创伤性脊髓损伤物理医学治疗.pptVIP

* 呼吸功能管理 如果可以，安静状态下使用腹式呼吸模式 深呼吸训练 吞咽呼吸 – 使用声门来吞咽一口空气到肺里面，以此增加吸气量。对于呼吸机依赖的患者可能有用 胸壁活动 在坐位下考虑腹肌的支持 (举例, 用一根绳索) 来改善静脉回流和增加血容量 体位引流，叩诊，振动排痰，吸痰 人工辅助咳嗽 治疗师或者患者把手放在上腹部 咳嗽随着手向上向内的压力同时快速进行 MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury Assisted Cough MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury * 呼吸功能管理 高位颈段损伤患者( C3 及以上) 将依赖呼吸机进行呼吸 C3-5 损伤患者可能要在夜间睡眠时使用呼吸机 MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury * 皮肤护理 患者（或护工）应该检查有压疮倾向的皮肤区域，至少一天一次 高位颈段损伤患者应当两小时翻身一次 轮椅应该有恰当的压力缓冲垫 骨盆应该放置在中立对称的位置上 在轮椅上患者应该每15分钟缓解下受压部位的压力(独自或者依靠帮助) 撑起 侧倾 前倾 MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury 侧倾Side Lean 撑起Push Up 前倾Forward Lean MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury * Skin Care If the patient develops an ulcer, the patient should be referred to a wound care specialist to facilitate healing and to prevent infection Patient should not put pressure on the ulcer until it is healed - for example, a patient with a right greater trochanter ulcer cannot lie on the right side until the wound is healed MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury * Early Strengthening and Range of Motion Exercises Strengthen all innervated muscles Watch for substitution For example, patient may use shoulder external rotators to substitute for elbow extensors Do not stretch Finger flexors to protect tenodesis Lower trunk muscles so that patient can lean on ligaments for sitting Stretch Hamstrings - to assure a straight leg raise to 100 degrees Hip flexors – to assure patient has 10 degrees of hip extension Ankle plantar flexors – to assure patient has 10 degrees of dorsiflexion MODULE C4/CSDLM/2013/NR Traumatic Spinal Cord Injury * Sitting Patient usually experiences postural hypotension in sitting or standing Initially, bring the patient to sitting slowly Use an abdominal binder and elastic (pressure) stockings to assist venous return Gradually elevate the head and upper trunk in bed May also use a tilt-in-place wheelchair with elevating leg rests or a tilt table Bi