury.

The brain has many parts including the cerebral cortex, brain stem, and cerebellum. By listing some of the functions of each part of the brain, we will provide an overview of what problems occur after injury to these parts. It is important to understand that the brain functions as a whole by interrelating its component parts. The injury may only disrupt a particular step of an activity that occurs in a specific part of the brain. The interruption of that activity at any particular step, or out of sequence, can reveal the problems associated with the injury. Below is a list of functions and deficits or problems revealed when injury occurs at particular locations. The terms in parenthesis are the professional terms used to describe the deficit.

大腦皮層

額葉：在腦袋的最前方，位於前額frontal位置


功能：

  • 知道身處的環境中自己正在做甚麼（Consciousness意識）
  • 面對當前環境，我們如何開展行動
  • 判斷及了解發生在我們週遭的日常活動
  • 控制我們的情緒反應
  • 控制語言的表達
  • 賦予語言的意義及選擇合適的詞句
  • 協調及聯繫詞句
  • 處理有關習慣及動作的記憶

額葉受到損害可能引致的問題：

  • 損失控制身體各部分的活動能力（癱瘓Paralysis）
  • 無法計劃一連串的動作去完成多步驟的任務，如沖咖啡等（序列Sequencing）
  • 失去與他人交往的自發性
  • 不能靈活思考
  • 不自主地持續重覆某一想法（持續重覆 Perseveration ）
  • 不能集中（ 專注力 Attention）
  • 出現情緒變化（ 情緒起伏Emotionally Labile ）
  • 與別人交往時的行為出現變化
  • 性情改變
  • 不能有效地解決問題
  • 無法以語言表達想法（ 布洛卡失語症Broca’s Aphasia ）

CEREBRAL CORTEX

Frontal Lobe: Most anterior, right under the forehead.

Functions:

  • How we know what we are doing within our environment (Consciousness). How we initiate activity in response to our environment. Judgments we make about what occurs in our daily activities. Controls our emotional response. Controls our expressive language. Assigns meaning to the words we choose. Involves word associations.
  • Memory for habits and motor activities.

Observed Problems:

  • Loss of simple movement of various body parts (Paralysis). Inability to plan a sequence of complex movements needed to complete multi-stepped tasks, such as making coffee (Sequencing). Loss of spontaneity in interacting with others. Loss of flexibility in thinking. Persistence of a single thought (Perseveration). Inability to focus on task (Attending). Mood changes (Emotionally Labile). Changes in social behavior. Changes in personality. Difficulty with problem solving.
  • Inablility to express language (Broca's Aphasia).

頂葉(parietal lobe)靠近頭頂的pat較後位置

功能 ：

  • 視覺集中力的區域
  • 觸感理解的區域
  • 有目標的自主動作
  • 操控物件
  • 整合不同的感觀，化成一個可理解的含意和概念

頂葉受損害後可能出現的問題：

  • 無法同時注意一個以上的事物
  • 無法說出物件正確的名稱（失去尋找詞彙能力Anomia ）
  • 無法找到合適字詞書寫（ 失寫症Agraphia ）
  • 閱讀障礙（失讀症Alexia ）
  • 無法繪圖
  • 難以區分左右
  • 計算或數學障礙（ 計算失能 Dyscalculia ）
  • 失去意識身體某些部位和/或周圍空間的能力（(失用症Apraxia）而導致自我照顧困難
  • 無法集中觀察事物
  • 手、眼協調有困難

Parietal Lobe: near the back and top of the head.

Functions:

  • Location for visual attention. Location for touch perception. Goal directed voluntary movements. Manipulation of objects.
  • Integration of different senses that allows for understanding a single concept.

Observed Problems:

  • Inability to attend to more than one object at a time. Inability to name an object (Anomia). Inability to locate the words for writing (Agraphia). Problems with reading (Alexia). Difficulty with drawing objects. Difficulty in distinguishing left from right. Difficulty with doing mathematics (Dyscalculia). Lack of awareness of certain body parts and/or surrounding space (Apraxia) that leads to difficulties in self-care. Inability to focus visual attention.
  • Difficulties with eye and hand coordination.

枕葉(occipital lobe)：靠在臚骨的後枕occipatal位置

功能 ：

  • 視覺感觀

枕葉受到損害可能出現的問題：

  • 視覺缺損（ 視野收窄Visual Field Cuts ）
  • 看出環境中的物件時出現困難
  • 難以分辨顏色（ 顏色失認症Color Agnosia ）
  • 產生視覺幻影---無法準確地看到物件
  • 無法辨識文字
  • 難以辨認圖像
  • 無法識別移動中的物件（ 動作失認Movement Agnosia）
  • 閱讀及寫作困難

Occipital Lobes:Most posterior, at the back of the head.

Functions:

  • Vision

Observed Problems:

  • Defects in vision (Visual Field Cuts). Difficulty with locating objects in environment. Difficulty with identifying colors (Color Agnosia). Production of hallucinations Visual illusions - inaccurately seeing objects. Word blindness - inability to recognize words. Difficulty in recognizing drawn objects. Inability to recognize the movement of an object (Movement Agnosia).
  • Difficulties with reading and writing.

 

顳葉(Temporal lobes)：位於臚骨兩側，temporal耳朶對上

功能 ：

  • 聽力及視覺的認知、獲取記憶
  • 事物的分類

顳葉受到損害可能導致的問題：

  • 不能辨別容貎（ Prosopagnosia面容失認症 ）
  • 難於理解說話（Wernicke's Aphasia 韋尼克失語症 ）
  • 視及聽的集中力受到干擾
  • 難以辨認及叙述物體
  • 喪失短期記憶
  • 長期記憶亦受到干擾
  • 可能增加或減少對性行為的興趣
  • 無法將物體分類（ Categorization分類法 ）
  • 右邊顳葉受損可以造成不停地說話
  • 行為容易變得具侵略性

Temporal Lobes: Side of head above ears.

Functions:

  • Hearing ability Memory acquisition Some visual perceptions
  • Catalogrization of objects.

Observed Problems:

  • Difficulty in recognizing faces (Prosopagnosia). Difficulty in understanding spoken words (Wernicke's Aphasia). Disturbance with selective
    attention to what we see and hear. Difficulty with
    identification of, and verbalization about objects.
    Short-term memory loss. Interference with long-term memory. Increased or decreased interest in sexual behavior. Inability to categorize objects (Categorization). Right lobe damage can cause persistent talking.
  • Increased aggressive behavior.

腦幹(brain stem)：中腦深部，伸延至brainstem脊髓 ：

功能：

  • 控制心跳、呼吸及吞嚥
  • 視和聽的反射動作（Startle Response驚跳反射）
  • 調節出汗，血壓，消化及體溫（Autonomic Nervous System 自主神經系統 ）
  • 影響清醒程度及睡眠
  • 平衡感（ Vestibular Function前庭功能 ）

腦幹受損害可能導致的問題：

  • 呼吸能力下降，嚴重影響說話
  • 吞嚥食物和水困難（Dysphagia 吞嚥困難 ）
  • 難於理解及組織週遭事物
  • 出現平衡及移動問題
  • 產生頭暈及噁心（Vertigo 眩暈 ）
  • 睡眠障礙（Insomnia失眠症，sleep apnea睡眠窒息症）

BRAIN STEM Deep in Brain, leads to spinal cord.

Functions:

  • Breathing Heart Rate Swallowing Reflexes to seeing and hearing (Startle Response). Controls sweating, blood pressure, digestion, temperature (Autonomic Nervous System). Affects level of alertness. Ability to sleep.
  • Sense of balance (Vestibular Function).

Observed Problems:

  • Decreased vital capacity in breathing, important for speech. Swallowing food and water (Dysphagia). Difficulty with organization/perception of the environment. Problems with balance and movement. Dizziness and nausea (Vertigo).
  • Sleeping difficulties (Insomnia, sleep apnea).

小腦(cerebellum)：位於臚骨底部：cerebellum

功能：

  • 協調隨意肌控制的動作達致平衡及穏定
  • 反射動作的一些記憶

小腦受到損害可能導致的問題：

  • 失去協調細微動作的能力
  • 喪失步行能力
  • 未能準確觸及或抓住物體
  • 出現震顫
  • 頭暈（ Vertigo眩暈 ）
  • 說話含糊不清（ Scanning Speech掃描語音 ）
  • 不能進行快速動作

CEREBELLUM Located at the base of the skull.

Functions:

  • Coordination of voluntary movement Balance and equilibrium
  • Some memory for reflex motor acts.

Observed Problems:

  • Loss of ability to coordinate fine movements. Loss of ability to walk. Inability to reach out and grab objects. Tremors. Dizziness (Vertigo). Slurred Speech (Scanning Speech).
  • Inability to make rapid movements.

對腦袋及其功能有基本的認識可以幫助我們理解康復的過程。更重要的是讓患者明白復康專業人員是關注於患者的整體需要而設計治療方案的。找出個別的問題固然可以令復康團隊設計出具體的治療方案，這些方案是為了患者整體的康復而設計的，因為一個困難可以影響生活的其他方面，而解決了一個困難往往可以令其他的問題都得到舒緩或解決，例如，重新令肢體平衡和減少暈眩可以大大增強專注力和集中力，進而改善認知和解決問題的能力。

Obtaining a general understanding of the brain and its functions is important to understanding the rehabilitation process. It is very important, however, to understand that the rehabilitation professional is concerned with the whole person. The identification of individual problems gives the rehabilitation team areas in which to focus treatment plans. All of these plans are designed to work toward the rehabilitation of the whole person. Each problem area affects other areas and many times resolving one problem has a major impact on other problems. For example, reestablishing postural balance and eliminating dizziness greatly enhances concentration and attention which allows for improved cognition and problem solving.

資料來源：
http://www.neuroskills.com/brain.shtml

 中文譯本如出現譯意偏差，一切以英文版為準