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Ngu van 6 tiet 92 - phuong phap ta nguoiDân Phạm Việt
Đây là phần hướng dẫn học sinh lớp 6 Học tốt bài Ngữ văn 6 - Tiết 92 - Phương pháp tả người - Có trên trang Văn Tiểu học - vantieuhoc.com - Thầy cô và quý phụ huynh vào trang này để tải nhanh, tải miễn phí bài
giảng điện tử này về để tư liệu giảng dạy. Các em cũng có thể xem toàn bộ bài giảng này để giúp phần soạn bài của các em tốt hơn. Cảm ơn thầy cô và các bạn đã xem video này ! Học tốt ngữ văn 6, Bài giảng ngữ văn 6, Ngữ văn 6, Học văn 6, viết văn Lớp 6, viết văn hay, văn mẫu Lớp 6,Tập làm văn 6, Ngữ văn 6, Tiết 92, Phương pháp tả người
Giáo trình Máy Xây Dựng - Nguyễn Phước Bình - ĐHBK Đà Nẵngshare-connect Blog
Download tại
http://share-connect.blogspot.com/2014/12/giao-trinh-may-xay-dung-nguyen-phuoc-binh.html
Tên Ebook: Giáo trình Máy Xây Dựng. Tác giả: Nguyễn Phước Bình - ĐHBK Đà Nẵng. Định dạng: PDF. Số trang: 88. Nhà xuất bản: . Năm phát hành: 2004
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The material in the presentation kit is designed to give viewers an understanding of the use of botulinum in the management of focal spasticity in adults. The presentation covers definitions of spasticity in the overall spectrum of management of adult spasticity and some details of the development of Allergan’s BOTOX and mechanisms of action. The presentation goes on to look at doses, injection techniques and finally reviews some outcome studies and cost benefit analysis of the use of the drug. The presentation has been compiled from existing presentations available world wide, as well as the experience of Australian physicians over the past decade.
This presentation focuses on the use of botulinum in the reduction of focal adult spasticity. In rehabilitation medicine the focus of treatment is on reducing disability and handicap in individuals with spasticity and the presentation will emphasise goal setting and the aim of improving function following the use of botulinum as a treatment to be integrated into the other treatments the patient receives such that an optimal response
The listed conditions may all cause an upper motor neurone syndrome, leading to neurological deficits that can adversely affect patient function. It should be noted that the development of spasticity is not immediate, and that muscles are often initially hypotonic or even flaccid. Spasticity can gradually develop days or even months following the initial event.
Spasticity is one component of the upper motor neurone syndrome that includes positive and negative symptoms. The positive symptoms include spasticity, clonus, hyper-reflexia, dystonia and rigidity and the negative symptoms include decreased dexterity, weakness, paralysis, fatigability and slowness of movement.
Negative symptoms are important in a functional sense as these deficits can limit the degree of functional benefit achieved when there is reduction of spasticity. Reducing spasticity can initially lead to apparent loss of function due to impaired dexterity (loss of fine motor planning skills resulting from the CNS injury) and underlying muscle weakness. When these negative symptoms are exposed, individuals will often need specific therapy interventions to strengthen muscles and retrain the use of movement in order to achieve the goals of improved function.
The direct consequences of spasticity leading to muscle shortening, muscle weakness and the over-activity of the stretch reflex, are noted as disabling consequences of spasticity. Other effects include the development of contractures and it should be noted that spasticity can be painful.
It can be emphasised that the overall concern in therapy is therefore to stretch shortened muscles, to strengthen antagonist muscles, to learn muscle relaxation techniques and to retrain the use of muscles in order to improve function. It is worth noting again in the presentation of this slide that reducing spasticity can unmask underlying weakness of muscles.
Whilst the pattern of spasticity is not specific to one cause, generalised spasticity, which is diffuse and affects multiple regions of the body is most often associated with traumatic brain injury and multiple sclerosis, regional spasticity affecting a large area of the body is most often associated with spinal cord injury, and focal spasticity, which is localised to a particular area, is often a characteristic of spasticity following stroke.
There are typical patterns of adult spasticity associated with the upper motor neurone syndrome. Lower limb spasticity commonly affects extensor muscles, which effectively increases leg length. This affects the swing phase of gait, such that an individual either has to circumduct the leg or “hitch” the hip during the gait cycle. This subsequently leads to difficulties in the speed of walking, balance and increased energy expenditure during the gait cycle.
Hip adduction as seen on the left side picture results in a narrow base of support with the feet crossing midline during the swing phase of locomotion, like walking on a tight rope.
Equinovarus will preferentially load the lateral boarder of the forefoot producing pain and instability as well as potential for skin breakdown.
A patient with hallux hyperextension is depicted here. Patients often do not practice full plantar weight bearing support (in an effort to reduce the reflex response to toe extension), have difficulty wearing normal shoes, and there is a propensity for skin breakdown and pain on the dorsal surface of the big toe due to constant pressure of the toe on the inner surface of the shoe.
Specifics of the muscles involved in the patterns of spasticity often encountered in the lower limb are presented, with some examples of the benefits of reducing spasticity around the knee, hip and ankle.
It should be noted that not all muscle groups are affected in all patients and that the functional consequences of spasticity in a muscle group is also influenced by the strength of the antagonist muscle.
In the upper limb, there is very commonly a predominant flexor pattern, which can functionally lead to a symmetry of gait and reduced balance, problems with reaching and thus in some individuals, limiting the use of intact distal movement, where proximal spasticity leads to an internally rotated adducted shoulder and flexed elbow.
In this slide, the muscles involved in the patterns of spasticity from proximal to distal in the upper limb are presented, with functional benefits of spasticity reduction being outlined.
Pre-injection examination of the patient should include a neurological examination and some direct measures of the effects of the spasticity such as the use of the Ashworth Scale and/or Tardieu scale. Goniometry of joints surrounded by muscles with increased tone prior to injection can also be useful. From a rehabilitation perspective, measures of patient function are particularly important. These can include measures of gait parameters such as velocity of gait, step width and step length. Disability measures such as Functional Independence Measure and motor functions such as measured by the Motor Assessment Scale.
Patient self report of the efficacy of the treatment is also important to record.
Modalities used in the treatment of spasticity are outlined. In general, the treatment measures are listed, commencing with the least invasive physical modalities and concluding with surgical intervention.
The use of botulinum toxin as a treatment modality in focal spasticity can be emphasized as one that can be integrated with physical therapy, oral medications (if still needed), and surgical treatments. It should be emphasized that this integrative approach is often the most successful in maximizing functional recovery.
In using the range of modalities outlined in previous slides for the management of focal adult spasticity, it must be emphasised that there should be clear functional objectives of the treatment, which align the technical objectives of the immediate consequences of improved range of movement of a joint, with the improvement of function that will be a consequence of this improved range of movement. It should be emphasised here that the patient and/or care giver objectives and expectations must also be taken into account. In consultation between the treating physician and the patient and/or care giver is essential to ensure that the goals set are realistic and achievable. Other aspects of the patient’s condition, such as cognitive and emotional function may influence the final outcome.
The Royal College of Physicians have produced a management strategy for the treatment of adult spasticity, which again makes the point that the management strategy needs to involve the team and the patient and again considers spasticity in terms of generalised, focal and regional.
This slide gives broad overview of the main drawbacks involved in the medical treatment of spasticity. With particular reference to the treatment of focal spasticity, it could be further noted that, with the use of alcohol and phenol in nerve or motor point blocks, the injections can be technically more difficulty and time consuming than with the use of botulinum toxin, as greater accuracy is required in targeting the motor point, whereas botulinum toxin has a clear lack of tissue toxicity. Typically there is no pain related to injection of the botulinum product other than the needle stick. Thus, the use of Botulinum overcomes some of the procedural difficulties of using phenol. Patients can tolerate the procedure and there is no risk of sensory dysesthesias, and tissue necrosis as is associated with phenol injections.
