版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
REHABILITATION
ASSESSMENTPingMiao,MDDepartmentofRehabilitationmedicineThesecondaffiliatedhospitalofGuangzhouMedicalUniversity1.REHABILITATION
ASSESSMENTPingContentsIntroductionMeasuresofimpairment(muscle,joint,cognitive...)Measuresofdisability(activityofdailylife...)Measuresofhandicap2.ContentsIntroduction2.TofindtheproblemsWhatkindofdysfunctioncongenital:heartproblems,etc.postnatal:CP,stroke,SCI,TBI,etcsecodary:contracturefollowingfracture,muscleatrophyafterperipheralnerveinjury,andsoonHowmanydysfunctionsPhysically,speech,psychological,socialaspectHowseverityofdysfunctionsOnpatientandhis/herfamily3.TofindtheproblemsWhatkindTosettreatmentgoalsshort-termgoalsCanbetouchedbyeffortswithinafewdaysorweekslong-termgoalsCanbeachievedforlongtime(terminal)Fromshort-termgoalstolong-termoneMustconsiderthefactorsage、profession、culturalbackgroud、familyconditions4.Tosettreatmentgoalsshort-teAssesstreatmenteffectsIsourtreatmentplaneffective?Yes/NoShouldthetreatmentplanbecontiniunedorshouldbeadjustedaccordingtomeasurementsYes/No5.AssesstreatmenteffectsIsour
Physicalexaminationandrehabilitationmeasurementhavesomethingincommonbutnotthesame.PurposeTimesWaysIntroduction6.Introduction6.7.7.8.8.ObjectivesofMeasurementTofindproblemsTosettreatmentgoalsToplantreatmentschedulesToassesstheeffectivenessTopredictoutcomesToanalyzethecost-effecitveReasonsforassessing9.ObjectivesofMeasurementTofiLevelsshouldbemeasuredimpairmentdisabilityhandicap10.LevelsshouldbemeasuredimpaiDevelopmentofICIDHInternationalClassificationofImpairments,Disabilities,andHandicaps(ICIDH)
1980,WHOdiseaseimpairmentdisabilityhandicap疾病病损残疾残障
(器官水平)(个体水平)(社会水平)
structure
abilityactivity/participation
TraditionalModelofMedicine:Etiology
Pathology
clinicalfeaturesLevels11.DevelopmentofICIDHInternatApplicationofICIDHDifferentcousesAmputeeinthelowerlimbCan`twalkCan`tgotoschool/workimpairmentdisabilityhandicapOrgansADLSocialactivityAtthelevelof12.ApplicationofICIDHDifferentApplicationofICIDHStroke/TBIHemiplagiaCan`tlookafterHim-/her-selfCan`twork/Jointhesociallife
impairmentdisabilityhandicaporgansADLSociallifeAtthelevelof13.ApplicationofICIDHStroke/TBI14.14.IntroductionPurposePlanatreatmentprogramandestablishoutcomesEvaluateresultsoftreatmentprogramModifytreatmentprogram15.IntroductionPurpose15.IntroductionGoodassessmentisdependentupon:KnowledgeoffunctionalanatomyHistoryCompleteexamination16.IntroductionGoodassessmentisClinicalEvaluationSequenceHistoryInspectionPalpationFunctionalTestingNeurologicalTesting17.ClinicalEvaluationSequenceHicategoryofmeasurmentRatioScalesInervalScalesOrdinalScalesNorminalScales18.categoryofmeasurmentRatioScRatioScalesFeaturesHasazeropointthatreprestnsthecompletabsenceofthequatityrepresented.TheintervalsamongallsuccessiveunitsonthescalemustbeequalinsizeCan`thaveaminusornegativevalue.%isaformofratioExamplesROMLimblengthTimetocompletanactivityVitalcapacityNerveconductionvelocity19.RatioScalesFeatures19.InervalScalesFeaturesLackofazeropointTheunitmustbeequalsizeExamplesBodytemperatureFunctinalscalesPsychologicaltests20.InervalScalesFeatures20.OrdinalScalesFeaturesMayhaveonly2categoriesPresent/absentDependent/independentExamplesMMTADLFugle-Meyer`sscale21.OrdinalScalesFeatures21.NorminalScalesFeaturesTheunitsarecategorywithoutindicatingtheorderorrankofthedifferencesMaybelabeledwithnumberals,letters,orwords,butthelablesdonotidicateorderorrankExamplesClassificationofgenders,diseaseStroke,Cerebralpalsy22.NorminalScalesFeatures22.QuantitativeandQualitativeScalesUnitsareassumedtobeofequalsizeAcontinuousscaleEqualsizesubunitsDistance:m,cm,mm,etcExamplesRatioscalesIntervalscalesCategorieshavenosizeCan`tbedivisibleintoequal-sizedsubcategoriesTendonreflexSittingbalanceExamplesNominalscales23.QuantitativeandQualitativeSvalidsensitivespecificreliable(inter-rater,test-retest)appropriateacceptable24.valid24.Procedureswhentomeasurewhattobemeasuredhowtomeasure25.ProcedureswhentomeasurewhatWhentomeasureInitialstageMiddlestageTerminalstageAtfollow-upDuringthetreatmentandtraining,evaluationcanberepeatedbyseveraltimes.Itusuallystartfromtheevaluationandendontheevaluation.26.WhentomeasureInitialstageMiInitialstage(firstmeasurement)WhenshouldbeconductedBeforephyiotherapyobjectivesFindtheproblemsanditsstatusInvestigatethepotentialofrehabilitationandrelatedfactorsAsevidenceofthetreatmentplanningAsthebaselineofreassessment27.Initialstage(firstmeasuremenMiddlestage(repeatedmeasurements)WhenshouldberepeatedOnceat1-2wksforthosewithquickrecoveryEarlyphaseorinpatientsOnceat3-4wksforthosewithslowrecoveryChronicphaseoroutpatientsobjectivesTofindanyimprovementanditsextendTodecideifanyadjustmentisneeded28.Middlestage(repeatedmeasuremeTerminalstage(final)WhenshouldbemeasuredBeforefinishingthephysiotherapyoratdischargeobjectivesToinvestigatetherehabeffectivenessAchivementshasbeenreachedToplandischageprogramContinuinetreatmentReferedtooutpatientorcommunity29.Terminalstage(final)WhenshoFollow-upWhenshouldbeVariationamongpatientsanddiseasesEachmonth,2-3monthsor6monthsobjectivesDeterminethefunctionofpatientDecidewhetherpatientneedstofuthertreatment30.Follow-upWhenshouldbe30.specificPhysicalfunctioncognitionlanguageSocialactivitiespsychologyglobalimpairmentdisabilityhandicapWhattobemeasured31.specificPhysicalfunctioncogniPhysicalfunctionMuscletoneROMBalanceMMTWalking???AschworthSpasticityScaleWhatshouldbemeasuredinneurorehabMotorAssessmentScaleBergBalanceScaleCompositeSpasticityScaleTheTimed“Up&Go”testFugle-MeyerMovementAssessmentReachTestBrunnstroumRoveryStages32.PhysicalfunctionMuscletoneRODatacollectionMedicalhistoryMedicalnotesFindtheproblemsassessmentDecidewhattoandhowtoassessStarttoassessDatarecordingDataanalysisFunctinaldiagnosisSettreatmentgoalsTreatmentplanAssessmentprocedues33.DatacollectionMedicalhistoryEvaluation效度信度sensitivetyvalidreliabilityIntra-raterInter-ratercriterion-relatedvalidation
content-relatedvalidationconstruct-relatedvalidationToevaluatethemethodologybeingused34.Evaluation效度信度sensitivetyvalid
RulesofS.O.A.Parewidelyuseallovertheworld:S(subjectivedata):maincomplaintandsymptomofthepatients;O(objectivedata):objectivesymptomandfunctionalbehaviorofthepatientsA(assessment):analyzeandclassifytheabove-mentionedmaterials;P(plan):setatreatmentplan.
Ⅱ.Methodsofevaluation35.RulesofS.O.A.Parewidel
Ⅱ.Methodsofevaluation36.Ⅱ.Methodsofevaluation36.SpecificEvaluation37.SpecificEvaluation37.SpecificEvaluation-MotorabilityevaluationMusclestrengthRangeofmotionMusculartoneMuscularenduranceGaitanalysisBalanceCoordination38.SpecificEvaluation-MotorabilManualmuscletest
(MMT)39.Manualmuscletest
(MMT)39.ManualMuscleTesting(MMT)Definition:subjectivetestingdonebythetherapisttoassessapatientsmusclestrength.Themusclestrengthisgradedtobeeithernormal,good,fair,poor,traceorzero.40.ManualMuscleTesting(MMT)DefMuscleGradesNormal:patientholdscontractionagainstmaximalresistanceatendrangeGood:patientholdscontractionagainstmoderateresistanceatendrangeFair:patientmovesthroughfullrangeofmotionagainstgravitybutunabletoholdagainstresistanceatendrangePoor:patientmovesthroughfullrangeofmotioninagravityminimizedpositionTrace:therapistpalpatesmusclecontractionaspatientattemptstomoveZero:therapistisunabletopalpateanymusclecontractionaspatientattemptstomove41.MuscleGradesNormal:patienthMuscleGradesNormal= 5/5Good= 4/5Fair= 3/5Poor = 2/5Trace= 1/5Zero= 0/542.MuscleGradesNormal= 5/542.ImportantpointsonmanualmuscletestingNeedtoplacepatientinstandardizedpositionIsolateonlyonejointmotionDon’tallowpatienttocompensateforweaknessComparesamemusclebilaterallyBeconsistentandreliablewithtesting43.ImportantpointsonmanualmusManualResistanceStabilizelimbproximallyResistanceprovideddistallyonbonetowhichmuscleattachesWatchforcompensation44.ManualResistance44.45.45.VIDEODEMOPRACTICEQ&A46.46.AttentionduringtheMMT1.Correctposture,limbpositionandnecessarysettlement.2.Makesurethepatientsunderstandtherequestandpurposeofmovement,sothatavoidingthefakemovementorcompensation.3.Whilethemusclestrengthreachthelevel4,resistanceisprovidedtothedistalareaofthelimb.47.AttentionduringtheMMT47.4.KeepavoidingtheMMTafterlongtimeexercisesormeals.5.Thepositionwhichismeasuredshouldbeexposedtothetherapistsordoctors.6.Remembertocomparewiththecontralaterallimb.48.48.MuscletestMeasurebyequipments1.GeneralequipmenttestGrippingtestPinchingtestDorsalmuscletestⅡ.MethodsofEvaluation-Muscletest49.MuscletestⅡ.MethodsofEvaluMuscletone
(ModifiedAshworthScale)50.Muscletone
(ModifiedAshworth51.51.Rangeofmotion
(ROM)52.Rangeofmotion
(ROM)52.RangeofMotion
(ROM)53.RangeofMotion
(ROM)53.MeasuringToolsGoniometerInclinometerElectrogoniometer54.MeasuringToolsGoniometer54.55.55.HowtomeasuretheROMofupperlimbs/lowerlimbs/trunk?Ⅱ.MethodsofEvaluation-ROMThreefactors(1)Axis(2)Stationaryarm(3)Movingarm56.HowtomeasuretheROMofuppe57.57.ROMMeasurementInformedconsentPositionthepatientPlacejointinzerostartingpositionStabilizeproximalsegmentofthejointMovepatientpassivelythroughavailableROMDetermineend-feelPalpatelandmarksAligngoniometerPassivelyoractivelytakepatientthroughavailableROMCheckalignmentReadgoniometer58ROMMeasurementInformedconsen59.59.Shoulderflexion(180°)Supinewitharmsatsides-liftoverheadStationaryarm-lateralmidlineofthoraxAxis-midpointoflateralaspectofacromionprocessMovingarm:lateralmidlineofthehumerustowardlateralhumeralepicondyle60.Shoulderflexion(180°)60.ShoulderExtension(60)Pronewitharmsatsides-trytoraisearmStationaryArm:lateralmidlineofthoraxAxis:midpointoflateralaspectofacromionprocessMovingArm:lateralmidlineofhumerustowardlateralhumeralepicondyle61.ShoulderExtension(60)61.ShoulderAbductionSupinewithshoulderatsideinanatomicalposition-raisearmoverheadStationaryArm:ParalleltosternumAxis:AnterioraspectofacromionprocessMovingArm:Anteriormidlineofhumerustowardmedialhumeralepicondyle62.ShoulderAbduction62.External/LateralRotation
Internal/MedialRotation63.External/LateralRotation
InteElbowFlexionSupinewithhandsbysideswithtowelunderarm-flexelbowStationaryarm:lateralmidlineofhumerustowardacromionprocessAxis:LateralepicondyleofHumerusMovingArm:Lateralmidlineofradiustowardradialstyloidprocess64.ElbowFlexion64.65.65.66.66.67.67.68.68.69.69.70.70.RangeofMotion(ROM)HelpstoassessfunctionalstatusComparebilaterallyTestjointsproximalanddistaltoinjuredareaOnlyperformifdonotsuspectafracture71.RangeofMotion(ROM)HelpstoImportantpointsonGoniometricmeasurementMotionsmeasuredcanbeeitheractiveorpassiveStandardizedtechniquesareusedforeachjointJointsshouldbeadequatelystabilizedduringmeasurement72.ImportantpointsonGoniometriPassiveRangeofMotion(PROM)ClinicalDefinition:Therapistmovesselectedjoint(s)throughfullrangeofmotionwithnoassistancefromthepatientActiveRangeofMotion(AROM)73.PassiveRangeofMotion(PROM)ImportantpointsonpassiverangeofmotionAdequatelystabilizepatientsjointsasyoumovethem.(somepatientsmayhavenoactivemovement)Don’tcausepainotherthanstretchingPerform5-10motionsperjointmovementFamiliarizeyourselfwithnormaldirectionsanddegreesofmovementforeachjointListentopatient74.ImportantpointsonpassiveraContraindicationsPatientisunabletovoluntarilycontractinjuredmusclePatientisunabletoperformAROMUnderlyingfracturesiteisnothealedInvolvedtissuesarenotyethealed75.Contraindications75.Ⅱ.MethodsofEvaluation-ROM76.Ⅱ.MethodsofEvaluation-ROM
Elbowflexion0°to160°extension145°to0°Forarmpronation(rotationinward)0°to90°supination(rotationoutward)0°to90°Ⅱ.MethodsofEvaluation-ROM77.EWristflexion0°to90°extension0°to70°abduction0°to25°adduction0°to65°Ⅱ.MethodsofEvaluation-ROM78.WristⅡ
Hipflexion0°to125°extension115°to0°hyperextension(straighteningbeyondnormalrange0°to15°abduction0°to45°adduction45°to0°lateralrotation(rotationawayfromcenterofbody)0°to45°medialrotation(rotationtowardscenterofbody)0°to45°79.HipKneeflexion0°to130°extension120°to0°80.KneeAnkleplantarflexion(movementdownward)0°to50°dorsiflexion(movementupward)0°to20°81.AnklMini-MentalState
Examination
(MMSE)82.Mini-MentalState
ExaminationThe
mini–mentalstate
examination
(MMSE)
isa30-pointquestionnairethatisusedextensivelyinclinicalandresearchsettingstomeasurecognitiveimpairment.Itiscommonlyusedin
medicine
andalliedhealthtoscreenfor
dementia.Itisalsousedtoestimatetheseverityandprogressionofcognitiveimpairmentandtofollowthecourseofcognitivechangesinanindividualovertime83.The
mini–mentalstateexaminatAdministrationofthetesttakesbetween5–10minutesandexaminesfunctionsincluding
registration,
attentionandcalculation,
recall,
language,abilitytofollowsimplecommands
and
orientation.84.AdministrationofthetesttakAdvantagestotheMMSEincluderequiringnospecializedequipmentortrainingforadministration,andhasbothvalidityandreliabilityforthediagnosisandlongitudinalassessmentofAlzheimer'sDisease.ThemostfrequentlynoteddisadvantageoftheMMSErelatestoitslackofsensitivitytomildcognitiveimpairment85.AdvantagestotheMMSEincludeAnyscoregreaterthanorequalto27points(outof30)indicatesanormalcognition.Belowthis,scorescanindicatesevere(≤9points),moderate(10–18points)ormild(19–24points)cognitiveimpairment.Therawscoremayalsoneedtobecorrectedforeducationalattainmentandage.86.AnyscoregreaterthanorequaActivityofdailylife
(ADL)87.Activityofdailylife
(ADL)87Bathing:includesgroomingactivitiessuchasshaving,andbrushingteethandhairDressing:choosingappropriategarmentsandbeingabletodressandundress,havingnotroublewithbuttons,zippersorotherfastenersEating:beingabletofeedoneself88.Bathing:includesgroomingactTransferring:beingabletowalk,or,ifnotambulatory,beingabletotransferoneselffrombedtowheelchairandbackContinence:beingabletocontrolone’sbowelsandbladder,ormanageone’sincontinenceindependentlyToileting:beingabletousethetoilet89.Transferring:beingabletowaModifiedBarthelIndexScore(MBI)TheMBIisameasureofactivitiesofdailyliving,whichshowsthedegreeofindependenceofapatientfromanyassistance.Itcovers10domainsoffunctioning(activities):bowelcontrol,bladdercontrol,aswellashelpwithgrooming,toiletuse,feeding,transfers,walking,dressing,climbingstairs,andbathing.
Totalscoresmayrangefrom0to100,withhigherscoresindicatinggreaterindependence.90.ModifiedBarthelIndexScore(Others91.Others91.BalanceDefinition:MaintainingcenterofmasswithinyourbaseofsupportOtherTerminologyusedtodescribebalance:CenterofGravityEquilibriumConeofStability92.BalanceDefinition:Maintaining
Ⅱ.Methodofevaluation93.Ⅱ.Methodofevaluation93.GaitOthertermsusedtodescribegait:Ambulation/LocomotionControlledmovementofyourbaseofsupport.94.GaitOthertermsusedtodescriGaitAssessments95.GaitAssessments95.96.96.Measuresofperception-cognition感知、认知评价Measuresofanxietyanddepression焦虑和忧郁评估MeasuresofTraumaticbraininjury脑外伤(TBI)评估Self-assessmentandself-efficacyscales自我评价(生活质量评价)97.Measuresofperception-cogni
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 太阳能光跟踪装置
- 吴景超“以工立国”政治思想初探
- 文献翻译-冲压工艺设计知识库系统的研究
- 台球记分器商业发展计划书
- 控制板电项目评价分析报告
- 屠宰废水处理行业市场特点分析
- 医用制氧气机相关项目实施方案
- 带帽外套市场环境与对策分析
- 大便软化药相关项目建议书
- 宝鸡文理学院《计算机辅助制图(CADUG)》2021-2022学年第一学期期末试卷
- 提高急性脑梗死再灌注率PDCA
- 《复变函数》教案 第三章 复变函数的积分 伊犁师范学院数学系
- 四川省专业技术人员继续教育2023年公需课试题及答案
- 职场人际关系与沟通课件
- 《伤仲永》词类活用
- 第九版内科学-高血压-课件
- Lesson13Atschool(课件)冀教版英语四年级上册
- 《汉字应用水平测试题》练习试卷及其参考答案
- 2023年江苏省安全员-《C证》考试题库及答案
- 新建小学建设工程项目建议书
- 升压站设备培训教材
评论
0/150
提交评论