梅氏手法--Maitland’s-Vertebral-Manipulation

Maitland’sVertebralManipulation谭杰文目的Purpose介绍西方其中一种手法治疗的原理（梅氏手法）Introductionofthemechanismofawesternmanipulation•问症及临床评估的运用Usageofperceptivequestioningandclinicalassessment•治疗法则Treatmentrules内容•手法治疗的原理PrincipleofMaitland’sManipulativeTreatment•体表图BodyChart•临床检查Clinicalexamination•症状应激度的概念及手法活动的级别Theconceptoftheirritabilityofthesymptomsandthegradeofthemanipulation手法治疗的原理PrincipleoftheManipulativeTreatment手法治疗的原理PrincipleofMaitland’sManipulativeTreatment•手法治疗的运作建立在检查病症、病因与治疗效果的过程时保持理论及临床两方面一个正确的关系。Maitland’sprocessbasesonacorrectrelationshipbetweenthetheoryandtheclinicduringthewholecourse,includingexaminethepatients,definethecauseandevaluatethetreatmenteffect.然而这个关系是运用逻辑和方法程序作思想指导。Thisisguidedbythelogicalmethod分析检查Examination•检查过程的发展从主诉部分到临床评估部分都是计划的过程，目的是要达到临床诊断及对相关的结构组织立论假设。•Thewholeexaminationfromthecomplaintotheclinicalevaluationmustbewellscheduled.Theaimistogenerateadiagnosisandmakeahypothesisofrelativestructure.检查目的GoalsofExamination•在不同的阶段设立治疗方案Setupthetreatmentplansindifferentstage•辨认危机因素、禁忌症及估计病人的愈后进展Recognizetheriskfactors,contradictions,andprognosisofthepatient.问症PerceptiveQuestioning包括Including•体表图Bodychart•病史Clinicalhistory•症状表态Symptoms•特设问题Setquestions问症目的GoalsofPerceptiveQuestioning辨认症状应激度及在临床检查时所需的注意事项Recognizetheirritabilityofthesymptomsandthenotesduringtheprocessofclinicalexamination对相关的结构组织作假设论点Generatethehypothesisoftherelativestructures找出症状的进展Findouttheprogressofthesymptoms设定临床检查计划Setuptheplanoftheclinicalexamination临床检查目的GoalsofClinicalExamination•确定或另设假想相关组织结构Determineormakeahypothesisoftherelativestructures•设计治疗手法和方向Designthepropermanipulativetreatmentandthedirection治疗原则TreatmentRules治疗方法必需与病史、病症、病状透过连贯分析检查联系Thetreatmentmustbeconnectedwiththehistory,symptomsandsignsthroughaserialanalysis手法选择ChoiceoftheManipulation•治疗手法TreatmentManipulation•治疗方向TreatmentDirection•级别Degree•何时加插或删减治疗Whentoaddorcutdownthetreatment?手法治疗的原理流程表检查Examination主观检查SubjectiveExamination客观检查ObjectiveExamination假设Hypothesis治疗Treatment再检查Re-examination体表图BodyChart要点覆盖KeyPoints•何为体表图What’saBodychart•运用体表图的技巧TheskillsofusingaBodyChart•体表图的临床应用TheclinicalapplicationoftheBodyChart首要做的事TheFirstThing怎样作业HowtoWork•由治疗师或病人填画Completionofthepicturebythetherapistorthepatient•描述症状Descriptionofthesymptoms•提供一个清晰快捷的病症记录Giveaclearrecord填上什么Whattorecord•第一步是要确定及记录症状的:-SEVERITY严重度-AREA范围-NATURE性质-DEPTH深度※症状之间的关系与出现的先后次序严重度SEVERITY对每一病症的表现程度作出的形容describethedegreeofeachsymptom•用十分比-如3/10[数目越大，情况越严重]•用文字-如轻微、中量、严重•用图表-如增加笔划、加上粗线条等范围AREA内容包括including•痛处及感觉受扰的范围theareaofthepainandtheabnormalsensation•关于最痛的范围及类别的短评theevaluationofthepain:areaandnature精确是非常重要exactionisveryimportant为余下来的检查提供一个极具价值的基础setupavaluablebasefortheleftexam观察病人怎样指示痛处observethepatienthowtopointoutthepain然后由治疗师辨别出准确的位置recognizetheexactlocationbythetherapist范围AREA修饰非言语沟通communicationwithoutlanguage•利用手指来指示一线或一点withafinger-代表病源的准确位置•利用手掌来指示病状withapalm-代表一个大且模糊的范围•感觉异常或消减的范围提示某一种神经根受影响。Abnormalsensationsuggeststheinjuryofthenerveroot性质NATURE病状的性质与受累结构•钝痛thickpain•拉扯痛stressingpain•烧灼痛burningpain•刺痛pinpain•割痛cuttingpain•异常感觉abnormalsensation•失去感觉/麻木lostofsensation/numb深度DEPTH症状是否可触及？Whetherthesymptomscanbepalpated?•与深层肌肉神经分布和骨骼神经分布区分•Skeletalnervedistributionandmusclenervedistribution•大而且模糊的范围显示其它组织结构问题Whethersymptomsarisefromthespinaljointsorpain-sensitivestructuresofthevertebralcanalorintervertebralforamen.可辨认的模式Therecognizablemode有多个可辨认的症状模式均显示那些出问题的可能结构或脊椎节定位意义表皮神经分布图1superficialnervedistribution1表皮神经分布图2superficialnervedistribution2表皮神经分布图3superficialnervedistribution3依据放射性疼痛（referredpain）的范围theareaofreferredpain骨骼神经分布图skeletal-nervedistribution肌肉神经分布图muscle-nervedistributionCLOWARDAREA卡洛区（1）CLOWARDAREA卡洛区（2）举例·胸脊痛的身体图（1）举例·胸脊痛的身体图（2）举例·胸脊痛的身体图（3）举例·胸脊痛的身体图（4）持续性Persistency•机械性，生理性，化学性根源mechanical,physiologicalandchemicalsource-断续interrupted-持续constant经验分享Experimentalshare•两神经根同时受影响可发生于腰椎，但甚少发生于颈椎Thesituationthattwonerverootsinfluencedatthesametimemayappearinlumbervertebra,butseldomincervicalvertebra.•有些病人能辨别出肌肉、软组织痛与骨关节痛somepatientscanrecognizethepainoriginatefrommuscle,softtissueorskeletal-joint分辨表面痛和深层痛是比较容易it’seasytoseparatesuperficialpainfromdeeppain当痛的范围是深和模糊，那时要界定痛区的边界会较困难whenthepainareaisdeepornotclear,it’sdifficulttodeterminethearea体表图的作用TheuseoftheBodyChart•显示问题的主次次序showthesequenceoftheproblems•为症状之间的关系提供参考资料areferencefortherelationshipbetweenthesymptoms•为问症及临床检查的指导guidethequestioningandclinicalexam•显示病情及治疗效果的演变showthetreatmenteffectandchangeofthecondition什么是体表图What’saBodyChart•一道沟通的桥梁Acommunicativebridge•一个记录Arecord•一个检查策划（主观及客观）Anexaminationplan(subjectiveandobjective)•一个评估工具Anevaluationtool触发和缓解因素Triggerandrelievingfactors目的goals来测定病人的症状有怎么容易被患者的活动所触发和那些症状有怎么容易消减•可避免因过度检查而加剧征状avoidworseningsymptomsbyover-examination•引出受影响组织的假设generatethehypothesisaboutrelativestructure缓解因素relievingfactors•能缓解症状的活动theactivitytorelievethesymptoms•让症状缓解所需的时间thetimeneededtorelievethesymptoms缓解因素举例Example•卧下，坐下，和其它特定的动作Liedown,sitdownandotherspecificmovements触发因素Triggerfactors•触发最坏症状的活动theactivitytotriggertheworstsymptom•甚么程度和时间会引致症状出现whentocausethesymptoms,andhowabout