神经康复工作坊幻灯.pptx

1、2014 年鄂港两地神经康复学会年会Neuro-rehabilitation Workshop 神经康复工作坊Approaches in Motor Retraining of Paretic Upper & Lower Limbs of Patient after Stroke 偏瘫手脚运动功能的复康方法10-12 Oct 2014 Wuhan中国湖北武汉,Ester Y L HO 2014,1,Approaches复康方法,Robotic therapy 机器人训练 Brain stimulation脑刺激 Somatosensory stimulation体感刺激 Constraint

2、therapy 限制治疗 Mirror therapy镜子反映治疗 Partial weight support training减负重训练 Virtual reality虚拟现实训练 ,Ester Y L HO 2014,2,2014 年鄂港两地神经康复学会年会 Neuro-rehabilitation Workshop 神经康复工作坊 12 Oct 2014 Wuhan 武汉,Respiratory Care for Stroke Patients胸肺护理与中风,Ester Y L HO 2014,3,Focus of Family家属的疑问,Life & Death 能生存吗? Cons

3、ciousness 能清醒吗? Movement 能活动吗? Temporary or Permanent 何时会恢复? Eating 可以进食吗?,Ester Y L HO 2014,4,Multi-function Involvement多功能受损,Limb mms 四肢肌力 Trunk mms 中心肌力 Sensation 触觉 Perception 感观 Cognition 认知 Speech 语言 Swallowing 吞咽 Respiratory function 胸肺功能,Ester Y L HO 2014,5,Respiratory Care after Stroke胸肺护理与

4、中风,Subtle but significant 易忽略,但重要. Little action but high impact 小行动,大改变.,Early mobilization 尽早活动,Ester Y L HO 2014,6,Risk Factors风险因素,Mortality Risk & Delay Rehab 增加死亡率,阻碍复康进度,Ester Y L HO 2014,7,Breathing Mechanism呼吸机转,Image Source Page: ,Expiration 呼气,Inspiration 吸气,胸廓向下,向内移.,横隔模放松,向上移.,胸廓压力增大,肺空

5、气往外排出.,胸廓向上,向外移.,横隔模收缩,向下移.,胸廓压力减少,空气往肺吸入.,Ester Y L HO 2014,8,Respiratory mm呼吸肌,/chemistry/2086/Chap23/The%20Respiratory%20System%20Part%202.htm,肋骨,胸骨上移,横隔膜收缩,斜角肌,小胸肌,前鋸肌,外肋间肌,内肋间肌,胸锁乳突肌,橫隔膜,腹直肌,内外腹斜肌,腹横肌,吸气,呼气,Ester Y L HO 2014,9,Lung volume肺容量,http:/kspark.kaist.ac.kr/BodyFa

6、t/Body%20Fat%20from%20Underwater%20Weighing.htm,Ester Y L HO 2014,10,Restrictive pattern限制性模式,Pulmonary gas exchange is usually well maintained until mm strength falls to 30%. 当气体传送能力减低,气体透析能力仍足够应付身体所需(特别是在静止休息的时候),Ester Y L HO 2014,11,Atelectasis & Pneumonia肺扩张不全及肺炎,Atelectasis 肺扩张不全 Obstruction of

7、 bronchioles-airless alveoli -reduced lung compliance 肺组织因分秘物堆积,阻塞呼吸道,使肺组织无法完全扩张. s/s dyspnea , tachycardia, cough, fever, decreased chest wall expansion, hypoxemia 表征及症状包括: 气喘,心率加速,咳嗽,发烧,胸肺扩张减少. Aspiration pneumonia 吸入性肺炎 Chemical irritant from aspirate may lead to broncho-constriction 食物错吸入气管内,导致气

8、管收缩及发炎. Bacterial or viral pneumonia 细菌或病毒性肺炎 Rapid onset of inflammation of alveoli, terminal & respiratory bronchioles 下呼吸道受细菌或病毒感染,引致肺泡,末端及呼吸细支气管发炎.,Result: shunting & v/Q mismatch lead to impair gas exchange,Ester Y L HO 2014,12,Clinical Observations临床经验,Decrease thoracic expansion 胸廓扩张减少 Unilat

9、eral involvement 影响偏瘫一方 Upper respiratory tract involvement sometimes due to impaired conscious level 神智清, 上呼吸道受损. Audible breathing 呼吸嘈吵 Ineffective cough 咳嗽失效 Attention to dependent lung area 注意依赖肺部份 Attention to resting & feeding position 注意卧床及进食时姿势 Cough on position changes 体位转变时咳嗽 Increase resp

10、iratory function post-treatment 胸肺护理后,肺功能改善.,Ester Y L HO 2014,13,Respiratory Care胸肺护理,Bronchial hygiene comprises a variety of techniques that promote mobilization & clearance of secretion. 胸肺护理包括各种提升肺活动量及清除痰液的方法. Lung expansion aims to assist patient to attain or maintain optimal lung volumes. 胸肺扩

11、张运动目的:增加肺容量(达致合适的肺容量). Lung volumes are directly related to expiratory flows, cough effectiveness & ability to clear secretion from the airways. 合适的肺容量与呼气速度,咳嗽力度有关,也是能有效地清除痰液的先决条件.,Ester Y L HO 2014,14,Respiratory Care胸肺护理,Positioning 姿位方法 Head-end elevation 避免平卧床上 Turning routine 定时转变姿位 “Dangling”

12、“晃来晃去”方法 Sit out of bed 离床坐 Activities 活动方法 Early mobility exercise 尽早活动 Thoracic expansion w facilitation 胸肺扩张运动Coughing +/- stimulation 咳嗽 Suction 抽痰 Percussion 拍击 Postural drainage 姿位引流,Ester Y L HO 2014,15,Thoracic Expansion胸肺扩张运动,/content/75/4/297.full,.hk/qeh

13、/department/phys/scope.htm,PNF,Ester Y L HO 2014,16,Percussion拍击,http:/printer-,柸形手,Ester Y L HO 2014,17,Postural Drainage姿位引流,http:/web.viu.ca/jung/pictures/respno1.jpg,Ester Y L HO 2014,18,Activities 活動,Immobility associates with decreased lung volume & hence increased pulmonary complications 缺乏活动

14、会引致肺容量减少,增加肺不张及肺炎风险. The most valuable and inexpensive intervention is to turn patients form supine to lateral position every 2 hrs 最有效又便宜的方法是每2小时转动姿位一次,如平卧-左侧卧-右侧卧-坐高等. The sooner a patient gets up & moves around, the faster breathing pattern and lung volume return to normal 病人越早离床走动,肺功能越早回复正常. “st

15、ir-up regimes” “搅动疗程”,Ester Y L HO 2014,19,“Dangling” “晃來晃去”,Ester Y L HO 2014,20,适合一般中风患者运动练习,Ester Y L HO 2014,21,仰卧 运动练习(1),仰卧, 双膝屈曲 提起臀部, 停留五秒, 然后慢慢返回原位。,Ester Y L HO 2014,22,仰卧,双膝屈曲并紧贴 双膝向左右两旁摆动,仰臥 运动练习(2),Ester Y L HO 2014,23,仰卧,双膝屈曲并紧贴, 分开双膝,停留五秒,然后慢慢返回原位。,仰臥 运动练习(3),Ester Y L HO 2014,24,坐着 运动练习(1),坐着,双脚平放在地上,腰伸直,双手紧扣,