Neurokinesitherapie 2: Volwassenen
Inhoud
Inleiding
1. Neurologische revalidatie................................................................................................................ 7
1.1 Conceptual framework ............................................................................................................ 8
1.2 Neurologische stoornissen ...................................................................................................... 8
Upper and lower motor neuron lesions .......................................................................................... 9
Zwakte ........................................................................................................................................... 10
Hypertonus / spastische patronen ................................................................................................ 11
Beroerte / CVA............................................................................................................................... 12
1.3 Principes/richtlijnen voor neurologische revalidatie ........................................................... 15
Principe 1: ICF ................................................................................................................................ 15
Principe 2: teamwerk .................................................................................................................... 15
Principe 3: Persoon - gecentreerde zorg ....................................................................................... 16
Principe 4: Voorspelling ................................................................................................................. 18
Principe 5: Neurale plasticiteit ...................................................................................................... 19
Principe 6: Motorische controle – A systems model..................................................................... 21
Principe 7: Functionele bewegingsherstel .................................................................................... 22
Principe 8: Vaardigheidsverwerving .............................................................................................. 23
Principe 9: Zelf-management (Self-Efficacy) ................................................................................. 25
Principe 10: Gezondheid promoten .............................................................................................. 26
1.4 Voorwaarden voor een efficiënte revalidatie ....................................................................... 28
1.5 Veelvoorkomende beperkingen en de impact op de activiteit ............................................. 28
Zwakte ........................................................................................................................................... 29
1
, Vermoeidheid ................................................................................................................................ 30
Stoornissen van spiertonus ........................................................................................................... 31
Stoornissen van coördinatie ......................................................................................................... 35
Stoornissen in motorische planning .............................................................................................. 36
Visuospatiale stoornissen .............................................................................................................. 38
Sensorische stoornissen ................................................................................................................ 40
Secundaire complicaties ................................................................................................................ 41
2. Beroerte / CVA............................................................................................................................... 42
2.1 Introductie ............................................................................................................................. 42
2.2 Epidemiologie ........................................................................................................................ 42
2.3 Pathofysiologie ...................................................................................................................... 43
Cirkel van willis .............................................................................................................................. 43
TOAST: trial of org 10172 in acute stroke treatment .................................................................... 43
Penumbra ...................................................................................................................................... 43
Hersenregio’s................................................................................................................................. 44
Hemisferen .................................................................................................................................... 44
2.3 Diagnose ................................................................................................................................ 46
Secundaire preventie .................................................................................................................... 46
Alarmsymptomen .......................................................................................................................... 47
2.4 Medisch management ........................................................................................................... 47
Ischemische beroerte .................................................................................................................... 47
Hemorragie beroerte..................................................................................................................... 47
2.5 Setting.................................................................................................................................... 48
2.6 Klinische representatie .......................................................................................................... 49
The Oxford Community Stroke Project Classification ................................................................... 49
2
, 2.7 Assessment / beoordeling ..................................................................................................... 50
2.8 Fases ...................................................................................................................................... 52
Hyperacute fase............................................................................................................................. 52
Revalidatiefase .............................................................................................................................. 52
Chronische fase ............................................................................................................................. 53
2.9 Prognose en tijdsverloop herstel .......................................................................................... 54
2.10 Interventies ........................................................................................................................... 55
Algemene beheers problemen ...................................................................................................... 55
Secundaire complicaties vermijden .............................................................................................. 55
2.11 Algemene therapie principes ................................................................................................ 56
Kenmerken van effectieve motorrevalidatie-interventies zijn: .................................................... 56
Algemene aanbevelingen .............................................................................................................. 56
Onderste ledenmaten en locomotorisch herstel: evenwichtstraining ......................................... 57
Gangtraining .................................................................................................................................. 57
Circuit class training ...................................................................................................................... 58
Elektrostimulatie van paretisch OL ............................................................................................... 59
Elektrostimulatie van paretische arm en hand ............................................................................. 59
Herstel bovenste lidmaat .............................................................................................................. 59
Virtuele realiteit ............................................................................................................................ 60
Robot geassisteerde therapie voor bovenste lidmaat .................................................................. 61
Therapie levering ........................................................................................................................... 61
Besluit ............................................................................................................................................ 62
Multiple Sclerose
1. Pathofysiologie .............................................................................................................................. 63
Proces ............................................................................................................................................ 64
3
, 2.1 Typen van MS ........................................................................................................................ 65
2.2 Diagnose ................................................................................................................................ 67
2. Symptomen ................................................................................................................................... 67
2.1 Mentaal ................................................................................................................................. 68
Vermoeidheid ................................................................................................................................ 68
2.2 Neuromuskuloskeletaal ......................................................................................................... 70
Hypertonie en spasticiteit ............................................................................................................. 70
Hypotonie en spierzwakte ............................................................................................................. 70
Ataxie ............................................................................................................................................. 70
2.3 Cardiovasculair ...................................................................................................................... 71
Aerobe capaciteit .......................................................................................................................... 71
3. Klinisch management .................................................................................................................... 72
3.1 Oefentherapie ....................................................................................................................... 72
Veiligheid ....................................................................................................................................... 72
Effectiviteit .................................................................................................................................... 72
Lichaamsfuncties ........................................................................................................................... 73
Actief ............................................................................................................................................. 73
3.2 Levensveranderingen ............................................................................................................ 74
Coping strategieën ........................................................................................................................ 74
Recreatie en vrijetijdsbesteding .................................................................................................... 74
3.3 Conclusie ............................................................................................................................... 74
Pusher-Syndroom
1. Definitie ......................................................................................................................................... 75
2. Kenmerken .................................................................................................................................... 75
2.1 Liggen .................................................................................................................................... 75
4
Inhoud
Inleiding
1. Neurologische revalidatie................................................................................................................ 7
1.1 Conceptual framework ............................................................................................................ 8
1.2 Neurologische stoornissen ...................................................................................................... 8
Upper and lower motor neuron lesions .......................................................................................... 9
Zwakte ........................................................................................................................................... 10
Hypertonus / spastische patronen ................................................................................................ 11
Beroerte / CVA............................................................................................................................... 12
1.3 Principes/richtlijnen voor neurologische revalidatie ........................................................... 15
Principe 1: ICF ................................................................................................................................ 15
Principe 2: teamwerk .................................................................................................................... 15
Principe 3: Persoon - gecentreerde zorg ....................................................................................... 16
Principe 4: Voorspelling ................................................................................................................. 18
Principe 5: Neurale plasticiteit ...................................................................................................... 19
Principe 6: Motorische controle – A systems model..................................................................... 21
Principe 7: Functionele bewegingsherstel .................................................................................... 22
Principe 8: Vaardigheidsverwerving .............................................................................................. 23
Principe 9: Zelf-management (Self-Efficacy) ................................................................................. 25
Principe 10: Gezondheid promoten .............................................................................................. 26
1.4 Voorwaarden voor een efficiënte revalidatie ....................................................................... 28
1.5 Veelvoorkomende beperkingen en de impact op de activiteit ............................................. 28
Zwakte ........................................................................................................................................... 29
1
, Vermoeidheid ................................................................................................................................ 30
Stoornissen van spiertonus ........................................................................................................... 31
Stoornissen van coördinatie ......................................................................................................... 35
Stoornissen in motorische planning .............................................................................................. 36
Visuospatiale stoornissen .............................................................................................................. 38
Sensorische stoornissen ................................................................................................................ 40
Secundaire complicaties ................................................................................................................ 41
2. Beroerte / CVA............................................................................................................................... 42
2.1 Introductie ............................................................................................................................. 42
2.2 Epidemiologie ........................................................................................................................ 42
2.3 Pathofysiologie ...................................................................................................................... 43
Cirkel van willis .............................................................................................................................. 43
TOAST: trial of org 10172 in acute stroke treatment .................................................................... 43
Penumbra ...................................................................................................................................... 43
Hersenregio’s................................................................................................................................. 44
Hemisferen .................................................................................................................................... 44
2.3 Diagnose ................................................................................................................................ 46
Secundaire preventie .................................................................................................................... 46
Alarmsymptomen .......................................................................................................................... 47
2.4 Medisch management ........................................................................................................... 47
Ischemische beroerte .................................................................................................................... 47
Hemorragie beroerte..................................................................................................................... 47
2.5 Setting.................................................................................................................................... 48
2.6 Klinische representatie .......................................................................................................... 49
The Oxford Community Stroke Project Classification ................................................................... 49
2
, 2.7 Assessment / beoordeling ..................................................................................................... 50
2.8 Fases ...................................................................................................................................... 52
Hyperacute fase............................................................................................................................. 52
Revalidatiefase .............................................................................................................................. 52
Chronische fase ............................................................................................................................. 53
2.9 Prognose en tijdsverloop herstel .......................................................................................... 54
2.10 Interventies ........................................................................................................................... 55
Algemene beheers problemen ...................................................................................................... 55
Secundaire complicaties vermijden .............................................................................................. 55
2.11 Algemene therapie principes ................................................................................................ 56
Kenmerken van effectieve motorrevalidatie-interventies zijn: .................................................... 56
Algemene aanbevelingen .............................................................................................................. 56
Onderste ledenmaten en locomotorisch herstel: evenwichtstraining ......................................... 57
Gangtraining .................................................................................................................................. 57
Circuit class training ...................................................................................................................... 58
Elektrostimulatie van paretisch OL ............................................................................................... 59
Elektrostimulatie van paretische arm en hand ............................................................................. 59
Herstel bovenste lidmaat .............................................................................................................. 59
Virtuele realiteit ............................................................................................................................ 60
Robot geassisteerde therapie voor bovenste lidmaat .................................................................. 61
Therapie levering ........................................................................................................................... 61
Besluit ............................................................................................................................................ 62
Multiple Sclerose
1. Pathofysiologie .............................................................................................................................. 63
Proces ............................................................................................................................................ 64
3
, 2.1 Typen van MS ........................................................................................................................ 65
2.2 Diagnose ................................................................................................................................ 67
2. Symptomen ................................................................................................................................... 67
2.1 Mentaal ................................................................................................................................. 68
Vermoeidheid ................................................................................................................................ 68
2.2 Neuromuskuloskeletaal ......................................................................................................... 70
Hypertonie en spasticiteit ............................................................................................................. 70
Hypotonie en spierzwakte ............................................................................................................. 70
Ataxie ............................................................................................................................................. 70
2.3 Cardiovasculair ...................................................................................................................... 71
Aerobe capaciteit .......................................................................................................................... 71
3. Klinisch management .................................................................................................................... 72
3.1 Oefentherapie ....................................................................................................................... 72
Veiligheid ....................................................................................................................................... 72
Effectiviteit .................................................................................................................................... 72
Lichaamsfuncties ........................................................................................................................... 73
Actief ............................................................................................................................................. 73
3.2 Levensveranderingen ............................................................................................................ 74
Coping strategieën ........................................................................................................................ 74
Recreatie en vrijetijdsbesteding .................................................................................................... 74
3.3 Conclusie ............................................................................................................................... 74
Pusher-Syndroom
1. Definitie ......................................................................................................................................... 75
2. Kenmerken .................................................................................................................................... 75
2.1 Liggen .................................................................................................................................... 75
4
