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臺灣醫學

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篇名 慢性中風個案之「國際健康功能與身心障礙分類系統」和「個案處理模式」之應用
卷期 17:3
並列篇名 Application of the International Classification ofFunctioning (ICF) Model and the ClientManagement Model for a Patient with ChronicStroke
作者 陳昊澤黃文興嚴筱晴
頁次 332-339
關鍵字 國際健康功能與身心障礙分類系統個案處理模式慢性中風不對稱步態任務導向訓練ICF modelclient management modelchronic strokeasymmetry gaittask-oriented approachTSCI
出刊日期 201305

中文摘要

中風常導致行走功能的問題,這常是多因子互相影響後的結果。本個案為一位67 歲慢性中風病患,於2011 年5 月腦部電腦斷層掃瞄後診斷為右側基底核及放射冠出血。本篇使用「個案處理模式」進行「評量分析-治療介入-再評量分析」的互動循環程序,再合併「國際健康功能與身心障礙分類系統」分析,從損傷層面、功能層面併以環境及個人因子層面完整分析此個案。發現個案因其健康狀態造成的左側肢體感覺異常、左下肢肌力不足、不對稱步態以及動態站立平衡能力不足,會影響個案行走活動能力,經由給予行走輔具後,個案現在可以在旁人監督下行走,但個案行走速度和行走距離的表現仍不佳,綜合考量個案為慢性中風個案,神經學恢復已達穩定,因此對其不對稱步態進行介入,並且提升動態站立平衡能力以增進行走速度和距離的表現。因此針對個案不對稱步態以及動態站立平衡問題,使用任務導向模式進行此問題之介入方式,四週後,個案行走速度及步態對稱性皆有改善。本報告顯示合併「國際健康功能與身心障礙分類系統」及「個案處理模式」,可以更完整分析慢性中風患者的活動功能,根據此分析結果再使用任務導向進行介入,不僅可以增進慢性中風患者行走速度和距離表現,也能改善其步態對稱性,促使其行走功能以達最佳狀態。

英文摘要

Stroke may result in impaired walking function. Walking function can be considered as an interactionof multiple factors. Our reported case is a 67-year-old patient, with chronic stroke whose MRI examination on2011/5 revealed right basal ganglia and corona radiate hemorrhage. We used client management model with thecycle of evaluation-intervention-reevaluation and the ICF model in the process of our examination andevaluation. The case was analyzed comprehensively from the aspects of impairment and function as well as theenvironmental and personal aspects. The results showed that our case had left limb paresthesia, weakness,asymmetrical gait and insufficient dynamic standing balance which affected his mobility. After being providedwith a walking device, walking ability has improved. However, the gait speed and walking distance were stillinsufficient. Since the case was a patient of chronic stroke, the neurologic progress has reached a plateau.Therefore, the intervention was through improving symmetry of gait and dynamic standing balance to increasethe gait speed and walking distance. After four-week intervention with task-oriented approach, bothasymmetrical gait and gait speed have improved. Our report showed that using the combined "ICF model" and"client management model" could comprehensively analyze activity function. Task-oriented approach could beused to effectively increase gait speed, walking distance, and improving asymmetrical gait to maximizeambulation function.

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