康复评定-英语-留学生课程课件

REHABILITATION

ASSESSMENTPingMiao,MDDepartmentofRehabilitationmedicineThesecondaffiliatedhospitalofGuangzhouMedicalUniversityContentsIntroductionMeasuresofimpairment(muscle,joint,cognitive...)Measuresofdisability(activityofdailylife...)MeasuresofhandicapTofindtheproblemsWhatkindofdysfunctioncongenital：heartproblems，etc.postnatal：CP，stroke，SCI,TBI,etcsecodary：contracturefollowingfracture，muscleatrophyafterperipheralnerveinjury,andsoonHowmanydysfunctionsPhysically,speech,psychological,socialaspectHowseverityofdysfunctionsOnpatientandhis/herfamilyTosettreatmentgoalsshort-termgoalsCanbetouchedbyeffortswithinafewdaysorweekslong-termgoalsCanbeachievedforlongtime(terminal)Fromshort-termgoalstolong-termoneMustconsiderthefactorsage、profession、culturalbackgroud、familyconditionsAssesstreatmenteffectsIsourtreatmentplaneffective?Yes/NoShouldthetreatmentplanbecontiniunedorshouldbeadjustedaccordingtomeasurementsYes/No

Physicalexaminationandrehabilitationmeasurementhavesomethingincommonbutnotthesame.PurposeTimesWaysIntroductionPhysicalExaminationRehabilitationmeasurementOperatorDoctorPhysiotherapistPurposeCheckforpossiblediseasesandidentifyanyissuesthatmaybecomemedicalconcernsinthefutureDysfunctionidentifiedandmakeafurthertreatmentscheduleItemsI.ObservationII.PalpationIII.PercussionIV.AuscultationI.PhysiologicalmovementII.MuscletestsIII.NeurologicaltestsIV.AccessorymovementV.MusculartensiontestsetcRecordMedicalrecordTreatmentrecordandastandardevaluationforassessmentandreassessmentRangesWidely(Ex:Bloodpressuremeasurement,Bloodvesselinspection,Reflectionmeasurement)ProfessionalTests(Ex:Physiologicalmovement,Muscletests,Accessorymovement)ObjectivesofMeasurementTofindproblemsTosettreatmentgoalsToplantreatmentschedulesToassesstheeffectivenessTopredictoutcomesToanalyzethecost-effecitveReasonsforassessingLevelsshouldbemeasuredimpairmentdisabilityhandicapDevelopmentofICIDH

InternationalClassificationofImpairments,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

clinicalfeaturesLevelsApplicationofICIDHDifferentcousesAmputeeinthelowerlimbCan`twalkCan`tgotoschool/workimpairmentdisabilityhandicapOrgansADLSocialactivityAtthelevelofApplicationofICIDHStroke/TBIHemiplagiaCan`tlookafterHim-/her-selfCan`twork/Jointhesociallife

impairmentdisabilityhandicaporgansADLSociallifeAtthelevelofIntroductionPurposePlanatreatmentprogramandestablishoutcomesEvaluateresultsoftreatmentprogramModifytreatmentprogramIntroductionGoodassessmentisdependentupon:KnowledgeoffunctionalanatomyHistoryCompleteexaminationClinicalEvaluationSequenceHistoryInspectionPalpationFunctionalTestingNeurologicalTestingcategoryofmeasurmentRatioScalesInervalScalesOrdinalScalesNorminalScalesRatioScalesFeaturesHasazeropointthatreprestnsthecompletabsenceofthequatityrepresented.TheintervalsamongallsuccessiveunitsonthescalemustbeequalinsizeCan`thaveaminusornegativevalue.%isaformofratioExamplesROMLimblengthTimetocompletanactivityVitalcapacityNerveconductionvelocityInervalScalesFeaturesLackofazeropointTheunitmustbeequalsizeExamplesBodytemperatureFunctinalscalesPsychologicaltestsOrdinalScalesFeaturesMayhaveonly2categoriesPresent/absentDependent/independentExamplesMMTADLFugle-Meyer`sscaleNorminalScalesFeaturesTheunitsarecategorywithoutindicatingtheorderorrankofthedifferencesMaybelabeledwithnumberals,letters,orwords,butthelablesdonotidicateorderorrankExamplesClassificationofgenders,diseaseStroke,CerebralpalsyQuantitativeandQualitativeScalesUnitsareassumedtobeofequalsizeAcontinuousscaleEqualsizesubunitsDistance:m,cm,mm,etcExamplesRatioscalesIntervalscalesCategorieshavenosizeCan`tbedivisibleintoequal-sizedsubcategoriesTendonreflexSittingbalanceExamplesNominalscalesvalidsensitivespecificreliable(inter-rater,test-retest)appropriateacceptableProcedureswhentomeasurewhattobemeasuredhowtomeasureWhentomeasureInitialstageMiddlestageTerminalstageAtfollow-upDuringthetreatmentandtraining,evaluationcanberepeatedbyseveraltimes.Itusuallystartfromtheevaluationandendontheevaluation.Initialstage（firstmeasurement)WhenshouldbeconductedBeforephyiotherapyobjectivesFindtheproblemsanditsstatusInvestigatethepotentialofrehabilitationandrelatedfactorsAsevidenceofthetreatmentplanningAsthebaselineofreassessmentMiddlestage(repeatedmeasurements)WhenshouldberepeatedOnceat1-2wksforthosewithquickrecoveryEarlyphaseorinpatientsOnceat3-4wksforthosewithslowrecoveryChronicphaseoroutpatientsobjectivesTofindanyimprovementanditsextendTodecideifanyadjustmentisneededTerminalstage（final）WhenshouldbemeasuredBeforefinishingthephysiotherapyoratdischargeobjectivesToinvestigatetherehabeffectivenessAchivementshasbeenreachedToplandischageprogramContinuinetreatmentReferedtooutpatientorcommunityFollow-upWhenshouldbeVariationamongpatientsanddiseasesEachmonth,2-3monthsor6monthsobjectivesDeterminethefunctionofpatientDecidewhetherpatientneedstofuthertreatmentspecificPhysicalfunctioncognitionlanguageSocialactivitiespsychologyglobalimpairmentdisabilityhandicapWhattobemeasuredPhysicalfunctionMuscletoneROMBalanceMMTWalking???AschworthSpasticityScaleWhatshouldbemeasuredinneurorehabMotorAssessmentScaleBergBalanceScaleCompositeSpasticityScaleTheTimed“Up&Go”testFugle-MeyerMovementAssessmentReachTestBrunnstroumRoveryStagesDatacollectionMedicalhistoryMedicalnotesFindtheproblemsassessmentDecidewhattoandhowtoassessStarttoassessDatarecordingDataanalysisFunctinaldiagnosisSettreatmentgoalsTreatmentplanAssessmentproceduesEvaluation效度信度sensitivetyvalidreliabilityIntra-raterInter-ratercriterion-relatedvalidation

content-relatedvalidationconstruct-relatedvalidationToevaluatethemethodologybeingused

RulesofS.O.A.Parewidelyuseallovertheworld:S(subjectivedata)：maincomplaint

andsymptomofthepatients;O(objectivedata)：objectivesymptomandfunctionalbehaviorofthepatientsA(assessment)：analyzeandclassifytheabove-mentionedmaterials;P(plan)：setatreatmentplan.

Ⅱ.Methodsofevaluation

Ⅱ.MethodsofevaluationSpecificEvaluationSpecificEvaluation-MotorabilityevaluationMusclestrengthRangeofmotionMusculartoneMuscularenduranceGaitanalysisBalanceCoordinationManualmuscletest

(MMT)ManualMuscleTesting(MMT)Definition:subjectivetestingdonebythetherapisttoassessapatientsmusclestrength.Themusclestrengthisgradedtobeeithernormal,good,fair,poor,traceorzero.MuscleGradesNormal:patientholdscontractionagainstmaximalresistanceatendrangeGood:patientholdscontractionagainstmoderateresistanceatendrangeFair:patientmovesthroughfullrangeofmotionagainstgravitybutunabletoholdagainstresistanceatendrangePoor:patientmovesthroughfullrangeofmotioninagravityminimizedpositionTrace:therapistpalpatesmusclecontractionaspatientattemptstomoveZero:therapistisunabletopalpateanymusclecontractionaspatientattemptstomoveMuscleGradesNormal= 5/5Good= 4/5Fair= 3/5Poor = 2/5Trace= 1/5Zero= 0/5ImportantpointsonmanualmuscletestingNeedtoplacepatientinstandardizedpositionIsolateonlyonejointmotionDon’tallowpatienttocompensateforweaknessComparesamemusclebilaterallyBeconsistentandreliablewithtestingManualResistanceStabilizelimbproximallyResistanceprovideddistallyonbonetowhichmuscleattachesWatchforcompensationVIDEODEMOPRACTICEQ&AAttentionduringtheMMT1.Correctposture,limbpositionandnecessarysettlement.2.Makesurethepatientsunderstandtherequestandpurposeofmovement,sothatavoidingthefakemovementorcompensation.3.Whilethemusclestrengthreachthelevel4,resistanceisprovidedtothedistalareaofthelimb.4.KeepavoidingtheMMTafterlongtimeexercisesormeals.5.Thepositionwhichismeasuredshouldbeexposedtothetherapistsordoctors.6.Remembertocomparewiththecontralaterallimb.MuscletestMeasurebyequipments1.GeneralequipmenttestGrippingtestPinchingtestDorsalmuscletestⅡ.MethodsofEvaluation-MuscletestMuscletone

(ModifiedAshworthScale)Rangeofmotion

(ROM)RangeofMotion

(ROM)MeasuringToolsGoniometerInclinometerElectrogoniometerHowtomeasuretheROMofupperlimbs/lowerlimbs/trunk?Ⅱ.MethodsofEvaluation-ROMThreefactors(1)Axis(2)Stationaryarm(3)MovingarmROMMeasurementInformedconsentPositionthepatientPlacejointinzerostartingpositionStabilizeproximalsegmentofthejointMovepatientpassivelythroughavailableROMDetermineend-feelPalpatelandmarksAligngoniometerPassivelyoractivelytakepatientthroughavailableROMCheckalignmentReadgoniometer58Shoulderflexion(180°)Supinewitharmsatsides-liftoverheadStationaryarm-lateralmidlineofthoraxAxis-midpointoflateralaspectofacromionprocessMovingarm:lateralmidlineofthehumerustowardlateralhumeralepicondyleShoulderExtension(60)Pronewitharmsatsides-trytoraisearmStationaryArm:lateralmidlineofthoraxAxis:midpointoflateralaspectofacromionprocessMovingArm:lateralmidlineofhumerustowardlateralhumeralepicondyleShoulderAbductionSupinewithshoulderatsideinanatomicalposition-raisearmoverheadStationaryArm:ParalleltosternumAxis:AnterioraspectofacromionprocessMovingArm:AnteriormidlineofhumerustowardmedialhumeralepicondyleExternal/LateralRotation

Internal/MedialRotationElbowFlexionSupinewithhandsbysideswithtowelunderarm-flexelbowStationaryarm:lateralmidlineofhumerustowardacromionprocessAxis:LateralepicondyleofHumerusMovingArm:LateralmidlineofradiustowardradialstyloidprocessRangeofMotion(ROM)HelpstoassessfunctionalstatusComparebilaterallyTestjointsproximalanddistaltoinjuredareaOnlyperformifdonotsuspectafractureImportantpointsonGoniometricmeasurementMotionsmeasuredcanbeeitheractiveorpassiveStandardizedtechniquesareusedforeachjointJointsshouldbeadequatelystabilizedduringmeasurementPassiveRangeofMotion(PROM)ClinicalDefinition:Therapistmovesselectedjoint(s)throughfullrangeofmotionwithnoassistancefromthepatientActiveRangeofMotion(AROM)ImportantpointsonpassiverangeofmotionAdequatelystabilizepatientsjointsasyoumovethem.(somepatientsmayhavenoactivemovement)Don’tcausepainotherthanstretchingPerform5-10motionsperjointmovementFamiliarizeyourselfwithnormaldirectionsanddegreesofmovementforeachjointListentopatientContraindicationsPatientisunabletovoluntarilycontractinjuredmusclePatientisunabletoperformAROMUnderlyingfracturesiteisnothealedInvolvedtissuesarenotyethealeddirection\jointflexionextensionabductionadductionShoulder0°to180°0°to50°0°to180°90°to0°direction\jointInternalrotationExternalrotationShoulder0°to90°0°to90°Ⅱ.MethodsofEvaluation-ROM

Elbowflexion0°to160°extension145°to0°Forarmpronation(rotationinward)0°to90°supination(rotationoutward)0°to90°Ⅱ.MethodsofEvaluation-ROMWristflexion0°to90°extension0°to70°abduction0°to25°adduction0°to65°Ⅱ.MethodsofEvaluation-ROM

Hipflexion0°to125°extension115°to0°hyperextension(straighteningbeyondnormalrange0°to15°abduction0°to45°adduction45°to0°lateralrotation(rotationawayfromcenterofbody)0°to45°medialrotation(rotationtowardscenterofbody)0°to45°Kneeflexion0°to130°extension120°to0°Ankleplantarflexion(movementdownward)0°to50°dorsiflexion(movementupward)0°to20°Mini-MentalState

Examination

(MMSE)The

mini–mentalstate

examination

(MMSE)

isa30-pointquestionnairethatisusedextensivelyinclinicalandresearchsettingstomeasurecognitiveimpairment.Itiscommonlyusedin

medicine

andalliedhealthtoscreenfor

dementia.ItisalsousedtoestimatetheseverityandprogressionofcognitiveimpairmentandtofollowthecourseofcognitivechangesinanindividualovertimeAdministrationofthetesttakesbetween5–10minutesandexaminesfunctionsincluding

registration,

attentionandcalculation,

recall,

language,abilitytofollowsimplecommands

and

orientation.AdvantagestotheMMSEincluderequiringnospecializedequipmentortrainingforadministration,andhasbothvalidityandreliabilityforthediagnosisandlongitudinalassessmentofAlzheimer'sDisease.ThemostfrequentlynoteddisadvantageoftheMMSErelatestoitslackofsensitivitytomildcognitiveimpairmentAnyscoregreaterthanorequalto27points(outof30)indicatesanormalcognition.Belowthis,scorescanindicatesevere(≤9points),moderate(10–18points)ormild(19–24points)cognitiveimpairment.Therawscoremayalsoneedtobecorrectedforeducationalattainmentandage.Activityofdailylife

(ADL)Bathing:includesgroomingactivitiessuchasshaving,andbrushingteethandhairDressing:choosingappropriategarmentsandbeingabletodressandundress,havingnotroublewithbuttons,zippersorotherfastenersEating:beingabletofeedoneselfTransferring:beingabletowalk,or,ifnotambulatory,beingabletotransferoneselffrombedtowheelchairandbackContinence:beingabletocontrolone’sbowelsandbladder,ormanageone’sincontinenceindependentlyToileting:beingabletousethetoiletModifiedBarthelIndexScore(MBI)TheMBIisameasureofactivitiesofdailyliving,whichshowsthedegreeofindependenceofapatientfromanyassistance.Itcovers10domainsoffunctioning(activities):bowelcontrol,bladdercontrol,aswellashelpwithgrooming,toiletuse,feeding,transfers,walking,dressing,climbingstairs,andbathing.

Totalscoresmayrangefrom0to100,withhigherscoresindicatinggreaterindependence.OthersBalanceDefinition:MaintainingcenterofmasswithinyourbaseofsupportOtherTerminologyusedtodescribebalance:CenterofGravityEquilibriumConeofStability

Ⅱ.MethodofevaluationGaitOthertermsusedtodescribegait:Ambulation/LocomotionControlledmovementofyourbaseofsupport.GaitAssessmentsMeasuresofperception-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