Integumentary Physical Therapy 피부계물리치료학

Transcription

1 Integumentary Physical Therapy 피부계물리치료학 Dong-Ryul Lee, PT, Ph.D. Movement Impairment Specialist & Performance Enhancement Specialist Neurofeedback, Robotics & Virtual Reality Research Specialites: NeuroRehabilitation & Pediatric Rehabilitation

2 Skin ( 피부 )

3 Wound ( 상처 )

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7 ( 신경병증궤양 )

8 Definition Infection, ulceration or destruction of deep tissues associated with neurological abnormalities & various degrees of peripheral vascular diseases in the lower limb based on WHO definition

9 Definition Diabetic foot ulcers occur as a result of various factors, such as mechanical changes in conformation of the bony architecture of the foot, peripheral neuropathy, and atherosclerotic peripheral arterial disease, all of which occur with higher frequency and intensity in the diabetic population.

10 Etiology diabetes, associated with arterial disease and peripheral neuropathy caused by repetitive trauma on insensitive skin. Epidemiology 85% of diabetic related foot amputation are preceded by foot ulcer 40% - 60% of all non traumatic lower limb amputation 4 out of 5 ulcer in diabetics are precipitated by trauma 4% -10% is the prevalence of foot ulcer in diabetics

11 Location occurs where arterial ulcers usually appear; or where peripheral neuropathy appears (plantar aspect of foot).

12 Risk Factors Vascular Disease( 혈관질환 ) Neuropathy ( 신경병 ) Sensory N. ( 감각신경병 ) Motor N. ( 운동신경병 ) Autonomic N. ( 자율신경병 ) Mechanical stress ( 기계적스트레스 ) ABNL foot function & Inappropriate footwear ( 비정상적인발기능과부적절한신발 ) LOM Foot deformity - varus, valgus

13 PERIPHRAL VASCULAR DISEASE NEURO- OSTEOARTHROPATHY (CHARCOT FOOT) Biomechanics of foot wear AREAS AT RISK OF ULCERATION

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15 Clinical features Pain: typically not painful; sensory loss usually present. Pulses: may be present or diminished. Absent ankle jerks with neuropathy. Sepsis common; gangrene may develop.

16 Classification Stage Normal High risk Ulcerated Cellulitic Necrotic Major amputa -tion

17 Test 순환기능평가 0.8 이하 느림 감각기능평가

18 Assessment Neuropathy Ischemia Deformity Callus Swelling Skin breakdown Infection Necrosis

19 Management

20 Management How To Prevent Foot Problems 5 corner stones Regular inspection & examination of foot & foot wear Identification of high risk patient Education of patient, family & health care providers Appropriate foot wear Treatment of non-ulcerative pathology

21 Physical Therapeutic Intervention 운동치료의학적처치 약물, 수술 ROM Ex. & Stretching Big toe Ext. / DF 등.. 유산소운동 (Aerobic Ex.) To 혈당관리 중강도 -150 분이상 / 주 가동성훈련 (mobility training) & 보행훈련 (Gait training) ( 안전가이드 ) 상처다리쪽부분체중부하보행을교육 좁은보폭보행 -> 앞쪽발바닥압력을 53% 까지줄일수있음 신발수정 -> 보행시압력감소가능 임시신발 (footwear) 보행신발 or 캐스트신발.. 영구신발 궤양발생과재발의위험을줄이기위해 발보호, 발바닥압력 / 전단력최소화해야함 적절한영구신발시결정사항 잘맞는신발크기 : 가장긴발가락 +1.27cm 발압력줄일수있는부드럽고신축성있는재질로제작 : 굽높이 2.54Cm 이하로 그이상의신발높이는발안정성, 발바닥압력 & 전단력 약물치료 - 혈당조절 - 감각이상관리 - 동반동맥부전관리 : 달테파린 - 항생체치료 외과수술 - 죽은조직제거 - 절개배액 - 항미생물제구슬삽입 - 절단 : 바그너등급 4-5 의괴사상처

22 Physical Therapeutic Intervention

23 Physical Therapeutic Intervention 전접촉석고붕대제작

24 참고문헌 피부물리치료학, 이재형외, 정담미디어, 2013 피부물리치료중재학, 박지환, 범문에듀케이션, 2013

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