Download 사 례 보 고 서 -Knee Joints-

사례보고서
-Knee Joints[전공심화과정]
교 과 명: 임상생체역학실습
교 수 명: 황 성 수 교수님
발 표 일: 2007. 6. 7
발 표 자: 곽 문 고
What’s the
Problem about
knee joints?
(SV3334)
General Information
•
•
•
•
•
Name: 박 재 O (F/75)
Dx: Cerebral Infarction, spinal stenosis
C/C: Rt. Hemiparesis; Gait disturbance
Onset: 2006.5.7
PHx: DM, HTN, Spinal OP Hx (+/+/+)
Mental status
•
•
•
•
•
•
Level of Consciousness: Alert
Orientation(T/P/P): (+/+/+)
Learning & Memory: Good
Attention: Good
Language: Mild dysarthria
Cortical & cognitive function: Good
Sensory & Muscle tone
• Sensory
– Pain & Temp.: Intact
– Touch & Pressure: Intact
– Proprioception: Hypoesthesia on Rt. side
• Muscle Tone
– U/E: MAS G 0
– L/E: MAS G 1
• MMT & ROM
Rt.
Lt.
Rt.
Lt.
Upper limb
Lower limb
G
170 ° with pain
Shoulder flex.
N
Full
F+
Full
Hip flex.
N
Full
G
Full
Ext.
N
Full
F
Full
Ext.
N
Full
G
0~135° with pain
Abd.
N
Full
F
Full
Abd.
N
Full
G
Full
Add.
N
Full
F+~G
Full
Add.
N
Full
G
Full
Elbow flex.
N
Full
F-~F
Full
Knee flex.
N
5 ° ~90 °
G
Full
Ext.
N
Full
F+
Full
Ext.
N
-90 ° ~-5 °
G
Full
Wrist flex.
N
Full
F+
0~5 °
G
Full
Ext.
N
Full
F+
Full
Ankle dorsi. N
Plantar.
N
Full
Full
Back Knee
• = Genu recurvatum, knee
hyperextension, excessive knee
extension
• Knee full extension(5~10°) + Rotation
– Knee close-packed position, stable
position
– LOG pass knee rotation axis anteriorly
– Knee extension torque QF muscles relax
– Passive tension
• Screw home motion
Back Knee 원인
• 15가지
• Weakness hip & knee flexors
• Quadriceps femoris muscles(esp. rectus femoris)
spasticity
• Weight에 의한 EMA & Knee posterior passive
tension loss
• Abnormal alignment & control of prox. & distal
joints
• Shorten TFL, Biceps femoris(long head)
• Unbalanced muscle firing patterns
• Sit to standing
• Walking (forward momentum, balance during unilat. Stance, lat. Hip control loss)
(pelvis forward & backward)
• Functional Ability
Roll-over
Adm.
Indep.(Both)
Sit-up
Indep.(Both)
Sitting balance
Good(Static,Dynamic)
Sit to standing
Indep.
Standing balance
Static: Good; Dynamic: Fair
Gait
Minimal assist
Problem lists
• Tibia mal-alignment (External rotation)
• Sit to standing시
– Ankle dorsiflexion (X)
– Both U/E compensation
• Gait시
– Heel contact inappropriated
– Affected side midstance (X)
– Pelvis & hip joint dyscontrol unaffected side
stance phase inappropriated
•
•
•
•
Pelvic dyscontrol
Hip extensors & abductors weakness
Knee flexors weakness
Ankle eversion muscles & plantar flexors
weakness
Assessment
Treatment Goal
Long term goal
•
Back knee gait pattern 치료를 통한 gait pattern
change
•
•
•
A: Patient
B: Hip extensors, abductors firing &strengthening
C: Sidelying
Resistance- therapist hands and gravity
D: 10 times, 3 set
•
Assessment
Treatment Goal
Long term goal
•
Back knee gait pattern 치료를 통한 gait
pattern change
•
•
•
A: Patient
B: Knee flexors firing & strengthening
C: Prone
Resistance- therapist hands and gravity
D: 10 times, 3 set
•
Treatment Plan
• Admission continue (2 months)
• 5 times a week
• 한달 후에 재평가 실시
감사합니다
.