Integumentary Physical Therapycontents.kocw.net/KOCW/document/2014/honam/leedongryul1/5.pdf ·...

Integumentary Physical Therapy

피부계 물리치료학

Dong-Ryul Lee, PT, Ph.D. Movement Impairment Specialist

& Performance Enhancement Specialist

Neurofeedback, Robotics & Virtual Reality Research

Specialites: NeuroRehabilitation & Pediatric Rehabilitation

[email protected] [email protected]

mailto:[email protected]

mailto:[email protected]

Skin (피부)

Wound (상처)

Wounds : Pressure Ulcer (압력 궤양)

Wounds : Pressure Ulcer

• Definition • result of pressure, or

pressure in combination with shear and/or friction

• localized injuries to the skin and/or underlying tissue • that usually occur over

a bony prominence

http://www.youtube.com/watch?v=QCW2R4vnzXc

http://www.youtube.com/watch?v=QCW2R4vnzXc


• Etiology • lesions caused by

unrelieved pressure resulting in • ischemic hypoxia

• and damage to underlying tissue.

Acidosis (산성)

: Metabolic acidosis may result from

• increased production of metabolic

acids

• or disturbances in the ability to

excrete배설하다 acid via the kidneys

원인

압력

혈관운동성 상실

감각저하

피부외상

욕창

7가지

피부마찰

습도와 체온

영양결핍


• Location


• Contributory Factors (4- 주요원인)

• Shear forces (전단력: 연부조직과 평행하게 힘을 받음)

• Prolonged pressure (압력: 연부조직에 수직으로 힘을 받음)

• Friction (마찰력: 연부조직에 평행하게 작용)

예) 환자를 운반차에서 침대로 끌어당겨 옮길 때

• Maceration (짓무름)

• softening associated with excessive moisture

• Impaired Mobility (운동장애) • By limited ROM, M. strength ↓, 의료장비 사용시

• By 환자 체위변경의 의지 無 통증 or 우울증으로 인해

• By 통증 인지능력 감소 약물 or UMNL / LMNL으로 통증인지 능력 감소시

• Nutritional deficiency (영양실조)

• 저알부민혈증

• Repetitive stress


• Risk Factors

• Elderly, debilitated쇠약, or immobilized individuals.

• Decrease blood flow from hypotension or microvascular disease: • diabetes, atherosclerosis.

• Neurologically impaired skin: • decreased sensation.

• Cognitive impairment.


• Clinical features

• Location: occurs over bony prominences, • i.e., sacrum, heels, trochanter, lateral

malleoli, ischia areas, elbows.

• Color: red, browniblack, or yellow.

• Localized infection.

• Pain: can be painful if sensation intact.

• Inflammatory response with necrotic tissue: • Hyperemia충혈, fever, increased WBC.

• If left untreated, will progress from superficial simple erosion짓무름 to involvement of deep layers of skin and underlying muscle and bone.


• Classification : Graded by stages of severity

(tissue damage)


Partial thickness loss of dermis

Subcutaneous fat may be visible

Exposed bone, tendon or muscle

Non-blanchable redness

• Classification : Graded by stages of severity (tissue damage)


• Classification : Graded by stages of severity

• (tissue damage)


• Classification : Graded by stages of severity (tissue damage)


• Exam & Evaluations • For Prevention (예방)

• 예방이 최선의 방법

• 압력궤양 예방을 위한 연상법



검사방법

Braden Scale for predictiong pressure sore risk (브레이든 압력궤양 위험 예측 척도)

Norton risk assessment scale (노턴 위험평가 척도)

Gosnell pressure sore risk assessment scale (고스넬 압력궤양 위험평가 척도)

• For evaluation (평가) 검사방법

Sessing scale (세싱 척도) : 상처와 상처주의의 특성을 관찰척도로 평가

: 7점 척도 (0-6점, 점수↑ 압력궤양 심 )

Bates-Jensen wound assessment tool (BWAT, 베이츠-젠슨 상처평가도구)

: 상처와 상처주의의 특성을 평가/15개 항목, 5점 척도 (1-5점, 점수↑ 압력궤양 심 )

Pressure Ulcer Scale for Healing (PUSH)



Braden Scale for predicting pressure sore risk (브레이든 압력궤양 위험 예측 척도)



Norton risk assessment scale (노턴 위험평가 척도)


• Exam & Evaluations • For evaluation (평가)

검사방법

Sessing scale (세싱 척도) : 상처와 상처주의의 특성을 관찰척도로 평가 : : : 7점 척도 (0-6점, 점수↑ 압력궤양 심 )





• Exam & Evaluations


• Exam & Evaluations • For evaluation (평가)

검사방법

Sessing scale (세싱 척도) : 상처와 상처주의의 특성을 관찰척도로 평가 : : : 7점 척도 (0-6점, 점수↑ 압력궤양 심 )





• Examination & Evaluations


• Management


• Physical Therapeutic Intervention

운동치료 물리적 인자치료 의학적 처치

활동중심중재 약물, 수술

• 유연성 운동(Flexibility Ex.)

• 근육강화 운동 (Strengthening Ex.) • UE : to 체위/자세변경 • LE: to 이동/보행 • 골반바닥근, 배근육 : 실금 동반 환자의 경우

• 유산소운동 (Aerobic Ex.)

• 보행훈련 (Gait training)

• 전기자극 (ES) • Grade II, III, IV

• UV, US, NPWT

• 압력궤양 치유 Help

• PL(흡입 맥동세척) or Whirlpool (회전욕) • 생물학적 부하가 높

거나 감염된 상처시…

• 약물치료 - 치매관련 약물

• 압력궤양 위험↓ • 상처치유 촉진o

- 항생체 치료 • + 감염, 연조직염, 골

수염, 패혈증 있을 경우

• 외과수술 - 죽은조직제거 : Grade III-IV - 근육피부판이식 (Musculo-

cutaneous flap)




운동치료

자세 취하기(positioning)

30도의 법칙

(30s angle law)

도수치료 - 피부 굴리기(skin

rolling )

도수치료 - 상처이완술(scar tissue release)



물리적 인자 치료

• 피부물리치료학, 이재형 외, 정담미디어, 2013

• 피부물리치료중재학, 박지환, 범문에듀케이션, 2013

참고 문헌

Dong-Ryul Lee, PT, Ph.D.

Copyright by Dong-Ryul Lee, PT, Ph.D.

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