Introduction of Physical Medicine and Rehabilitation R 4
Introduction of Physical Medicine and Rehabilitation 台北榮總復健醫學部 R 4 程遠揚
Physical medicine Treat the physical problem detected by physical examination Musculoskeletal examination Neurological examination Functional examination
Musculoskeletal examination Inspection Palpation Active and passive ROM Joint stability Manual muscle testing Specific tests
Specific tests for shoulder
Demonstration of shoulder impingement
Specific tests for lower limbs
Specific test for contracture
Neurological examination Consciousness-GCS Cognitive status-JOMAC Cranial nerves Sensory system- temperature, pinprick, light touch, vibration Motor coordination- HKS, FNF, RAM Deep tendon reflex Pathological reflex Spasticity-Modified Ashworth scale
Brunnstrom Upper limb Lower limb Hand stage I Flaccid II Associate movement Flexion synergy Extension synergy Mass grasp with no III release IV V VI 1. Placing the hand behind the body 2. Elevation of the arm to a forwardhorizontal position 3. Pronation-supination, elbow at 90° Isolated knee flexion beyond 90’ or ankle dorsiflexion while sitting 1. Arm-raising to a sidehorizontal position 2. Arm-raising forward and overhead 3. Pronation-supination, elbow extended Isolated knee flexion beyond 90’ or ankle dorsiflexion while standing 1. Lateral prehesion, release by thumb movement 2. Semivoluntary finger extension 1. Palmar prehension 2. Possible cylindrical and spherical grasp 3. Mass extension of digits Isolated joint movements are now freely performed
Rancho Los Amigos scale 1. No response 2. Generalized response to stimuli 3. Localized response to stimuli 4. Confused agitated 5. Confused inappropriate 6. Confused appropriate 7. Automatic appropriate 8. Purposeful appropriate
Functional examination Bed mobility Sitting ability Standing ability Activity of daily living evaluation FIM (functional independence measure) instrument Self-care: 6 items Sphincter control: 2 items Transfers: 3 items Locomotion: 2 items Communication: 2 items Social cognition function: 3 items 1 -7 score is given for each item
Rehabilitation Return patients suffered from diseases to previous function PM&R represent a life-long care for patients of certain diseases A practical science of medicine
Patients of PMR department The neonatal and child period: CP, MMC, autism, ADHD, unspecified developmental delay Adolescent period: sports injury, TBI, SCI, AS Elderly period: CVA, SCI, OA, Parkinsonism, LBP, Frozen shoulder Post-operative patients
Criteria for admission to a rehabilitation program Stable clinical status Significant persisting deficit Sufficient cognitive function to learn
Subdivision of PMR department Physical therapy: Neuro-rehabilitation Physical modalities Pediatric rehabilitation Hydrotherapy Cardiopulmonary rehabilitation Occupational therapy Functional training of daily living Orthosis forming Sensory-integration training
Subdivision of PMR department Speech training and swallowing training Psychosocial consulting Vocational evaluation Prosthesis designing
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