Geriatrie: kuni
Inhoud
2 Kuni deel 1................................................................................................................................5
Terminologie...............................................................................................................................5
AH / NAH.....................................................................................................................................6
CVA..............................................................................................................................................6
Vormen CVA............................................................................................................................6
Preventie.................................................................................................................................7
FAST.........................................................................................................................................7
Gevolgen van hersenletsel..........................................................................................................7
Rechter hersenletsel VS linker hersenletsel...........................................................................7
Motorische symptomen..........................................................................................................7
tractussen................................................................................................................................8
Hemiplegie/parese..................................................................................................................8
Gezicht.................................................................................................................................8
Tractus cortico spinalis............................................................................................................9
Tractus corticospinalis lateralis...........................................................................................9
Tractus corticospinalis anterior...........................................................................................9
Somatopische organisatie, tractus corticospinalis lateralis (1a)............................................9
Plaats hersenletsel en motorsiche uitval..............................................................................10
stadia van brunstrom............................................................................................................11
Tonus.....................................................................................................................................11
Posturale controle.................................................................................................................11
Stabiliteit...........................................................................................................................11
Mobiliteit...........................................................................................................................12
Orientatie (actieve controle van uitlijning en tonus)........................................................12
spacticiteit.............................................................................................................................12
Spacticiteit vs rigiditeit......................................................................................................13
Meetinstrumenten spasticiteit.........................................................................................13
Behandeling spasticiteit....................................................................................................14
Stadie van brunnstrom......................................................................................................14
Synergie (pathologisch).....................................................................................................14
1
, Pushersyndroom...................................................................................................................15
Diagnose: EXAMENVRAAG: nakijken in cursus.................................................................15
Prognose...........................................................................................................................16
Behandeling......................................................................................................................16
Tonische reflexen..................................................................................................................16
Asymetrische tonische nekreflex......................................................................................17
Gekruiste strekreflex.........................................................................................................17
grijpreflex..........................................................................................................................17
symetrische tonische nekreflex........................................................................................18
positieve steunreflex.........................................................................................................18
andere motorische gevolgen................................................................................................18
3 kuni deel 3..............................................................................................................................18
Terminologie.............................................................................................................................19
Sensomotoriek..........................................................................................................................19
Initiatie/ feedback.................................................................................................................19
sensoriek...................................................................................................................................19
zintuigen................................................................................................................................20
exteroceptie......................................................................................................................20
Interoceptie.......................................................................................................................21
Beperkingen..........................................................................................................................22
Therapie............................................................................................................................22
feedforward:.....................................................................................................................23
extrinsieke feedback.........................................................................................................23
Afwezigheid sensoriek = wat met motoriek.........................................................................24
motorisch leren (lashey)...................................................................................................25
Motorisch leren (Schmidt)................................................................................................25
Motorisch leren (Newell)..................................................................................................25
Cognitie.....................................................................................................................................26
Er is een cognitieve hierarchie:.............................................................................................27
Cognitive disabilities model..................................................................................................27
level 6: geplande acties.....................................................................................................28
Level 5: explorerende acties.............................................................................................28
Level 4: doelgerichte acties...............................................................................................29
2
, ...........................................................................................................................................29
Level 3: manuele acties.....................................................................................................30
...........................................................................................................................................30
Posturale acties.................................................................................................................30
...........................................................................................................................................30
level 1: automatische acties.............................................................................................30
Level bepalen....................................................................................................................31
gebruik..............................................................................................................................31
neglect.......................................................................................................................................31
Pijn.............................................................................................................................................31
Diagnose................................................................................................................................32
centrale pijn..........................................................................................................................32
Spacticiteit.............................................................................................................................32
CRPS : complex regionaal pijn syndroom..............................................................................34
Hoe pijn bestrijden? Empirische cyclus................................................................................34
Doel...................................................................................................................................35
Intensiteit en frequentie...................................................................................................35
aard van de oefening........................................................................................................35
Actief vs passief.................................................................................................................36
keuze strategie..................................................................................................................37
Forced use.........................................................................................................................37
spiegel van ramachandran (spiegeltherapie).......................................................................37
Error based/ error less learning........................................................................................38
chaining, chunking............................................................................................................38
benaderingswijzen/behandelingsstrategien.....................................................................38
Incidentie...................................................................................................................................41
Oorzaak.....................................................................................................................................41
overweging operatie.................................................................................................................41
Eerste overweging: re vascularisatie........................................................................................41
Bepalen amputatieniveau.........................................................................................................42
hoge amputatie.........................................................................................................................42
transtibiaal (of lager).................................................................................................................42
Transtibiaal vs transfemoraal....................................................................................................42
3
, Waneer amputeren...................................................................................................................43
belang preoperatieve mogelijkheden.......................................................................................43
Knie exarticulatie.......................................................................................................................44
voorlichting...............................................................................................................................44
Postoperatief............................................................................................................................45
Pijn.............................................................................................................................................45
complicatie................................................................................................................................45
Mobiliteit...................................................................................................................................46
psychische problemen..............................................................................................................46
revalidatie: preoperatief...........................................................................................................46
Revalidatie: postoperatief.........................................................................................................47
Revalidatie prothesefase...........................................................................................................48
werkhervatting..........................................................................................................................49
negatieve factoren werkhervatting...........................................................................................49
prothesetraining: voorwaarden................................................................................................49
prothese training.......................................................................................................................50
Verloop prothese......................................................................................................................50
groepen voor prothese.............................................................................................................50
Toelichting groepen..................................................................................................................51
Belang groepen.........................................................................................................................52
prothese onderderelen.............................................................................................................52
Ophanging.................................................................................................................................52
Totale knieprothese/totale heupprothese...............................................................................56
Epidemiologie artrose...........................................................................................................58
Symptomen...........................................................................................................................58
Risicofactoren artrtose..............................................................................................................59
Risicofactoren progressie artrose.........................................................................................59
Verloop behandeling: stepped care......................................................................................60
Multidisciplinair.....................................................................................................................60
Rol ergotherapeut.................................................................................................................61
Diagnose....................................................................................................................................61
Anamnese activiteitenniveau....................................................................................................61
Meetinstrumenten....................................................................................................................64
4
Inhoud
2 Kuni deel 1................................................................................................................................5
Terminologie...............................................................................................................................5
AH / NAH.....................................................................................................................................6
CVA..............................................................................................................................................6
Vormen CVA............................................................................................................................6
Preventie.................................................................................................................................7
FAST.........................................................................................................................................7
Gevolgen van hersenletsel..........................................................................................................7
Rechter hersenletsel VS linker hersenletsel...........................................................................7
Motorische symptomen..........................................................................................................7
tractussen................................................................................................................................8
Hemiplegie/parese..................................................................................................................8
Gezicht.................................................................................................................................8
Tractus cortico spinalis............................................................................................................9
Tractus corticospinalis lateralis...........................................................................................9
Tractus corticospinalis anterior...........................................................................................9
Somatopische organisatie, tractus corticospinalis lateralis (1a)............................................9
Plaats hersenletsel en motorsiche uitval..............................................................................10
stadia van brunstrom............................................................................................................11
Tonus.....................................................................................................................................11
Posturale controle.................................................................................................................11
Stabiliteit...........................................................................................................................11
Mobiliteit...........................................................................................................................12
Orientatie (actieve controle van uitlijning en tonus)........................................................12
spacticiteit.............................................................................................................................12
Spacticiteit vs rigiditeit......................................................................................................13
Meetinstrumenten spasticiteit.........................................................................................13
Behandeling spasticiteit....................................................................................................14
Stadie van brunnstrom......................................................................................................14
Synergie (pathologisch).....................................................................................................14
1
, Pushersyndroom...................................................................................................................15
Diagnose: EXAMENVRAAG: nakijken in cursus.................................................................15
Prognose...........................................................................................................................16
Behandeling......................................................................................................................16
Tonische reflexen..................................................................................................................16
Asymetrische tonische nekreflex......................................................................................17
Gekruiste strekreflex.........................................................................................................17
grijpreflex..........................................................................................................................17
symetrische tonische nekreflex........................................................................................18
positieve steunreflex.........................................................................................................18
andere motorische gevolgen................................................................................................18
3 kuni deel 3..............................................................................................................................18
Terminologie.............................................................................................................................19
Sensomotoriek..........................................................................................................................19
Initiatie/ feedback.................................................................................................................19
sensoriek...................................................................................................................................19
zintuigen................................................................................................................................20
exteroceptie......................................................................................................................20
Interoceptie.......................................................................................................................21
Beperkingen..........................................................................................................................22
Therapie............................................................................................................................22
feedforward:.....................................................................................................................23
extrinsieke feedback.........................................................................................................23
Afwezigheid sensoriek = wat met motoriek.........................................................................24
motorisch leren (lashey)...................................................................................................25
Motorisch leren (Schmidt)................................................................................................25
Motorisch leren (Newell)..................................................................................................25
Cognitie.....................................................................................................................................26
Er is een cognitieve hierarchie:.............................................................................................27
Cognitive disabilities model..................................................................................................27
level 6: geplande acties.....................................................................................................28
Level 5: explorerende acties.............................................................................................28
Level 4: doelgerichte acties...............................................................................................29
2
, ...........................................................................................................................................29
Level 3: manuele acties.....................................................................................................30
...........................................................................................................................................30
Posturale acties.................................................................................................................30
...........................................................................................................................................30
level 1: automatische acties.............................................................................................30
Level bepalen....................................................................................................................31
gebruik..............................................................................................................................31
neglect.......................................................................................................................................31
Pijn.............................................................................................................................................31
Diagnose................................................................................................................................32
centrale pijn..........................................................................................................................32
Spacticiteit.............................................................................................................................32
CRPS : complex regionaal pijn syndroom..............................................................................34
Hoe pijn bestrijden? Empirische cyclus................................................................................34
Doel...................................................................................................................................35
Intensiteit en frequentie...................................................................................................35
aard van de oefening........................................................................................................35
Actief vs passief.................................................................................................................36
keuze strategie..................................................................................................................37
Forced use.........................................................................................................................37
spiegel van ramachandran (spiegeltherapie).......................................................................37
Error based/ error less learning........................................................................................38
chaining, chunking............................................................................................................38
benaderingswijzen/behandelingsstrategien.....................................................................38
Incidentie...................................................................................................................................41
Oorzaak.....................................................................................................................................41
overweging operatie.................................................................................................................41
Eerste overweging: re vascularisatie........................................................................................41
Bepalen amputatieniveau.........................................................................................................42
hoge amputatie.........................................................................................................................42
transtibiaal (of lager).................................................................................................................42
Transtibiaal vs transfemoraal....................................................................................................42
3
, Waneer amputeren...................................................................................................................43
belang preoperatieve mogelijkheden.......................................................................................43
Knie exarticulatie.......................................................................................................................44
voorlichting...............................................................................................................................44
Postoperatief............................................................................................................................45
Pijn.............................................................................................................................................45
complicatie................................................................................................................................45
Mobiliteit...................................................................................................................................46
psychische problemen..............................................................................................................46
revalidatie: preoperatief...........................................................................................................46
Revalidatie: postoperatief.........................................................................................................47
Revalidatie prothesefase...........................................................................................................48
werkhervatting..........................................................................................................................49
negatieve factoren werkhervatting...........................................................................................49
prothesetraining: voorwaarden................................................................................................49
prothese training.......................................................................................................................50
Verloop prothese......................................................................................................................50
groepen voor prothese.............................................................................................................50
Toelichting groepen..................................................................................................................51
Belang groepen.........................................................................................................................52
prothese onderderelen.............................................................................................................52
Ophanging.................................................................................................................................52
Totale knieprothese/totale heupprothese...............................................................................56
Epidemiologie artrose...........................................................................................................58
Symptomen...........................................................................................................................58
Risicofactoren artrtose..............................................................................................................59
Risicofactoren progressie artrose.........................................................................................59
Verloop behandeling: stepped care......................................................................................60
Multidisciplinair.....................................................................................................................60
Rol ergotherapeut.................................................................................................................61
Diagnose....................................................................................................................................61
Anamnese activiteitenniveau....................................................................................................61
Meetinstrumenten....................................................................................................................64
4
