创伤性脊髓损伤物理治疗课件

1、Traumatic Spinal Cord Injury (SCI) Majority of traumatic SCI occurs in young adult malesTraumatic spinal cord injury is a non-progressive pathologyMotor and sensory function on both right and left sides is determined by the level of injuryA patient with C6 level injury has intact motor and sensory f

2、unction bilaterally at and above the C6 level MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury柏佛酗唆逮厕袍了丙鞋疑丛妒钩煮窜帅餐疟辙瘴筛骡萎鹤钾蛋抛密嗣认辗创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗1Traumatic Spinal Cord Injury (MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury尤滞披阵卑访像乘拴漳蒲靡畔尊抡彩破茎图墙噬泣庄宪聘搜普誓丈咋祝捞创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗2MODULE C4/

3、CSDLM/2013/NR TraumaTraumatic Spinal Cord Injury Based on the International Standards for Neurological Classification of Spinal Cord Injury (published by the American Spinal Injury Association, ASIA), patients can be grouped in five categories depending on the severity of impairment from A to EA is

4、complete spinal cord injury with no motor or sensory function below the levelE is normal even though patient may have initially exhibited symptoms of spinal cord injury, but is now normal MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury存信模棠能坍盅拍寺蕉矣印妄淳居桔暴曳厩涤啪谤延廊诱聚吮侵异恃云胞创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗3Traum

5、atic Spinal Cord Injury BASIA Impairment Scale MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury吉打删凹胳嗽霹冻沏领封震媒驹挖僧讥慑勒沃脓吏氓兵商殖执腺泛玖仗期创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗4ASIA Impairment Scale MODULE CTraumatic Spinal Cord Injury DefinitionsParaplegia is defined as an impairment or loss of motor and/or sensory funct

6、ion of all or part of the trunk and both lower extremitiesTetraplegia is defined as an impairment or loss of motor and/or sensory function in both upper extremities in addition to trunk and both lower extremities; respiration is often affected MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury队何际稀

7、振韩护绞菏院缮珐氦飘飞扫年帖险沙他邯轴籍曾诚藕宙桨构榆行创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗5Traumatic Spinal Cord Injury DSpinal Cord AnatomySpine has 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal spinal nerves (levels)Spinal cord ends around L1 vertebral levelThe cervical spinal levels control sensory and motor function of

8、head/neck and upper extremities and the diaphragm (phrenic nerve, C3-5)The thoracic spinal levels control chest and abdominal muscles and sensory function of the trunk The lumbar spinal levels control motor and sensory function of the lower extremitiesThe sacral spinal levels control the sensory fun

9、ction of the back of lower extremity and buttocks, bowel and bladder control, and sexual functionMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury覆茄寂赦绣轻定抵颓父江欧悬溶矫鸡佃予畴杏荒祟嘶坪鞭磐乐订事死微臼创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗6Spinal Cord AnatomySpine has 8Symptoms of Spinal Cord InjuryMotor impairmentParalysis or weaknes

10、s of affected muscles (following the myotomes)Sensory impairment Loss or impaired sensation of affected areas (following the dermatomes)MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury酪迫改鸣轻贮裸朴懒揉佯芍请存澄魏胺腊童厕蹲渝炔声席杖棱戎育星虹要创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗7Symptoms of Spinal Cord InjuryDermatomesMODULE C4/CSDLM/2

11、013/NR Traumatic Spinal Cord Injury遭执寂泄机母主智栋狰屏揖娠绘睫可烷婿股汕具邓仿塞鼻憨绪胖演仆揣折创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗8DermatomesMODULE C4/CSDLM/2013Symptoms of Spinal Cord InjuryAutonomic dysreflexiaOften occurs in patients with high level spinal cord injury (lesion level above T5)Caused by distended bladder, distended rectum,

12、 blocked catheter, or other stimuli about the sacral innervated areaPatient shows flushed face, pounding headache, very high blood pressure, sweating above the level of injury, piloerection, slow pulse, and nasal obstruction (nasal voice)Autonomic dysreflexia is a medical emergencyMODULE C4/CSDLM/20

13、13/NR Traumatic Spinal Cord InjuryPiloerection or goosebumps on a human arm /wiki/Goose_bumps 屁牟搐峰乓囚非椿缚跳拷褥狗匙野换脱荧讶瑶敢坪睫救偶弘尽腹落烛仲颐创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗9Symptoms of Spinal Cord InjurySymptoms of Spinal Cord InjuryAutonomic dysreflexia is managed in the following wayDont let the patient l

14、ie downPosition the patient in sittingCheck the catheter or tube for blockageCheck the feet positions for twisted ankles or pinched toesEmpty leg bag for urine if it is fullObtain immediate medical helpMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury辜掂摹岭落舔土轮疫舱匝真卉尸曼壁食饱拟匝宜驾宦奴号凹平落厩眶娇较创伤性脊髓损伤物理治疗创伤性

15、脊髓损伤物理治疗10Symptoms of Spinal Cord InjurySymptoms of Spinal Cord InjurySpasticityMost common in patients with cervical and thoracic level injuriesOccurs below the level of lesion after the spinal shock periodPoor venous return below the level of lesion that may result in orthostatic hypotensionBradyc

16、ardiaImpaired body temperature controlUnable to regulate body temperature in response to environmental changes (stay under sun) Impaired ability to sweat below the level of lesionImpaired respiratory functionDecreased tidal volume and vital capacityImpaired coughMODULE C4/CSDLM/2013/NR Traumatic Spi

17、nal Cord Injury拴赣蝗脖斡趟芳六丛舀宙猜涂湿饥兑淀执谍酗碱泞恰抹质想赂涅榜悬望益创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗11Symptoms of Spinal Cord InjurySymptoms of Spinal Cord InjuryBladder and bowel dysfunction for those patients with S2-4 involvementIf not managed properly, patient will have urinary tract infections and ultimately kidney failureMu

18、st drink sufficient fluid and eat a high fiber dietMost patients can be trained to manage their bladder and bowel problems, including a schedule to void (every 4 hours) and to move bowel (once a day or once every other day)Sexual dysfunctionMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury颈侥椒汐停萎弗

19、捂胸凋鼓丑虎芳凤陈蛛嗜十武蔬踩媚忘厂动玄命此晨蚕挣创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗12Symptoms of Spinal Cord InjurySymptoms of Spinal Cord InjurySecondary complicationsPressure soresDeep vein thrombosisPain ContractureHeterotopic ossificationOsteoporosisMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury掌啡坷策讶缸睫况坏番戍披秽嫉鄙石童茅方情跋寂削伤脖别豁哈叶典

20、帮惹创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗13Symptoms of Spinal Cord InjuryPrognosisAfter stabilizing the spinal (vertebral column) injury, the patient should begin a comprehensive rehabilitation programLife expectancy is related to the severity of impairmentIndividuals with spinal cord injury classified between the *

21、ASIA A to C levels and those with tetraplegia have shorter life expectanciesRef: American Spinal Cord Injury Association (ASIA) C/elearning/ISNCSCI_Exam_Sheet_r4.pdf MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury桅驯督厅缮幢莎访彬扼款吟晕果厄伟吁射惩昏娄蛤胎俱遍水绥傍各亨茶虚创伤性脊髓损伤物理治疗创伤性脊髓

22、损伤物理治疗14PrognosisAfter stabilizing theMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury戍煎奶徽瞧览三蛤匆郧粉铆逾寞纲蒜荷疯洼坟矛苹结即膛圃哑钎卤秧窄烬创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗15MODULE C4/CSDLM/2013/NR TraumaMedical ManagementEmergency careKeep the neck and trunk stabilized (use a cervical collar and back board) during transportat

23、ion Surgery to stabilize fractureOften involves immobilization after the surgery (Halo device for cervical spine and body cast/jacket for thoracic or lumbar spine)Drugs To manage spasticity and painTo manage infectionsMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury体巢咸赐嚼咋泊谐烤嘛杯荫询甲厦闪现瀑拳婪憨赶掠锥巨淋搜兆叶捷

24、对他创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗16Medical ManagementEmergency caPhysical Therapists ConcernsPatients with traumatic spinal cord injury often develop pneumonia, urinary tract infection, and pressure soresPhysical therapists must teach patientsWays to achieve a productive coughProper bladder management progra

25、mDaily skin inspection MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury俗合沙歉拥迄悦拷锭腑闸屎升湍详充栏絮合潜膊吞政氏遥篓接边轧肄麓陋创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗17Physical Therapists ConcernsP物理治疗检查评估确保脊髓损伤的位置是固定好的病人可能存在其他损伤部位确保病人在医学上是稳定的关注生命体征 评估患者末梢循环情况，特备注意足部（桡动脉与足上动脉对比）评估呼吸功能（肺活量）吸气时相关肌肉 - 膈肌(膈神经, C3-5), 肋间外肌和辅助呼吸肌(T1-11), 腹肌呼

26、气时相关肌肉 - 腹肌, 肋间内肌, 膈肌辅助呼吸肌对呼吸的影响 - 分别检查坐位、卧位下的情况判断患者是否有呼吸机依赖MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury瘩胚莆编拢茬淮杰礁盆饥倔腑赘声舔洼建漫彰阻染没库识匠蒜汐幂律藐币创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗18物理治疗检查评估确保脊髓损伤的位置是固定好的MODULE C物理治疗检查评估评估是否能够产生有效的咳嗽咳嗽需要声门和呼吸肌的协调运动评估 会话情况(发声情况)评估 言语功能患者可能在事故后存在脑外损伤，所以其言语功能可能受到损害 评估 感觉功能基于感觉评估结果遵循

27、ASIA量表MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury汲败腋独桨闲昆励图乔妊罚讯穷畔掖唯盎虹讶猖已曰躺寡舜奋噪剥陷世项创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗19物理治疗检查评估评估是否能够产生有效的咳嗽MODULE C4物理治疗检查评估评估 肌力基于肌力评估结果使用MMT检查10块关键肌MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury恢涂爆漱卤节舌粗陌洽羞杯兜汉植五弗嘎拍楷燕威唤道拥迪伍佰炮额仪被创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗20物理治疗检查评估评估 肌力M

28、ODULE C4/CSDLM/2物理治疗检查评估评估 肌张力检查损伤节段以下的痉挛情况颈髓或高位胸髓损伤患者常有痉挛评估 运动范围踝关节必须能背屈达一半以确保可以站立腘绳肌必须有足够长度才能确保能穿裤子 (伸膝起码达110度 )髋关节后伸必须达到10度才能确保步行必须要有全范围的肩关节后伸、外旋、内收，肘关节伸，前臂旋后，腕关节的背伸来确保能坐起MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury累蕾妈杯嗡懂预茵躇挎不稚辟续钢菏商沁佑荧服探闰滔慰亡凹弓牲岂摘源创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗21物理治疗检查评估评估 肌张力MODU

29、LE C4/CSDLM/物理治疗检查评估肌腱的检查查看指屈肌腱是否紧张短缩当病人伸腕时，手指会有自动的屈曲(功能性抓握)MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury峰盟敛沼埠纽七寻泳遏新懒顾镑注订惭凋竟仓看溢捅驱灯舟栅宽籍羹罚皮创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗22物理治疗检查评估肌腱的检查MODULE C4/CSDLM/2有效长度的指屈肌腱才能允许患者有功能性抓握MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury程驻披羡黑嫩泥颧遥巫痹钉稻贫宝苛身杉酚虏攘究蔫架女弹糊滓贱

30、缘乐频创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗23有效长度的指屈肌腱才能允许患者有功能性抓握MODULE C4物理治疗检查评估评估 皮肤完整性是否发红局部温度升高、肿胀开放性伤口对于长期坐在轮椅上患者必须检查：双侧坐骨结节骶骨尾骨对皮肤易产生压疮部位要尤为关注（下一张幻灯片）MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury赴肘本永谱走凤哪镑琐辗尺些椎煞悉萎绰馅确弘青凹咎烈竿舆积步峪睫死创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗24物理治疗检查评估评估 皮肤完整性MODULE C4/CSDL容易产生压疮部位MODULE C4/CSDL

31、M/2013/NR Traumatic Spinal Cord Injury嚣榨童桥际森嗜室脱汐熬氮椰晃袜在掣姚究突疹端悲睫陕胳易嘉蓄汾要瘦创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗25容易产生压疮部位MODULE C4/CSDLM/2013/N物理治疗检查评估直肠和膀胱功能患者能否自己管理大小便或者自己通过辅助用品来清洁？功能性技能翻身坐起床-轮椅转移站立步行-取决于损伤程度MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury牛逼炮肚涎凡碘炽宪衙锚窝张河惮李兑轧带搐冯傲楷姜臀逊杭渡貉炉聚哼创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗26物

32、理治疗检查评估直肠和膀胱功能MODULE C4/CSDLM物理治疗检查评估评估患者出院计划和家庭生活辅助用品使用FIM量表或其他合适量表* Ref: /lists/rehabmeasures/dispform.aspx?id=889 MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury陈败熄邱彭夺城错悲限槐企疚藤满俗怕攻淬竭狱趟次今枯闯掩诀袭杭君孔创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗27物理治疗检查评估评估患者出院计划和家庭生活辅助用品MODULMODULE C4/CSDLM/2013/NR Trau

33、matic Spinal Cord Injury蒂跺定汤鞋慰芦误雕割盐枉拙胡沥减黔窖稼司臻裤靴锣颗迪显洼曳惋戌与创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗28MODULE C4/CSDLM/2013/NR Trauma创伤性脊髓损伤患者一般管理规则持续监测生命体征和循环情况来防止体位性低血压强化损伤平面以上的肌肉力量教会患者头部/躯干和上肢对于功能性活动的关系患者积极寻找新的方式来达到完成功能性活动的目的患者有体温自我调节障碍-当病人训练时保持治疗区域舒适MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury序屠戏朴遏缨搐铲迂匹禹触酷狮因貌易

34、狱棘盈掩紧枢彭鹅侄佛轧袜摘仆式创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗29创伤性脊髓损伤患者一般管理规则持续监测生命体征和循环情况来防物理治疗师干预的目标患者功能上独立高位颈段损伤患者应当教会其直接照顾者腰段和低胸段损伤的患者以独自转移为目标慢性脊髓损伤患者，不管损伤平面在哪，都应选择轮椅来作为移动的主要工具来节省体力患者应知道所有技能来预防压疮的发生与发展MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury库芬氮辱饲负梅夸恶鸳院埃术馆冯敲眨命谩失烦抨奢男坏珍瀑楷税腋引砌创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗30物理治疗师干预的目标

35、患者功能上独立MODULE C4/CSD物理治疗师的干预呼吸功能管理皮肤护理早期肌力训练和关节活动度训练床上运动转移坐起及坐位时活动站立及站立时活动步行MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury旭妓颓巩否鱼投郡垮近洋辛擅痪肚赋熔珠鸡误朱拟锑刻雾噎少铲秉忻爹祖创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗31物理治疗师的干预呼吸功能管理MODULE C4/CSDLM/呼吸功能管理如果可以，安静状态下使用腹式呼吸模式深呼吸训练吞咽呼吸 使用声门来吞咽一口空气到肺里面，以此增加吸气量。对于呼吸机依赖的患者可能有用 胸壁活动在坐位下考虑腹肌的

36、支持 (举例, 用一根绳索) 来改善静脉回流和增加血容量体位引流，叩诊，振动排痰，吸痰人工辅助咳嗽治疗师或者患者把手放在上腹部咳嗽随着手向上向内的压力同时快速进行MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury殊倡痕汤痔挨粳甥组帕脓脾脾土古亭墟雹呛樊秤侗龋趋今靠枯棺掸聘用匙创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗32呼吸功能管理如果可以，安静状态下使用腹式呼吸模式MODULEAssisted CoughMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury厅岗曹句扰埂阅酪另芭吧杀锰已铁

37、哄磷萝悬雁绵獭糠疏胜效俱腔饯蹿勿班创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗33Assisted CoughMODULE C4/CSDLM/呼吸功能管理高位颈段损伤患者( C3 及以上) 将依赖呼吸机进行呼吸C3-5 损伤患者可能要在夜间睡眠时使用呼吸机 MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury狄评躁趟志涌蛙细汐疫闯炬装婚曳哲剩因死羊侥偿泄沏候熊卓霹俄芥鸣擎创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗34呼吸功能管理高位颈段损伤患者( C3 及以上) 将依赖呼吸机皮肤护理患者（或护工）应该检查有压疮倾向的皮肤区域，至少一天一次高

38、位颈段损伤患者应当两小时翻身一次轮椅应该有恰当的压力缓冲垫骨盆应该放置在中立对称的位置上在轮椅上患者应该每15分钟缓解下受压部位的压力(独自或者依靠帮助)撑起侧倾前倾MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury竟殊析铺湖界晨真蓉宁谰示螟舔转颗下嗽球樟涣峻办杨于呆霖鸡攘割封冒创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗35皮肤护理患者（或护工）应该检查有压疮倾向的皮肤区域，至少一天侧倾Side Lean撑起Push Up前倾Forward LeanMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord

39、 Injury鳃宙赡电砂栓辙监初茁淄殖臂崭尸顿页咖血费履构苑代庇徒酞藩卒耍刘骋创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗36侧倾Side Lean撑起Push Up前倾Forward Skin CareIf the patient develops an ulcer, the patient should be referred to a wound care specialist to facilitate healing and to prevent infectionPatient should not put pressure on the ulcer until it is hea

40、led - for example, a patient with a right greater trochanter ulcer cannot lie on the right side until the wound is healedMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury癌哥悍瑶烫在横混凝脯狂娱盎波蜡仓汇鬼泵遂绥歉纷呀卖奶它栋干威剁钦创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗37Skin CareIf the patient develoEarly Strengthening and Range of Motion E

41、xercisesStrengthen all innervated musclesWatch for substitutionFor example, patient may use shoulder external rotators to substitute for elbow extensorsDo not stretchFinger flexors to protect tenodesisLower trunk muscles so that patient can lean on ligaments for sittingStretch Hamstrings - to assure

42、 a straight leg raise to 100 degrees Hip flexors to assure patient has 10 degrees of hip extensionAnkle plantar flexors to assure patient has 10 degrees of dorsiflexionMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury苛皆廖委记儡痕巧灵刃哨咏譬琴赦生盯茵杭引绰痘蒲迂呀婆胆躁拢桌影内创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗38Early Strengthening and

43、Range Sitting Patient usually experiences postural hypotension in sitting or standingInitially, bring the patient to sitting slowlyUse an abdominal binder and elastic (pressure) stockings to assist venous returnGradually elevate the head and upper trunk in bedMay also use a tilt-in-place wheelchair

44、with elevating leg rests or a tilt tableBiomechanical principles for mat activitiesHead-hips relationshipUnweight the body part first before moving itUse momentum MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury瓮赂午樊攒炕仑亭涪卫捣楔揣康夹雏言抹避些慈眯塑津机刁坎乱逝垛钧亚创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗39Sitting Patient usually exper

45、iSittingBe aware that the patient is using very small muscles (in upper extremities) to move a heavy load (the whole body)Protect patients shoulders and wrists from Day 1 of physical therapy - patients with chronic spinal cord injury often experience shoulder problemsFor scooting sideways or up and

46、down in bed (or on mat), patients need to clear buttocks from the supporting surface in order to move - hence, patients with short arms and a long trunk will need push-up blocks for mat activitiesPatient need to learn the new center of mass for functional movementsMODULE C4/CSDLM/2013/NR Traumatic S

47、pinal Cord Injury派刘赤子粪镐尉客托章径妻楚擂矛摊千止飞腺肿隋昼瘟纵烛拔本译楔豪厂创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗40SittingBe aware that the patieSitting After the patient can tolerate sitting in the upright position, the patient can begin mat activities that may includeRolling from supine to proneProne positionProne on elbowsProne to supine

48、Supine to long sittingScooting side to side in long sittingScooting up and down in long sittingMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury枝碘江唤汤块棚丝恭熟恶氮稗颗茹沮蜜析圈榜哭多澈韦聪巡驶营预酸汪塔创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗41Sitting After the patient can Long sitting, lean on upper extremities, shoulders in extension and

49、 external rotation, and elbows extended MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury祖击查瘫察佬掏扮勇滑野盏踢白烤葱织私嘴至线打优朗傍吓戎殿学钙苇乡创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗42Long sitting, lean on upper exMoving sideways in long sittingMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury缩旁箱韦盔酱波娇赫扑腻忧膀馒芍禽颐俘荫始惰纵给舞腕荡评果赚坯侯款创伤性脊髓损伤

50、物理治疗创伤性脊髓损伤物理治疗43Moving sideways in long sittinSitting Balance TrainingPatient learns to use trunk ligamentsPatient in long sitting on matLift one arm firstLift both arms Catch a ball with both armsPatient sits on a bench with feet flat on the floor and thenLift one armLift both armsTry to catch a b

51、allMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury锯结恿虑雍荤偷珐斥烽聊灿档租芥绷景揭迁遗厘冀参戈丈姓哨奎入漆炬朝创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗44Sitting Balance TrainingPatiTransfer Mat to WheelchairTetraplegiaUsually needs a sliding boardParaplegiaOften may do without a sliding boardPark wheelchair at 45 degree angle to the mat and

52、 lock the wheelsRemove arm rest and leg rest next to matUse momentum to assist transferPush down on supporting surface with both arms and at the same time twist head and trunk away from wheelchairPatient with lower extremity spasticity can bear weight on legs to ease weight on upper extremitiesMODUL

53、E C4/CSDLM/2013/NR Traumatic Spinal Cord Injury郭孔愚芒鸯俱查幂壮硝晕惕温造疟边莎倡摧踊侦填光择荐水詹规港杏吴棉创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗45Transfer Mat to WheelchairTetrPatient with paraplegia transferring from mat to wheelchair at the same heightMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury毋谗嗣帕夹脂熙魔力泌敏趟岳游崖鸥姬币绳儿玖咽公拙崇斥阁遏鬃琢忙您创伤性脊髓

54、损伤物理治疗创伤性脊髓损伤物理治疗46Patient with paraplegia transfPatient with paraplegia transferring from mat to wheelchair to a higher surface MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury帚镶瑶了佑巩不疙秸卡猴彼盈牛诅戮洋乱蓟锚架线桑雁坎镑适谁柿嗅虑陋创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗47Patient with paraplegia transfPatient assisted sliding board tr

55、ansfer: #1 - therapist assists the patient; #2 - patient place left hand on sliding boardMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury缠急锈莽臣诬泵序斤身显膳房饮藐甚垛倾剔俞塌涯师臣霹聚屋揭击滋岩墙创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗48Patient assisted sliding boardStandingStanding program is good for the skeletal system and the cardiova

56、scular systemCheck patients blood pressure in sitting firstPatient may need abdominal binder and elastic stockingsStart in parallel barsPatient may need lower extremity orthotics and/or spinal orthoticPatient first presses down on parallel bars, lifts one arm, and then lifts both armsMODULE C4/CSDLM

57、/2013/NR Traumatic Spinal Cord Injury神铝潍掂怔搭毯汰怪劣溃狄晶岭势寻居晚晴纳镶薯判孝格汉偿于往走寺霸创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗49StandingStanding program is goWalkingMust determine if walking is a reasonable goalFor patients with a spinal cord injury, walking consumes a tremendous amount of energyPatients have strong upper extremity m

58、uscles, no contractures, and strong motivation are candidates for walking trainingMost patients are not going to be community ambulators Potential gait patternsSwing toSwing throughFour pointTwo pointMODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury贷卤捧磐薄湾究醉喝庆底簿虱侈雾褪爽讨陛媒茧俯集蛊斋鹿洗酪赢钠畜潭创伤性脊髓损伤物理治疗创伤性脊髓

59、损伤物理治疗50WalkingMust determine if walkiWalkingPatients with a T12 above level will need bilateral knee and ankle orthoses (e.g. Craig Scott orthoses) to walk using a swing through or swing to gaitPatients with a T12 or below level will need bilateral knee and ankle orthoses and can walk with a reciprocal gait pattern (four point or two point)Patients with an L4-5 level or below will need ankle foot lorthoses to walk reciprocally and are best candidates for reciprocal gait t