Irinse fun isodi

Irin-ajo jẹ okuta igun-ile ti isọdọtun apa isalẹ. Ipa kekere rẹ, ikojọpọ iṣakoso jẹ ki o jẹ apẹrẹ fun imularada ilọsiwaju lati ipalara tabi iṣẹ abẹ. Abojuto imọ-jinlẹ ti awọn metiriki gait-paapaa iyara, cadence, ati afọwọṣe-faye gba ipasẹ imudani ti iwosan ati itọsọna ailewu ipadabọ si iṣẹ ṣiṣe ni kikun.

Awọn Ilana Ikojọpọ Onitẹsiwaju

The Rehabilitation ti tẹ

Iwosan ti ara tẹle awọn ipele asọtẹlẹ. Ẹrù ìrìn àjò gbọ́dọ̀ bá agbára àsopọ̀ mu:

Ofin 10% naa (Ti ṣe atunṣe fun isọdọtun)

Ni awọn elere idaraya ti o ni ilera, "ofin 10%" ṣe opin iwọn didun osẹ lati ṣe idiwọ ipalara lilo. Ni atunṣe,lo kan diẹ Konsafetifu 5-10% lilọsiwaju:

Week 1: 10 min/day × 3 days = 30 min total
Week 2: 11 min/day × 3 days = 33 min total (+10%)
Week 3: 12 min/day × 4 days = 48 min total (+45% - TOO FAST!)

BETTER:
Week 1: 10 min/day × 3 days = 30 min
Week 2: 10 min/day × 4 days = 40 min (+33% via frequency)
Week 3: 12 min/day × 4 days = 48 min (+20% via duration)
Week 4: 12 min/day × 5 days = 60 min (+25% via frequency)
            

Imọran:Ilọsiwaju ilọsiwaju ni akọkọ (fi awọn ọjọ kun), lẹhinna iye akoko (fi awọn iṣẹju kun), lẹhinna kikankikan (mu iwọn / iyara pọ si). Eyi dinku wahala ti ara.

ACWR (Lai: Ipin Iṣe-iṣẹ Onibaje) ni Isọdọtun

ACWR = Acute Load (7 days) / Chronic Load (28-day average)

Ideal range for rehabilitation: 0.80-1.20
  - <0.80: Deconditioning risk (undertraining)
  - 0.80-1.30: "Sweet spot" for adaptation
  - >1.50: High re-injury risk (overtraining spike)
            

Ohun elo:Ti o ba rin iṣẹju 60 ni ọsẹ 1, iṣẹju 80 ni ọsẹ 2, 100 min ni ọsẹ 3, ẹru onibaje ọjọ 28 rẹ = (60+80+100+0)/4 = 60 min/ọsẹ apapọ. Ni ọsẹ 4, afojusun 48-72 min (ACWR 0.80-1.20) lati yago fun iwasoke.

Awọn Ilana Ifarapa lẹhin-ipalara

Awọn Ẹsẹ Ikẹhin Isalẹ (Kọsẹ, Orunkun)

Ite I Sprain (Iwọnwọn - omije airi)

• Ọsẹ 1:RICE (isinmi, yinyin, funmorawon, igbega); Idaabobo iwuwo-ara pẹlu àmúró/atilẹyin
• Ọsẹ 2:Ti nso iwuwo ni kikun, 10-15 min hikes 2-3 × / ọjọ lori awọn ipele alapin
• Awọn ọsẹ 3-4:Awọn irin-ajo iṣẹju 20-30, ilọsiwaju si ilẹ aiṣedeede, yọ àmúró kuro
• Pada si ere idaraya:4-6 ọsẹ ti o ba ti irora-free ati ki o symmetrical

Ite II Sprain (Dede - Yiya apakan)

• Awọn ọsẹ 1-2:Idaabobo iwuwo-ara (bata / crutches), irin-ajo ti o kere ju
• Awọn ọsẹ 3-4:Iwọn iwuwo ni kikun, awọn irin-ajo iṣẹju 10-20 pẹlu àmúró
• Ọsẹ 5-8:Awọn irin-ajo iṣẹju 30-60, yiyọ àmúró mimu diẹdiẹ, awọn adaṣe idawọle
• Pada si ere idaraya:Awọn ọsẹ 8-12 pẹlu idasilẹ lati ọdọ PT / dokita

Ite III Sprain (Layi - yiya patapata)

• Awọn ọsẹ 1-3:Imobilization (bata/simẹnti), ti kii ṣe iwuwo tabi fifọwọkan iwuwo nikan
• Awọn ọsẹ 4-6:Iyipada si iwuwo-ara apakan, irin-ajo adagun-odo, awọn akoko iṣẹju 5-10
• Ọsẹ 7-12:Ilọsiwaju si iwuwo ni kikun, awọn irin-ajo iṣẹju 10-30 pẹlu àmúró
• Awọn oṣu 3-6:Irin-ajo ti ko ni ihamọ, iwọntunwọnsi / ikẹkọ agbara, mura silẹ fun ṣiṣe
• Pada si ere idaraya:O kere ju oṣu 4-6; le nilo abẹ

ACL Atunṣe

Irinse ni aringbungbun si ACL isodi. Abojuto ami-ara gait ṣe pataki lati ṣawari awọn ilana isanpada.

Plantar Fasciitis

• Ipele nla (ọsẹ 1-2):Din iwọn irin-ajo dinku nipasẹ 50%; wọ bata atilẹyin pẹlu orthotics; yinyin lẹhin hikes
• Ihalẹ-apapọ (ọsẹ 3-6):Pada sẹhin si iwọn didun ipilẹ; fi ọmọ malu nínàá 3 × / ọjọ; ro night splint
• Onibaje (> ọsẹ 6):Le nilo PT, abẹrẹ corticosteroid, tabi extracorporeal shockwave therapy (ESWT)
• Idena:Yago fun irin-ajo laisi ẹsẹ lori awọn aaye lile; rọpo bata ni gbogbo 400-500 miles; teramo ẹsẹ intrinsics

Imularada Iṣẹ-abẹ lẹhin

Apapọ Rirọpo ibadi (THR)

Standard isodi Ago

Gait Iyara Ìgbàpadà Awọn ipilẹ

Akiyesi:Ọpọlọpọ awọn alaisan THR ti ni ailagbara gait ni iṣaaju-iṣiṣẹ nitori irora (iyara 0.60-0.90 m/s). Lẹhin-op isodi igba àbábọrẹ niiṣẹ ti o dara ju-ipele lọni kete ti larada.

Lapapọ Rirọpo Orunkun (TKR)

Ago to jọra si THR ṣugbọn dojukọ:

• Ibiti išipopada:Ṣe aṣeyọri 0° itẹsiwaju ati 110-120° yiyi pada nipasẹ ọsẹ 6
• Agbara Quad:Lominu ni fun gígun pẹtẹẹsì ati joko-si-duro
• Iṣapẹẹrẹ Gait:Yago fun itẹramọṣẹ “orokun lile” (GSI> 10% nipa)

Hip Fracture Tunṣe

Awọn fifọ ibadi (paapaa ni awọn agbalagba) jẹ idẹruba aye: 20-30% iku laarin ọdun kan.Ikoriya ni kutukutu jẹ patakilati yago fun awọn ilolu (pneumonia, DVT, deconditioning).

• Ọjọ 1-2 lẹhin-op:Joko-si-duro pẹlu PT; rin 10-50 ẹsẹ pẹlu alarinkiri
• Ọsẹ 1:Gigun 50-200 ẹsẹ 3-4 × / ọjọ; iyipada si ireke ti o ba jẹ iduroṣinṣin
• Awọn ọsẹ 2-6:Ilọsiwaju si awọn hikes 10-20 iṣẹju; ibi-afẹde = tun gba arinbo ṣaaju-egugun
• Awọn oṣu 3-6:Pada si ipilẹṣẹ tabi iṣẹ ipilẹ-sunmọ (ọpọlọpọ ko gba pada ni kikun)

Iṣatunṣe Ẹdọkan

Ikẹkọ Gait Post-Ọpọlọ

Awọn olugbala ikọlu nigbagbogbo n ṣe afihan gait hemiparetic pẹlu asymmetry ti o lagbara. Isọdọtun irin-ajo jẹ pataki #1 fun ominira iṣẹ-ṣiṣe.

Wọpọ Gait Iyapa Post-ọpọlọ

• Gat hemiparetic:Ẹsẹ ti o ni ipa fihan fifẹ dinku, yipo, sisọ ẹsẹ
• Asymmetry:GSI ni deede 15-35% ni imularada ni kutukutu
• Idinku ti o dinku:Nigbagbogbo 60-80 spm vs 100+ spm ni awọn agbalagba ilera
• Iyara kekere:Nigbagbogbo 0.40-0.80 m / s; <0.40 m/s = ambulator agbo ile nikan

Awọn ilana atunṣe

Imularada Iṣẹ-ṣiṣe Milestones

Arun Pakinsini

Parkinsonian gait ṣe afihan:

• Bradykinesia:Iyara kekere (0.60-1.00 m/s)
• Ilọpo:Gigun igbesẹ kukuru, imukuro ilẹ ti o dinku
• Ajọdun:Isare lainidii, titẹ si apakan siwaju
• Didi ti ẹsẹ:Ailagbara lojiji lati bẹrẹ/tẹsiwaju awọn igbesẹ

Awọn Idawọle Irin-ajo

• Cueing (agbohunsilẹ/iwo):Metronome tabi awọn asami ilẹ ṣe ilọsiwaju cadence ati gigun igbesẹ
• Ikẹkọ iṣipopada titobi nla:Fi imọra ṣe “awọn igbesẹ nla” lati bori bradykinesia
• Ikẹkọ iṣẹ-meji:Gigun lakoko ṣiṣe awọn iṣẹ-ṣiṣe oye lati mu ilọsiwaju adaṣe ṣiṣẹ
• Idaraya agbara-giga:70-80% HRmax irinse 3-4×/ọsẹ fa fifalẹ lilọsiwaju arun

Gait Symmetry Abojuto

Kini idi ti Symmetry ṣe pataki ni Rehab

Ẹsẹ asymmetrical tọkasi:

• Ẹsan fun irora tabi ailera
• Iwosan ti ko pe (afẹfẹ ẹgbẹ ti o farapa)
• Imudara ti o pọ si lori ẹgbẹ ti ko ni ipalara → ewu ti ipalara ti o lodi si
• Inawo agbara ailagbara
• Awọn ajeji biomechanical igba pipẹ (fun apẹẹrẹ, eewu osteoarthritis)

Diwọn Atọka Symmetry Gait (GSI)

GSI (%) = |Right - Left| / [0.5 × (Right + Left)] × 100

Example (step length):
  Right leg: 0.65 m
  Left leg: 0.55 m
  GSI = |0.65 - 0.55| / [0.5 × (0.65 + 0.55)] × 100
      = 0.10 / 0.60 × 100
      = 16.7% (moderate asymmetry)
            

GSI fojusi Jakejado isodi

Awọn irinṣẹ fun Iṣayẹwo Iṣayẹwo

• Awọn sensọ ti o wọ:Awọn eto orisun-IMU (fun apẹẹrẹ, RunScribe, Stryd) wiwọn gigun igbesẹ, akoko iduro, akoko olubasọrọ ilẹ fun ẹsẹ kọọkan
• Awọn awo ipa:Iwọn goolu ni awọn eto lab; ṣe iṣiro GRF asymmetry
• Ayẹwo fidio:Ọna ti o rọrun-igbasilẹ lati iwaju/ẹhin, ka awọn igbesẹ ni iṣẹju-aaya 30 fun ẹsẹ kan
• Akiyesi ile-iwosan:Awọn iṣọ PT fun limp, gait Trendelenburg, ju ẹsẹ silẹ, ati bẹbẹ lọ.

Pada-si-Apeere aṣayan iṣẹ-ṣiṣe

Àwárí Idi fun Kiliaransi

Ipadabọ ailewu nilo lati kọja GBOGBO awọn ibeere:

Pada-si-Ṣiṣe Ilana

Ni kete ti awọn ibeere irin-ajo ti pade, iyipada si ṣiṣiṣẹ diẹdiẹ:

Awọn ofin:

• Tun ipele kan tun ti irora ba waye (ma ṣe ilọsiwaju)
• Sinmi 1 ọjọ laarin awọn akoko ni ibẹrẹ
• Duro lesekese ti irora didasilẹ, wiwu, tabi fifẹ ba waye
• Lapapọ eto = Awọn ọsẹ 10-12 o kere ju lati irin-ajo si ṣiṣe ni kikun

Iṣakoso irora Nigba Isọdọtun

Oye Irora Isọdọtun

Ko gbogbo irora jẹ ipalara. Ṣe iyatọ laarin:

• "O dara" irora (aibalẹ):Rirẹ iṣan, ọgbẹ kekere 24-48 wakati lẹhin idaraya (DOMS). O ti ṣe yẹ ati ailewu.
• Irora "buburu" (ifihan agbara):Sharp, agbegbe, irora ti o buru si nigba tabi lẹsẹkẹsẹ lẹhin iṣẹ-ṣiṣe. Tọkasi irritation àsopọ tabi tun-ipalara ewu.

Iwọn Abojuto Irora (0-10)

24-wakati irora Ofin

Lẹhin igbimọ irin-ajo kọọkan, ṣe ayẹwo irora 24 wakati nigbamii:

• Ti irora ≤3/10:Tẹsiwaju pẹlu ilọsiwaju ti a gbero
• Ti irora 4-6/10:Tun iwọn didun kanna ṣe (ma ṣe ilọsiwaju)
• Ti irora ba ≥7/10:Din iwọn didun silẹ nipasẹ 30-50%, isinmi ni afikun ọjọ

Awọn ilana iṣakoso irora

Ti kii-Pharmacological

• Yinyin:Waye awọn iṣẹju 15-20 lẹhin irin-ajo (awọn ipalara nla, igbona)
• Funmorawon:Lo apa aso / ipari lati dinku wiwu
• Igbega:Gbe ẹsẹ ti o kan ga ju ipele ọkan lọ
• Nina pẹlẹ:Bojuto ni irọrun lai overstretching iwosan àsopọ
• Ifọwọra:Imọlẹ asọ ti àsopọ iṣẹ lati din isan oluso

Pharmacological

• Acetaminophen:Irora irora laisi ipa-iredodo (ailewu fun iwosan egungun / tendoni)
• Awọn NSAIDs (ibuprofen, naproxen):Din irora ati igbona; lo niwọnba (le ba iwosan tendoni jẹ ti lilo onibaje)
• Awọn analgesics ti agbegbe:Geli Diclofenac, awọn abulẹ lidocaine fun irora agbegbe

Išọra pẹlu awọn NSAIDs:Lakoko ti o munadoko fun irora, lilo NSAID onibaje (> ọsẹ 2) le ṣe ailagbara iṣelọpọ collagen ati itọju tendoni / ligamenti lọra. Lo nikan lakoko awọn gbigbọn nla; ayo isakoso fifuye.

Awọn gbigba bọtini fun isọdọtun

Awọn orisun ti o jọmọ