常見(jiàn)康復(fù)治療技術(shù)操作規(guī)范

第一篇物理治療....................................................................................................................7一章功能評(píng)估..............................................................................................................................7第一節(jié)身體形態(tài)評(píng)估..................................................................................................................7一、姿勢(shì)........................................................................................................................................7二、身高與體重............................................................................................................................8三、肢體長(zhǎng)度和圍度....................................................................................................................8第二節(jié)關(guān)節(jié)活動(dòng)范圍測(cè)量........................................................................................................9一、四肢關(guān)節(jié)..............................................................................................................................9二、脊柱關(guān)節(jié)..............................................................................................................................9第三節(jié)肌力評(píng)估........................................................................................................................10一、徒手肌力評(píng)估......................................................................................................................10二、等速肌力評(píng)估......................................................................................................................12三、其他器械肌力評(píng)估..............................................................................................................13四、肌肉耐力評(píng)估......................................................................................................................13第四節(jié)肌張力評(píng)估....................................................................................................................14一、手法評(píng)估..............................................................................................................................14二、儀器評(píng)估..............................................................................................................................16第五節(jié)感覺(jué)評(píng)估........................................................................................................................17一、淺感覺(jué)..................................................................................................................................17二、深感覺(jué)..................................................................................................................................17三、復(fù)合感覺(jué)..............................................................................................................................18第六節(jié)平衡評(píng)估........................................................................................................................18一、臨床觀測(cè)..............................................................................................................................18二、量表評(píng)估..............................................................................................................................19三、儀器評(píng)估..............................................................................................................................21第七節(jié)協(xié)調(diào)評(píng)估........................................................................................................................21一、上肢......................................................................................................................................21二、下肢......................................................................................................................................22第八節(jié)步行評(píng)估........................................................................................................................22一、步行能力..............................................................................................................................22二、步態(tài)分析..............................................................................................................................23第九節(jié)心血管評(píng)估....................................................................................................................24一、心率......................................................................................................................................24二、血壓......................................................................................................................................25三、心電分級(jí)運(yùn)動(dòng)試驗(yàn)..............................................................................................................26四、簡(jiǎn)易運(yùn)動(dòng)試驗(yàn)技術(shù)..............................................................................................................27第十節(jié)呼吸評(píng)估........................................................................................................................27一、通氣功能..............................................................................................................................27二、代謝當(dāng)量..............................................................................................................................29三、心肺聯(lián)合運(yùn)動(dòng)試驗(yàn)..............................................................................................................29第十一節(jié)疼痛評(píng)估....................................................................................................................30一、壓力測(cè)痛法..........................................................................................................................30二、視覺(jué)模擬評(píng)分法..................................................................................................................31三、疼痛問(wèn)卷..............................................................................................................................31附錄..............................................................................................................................................32附表1-2-1上肢關(guān)節(jié)活動(dòng)范圍測(cè)量.........................................................................................32附表1-2-2下肢關(guān)節(jié)活動(dòng)范圍測(cè)量.........................................................................................32附表1-2-3脊柱關(guān)節(jié)活動(dòng)范圍測(cè)量.........................................................................................33附表1-3-1上肢肌肉徒手肌力檢查.........................................................................................34附表1-3-2下肢肌肉徒手肌力檢查.........................................................................................46附表1-3-3軀干肌肉徒手肌力檢查.........................................................................................53第二章運(yùn)動(dòng)治療........................................................................................................................57第一節(jié)關(guān)節(jié)活動(dòng)范圍訓(xùn)練........................................................................................................57一、被動(dòng)關(guān)節(jié)活動(dòng)范圍訓(xùn)練......................................................................................................57二、積極-助力關(guān)節(jié)活動(dòng)訓(xùn)練.....................................................................................................58三、積極運(yùn)動(dòng)..............................................................................................................................58第二節(jié)關(guān)節(jié)松動(dòng)技術(shù)................................................................................................................59一、上肢......................................................................................................................................59二、下肢......................................................................................................................................60三、脊柱......................................................................................................................................61第三節(jié)牽伸技術(shù)........................................................................................................................62一、上肢......................................................................................................................................62二、下肢......................................................................................................................................62三、軀干......................................................................................................................................63第四節(jié)肌力訓(xùn)練........................................................................................................................63一、徒手肌力訓(xùn)練......................................................................................................................63二、等長(zhǎng)肌力訓(xùn)練......................................................................................................................64三、等張肌力訓(xùn)練......................................................................................................................64四、等速肌力訓(xùn)練......................................................................................................................65第五節(jié)步行訓(xùn)練........................................................................................................................65一、步行前訓(xùn)練..........................................................................................................................66二、步行訓(xùn)練..............................................................................................................................66第六節(jié)呼吸訓(xùn)練........................................................................................................................67一、腹式呼吸訓(xùn)練......................................................................................................................67二、抗阻呼氣訓(xùn)練......................................................................................................................68三、深呼吸訓(xùn)練..........................................................................................................................68四、局部呼吸訓(xùn)練......................................................................................................................68五、排痰訓(xùn)練..............................................................................................................................69六、呼吸肌訓(xùn)練..........................................................................................................................69第七節(jié)平衡與協(xié)調(diào)訓(xùn)練............................................................................................................70一、無(wú)器械平衡訓(xùn)練..................................................................................................................70二、簡(jiǎn)易設(shè)備平衡訓(xùn)練..............................................................................................................71三、儀器平衡訓(xùn)練......................................................................................................................71四、協(xié)調(diào)訓(xùn)練..............................................................................................................................71第八節(jié)有氧訓(xùn)練........................................................................................................................72一、器械有氧訓(xùn)練......................................................................................................................72二、無(wú)器械有氧訓(xùn)練..................................................................................................................73第九節(jié)神經(jīng)發(fā)育療法................................................................................................................73一、Brunnstrom技術(shù)..................................................................................................................73二、Bobath技術(shù)..........................................................................................................................75三、PNF技術(shù)..............................................................................................................................76第十節(jié)運(yùn)動(dòng)再學(xué)習(xí)....................................................................................................................80一、上肢功能訓(xùn)練......................................................................................................................81二、口面部功能訓(xùn)練..................................................................................................................82三、臥位到床邊坐起及坐位平衡訓(xùn)練......................................................................................82四、站起與坐下訓(xùn)練..................................................................................................................83五、站立平衡訓(xùn)練......................................................................................................................83六、行走訓(xùn)練..............................................................................................................................84第十一節(jié)醫(yī)療體操....................................................................................................................84一、偏癱......................................................................................................................................84二、頸椎病................................................................................................................................86三、腰椎間盤突出癥................................................................................................................87四、肩周炎................................................................................................................................88五、膝關(guān)節(jié)骨關(guān)節(jié)炎................................................................................................................89六、脊柱側(cè)凸............................................................................................................................89第十二節(jié)牽引治療..................................................................................................................90一、腰椎牽引............................................................................................................................90二、頸椎牽引............................................................................................................................91三章物理因子治療..................................................................................................................92第一節(jié)電療法..........................................................................................................................92一、直流電療法........................................................................................................................92二、直流電藥物離子導(dǎo)入療法................................................................................................92三、低頻電療法........................................................................................................................93四、中頻電療法........................................................................................................................94五、高頻電療法........................................................................................................................94第二節(jié)光療法..........................................................................................................................98一、紅外線療法........................................................................................................................98二、紫外線療法........................................................................................................................98三、激光療法............................................................................................................................100第三節(jié)磁療法..........................................................................................................................100一、靜磁場(chǎng)療法........................................................................................................................100二、動(dòng)磁場(chǎng)療法........................................................................................................................101第四節(jié)超聲波療法...................................................................................................................101一、超聲波療法........................................................................................................................101二、超聲藥物透入療法............................................................................................................102第五節(jié)冷療法...........................................................................................................................103一、冷療法................................................................................................................................103二、冷凍療法............................................................................................................................103第六節(jié)熱療法..........................................................................................................................104一、石蠟療法............................................................................................................................104二、濕熱袋敷療法....................................................................................................................105三、泥療法................................................................................................................................105第七節(jié)壓力療法......................................................................................................................106一、正負(fù)壓療法........................................................................................................................106二、負(fù)壓療法............................................................................................................................107三、正壓次序循環(huán)療法............................................................................................................107第八節(jié)肌電生物反饋療法......................................................................................................108第二篇作業(yè)治療.....................................................................................................................108一章作業(yè)評(píng)估..........................................................................................................................108第一節(jié)作業(yè)體現(xiàn)層次..............................................................................................................108一、作業(yè)需求............................................................................................................................108二、平常生活活動(dòng)....................................................................................................................109三、工作....................................................................................................................................110四、生存質(zhì)量............................................................................................................................111第二節(jié)作業(yè)構(gòu)成層次..............................................................................................................112一、手功能................................................................................................................................112二、知覺(jué)功能............................................................................................................................114三、認(rèn)知功能............................................................................................................................120第三節(jié)物理環(huán)境......................................................................................................................123一、家居和小區(qū)環(huán)境................................................................................................................123二、工作環(huán)境............................................................................................................................123二章作業(yè)治療..........................................................................................................................124第一節(jié)作業(yè)體現(xiàn)層次..............................................................................................................124一、平常生活活動(dòng)....................................................................................................................124二、娛樂(lè)與休閑活動(dòng)................................................................................................................127三、職業(yè)康復(fù)............................................................................................................................129第二節(jié)作業(yè)構(gòu)成層次..............................................................................................................133一、功能性作業(yè)活動(dòng)................................................................................................................133二、手功能................................................................................................................................137三、知覺(jué)功能............................................................................................................................141四、認(rèn)知功能............................................................................................................................144第三節(jié)環(huán)境改造與輔助..........................................................................................................145一、自助具適配........................................................................................................................145二、助行器使用........................................................................................................................146三、輪椅選擇與使用................................................................................................................147四、環(huán)境適應(yīng)與改造................................................................................................................150第四節(jié)矯形器制作與使用......................................................................................................150一、矯形器制作........................................................................................................................150二、矯形器使用........................................................................................................................151三、壓力衣制作與使用............................................................................................................152第三篇言語(yǔ)治療....................................................................................................................153第一章聽(tīng)力障礙......................................................................................................................153第一節(jié)評(píng)估技術(shù)......................................................................................................................153一、主觀測(cè)聽(tīng)............................................................................................................................153二、客觀測(cè)聽(tīng)............................................................................................................................154第二節(jié)治療技術(shù)......................................................................................................................154一、聲音察覺(jué)訓(xùn)練....................................................................................................................154二、聲音辨別訓(xùn)練....................................................................................................................155三、聲音識(shí)別訓(xùn)練....................................................................................................................155四、聲音理解訓(xùn)練....................................................................................................................155五、助聽(tīng)器和電子耳蝸應(yīng)用技術(shù)............................................................................................155二章失語(yǔ)癥..............................................................................................................................156第一節(jié)評(píng)估技術(shù)......................................................................................................................156一、失語(yǔ)癥................................................................................................................................156二、口面失用癥........................................................................................................................159三、言語(yǔ)失用癥........................................................................................................................160第二節(jié)治療技術(shù)......................................................................................................................160一、聽(tīng)理解治療技術(shù)................................................................................................................160二、閱讀理解治療技術(shù)............................................................................................................161三、言語(yǔ)體現(xiàn)治療技術(shù)............................................................................................................162四、書(shū)寫體現(xiàn)治療技術(shù)............................................................................................................164五、實(shí)用交流能力技術(shù)............................................................................................................164六、輔助交流技術(shù)....................................................................................................................165第三章構(gòu)音障礙......................................................................................................................166第一節(jié)評(píng)估技術(shù)......................................................................................................................166一、呼吸評(píng)估............................................................................................................................166二、喉功能評(píng)估........................................................................................................................167三、口唇評(píng)估............................................................................................................................168四、下頜評(píng)估............................................................................................................................169五、軟腭評(píng)估............................................................................................................................169六、舌評(píng)估................................................................................................................................170七、反射評(píng)估............................................................................................................................171八、言語(yǔ)評(píng)估............................................................................................................................172第二節(jié)治療技術(shù)......................................................................................................................174一、舌感覺(jué)運(yùn)動(dòng)技術(shù)................................................................................................................174二、口唇感覺(jué)運(yùn)動(dòng)技術(shù)............................................................................................................174三、下頜運(yùn)動(dòng)技術(shù)....................................................................................................................175四、軟腭感覺(jué)運(yùn)動(dòng)技術(shù)............................................................................................................176五、聲帶運(yùn)動(dòng)技術(shù)....................................................................................................................176六、呼吸訓(xùn)練技術(shù)................................................