康复治疗技术规范
第一篇物理治疗 ............................................................................................8第一章 功能评定................................................................................................................................8
第一节身体形态评定......................................................................................................................8
一、姿势........................................................................................................................................8
二、身高与体重............................................................................................................................9
三、肢体长度和围度....................................................................................................................9
第二节关节活动范围测量............................................................................................................10
一、四肢关节..............................................................................................................................10
二、脊柱关节.............................................................................................................................. 11
第三节肌力评定............................................................................................................................12
一、徒手肌力评定......................................................................................................................12
二、等速肌力评定......................................................................................................................14
三、其他器械肌力评定..............................................................................................................15
四、肌肉耐力评定......................................................................................................................16
第四节肌张力评定........................................................................................................................16
一、手法评定..............................................................................................................................16
二、仪器评定..............................................................................................................................18
第五节感觉评定............................................................................................................................19
一、浅感觉..................................................................................................................................19
二、深感觉..................................................................................................................................20
三、复合感觉..............................................................................................................................20
第六节平衡评定............................................................................................................................21
一、临床观察..............................................................................................................................21
二、量表评定..............................................................................................................................22
三、仪器评定..............................................................................................................................24
第七节协调评定............................................................................................................................24
一、上肢......................................................................................................................................24
二、下肢......................................................................................................................................25
第八节步行评定............................................................................................................................26
一、步行能力..............................................................................................................................26
二、步态分析..............................................................................................................................26
第九节心血管评定........................................................................................................................28
一、心率......................................................................................................................................28
二、血压......................................................................................................................................29
三、心电分级运动试验..............................................................................................................30
四、简易运动试验技术..............................................................................................................31
第十节呼吸评定............................................................................................................................32
一、通气功能..............................................................................................................................32
二、代谢当量..............................................................................................................................34
三、心肺联合运动试验..............................................................................................................34
第十一节 疼痛评定........................................................................................................................35
一、压力测痛法..........................................................................................................................36 2/262
二、视觉模拟评分法..................................................................................................................36
三、疼痛问卷..............................................................................................................................37
附录..................................................................................................................................................38
附表1-2-1 上肢关节活动范围测量.......................................................................................38
附表1-2-2下肢关节活动范围测量.......................................................................................38
附表1-2-3 脊柱关节活动范围测量.......................................................................................39
附表1-3-1上肢肌肉徒手肌力检查.......................................................................................40
附表1-3-2 下肢肌肉徒手肌力检查.........................................................................................52
附表1-3-3 躯干肌肉徒手肌力检查.........................................................................................59
第二章 运动治疗..............................................................................................................................63
第一节关节活动范围训练............................................................................................................63
一、被动关节活动范围训练......................................................................................................63
二、主动-助力关节活动训练.....................................................................................................64
三、主动运动..............................................................................................................................65
第二节关节松动技术....................................................................................................................66
一、上肢......................................................................................................................................66
二、下肢......................................................................................................................................68
三、脊柱......................................................................................................................................68
第三节牵伸技术............................................................................................................................69
一、上肢......................................................................................................................................69
二、下肢......................................................................................................................................70
三、躯干......................................................................................................................................70
第四节肌力训练............................................................................................................................71
一、徒手肌力训练......................................................................................................................71
二、等长肌力训练......................................................................................................................72
三、等张肌力训练......................................................................................................................72
四、等速肌力训练......................................................................................................................73
第五节步行训练............................................................................................................................74
一、步行前训练..........................................................................................................................74
二、步行训练..............................................................................................................................75
第六节呼吸训练............................................................................................................................76
一、腹式呼吸训练......................................................................................................................76
二、抗阻呼气训练......................................................................................................................77
三、深呼吸训练..........................................................................................................................78
四、局部呼吸训练......................................................................................................................78
五、排痰训练..............................................................................................................................79
六、呼吸肌训练..........................................................................................................................79
第七节平衡与协调训练................................................................................................................80
一、无器械平衡训练..................................................................................................................80
二、简易设备平衡训练..............................................................................................................81
三、仪器平衡训练......................................................................................................................82
四、协调训练..............................................................................................................................82
第八节有氧训练............................................................................................................................83 3/262
一、器械有氧训练......................................................................................................................83
二、无器械有氧训练..................................................................................................................84
第九节神经发育疗法....................................................................................................................84
一、Brunnstrom技术...................................................................................................................84
二、Bobath技术..........................................................................................................................86
三、PNF技术..............................................................................................................................88
第十节运动再学习........................................................................................................................92
一、上肢功能训练......................................................................................................................93
二、口面部功能训练..................................................................................................................94
三、卧位到床边坐起及坐位平衡训练......................................................................................94
四、站起与坐下训练..................................................................................................................95
五、站立平衡训练......................................................................................................................96
六、行走训练..............................................................................................................................97
第十一节 医疗体操........................................................................................................................97
一、偏瘫......................................................................................................................................98
二、颈椎病................................................................................................................................ 100
三、腰椎间盘突出症................................................................................................................101
四、肩周炎................................................................................................................................ 102
五、膝关节骨关节炎................................................................................................................103
六、脊柱侧凸............................................................................................................................104
第十二节 牵引治疗......................................................................................................................105
一、腰椎牵引............................................................................................................................105
二、颈椎牵引............................................................................................................................106
第三章 物理因子治疗....................................................................................................................107
第一节 电疗法..............................................................................................................................108
一、直流电疗法........................................................................................................................108
二、直流电药物离子导入疗法................................................................................................109
三、低频电疗法........................................................................................................................ 110
四、中频电疗法........................................................................................................................ 111
五、高频电疗法........................................................................................................................ 111
第二节光疗法.............................................................................................................................. 116
一、红外线疗法........................................................................................................................ 116
二、紫外线疗法........................................................................................................................ 116
三、激光疗法............................................................................................................................ 118
第三节磁疗法.............................................................................................................................. 119
一、静磁场疗法........................................................................................................................ 119
二、动磁场疗法........................................................................................................................120
第四节超声波疗法......................................................................................................................120
一、超声波疗法........................................................................................................................120
二、超声药物透入疗法............................................................................................................122
第五节冷疗法..............................................................................................................................122
一、冷疗法................................................................................................................................ 122
二、冷冻疗法............................................................................................................................123 4/262
第六节热疗法..............................................................................................................................124
一、石蜡疗法............................................................................................................................124
二、湿热袋敷疗法....................................................................................................................125
三、泥疗法................................................................................................................................ 126
第七节压力疗法..........................................................................................................................126
一、正负压疗法........................................................................................................................126
二、负压疗法............................................................................................................................127
三、正压顺序循环疗法............................................................................................................128
第八节肌电生物反馈疗法..........................................................................................................129
第二篇作业治疗 ........................................................................................131
第一章 作业评定............................................................................................................................131
第一节作业表现层次..................................................................................................................131
一、作业需求............................................................................................................................131
二、日常生活活动....................................................................................................................132
三、工作.................................................................................................................................... 133
四、生存质量............................................................................................................................135
第二节作业构成层次..................................................................................................................136
一、手功能................................................................................................................................ 136
二、知觉功能............................................................................................................................138
三、认知功能............................................................................................................................146
第三节物理环境..........................................................................................................................149
一、家居和社区环境................................................................................................................149
二、工作环境............................................................................................................................150
第二章作业治疗..............................................................................................................................152
第一节作业表现层次..................................................................................................................152
一、日常生活活动....................................................................................................................152
二、娱乐与休闲活动................................................................................................................156
三、职业康复............................................................................................................................157
第二节 作业构成层次..................................................................................................................162
一、功能性作业活动................................................................................................................162
二、手功能................................................................................................................................ 167
三、知觉功能............................................................................................................................173
四、认知功能............................................................................................................................177
第三节环境改造与辅助............................................................................................................178
一、自助具适配........................................................................................................................178
二、助行器使用........................................................................................................................179
三、轮椅选择与使用................................................................................................................181
四、环境适应与改造................................................................................................................184
第四节 矫形器制作与使用..........................................................................................................185
一、矫形器制作........................................................................................................................185
二、矫形器使用........................................................................................................................186
三、压力衣制作与使用............................................................................................................187 5/262
第三篇言语治疗 ........................................................................................188
第一章听力障碍..............................................................................................................................188
第一节评定技术........................................................................................................................189
一、主观测听............................................................................................................................189
二、客观测听............................................................................................................................190
第二节治疗技术........................................................................................................................190
一、声音察觉训练....................................................................................................................190
二、声音辨别训练....................................................................................................................191
三、声音识别训练....................................................................................................................191
四、声音理解训练....................................................................................................................192
五、助听器和电子耳蜗应用技术............................................................................................192
第二章失语症.................................................................................................................................. 192
第一节评定技术........................................................................................................................192
一、失语症................................................................................................................................ 192
二、口面失用症........................................................................................................................196
三、言语失用症........................................................................................................................197
第二节治疗技术........................................................................................................................198
一、听理解治疗技术................................................................................................................198
二、阅读理解治疗技术............................................................................................................200
三、言语表达治疗技术............................................................................................................201
四、书写表达治疗技术............................................................................................................203
五、实用交流能力技术............................................................................................................204
六、辅助交流技术....................................................................................................................204
第三章 构音障碍............................................................................................................................207
第一节评定技术........................................................................................................................207
一、呼吸评定............................................................................................................................207
二、喉功能评定........................................................................................................................208
三、口唇评定............................................................................................................................209
四、下颌评定............................................................................................................................210
五、软腭评定............................................................................................................................ 211
六、舌评定................................................................................................................................ 212
七、反射评定............................................................................................................................214
八、言语评定............................................................................................................................215
第二节治疗技术........................................................................................................................216
一、舌感觉运动技术................................................................................................................216
二、口唇感觉运动技术............................................................................................................217
三、下颌运动技术....................................................................................................................218
四、软腭感觉运动技术............................................................................................................219
五、声带运动技术....................................................................................................................220
六、呼吸训练技术....................................................................................................................220
七、发音训练技术....................................................................................................................221
八、语调音量训练技术............................................................................................................222 6/262
九、交流辅助系统应用技术....................................................................................................222
第四章 吞咽障碍............................................................................................................................223
第一节评定技术........................................................................................................................224
一、口面部评定........................................................................................................................224
二、吞咽功能评定....................................................................................................................225
三、摄食吞咽评定....................................................................................................................227
四、吞咽失用评定....................................................................................................................229
五、录像吞钡造影检查............................................................................................................229
第二节治疗技术........................................................................................................................231
一、颈部放松及口周肌群训练................................................................................................231
二、咳嗽训练............................................................................................................................232
三、门德尔松手法....................................................................................................................233
四、屏气吞咽训练....................................................................................................................234
五、吞咽反射促通技术............................................................................................................234
六、电疗.................................................................................................................................... 235
七、球囊扩张技术....................................................................................................................235
八、进食训练............................................................................................................................236
第五章 发声障碍............................................................................................................................238
第一节评定技术........................................................................................................................238
一、发声的客观评定................................................................................................................238
二、声质的评定........................................................................................................................239
第二节发声训练治疗技术........................................................................................................239
一、基础发声训练....................................................................................................................239
二、发声矫治训练....................................................................................................................240
第六章口吃...................................................................................................................................... 242
第一节评定技术........................................................................................................................242
一、儿童口吃评定....................................................................................................................242
二、成人口吃评定....................................................................................................................243
第二节治疗技术........................................................................................................................244
一、儿童口吃治疗....................................................................................................................244
二、成人口吃治疗....................................................................................................................245
第七章 唇腭裂................................................................................................................................ 247
第一节评定技术........................................................................................................................247
一、器官结构及功能评定........................................................................................................247
二、语音评定............................................................................................................................248
第二节治疗技术........................................................................................................................249
一、发声异常训练....................................................................................................................249
二、腭咽闭合不全训练............................................................................................................250
三、构音训练............................................................................................................................251
第八章 儿童语言发育迟缓............................................................................................................252 7/262
第一节评定技术........................................................................................................................252
一、物体操作评定....................................................................................................................252
二、语言发育能力评定............................................................................................................253
三、语言发育相关能力评定....................................................................................................254
四、交流态度评定....................................................................................................................255
第二节治疗技术........................................................................................................................256
一、事物及事物状态理解训练................................................................................................256
二、事物基本概念的理解训练................................................................................................256
三、事物的符号理解训练........................................................................................................257
四、词句及句子主要成分理解训练........................................................................................258
五、句子及语法规则的理解训练............................................................................................259
第九章 孤独症语言障碍................................................................................................................260
第一节评定技术........................................................................................................................260
第二节治疗技术........................................................................................................................260
一、孤独症语言交流训练........................................................................................................260
二、孤独症治疗技术对语言的影响........................................................................................262 8/262
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