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RCUPRR N SCLRZMULTIPL
1
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CUPRINS:
INTRDUCR...............................................................................................................3
PRT I. SPCT TRTIC.............................................................................5CPITLUL I. SCLRZ. SPCT INTRDUCTIV......................................5
1.1. Dfini i .....................................................................................................................5
1.2. Istric ! crct"rii #i$%i!&ic 'n SM.................................................................(
1.). *r% i %nifst"ri c!inic. Di&nstic+! c!inic ! SM ........................................1,
CPITLUL II. FCTL SCLRZI MULTIPL I RCUPRR N
SCLRZ MULTIPL...........................................................................................................26
2.1. T+!-+r"ri! $ ci!i-r+ i cr$nr .....................................................................2(
2.2. fct! ! !c+! $ %+nc".......................................................................................2/
2.). fct! s+#r 0i ii f%i!i! i sci! ................................................................2,
2.. Disf+nc i snri!" ...............................................................................................)3
2.5. Dirtri i $isf&i ..................................................................................................)2
2.(. Disf+nc i c&niti0" i t+!-+r"ri! % in!. Pr-!% #siic ...........................)2
2./. S#sticitt.............................................................................................................3
PRT II-. SPCT PRCTIC....................................................................43
CPITLUL III. RCUPERAREA CHILIRULUI N RTSTTISM !I MRSULUI L LNVII D SCLRZ MULTIPL..................................................43
).1. Mtri! 4i %t$...................................................................................................)
).2. I#t crct"rii.....................................................................................................5)
).). -icti0! #r&r%+!+i $ rc+#rr...................................................................5)
).. Pr&r%+! intic....................................................................................................5
).5. n!i 4i intr#rtr r+!tt!r.........................................................................5,
).(. Cnc!+ii! st+$i+!+i................................................................................................()
CNCLUZII....................................................................................................................64
ILI"RFI..............................................................................................................66
2
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INTRDUCR
N+ c+ %+!t ti%# 'n +r%" % #+t +i $ ! #cin6i c+ sc!r %+!ti#!" 7SM8 r#r4+ri
c" #+6in s c+n4t s+ #+6in s fc #ntr+ 4 -!n0i c i9 $r #r&rs s%nificti0 $in+!ti%ii 13:15 $ ni + sci%-t r$ic! tit+$in9 -&;+! $ infr%6ii9 #si-i!it"6i tnic 4i
tr#+tic i s#ci!i4ti!r $in $%ni+. Crct"ri! 'n $%ni+ i%+n!&ii9 tnicii $
$i&nstic9 in$+strii fr%c+tic $in +!ti%+! $cni+ + c!i#st #rc$nt! 3 $ ni9 c
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cti0it"6ii i!nic cti$in 4i '%-+n"t"6ir -i!it"6i!r in$i0i$+! i #cin6i!r 'n 0i6 !r9 'n
%$i+ !r -it+!. n #!+s9 Aist" r&+%nt 4tiin6ific c r s+&r c" r-i!itr #t #r0ni
c%#!ic6ii! sc+n$r9 '%-+n"t"6i c!itt 0i6ii 4i r$+c #!+ri ! 'n&ri;iri s#it!ic4ti. S#r
A%#!+ cti0itt fiic" s+ Arci6ii! fiic + fst $0$it fi -nfic #rsn!r c+ SM
7Pt;n EF G##%nir 9 Hit T9 1(8. ntrir9 #cin6ii c+ SM + fst $sc+r;6i $
cr4t cti0itt !r fiic"9 cnsi$rt fiin$ c" strs+! fiic r #+t %"ri cti0itt %!$ii.
cst %it fst risi#it 'n ti%# #rin A#rin6". cti0itt fiic" %ic4rt" $+c ! !t !i%it"ri
fiic 7I-i$J%89 ir incti0itt #t cr4t +nr c%#!ic6ii sc+n$r9 c $ A%#!+ rstric6i
'n 0!+%+! %i4c"ri!r rtic+!r9 scr9 $#rsi9 tc.
R-i!itr 'n Sc!r M+!ti#!" st +n #rcs c:! ;+t" # s+-ict s" tin&" 4i s"
%n6in" +n #tn6i! fiic9 #si!&ic9 sci! 4i 0c6in!9 # $ #rt 4i c!itt 0i6ii
cnsc0nt" c+ n$ic# fii!&ic9 $ %-in6" 4i sc#+! 0i6ii9 # $ !t" #rt. Din cst"$fini6i ris c"9 r-i!itr tr-+i s" fi in$i0i$+!it" 'ntr+ s #tri0i ncsit"6i!r
s#cific #ntr+ ficr #cint. R-i!itr n+r!&ic" st +n #rcs cti0 $ 'n0"6r9 #rin
cr #rsn c+ SM cii6in" c+n4tin6 4i -i!it"6i ncsr #ntr+ f+nc6inr #ti%"
7n$rs R%-r&9 H$ DT9 2338. cst #rcs9 c r $r#t sc# $ %Ai%i #rtici#r
#cint+!+i 'n c$r+ sci! #r#ri+9 #t fi $i0it 'n #tr+ t# A%inr9 str sc#+!+i9
trt%nt 4i 0!+r.
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PRT I. SPCT TRTIC
CPITLUL I. SCLRZ. SPCT INTRDUCTIV
#.#. D$%&'& &$
Sc!r %+!ti#!" 7SM8 st -!" n+r!&ic" in0!i$nt"9 c! %i frc0nt
$i&nstict" ! $+!t+! t
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D4i r&+%nt! #ntr+ %cnis%+! +ti%+n s+nt 0i$nt9 r+!tt! ni!r tr#ii
%$ic%nts s+nt $ifrit. Un s#ri;in 0!rs 'n intr$+cr ni!r tr#ii r#rint" i%&ri
#rin RMN. P
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In$ic! $ #r0!n6" st n+%"r+! $ c+ri $ -!" ! +n n+%it %%nt $t 7i+ $
#r0!n6"8 r#rtt ! 133.333 !c+itri. cst in$ic fr" c! %i -icti0 infr%6ii s+#r
frc0n6i -!ii. ricr r fi !tit+$in9 fctrii $ risc %$+!" #r0!n6. *ctrii $
s+sc#ti-i!itt &ntic"9 fctrii $ risc i %$i+!+i9 #rfsin!i9 !i%ntri 4i infc6i4i + fst
in$i0i$+!i6i f"r" s #+t ;+n& ! 0r cnc!+i9 'n c c #ri04t r!+! !r 'n
ti#t&ni SM.
In f%i!ii! $ -!n0i c+ SM 4i cir ! -!n0ii c+ SM s cnstt" frc0n6" crsc+t"
n+%itr fc6i+ni9 'n cr st i%#!ict sist%+! E.L.. $i-t ins+!in$#n$nt9 st%9 c!it"
+!crs"9 s#n$i!it" nci!nt"9 n0rit" crnic"9 %istni9 tiri$it"9 tc.
ri&in i%+nitr" +nr $in cst fc6i+ni st st-i!it" 4i $ci +n %cnis% $
c4i nt+r" r #+t fi i%#!ict 'n SM.
Prin crctr+! s"+ f+nc6in! sist%+! E.L.. ;c" +n r! $ #ri% r$in 'n $finir%$!it"6ii rcti0 i%+nitr +n+i r&nis%.
C! %i $isc+tt fctr A&n c r inf!+n6 SM st fctr+! n+tri6in!. P -
cr!6ii!r &&rfic s: s+&rt c" !i%nt6i -&t" 'n &r"si%i ni%! r fi scit" c+
#r0!n6" ri$ict" SM. In s#ri;in+! csti i#t n"sc+t $in #i$%i!&i &&rfic"9 +
fst 0ct r+!tt! crct"ri!r s+#r 0ri6ii!r c!itti0 cii!r &r4i i 6s+t+!+i
cr-r! 4i i %i!ini9 'n f+nc6i $ !i%nt6i. !i%nt6i -&t" 'n cii &r4i9 #!ist+r6i 4i
0it%in D r #+t A#!ic #r0!n6 sc"+t" SM ! #scrii nr0&ini. cst ns%-!+ $
f#t #"r+t $st+! $ crnt #ntr+ ;+stific st+$i+! ficcit"6ii r&i%+ri!r -&t 'n cii
&r4i nst+r6i 'n SM.
Cncrt9 $isc+t
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!i%nt6i -&t" 'n &r"si%i %"r4t ri&i$itt %%-rn!r c!+!r9 stf! c!+! st %i
+4r tct" $ nA $ifrit. $it" -&t" 'n +!i+ri r$+c cst" ri&i$itt %%-rn!".Dc"
s+nt st+$ii %+!ti#! cr s+s6in c" +n r&i% !i%ntr s"rc 'n !i#i$ r +n r! #iti0 'n 0!+6i
SM9 n+ Aist" st+$ii A#ri%nt! 4i c!inic cr s" $%nstr Aistn6 +n+i r#rt 'ntr
$ficit+! $ +!i+ri 4i n%!ii! #ri0in$ i%+nitt +%r!" 4i c!+!r" 'n SM.
Crctr #i$%i!&ic" s:r #+t $0!t 4i 'n !t $irc6ii. Pr&rs! cntin+i ! tnici!r
$ &ntic" %!c+!r" incit" ! st+$ir n+%itr s#ct $ #i$%i!&i &ntic" SM9 %i
!s 'n fr%! f%i!i!. Difrit! !%nt #i$%i!&ic c!inic 4i &ntic s+&r" c"9 SM
st -!" tr&n"9 $ +n$ intrs+! #tn6i! $ st+$i s#rt fr%! c+ #+s c+t 4i
fr%! c+ 0!+6i #r&rsi0"9 ! c"rr fctri $ risc r #+t fi $ifri6i.
R"s#
s%n!" c" $-+t+! c! %i frc0nt st c! -r+t!. D-+t+! -r+t! #t fi c+ +n sin&+r
si%#t% s+ c+ $+" s+ %i %+!t si%#t%. Mc LPIN -sr0" $-+t+! n+%i 'n #r#r6i $
5 $in c+ri9 r$in si%#t%!r fiin$ n0rit #tic" )(9 #rstii )5 4i $ficit+! %tr
2(. In c$r+! $-+t+!+i #!isi%#t%tic9 $ficit+! %tr st 'nt
$ #rstii 2( 4i n0rit #tic" 2. Dst+! $ frc0nt Aist" $-+t+ri c+ si%#t%t!&i
n+%i s+-icti0"9 ns#cific" +ni -!i n+r!&ic9 r#rntt" #rintr:+n t-!+ n0rtic. cst
ti# $ $-+t fst n+%it $ c"tr HILSN ti# =#r$is%inn$9 #+t
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Prsn!9 cnsi$r cst $-+t $st+! $ frc0nt 4i !:4 n+%i dbutpsudnurstnic,
crctrit #rin $+" %ri si%#t% c"rr $ %+!t ri n+r!&+! n+ ! $" tn6i c+0nit"
stni fizic prmnnt4i prstzii cu lclizr slttri. A%inr n+r!&ic" tnt"
'ns6it" $ A%in"ri #rc!inic 7i%+n!&i !ici$+!+i cf!ri$in9 rnn6 %&ntic"
n+c!r"8 n ;+t" s" #+n% $i&nstic+! $ SM #si-i!" 'n cst" f"9 0it
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Dc" !i+ni! s+nt %+!ti#! ! ni0!+! %isfr!r cr-r!9 #r t+!-+r"ri $ &
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D+#" cns+!t6ii %+!ti#! ! $ifrit si%#in intrn6in!9 KUR 71,38 #r#+s
$ifrit critrii c!inic $ $i&nstic 'n f+nc6i $ st$i+! c!inic ! -!ii.
stf! % 0
1. SM 0rifict" ! A%n+! nt%ic.
2. SM $finit" c!inic
: 0!+6i c+ #+s 4i r%isi+ni $ c! #+6in $+" ri9 s#rt $ c! #+6in !+n"
intr0!F
- : #r&rsi !nt" s+ 'n #+s r#tt 'ntin
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+n! s#it!. stf!9 critrii! !+i MC DNLD 4i ELIDO 71//8 ni s #r ! 'n$%
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#ri6i +ni sc"$ri c+it"6ii 0i+!9 #i ( !+ni %i t
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"+0 : $finit" c!inic r $+" fr%
1 : c
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CPITLUL II. FCTL SCLRZI MULTIPL I
RCUPRR N SCLRZ MULTIPL
2.#. T+/+&$ 1$ $,7&&+ & ,**+1*'+$
Un $in c! %i $rn;nt #ntr+ -!n0ii $ SM st t+!-+rr $ %-i!itt.
#rAi%ti0 /3 $in #cin6ii c+ SM #rint" $isf+nc6i %-i!it"6ii9 'nc$r
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Un sc+n # rti! s+ !t %i;!c $ $#!sr %trit # tri r6i #t fi frt +ti!
#ntr+ #cin6ii c+ SM %-+!trii. cst %i;!c $ $#!sr 'i ;+t" 'n cn%isir
nr&ii 4i 'n $#!sr c+ 0it" s#rit" # $istn6 %i %ri. Prscrir $c0t" sc+n+!+i
# rti! c $i%nsi+n9 s+#rt #i6i9 4i s#ct $#tti0 st sn6i!" #ntr+ %-i!itt
#ti%" c+ ;+tr+! sc+n+!+i r+!nt. $#t"ri! s#ci! c%#ns" cntr!+! ncrs#+n"tr
! tr+nci+!+i s+ s#s%! Atr%it"6i!r infrir.
Dficit! cr-!s 4i c&niti0 #t !i%it +nri +ti!ir in$#n$nt" sc+n+!+i
r+!nt. ! tr-+i tt+4i 'ncrct 4i 'n s%n sit+6ii9 $rc $ %+!t ri9 $+#" +n ti%#9
%i4c"ri! tAic s #t r$+c. List %i;!c!r +Ai!ir #ntr+ $#!sr -!n0i!r c+ SM
crsc+t n $ n9 $rc cst s+nt cnsi$rt #&rs cnsi$r-i! 'n sistn6 %$ic!"
4i sci!" -!n0i!r.
2.2. %$,)$$ *, 1$ ',/
Un !c i%#rtnt 'n 0i6 -!n0i!r c+ SM st #rfsi 7c+#6i8 4i r!Ar.
In #r# tt 6"ri!9 -!n0ii c+ SM '4i #ir$ sr0ici+! n+ n+%i $trit" in0!i$it"6i!r9
ci 4i $trit" t%ri!r c+t $ -!". *ctrii #rinci#!i cr '%#i$ic" nr% 'ntr&" #ntr+
-!n0ii c+ SM s+nt %-i!itt r$+s"9 ncr$nr9 $isf+nc6i 0icii9 -s!9 $ficit!
0i+!9 t+!-+r"ri! $ #rc#6i 4i c%+nicr9 $ific+!t"6i! $ trns#rt9 $#rsi9 ntici#rin0!i$it"6ii 4i t%ri! #trni!r.
Pr-!% c+#6in! ! -!n0i!r c+ SM tr-+i #+s $0r% 7%i !s c" -!n0ii
s+nt tinri89 $rc st %i +4r #ntr+ %ni s":4i %n6in"9 $c
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SM cr r"%
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s+ficint" 'n f#t+! c" #t s" %n6in" -!n0+! 'n $ifrit cti0it"6i sci!. C#iii9 'n s#ci!9
ncsit" ;+tr 'n 'n6!&r fct+!+i c '! r SM s+#r +n+i #"rint. i tr-+i s" fi
$s#0"r6i $ #rs+#+s c+!#" 4i si&+r6i $ #rn6 cntin+" $r&sti #"rint4ti.
In c! $in +r%"9 #cin6i!r tr-+i s" !i s %intsc" f#t+! c" st %i i%#rtnt cin
s+nt i $c
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Pcin6ii $0in c#-i!i s" cc#t r!itt $ 0 SM9 t
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cntin+"9 fiin$ $scris" c str
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SM st c +n 4c9 c sn6i $ c+rnt !ctric9 'nc#
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Disf+nc i c&niti0"9 t+!-+r"ri! % in! i c! #siic 'n SM s+nt 'nt
frc0nt. St+$ii ! !+i MNTRUIL 4i DRUSN 7118 rt" c" $trit" !i+ni!r $in
%isfr! cr-r!9 ! -!n0ii c+ SM s+nt #rnt t+!-+r"ri #siic $ intnsitt +4r" s+
%$rt"9 tMi s+nt 4i !t %ti0 cr A#!ic" cst" sit+6i # $ #rt $iscr$n6 r+!tt!r
st+$ii!r c !:+ fst cnscrt9 $iscr$n6" $t" $ $i0rsitt %t$!r $ st+$i+ f!sit 4i
$ 0ri-i!itt 4ntin!r st+$itF # $ !t" #rt9 snti%nt+! c" #+n ccnt+! # cst
t+!-+r"ri 'n -sn6 +ni tr#+tici ficint n+ fc $c
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Dtr" +nr #r-!% %t$!&ic !&t $ instr+%nt! f!sit #ntr+ ! sct
'n 0i$n6"9 $ 4ntin+! st+$it 4i $ &r+#+! $ cntr!. Tt+4i9 frc0n6 t+!-+r"ri!r c&niti0
fst 0!+t"9 'n %$ cn0r&nt9 'n %i %+!t !+cr"ri rcnt9 'n ;+r $ 55:(3 $in c+ri
7ROSR . M. 4i c!-rtrii9 1,3F TRULL 4i c!-rtrii9 1,/8.
Dficit+! int!ct+! 0i$nt ! A%n+! c!inic st %i rr 'nt
RKIMS P. .9 +ti!i s+nt %+!t %i si%#! 4i s+-ic6ii =nr%!i> tr-+i
s" -6in" nt %Ai%". R#i$itt 4i si%#!itt tst+!+i #r%it s" s #rc$ ! 0!+r9 f"r"
2
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0 c%#tn6" #si!&ic" $s-it". Cnsi$r"% $ s%n c" tst+! H..I.S. st
ncsr fi $scris9 $trit" f!sirii !+i %i frc0nt.
Scr $ int!i&n6" !+i HCESLR #ntr+ $+!6i 7tst+! H..I.S.8 st sc!"
c%#it"9 t!nt" # 0
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ni0! c+!t+r!. In sci%- s #t st-i!i cr!6i 'ntr intnsitt $ficit!r #siic 4i
0!+%+! 0ntric+!i!r cr-r!i 0i+!i6i #rin scnnr9 trfi cr#+!+i c!s9 ri Atnsii
!i+ni!r $%i!init9 -icti0t #rin rnn6" %&ntic" n+c!r" 4i $s%n9 c+
sc"$r %t-!is%+!+i cr-r! %"s+rt #rin t%&rf c%#+trit c+ %isi $ #itrni.
n+%i6i +tri + s+&rt c" $ficit! int!ct+! r #+t fi 'n r#rt9 fi c+ #rn6 +nr #!"ci
!tnt n+r!&ic9 fi c+ #rt+r-r cti0it"6i!r r&i+ni!r frnt!9 !&t" $ !c!ir
#rfrn6i!" #!"ci!r 'n r&i+ni! #ri0ntric+!r9 #r#iin$+:s stf! $ cnc#t+! $
=$%n6" s+-crtic!" . !6ii + s+-!init Aistn6 +ni 'nctiniri #rcs+!+i $ infr%6i9
cr r #+t fi ! ri&in $ficin6!r -sr0t 7LITN 4i c!-rtrii9 1,,8.
a) T+!-+r"ri! $ %%ri s+nt f"r" 'n$i!" c! %i frc0nt 4i c! %i st+$it.
#rAi%ti0 (3:,3 $in -!n0ii c+ SM + t+!-+r"ri %nic. K!n0ii c+ SM #rint" +n
cficint %nic infrir c+ 13 #+nct9 'n r#rt c+ ##+!6i cntr!9 #tri0it sc"rii $ %%ri !+i HCESLR. Difrit st+$ii + 0i$n6it $i%in+r c#cit"6ii $ 'n0"6r +n+i
%tri! 0r-! s+ nn:0r-!9 cr r fi !&t" $ $ific+!tt $ 'ncifrr s%ntic" s+ $
#rt+r-r %%rii $ !+cr+ 4i +n $ficit ! %%ri"rii $ $+rt"9 'n ti%# c %%ri
i%$it" #r #"strt". In fr%! #r&rsi0 $ SM + fst -sr0t !tr"ri ! c#cit"6i!r $
rc+n4tr.
T+!-+r"ri! $ %%ri n+ #r %i c!r cr!t c+ s0ritt n$ic#+!+i n+r!&ic
%"s+rt c+ scr BURZTB9 nici c+ $+rt -!ii9 $4i +n! st+$ii + s+-!init ccnt+r !r 'n
c+rs+! 0!+6ii -!ii. St+$ii! $ &r+# %sc" tr&nitt ##+!6ii. stf! R S. 4i
c!-rtrii + $istins tri &r+# $ #cin6i +nii #rnt+ #rfr%n6 %nic nr%!9
ci!!6i 0+ t+!-+r"ri %nic %$rt9 $s scit c+ $#rsi9 +!ti%ii #rnt+
t+!-+r"ri $ %%ri ccnt+t" cr r+ scit c+ #rt+r-"ri ! !tr f+nc6ii c&niti09 'ntr:+n
t-!+ $ $trirr int!ct+!" &!-!". C! tri &r+# n+ s $s-+ 'n f+nc6i $ $+rt s+
s0ritt -!ii. cst $t + fst cnfir%t 'ntr:+n st+$i+ fct+t $ NNBNS:
SCEINBL . 4i c!-rtrii 71389 # #cin6i c+ $istn6" 'ntr #+s. In cst st+$i+9 5(
$in #cin6i #rnt+ #rfr%n6 si%i!r c+ s+-ic6ii $ cntr!. Din ci r"%4i 71/
#cin6i89 2 r+ %nici9 ir 5 #rnt+ $ficit c&niti09 'n s#ci! 'n #r-! $ 'n0"6r
+$iti0:0r-!. T+!-+r"ri! $ %%ri r fi !&t $ 'nctinir #rcs!r $ trt%nt !
infr%6ii9 0i$n6it c+ +n tst s#ci!.
2(
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St+$i+! t+!-+r"ri!r c&niti0 fst #
st #ti%ist 'n c c #ri04t 0iitr+!. cst" str s $s-4t $ !-i!itt %6in!"
r
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c!-rtrii 71,89 Aistn6 +ni $#rsii9 $finit" #rin critrii! D.S.M. III9 fst -sr0t" !
5, $in #cin6ii c"rr -!" 0!+ $ %i #+6in $ $i ni 4i 1/ $in #cin6ii c"rr -!"
r %i 0c $ $i ni. S0ritt si%#t:%t!&ii $#rsii9 %"s+rt" c+ scr !+i
EMILTN9 r $ s%n %i ccnt+t" ! #cin6ii c"rr -!" r %i rcnt". D#rsi
st $ -ici %$rt"9 #cint+! fiin$ irit-i!9 $sc+r;t9 n!ini4tit9 &itt. nci$r 'n sin9
snti%nt+! $ 0in0"6i9 $intrs+!9 s+nt %i rr. Sin+ci$r fst -sr0t" ! 2:5.
+ fst #r#+s %i %+!t i#t #ntr+ A#!ic $#rsi scit" SM. I#t +ni
cinci$n6 s !04t $ %i %r frc0n6" $#rsii ! c4ti #cin6i9 $c
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n+ s+nt 'ns6it $ tr"ir s+-icti0"9 $ cr ! #t s" fi $iscit 7-!n0+! s#+n c" st trist 'n
c+rs+! +n+i ccs $ r
c. *bilitt minl si incntinn fctiv.S+nt $s cnf+n$t c+ r
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&"s4t +n s#ri;in 'n $%nstrr inf!+n6i sit+6ii!r $ strss s+#r rc6ii!r i%+n!&ic. C+
tt cst nici +n st+$i+ #+-!ict n+ f+rni" !%nt c #r%it s" s 0!+ inf!+n6
$ifrit!r !%nt cr intr0in 'n sit+6i $ strss 7nt+r s+rs!r $ strss9 0+!nr-i!itt
#si!&ic"9 nt+r rc6ii!r s+-ict+!+i 'n f6 sit+6ii!r $ strss9 s+#rt+! sci! tc.8
Mi %+!t st+$ii + s+-!init tt+4i inf!+n6 -nfic" #sitr#ii!r s+#r 0!+6ii
-!ii ! n+%i6i -!n0i c+ SM.
2.. S0()&,&))$
Spsticitt : st cr4tr tn+s+!+i %+sc+!r9 inf!+n6
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Dntri+% 7Si!$!+r$t8 s #t f!si c
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SEPIR 'nc$r" 'n si%#t%! #ri%r ! SM. -s! sci!" $ ! intnsitt
%$i ! frt ccnt+t". Mcnis%+! -s!ii n+ st c+nsc+t9 fiin$ #r--i! %+!tifctri!.
Drc %+!6i -!n0i incri%in" cr4tr -s!ii 'nint 4i 'n c+rs+! +n+i #+s+ c+t9 +n
c%#nnt ! %cnis%+!+i #t!&ic ! i9 s:r #+t #+n 'n !&"t+r" c+ $r&!"ri! sist%+!+i
i%+n.
-s! s ccnt+" c
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PRT II-. SPCT PRCTIC
CPITLUL III. RCUPERAREA CHILIRULUI N
RTSTTISM !I MRSULUI L LNVII D
SCLRZ MULTIPL
3.#. M)$+& ;& $)*1$
Sc!r %+!ti#!" 7SM8 st fc6i+n crctrit" #rin tri$ : inf!%6i9
$%i!inir9 &!i". r 0!+6i #r&rsi0" s+ 'n #+s 0!+ti0.
Print" t+!-+r"ri n+r%trii 7#r!iii9 s#sticitt9 tAi9 tr%r9 $is%tri9 0rti;9
$+rri n+r&n9 sc"$r fr6i %+sc+!r89 t+!-+r"ri ft!%!&ic9 c&niti09 $#rsi9
nAitt9 s+ $i%#tri0" +fri9 0s!i9 Acr-t.
Trt%nt+! $ r-i!itr s $rs" t+)9?$ r!it sc!" c+ 13 #+nct $ #rcir $i-i!it"6i!r 'n SM9 $ cr s 0
6in s% 'n #rscri#6ii! tr#+tic cr 0: fi #rntt" %i ;s.
Rc%n$r st c r-i!itr s" intr0in" #rcc9 c
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Binttr#i ncsit" strict" in$i0i$+!ir 'n c+! SM 4i c6in" 'n s#ci! s+#r
$i-i!it"6ii9 nintr0nin$ s+#r !i+ni!r s+ 'n sci%-r #r&rsii %!$ii.
Tr#i ntrn" #cint+! 'n cti0it"6i in$i0i$+! -t # 0!+r -!n0+!+i 4i s
0 cnstit+i 'n f+nc6i $ %ti06i cst+i. 7Er9 Hi!!i%s8
P+&',&0&&$ %&9&*)$+0&$& 0&,)$ ' ,$()/ ,$+,$)+$: @(7+'= D$ S*9
sti%+!r strt&ii!r $ %i4cr
sti%+!r 'n0"6"rii -i!it"6i!r %trii
'%-+n"t"6ir c!it"6ii %$!!r $ %i4cr
$i%in+r nr%!it"6ii tn+s+!+i %+sc+!r
ccnt+r #!ic"rii fiitr#ii f+nc6in!
f+rnir $ s+#rt #ntr+ %n6in %ti06i 4i c#rr #cint+!+i !tr#i
i%#!%ntr tr#ii!r #r0nti0
$+cr #cint+!+i #ntr+ 'n6!&r si%#t%t!&ii SM 4i c+% 'i fct"
cst 0i6 $ i c+ i.
S,*0+&$ %&9&*)$+0&$& 0&,)$ ' ,$()/ ,$+,$)+$: @/B$'+
%n6inr st-i!it"6ii #st+r! crct
cnsr0r 4i %!irr %-i!it"6ii rtic+!r #r0nir cntrct+ri!r 4i trfii!r %+sc+!r
%!irr f+nc6ii!r 0it!9 %i !s rs#ir6ii
%n6inr &r+t"6ii cr#r! 'n !i%it cc#t-i!
ini-r sc%!r %trii n$rit
cnsr0r # c
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st #rnt" 'n /, $in c+ri 7*r!8
0!+r 'n f+nc6i $ sc! s0rit"6ii fti&-i!it"6ii 7Br+##8
ti#+! $ fti&-i!itt 'n ti%#+! i!i
#ri$ $in i c
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' ()1& %',
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i$rtr#i 7t%#rt+r #i s" n+ $#"4sc" )3 $ &r$8
#ntr+ rntrnr #r#ric#6ii s f!s4t f$:-c c+ s%n!ir c+stic"
4i 0i+!"
tr#i c+#6in!".
Arci6ii! s Ac+t" $ 1:) ri # i9 15 i! cnsc+ti09 s+ i $9 +n n+9 %ini%+% 5:
( t# # n. 7Biss8
' ()1&&$ III ;& IV: @D$ S*9= F+$$'= >&((
#r&r%+! ntrir s cntin+"
#rfi!Ai sc!!r rt#$ic
0rtic!ir -!n0+!+i #ntr+ c%-tr t+!-+r"ri!r circ+!trii 4i
st#ri %s; -!
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tn6i Intnsitt Arci6ii!r s" n+ #r0c -s!" ccnt+t"9 cst s 0r $#t
#si-i!it"6i!r #cint+!+i.
N+ s 0r #rctic Arci6ii s+- ristn6"
(0$,)$ 0+)&,+$ $ ?&'$)*)$+0&$& ' ,9+&$ '1$ 0+$1*&'/ (&'1+*
7&0$+)*'&,:
)$'
t+!-+r"ri sniti09 0i+! s+ sfinctrin.
Pcin6ii tAici $%nstr" in-i!itt 'n r!i %i4c"ri! cr s!icit" %+4ci!r
c6i+n $ &r+#9 n+% cntrc6i.
)
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n %rs Aist" $ific+!t"6i 'n s#ri;in+! +ni#$! 'n %%nt+! cntrc6ii %+4ci!r
%%-r!r infrir9 cnc%itnt c+ ncsitt #ric6ii &r+t"6ii cr#+!+i s#r 'nint.
C%#nsr s r!i" $sri #rin ;+tr $ %rs9 $ A%#!+ c$r+! $ %rs.
Dficin6 #st+r! 'n tAi
!r$ !%-r" A&rt"
nt0rsi #!0is+!+i
f!Ai rtic+!6ii cA:f%+r!
i#rAtnsi &n+nci!r
&r+tt cr#+!+i 'n %rs st ! ni0!+! c"!c
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D'1+*$' : r$+c cntrc6i %+4ci!r9 'n s#ci! #ntr+ fi-r! r#i$9
$i%in+
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sc$ tn+s+! %+sc+!r
#r n%!ii $ #st+r" 7f!Ai c#si9 f!Ai !tr!" tr+nci+!+i8
f+nc6i %%-r!r s+#rir #t fi c%#r%is". st #rfr-i! c -!n0+! s"
fi sf"t+it s" n+ f!ssc" $ %-+!tr+! 4i c
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st sn6i!. *iitr#+t+!9 r&tr#+t+!9 #si!&+!9 + +n r! i%#rtnt 'n instr+ir
f%i!ii #ntr+ %ni#+!r -!n0+!+i 4i sti%+!r cst+i. 7Mc Q+n8
SM st +n $in c! %i c%#!A 4i 0ri-i! fc6i+ni 'nt
n c$r+! crct"rii nstr s:+ !+t 'n st+$i+ 1) $ #cin6i c+ c!4i $i&nstic c!inic 4i
ti# $ 0!+6i ! -!ii9 #rc+% 4i c+ si%#t%t!&i s%"n"tr9 f!6i 'n st$ii! 1:5 cnfr%
sc!i $scris $ B+rt9 cst fiin$ +n critri+ %;r $ s!c6i. S:+ fct+t 2 $ 4$in6
$ inttr#i s#cific" 'n #ri$ f-r+ri:%rti 23119 $ tri ri # s"#t"%
%trii.
3: A%n n+r!&ic nr%!
1: f"r" $isf+nc6i9 $r c+ s%n %ini% 7K-insi #iti09 s%n #r%trii tAii9
sc"$r snsi-i!it"6ii ! 0i-r6i8
2: $ficit %ini%! 7+4r" s!"-ici+n s+ ri&i$itt9 +4r" t+!-+rr %rs+!+i9
n'n$%
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,: $isf+nc6i cr -!i&" ! r"%
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n cst st+$i+ % #rnit $ ! #rs+#+nr c" 'n #ri%! st$ii ! sc!ri %+!ti#! +n
#r&r% $ inttr#i ri&+rs9 c+ $; in$i0i$+!it 4i fct+t $ tri ri # s"#t"%
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*i&. 1 ]2(^
. f!JAiJ Y JAtJnsiJ c#+!+i 7-!n0+! #r#iJ -"r-i $J #iJ#t Yf!JAi c#+!+i9
#i $+cJ c#+! #J s#tJ Y#ri0J4tJ 'n s+s _JAtJnsi c#+!+i98
-. !tJr! $rJ#t Y st
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*i&. 2 ]2(^
K!n0+! st" 'n $Jc+-it $rs! c+ -r6J!J #J !
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*i&. ) ]2(^
St
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*i&. ]2(^
ntins #J #t s+ #J s!tJ9 'n $Jc+-it $rs!9 -r6+! 'ntins #J !
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*i&. 5 ]2(^
: %i4c"ri $J $$+c6iJ 4i -$+c6iJ #!icJ!+i $J #!%"9
: tin&JrJ $J&Jt+!+i %ic c+ $J&Jt+! %rJ 7#i6iJ8.
: %i4c"ri $J rt6iJ %
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8 $in #i6i $J $Jc+-it $rs!9 ntJ-r6+! 'n +n&i $rJ#t #J -r69 sJ rtJ4tJ
ntJ-r6+! stfJ! 'nc
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- c
*i&. , ]2(^
8 %i4c"ri $J rt6iJ in rtic+!6i &!JnJi 7rt6iJ JAtJrn" +r%t" $J rt6i intJrn"
c+ fiJcrJ &!Jn" 'n #rtJ9 #i rt6i intJrn" %-J!r &!JnJ $t"F
-9 c8 $in $Jc+-it $rs! c+ +n &Jn+nci 'n$it9 sJ ri$ic" %J%-r+! infJrir #+s
'ntins $Js+#r #t+!+i9 'ncJt9 13:25 c%F sJ c-r" tt 'ncJt #J #t 4i #i sJ rJi c+ cJ!"!!t
%J%-r+ infJrir. Dc" %i4crJ JstJ $ifici!" #Jntr+ -!n0 sJ #tJ ;+t c+ #!%J!J crJ sJ
#!ic" #J #t 'n $rJ#t+! rJ&i+nii $rs!J infJrirJ.
. VAJrci6ii #Jntr+ &!JnJ 4i #icirJ 7fi&. 9 - 4i c8
-
52
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c
*i&. ]2(^
8 $in $Jc+-it $rs!9 sJ fcJ f!JAi 4i JAtJnsi #icir+!+i #J &%-" 71 4i 28F
-8 $in $Jc+-it $rs!9 -$+c6i 4i $$+c6i si%+!tn" #icirJ!r 'n rtic+!6i &!JnJ!r
71 4i 28F
c8 $in $Jc+-it $rs!9 f!JAi 4i JAtJnsi $J&JtJ!r #icirJ!r.
13. VAJrci6ii #Jntr+ tr+nci 7fi&. 13 9 - 4i c8
-
c
*i&. 13 ]2(^
5)
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Grfic nr.).) R#rint" scr+ri! -6in+t $ c"tr #cin6i ! tstr ci!i-r+!+i cr#r! $+#"
sc! Kr&
L tst+! Ti%$ U# n$ G % cnsttt #r&rs t
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Grfic nr. ). R#rint" 0!ri! 0!+6ii ci!i-r+!+i cr#r! 'n c+! #cin6i!r inc!+4i 'n
sc! B+rt 3:5
T-! nr. ).2. T-! cntr!itr ! r+!tt!r tst"rii ci!i-r+!+i $+#" sc! Kr&
,7&&+
,*+0*+
Mdi
scrurilr
initil
Mdi
scrurilr
finl
Mdi
scrurilr d
difrn
Scr ttl scl
Arg
SCL
R"
3K=3J 4J=6 K=3J 56
5(
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T-! nr. ).). R+!tt! ini6i! 4i fin! ! tst!r =Ri$ic":t 4i %r&i> 4i =Ri$ic":t 4i %r&i crn%trt>
Nr.crt. 1. 2. ). . 5. (. /. ,. . 13. 11. 12. 1).Pcin6i KR G LC CM M GM D M* LS KD T B SA * * * * * M * M * M * * *
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Difrn6
ntr cttii!
ini6i! 4i fin! I*
1 3 1 2 5 1 3 3 2 3 2
Difrn6 'ntr
ti%#+!
crn%trt ini6i!
4i fin! I*
sc. / sc. 5 sc. 11 sc. 12 sc. 1 sc. , sc. ( sc. / sc. 1 sc. / sc. ) sc. sc
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Grfic nr. ).5 R#rint" 0!ri! 7'n sc+n$8 -6in+t ! tst+! =Ri$ic":t 4i %r&i
Grfic nr. ).( R#rint" 0!+6i #iti0" #cin6i!r ! tst+! =Ri$ic":t 4i %r&i crn%trt>
c+ntifict 'n sc+n$
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3.6. C*',9&&$ ()1&&
R-i!itr st #rt sn6i!" trt%nt+!+i 'n SM. Prtic+!rit"6i! s+nt !&t $0ri-i!itt %r si%#t%t!&ii9 $ nt+r f!+ct+nt"9 #r&rsi0" 4i i%#r$icti-i! -!ii :
st-i!ir +nr -icti0 r!ist cr s" 6in" cnt $ n0i! 4i rs+rs! finncir9 sci!9
%6in! 4i 0c6in! ! #cin6i!r. Rc+#rr r !c cntin++9 t
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CNCLUZII
SM #rJ fi -! 'n crJ sJ -6in rJ+!ttJ cJ! %i #+6in stisf"c"trJ $in #+nct $J
0J$JrJ ! J0!+6iJi #J tJr%Jn !+n&. n ci+$ %J$ic6iJi %intitJ %i s+s9 c+ ti%#+! strJ#ciJn6i!r sJ 'nr"+t"6J4tJ. n nici !t" -! nJ+r!&ic" n+ s+nt fJcttJ t
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T+!-+r"ri!J +rinrJ s+nt frtJ frJc0JntJ9 0
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ILI"RFI
W$!Jr9 S.S.9 KJcJrs9 D.9 K+c9 M. 7233,8: PN* in #rcticJ: n i!!+strtJ$ &+i$J9
V$it+rJ S#rin&Jr9 H+r-+r& Wn$rnJsc+9 W. 71/8: Wnt%i f+nc6in!" sistJ%+!+i nJr0s cJntr!9 V$it+r
Di$ctic" 4i PJ$&&ic"9 K+c+rJ4ti
K";Jnr+ a.9 723358 Gi$+ri $J $i&nstic i trt%Jnt 'n nJ+r!&iJ9 J$. W%J!tJ9
K+c+rJ ti
Cr$+n9 M. 72338: Binntr#%JtriJ9 V$it+r PrJss9 K+c+rJ4ti
D+%itr+9 D. 71,18: Gi$ $J rJJ$+crJ f+nc6in!"9 V$it+r S#rt:T+ris%9
K+c+rJ4ti E
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NsJ@rt?9 .E. 723338: M+!ti#!J sc!Jrsis9 V$it+rJ MJ$.23339 Vn&!n$
Prtri$&J9 C. 723328: NJ+r!&ic! #?sitJr#?: KsJ f J0i$JncJ fr #rcticJ9
V$it+rJ H+rr P+-!isJrs9 USW
S-Jn&J9 T. 71,/8: BinJt!&iJ #rfi!ctic"9 tJr#J+tic" 4i $J rJc+#JrrJ9 V$it+r
MJ$ic!"9 K+c+rJ4ti
Sc#ir9 R.T. 7118: M+!ti#!J sc!Jrsis. W rJ-i!itin ##rc t
%n&J%Jnt9 V$it+rJ DJ%s P+-!ictins
SJrc9 . 723358: Mn+! $J inJttJr#iJ #Jntr+ #JrsnJ c+ sc!Jr" %+!ti#!"9
MS MJ!s-rJ KJ!&i
St%ti+9 I.C. 71,8: Sc!Jr %+!ti#!"9 V$it+r MJ$ic!"9 K+c+rJ4ti
tt#@@@.s%r%ni.rrs%b-! tt#@@@.scri-$.c%$c1/)55,/Sc!Jr:%+!ti#!
tt#@@@.sft+!%J$ic+!+i.rSc!Jr:%+!ti#!sc!Jr:%+!ti#!b)2)
tt#@@@.#irsn.rn+ttisc!Jrb%+!ti#!.t%!
tt#@@@.@rn&$i&nsis.c%%%+!ti#!Jbsc!JrsistrJt%Jnts.t%trJt%Jntb$
isc+ssi n