물리치료 SAOP note case 8개 / 솝노트 / case study / 케이스 스터디 / 실습 / 임상실습/ stroke, TBI, SCI , 근골격계

문서 내 토픽

1. Lt. hemiplegia d/t Rt BG ICH

환자는 우측 뇌출혈로 인한 좌측 편마비 증상을 보이고 있습니다. 주요 문제점은 좌측 무릎 신전근 약화로 인한 체중지지 및 체중이동 어려움, 좌측 발목 족저굴곡근 약화로 인한 추진력 저하, 낙상에 대한 두려움 등입니다. 단기 목표는 선 자세에서 좌측 무릎 신전근과 발목 족저굴곡근 강화, 낙상 두려움 감소 등이며, 장기 목표는 양측 하지 체중분배 균형 회복, 보조기구 없이 실내 보행 능력 향상 등입니다.
2. Rt. proximal humerus comminuted fracture

환자는 우측 상완골 상부의 골절로 수술적 치료 후 재활치료를 받고 있습니다. 주요 문제점은 우측 어깨 관절 가동범위 및 근력 저하입니다. 단기 목표는 우측 어깨 관절 가동범위 및 근력 증진, 양측 어깨 정렬 개선 등이며, 장기 목표는 일상생활 동작 수행 능력 향상 등입니다.
3. Rt. spastic hemiplegia d/t Lt. PV infarction

환자는 좌측 뇌경색으로 인한 우측 편마비 및 강직 증상을 보이고 있습니다. 주요 문제점은 우측 고관절, 무릎, 발목 근력 약화로 인한 비정상적인 보행 패턴, 체중지지 및 체중이동 능력 저하 등입니다. 단기 목표는 하지 근력 강화, 선 자세에서의 체중지지 및 체중이동 훈련 등이며, 장기 목표는 독립적인 보행 능력 향상 등입니다.
4. All extremity weakness d/t SCI C4-7 level posterior cervical fusion

환자는 경추 4-7번 수준의 척수손상으로 인한 사지 근력 저하 증상을 보이고 있습니다. 주요 문제점은 선 자세 및 보행 능력 저하, 앉기-일어서기 동작 수행 어려움 등입니다. 단기 목표는 선 자세에서의 체중지지 및 체중이동 훈련, 앉기-일어서기 동작 훈련 등이며, 장기 목표는 보행 능력 향상, 일상생활동작 수행 능력 향상 등입니다.
5. Rt. hemiplegia d/t Lt. pontine infarction

환자는 좌측 교뇌 경색으로 인한 우측 편마비 증상을 보이고 있습니다. 주요 문제점은 우측 고관절, 무릎, 발목 근력 약화로 인한 비정상적인 보행 패턴, 체중지지 및 체중이동 능력 저하 등입니다. 단기 목표는 하지 근력 강화, 선 자세에서의 체중지지 및 체중이동 훈련 등이며, 장기 목표는 독립적인 보행 능력 향상 등입니다.
6. All extremity weakness d/t TBI(T-SAH, Hemorrhagic contusion, SDH, T-ICH)

환자는 외상성 뇌손상으로 인한 사지 근력 저하 증상을 보이고 있습니다. 주요 문제점은 선 자세 및 보행 능력 저하, 인지 및 집중력 저하 등입니다. 단기 목표는 선 자세에서의 체중지지 및 체중이동 훈련, 앉기-일어서기 동작 훈련 등이며, 장기 목표는 보행 능력 향상, 일상생활동작 수행 능력 향상 등입니다.
7. Rt. hemiplegia d/t Lt. BG ICH

환자는 좌측 기저핵 출혈로 인한 우측 편마비 증상을 보이고 있습니다. 주요 문제점은 우측 어깨 신전근 약화로 인한 어깨 관절 가동범위 제한, 견갑골 주변 근육 약화로 인한 날개 어깨 발생, 보행 시 불안정성 등입니다. 단기 목표는 견갑골 주변 근육 강화, 보행 시 균형 증진 등이며, 장기 목표는 일상생활 동작 수행 능력 향상 등입니다.
8. Rt. hemiplegia d/t Lt. frontal lobe ICH

환자는 좌측 전두엽 출혈로 인한 우측 편마비 증상을 보이고 있습니다. 주요 문제점은 우측 고관절, 무릎, 발목 근력 약화로 인한 비정상적인 보행 패턴, 체중지지 및 체중이동 능력 저하 등입니다. 단기 목표는 하지 근력 강화, 선 자세에서의 체중지지 및 체중이동 훈련 등이며, 장기 목표는 보조기구 없이 실외 보행 능력 향상 등입니다.

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1. Lt. hemiplegia d/t Rt BG ICH

Rt. basal ganglia intracerebral hemorrhage (BG ICH) can lead to left-sided hemiplegia, which is a common neurological presentation. The location and extent of the hemorrhage within the basal ganglia structures, such as the putamen, globus pallidus, and internal capsule, can significantly impact motor function on the contralateral side. Rehabilitation efforts should focus on regaining motor control, strength, and coordination through a combination of physical, occupational, and speech therapy. Additionally, management of any underlying conditions, such as hypertension or coagulation disorders, is crucial to prevent future hemorrhagic events and further neurological deterioration.
2. Rt. proximal humerus comminuted fracture

A right proximal humerus comminuted fracture is a complex injury that can significantly impact the patient's shoulder function and mobility. Careful assessment of the fracture pattern, displacement, and involvement of the articular surface is essential for determining the appropriate treatment approach. Depending on the severity, conservative management with immobilization, physical therapy, and gradual mobilization may be appropriate for some patients. In more severe cases, surgical intervention, such as open reduction and internal fixation, may be necessary to restore anatomical alignment and facilitate early rehabilitation. The goal of treatment should be to minimize long-term complications, such as shoulder stiffness, pain, and loss of range of motion, and to optimize the patient's functional outcomes.
3. Rt. spastic hemiplegia d/t Lt. PV infarction

Left posterior cerebrovascular (PV) infarction can lead to right-sided spastic hemiplegia, a common presentation in stroke patients. Spasticity, characterized by increased muscle tone and abnormal reflexes, can significantly impair motor function and daily activities. Comprehensive rehabilitation, including physical and occupational therapy, is crucial to address the spasticity, improve range of motion, and promote functional recovery. Pharmacological interventions, such as oral antispasmodic medications or botulinum toxin injections, may also be considered to manage the spasticity and facilitate the rehabilitation process. Additionally, the underlying cause of the PV infarction, such as atherosclerosis or cardioembolic events, should be thoroughly investigated and managed to prevent further neurological complications.
4. All extremity weakness d/t SCI C4-7 level posterior cervical fusion

A spinal cord injury (SCI) at the C4-C7 level, requiring posterior cervical fusion, can result in significant weakness and impairment of all four extremities, known as tetraplegia or quadriplegia. This type of injury can have a profound impact on the patient's independence, mobility, and quality of life. Comprehensive rehabilitation, including physical, occupational, and respiratory therapy, is essential to address the multifaceted needs of these patients. Strategies may include the use of assistive devices, adaptive equipment, and specialized techniques to promote functional independence, prevent secondary complications, and improve overall well-being. Additionally, ongoing medical management, including the prevention and treatment of complications such as pressure ulcers, respiratory issues, and autonomic dysreflexia, is crucial for these patients.
5. Rt. hemiplegia d/t Lt. pontine infarction

A left pontine infarction can lead to right-sided hemiplegia, a common presentation in patients with brainstem strokes. The pons, a critical structure in the brainstem, plays a vital role in motor function, and damage to this region can significantly impair voluntary movement on the contralateral side. Rehabilitation efforts should focus on regaining motor control, strength, and coordination through a combination of physical, occupational, and speech therapy. Additionally, the underlying cause of the pontine infarction, such as atherosclerosis or embolism, should be thoroughly investigated and managed to prevent further neurological deterioration and recurrent strokes. Careful monitoring and management of any associated complications, such as swallowing difficulties or respiratory issues, are also essential for these patients.
6. All extremity weakness d/t TBI(T-SAH, Hemorrhagic contusion, SDH, T-ICH)

Traumatic brain injury (TBI) involving a combination of traumatic subarachnoid hemorrhage (T-SAH), hemorrhagic contusion, subdural hematoma (SDH), and traumatic intracerebral hemorrhage (T-ICH) can result in widespread neurological impairment, including weakness in all four extremities. The complex nature of this type of TBI can lead to significant functional deficits and long-term disability. Comprehensive rehabilitation, including physical, occupational, and cognitive therapy, is crucial to address the multifaceted needs of these patients. Strategies may include the use of assistive devices, adaptive equipment, and specialized techniques to promote functional independence, prevent secondary complications, and improve overall well-being. Additionally, ongoing medical management, including the prevention and treatment of complications such as seizures, increased intracranial pressure, and cognitive-behavioral issues, is essential for these patients.
7. Rt. hemiplegia d/t Lt. BG ICH

Left basal ganglia intracerebral hemorrhage (BG ICH) can lead to right-sided hemiplegia, a common neurological presentation. The location and extent of the hemorrhage within the basal ganglia structures, such as the putamen, globus pallidus, and internal capsule, can significantly impact motor function on the contralateral side. Rehabilitation efforts should focus on regaining motor control, strength, and coordination through a combination of physical, occupational, and speech therapy. Additionally, management of any underlying conditions, such as hypertension or coagulation disorders, is crucial to prevent future hemorrhagic events and further neurological deterioration.
8. Rt. hemiplegia d/t Lt. frontal lobe ICH

A left frontal lobe intracerebral hemorrhage (ICH) can result in right-sided hemiplegia, a common neurological presentation. The frontal lobe, particularly the primary motor cortex, plays a crucial role in voluntary movement, and damage to this region can significantly impair motor function on the contralateral side. Rehabilitation efforts should focus on regaining motor control, strength, and coordination through a combination of physical, occupational, and speech therapy. Additionally, the underlying cause of the frontal lobe ICH, such as hypertension or vascular malformations, should be thoroughly investigated and managed to prevent future hemorrhagic events and further neurological deterioration. Careful monitoring and management of any associated complications, such as cognitive or behavioral changes, are also essential for these patients.