integumentary physical therapycontents.kocw.net/kocw/document/2014/honam/leedongryul1/5.pdf ·...
TRANSCRIPT
Integumentary Physical Therapy
피부계 물리치료학
Dong-Ryul Lee, PT, Ph.D. Movement Impairment Specialist
& Performance Enhancement Specialist
Neurofeedback, Robotics & Virtual Reality Research
Specialites: NeuroRehabilitation & Pediatric Rehabilitation
Wounds : Pressure Ulcer
• Definition • result of pressure, or
pressure in combination with shear and/or friction
• localized injuries to the skin and/or underlying tissue • that usually occur over
a bony prominence
Wounds : Pressure Ulcer
• Etiology • lesions caused by
unrelieved pressure resulting in • ischemic hypoxia
• and damage to underlying tissue.
Acidosis (산성)
: Metabolic acidosis may result from
• increased production of metabolic
acids
• or disturbances in the ability to
excrete배설하다 acid via the kidneys
• Contributory Factors (4- 주요원인)
• Shear forces (전단력: 연부조직과 평행하게 힘을 받음)
• Prolonged pressure (압력: 연부조직에 수직으로 힘을 받음)
• Friction (마찰력: 연부조직에 평행하게 작용)
예) 환자를 운반차에서 침대로 끌어당겨 옮길 때
• Maceration (짓무름)
• softening associated with excessive moisture
• Impaired Mobility (운동장애) • By limited ROM, M. strength ↓, 의료장비 사용시
• By 환자 체위변경의 의지 無 통증 or 우울증으로 인해
• By 통증 인지능력 감소 약물 or UMNL / LMNL으로 통증인지 능력 감소시
• Nutritional deficiency (영양실조)
• 저알부민혈증
• Repetitive stress
Wounds : Pressure Ulcer
• Risk Factors
• Elderly, debilitated쇠약, or immobilized individuals.
• Decrease blood flow from hypotension or microvascular disease: • diabetes, atherosclerosis.
• Neurologically impaired skin: • decreased sensation.
• Cognitive impairment.
Wounds : Pressure Ulcer
• Clinical features
• Location: occurs over bony prominences, • i.e., sacrum, heels, trochanter, lateral
malleoli, ischia areas, elbows.
• Color: red, browniblack, or yellow.
• Localized infection.
• Pain: can be painful if sensation intact.
• Inflammatory response with necrotic tissue: • Hyperemia충혈, fever, increased WBC.
• If left untreated, will progress from superficial simple erosion짓무름 to involvement of deep layers of skin and underlying muscle and bone.
Wounds : Pressure Ulcer
• Classification : Graded by stages of severity
(tissue damage)
Wounds : Pressure Ulcer
Partial thickness loss of dermis
Subcutaneous fat may be visible
Exposed bone, tendon or muscle
Non-blanchable redness
• Exam & Evaluations • For Prevention (예방)
검사방법
Braden Scale for predictiong pressure sore risk (브레이든 압력궤양 위험 예측 척도)
Norton risk assessment scale (노턴 위험평가 척도)
Gosnell pressure sore risk assessment scale (고스넬 압력궤양 위험평가 척도)
• For evaluation (평가) 검사방법
Sessing scale (세싱 척도) : 상처와 상처주의의 특성을 관찰척도로 평가
: 7점 척도 (0-6점, 점수↑ 압력궤양 심 )
Bates-Jensen wound assessment tool (BWAT, 베이츠-젠슨 상처평가도구)
: 상처와 상처주의의 특성을 평가/15개 항목, 5점 척도 (1-5점, 점수↑ 압력궤양 심 )
Pressure Ulcer Scale for Healing (PUSH)
Wounds : Pressure Ulcer
• Exam & Evaluations • For Prevention (예방)
Braden Scale for predicting pressure sore risk (브레이든 압력궤양 위험 예측 척도)
Wounds : Pressure Ulcer
• Exam & Evaluations • For Prevention (예방)
Braden Scale for predicting pressure sore risk (브레이든 압력궤양 위험 예측 척도)
Wounds : Pressure Ulcer
• Exam & Evaluations • For Prevention (예방)
Braden Scale for predicting pressure sore risk (브레이든 압력궤양 위험 예측 척도)
Wounds : Pressure Ulcer
• Exam & Evaluations • For Prevention (예방)
Norton risk assessment scale (노턴 위험평가 척도)
Wounds : Pressure Ulcer
• Exam & Evaluations • For evaluation (평가)
검사방법
Sessing scale (세싱 척도) : 상처와 상처주의의 특성을 관찰척도로 평가 : : : 7점 척도 (0-6점, 점수↑ 압력궤양 심 )
Bates-Jensen wound assessment tool (BWAT, 베이츠-젠슨 상처평가도구)
: 상처와 상처주의의 특성을 평가/15개 항목, 5점 척도 (1-5점, 점수↑ 압력궤양 심 )
Pressure Ulcer Scale for Healing (PUSH)
Wounds : Pressure Ulcer
• Exam & Evaluations • For evaluation (평가)
검사방법
Sessing scale (세싱 척도) : 상처와 상처주의의 특성을 관찰척도로 평가 : : : 7점 척도 (0-6점, 점수↑ 압력궤양 심 )
Bates-Jensen wound assessment tool (BWAT, 베이츠-젠슨 상처평가도구)
: 상처와 상처주의의 특성을 평가/15개 항목, 5점 척도 (1-5점, 점수↑ 압력궤양 심 )
Pressure Ulcer Scale for Healing (PUSH)
Wounds : Pressure Ulcer
• Exam & Evaluations • For evaluation (평가)
검사방법
Sessing scale (세싱 척도) : 상처와 상처주의의 특성을 관찰척도로 평가 : : : 7점 척도 (0-6점, 점수↑ 압력궤양 심 )
Bates-Jensen wound assessment tool (BWAT, 베이츠-젠슨 상처평가도구)
: 상처와 상처주의의 특성을 평가/15개 항목, 5점 척도 (1-5점, 점수↑ 압력궤양 심 )
Pressure Ulcer Scale for Healing (PUSH)
Wounds : Pressure Ulcer
• Physical Therapeutic Intervention
운동치료 물리적 인자치료 의학적 처치
활동중심중재 약물, 수술
• 유연성 운동(Flexibility Ex.)
• 근육강화 운동 (Strengthening Ex.) • UE : to 체위/자세변경 • LE: to 이동/보행 • 골반바닥근, 배근육 : 실금 동반 환자의 경우
• 유산소운동 (Aerobic Ex.)
• 보행훈련 (Gait training)
• 전기자극 (ES) • Grade II, III, IV
• UV, US, NPWT
• 압력궤양 치유 Help
• PL(흡입 맥동세척) or Whirlpool (회전욕) • 생물학적 부하가 높
거나 감염된 상처시…
• 약물치료 - 치매관련 약물
• 압력궤양 위험↓ • 상처치유 촉진o
- 항생체 치료 • + 감염, 연조직염, 골
수염, 패혈증 있을 경우
• 외과수술 - 죽은조직제거 : Grade III-IV - 근육피부판이식 (Musculo-
cutaneous flap)
Wounds : Pressure Ulcer
• Physical Therapeutic Intervention
Wounds : Pressure Ulcer
운동치료
자세 취하기(positioning)
30도의 법칙
(30s angle law)
도수치료 - 피부 굴리기(skin
rolling )
도수치료 - 상처이완술(scar tissue release)