|
確胺 |
|
癡絤もの痜┬砏絛
|
癩刮猭┌├洛皘狶だ皘
確胺 絪
洛厩 毙▅〆穦
い地チ瓣る璹
ヘ魁
1.確胺痜┬龟策洛畍毙厩癡絤璸购の戮砫.3
2.確胺痜┬皘洛畍毙厩癡絤璸购の斗...8
3.痜菌糶璶翴10
(1).Stroke..12
(2).Spinal cord
injury..15
(3).Low back
pain.17
4.確胺盽ǎ浪琩19
(1)EMG/NCV 竒肚旧硉/筿瓜浪琩20
(2)Soft tissue Ultrasonography 硁舱麓禬猧...20
(3)UrodynamicsЭ笆厩浪琩..20
(4)Gait Analysis˙篈だ猂..21
(5)Kincom Isokinetic Evaluation单硉蝶︳.23
(6)BMCA (Brain Motor Control Analysis) 笲笆北
蝶︳.24
(7)Cardi-O2 Exercise Testみ笲笆代刚..25
5.確胺盽ǎ痚痜の矪竚虏ざ.26
1). Cerebrovascular Accident.27
2). Traumatic Brain Injury .29
3). Spinal Cord Injury 31
4). Amputee33
5). Orthopedic.36
6). Neurogenic Bladder...38
7). Physical Modality .47
8). Pressure sore..49
9). Autonomic dysreflexia..51
10). Functional independence measure...53
11). Cerebral palsy..54
12). Spasticity..59
13). Botox62
6.
Case conference 絛セ..64
7.
痜菌糶盽ǎ拜肈のэ到某...67
8.
毙厩膟...68
9.
確胺の闽ヘ戳ヘ魁...72
10. 痜┬矪竚砏絛...73
1). On foley...74
2). On NG
tube feeding.79
3). EKG
examination87
確胺痜┬龟策洛畍毙厩癡絤璸礶の戮砫
毙厩癡絤璸礶
1.癡絤ず甧
A. 確胺洛厩阀猵
B. 確胺洛励癘魁ぇ莱ノ
C. 畕も代刚
D. 闽竊笆ぇ代秖
E. 荐筿单祸竟ぇ芠集
F. 竒肚旧籔筿瓜ぇ芠集
G. 笲笆ネ瞶蝶︳ぇ芠集
H. タ盽籔钵盽˙篈ぇ挪
I. 竒毁锚眞ぇ稰谋笲笆浪琩籔確胺
J. 癌ч籔闽竊砃ぇ確胺
K. 硁舱麓癌纅闽竊ぇ確胺
L. も场ぇ確胺
M. みぇ確胺
N. や琜竡矪よ籔浪琩ぇ芠集
O. 瞶獀励膀セ瞶阶のよ猭
P. 戮獀励膀セ瞶阶籔よ猭
Q. 粂ē獀励膀セ瞶阶籔よ猭
2.癡絤ず甧灿玥の厩砃笆
1).羬龟策灿玥羬皘洛畍厩策皘痜眞ぇ矪瞶
|
翴 |
龟策兜ヘ |
繵瞯 |
弧 |
璽砫洛畍 |
|
痜┬ |
1.把洛厩穦某 |
–秅ㄢΩ |
²
把籔贬穦の龟策洛畍癡絤揭祘癚阶 秅と07:30 |
獀洛畍 羆洛畍 |
|
2.痜┬ǖ禘 |
–ぱΩ |
²
把籔琩┬ǖ禘籔娩毙厩(–龟策洛畍蛤繦旧ぇ獀洛畍の皘洛畍秈︽) |
|
|
|
3.钡穝 |
跌惠璶 |
²
籔皘洛畍钡恶糶锣の皘痜菌 |
|
|
|
4.痜菌糶 |
┮璽砫ぇ痜眞–ぱΩ |
²
癘魁皘眞痜菌の–ぱ痜薄秈甶 |
|
|
|
5.洛篷矪瞶 |
跌惠璶 |
²
皘洛畍矪瞶洛篷秨ミ虫沮旧Э璆恨闽竊の竫猔甮 |
|
|
|
痁 |
1.矪瞶╆ぃ続 2. 矪瞶羬祇ネぇ猵 3. 钡穝皘の锣痜眞 |
ぱ痁(–る痁) |
²
痁洛畍矪瞶痜猵 ²
籔皘洛畍钡 ²
皘洛畍矪瞶 |
|
2) .毙厩笆龟策洛畍近秸材ぱ莱璽砫ぇ羆洛畍厨厨翴5G
痜┬だ璽砫ぇ獀洛畍の皘洛畍–秅パ羆洛畍璽砫
龟策洛畍毙▅揭祘把ぉセ兜毙▅笆
|
秅计 |
厩策ヘ夹 |
揭祘ず甧 |
璽砫 |
|
材秅 |
1.秆確胺吏挂籔盽砏 2.確胺や琜竡籹ざ残 |
²
吏挂の盽砏ざ残 ²
洛畍à︹籔 ²
瞶獀励ざ残 ²
戮獀励ざ残 ²
粂ē獀励ざ残 |
羆洛畍 |
|
3.福い皘痜眞獀励家Α |
²
福い皘痜眞獀励 ²
獀励璸礶砞﹚ ²
盽ǎぇㄖ痝虏ざ ²
ㄖ痝ぇ矪瞶 |
獀洛畍 |
|
|
材秅 |
1.盆端痜眞ぇ獀励家Α |
²
盆端痜眞獀励 ²
獀励璸礶砞﹚ ²
盽ǎぇㄖ虏ざ ²
ㄖ痝ぇ矪瞶 |
獀洛畍 |
|
2.ㄤ禘の皘痚痜虏ざ 3.確胺厩の祘狝叭いみ虏ざ |
²
ㄠ担確胺 ²
摸痥礹確胺獀励 ²
摸癌闽竊痜確胺獀励 ²
秆ヘ玡確胺龟喷 ²
肈の闽祸竟ぇ虏ざ |
羆洛畍 |
毙厩癡絤璽砫籔旧畍虫
1.毙厩癡絤璽砫 繟骸洛畍
2.旧畍獀洛畍
把σゅ膍
1. Krusen
/ Handbook of Physical Medicine and Rehabilitation
2. Delisa
/ Rehabilitation Medicine : Principle and Practice
3. Braddom
/ Physical Medicine & Rehabilitation
4. Grabois/
Physical medicine & Rehabilitation: The complete approach
戮砫
1.痜┬
1).Ν边痜┬贝高痜眞冈灿癘更眞痜薄
2).盞ち猔種眞痜薄ぇ祇甶籔洛篷ぇ龟琁薄Τ疭跑て莱ミ厨皘洛畍┪羆洛畍矪瞶
3).把ヴ獀洛畍羆洛畍の皘洛畍琩┬琩┬莱罙眞秈甶薄猵繦篕璶癘更痜菌洛畍矗厨
4).皘洛畍琩Lab data琩┬ǖ跌痜矪瞶洛篷on NGFoleystat and regular ICPresting EKG单
5).ちづ︽秨ミ浪琩璶ノ媚筁LabSMA-12ぃ絋﹚叫叫ボVS┪R
6).痜┬紀斌叫叭ゲだ摸メ斌╊絬芭鹅溅苃АΤ盡妮竚ICP/Foleyぇ10cc皐璶だ秨メ璝ぃ睲贰叫拜臔瞶
7).叫ぉVSのR癚阶籔痜┪產妮秆睦痜薄Τゲ璶玥洛畍叫ボよ眔ぇ
8).フ痁钡new patientぃ禬筁5玥10パ皘洛畍跌薄猵秸俱
9).穝皘痜眞斗ず盢痜菌瞶厩浪琩の浪琩ЧΘ莱赣矪竚璶皑秨ミorder磅︽
--
Sciatica patientbed side sustained pelvic traction
-- CVA
patientPT/OT/ST单
10).莱籔臔瞶のセ玂▆ぇ闽玒
2.痁
1).讽らAM 8:00 ~ 筳ら8:00だㄢ琿
讽らAM 8:00- PM 4:00 磅︽┮Τ皘皘痜ICP
PM 4:00- 筳らAM 8:00 籔痁
2).ゲ斗痙痁on duty
3).腨窽ㄖ痁笻眖腨某矪
4).痁钡New Patientぃ禬筁3玥5パ皘洛畍跌薄猵秸俱
5).璝Τㄆ斗传痁叭ゲ矗Ν硄臔瞶5G8Hの讽ら痁R斗竒CR︽ぇ荡癸窽ゎ传痁粇洛励
.痜菌糶
1) .Progress
note叭ゲぶ–ぱ糶Ω安らョ
2) .秨order璶糶progress note弧
3) .Admission
/ acceptation note叫宽酚痜菌糶璶翴硋兜癘魁 Native place膟砮璶糶
.厩砃笆
– W2W3 5G癚阶Τmeeting叭ゲ非畊畊癘魁
Θ罿σ璶把σ
W2 07:30 W3 07:30 Book Reading conference ┪Journal meeting
& case conference
き.σ快猭
1. パ皘洛畍の獀洛畍沮ら盽瞷meeting presentationの掸刚Θ罿∕﹚だσの蝶だ
2. σず甧珹
|
癡絤ず甧 |
蝶糵兜ヘ |
||
|
skill |
knowledge |
judgement |
|
|
1.虏ざ確胺洛厩ぇ絛瞅の狝叭癸禜 |
|
v |
v |
|
2.把芠ざ残瞶の戮獀励ぇ祸竟の穨よΑ |
|
v |
v |
|
3.贺近慈や琜確胺竟粄醚 |
v |
v |
v |
|
4.福い痜眞ぇ蝶︳酚臮籔確胺 |
v |
v |
v |
|
5.篊┦痚痜ぇ蝶︳籔確胺ヘ夹ぇ絋ミ |
v |
v |
v |
|
6.盆穕端痜ぇ蝶︳酚臮籔確胺 |
v |
v |
v |
|
7.篒痜眞ぇ蝶︳酚臮籔確胺 |
v |
v |
v |
|
8.確胺痜眞籋癡絤ぇмォ |
v |
v |
v |
|
9.
弄穦の弄阶ゅぇみ眔厨 |
v |
v |
v |
|
10.
痜菌糶旧 |
v |
v |
v |
確胺痜┬皘洛畍毙厩癡絤璸礶の斗
1. 確胺材皘洛畍癡絤翴の厩策兜ヘ
1)
皘痜眞羬禘励癡絤珹痚痜ぇ禘耞蝶︳獀励の確胺ヘ夹ぇミ
a.
福い
b. 盆穕端
c.
繷场端のㄤ福场痜跑
d. 癌纅ψ╰参
2) .瞶獀励ぇ粄醚
戮獀励ぇ粄醚
粂ē獀励ぇ粄醚
や琜竡近慈ぇ粄醚
3) .й弄穦ゅ膍厨癡絤
4) .ACLS癡絤
5) .毕м砃癡絤陈綤近癡
6) .把籔厩砃癚穦
7) .竒ず近癡癡絤
2.確胺材皘洛畍癡絤翴の厩策兜ヘ
1)
皘痜眞羬禘励癡絤珹福い盆穕端繷场端の癌纅ψ╰参单
2) .筿厩禘耞顶癡絤
a.
筿瓜
b. 笲笆の稰谋护祇筿
c.
笲笆北蝶︳
3) .徊ㄣ膀セ籹мォぇ粄醚の癡絤
4) .й弄穦ゅ膍厨癡絤
5).毙厩癡絤
a.
ǎ策龟策洛畍
b. 確胺臔
6) .近秸ㄤ竒み纽ず俱楞縎端单
7) .把籔洛厩╯˙癡絤
8) .把籔厩砃癚穦
3.確胺材皘洛畍癡絤翴の厩策兜ヘ
1) .兜確胺癡絤ぇ眏
2) .酚穦癡絤
a.
CVA
b. SCI
c.
Orthopedic
d. ず╰
e.
Pediatric
f.
╰の端
3) .禘痜禘励癡絤
4) .seminar
5) .筿厩禘耞弄
6) .硁舱麓禬猧巨の弄
7) .Э笆厩巨の弄
8) .A.ネ厩
a.
˙篈だ猂
b. 单硉蝶︳
c.
ì┏溃
B. 笲笆ネ瞶蝶︳
7) .毙厩旧ǎ策龟策洛畍の確胺臔ぇ毙厩
8) .把籔洛厩阶ゅ╯
9) .把籔厩砃癚穦
4. 確胺材皘洛畍癡絤翴の厩策兜ヘ
1) .兜確胺癡絤ぇ眏の膥尿癡絤
a.
穦禘
b. 禘
c.
兜浪琩の確胺洛厩祘
2) .︽現癡絤逼痁穦某洛畍の痜┬秸单
3) .ACLS癡絤
4) .毙厩旧皘洛畍のǎ策龟策洛畍確胺臔ぇ毙厩
5) .阶ゅ矗厨
6) .把籔厩砃癚穦
7) .確胺獀励痜眞ぇ蝶︳の璸购璹﹚
痜菌糶璶翴
1. 痜菌癘更筿福糶
2. 皘禘耞Final Diagnosis
1) .皘ら戳獀洛畍帽彻ゲ斗Ч俱
2) .程禘耞ゲ斗籔皘痜菌篕璶厚虫ぇ皘禘耞璓
3) .タ絋ぃノDittoの虏糶
3. 拜肈旧Problem Oriented Sheet
拜肈祇ネの矪瞶よ猭絋龟恶糶
4. 皘痜菌篕璶Discharge Summary
1) .痜膀セ戈皘锣の皘ら戳ゲ斗Ч俱
2) .皘の皘禘耞絋龟恶糶ぃノDittoの虏糶
3) .–逆А絋龟恶糶ぃフゼ浪琩兜ヘ糶Nil
4) .皘獀励竒筁ゲ斗爹獀励玡ぇ痜猵祇甶Brunnstromˇs
stagefunctional status单
5) .皘ボ逆ゲ斗爹皘ぇノ媚の琌OPD F/U
6) .獀洛畍の皘洛畍帽彻ゲ斗Ч俱
5. 洛篷虫Order Sheet
1) .埃候猵ゲ斗ㄏノ筿福洛篷
2) .洛篷Τ粇ゲ斗ㄌ砏﹚эぃ额эよΑぇ
3) .羬の戳洛篷ぇ癬﹍逆ゲ斗タ絋
4) .皘ぇ猵の禘丁ゲ斗恶糶
5) .┮Τ洛篷А斗Τ皘洛畍┪獀洛畍帽
6. 皘癘魁Admission Note
ゲ斗珹兜
Chief Complaint
Present Illness
Past History
Family History
Physical
Examination
Neurological
Examination
Laboratory Data璝礚浪喷玥糶not available
Impression
Plan
7. 痜祘癘魁Progress Note
1) .–ぱ糶Ω珹安ら
2) .锣ゲ斗恶糶Transfer NoteのAcceptance Note
3) .獀洛畍琩┬ぇcomment斗癘魁
4) .獀洛畍–秅程ぶ斗帽ㄢΩ
8. 浪喷癘魁虫Laboratory Sheet
絋龟癘魁恶糶
Date
/ / REHABILITATION ADMISSION/ACCEPTION NOTE CNS lesion
CHIEF COMPLAINT:
PRESENT ILLNESS:
Native place:__________
PAST
HISTORY:previous( )stroke/( )HI/( )Trauma
Hx.during_____Ys/Ms/Ds ( )DM ,( )H/T,( )HEART DIS,( )BRAIN DIS,( )LIVER DIS,(
)KIDNEY DIS,
( )RESPIRATORY DIS,( )INFECTIOUS DIS,(
)ALLERGY,sequalae:_________
PERSONAL HISTORY:
( )smoking:____PPD,___Ys/Ms/Ds;( )Alcohol
drinking____C/B, Ys / Ms/ Ds; ( )Chineseherbs:____Pkg___
Ys/Ms/Ds;OTHER:________.
FAMILY HISTORY:
( )DM ,( )H/T,( )HEART DIS,( )BRAIN DIS,( )LIVER
DIS,( )KIDNEY DIS,
( )RESPIRATORY DIS,( )INFECTIOUS DIS,(
)ALLERGY,sequalae:_________
PHYSICAL EXAMMINATION:
Vital sign:T___,P___,R____,B/P___/___mmHG.
HEENT: ( )gross normal,( )abnormal;conjunctiva,(
)pale;sclera:( )icteric
Neck: ( )supple/( )rigid;( )JVE;( )LAP;(
)goiter;( )bruit
Chest:symmetric expansion(+/-) breathing sound:
( )clear;( )coarse;( )wheezing;
( )rales.
Heart: ( )RHB,no murmur noted;(
)irregular,______________
Abdomen: ( )soft & flat;( )tenderness;Bowel
sound: ( )normal,( )hyperactive,
(
)hypoactive.
Extremities: ( )freely movable /( ) hemiplegia/ ( )paraplegia;( )cyanosis; ( )clubbing ;( )pitting edema.
NEUROLOGICAL EXAMINATION:
CONSCIOUSNESS: ( )clear &
alert,( )drowsy GCS:E__V__M__
MENTAL STATUS:JOMAC: ( )good,(
)fair,( )poor.
CRANIAL NERVE:
CN I : sense of
smell: ( )intact,( )not testable,( )abnormal__________
CN II:visual
acuity & field: ( )intact,( ) abnormal__________
CN III IV VI:eyelids: (
)intact,( )ptosis,( )retraction,( )blepharospasm,describe:______
PUPILS
|
ITEMS |
R'T |
L'T |
|
size(mm) |
|
|
|
shape |
|
|
|
light reflex(D) |
|
|
|
light reflex(I) |
|
|
EOM RˇT LˇT
CN
V:facial
skin sensation : ( )intact,( )not testable,( )abnormal__________
corneal reflex:
( )RˇT/( )LˇT.
CN
VII:facial
palsy: ( )central, ( )peripheral.
CNVIII: hearing
impaired: ( )intact,( )not testable,( )abnormal. ( )RˇT/( )LˇT/( )BIL
Nystgmus:
CN
IX XXII:gag
reflex( )RˇT/( )LˇT,uvula deviation--( )RˇT/( )LˇT.
swallowing: ( )intact/on NG/( )dysphagia( )liquid,( )soild
motor control of tongue: ( )intact,( )not testable,( )abnormal__________
CN
XI:turning
head (sternocleidomastoid): ( )intact,( )not testable,( )abnormal_____
shrugging
shoulder(trapezius)-- ( )intact,( )not testable,( )abnormal
describe:________________
MOTOR FUNCTION
Brunnstrom
stage:
|
ITEMS |
R'T |
L'T |
|
upper limbs(p) |
|
|
|
upper limbs(d) |
|
|
|
lower limbs |
|
|
SENSORY
DTR
ANS FUNCTION:sphincter
tone: ( )intact,( )flaccid,( )hyper.
( )bulbocavernous reflex; ( )anal reflex
Urine:( )retention/( )incontinence;Stool:( )impaction/( )incontinence
FUNCTIONAL
STATUS
(1.total
assist,2.partial assist 3.supervision,4.independence)
( )personal care,( )rolling,( )sitting,( )standing,( )transfer,(
)ambulation:
(wheelchair,walk) with/without device.
SPEECH ( )fluency,( )comprehension,(
)repetition,( )naming.(+:intact,-:impaired)
if aphasia,describe:________________________________
SPECIAL
EXAM FINDING:
IMPRESSION:
REGAB GOAL:
PLAN:
Date /
/ REHABILITATION ADMISSION/ACCEPTION NOTE SCI
CHIEF COMPLAINT:
PRESENT ILLNESS:
Native place:__________
PAST HISTORY:previous
paraplegia/quadriplegia Hx( )________year ago;DM( ),
H/T( ),HEART DIS( ),BRAIN DIS( ),LIVER DIS( ),KIDNEY DIS( ), RESPIRATORY DIS( ),INFECTIOUS DIS( ),ALLERGY( ):
PERSONAL HISTORY:
Smoking:____PPD___yrs;alcohol drinking____cup/bottle___yrs Chineseherbs:____Pkg___yrs.
FAMILY HISTORY:
PHYSICAL EXAMMINATION:
Vital sign:
General appearance:
HEENT:gross normal( ),trauma( ),deformity(
),conjunctiva:pale( ),sclera:icteric( )
Neck:supple( ),or rigid( ),JVE( ),LAP(
),goiter( ),bruit( ),if(+):
Chest :symmetric expansion(+/-) breathing
sound:clear( ),coarse( ),wheezing( ),
rales(
)if(+):
Respiratory condition: breathing pattern:normal(
) if abnormal refer to special sheet.
Heart:regular heart beat,no murmur noted(
),if(-):
Abdomon :soft & flat( ),tenderness(
),Bowel sound:normal( ),hyperactive( ),
hypoactive( )
Extremities:freely movable( ),cyanosis(
),clubbing( ),pitting edema( )
Skin:dryness( ),dehydration( ),pressure sore( ) if(+):location___________, grade_______________
NEUROLOGICAL EXAMINATION:
CONSCIOUSNESS:clear & alert (
),drowsy GCS:E__V__M__
MENTAL STATUS:JOMAC (good or poor)
MUSCLE POWER:
|
UPPER |
RT |
LT |
RT |
LT |
LOWER |
|
LIMB |
|
|
|
|
LIMB |
|
C5 |
|
|
|
|
L2 |
|
C6 |
|
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|
L3 |
|
C7 |
|
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L4 |
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C8 |
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L5 |
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T1 |
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S1 |
SENSORY:
POSITIONAL SENSE:
DEEP TOUCH:
DTR:
ANS
FUNCTION:Sphincter tone:flaccid( ),normal(
),hyperactive( )
Bulbocavernous reflex( ), anal reflex( )
Urine (retention/incontinence),Stool (impaction/incontinence)
FUNCTIONAL
STATUS (0.not testible.1.poor 2.fair 3.good )
rolling( ),siting( ), standing( ),ambulation(with/without) device( )
ADL:dependent(
),partial dependent( ), partial independent( ), independent( ),
SPECIAL
EXAM FINDING:
IMPRESSION:
GOAL:
PLAN:
Date / / REHABILITATION ADMISSION/ACCEPTION NOTE LBP
CHIEF COMPLAINT:
PRESENT ILLNESS:
PAST HISTORY:
Previous ( )trauma/( )back pain Hx.during
Ys/Ms/Ds
(
)DM;( )H/T;( )Heart dis.;( )Brain dis.;( )Liver dis.;
(
)Kidney dis.;( )Respiratory
dis.;( )Infectious dis.;( )Allergy
Sequelae:
.
PERSONAL HISTORY:
(
)Smoking PPD Ys/Ms/Ds,
(
)Alcohol drinking cc/Bt
Ys/Ms/Ds
( )Chinese herbs pkg
Ys/Ms/Ds
Others:
.
FAMILY HISTORY:
(
)DM;( )H/T;( )Heart dis.;( )Brain dis.;( )Liver dis.;
(
)Kidney dis.;( )Respiratory
dis.;( )Infectious dis.;( )Allergy
Sequelae:
.
PHYSICAL EXAMINATION:
Vital sign: T P R ,BP / mmHg
HEENT: Grossly ( )normal/( )abnormal
Conjunctiva( )pale;Sclera( )icteric
Neck: ( )Supple/( )Rigid;( )JVE;( )LAP;( )Goiter;( )Bruit
Chest: Symmetric expansion(+/-)
BS:(
)Clear/( )Coarse,( )Wheezing,( )Rales
Heart: ( )RHB/( )Irregular
Murmur(+/-):Gr over
.
Abdomen: ( )Soft♭ ( )Tenderness
Bowel sound:( )normal/( )hyperactive/( )hypoactive
Extremities: ( )Freely movable/( )Hemiplegia/( )paraplegia
( )Cyanosis;( )Clubbing;( )Pitting edema;
( )Intermittent claudication
Walking on toe:R( )/L( ); Walking on heel:R( )/L( )
SLRT:R /L
; Crossed
SLRT:R( )/L( )
Fabere test:R( )/L( )
Back: ( )Scoliosis spine; ( )Pelvic tilt; ( )SI joint tenderness
( )Knocking pain; ( )Night pain
Trigger
point over
.
ROM: ( )C-/L- spine forward bending ,pain(+/-)
backward extension ,pain(+/-)
lateral bending ,pain(+/-)
NEUROLOGICAL EXAMINATION:
Consciousness:
( ) clear & alert/( )drowsy( ); GCS:E M V
Mental
status: JOMAC: (
)good/( )/fair/( )/poor
Muscle power:
Sensory:
DTR:
ANS function: Sphincter tone: ( )intact/( )flaccid/( )hyper
( )Urine/( )Stool ( )Continence/( )Incontinence
FUNCTIONAL STATUS: (1:total
assist, 2:partial assist, 3:supervision, 4:independence.)
(
)Personal care;(
)Rolling;( )Sitting;( )Standing; ( )Transfer
(
)Ambulation: ( )Wheelchair/( )Walk ( )with/( )without device
SPECIAL EXAM.FINDINGS:
IMPRESSION:
REHAB.GOAL:
PLAN:
確胺盽ǎ浪琩
EMG/NCV 竒肚旧硉/筿瓜浪琩
Soft Tissue
Ultrasonography 硁舱麓禬猧
UrodynamicsЭ笆厩浪琩
Gait Analysis˙篈だ猂
きKincom Isokinetic
Evaluation单硉蝶︳
せBMCA (Brain Motor
Control Analysis) 笲笆北蝶︳
Cardi-O2 Exercise
Testみ笲笆代刚
EMG/NCV 竒肚旧硉/筿瓜浪琩
筿瓜浪琩筿禘耞厩场ウㄤ龟琌竒肚旧硉浪琩Nerve Conduction Velocity, NCVの皐伐筿瓜Needle
Electromyography, Needle EMGㄢ兜浪琩虏嘿璶ノㄓ羬洛畍禘耞竒のψ╰参よ痚痜
(1).
竒肚旧硉浪琩Nerve Conduction Velocity, NCV
ノ筿縀琘兵竒パ筿縀矪竒狠癘魁筿伐钡Μ竒肚旧筿猧┮惠丁の┮ǐ禯瞒传衡竒肚旧硉狦竒Τ痜跑┪溃竒肚旧硉穦獽篊猧э跑
(2).
皐伐筿瓜浪琩Needle Electromyography, Needle EMG
ノ皐伐ψ癘魁ψ繰ゎのΜ罽筿笆и匡拒兵ψㄓ﹚竒ψ痜跑ぇ疭┦场絛瞅の腨Τㄇ痜眞ぃ続暗兜浪琩珹1.Τ﹀渡狝ノк井﹀警┪﹀ね痜眞2.钵盽┪Τ╰参┦稰琕3.Τみ纽盲饯钵盽┪盲饯竚传
Soft Tissue Ultrasonography 硁舱麓禬猧
ノ蔼秆猂龟丁(high-resolution real-time)ぇ蔼繵禬猧秈︽ψ癌纅╰参硁舱麓禬猧浪琩浪琩絛瞅珹▂得闽竊㏄娩硁舱麓芺渐斤闽竊㏄娩硁舱麓ㄠ弊繴单皐癸竫祇┪耞吊﹀竳竳紽ミ陪钩ぇ紇钩禘耞ノ眒︹常扒禬猧Color Duplex Sonography, CDSだ猂硁舱麓ず﹀恨だの﹀瑈硉
UrodynamicsЭ笆厩浪琩
Э笆厩浪琩セノ竒┦籋neurogenic bladder浪琩浪琩兜ヘ珹
(1).籋溃瓜cystometry, CMGH2Oい单硉拈猔籋蝶︳籋
拈猔ぇ甧秖籔溃跑て薄罙秆代籋稰谋眏sensitivity
铆﹚stability続莱┦complianceのΜ罽contrctility
(2).珹筿瓜sphincter electromyography, sphincter EMG筿瓜
筿伐癘魁▃㏄瞅ぇψ笆薄
(3).Э笵溃瓜urethral pressure profile, UPP俱兵Э笵ず溃籋
繰ゎ篈┮代眔嘿繰篈Э笵溃瓜static UPP逼Э┮代眔
嘿笆篈Э笵溃瓜dynamic
UPP
Gait Analysis˙篈だ猂
˙篈だ猂璶Τ╰参
暏 (1)丁˙篈だ猂╰参
暢 (2)硈尿┦ì┏溃˙篈だ猂╰参
(3)ì┏溃代秖╰参(Foot pressure)
(1).丁˙篈だ猂╰参
丁˙篈だ猂╰参(Gait Analysis System)1.夹粁╰参(marker system)Τ笆祇夹粁の砆笆は夹粁р笲笆瓂格陪ボㄓ2.尼紇诀盢笲笆瓂格癘魁ㄓ璝璶弘絋だ猂丁笲笆ぶ璶Τ4~5 场尼紇诀˙癘魁 3.筿福のだ猂笲衡硁砰: Τ贺砞称獽冈龟だ猂笲笆篈硂碞琌┮孔笲笆厩 (kinematics)だ猂4.代狾(force plates)Τ㏕﹚代狾遏 5.筿瓜(electromyography)代笲笆俐丁琘场ψタノのノ癸祘Τぶ皌代狾笆厩(kinetics)だ猂代秖闽竊┮┯痻
続ノ絛瞅珹
1.獀励玡蝶︳览﹚程獀励家Α:
I.福┦陈肤眞福┦陈肤眞パも砃э到笲笆程Τì秈
甶硂よ˙篈だ猂ш簍帝讽璶à︹虑パ˙篈だ猂и笵˙︽讽いê兵ψΤぃタ盽は莱┪琌闽竊笆┦沮ち耞ㄤ竒や皌┪琌盢ψ锣ㄏ眞莉眔タ盽˙篈の耕笲笆II.癌よ洞盿穕端┪癌ч瘤竒も砃確˙篈だ猂矗ㄑ┦浪琩匡ノも砃よΑэ秈˙篈だ猂常ㄣΤ砃玡蝶︳箇
代砃Θ狦 III.俱砰も砃よ IV.媚╯よぃ媚舱癸ぺ此ん痝(Parkinsonism)笲笆 э到み纽癐很眞竒媚獀励˙︽秖薄都皊秖癸 ˙︽铆﹚Τ紇臫......单
2.竡罛ㄣ徊竟瘪砞璸莱ノ籔癡絤
3.箇ň洛厩籔瑈︽痜厩よи笵禴Θρ材繧虑˙篈だ猂т旧璓禴繧Ν戳逼埃硂ㄇ甧禴倒ぉρ続讽矫毙癡絤ら盽ネ秸続┪皌ぉ˙︽徊竟瘪┪パ酚盢碩產畑の穦璽踞皐癸璂闽竊笲笆端甡Ы场﹀睪碻吏单痚痜籔ネ厩贝癚タ硋亥酱玨祇甶
(2).硈尿┦ì┏溃˙篈だ猂
硈尿┦ì┏溃˙篈だ猂(computer dynography, CDG)琌甅˙篈だ猂╰参,ウ镑代秖代˙︽ì┏溃硈尿跑て秈τだ猂˙︽铆﹚┦癸嘿┦の璽だ薄
CDG程ノ菏代刚˙︽いみ锣簿铆﹚┦ㄢ竲˙篈癸嘿┦ì┏璽のだ薄τ硂ㄇ戈癸羬洛畍蝶︳痜˙篈Τ腊癸竒╰参よ痚痜い┪ㄤい枷竒㏄娩竒痜跑癌纅闽竊╰参痚痜闽竊ま癬痥礹癌чぃ▆隆
硑Θㄢ竲ぃ单贺闽竊も砃┪ψ竫洞盿单硁舱麓拜肈常ノCDGウ癸˙篈硑Θ紇臫ノㄓ蝶︳獀励狦癸癌чも砃ガ︽璽薄ノCDG暗﹚秖代秖硁舱麓も砃ブ盲单痜も砃˙︽ョノCDG暗蝶︳
媚癸痜笲笆北┪ψ眎紇臫ノCDGㄤ˙篈э跑˙篈毁锚痜確胺筁祘い˙篈秈˙薄ノCDG痙癘魁癸贺ぃ竡杆ㄣ徊竟狦ノCDG暗芠ゑ耕
(3)ì┏溃代秖╰参(Foot pressure)
ì┏溃代秖蹦EMED╰(Novel Gmbh, Munich, Germany)ぇPEDAR-system癘魁ì┏溃だ跋办EMED╰参ㄤ砞称蛮綾乖ぇ溃稰莱竟(sensors)ㄤ–キよそだΤ溃稰莱竟ノㄓ代秖代ミ┪︽ǐ┮ 玻ネぇì┏溃跑て薄竒旧絬肚癳癟腹硈ぇ筿福竒┮硁砰秈︽戈俱瞶籔だ猂眔闽ぇ溃だ计籔瓜
きKincom Isokinetic Evaluation单硉蝶︳
(1)单硉祸
单硉祸莱ノ約獂ψ癌纅╰参蝶︳の癡絤ヘ玡ョ崩約竒ψ╰参蝶︳の癡絤矗ㄑ眞冈灿蝶︳の獀励セ╯Kincom单硉祸ㄑ羬╯蝶︳の獀励
(2)癡絤
癡絤沮璽颤笲笆硉のψΜ罽盢癡絤だ贺
1.
单笲笆(isometric exercise)单笲笆ボ笲笆筁祘いψ蝴ぃ跑羭匡も羭ㄤ繷㎝繷常ΤΜ罽ノㄤ纔翴琌甧磅︽の闽竊笆ㄏノ
2.
单眎笲笆(istonic exercise)单眎笲笆琌笲笆筁祘い┮┯璽颤㏕﹚纔翴砞称虏虫甧琁︽笆篈┦癡絤
3.
单硉笲笆笲笆筁祘い硉蝴﹚单硉笲笆ㄤ癡絤沮癡τ﹚ョ癡ㄤ玂笲笆硉眖眔ョ瞷癡笆篈┦
(3)羬莱ノ
羬蝶︳の╯单硉祸ぃ度蝶︳ψ秖ョ蝶︳ψ瑻ウ矗ㄑ砛芠计沮畃痻Ρ絬羆秖キА瞯の瑻ゑ单パ单硉代刚┮眔计沮ㄣΤ蔼獺の蔼珿続暗羬蝶︳の╯
(4)单硉笲笆疭┦
1.Τ┦2.┦3.秸続┦单硉祸沮癡ψΜ罽倒ぉ続讽秸続┦4.闽竊ず5.糤闽竊緄だㄑ倒6.ネ瞶犯瑈瞷禜(physiological overflow)单硉笲笆蔼硉┮眔糤ョ锣簿硉糤眏7.硉眯癡絤(velocity spectrum training)ぃ硉皌ㄓ暗癡絤璸礶糤贺硉才ら盽ネ┦惠―8.芠┦癹鮔9.笲笆端甡箇ňの笲笆匡も縵匡
せBMCA (Brain Motor Control Analysis) 笲笆北蝶︳
ㄓ笲笆赤ア┪毁锚確胺洛厩烩办い羬獀励祇甶常玗ㄇ肚参┦獀励мォの纕┦惫琁笲笆ぃ镑瞶稱ㄤい闽笲笆北╯㎝蝶︳玥琌ヘ玡伐荐Τ辨瘆瞺繴厩砰笲笆北埃い枷癘拘㏄娩笲笆稰谋璶ㄓ癌纅ψ濒(muscle spindle)㎝蔼膀竫竟﹛(Golgi tendon
organ)ㄓ稰笲笆┮惠硂贺稰谋ノ秸竊秈︽い笲笆まΩヴ叭磅︽┮笲笆北琌ノい枷玡竚璸购е硉耞㎝秸俱莱ノ㏄娩稰谋癹鮔非絋タ㎝磅︽τ程笲笆мォ矗狜玥璶綼ぃ耞竒喷㎝厩策
羬璶┦
笲笆北蝶︳羬璶┦疭い枷竒穕端確胺獀励パい枷竒穕端繷场端い┪盆穕端单硑Θ逞摧緇笲笆北璓ㄏ玻ネぃ▆墩㎝笆礚猭Τ北祇甶ぃ▆北家Α秈τ紇臫笲笆箇┮Ν戳秈︽福笲笆北蝶︳(brain motor control assessment, BMCA)皐癸ㄤ笲笆瞷翴览タ絋獀励よ竒パ瞶㎝戮獀励痜Ν戳ミ穝Τ笲笆北玻ネ穝タ絋墩㎝笆舱筀ゎぃ▆北家Α㎝墩笆舱
.Cardi-O2 Exercise Testみ笲笆代刚
笲笆膀セㄣ琌ψ砰の笲笆瞷琌瞏紇臫ㄤい珹秖块瞯(珹Τ㎝礚秖)闽竊笆琗硁竒ψ秸мォ籔み瞶单紇臫砰竒筁笲笆癡絤玻ネ┦の篊┦ネ瞶跑て玡琌笲笆讽いの笲笆ō砰┮玻ネ贺贺钵ヰ篈ネ瞶瞷禜琌ō砰竒筁琿丁は滦笲笆縀┮玻ネネ瞶跑て笲笆獀励確胺獀励癡絤い璶吏ゲ斗罙秆み癌纅ψ单疭┦芠の厩て祸竟ㄓ代﹚ㄤ程絛瞅矗ㄑ痜眞タ絋砰癡絤よ猭の璶烩ㄏ祇揣笲笆獀励程箇戳狦
み代刚よ猭
代刚程尼秖祸竟贺摸珹秸俱硉の℡糹盿Α禲˙诀秸俱Α玡近璽颤竲今óも穘óの竲穘ó㊣砰Μ栋杆竚贺摸よ珹砰Μ栋砋旧恨の栋竛盢Μ栋て阂の緻竒筁夹非そΑ传衡Θ砰砰縩τ代眔笲笆尼秖確胺痜眞福い盆穕端篒单痜眞ㄤ砰笆毁锚┪摧礚猭ノ禲˙诀代刚ㄣ珿福い痜眞ㄏノ竲今ó┪竲穘ó代刚ㄣパ贺笲笆熬ψ笆τψ笆秖ぶ代眔程尼秖ゑㄏノ禲˙诀キАぶ5%オ代刚玡絋玂痜眞の舦痲ゲ斗琵痜眞秆代刚ヘの繧┦
羬莱ノ:
1.福﹀恨痜跑沮参璸福い痜眞い60%ㄖΤみ纽﹀恨痚痜硂ㄇ痜眞逼笲笆獀励璸购ぇゲ斗みτ砰笆毁锚礿潘捌れㄏノ单ㄏ痜眞˙︽┮ㄏノΘセ(oxygen cost)眖0.15糤0.54ml/kg-mオ続讽笲笆癡絤э到み猵﹀溃北单
2.籔˙篈闽玒Θ滴続キ铆薄猵タ盽˙︽硉–だ牧70~80そへ秖–そょ砰惠12睝どパ確胺い篒痜眞盆穕端福┦陈肤ㄠ担ㄤ砰摧礚┪北ぃ▆珿ㄤ˙︽螟糤癸τē硑Θ˙︽硉搭絯の秖糤確胺˙︽癡絤莱眖э跑钵盽˙篈┪糤の秸甄ぶ˙︽い秖穕
3.笲笆洛厩烩办い程尼秖籔琘ㄇ笲笆兜ヘい禯瞒辽禲村猘单笲笆Θ罿瞷Τ盞ち闽玒癸硂贺惠璶尿┦方ㄑ莱笲笆兜ヘ程尼秖禫蔼笲笆ㄤ瞷莱纔钵
確胺
CEREBROVASCUAR ACCIDENT
1. Definition:
a sudden neurological deficit characterized by loss of motor control, altered sensation, cognitive or language impairment, and disequilibrium or coma, caused by nontraumatic brain injury resulting from occlusion or rupture of cerebral blood vessels
2. Classification:
1). Hemorrhagic:
(1) .ICH (Intracerebral Hemorrhage): HTN, tumor, AVM
(2) .SAH (Subarachnoid Hemorrhage): AVM or aneurysm rupture
2). Ischemic:
(1).Thrombosis: atherosclerotic cerebrovascular disease at major vascular branching site, often associated with HTN
(2).Embolism: mostly from cardiac origin(e.g.atrial fibrillation)
(3).Others: cerebral vasculitis or cerebral hypoperfusion eg. SLE
3. Risk factor
--Major risk factors
|
Age Hypertension Cardiac disease Diabetes Previous stroke or transient ischemic
attack |
4.Stroke-related impairment
1). Motor control and strength
2). Motor coordination and balance
3). Sensation
4). Language and communication
5). Apraxia
6). Neglect syndrome
7). Dysphagia
8). Uninhibited bladder and bowel
5.Brunnstromˇs staging
--for evaluation of the motor condition of brain lesion
Stage I : Flaccid
Stage II : Associated reaction
Spasticity(+)
DTR(+)
Stage III: Start of voluntary movement with synergy
Spasticity(+)
DTR increase
Stage IV: Voluntary movement with break of synergy
Spasticity(+)
DTR increase
Stage V : Voluntary movement with less synergy than stage IV
Spasticity decrease
DTR may return to normal or remain increased
Fine movement(+)
Stage VI: Nearly normal
No spasticity
6. Ashworth
Scale
0=normal tome
1=slight hypertonus, a ¨catch〃 when limb is
moved
2=miod hypertonus, limb moves easily
3=moderate hypertonus, passive limb movement
difficult
4=severe hypertonus, limb rigid
Functional condition:
1. sitting
balance: good; fair; poor
2. standing
balance: good; fair; poor
3. walking
balance: crutch; walker; cane; stick; etc.
4. ADL
(activity of daily living):
Independent; partial dependent; partial independent; dependent
TRAUMATIC BRAIN
INJURY
1. Definition:
all injuries to the brain caused by trauma
2.Subtypes
of brain injury
1) .Traumatic
brain injury
(1)
.Closed head injury: dura remained intact
(2)
.Open head injury: dura was opened
(3)
.Penetrating head injury: a foreign object
penetrated the dura and entered the brain
2) .Nontraumatic
brain injury
(1)
.Stroke
(2)
.Anoxic brain injury(hypoxic encephalopathy)
(3)
.Toxic brain injury and metabolic brain injury
3. Assessment
1) .Glasgow
coma scale (GCS)
|
Patientˇs
Response |
Score |
|
Eye
opening Eyes open spontaneously Eyes open when spoken to Eyes open to painful stimulation Eyes do not open Motor Follows commands Makes localizing movement to pain Makes withdrawal movements to pain Flexor(decorticate)posturing to pain Extensor(decerebrate)posturing to pain No motor response to pain Verbal Oriented to place and data Converses but is disoriented Utters inappropriate words, not
conversing Makes incomprehensible nonverbal
sounds Not vocalizing |
4 3 2 1 6 5 4 3 2 1 5 4 3 2 1 |
2). Severity of TBI
|
Mild Moderate Severe |
GCS
score of 13-15 at lowest point after resuscitation Additional criteria: 1. Loss
of consciousness<20min 2. No
TBI-related abnormalities on neurological exam. and normal CT scan of the brain (if positive,
classify patient as moderate TBI or mild TBI with
complications) GCS
score of 9-12 at lowest point after resuscitation GCS
score of 3-8 at lowest point after resuscitation |
3) .
Rancho Los Amigos medical center levels of cognitive functioning
|
Level |
Name |
Description |
|
I II III IV V VI VII VIII |
No
response Generalized
response Localized
response Confused-agitated Confused-inappropriate Confused-appropriate Automatic-appropriate Purposeful-appropriate |
Appears
to be in deep sleep; no response to any stimulation Appears
to be resting quietly; makes gross movement in response to noxious stimulation Makes
spontaneous, purposeful movement; may follow commands inconsistently Confused,
amnestic and inattentive; may be aggressive Not
agitated, confused and amnestic Lacks
initiative and problem solving; functional with structure and supervision Follows
daily routines; needs supervision for home and community skills; independent in self-care within physical ability Independent
in home and community skills; may have cognitive deficits |
SPINAL CORD INJURY
1. Neurological level of SCI
1) .Motor level:ō砰オㄢ凹ㄣΤタ盽笲笆诀ぇ程盆场沮
10兵闽龄(Key muscles)ぇτ﹚
a. Key muscles
C5 Elbow flexors
C6 Wrist extensors
C7 Elbow extensors
C8 Finger flexors
T1 Finger abductors
L2 Hip flexors
L3 Knee extensors
L4 Ankle dorsiflexors
L5 Long toe extensors
S1 Ankle plantar flexors
b. Muscle power
0=total paralysis
1=palpable or visible contraction
2=active movement, gravity eliminated
3=active movement, against gravity
4=active movement, against some resistance
5=active movement, against full resistance
c. Motor levelぇ∕﹚赣场闽龄ぇgrade 3grade 3竊闽龄ぇゲ斗琌grade 4
2) .Sensory level:オㄢ凹28 dermatomeぇkey sensory point
a. 代pin-prick籔light-touch sensation
b. 0=absent
1=impaired
2=normal
c. Sensory levelぇ∕﹚:ō砰オㄢ凹ㄣΤタ盽稰谋诀ぇ程盆场
ASIA
Impairment Scale
A= Complete: No motor or sensory function is preserved in the sacral segments S4-S5
B= Incomplete: Sensory but not motor functions preserved below the neurological level and extends through the sacral segments S4-S5
C= Incomplete: Motor function is preserved below the neurological level, and the majority of key muscles below the neurological level have a muscle grade less than 3
D= Incomplete: Motor function is preserved below the neurological level, and the majority of key muscles below the neurological level have a muscle grade greater than or equal to 3
E= Normal: Motor and sensory function is normal
Frankel classification
A= motor and sensory function complete without any movement or sensation below the lesion
B= motor complete with some sensory sparing
C= motor and sensory incomplete without functional motor recovery
D= functionally useful movement below the lesion
E= motor and sensory recovery to normal function but residual clinical evidence of SCI may still be present
AMPUTEE
1.
Incidence: L/E>U/E(3:1)
L/E:
BK>AK
2.
Indication of amputation
1).PVD(peripheral vascular
disease)- mostly
2).trauma
3).infection
4).malignancy
5).nerve injury
6).congenital deformity
7).non-union of fracture
3.
Level of amputation
1).stump as longer as possible, but residual limb must be functional
2).Doppler pressure measurement
--ischemic index>0.45
4.
U/E prosthesis
1).Body powered prosthesis
2).External powered prosthesis
5.
L/E prosthesis
1).Foot
--SACH
foot(solid ankle cushing heel)
--Single axis
footàmulti-axis
foot
--Energy-storing
foot : Seatle foot, Carbon copy II, Quantum foot, Flex foot
2).Socket
--Plug-in socket
--Quadrilateral
socket
--CAT-CAM(contoured adducted trochanteric- controlled alignment
method)
3).CAD-ACM(computer aided
design-computer aided manufacturing)
Rehabilitation
of amputee
New surgical
techniques, improvement in pre-op, post-op care, advance in prosthetic
technology, better understand of psychosocial implication of limbs loss.
Prothesis must
assure comfortable, cosmetic, functional goal.
Etiology: U/E:
trauma, disease.
L/E:
disease, trauma.
Tumor, DM, peripheral vascular disease.
Amputation surgery:
To provide best
potential for rehab & prosthetic restoration, plastic & reconstructive
procedure, beveling the ends, sharp transection of nerve, appropriate
myofascial closure of muscle, myodesis, skin incision avoid bony prominences.
Level
selection: good healing, adequate full-thickness skin cover, vascular perfusion
(Doppler analysis, Xenon washout study).
Low extremity
1.
Toe
amputations
2.
Ray
resections.
3.
Transmetatarsal
amputations.
4.
Syme
amputation. (disarticulation of the foot)
5.
B-K
amputation
6.
Knee
disarticulation.
7.
A-K
amputation.
8.
Hip
disarticulation.
9.
Hemipelvectomy.
Upper extremity
1.