RECUPERARE MEDICALA

CLINICA DE RECUPERARE III INRMFB FILANTROPIA

Recuperarea medicala

Specialitate de tip conservator Viziune holistica Scop: refacerea functionalului Intretinerea/cresterea nivelului functional in

diverse patologii (ap locomotor) Realizarea unor mijloace facilitatorii,

compensatorii, intrinseci/extrinseci

CATEGORII DE AFECTARE FUNCTIONALA

Infirmitatea (impairment) = alterarea structurala/functionala in plan psihologic/fiziologic/anatomic, care permite desfasurarea activitatii

Incapacitatea (disability) = reducere partiala/totala

a capac. de desfasurare a unei activitati ( dificultati de autoingrijire/locomotie)

Handicapul = dezavantajul social in urma unei

infirmitati/incapacitatii => limiteaza desfasurarea unei vieti normale => pacient dependent social si profesional

EVALUARE CLINICO-FUNCTIONALA

EXAMEN CLINIC

EVALUARE FUNCTIONALA:

- BILANT ARTICULAR - BILANT MUSCULAR

- EVALUAREA MERSULUI

- EVALUAREA ACTIVITATILOR ZILNICE (ADL)

- INDICE WOMAC/LEQUESNE/FIM/DAUBIGNE

EVALUAREA CALITATII VIETII

EVALUARE PARACLINICA

ANALIZE SANGE/LICHID ARTICULAR/SPUTA

ECG

SPIROMETRIE

IMAGISTIC - RX/MIELOGRAFIE

- ECHOGRAFIC ABD/PELVIN/PARTI MOI

- RMN/CT/ANGIORMN/PET-CT

EMG/EEG

OBIECTIVE TERAPEUTICE IN RECUPERAREA MEDICALA

SCADEREA DURERILOR

CRESTEREA STABILITATII MI

CRESTEREA MOBILITATII ARTICULARE

CRESTEREA GRADULUI DE COORDONARE A MI

AMELIORAREA ECHILIBRULUI

ANTRENAMENTUL MERSULUI

MIJLOACE TERAPEUTICE

1. Regim higieno-dietetic: dieta, supl. nutritive, reguli higiena articulara

2. Tratament medicamentos (afectiuni asociate)

3. Tratament fizical kinetic: G, posturari, orteze, TT, ET, masaj, TO KT (antrenam efort/incarcare artic) 4. Suplimentare vascoelastica 5. Infiltratii cortizonice 6. Cura balneara 7. Indicatia chirurgicala 8. Psihoterapie/logopedie

METODOLOGIE SPECIFICA

TERAPIA FIZICALA

- ET

- TT

- HTT

MASAJUL TERAPEUTIC

KINETOTERAPIA

HIDROKT

TO/ERGO

Scale de evaluare - OSTEOPOROZA Evaluarea calitii vieii

chestionarul QUALEFFO 41, (iniial i dup ase luni de program kinetic controlat).

Chestionarul tip Qualeffo 41 este un instrument standardizat, utilizat de Fundatia Europeana pentru Osteoporoza .

Se adreseaz pacienilor cu osteoporoz vertebral instalat i este alctuit din 41-48 de ntrebari i ase scale vizuale analoge.

Poate fi autoadministrat.

Intrebrile se refer la apte domenii :

Durere

ADL

Activiti casnice

Mobilitate

Activiti de relaxare i sociale

Percepia general asupra sntii

Dispoziia

Este tradus n german, francez, olandez, italian, suedez .

Scale de evaluare MEASUREMENT SCALES USED IN ELDERLY CARE FUNCTIONAL INDEPENDENCE MEASURE AND FUNCTIONAL ASSESSMENT

MEASURE

Functional Independence Measure

The Functional Independence Measure (FIM) scale assesses physical and cognitive disability

This scale focuses on the burden of care that is, the level of disability indicating the burden of caring for them.

Scoring

Items are scored on the level of assistance required for an individual to perform activities of daily living. The scale includes 18 items, of which 13 items are physical domains based on the Barthel Index and 5 items are cognition items.

Each item is scored from 1 to 7 based on level of independence, where 1 represents total dependence and 7 indicates complete independence.

The scale can be administered by a physician, nurse, therapist or layperson.

Possible scores range from 18 to 126, with higher scores indicating more independence.

Alternatively, 13 physical items could be scored separately from 5 cognitive items.

Time

It takes 1 hour to train a rater to use the FIM scale, and 30 minutes to score the scale for each patient.

The FIM can be completed in approximately 20-30 minutes in conference, by observation, or by telephone interview.

Scale de evaluare

Disability Rating Scale

DRS address all three World Health Organization categories: impairment, disability and handicap, the DRS is able to measure across the span of recovery to track an individual from coma to community

The maximum score a patient can obtain on the DRS is 29, which represents an extreme vegetative state. A person without disability would score zero. For the DRS to be reliable, it must be employed when the individual is free from the influence of anesthesia, other mind-altering drugs, recent seizure, or recovery from surgical anesthesia.

The DRS can be self-administered or scored through interview with the client or family member.

The ease of scoring and the brevity of the scale are compelling reasons for its popularity. Scoring time can range from 30 seconds (if one is very familiar with the scale and the client) to 15 minutes, assuming the rater must interview the client/family and seek additional information from available staff.

A limitation of the DRS is its relative insensitivity at the low end of the scale (mild TBI) and its inability to reflect more subtle but sometimes significant changes in an individual within a specific, limited window of recovery.

The purpose of a neuropsychological screening examination is to determine if there is reasonable evidence, beyond initial clinical impression, for a diagnosis of brain injury or brain disease. Even though it is "screening," the examination must be definitive in this regard.Once a screening points to reasonable probability that a neurological condition exists, a full neuropsychological examination would be indicated to attain further diagnostic, prognostic, and treatment planning information. Both screening and full neuropsychological examinations offer the opportunity for diagnosis of probability of brain dysfunction (as opposed to diagnosis of psychodynamic, personality, and/or emotional disorder not associated with neurological causes). For a screening examination, assessing probability of brain dysfunction is about as far as the diagnosis goes. A full neuropsychological examination, on the other hand, is necessary to delineate the wide variety of functional manifestations of brain damage or disease. Such detail is necessary to understand the life consequences of functional impairment (e.g., work, school, relationships, driving potentials, competency, and so forth).

NEUROPSYCHOLOGICAL SCREENING EXAMINATION

Scale de evaluare - Neurologie

The Barthel scale or Barthel ADL index is a scale used to measure performance in basic Activities of Daily Living. It uses ten variables describing activities of daily living (ADL) and mobility. A higher number is associated with a greater likelihood of being able to live at home with a degree of independence following discharge from hospital. The scale was introduced in 1965,[1] and yielded a score of 0-20. Although this original version is still widely used, it was modified by Granger et al. in 1979, when it came to include 0-10 points for every variable,[2] and further refinements were introduced in 1989.[3] The scale is regarded as reliable, although its use in clinical trials in stroke medicine is inconsistent.[4]

The ten variables addressed in the Barthel scale are[1]: presence or absence of fecal incontinence presence or absence of urinary incontinence help needed with grooming help needed with toilet use help needed with feeding help needed with transfers (e.g. from chair to bed) help needed with walking help needed with dressing help needed with climbing stairs and help needed with bathing

Scale de evaluare - Stroke

Stroke: The National Institute of Health (NIH) stroke scale (NIHSS) is a standardized method used by physicians and other health care professionals to measure the level of impairment caused by a stroke.

The NIH stroke scale serves several purposes, but its main use in clinical medicine is during the assessment of whether or not the degree of disability caused by a given stroke merits treatment with tPA.

Another important use of the NIHSS is in research, where it allows for the objective comparison of efficacy across different stroke treatments and rehabilitation interventions.

Scale de evaluare - Stroke

The NIH stroke scale measures several aspects of brain function, including consciousness, vision, sensation, movement, speech, and language. A certain number of points are given for each impairment uncovered during a focused neurological examination. A maximal score of 42 represents the most severe and devastating stroke. Current guidelines as of 2008 allow strokes with scores greater than 4 points to be treated with tPA.

The level of stroke severity as measured by the NIH stroke scale scoring system:

0= no stroke

1-4= minor stroke

5-15= moderate stroke

15-20= moderate/severe stroke

21-42= severe stroke

Scale de evaluare Spasticitate in boli neurologice

The Ashworth scale is one of the most widely used methods of measuring spasticity, due in a large part to the simplicity and reproducible method. 5-Point Scale

Muscle tone is defined by the resistance of a muscle being stretched without resistance.

The Modified Ashworth Scale (MAS) has a 6-point scale that assists with stroke patients.

The MAS better measures muscle hypertonia instead of spasticity.

Scale de evaluare

Ashworth Scale 1. No increase in muscle tone. 2. Slight increase in tone giving a catch

when affected part is moved in flexion or extension.

3. More marked increase in tone but affected part is easily flexed.

4. Considerable increase in tone; passive movement difficult.

5. Affected part is rigid in flexion or extension.

Scale de evaluare - Ortopedie

De la dezvoltarea lui n 1982, The Western Ontario Mc Master Scor WOMACTM Index a suferit mai multe revizii i modificri;

este auto-administrat i evalueaz trei dimensiuni ale disfunctiei membrului inferior: durere, redoarea articular si afectarea functionala n afectiunile de genunchi folosind o baterie de 24 de ntrebri.

Cea mai recent versiune a instrumentului (WOMACTM 3.1) este disponibil n 65 de limbi, disponibil n ambele formate: 5 puncte Likert i 100mm Scala Analoga Visuala

Este o msur valabil si fiabila, fiind utilizata n diverse studii clinice i intervenionale

Validarea acestei scale de evaluare s-a realizat in afectiunile degenerative de la nivelul genunchiului si soldului

The index consists of 24 questions (5 pain, 2 stiffness and 17 physical function) and can be completed in less than 5 minutes.

The WOMAC is a valid, reliable and sensitive instrument for the detection of clinically important changes in health status following a variety of interventions (pharmacologic, surgical, physiotherapy, etc.).

Scale de evaluare - ORTOPEDIE

REGION Clinician completed Patient completed

Hip Harris Hip Score Oxford Hip Score

HOOS (Hip disability and

Osteoarthritis Outcome)

WOMAC Score

Knee (Osteo Arthritis) Knee Society Score (KSS) Oxford Knee Score

KOOS (Knee Injury &

Osteoarthritis Outcome)

WOMAC Score

SCALE DE EVALURE - ORTOPEDIE

Knee (Anterior

Cruciate Ligament)

Modified Cincinatti Rating

system

KOOS (Knee Injury &

Osteoarthritis Outcome)

Tegner Lysholm Knee

Scoring Scale

Modified Cincinatti Rating

system

Tegner Lysholm Knee Scoring

Scale

Foot/Ankle American Foot & Ankle

Score

Shoulder Constant Shoulder Score Oxford Shoulder Score

UCLA Shoulder rating

scale

DASH (Disabilities of arm,

shoulder & hand) Score

Quick-DASH Score

SCALE DE EVALUARE - ORTOPEDIE

Wrist

MAYO Wrist Score

DASH (Disabilities of arm, shoulder & hand) Score

Quick-DASH Score

Hand

DASH (Disabilities of arm, shoulder & hand) Score

Quick-DASH Score

Lumbar Spine

Oswestry Low Back Pain Score

Modified Oswestry Low Back Pain Score

Back Pain Index new

Cervical Spine

Vernon & Mior Cervical Spine Score