1. Concept
Rehabilitation evaluation refers to the objective, qualitative or quantitative description of the functional status and level of the sick, injured or disabled, and the results The process of making reasonable explanations is also called functional assessment.
2. Content
Rehabilitation assessment is divided into clinical assessment and functional assessment.
Functional assessment includes individual functional assessment and overall functional assessment
Examination content includes:
General information
Chief complaint: The patient’s most important complaint Main symptoms or signs and duration of onset
History of current illness
Past history
Personal history
Marital and childbearing history
Family history
Physical examination
Functional assessment: physical function, speech (communication) function, mental and psychological function and social adaptation function. Physical function includes muscle strength assessment and muscle tone assessment. , joint mobility assessment, gait analysis, balance and function assessment, and hemiplegic motor function assessment.
3. Purpose
To clarify the nature of functional impairment
To clarify the scope of functional impairment
To clarify the degree of functional impairment
Clarify rehabilitation goals and treatment plans
Evaluate rehabilitation treatment and prognosis judgment
4. Reliability
Reliability (reliability), also known as dependability, It refers to the degree of repeatability and stability of the assessment method, expressed by the reliability coefficient (coefficient).
Including intra-group and inter-group reliability tests.
The intra-group reliability test is a test where the same group of subjects uses the same assessment method to conduct two assessments at a certain interval. It tests the impact of the time interval on the stability of the assessment results. It is also called test-retest reliability. Spend.
The inter-group reliability test is the consistency of different evaluators using the same evaluation method to evaluate the same group of patients to estimate the objectivity of the evaluators.
5. Validity
Validity (validity), also known as accuracy, refers to the authenticity and effectiveness of the measurement method. It means that the evaluation effect of a set of evaluation methods meets the purpose of evaluation. extent.
The characteristics of the subject's dysfunction indicated by the assessment
Reflect the severity of the dysfunction
Method: Correlation validity (correlation check) gt ; Construct validity (existing assessment methods) gt; Content validity
6. Sensitivity
Sensitivity means that the selected assessment method should be sensitive to the content being assessed, that is, it can measure Produce meaningful changes in a subject's characteristics, behavior, or degree.
True positive? / (false negative, true positive) A criterion for test validity
7. Specificity
Specificity refers to the application of a specific method When assessing groups without a certain functional impairment, there may be true negatives (no functional impairment and the assessment results confirm it) and false positives (no functional impairment but the assessment results show that there is a functional impairment).
True negative? / (False positive, true negative) A standard for testing validity
1. Qualitative assessment
Grasp the "quality" of the research object
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2. Quantitative assessment
Quantitative assessment of grade data: muscle strength assessment, life activity assessment, various scales, etc.
Measurement data assessment: joint mobility ( °), stride length (cm), muscle strength test (N.m)
3. Workflow
Initial assessment: Assessment upon admission
Mid-term assessment: Patients who recover quickly are recommended to be assessed once every 1 to 2 weeks; for patients who recover slowly, they can be assessed once every 3 to 4 weeks
Terminal assessment: assessment before discharge
Rehabilitation medicine The main purpose is not to pursue a "cure" of the disease, but to focus on restoring the patient's functions to the maximum extent so that the patient can return to society.
The degree of independence is divided into four levels:
Completely independent (no dependence required)
Mostly independent (a small amount of dependence)
Small Partially independent (mostly dependent)
Unable to be independent (completely dependent)
Note:
For the correct assessment method, the measured value must be compared with the normal reference value Contrast, compare the left and right sides of the body
Master the appropriate assessment time, and the time for each assessment should not be too long to avoid causing patient fatigue
Handle the communication between doctors and patients, and actively win over patients and their families Support
Let the same evaluator evaluate the patient's functional status, and it is not appropriate to change the evaluator during the evaluation at different periods
To prevent accidents
1. Human Morphology Measurement
Physical fitness assessment
Muscle strength: refers to the ability of muscles to overcome internal and external resistance when working, static strength and explosive strength
Endurance: refers to the human body The ability to perform muscle work for a long time
Speed: reaction speed, action speed and displacement speed of periodic movements
Balance and coordination: Balance refers to the balance of the human body, no matter where it is, at rest, The process of automatically adjusting and maintaining posture when exercising or under the action of external forces; coordination refers to the human body's ability to produce smooth, accurate, and controlled movement. It requires movement to have a certain direction, rhythm, appropriate distance, speed, and movement. Muscle strength to accurately reach the sports target.
Sensitivity: refers to the human body's ability to quickly, accurately and coordinately change body posture, switch actions and adapt to various circumstances under various complex situations. It is the comprehensive expression of motor function and physical fitness in sports activities. Generally, there are visual inspection method and game measurement method.
2. Evaluation of joint mobility ※
Range of motion (ROM), also known as joint range of motion, refers to the movement of the distal end of the joint toward or away from the proximal end , the angle between the new position reached by the distal bone and the proximal bone.
During the measurement, except for the forearm rotation test, when the palm is in the sagittal plane, which is 0°, all other joints are divided into active joint mobility, which is 0° when the limb is in the anatomical position.
and passive range of motion.
Active joint mobility reflects the degree of joint activity and muscle strength; passive joint mobility reflects the nature of the joint at the end of the activity.
Those who are unable to move actively but have normal passive movement are often caused by nerve paralysis or muscle or tendon rupture;
Those who are partially limited in both active and passive movements are often caused by joint stiffness , mainly caused by intra-articular adhesion, muscle spasm or contracture, or long-term joint immobilization;
Those who are unable to move actively or passively often have joint stiffness, indicating that there is bone between the bones that make up the joint. or strong fiber connections.
First evaluate the active range of motion of the joint, then evaluate the passive range of motion, and compare it with the evaluation results of the corresponding joints on the contralateral side.
1. Shoulder joint
Flexion and extension. ? Flexion: 0° ~ 170°, extension 0° ~ 60°
Abduction, adduction. ? Abduction: 0° ~ 170°, adduction 0° ~ 45°, adduction: the shoulder joint is in a flexion position of 20° ~ 45°, and the upper limb moves inward from the front of the body
External rotation, internal rotation Spin. ? External rotation: 0° ~ 90°, internal rotation: 0° ~ 90°
Horizontal flexion, horizontal extension. Take a sitting position, abduct the shoulder joint 90°, extend the elbow, palms downward, horizontal flexion 0° ~ 135°, horizontal extension 0° ~ 30°
2. Elbow joint
Flexion, extension. Flexion 0° ~ 145°, extension 0°, hyperextension 0° ~? 5°
3. Forearm
Pronation and supination. Pronation 0° ~ 90°, supination 0° ~ 90°
4. Wrist joint
Palmar flexion and dorsiflexion. Palmar flexion 0° ~ 90°, dorsiflexion 0° ~ 70°
Radial deviation and ulnar deviation. Radial deviation is 0° ~ 25°, ulnar deviation is 0° ~ 55°, inner ulnar and outer radial
5. Fingers
1. Metacarpophalangeal joint (MP)
Flexion, extension. Flexion 0° ~ 90°, extension 0° ~ 45°
Abduction, adduction. Abduction or adduction 0° ~ 20°
2. Proximal interphalangeal joint (PIP)
Flexion and extension. Flexion 0° ~ 100°, extension 0°
3. Distal interphalangeal joint (DIP)
Flexion and extension. Flexion 0° ~ 90°, extension 0° ~ 10°
6. Thumb
Abduction and adduction. Abduction 0° ~ 60°, adduction 0° ~ 60°
Palmar abduction, volar adduction. Palmar abduction 0° ~ 90°, volar adduction 0° ~ 90°
Opposite palm
Metacarpophalangeal joint (MP). Flexion 0° ~ 60°, extension 0° ~ 10°
Interphalangeal joint (IP). Flexion 0° ~ 80°, extension 0° ~ 10°
7. Hip joint
8. Knee joint
9. Ankle joint
10. Cervical vertebrae
11. Thoracic vertebrae and lumbar vertebrae
(omitted)
1. Basic concepts
Muscle strength refers to The maximum force produced when a muscle or muscle group contracts, divided into static muscle strength and dynamic muscle strength.
Muscle strength assessment refers to the assessment of the contraction force of muscles or muscle groups during active exercise, and is used to evaluate the functional status of muscles.
2. Classification of muscles
Prime mover muscles: also called agonist muscles, are the main action muscles that initiate and complete an action.
Antagonist muscle: A muscle that acts in the opposite direction to the prime mover, that is, a muscle that opposes the direction of movement and acts as an antagonist.
Fixator muscles: In order to give full play to the role of the prime mover, the bones at its relatively fixed end must be fully fixed. The muscles involved in the fixation are the fixator muscles.
Synergist muscles: Cooperate with the prime mover muscles and contract together with the prime mover muscles or muscle groups
3. Types of muscle contraction
Isometric contraction: only A form of contraction in which muscle tension changes while the length remains essentially unchanged. The tension is equal to the applied resistance and the muscle length remains unchanged.
Isotonic contraction: A form of contraction in which only the length of the muscle changes but the muscle tension remains basically unchanged.
Concentric contraction: It is characterized by the muscle starting and ending points being close to each other and the muscle length shortening, the tension is greater than the external resistance, and the muscle length is shortened, such as swinging the arm, raising the leg, etc.
Eccentric contraction : Specifically, the starting and ending points of the muscles are far away from each other and the muscle length is increased. The obstacle is less than the external resistance and the muscle length is lengthened, such as squatting, running downhill, jumping from high places, etc.
4. Indications and contraindications
Contraindications:
Local inflammation, joint effusion, joint instability, acute sprains
Severe local pain
Severe heart disease or high blood pressure
5. Precautions
Necessary demonstration and patient cooperation
Reduce interfering factors, such as pain, fatigue, clothes that are too thick or too tight, etc.
Avoid adverse reactions, such as increased blood pressure, increased heart load, etc.
Avoid compensatory exercise
6. Result recording and analysis
Result record:
Muscle strength level: 0 ~ 5, indicate " ", "-" when necessary
If the ROM is limited, the range should be recorded
If there is spasm, contracture, pain, etc., it should be noted
Result analysis:
Muscle When assessing strength, pay attention to the comparison between the healthy side and the affected side
7. Assessment method
Manual muscle strength assessment and instrument muscle strength measurement
Grip dynamometer
p>Pinch dynamometer
Tensile dynamometer
Isometric muscle strength test bench
Isokinetic exercise tester: fixed speed, keep the equipment moving at a uniform speed .
Measurement parameters
Parameters for isokinetic motion measurement
Peak moment: the highest point of the torque curve, the unit is N*m
Optimum force angle: the corresponding joint angle when peak torque is generated? ==gt; Joint angle torque curve
Time to reach peak torque: the time from the beginning of muscle contraction to reaching peak torque, the unit is seconds (Explosive force) ==gt; Time torque curve
Torque acceleration capability (explosive force): the amount of work done in the first 1/8 s of the torque, or the area covered
Peak Torque to body weight ratio
Muscle work amount, the work done in one contraction, can be measured multiple times, take the maximum value
Endurance ratio = average peak torque of the last 20 contractions / first 20 Average peak torque of contraction * 100
Antagonist muscle moment ratio: ratio of prime mover to antagonist muscle torque
Joint range of motion
Gravity effect torque
1. Basic concept
Muscle tone refers to a sustained, small, involuntary contraction of muscle tissue in a resting state.
The essence is? Tonic stretch reflex
2. Abnormal muscle tone
Increased muscle tone: spasm (speed-dependent, the higher the speed, the more prone to occur)/stiffness (compared with spasticity, stiffness is relatively continuous and does not depend on the speed of passive movement, that is, no speed dependence)
Hypotonia: muscle relaxation and weakness, passive movement resistance is weakened or even Disappear
Dystonia: Muscle contraction is fast or slow, repetitive movements, twisting deformities and a series of involuntary movements, etc. Muscle tone is usually unpredictable
3. Equipment inspection
p>Biomechanical examination method
Electrophysiological examination method
4. Assessment criteria for spasticity
Modified Ashworth classification method
Penn grading method
Clonus grading method
5. Assessment criteria for hypotonia
Mild
Moderate to mild
6. Precautions
Pay attention to choosing the right time and the right environment. It is best to choose the same time period for assessment before and after treatment
Pay attention to the problem of comorbidities. Fully understand the patient's physical condition and eliminate the influence of drugs and other factors
(omitted)
1. Basic concepts
Coordination function: Coordination is also called *** Economic. Refers to the ability to produce smooth, accurate, and controlled movement, which requires appropriate speed, distance, direction, rhythm, and muscle strength.
Coordinated movement: refers to the fact that under the control of the central nervous system, muscle groups related to a specific movement or action work together in a certain spatio-temporal relationship, resulting in smooth, accurate, and controlled movement.
Coordination dysfunction: Coordination dysfunction is also called dystaxia. Coordination dysfunction refers to abnormal movements characterized by clumsy, unbalanced, and inaccurate movements.
2. Coordination dysfunction and damage to the central nervous system
Characteristics of coordination dysfunction in cerebellar insufficiency
Poor spacing: drawing circles or horizontal 8 Word test
Intention tremor: The closer the hands and feet are to the target, the more obvious the tremor
Postural tremor
Alternating dyskinesia: difficulty completing rapid alternating movements
Motor dissociation: When completing an action, it is not a smooth movement, but a series of motor components
Coordination dysfunction characteristics of basal ganglia insufficiency (Parkinson, sequelae of stroke) ※
Resting tremor: tremor at rest, reduced after activity
Akinesia: difficulty in initiating movement
Athetosis: extremities, trunk, and face Slow, involuntary twisting movements of parts
Hemichorea
Muscle tone disorder
Coordinated movement disorder characteristic of posterior cord insufficiency (fine The sense of touch and consciousness decreases or disappears. Without the help of vision, the position and direction of movement of joints cannot be known, and the sense of two-point discrimination and vibration sense also disappear)
Balance disorder
Abnormal gait
Poor spacing
3. The purpose and content of coordination function assessment
The purpose of coordination function assessment
Coordination function Contents of assessment
Whether the starting and stopping movements are accurate
Whether the movement is smooth and smooth
4. Assessment of non-balanced coordination function (the body is not in an upright position)
5. Balance and coordination function assessment (body in upright position)
Here we take part of the concept of coordination function assessment - fine coordination dysfunction, and set a level for coordination within the plane range. Standards, not for assessment of coordination dysfunction
1. Motor control dysfunction caused by damage to the central nervous system
Abnormal muscle tone.
The spasms mainly occur in the antigravity muscles, with flexor type spasms in the upper limbs and extensor type spasms in the lower limbs
Abnormal movement patterns. Synkinesis is distinguished from dissociation
An abnormality in reflexes. In the early stage of stroke, the muscle tone of the affected limb is low and the reflexes are lost; in the middle stage of stroke, the deep reflexes are hyperactive, and joint reactions of spasm and synkinesis occur.
Movement of the unaffected side causes involuntary movement of the affected side, and movement of the upper limb causes involuntary movement of the lower limb
Others
2. Assessment of motor control function
Assessment of muscle tone
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Modified Ashworth classification
Penn classification
Clonus classification
Assessment of abnormal movement patterns
Brunnstorm Assessment method 0 ~ 5 levels
0 Chilling stage
Spastic stage
Synkinesis stage
Partially dissociated movement stage
Separation movement stage
Normal stage
Bobath assessment method
Fugl-Meyer assessment method
Plastic cup from Move from one side to the other (the plastic cup cannot be deformed)
Move the jelly beans from one container to another
Draw horizontal lines to meet vertical lines, and place them ten times within 20 seconds (At least 5 encounters with vertical lines)
Reflection judgment
Joint reaction judgment
Evaluation of other obstacles
1. Barthel Index Evaluation
Barthel Index is the most commonly used daily life evaluation method in China.
1. Content
Barthel is divided into 10 items, divided into 0 5 10 15 according to whether help is needed and the degree of need for help, with a total score of 100 points
Eating
Dressing
Bowel control
Urinary control
Going up and down stairs
Going to the toilet
Grooming: Wash your face/brush your teeth/comb your hair/shave your face
Take a bath
Transfer
Walk
2. Judgment of results
lt; 20: Severe functional impairment
lt; 40: Needing a lot of help in life
lt; 60: Needing help in life
gt; 60 : Basic self-care
3. Precautions
Focus on what the patient can do, rather than what is possible or should be achieved
2. Assessment of functional independence
1. Functional independence measure (functional independent measure) has a patent and is difficult to apply in China
Self-care 6 items* 7 = 42
Sphincter control 2 Items* 7 = 14
Transfer ability 3 items* 7 = 21
Motor ability 2 items* 7 = 14
Communication 2 items* 7 = 14
Social 3 items* 7 = 21
2. Result Judgment
126: Completely independent
108 ~ 125: Basically independent
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90 ~ 107: Very mild dependence or conditional independence
72 ~ 89: Mild dependence
54 ~ 71: Moderate dependence
36 ~ 53: Severe dependence
19 ~ 35: Extremely severe dependence
18: Complete dependence
5. Assessment of mental and psychological functions
6. Assessment of speech and swallowing functions
7. Assessment of quality of life and social functions
8. Assessment of rehabilitation of common clinical diseases
1. Brain Rehabilitation assessment after vascular accident
1. Associated reaction
Associated reaction refers to the induction of related muscles on the affected side when resistance exercise or active exertion is performed on a certain part of the body. Involuntary tension increases or motor reactions occur.
Contralateral combined reaction: Movement of the unaffected side causes increased tension in certain muscle groups on the affected side
Ipsilateral combined reaction: Movement of the upper limb causes certain muscles of the lower limb Increased group tension
2. Synergy movement
Synergy movement, also known as synergy or coordinated movement, is a pathological abnormal movement pattern. It means that after a brain injury, when a patient moves a certain joint of the affected limb, he cannot perform single-joint movements, but the adjacent joints or even the entire limb undergo an uncontrollable identical movement.
3. Abnormal postural reflexes
Tonic reflex
Balanced motor reflex
4. Abnormal muscle tone
2. Rehabilitation assessment after spinal cord injury
Spinal Cord Injury (SCI, Spinal Cord Injury)
The spinal cord is the main pathway for transmitting motor and sensory information between the brain and the body, and is the central Components of the nervous system.
Total length 42 ~ 45 cm, 31 segments, namely 8 cervical segments (C1 ~ C8), 12 thoracic segments (T1 ~ T12), 5 lumbar segments (L1 ~ L5), 5 sacral segments (S1 ~ S5) and one telson.
3. Cerebral palsy rehabilitation assessment
Cerebral palsy (CP) in children refers to non-progressive symptoms caused by various reasons from before birth to within one month after birth. Brain injury syndrome.
4. Post-fracture rehabilitation assessment
Classification
Whether it is connected to the outside world: open fracture (the bone is connected to the outside world) and closed fracture
Fracture degree: complete fracture and incomplete fracture
Fracture fixation: stable fracture and unstable fracture
Fracture shape: transverse, displaced, Comminuted fracture