神经疾病的作业治疗
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神经疾病的作业治疗. 李国辉 香港作业治疗师协会 香港理工大学 昆明医学院外聘教师. Rehabilitation. Definition WHO in 1986

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神经疾病的作业治疗

李国辉

香港作业治疗师协会

香港理工大学

昆明医学院外聘教师


Rehabilitation
Rehabilitation

  • Definition

  • WHO in 1986

    • Rehabilitation implies the restoration of patients to the highest level of physical, psychological and social adaptation attainable. It includes all measures aimed at reducing the impact of disabling and handicapping conditions and a enabling disables people to achieve optimum social integration


Physical rehabilitation
Physical Rehabilitation

  • Aim

    • restore the patients function by all measures and to reduce the impact of physical diseases


What guide the physical treatment
What guide the physical treatment?

  • How to provide treatments in physical rehabilitation?

  • Anything guided the treatment provided to patient?

  • Model & Frame of reference


Model
Model

  • is characterizes by a description of the profession’s philosophical assumptions, ethical code, theoretical foundation, domain of concern, legitimate tools, and the nature of and principles for sequencing the various aspects of practice (Mosey, 1981)


Frame of reference
Frame of reference

  • principles behind practice with specified patient or client populations. It includes a description of the population to be served, guidelines for determining adequate function or dysfunction, and principle of remediation (Bruce & Borg, 1993)


Model frame of reference and approaches

A profession model

e.g. Medical model, Model of Occupational Performance, etc

Frame of Reference

e.g. Behavior frame of reference, Cognitive-behavioral frame of reference, Biomechanical frame of reference, etc.

Approaches

e.g. Biomechanical approach,

Rood approach, NDT approach, etc.

Model, Frame of reference and Approaches


Model of occupational performance
Model of Occupational Performance

Work

Performance Component

Sensori-motor

Community independent, fulfill roles in community

Cognitive

Self- Care

Leisure

Psychosocial

Environment


Treatment process
Treatment Process

  • Treatment provided to patients depends on:

    • What problems did the patients suffer?

    • What assets did patient have?

To obtain the answers, we need to conduct assessments


Treatment process1
Treatment Process

Assessment

Problem Identification

Goals Setting

Evaluation

Treatment Intervention


Treatment continuum
Treatment Continuum

ADL

Work

Leisure activities

Sensorimotor

Cognitive function

Psychosocial component

Occupational Performance

Purposeful Activities

Enabling Activities

Adjunctive methods


Assessments
Assessments

  • Mental State,

    • Alertness, Orientation, follow instruction,etc.

  • Motor

    • AROM, PROM, MMT, Muscle tone, coordination,etc.

  • Vestibular

    • Sitting / Standing balance (Static / Dynamic)

  • Sensory

    • Sensation, proprioception, kinesthesia, stereognosis

  • ADL function


Treatment approaches
Treatment Approaches

  • Biomechanical approach

  • Sensory-motor approach

  • Rehabilitative approach


Biomechanical approach
Biomechanical Approach

  • Basic assumption

    • CNS intact

  • Based on the mechanical principle

  • Dealing with the force and movement acting on body

  • Knowledge of Anatomy

    • Bone structure

    • Muscle groups’ function, e.g. origin and exertion

  • Applied for most orthopedic cases


Sensory motor approach
Sensory – Motor Approach

  • Basic assumption

    • CNS deficit

  • Based on the theory of motor recovery and neurophysiology

  • Various approaches developed

    • Rood approach

    • Brunnstom movement therapy

    • Proprioceptive neuromuscular facilitation (PNF)

    • Bobath (neurodevelopmental technique, NDT)


Rood approach principle of treatment rood 1956
Rood Approach – Principle of treatment (Rood, 1956)

  • Tone normalization

  • Tonic neck and labyrinthine reflex


Rood approach principle of treatment
Rood Approach – Principle of treatment

  • Ontogenetic motor pattern

    • Supine withdrawal (Supine Flexion)

    • Rollover (Side lying)

    • Pivot Prone (Prone extension)

    • Neck co-contraction (Co-innervations)

    • On elbow (Prone on elbow)

    • All Fours (Prone on 4 limbs)

    • Static Standing


Rood approach special techniques used in treatment
Rood Approach – Special Techniques used in treatment

  • Light moving touch

  • Important for normal growth

    • Send input to limbic structure and increase the corticosteroid, which increase resistance against disease, tissue repair and fluid and electrolyte balance


Rood approach special techniques used in treatment1
Rood Approach – Special Techniques used in treatment

  • Fast Brushing

    • Stimulate C fibers, send collaterals to the reticular activating system

    • Increase fusimotor activities

    • Applied over dermatomes

    • Effect last for 30 minutes

    • Contraindication – do not applied outer ring of trigeminal nerve (C2 dermatomes begin)

    • Not applied for cervical spinal cord and brain stem injuries, as autonomic dysreflexia and possible induce deep state of unconsciousness


Rood approach special techniques used in treatment2
Rood Approach – Special Techniques used in treatment

  • Icing

    • A icing (Fast Icing) – stimulate A fibers causing reflex withdraw response in superficial muscle.

    • C icing – Stimulate non specific C fibers that maintain postural response

    • Applied according to dermatomes

    • Contraindications – Avoided for patient with hx of cardiovascular problems.

    • Do not applied over the neck, otherwise will cause sudden low BP


Brunnstom movement therapy
Brunnstom movement therapy

  • By Signe Brunnstrom in 1970

  • Described stages of motor recovery

    • Flaccidity

    • Begin develop of spasticity

    • Spasticity increase, synergy pattern

    • Spasticity decrease, movement deviated from synergy pattern

    • Synergy no longer dominant

    • Spasticity absent except rapid movement, isolated joint movement


Proprioceptive neuromuscular facilitation pnf
Proprioceptive neuromuscular facilitation (PNF)

  • All Human beings have potentials that are not fully developed

  • Normal motor development proceeds in a cervico-caudal and proximal –distal direction

  • Early motor behavior is dominated by reflex activity. Mature motor behavior is reinforced or supported by postural reflex

  • The growth of motor behavior has cyclic trends as evidenced by shifts between flexor and extensor


Proprioceptive neuromuscular facilitation pnf1
Proprioceptive neuromuscular facilitation (PNF)

  • Goal-directed activity is made up of reversing movement

  • Normal movement and postural depend on synergism and a balance interaction of antagonists

  • Develop motor behavior is expressed in orderly sequence of total pattern of movement and postural

  • Normal of motor development has an orderly sequence but lacks a step by step quality


Proprioceptive neuromuscular facilitation pnf2
Proprioceptive neuromuscular facilitation (PNF)

  • Improvement of motor ability depends on motor learning

  • Frequency of stimulation and repetition of activity are used for promotion and retention of motor learning and for development of strength and endurance

  • Goal-directed activities, coupled with facilitation are used to hasten learning of total pattern of walking and self-care




Bobath neurodevelopmental technique ndt
Bobath (neurodevelopmental technique, NDT)

  • Developed by Bobath in 1940

    • Encourage normal movement and proper position

    • Treatments techniques included:

    • Weight-bearing

    • Trunk rotation

    • Scapular protraction

    • Pelvis forward


Rehabilitative approach
Rehabilitative Approach

  • Also know as compensation approach

  • Fully use of patient’s assets

  • By providing of aids to enhance function

  • Adaptation of environments


Treatment skills
Treatment skills

  • Remedial and Functional activities

  • Physical agent

  • Splinting and pressure garment

  • Aids and Environment adaptation


Remedial activities
Remedial Activities

  • Exercise – repetition of an action

  • Remedial Activity – Goal directed activities

  • Functional Activity – Activities that is goal directed and the goal is purposeful and meaningful to the patient




Functional activities
FunctionalActivities


Physical agent
Physical Agent

  • Thermo – therapy

  • Cryotherapy

  • Hydrotherapy

  • Ultrasound

  • Electrotherapy

  • LASER therapy




Environment modification
EnvironmentModification





~END~

Thank You


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