肌肉骨骼物理治疗评定的原则VIP免费

PeripheralJoints–subjectiveexamination肌肉骨骼物理治疗评定的原则肌肉骨骼物理治疗评定的原则PrinciplesofMusculoskeletalPhysiotherapyAssessmentPrinciplesofMusculoskeletalPhysiotherapyAssessment第一部分:主观检查和客观检查PartI:Subjective&ObjectiveExaminationDr.GraceSzetoContributionsbyDrEllaYeungDepartmentofRehabilitationSciencesTheHongKongPolytechnicUniversityKunming,July2009PeripheralJoints–subjectiveexamination完整的肌肉骨骼评定完整的肌肉骨骼评定TotalmusculoskeletalassessmentTotalmusculoskeletalassessment•病史Patienthistory•观察Observation•运动检查（主动和被动）Examinationofmovements(activeandpassive)•附属运动（关节摆弄）Accessorymovements(jointplay)•肌力检查Muscletests•特殊检查Specialtests•神经系统检查Neurologicalexamination•触诊Palpation•诊断性检查结果（影像学、血检等）Diagnostictestresults(imaging,bloodtestetc)PeripheralJoints–subjectiveexamination资料收集DataGathering资料收集资料收集DataGatheringDataGathering资料分析DataAnalysis资料分析资料分析DataAnalysisDataAnalysis确定问题ProblemIdentification确定问题确定问题ProblemIdentificationProblemIdentification目标Aims&Objectives目标目标Aims&ObjectivesAims&Objectives物理治疗计划PhysiotherapyPlan物理治疗计划物理治疗计划PhysiotherapyPhysiotherapyPlanPlan治疗方法Intervention治疗方法治疗方法InterventionIntervention评估Evaluation评估评估EvaluationEvaluation物理治疗过程物理治疗过程PhysiotherapyProcessPhysiotherapyProcessPeripheralJoints–subjectiveexamination诊断程序DiagnosticProcess•做一个益智拼图游戏Puttingtogetherajigsawpuzzle•将小片信息拼在一起构建成一个整体病人的图片PiecingtogethersmallbitsofinformationtobuildanoverallpictureofthepatientPeripheralJoints–subjectiveexamination主观和客观检查的目标AimsofS/E•症状的来源Source(s)ofthesymptoms•原因Contributingfactors(causes)•严重性和激惹性SeverityandIrritability•物理检查和治疗的慎用症和禁忌症Precautionsandcontraindicationstophysicalexaminationandtreatment•预后Prognosis•处理Management•进步-再次评估标记Progress–Reassessmentasterisk(*)PeripheralJoints–subjectiveexamination主观检查的组成主观检查的组成ComponentsofS/EComponentsofS/E•主要问题和身体图MainproblemandBodychart•症状表现Behaviorofsymptoms––加剧症状的活动/姿势aggravatingactivities/positions–缓解症状的活动和姿势relievingactivities/positions–24小时变化情况24-hourpicture•特殊问题SpecialQuestions•病史History–现病史presenthistory–过去史pasthistory•社会史SocialHistoryPeripheralJoints–subjectiveexamination主要问题主要问题&&身体图身体图MainProblem&BodyChartMainProblem&BodyChart主要问题----与症状相关的、与功能相关的、或与病理相关的Mainproblem–symptomrelatedorfunctionrelatedorpathologyrelated•如果是近期创伤---首先了解近期病史Ifrecenttrauma–takerecenthistoryfirst•“现阶段，你的主要问题是什么”“Atthisstage,whatisyourmainproblem?”•如果答案是不能做一些活动，例如“不能下蹲”，确定为什么？疼痛、僵硬、肌力减弱？If,answer,unabletodosomeactivity,e.g.“unabletosquat”,clarifywhy?Pain,stiffness,weakness?PeripheralJoints–subjectiveexamination身体图身体图BodyChartBodyChart所有症状ALLsymptoms•严重性Severity•区域Area•性质Nature•深度DepthPeripheralJoints–subjectiveexamination身体图身体图BodyChartBodyChart--S.A.N.DS.A.N.D..•严重性–如VAS量表，10分之几(注：老年病人有时比较困难)Severity–intermsofVASscale,outof10.(note:sometimesdifficultforelderlypatient)•区域–准确位置，用手指指出并确定Area–exactarea,usefin...