Transcript 復健醫學簡介 - 台北榮民總醫院

Introduction of Physical
Medicine and Rehabilitation
台北榮總復健醫學部
R4 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