과목명 : 임상생체역학실습 교수명 : 황 성 수 교수님 발표일 : 발표자 : 박 용 신

Presentation on theme: "과목명 : 임상생체역학실습 교수명 : 황 성 수 교수님 발표일 : 발표자 : 박 용 신"— Presentation transcript:

1 과목명 : 임상생체역학실습 교수명 : 황 성 수 교수님 발표일 : 2007. 6. 7 발표자 : 박 용 신
사례 보고서 과목명 : 임상생체역학실습 교수명 : 황 성 수 교수님 발표일 : 발표자 : 박 용 신

2 General information 성명 : 김 O O 성별 : M 나이 : 56세
진단명 : Double hemiplegia d/t bilateral ACA area infarction (Rt.>Lt.) 본원에 입원하여 약 3개월 정도치료 받았음

3 Subjective information
Onset PI - 기도 중 쓰러짐. 서울복지병원에서 진단 받음. Lt. ICA stent 시술( ) PHx. - HTN, L-HNP, knee OA C/C - 몸통을 가누기가 어렵고 오른다리 힘이 약하다⇒ 일상생활을 어렵게 한다. Pt’s goal - 일상생활 독립적으로 하기(화장실 사용, 이동 등), 걷기(가능하면 혼자서)

4 Objective information
Sensory Rt. Lt. Superficial (light touch, pain, Tem.) Intact Deep (pressure, vibration) Proprioception (Jt. Position) Impaired (nearly intact)

5 Objective information
Muscle tone - MAS Rt. Lt. U/E G 1 G 0 L/E G 1~1+

6 Objective information
Passive ROM - Generally full ROM without Hip flexion & extension Rt. Lt. Hip flexion (with knee flexion) normal Hip flexion (with knee extension) 65⁰ 70⁰ Hip extension (with knee flexion) 0⁰ 10⁰ Hip extension (with knee extension)

7 Objective information
MMT Rt. Lt. Trunk flexor F Trunk extensor Trunk rotator To Lt.: F+, To Rt.: F Quadratus lumborum Hip flexor (with knee flexion) F+ G Hip flexor (with knee extension) P+ Hip extensor (with knee flexion) Hip extensor (with knee extension) P Hip abductor

8 Objective information
Functional ability Assist grade Roll-over Ind. Sit up Min. Sit to stand Mod. ~ Min. Transfer(W/C↔bed) Gait Max. ~ Mod. Balance - functional balance grade sitting Static: Good Dynamic: Fair ~ Good standing Static: Poor ~ Fair Dynamic: Poor ~ Fair

9 Objective information
Sitting posture

10 Objective information
Standing posture

11 Objective information
Transfer Rolling

12 Objective information
Come to sit Sitting balance 1

13 Objective information
Sitting balance 2 Sitting balance 3

14 Objective information
Sit ↔ stand Standing balance 1

15 Objective information
Standing balance 2 Standing balance 3

16 Assessment – problem list
Core stability 부족 ⇒ Trunk stability(esp. lower part) & mobility 감소(esp. rotation) Obesity(esp. abdominal part), Abdominal m. weakness, hip flexor shortening ⇒ pelvic malalignment(lumbar curve ↑) 형성 및 pelvic mobility 감소

17 Assessment – short term goal 1
Core stability 향상 A: patient B: spinal stabilization, trunk movement.(esp. lower part) C: supine, sitting, standing position active or active-assistive ex. D: 15 Min.

18 Assessment – short term goal 2
Pelvic realignment A: patient B: pelvic tilting ex., Abdominal m. strengthening, hip flexor lengthening C: hooklying, sitting, standing position active or active-assistive, resistive ex. D: 15 Min.

19 Assessment – long term goal
Dynamic sitting & standing balance 증진을 통해 일상생활 능력 향상 A: patient B: trunk의 movement를 동반한 여러 가지 activity(공 주고받기, 배드민턴 등), 일상생활 동작 연습 C: supine, sitting, standing position active or active-assistive ex. D: 10 Min.

20 Plan Adm. 1 time(40Min.)/day, 5 times/week
치료실에서 치료사와 함께 운동치료 ward re-education ⇒ pelvic movement, sit to standing 1 month later reassessment

21 Treatment Spinal stabilization

22 Treatment Trunk rotation movement re-education

23 Treatment Balance training 치료 후 모습

24 Treatment Activity

25 감사합니다!!