Phc hi chc nng da vo cng ng

Ti liu s 9

Phc hi chc nng bn chn khoo bm sinh

Ban bin son b ti liu Phc hi chc nng da vo cng ng

(Theo quyt nh s 1149/Q BYT ngy 01 thng 4 nm 2008)

Trng ban
TS. Nguyn Th Xuyn Th trng B Y t

Ph trng ban
PGS.TS Trn Trng Hi TS. Trn Qy Tng V trng V hp tc Quc t, B Y t Ph cc trng Cc Qun l khm cha bnh, B Y t

Cc y vin
PGS.TS. Cao Minh Chu TS. Trn Vn Chng TS. Phm Th Nhuyn BSCK. II Trn Quc Khnh PGS.TS V Th Bch Hnh TS. Trn Th Thu H TS. Nguyn Th Minh Thu ThS. Nguyn Quc Thi ThS. Phm Dng ThS. Trn Ngc Ngh Ch nhim B mn PHCN Trng i hc Y H Ni Gim c Trung tm PHCN, Bnh vin Bch Mai Ch nhim B mn PHCN Trng i hc k thut Y t Hi Dng Trng khoa Vt l tr liu - PHCN, Bnh vin Trung ng Hu Ph ch nhim B mn PHCN Trng i hc Y H Ni Ph trng khoa Vt l tr liu - PHCN Bnh vin Nhi Trung ng Ph ch nhim B mn PHCN Trng i hc Y t cng cng Hiu trng Trng Trung hc Y t tnh Bn Tre iu phi vin chng trnh U ban Y t H Lan - Vit Nam Chuyn vin Cc Qun l khm, cha bnh - B Y t

ThS. Nguyn Th Thanh Bnh Trng khoa Vt l tr liu - PHCN, Bnh vin C Nng

Vi s tham gia ca chuyn gia quc t v phc hi chc nng da vo cng ng

TS. Maya Thomas ThS. Anneke Maarse Chuyn gia t vn v PHCNDVC C vn chng trnh U ban Y t H Lan - Vit Nam

LI GII THIU
Phc hi chc nng da vo cng ng (PHCNDVC) c trin khai Vit Nam t nm 1987. B Y t rt quan tm ch o v hng dn thc hin cng tc PHCNDVC cc a phng. c s phi hp ca B Lao ng, Thng binh & X hi, B Gio dc & o to v cc B, Ngnh lin quan khc, cng nh s ch o, u t ca chnh quyn cc cp, s gip c hiu ca cc t chc quc t, cng tc PHCNDVC nc ta trong thi gian qua ginh c mt s kt qu bc u rt ng khch l. Nhiu cp lnh o B, Ngnh, a phng thy r tm quan trng ca PHCNDVC i vi vic tr gip ngi khuyt tt nhm gim t l tn tt, gip h ti ha nhp cng ng, nng cao cht lng cuc sng. V t chc, n nay hnh thnh mng li cc bnh vin iu dng PHCN, cc trung tm PHCN, cc khoa Vt l tr liu PHCN vi nhiu thy thuc c o to chuyn khoa su v PHCN, tham gia trin khai thc hin k thut PHCN cc a phng. Nhm y mnh chng trnh PHCNDVC Vit Nam, yu cu v ti liu hng dn PHCNDVC s dng trong ton quc l rt cp thit v hu ch. Vi s gip k thut ca chuyn gia ca T chc Y t th gii (WHO), s ti tr, chia s kinh nghim c hiu qu ca y ban Y t H Lan Vit Nam (MCNV), t nm 2006, B Y t bt u tin hnh t chc bin son b ti liu s dng thng nht trong chng trnh PHCNDVC trn ton quc. Sau nhiu ln Hi tho, xin kin ng gp ca cc chuyn gia Y hc trong nc v nc ngoi, n nay, B ti liu v PHCNDVC hon thnh v c B Y t ph duyt. B ti liu ny bao gm:
n

Ti liu Hng dn qun l v thc hin PHCNDVC dnh cho cn b qun l v lp k hoch hot ng PHCNVC. Ti liu o to nhn lc PHCNDVC dnh cho cc tp hun vin v PHCNDVC. Ti liu Hng dn cn b PHCN cng ng v Cng tc vin v PHCNDVC. Ti liu Hng dn ngi khuyt tt v gia nh v PHCNDVC. 20 cun ti liu hng dn thc hnh v PHCN theo cc dng tt thng gp.

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Ni dung ca b ti liu c xy dng da trn nhng ti liu sn c v phc hi chc nng v PHNCDVC ca WHO v c iu chnh cho ph hp vi thc t ti Vit Nam.

Phc hi chc nng bn chn khoo bm sinh 3

Cun Phc hi chc nng bn chn khoo bm sinh ny l mt trong 20 cun hng dn thc hnh v phc hi chc nng cc dng tt thng gp ni trn. i tng s dng ca ti liu ny l cn b PHCN cng ng, cng tc vin PHCNDVC, gia nh ngi khuyt tt. Ni dung cun sch bao gm nhng kin thc c bn nht v khi nim, triu chng, cch pht hin, cc bin php chm sc v PHCN cho tr c bn chn khoo bm sinh. Ngoi ra, ti liu cng cung cp mt s thng tin c bn v nhng ni c th cung cp dch v cn thit m gia nh tr c th tham kho. Ti liu hng dn ny c son tho cng phu ca mt nhm cc tc gi l chuyn gia PHCN v PHCNDVC ca B Y t, cc bnh vin trc thuc trung ng, cc trng i hc Y v Y t cng cng, trong TS Trn Th Thu H l tc gi chnh bin tp ni dung. Trong qu trnh son tho b ti liu, Cc qun l khm cha bnh nhn c s h tr v k thut v ti chnh ca U ban Y t H Lan Vit Nam (MCNV), trong khun kh chng trnh hp tc vi B Y t v tng cng nng lc PHCNDVC giai on 2004-2007. Mt ln na, chng ti trn trng cm n s gip qu bu ny ca MCNV. Ban bin son trn trng cm n nhng gp rt gi tr ca cc chuyn gia PHCN trong nc v cc chuyn gia nc ngoi v ni dung, hnh thc cun ti liu. Trong ln u tin xut bn, mc d nhm bin son ht sc c gng nhng chc chn vn cn nhiu thiu st. Mong bn c gi nhng nhn xt, phn hi cho chng ti v b ti liu ny, ln ti bn sau, ti liu c hon chnh hn. Mi thng tin xin gi v: Cc Qun l khm cha bnh, B Y t, 138A Ging V, Ba nh, H Ni. Trn trng cm n. TM. BAN BIN SON TRNG BAN TS. Nguyn Th Xuyn Th trng B Y t

4 Phc hi chc nng da vo cng ng / Ti liu s 9

Phc hi chc nng bn chn khoo bm sinh

1. Gii thiu Bn chn khoo bm sinh
L mt d tt bn chn xy ra trong thi k bo thai. Bao gm phn trc bn chn nghing, xoay trong v b ko xung di; phn gt chn b ko vo trong, mt s c v dy chng b ngn li v co rt.

T l mc
C 1.000 tr s sinh sng c khong 1 - 2 tr mc d tt bn chn khoo bm sinh; trong tr trai hay mc hn tr gi gp 2 ln.

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Cc vn lin quan
Vn ng: tr b bn chn khoo i li c th b lch ngi, dng i xu. Tm l: Tr, ngi ln b bn chn khoo khng c phc hi chc nng sm thng c cm gic t ti, xu h, khng mnh dn tham gia vo cc hot ng nh vui chi, hc hnh, th dc th thao, tm kim vic lm v xy dng gia nh. Vic lm: Ngi ln b bn chn khoo nu khng c phc hi chc nng c th gp kh khn trong kim vic lm do hnh thc v chc nng vn ng b hn ch nn kh c chp nhn. X hi: Tr em v ngi ln b bn chn khoo khng c phc hi chc nng sm thng b bn b, ngi xung quanh ch nho.

2. Nguyn nhn
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Nguyn nhn trc sinh

Bt thng v gien: mt s gia nh c vi ngi b bn chn khoo. T th bn chn ca bo thai bt thng. t bin nhim sc th: Tr b cng a khp bm sinh (bn chn khoo, bn tay khoo, cng khp gi, cng khp khuu, cng khp vai, trt khp hng...). Bt thng v cu trc xng bn chn bm sinh. Bt thng v thn kinh chi phi bn chn.

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Khng r nguyn nhn

Phc hi chc nng bn chn khoo bm sinh 5

3. Pht hin sm
1. 2. 3. 4. 5. 6. 7. 8. 9.

Du hiu v triu chng

10 du hiu pht hin bn chn khoo bm sinh. Khp v nghing trong phn trc, gia bn chn. Bn chn t th thung (Gp lng bn chn). Mp ngoi bn chn cong. Np ln da sau gt bn chn r. Np ln da phn gia bn chn r. Khong gia mt c trong v xng ghe khng s thy. Ngn ngn chn ci. C cng chn c th b teo hoc lit. Dng tay khng th a bn chn v v tr trung gian.

10. Cc d tt khc c th km theo nh trt khp hng, cng khp gi, trt khp xng bnh ch, cng khp khuu, bn tay khoo.

3 4 1-2 4

6-7

Xt nghim
Chp X-quang pht hin cc bt thng v xng, khp c chn v bn chn, c bit khi nghi ng c trt khp hng.

6 Phc hi chc nng da vo cng ng / Ti liu s 9

4. Can thip sm 4.1 Phc hi chc nng/ iu tr

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Nguyn tc
Can thip sm ngay sau khi sinh. Can thip phc hi chc nng ton din: b bt chnh hnh, bi tp ko dn, np chnh hnh. Khm li thng quy 6 thng/ln sau khi kt thc b bt nh gi tin trin.

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Mc tiu can thip sm

Nn chnh dn dn bin dng bn chn. Ko dn cc c, dy chng b co ngn. Duy tr bn chn t th trung gian sau b bt. Ci thin dng i ng v sau.

(1)

K thut can thip

B bt chnh hnh Ch nh: Tr bn chn khoo bm sinh <12 thng tui. Ngi thc hin: Bc s phc hi chc nng, k thut vin phc hi chc nng ti Khoa/Trung tm phc hi chc nng Thi gian b bt: 4-5 thng (2 tun/t x 8 - 10 t). Cc bc tin hnh b bt theo 4 giai on Giai on 1: Chnh bn chn ra ngoi dn dn v ng gia, 4 ln b (2 thng). Giai on 2: Chnh bn chn thung dn v 0 trong lc gi nguyn nghing trong 0, 4 t tip theo (2 thng). Giai on 3: Chnh bn chn nghing ngoi 5, gp mu bn chn 5, 2 t cui (1 thng). Theo di khi chn ang b bt: Nu cc ngn chn sng, tm, au tho bt ngay trnh hoi t. Sau khi tho bt cn ra sch chn tr, bi Betadin vo ch xc, lot. Nu c nhim trng da cn dng khng sinh thch hp. Lm cc bi tp ko dn th ng ti khp c chn - bn chn trong lc khng b bt gia cc t v trc khi b bt.
Phc hi chc nng bn chn khoo bm sinh 7

Lu

(2) Bng chnh hnh Ch nh: Tr bn chn khoo bm sinh <6 thng tui khng c iu kin b bt chnh hnh. Ngi thc hin: Gia nh Nguyn liu: Bng hoc vi m mm dy 8mm, rng 25mm, bng dnh rng 25m. Thi gian bng: cho n khi phc hi hon ton. Cc bc tin hnh bng:

h.1

h.2

h.3 t tr nm nga, gp gi. Qun vi m lt quanh bn chn, gi v i (h.1).

h.4

Qun bng dnh ph ln trn m lt t mp ngoi bn chn, ln mu bn, xung lng bn chn, qua gi sang pha bn kia (h.2). Qun bng dnh ln 2 quanh cng chn gi bng dnh ln 1 (h.3). C 2 - 3 ngy tht cht thm 1 lp bng dnh mi ln trn lp c (h.4). Sau 7 ngy tho tt c bng dnh v m lt ra. Ngy th 8 bng li ln mi nh cch m t trn. Hng ngy thc hin bi tp ko dn th ng ti khp c chn - bn chn trong bng cho tr.

8 Phc hi chc nng da vo cng ng / Ti liu s 9

(3)

Np chnh hnh Ch nh: Tr bn chn khoo sau b bt chnh hnh. Ngi thc hin: K thut vin phc hi chc nng, dng c chnh hnh.

Np di gi bng Polypropylen khng khp + giy hoc dp bn ngoi. Thi gian eo np: c ngy ln m, c 2 gi tho ra kim tra v xoa bp nh nhng. Kim tra np nh k 2 thng/ln hoc khi np cht.

(4) Vn ng tr liu Bi tp 1: Xoa bp vng ngn chn, mu bn chn (c gp mu cc ngn chn) v pha di cng chn (c sinh i, dp).

Phc hi chc nng bn chn khoo bm sinh 9

 Bi tp 2: Bi tp ko dn th ng ti khp c chn - bn chn: lm theo th t t sau bn chn trc bn chn Khp c chn. Ko nh xng gt xung pha di (ko dn gn Asin). Ko nh xng gt ra pha ngoi ( sa li phn trc bn chn b nghing trong). Ko nh phn trc bn chn v pha trc. y nh xng sn ra pha sau v ko nh phn trc bn chn ra pha ngoi sa li phn trc bn chn b khp v nghing trong. Ko nh xng gt xung di v y phn trc bn chn ln trn sa li t th c chn b gp mt lng. Chnh nghing trong bn chn bng nn chnh 3 im: gt ko ra ngoi + phn trc bn chn ko ra ngoi + phn gia mp ngoi bn chn y vo trong.

(5) Phu thut chnh hnh Ch nh: Tr bn chn khoo bm sinh >12thng tui cha c b bt chnh hnh. Ngi thc hin: bc s ngoi khoa.

4.2 Gio dc tr v t vn cho gia nh

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Nh trng, cha m tr cn ng vin tr i hc. Cha m c th lin h vi bc s phc hi chc nng, k thut vin phc hi chc nng ti cc Khoa phc hi chc nng ca cc bnh vin Trung ng-tnh, cc trung tm chnh hnh v phc hi chc nng c c cc thng tin v phc hi chc nng cho tr b bn chn khoo bm sinh. Ngi b bn chn khoo bm sinh khng c phc hi chc nng sm cn trnh nhng ngh lao ng nng, nh hng ln bn chn.

4.3 Hng nghip

10 Phc hi chc nng da vo cng ng / Ti liu s 9

4.4 H tr v tm l
n

Tr em, ngi ln b bn chn khoo bm sinh khng c phc hi chc nng sm c th c nhng vn v tm l cn c cn b tm l h tr. Gia nh cn gii thch cho tr hiu v tnh trng bnh tt ca tr, chp nhn v vt qua mc cm ca bnh tt. Nh trng cn gii thch cho cc hc sinh trong trng hiu v tnh trng bnh tt ca tr bn chn khoo c s thng cm v gip .

5. Cc cu hi cha m hay hi Con ca ti c th i li bnh thng khng?

Tr hon ton c th i li bnh thng, nu c can thip sm v kin tr theo s hng dn ca bc s chuyn khoa phc hi chc nng.

Phu thut c th cha khi bn chn khoo khng?

C th. Tuy nhin nu tr c phc hi chc nng sm th s trnh khi mt cuc phu thut.

Cc con khc ca ti c th mc bn chn khoo khng?

Khng phi tt c mi trng hp bn chn khoo bm sinh u c tnh di truyn.

6. Cc c s cung cp dch v cho tr bn chn khoo

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Trung tm chnh hnh - phc hi chc nng ti cc thnh ph ln, cc tnh. Cc khoa Chn thng chnh hnh, phc hi chc nng ca cc bnh vin Trung ng - tnh.

Phc hi chc nng bn chn khoo bm sinh 11

Ti liu tham kho

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Gio trnh Vt l tr liu Phc hi chc nng, NXB Y hc, 2000. Trn Th Thu H - Trn Trng Hi, 2005, Pht hin sm, can thip sm mt s dng tn tt tr em Vit Nam, NXB Y hc. Ma. Lucia Mirasol Magallona, 2005, Manual for CBR workers and Caregivers, C&E Publishing Inc.

Danh mc b ti liu Phc hi chc nng da vo cng ng

Hng dn qun l v thc hin phc hi chc nng da vo cng ng o to nhn lc phc hi chc nng da vo cng ng Hng dn cn b PHCNC v cng tc vin v Phc hi chc nng da vo cng ng Hng dn ngi khuyt tt v gia nh v Phc hi chc nng da vo cng ng Phc hi chc nng sau tai bin mch mu no Phc hi chc nng tn thng tu sng Chm sc mm ct Phc hi chc nng trong bnh vim khp dng thp Phng nga thng tt th pht Dng c phc hi chc nng t lm ti cng ng Phc hi chc nng tr trt khp hng bm sinh Phc hi chc nng cho tr cong vo ct sng Phc hi chc nng bn chn khoo bm sinh Phc hi chc nng cho tr bi no Phc hi chc nng kh khn v nhn Phc hi chc nng ni ngng, ni lp v tht ngn Phc hi chc nng tr gim thnh lc (khim thnh) Phc hi chc nng tr chm pht trin tr tu Phc hi chc nng tr t k Phc hi chc nng ngi c bnh tm thn ng kinh tr em Phc hi chc nng sau bng Phc hi chc nng bnh phi mn tnh Th thao, vn ho v gii tr cho ngi khuyt tt

20 Ti liu k thut v PHCN cho tuyn cng ng s dng, bao gm: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

Sn phm chng trnh hp tc Tng cng nng lc Phc hi chc nng da vo cng ng gia B Y t Vit Nam v U ban Y t H Lan Vit Nam

SCH KHNG BN