חוט שדרה טרומבלי.doc
TRANSCRIPT
(" 965-972 )
" -10,000 SCI . -183,000-203,000 SCI ". SCI 4 . : 31.8 (50% 16-30).
NSCISC- (the national spinal cord injury statistical center) -1973, ".
- NSCISC (1973-1997): 43% ,
22% ,
19%- ( "),
11%- ,
5%- , SCI - " , ( ), ( " ).
": 59%
27.6% ,
7.7% ,
2.1% ,
0.4%
0.5%
2.5%
-SCI (59.3%) " , 49.6% .
- . .
" , ', . .
SCI:
. , . : C6- -C6 . .
- " : . / . - -. .
SCI:
" SCI .
: tetraplegia- : , , , .
Tetraplegia=quadriplegia- / " . .
Paraplegia- : (thoracic), (lumbar), ( sacral) " . . - ( ), , .
- paraplegia - quadriplegia , . " . " 10 "" . " 28 . 3 5 (MMT= manual muscle testing) . , .
( " " )- 3+ 5 -MMT, . .
ASIA ( 43.2(.
- -lower sacral.
- / (sacral). .
- . - -C5 " C6 (= ). ' .
:
, .
. . ( : extensor carpi radialis) . - , . .
- ' , - . -6 , .
. .
, .
SCI- -50 . ( ), .
:
-SCI. . .
:
SCI , . , SCI. C4, -phrenic nerve, . (). ( ) : intercostals, abdominal, lattissimus dorsi. .
. , . " .
:
T6 ( box 43-2). , : , , , , , , , . .
(ortostatic) :
" " (box 43-2). T6 . . , " . " "H . - . . " . " , " .
, (binder) .
(pressure ulces and pressure relief):
" SCI. . - .
, . .
- -spine of scapula .
SCI . . - 1 .
:
SCI /. . " / (digital) ( ) . . , . " . "G .
. / , . . , . 45 .
:
, S2-5. -S2-5 . , . " ". , . - -SCI. 6 . . , .
:
SCI. , , " . SCI . " . " . -S2-5 , , . SCI .
, , . : .
, : , . , SCI . . , , "H . 4 " : , , . .
" ":
" .
.
" .
" , .
:
- . , , Fairholm.
- , " .
- ( afferent). " .
.
" . " , .
, .
, , . " ( , ).
. .
" " . ----> . () , .
.
, , .
" Bacofen. .
" . .
: , .
: (). .
: " , / '.
: () .
...
- ( ).
15%- 20% " .
" 4 .
: , , .
. " " . " .
?
" :
, , , , , , .
:
,
" . " 25% 47% .
. , .
. .
, . . .
. . .
:
1. , .
2. . . , .
3. . CD .
4. . . . , .
5. " , . .
box 43-3- 973.
650 " .
. . . .
:
.
.
" " .
assesment " . " ' , . " .
, . " . " , .
" , . .
2-3 " .
: , .
:
. .
. . .
, , . . COPM ". . , " ".
, , " 44 144 . " . .
:
" " . , ".
:
# # # #
.. (balance), (endurance ), .
reflex sympathetic dystropy .
.
:
" : ADL,IADL, , , .
: , . Sullerman hand function .
' .. .
ADL & IADL:
ADL -IADL " .
FIM-functional independence measure ". Modified barthel index -Quadraplegia Index .
:
" . , .
:
" , .
. .
:
" . , . . .
- .
.
, . , .
1. ?
2. ?
".'- C4 . " .
:
, .
: Outcome following traumatic SCI- clincal practice .
, , , FIM .
ADL IADL , .
care giver .
" CLIENT CENTERED .
:
:
\ ", .
, .
. , "" .
, . .
" :
1. ""- " .
2. ""- . , , .
3. - . , , .
, , . .
-eldery :
, . " Central cord syndrom .
" \ FIM .
:
# # # # # # # .
" . / . , , " ", , . .
" " ", . - C7 .
:
: - .
" , . " - , . " .
" , . .
:
1. .
2. .
, .
: , , , .
. " " , .. ... ( - ).
: - , .
, . ". .
" .
# : " " . " ".
- .
, " , .
, . " .
, .
C1-C4
C1-C3 (C3).
.
- . . ( ).
. .
" : , , .
.
.
ADL. , , , .
: C5 C8
, , , , . , , " , , , , .
C5
, - deltoid - biceps, , , . , a ball bearing feeder, . - . , , , , . - deltoid - biceps 3+/5 , .
- C5 , . , . , . -universal cuff , . C/U , . , . , .
C5 . , . . ( )
C6 - C7
- C5. tenodesis. , , . , pinch .
, - rotator cuff, deltoids, biceps, . , , clavicular pectoralis. - triceps, C7, ( ), , .
C8
- extrinsic. - intrinsic. C8 - metacarpophalangeal , - PIP - DIP . claw hand intrinsic minus.
. , C5, C6, C7 . , '. , -.
, -70 -80, , . () . . , 4/5 . , . - brachioradialis - flexor policis longus. lateral pinch " (4/5 ) - brachioradialis -FPL . ', . , - IP .
, , , " . , .
. Neuroprosthesis , , C5-C6 " . -8 ; ; ; . . .
, , . T10 . . ( ) " , .
, , . , . .
:
, , . . " . .
, " . " . :
1. ( )? , ?
2. ? ?
3. ?
, . , , . , , . ( ). , .
, . , , . - 40-50%. , . .
. . . , . , . , , , , . . .
. , , , . . , .
:
. " , . , " : .
, . , . . ", case manager , . (). , " . , " . " . , , .
. . ADL. , . : , Manual Muscle Testing , .
" , , . . , .
" / / (: - ). .
:
. " " . (") " , . " , .
Yerxa -Baum -1990 ". " (). , . , . " " " " . " , ". . .
1. 3 " .
2. 3 C5.
3. Tenodesis grasp? " ?
4. 5 " ".
5. C5.
6. C7?
7. . ? .
8. " ?
C1-3
: SCM, cervical paraspinal, neck accessories
: , .
: , , , .
/FIM
IR
, 2 ( ), , /
111
111
.
/" , 111
, . " , , , , .
111
111
111
, , 111
":
: " / , , , . 611-6
, :
:
, . , , . .
( , ") .
24 , . 24 24 12-24
C4
:
: 1, , cervical paraspinal muscle
: , , , .
: , , , , .
/FIM
IR
- .
111
111
.
/" , 111
, . " , , , , .
111
111
111
, , 111
":
: " / , , , - . 611-6
, :
: " ,
, . , , . .
( , ") .
24 , . 24 24 12-24
" 994-999
C5
:
: , , -, , - ( ).
:
: , ,
: ,
: .
:
,
,
.
* FIM\ : - FIM , NSCISC, IR NSCISC Interquartile Range
NSCISC Sample Size: FIM=41/ Assist=35
FIM\ :
::::IR:
: -intercostals .
.
: , ( , : padded shower, commode chair or padded transfer tub bench with commode cutout) 111
: (electric leg bag emptying)111
: - "full" ""
-
: -
- 111
, positioning , Power recline- \ \.
-
-
-
-
Eating -: , - -long opponens
- 552.5-2.5
:- :
- : - -long opponens
- 111-4
: - -long opponens
- 1-311-5
: - -
- () 111-3
\ :- :
- :
- : power recline \
- :lightweight rigid or folding frame with hand rim modifications665-6
, : Hydraulic standing frame
: - -long opponens
- : , ,
:- \ ,
- ,
- attendant-operated (van)
Homemaking:
:- : 10
- : 6
-
16 23 10-24
C6
:
: clavicular pectoralis, supinator, extensor carpi radialis longus and brevus, serratus anterior, latissimus dorsi
:
Scapular protractor,
:
:
:
.
* FIM\ : - FIM , NSCISC, IR NSCISC Interquartile Range
NSCISC Sample Size: FIM=43/ Assist=35
FIM\ :
::::IR:
: -intercostals .
.
: - -
- 1-211
:
- leg bag emptying 1-211
: - "full"
-
- "full" "king"
: :
: -
- 311-3
, positioning , \ - Power recline
-
-
-
Eating -: - (: U-caff, -tenodesis, , )5-654-6
:- :
- : - (: , , , , , )1-321-5
: - (: U-caff, )3-642-6
:- :
- : - -
- ()
- 1-311-3
\ :- :
- : , - : -power recline
- :lightweight rigid or folding frame with modified rims664-6
, (ambulation):- :
- : Hydraulic standing frame
: (: -tenodesis, , , \ , )
:- -
- sensitized hand controls
- tie downs
Homemaking:-
- homemaking
:- : 6
- : 4
10 17 8-24
C7-8
:
:latissimus dorsi, sternal pectoralis, triceps, pronator quadratus, extensor carpi ulnaris, extensor carpi radialis, flexot digitorum profundus and superficials, extensor communis, pronator/flexor/extensor/adductor pollicis, lumbricals (partially innervated)
:
:
:
:
:
:,
:
Limited grasp release and dexterity secondary to partial intrinsic muscles of the hand
* FIM\ : - FIM , NSCISC, IR NSCISC Interquartile Range
NSCISC Sample Size: FIM=43/ Assist=35
FIM\ :
::::IR:
: -intercostals .
.
: - -
- 1-411-4
: 2-631-6
: "full" "full" "king"
: 3-742-6
, positioning , -
-
-
Eating -: 6-765-7
:- :
- : 4-764-7
: 6-764-7
:- :
- : - -
- ()
- 3-642-6
\ :- : , \ - :rigid or folding lightweight or folding wheelchair with modified rims666
, (ambulation):- :
- : Hydraulic or standart standing frame
:
: .
.-
-
Homemaking:-
- homemaking
- .
:- : 6
- :
8 12 2-24
T1-9
:
: , , erector spinae, , flexor/extensor/abductor pollicis
:
intercostals.
:
* FIM\ : - FIM , NSCISC, IR NSCISC Interquartile Range
NSCISC Sample Size: FIM=144/ Assist=122
FIM\ :
::::IR:
:
: 6-764-6
:665-6
: "full" "king"
: 6-766-7
, positioning , -
-
-
Eating -:777
:777
:777
:- -
- () 6-765-7
\ : Manual rigid or folding lightweight or folding wheelchair 666
, (ambulation):- :
- : standing frame
:
: .Hand controls
Homemaking:-
- .
:Homemaking 3
3 0-15
T10-L1
:
: : intercostals, external obliques, rectus abdominis
:
:
* FIM\ : - FIM , NSCISC, IR NSCISC Interquartile Range
NSCISC Sample Size: FIM=71/ Assist=57
FIM\ :
::::IR:
:
: 6-766
:666
: "full" "king"
:776-7
, positioning , -
-
-
Eating -:777
:777
:777
:-
- () 6-766-7
\ : Manual rigid or folding lightweight wheelchair 666
, (ambulation):- :
- : , - standing frame
-
- orthesis ,
:
: .Hand controls
Homemaking:-
- .
:Homemaking
0-8
L2-S5
:
: : ; , , , ; ; .
:
:
, , ,
* FIM\ : - FIM , NSCISC, IR NSCISC Interquartile Range
NSCISC Sample Size: FIM=20/ Assist=16
FIM\ :
::::IR:
:
: 6-766-7
:666-7
:
: "full" "king" 777
, positioning , -
-
Eating -:777
:777
:777
:-
- () 6-776-7
\ : Manual rigid or folding lightweight wheelchair 666
, (ambulation):- :
- : , - standing frame
-
- orthesis -- orthesis-
:
: .Hand controls
Homemaking:- ,
- .
:Homemaking 0-1
0-1 0 0