常见康复治疗技术操作规范

第一篇物理治疗....................................................................................................................7一章功能评估..............................................................................................................................7第一节身体形态评估..................................................................................................................7一、姿势........................................................................................................................................7二、身高与体重............................................................................................................................8三、肢体长度和围度....................................................................................................................8第二节关节活动范围测量........................................................................................................9一、四肢关节..............................................................................................................................9二、脊柱关节..............................................................................................................................9第三节肌力评估........................................................................................................................10一、徒手肌力评估......................................................................................................................10二、等速肌力评估......................................................................................................................12三、其他器械肌力评估..............................................................................................................13四、肌肉耐力评估......................................................................................................................13第四节肌张力评估....................................................................................................................14一、手法评估..............................................................................................................................14二、仪器评估..............................................................................................................................16第五节感觉评估........................................................................................................................17一、浅感觉..................................................................................................................................17二、深感觉..................................................................................................................................17三、复合感觉..............................................................................................................................18第六节平衡评估........................................................................................................................18一、临床观测..............................................................................................................................18二、量表评估..............................................................................................................................19三、仪器评估..............................................................................................................................21第七节协调评估........................................................................................................................21一、上肢......................................................................................................................................21二、下肢......................................................................................................................................22第八节步行评估........................................................................................................................22一、步行能力..............................................................................................................................22二、步态分析..............................................................................................................................23第九节心血管评估....................................................................................................................24一、心率......................................................................................................................................24二、血压......................................................................................................................................25三、心电分级运动试验..............................................................................................................26四、简易运动试验技术..............................................................................................................27第十节呼吸评估........................................................................................................................27一、通气功能..............................................................................................................................27二、代谢当量..............................................................................................................................29三、心肺联合运动试验..............................................................................................................29第十一节疼痛评估....................................................................................................................30一、压力测痛法..........................................................................................................................30二、视觉模拟评分法..................................................................................................................31三、疼痛问卷..............................................................................................................................31附录..............................................................................................................................................32附表1-2-1上肢关节活动范围测量.........................................................................................32附表1-2-2下肢关节活动范围测量.........................................................................................32附表1-2-3脊柱关节活动范围测量.........................................................................................33附表1-3-1上肢肌肉徒手肌力检查.........................................................................................34附表1-3-2下肢肌肉徒手肌力检查.........................................................................................46附表1-3-3躯干肌肉徒手肌力检查.........................................................................................53第二章运动治疗........................................................................................................................57第一节关节活动范围训练........................................................................................................57一、被动关节活动范围训练......................................................................................................57二、积极-助力关节活动训练.....................................................................................................58三、积极运动..............................................................................................................................58第二节关节松动技术................................................................................................................59一、上肢......................................................................................................................................59二、下肢......................................................................................................................................60三、脊柱......................................................................................................................................61第三节牵伸技术........................................................................................................................62一、上肢......................................................................................................................................62二、下肢......................................................................................................................................62三、躯干......................................................................................................................................63第四节肌力训练........................................................................................................................63一、徒手肌力训练......................................................................................................................63二、等长肌力训练......................................................................................................................64三、等张肌力训练......................................................................................................................64四、等速肌力训练......................................................................................................................65第五节步行训练........................................................................................................................65一、步行前训练..........................................................................................................................66二、步行训练..............................................................................................................................66第六节呼吸训练........................................................................................................................67一、腹式呼吸训练......................................................................................................................67二、抗阻呼气训练......................................................................................................................68三、深呼吸训练..........................................................................................................................68四、局部呼吸训练......................................................................................................................68五、排痰训练..............................................................................................................................69六、呼吸肌训练..........................................................................................................................69第七节平衡与协调训练............................................................................................................70一、无器械平衡训练..................................................................................................................70二、简易设备平衡训练..............................................................................................................71三、仪器平衡训练......................................................................................................................71四、协调训练..............................................................................................................................71第八节有氧训练........................................................................................................................72一、器械有氧训练......................................................................................................................72二、无器械有氧训练..................................................................................................................73第九节神经发育疗法................................................................................................................73一、Brunnstrom技术..................................................................................................................73二、Bobath技术..........................................................................................................................75三、PNF技术..............................................................................................................................76第十节运动再学习....................................................................................................................80一、上肢功能训练......................................................................................................................81二、口面部功能训练..................................................................................................................82三、卧位到床边坐起及坐位平衡训练......................................................................................82四、站起与坐下训练..................................................................................................................83五、站立平衡训练......................................................................................................................83六、行走训练..............................................................................................................................84第十一节医疗体操....................................................................................................................84一、偏瘫......................................................................................................................................84二、颈椎病................................................................................................................................86三、腰椎间盘突出症................................................................................................................87四、肩周炎................................................................................................................................88五、膝关节骨关节炎................................................................................................................89六、脊柱侧凸............................................................................................................................89第十二节牵引治疗..................................................................................................................90一、腰椎牵引............................................................................................................................90二、颈椎牵引............................................................................................................................91三章物理因子治疗..................................................................................................................92第一节电疗法..........................................................................................................................92一、直流电疗法........................................................................................................................92二、直流电药物离子导入疗法................................................................................................92三、低频电疗法........................................................................................................................93四、中频电疗法........................................................................................................................94五、高频电疗法........................................................................................................................94第二节光疗法..........................................................................................................................98一、红外线疗法........................................................................................................................98二、紫外线疗法........................................................................................................................98三、激光疗法............................................................................................................................100第三节磁疗法..........................................................................................................................100一、静磁场疗法........................................................................................................................100二、动磁场疗法........................................................................................................................101第四节超声波疗法...................................................................................................................101一、超声波疗法........................................................................................................................101二、超声药物透入疗法............................................................................................................102第五节冷疗法...........................................................................................................................103一、冷疗法................................................................................................................................103二、冷冻疗法............................................................................................................................103第六节热疗法..........................................................................................................................104一、石蜡疗法............................................................................................................................104二、湿热袋敷疗法....................................................................................................................105三、泥疗法................................................................................................................................105第七节压力疗法......................................................................................................................106一、正负压疗法........................................................................................................................106二、负压疗法............................................................................................................................107三、正压次序循环疗法............................................................................................................107第八节肌电生物反馈疗法......................................................................................................108第二篇作业治疗.....................................................................................................................108一章作业评估..........................................................................................................................108第一节作业体现层次..............................................................................................................108一、作业需求............................................................................................................................108二、平常生活活动....................................................................................................................109三、工作....................................................................................................................................110四、生存质量............................................................................................................................111第二节作业构成层次..............................................................................................................112一、手功能................................................................................................................................112二、知觉功能............................................................................................................................114三、认知功能............................................................................................................................120第三节物理环境......................................................................................................................123一、家居和小区环境................................................................................................................123二、工作环境............................................................................................................................123二章作业治疗..........................................................................................................................124第一节作业体现层次..............................................................................................................124一、平常生活活动....................................................................................................................124二、娱乐与休闲活动................................................................................................................127三、职业康复............................................................................................................................129第二节作业构成层次..............................................................................................................133一、功能性作业活动................................................................................................................133二、手功能................................................................................................................................137三、知觉功能............................................................................................................................141四、认知功能............................................................................................................................144第三节环境改造与辅助..........................................................................................................145一、自助具适配........................................................................................................................145二、助行器使用........................................................................................................................146三、轮椅选择与使用................................................................................................................147四、环境适应与改造................................................................................................................150第四节矫形器制作与使用......................................................................................................150一、矫形器制作........................................................................................................................150二、矫形器使用........................................................................................................................151三、压力衣制作与使用............................................................................................................152第三篇言语治疗....................................................................................................................153第一章听力障碍......................................................................................................................153第一节评估技术......................................................................................................................153一、主观测听............................................................................................................................153二、客观测听............................................................................................................................154第二节治疗技术......................................................................................................................154一、声音察觉训练....................................................................................................................154二、声音辨别训练....................................................................................................................155三、声音识别训练....................................................................................................................155四、声音理解训练....................................................................................................................155五、助听器和电子耳蜗应用技术............................................................................................155二章失语症..............................................................................................................................156第一节评估技术......................................................................................................................156一、失语症................................................................................................................................156二、口面失用症........................................................................................................................159三、言语失用症........................................................................................................................160第二节治疗技术......................................................................................................................160一、听理解治疗技术................................................................................................................160二、阅读理解治疗技术............................................................................................................161三、言语体现治疗技术............................................................................................................162四、书写体现治疗技术............................................................................................................164五、实用交流能力技术............................................................................................................164六、辅助交流技术....................................................................................................................165第三章构音障碍......................................................................................................................166第一节评估技术......................................................................................................................166一、呼吸评估............................................................................................................................166二、喉功能评估........................................................................................................................167三、口唇评估............................................................................................................................168四、下颌评估............................................................................................................................169五、软腭评估............................................................................................................................169六、舌评估................................................................................................................................170七、反射评估............................................................................................................................171八、言语评估............................................................................................................................172第二节治疗技术......................................................................................................................174一、舌感觉运动技术................................................................................................................174二、口唇感觉运动技术............................................................................................................174三、下颌运动技术....................................................................................................................175四、软腭感觉运动技术............................................................................................................176五、声带运动技术....................................................................................................................176六、呼吸训练技术................................................