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Samenvatting fysieke & geriatrische revalidatie II
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Samenvatting cursus fysieke & geriatrische revalidatie II Theorie
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Inhoudsopgave1. Niet aangeboren hersenletsels (NAH) ..................................................................................................... 6
1.1. Indeling................................................................................................................................................. 6
1.2. Soorten ................................................................................................................................................. 6
CVA ................................................................................................................................................................ 6
Schedeltrauma ............................................................................................................................................... 7
Cerebrale infecties, intoxicaties en voedingsdeficiënties .............................................................................. 7
Hersentumoren ............................................................................................................................................. 8
Andere NAH ................................................................................................................................................... 8
1.3. Opname in een ziekenhuis.................................................................................................................... 8
1.4. Prognose .............................................................................................................................................. 9
1.5. Indeling naar verloop ......................................................................................................................... 10
1.6. Herstelproces: plasticiteit ................................................................................................................... 10
2. Revalidatie van CVA patiënten .............................................................................................................. 11
2.1. Het leerproces .................................................................................................................................... 11
Fase 1: De oriëntatiefase ............................................................................................................................. 11
Fase 2: De oefenfase ................................................................................................................................... 11
Fase 3: De automatische fase ...................................................................................................................... 11
2.2. Factoren die leren beïnvloeden .......................................................................................................... 12
• Invloed van slaap................................................................................................................................ 12
• Het inprentingskanaal ........................................................................................................................ 12
• Arousal niveau.................................................................................................................................... 12
• De gerichte aandacht ......................................................................................................................... 12
• De emotie ........................................................................................................................................... 12
• De cognitie ......................................................................................................................................... 12
• Oefening en herhaling ........................................................................................................................ 12
• Interferentie ....................................................................................................................................... 13
• Organisatie en ordening ..................................................................................................................... 13
• Negatieve invloeden van stress en depressie .................................................................................... 13
2.3. Vormen van leren in de revalidatie .................................................................................................... 13
2.3.1. Het non-associatief leren .............................................................................................................. 13
2.3.2. Het associatief leren: klassiek en operant conditioneren ............................................................. 14
2.3.3. Andere vormen van leren.............................................................................................................. 15
2.4. Komen tot klinsich redeneren ............................................................................................................. 18
2.5. Revalidatie ......................................................................................................................................... 19
3. Primair neurologische stoornissen .......................................................................................................... 20
3.1. Motoriek en tonus ..................................................................................................................................... 20
3.1.1. Hemiparese........................................................................................................................................ 20
3.1.2. Abnormale spiertonus ....................................................................................................................... 21
3.1.3. Typisch spastisch patroon.................................................................................................................. 21
3.1.4. Geassocieerde reacties ...................................................................................................................... 22
3.1.5. Geassocieerde bewegingen ............................................................................................................... 22
3.1.6. Afwezigheid van normale placing ...................................................................................................... 22
3.1.7. Reflexen ............................................................................................................................................. 22
3.2. Sensibiliteit ................................................................................................................................................ 23
, 3.2.1. Uitval van sensibiliteit is hinderlijk .................................................................................................... 23
3.2.2. Assessment ........................................................................................................................................ 24
3.2.3. Vormen van sensibiliteit .................................................................................................................... 24
3.2.4. Pijn door hersenbeschadiging ........................................................................................................... 24
3.2.5. De therapie ........................................................................................................................................ 25
3.3. Gezichtsveld ............................................................................................................................................... 26
3.3.1. De therapie ........................................................................................................................................ 26
4. Neuropsychologische functiestoornissen .............................................................................................. 28
4.1. Stoornissen in de taal ................................................................................................................................ 28
4.1.1. Afasie ................................................................................................................................................. 28
4.1.2. Lees- en schrijfstoornissen ................................................................................................................ 29
4.1.3. Stoornissen in het rekenen ................................................................................................................ 29
4.2. Apraxie ...................................................................................................................................................... 30
4.2.1. Therapie ............................................................................................................................................. 31
4.2.2. Therapie bij ideatorische apraxie ...................................................................................................... 31
4.2.3. Therapie bij ideomotorische apraxie ................................................................................................. 32
4.3. Stoornissen van de links-rechts oriëntatie ................................................................................................. 32
4.3.1. Cognitieve vaardigheden ................................................................................................................... 33
4.4. Stoornissen in het lichaamsschema ................................................................................................... 33
4.5. Neglect ............................................................................................................................................... 34
4.5.1. Therapeutische aanpak bij nosoagnosie ....................................................................................... 39
4.5.2. Therapeutische aanpak bij neglect................................................................................................ 40
4.6. Agnosieën ........................................................................................................................................... 43
4.6.1. Soorten agnosieën ........................................................................................................................ 43
4.6.2. Therapiën bij agnosieën ................................................................................................................ 45
4.7. Amnesieën .......................................................................................................................................... 46
4.7.1. Amnsesie na hersentrauma .......................................................................................................... 47
..................................................................................................................................................................... 47
4.7.2. Lokalisatie geheugen ..................................................................................................................... 48
4.7.3. Indeling geheugen ......................................................................................................................... 49
4.7.4. Overgang sensorisch geheugen naar KTG en LTG ......................................................................... 49
4.7.5. Modalitaitsgebonden vormen van geheugen ............................................................................... 50
4.7.6. Kenmerken van zuivere amnesie .................................................................................................. 50
4.7.7. Geheugeninterventiemethoden.................................................................................................... 50
4.8. Aandacht en concentratiestoornissen ................................................................................................ 51
4.8.1. Aandacht ....................................................................................................................................... 51
4.8.2. Aandachtstraining ......................................................................................................................... 51
4.9. Stoornissen in de executieve functies ................................................................................................. 52
4.9.1. Therapeutische aanpak ................................................................................................................. 53
5. Psychologische problemen na een CVA ................................................................................................. 54
6. Schouderproblemen bij een hemiplegie ................................................................................................ 54
6.1. De gesubluxeerde schouder ....................................................................................................................... 54
6.2. De pijnlijke schouder.................................................................................................................................. 55
6.2.1. Oorzaak .............................................................................................................................................. 55
6.2.2. activiteiten die veel pijn veroorzaken................................................................................................ 56
6.2.3. Voorkomen en behandelen ............................................................................................................... 56
6.3. Complex regionaal pijnsyndroom type I (Algoneurodystrofie) .................................................................. 57
6.3.1. Symptomen ....................................................................................................................................... 58
, 6.3.2. Voorkomen en behandelen van oedeem .......................................................................................... 58
6.3.3. Elevatie van de hand.......................................................................................................................... 58
6.3.4. Vermijden van palmair flexie ............................................................................................................. 58
6.3.5. Centripetaal wikkelen ........................................................................................................................ 59
6.3.6. Toepssen van ijs ................................................................................................................................. 59
6.3.7. Stimuleren van lymfedrainage ........................................................................................................... 59
6.3.8. Actieve bewegingen .......................................................................................................................... 60
7. Het stappen .......................................................................................................................................... 60
7.1. Welke problemen zien we vaak tijdens het stappen?................................................................................ 60
8. Het pusher-syndroom ........................................................................................................................... 61
8.1. Definitie ..................................................................................................................................................... 61
8.2. Diagnose .................................................................................................................................................... 61
8.3. Symptomen................................................................................................................................................ 62
8.4. Behandeling ....................................................................................................................................... 62
8.4.1. Behandeling volgens BOBATH ....................................................................................................... 63
9. Assessment ........................................................................................................................................... 64
9.1. Motorische assessments ............................................................................................................................ 64
9.1.1. Jebsen-Taylor hand function test ...................................................................................................... 64
9.1.2. De ARA test ........................................................................................................................................ 64
9.1.3. De Nine Hole Peg Test ....................................................................................................................... 64
9.1.4. De TISC ............................................................................................................................................... 65
9.1.5. De Brünnstom-Fugl-Meyer test Upper limb ...................................................................................... 65
9.2. Cognitief assessment ................................................................................................................................. 65
9.2.1. De AMPS ............................................................................................................................................ 65
9.2.2. De A-ONE ........................................................................................................................................... 65
9.2.3. De ONO .............................................................................................................................................. 65
9.2.4. De PRPP ............................................................................................................................................. 65
9.3. Assessment voor de functionaliteit............................................................................................................ 66
9.3.1. De FIM ............................................................................................................................................... 66
9.3.2. De FAM .............................................................................................................................................. 66
9.4 Lijst van te kennen termen ................................................................................................................. 66
10. Het BOBATH of NDT-concept ............................................................................................................ 67
10.1. Basisprincipes .......................................................................................................................................... 67
10.2. Andere principes ...................................................................................................................................... 67
10.3. Keypoints ................................................................................................................................................. 68
10.4 Therapeutische aanpak ............................................................................................................................ 68
10.5. Normaliseren van de houdingstonus en de patiënt leren selectief bewegen .......................................... 69
10.6. Motor learning ........................................................................................................................................ 70
10.7. Motor control .......................................................................................................................................... 72
10.8. Positioneren ............................................................................................................................................. 73
10.8.1. Indeling van de kamer ..................................................................................................................... 73
11. Het gebruik van mental practise bij CVA patiënten .......................................................................... 74
11.1. Werking ................................................................................................................................................... 74
, 11.1.1. Mentale voorstelling vs. fysieke uitvoering ..................................................................................... 74
11.1.2. Hersenactiviteit ............................................................................................................................... 74
11.1.3. Visuele voorstelling vs. kinetische voorstelling ............................................................................... 75
11.2. Assessments ............................................................................................................................................ 75
11.2.1. Het cognitieve vermogen ................................................................................................................ 75
11.2.2. Het vermogen tot mentale voorstelling .......................................................................................... 75
11.2.3. Andere assessments ........................................................................................................................ 76
11.3. Zelstandig oefenen vs. begeleid oefenen................................................................................................. 76
11.4. Richtlijnen........................................................................................................................................... 76
12. Spiegeltherapie ................................................................................................................................ 77
12.1. Hoe wordt spiegeltherapie toegepast? ................................................................................................... 77
12.2. Oefeningen .............................................................................................................................................. 78
13. Het gebruik van opblaasbare spalken van PANAT............................................................................. 79
13.1. Algemene regels ...................................................................................................................................... 79
13.2. Specifieke spalk ....................................................................................................................................... 80
13.2.1. Lange armspalk ................................................................................................................................ 80
13.2.2. Lange dubbelkamer armspalk ......................................................................................................... 81
13.2.3. De halve armspalk ........................................................................................................................... 81
13.2.4. De halve dubbelkamer armspalk ..................................................................................................... 81
13.2.5. De elleboogsplint ............................................................................................................................. 82
13.2.6. De handspalk ................................................................................................................................... 82
13.2.7. De beenspalk ................................................................................................................................... 83
13.2.8. De voetspalk .................................................................................................................................... 84
13.2.9. De dubbelkamer voetspalk .............................................................................................................. 84
13.3. Intermitterende druk ............................................................................................................................... 85
14. Ziekte van Parkinson ........................................................................................................................ 86
14.2. Klinische verschijnselen ........................................................................................................................... 87
14.2.1. De rusttremor .................................................................................................................................. 87
14.2.2. Bewegingsarmoede ......................................................................................................................... 87
14.2.3. Instabiliteit ....................................................................................................................................... 87
14.2.4. Essentiële tremor............................................................................................................................. 88
14.2.5. Secundaire parkinsonsyndromen .................................................................................................... 88
14.2.6. Pathofysiologie van de ziekte van Parkinson ................................................................................... 88
14.3. Classificatie .............................................................................................................................................. 89
14.4. Fysieke mogelijkheden en beperkingen.............................................................................................. 89
14.4.1. Transfers ................................................................................................................................... 89
14.4.2. Arm- en handvaardigheden ...................................................................................................... 89
14.4.3. Evenwichtsproblemen .............................................................................................................. 90
14.4.4. Stapproblemen ......................................................................................................................... 90
14.4.5. Pijn ............................................................................................................................................ 90
14.5. Behandeling ....................................................................................................................................... 91
14.6. Cueing bij Parkinson ........................................................................................................................... 91
14.6.1. Visuele cues .............................................................................................................................. 92
14.6.2. Auditieve cues .......................................................................................................................... 92
14.6.3. Tactiele cues ............................................................................................................................. 92
14.6.4. Interne cues .............................................................................................................................. 92
14.7. Nordic Walking bij Parkinson ............................................................................................................. 93
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