创伤性脊髓损伤物理治疗ppt课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,*,Traumatic Spinal Cord Injury (SCI),Majority of traumatic SCI occurs in young adult males,Traumatic spinal cord injury is a non-progressive pathology,Motor and sensory function on both right and left sides is determined by the level of injury,A patient with C6 level injury has intact motor and sensory function 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,1,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,2,Traumatic 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 E,A,is complete spinal cord injury with no motor or sensory function below the level,E,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,3,ASIA 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,4,Traumatic Spinal Cord Injury,Definitions,Paraplegia is defined as an impairment or loss of motor and/or sensory function of all or part of the trunk and both lower extremities,Tetraplegia 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,5,Spinal Cord Anatomy,Spine has 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal spinal nerves (levels),Spinal cord ends around L1 vertebral level,The,cervical spinal levels,control sensory and motor function of 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 extremities,The,sacral spinal levels,control the sensory function of the back of,lower extremity and buttocks, bowel and bladder control, and sexual function,MODULE 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,6,Symptoms of Spinal Cord Injury,Motor impairment,Paralysis or weakness 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,7,Dermatomes,MODULE C4/CSDLM/2013/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,8,Symptoms of Spinal Cord Injury,Autonomic dysreflexia,Often occurs in patients with,high level spinal cord injury,(lesion level above T5),Caused by,distended bladder, distended rectum, blocked catheter, or other stimuli about the sacral innervated area,Patient 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 emergency,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,Piloerection or goosebumps on a human arm,en.wikipedia.org/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,9,Symptoms of Spinal Cord Injury,Autonomic dysreflexia is managed in the following way,Dont let the patient lie down,Position the patient in sitting,Check the catheter or tube for blockage,Check the feet positions for twisted ankles or pinched toes,Empty leg bag for urine if it is full,Obtain immediate medical help,MODULE 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脊髓损伤物理治疗,10,Symptoms of Spinal Cord Injury,Spasticity,Most common in patients with cervical and thoracic level injuries,Occurs below the level of lesion after the spinal shock period,Poor venous return,below the level of lesion that may result in,orthostatic hypotension,Bradycardia,Impaired body temperature control,Unable to regulate body temperature in response to environmental changes (stay under sun),Impaired ability to sweat below the level of lesion,Impaired respiratory function,Decreased tidal volume and vital capacity,Impaired cough,MODULE C4/CSDLM/2013/NR Traumatic Spinal 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,11,Symptoms of Spinal Cord Injury,Bladder and bowel dysfunction for those patients with S2-4 involvement,If not managed properly, patient will have urinary tract infections and ultimately kidney failure,Must drink sufficient fluid and eat a high fiber diet,Most 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 dysfunction,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,颈侥椒汐停萎弗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,12,Symptoms of Spinal Cord Injury,Secondary complications,Pressure sores,Deep vein thrombosis,Pain,Contracture,Heterotopic ossification,Osteoporosis,MODULE 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帮惹创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗,13,Prognosis,After stabilizing the spinal (vertebral column) injury, the patient should begin a comprehensive rehabilitation program,Life expectancy is related to the severity of impairment,Individuals with spinal cord injury classified between the *ASIA A to C levels and those with tetraplegia have shorter life expectancies,Ref: American Spinal Cord Injury Association (ASIA) Classification,asia-spinalinjury.org/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损伤物理治疗,14,MODULE 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,15,Medical Management,Emergency care,Keep the neck and trunk stabilized (use a cervical collar and back board) during transportation,Surgery to stabilize fracture,Often involves immobilization after the surgery (Halo device for cervical spine and body cast/jacket for thoracic or lumbar spine),Drugs,To manage spasticity and pain,To manage infections,MODULE 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对他创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗,16,Physical Therapists Concerns,Patients with traumatic spinal cord injury often develop,pneumonia,urinary tract infection, and pressure sores,Physical therapists must teach patients,Ways to achieve a productive cough,Proper bladder management program,Daily 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,17,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,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 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,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,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,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,容易产生压疮部位,MODULE C4/CSDLM/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,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:,rehabmeasures.org/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,MODULE C4/CSDLM/2013/NR Traumatic 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,28,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,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,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,Assisted Cough,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,厅岗曹句扰埂阅酪另芭吧杀锰已铁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,33,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,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,侧倾,Side Lean,撑起,Push Up,前倾,Forward Lean,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord 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,Skin Care,If the patient develops an ulcer, the patient should be referred to a wound care specialist to facilitate healing and to prevent infection,Patient should not put pressure on the ulcer until it is healed - for example, a patient with a right greater trochanter ulcer cannot lie on the right side until the wound is healed,MODULE 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,37,Early Strengthening and Range of Motion Exercises,Strengthen all innervated muscles,Watch for substitution,For example, patient may use shoulder external rotators to substitute for elbow extensors,Do not stretch,Finger flexors to protect tenodesis,Lower trunk muscles so that patient can lean on ligaments for sitting,Stretch,Hamstrings - to assure a straight leg raise to 100 degrees,Hip flexors to assure patient has 10 degrees of hip extension,Ankle plantar flexors to assure patient has 10 degrees of dorsiflexion,MODULE 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,38,Sitting,Patient usually experiences postural hypotension in sitting or standing,Initially, bring the patient to sitting slowly,Use an abdominal binder and elastic (pressure) stockings to assist venous return,Gradually elevate the head and upper trunk in bed,May also use a tilt-in-place wheelchair with elevating leg rests or a tilt table,Biomechanical principles for mat activities,Head-hips relationship,Unweight the body part first before moving it,Use 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,39,Sitting,Be aware that the patient is using very small muscles (in upper extremities) to move a heavy load (the whole body),Protect patient,s shoulders and wrists from Day 1 of physical therapy - patients with chronic spinal cord injury often experience shoulder problems,For scooting sideways or up and 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 activities,Patient need to learn the new center of mass for functional movements,MODULE C4/CSDLM/2013/NR Traumatic Spinal 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,40,Sitting,After the patient can tolerate sitting in the upright position, the patient can begin mat activities that may include,Rolling from supine to prone,Prone position,Prone on elbows,Prone to supine,Supine to long sitting,Scooting side to side in long sitting,Scooting up and down in long sitting,MODULE 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,41,Long sitting, lean on upper extremities, shoulders in extension and 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,42,Moving sideways in long sitting,MODULE 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物理治疗创伤性脊髓损伤物理治疗,43,Sitting Balance Training,Patient learns to use trunk ligaments,Patient in long sitting on mat,Lift one arm first,Lift both arms,Catch a ball with both arms,Patient sits on a bench with feet flat on the floor and then,Lift one arm,Lift both arms,Try to catch a ball,MODULE 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,44,Transfer Mat to Wheelchair,Tetraplegia,Usually needs a sliding board,Paraplegia,Often may do without a sliding board,Park wheelchair at 45 degree angle to the mat and lock the wheels,Remove arm rest and leg rest next to mat,Use momentum to assist transfer,Push down on supporting surface with both arms and at the same time twist head and trunk away from wheelchair,Patient with lower extremity spasticity can bear weight on legs to ease weight on upper extremities,MODULE 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,45,Patient with paraplegia transferring from mat to wheelchair at the same height,MODULE 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损伤物理治疗创伤性脊髓损伤物理治疗,46,Patient 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,47,Patient assisted sliding board transfer: #1 - therapist assists the patient; #2 - patient place left hand on sliding board,MODULE 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,48,Standing,Standing program is good for the skeletal system and the cardiovascular system,Check patient,s blood pressure in sitting first,Patient may need abdominal binder and elastic stockings,Start in parallel bars,Patient may need lower extremity orthotics and/or spinal orthotic,Patient first presses down on parallel bars, lifts one arm, and then lifts both arms,MODULE C4/CSDLM/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,49,Walking,Must determine if walking is a reasonable goal,For patients with a spinal cord injury, walking consumes a tremendous amount of energy,Patients have strong upper extremity muscles, no contractures, and strong motivation are candidates for walking training,Most patients are not going to be community ambulators,Potential gait patterns,Swing to,Swing through,Four point,Two point,MODULE 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损伤物理治疗,50,Walking,Patients 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 gait,Patients 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 training,Ref:,U,ustal H. and Baerga E Orthotics in,Physical Medicine and Rehabilitation Board Review,Cuccurullo S, Editor. New York:,Demos Medical Publishing,; 2004,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,航狈壬掩蘸美军靶俞剔疚饰吮术胆檬楚瑶础闲火叫台而怠沫顶议烧攀硒灭创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗,51,Wheelchair,Patients with a high cervical level injury may have difficulty sitting upright, due to postural hypotension, and will need a wheelchair with a reclining backrest,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,悉好耽荔拥狙动污扮维坡护揣驹铝吐疚提鸯汐溶国肆任削立堵蝗蔚恭蜀涝创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗,52,Wheelchair,Wheelchair should be fitted for each patient. It is not one size fits all patients.,Patient should have a proper cushion providing sufficient pressure relief to ischial tuberosities.,For patients who manually propel wheelchairs, lightweight and durability are two main considerations.,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,隆多哩铣洲镍蠢鹃硫斡藻贰附在棋羚贯绵幅蹭捣惭蚜忌彝褥打涉携颅侗傻创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗,53,Wheelchair Propulsion Techniques,Use a semicircular pattern,Let the hand fall below the push rim during recovery,Take a long, smooth propulsive stroke that the patient grasps and pushes as much of the push rim as possible,Minimize the cadence and peak forces applied - slow, long pushes,Manual wheelchair users often develop shoulder and wrist problems due to repetitive use,Prevent these injuries by teaching the patient correct and biomechanically efficient propulsion techniques,Reduce shoulder forces and moments during propulsion (protect shoulders),Use of all upper extremity muscles for propulsion (shoulder, elbow, wrist, and fingers),MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,搁淌亦窍肖类枢恶跋桐摧陕辩窑瞒弃秋鸡神撇蝇爪蔓伯鬃颠猎粗盗阔杏濒创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗,54,Semi-circular method of propulsion,MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury,滤筹粳府哉俘勺缨算柴硝膜体栈绿韭唱洽臃务傀腕经赵驴莲帽粗栅摧辐怂创伤性脊髓损伤物理治疗创伤性脊髓损伤物理治疗,55,