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Jingdong book

康复治疗与护理

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康复治疗与护理

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康复治疗与护理是研究伤、病、残患者身体与精神康复有效的治疗和护理方法。为了康复目的，须对病患者、伤残者有关功能障碍进行评定和处理（进行治疗、训练、护理）。《康复治疗与护理》由预防、治疗、保健和临床护理共同组成，旨在促进康复。
《康复治疗与护理》共十二章七十二节，以康复医学为基础，从健康教育、康复工程、常见症状与疾病治疗护理，以至延续到社区康复等，全面论述了康复的重要性及具体做法，力求深入浅出，简便易懂，结构严谨，一目了然，注重新技术和新方法的介绍，也有总结和归纳的内容，重点突出，适合广大医务人员、患者及家属参考。
Catalogue

第一章 概论
第一节 康复的概念及领域
第二节 康复内容及对象
第三节 康复治疗及护理
第四节 康复医学的组成及工作方式

第二章 康复的基础理论
第一节 运动学
第二节 神经学

第三章 康复健康教育
第一节 概述
第二节 康复健康教育程序

第四章 康复治疗技术
第一节 康复治疗
第二节 物理疗法
第三节 作业治疗
第四节 语言治疗
第五节 心理治疗
第六节 中医治疗

第五章 康复护理技术
第一节 康复护理
第二节 康复护理程序
第三节 康复护理环境
第四节 体位与体位转移
第五节 康复护理技术在病房延续
第六节 心理护理技术

第六章 康复工程
第一节 康复辅助器具的应用
第二节 假肢使用
第三节 轮椅及助行器使用
第四节 义眼、导盲器和义耳、助听器使用

第七章 常见症状与康复
第一节 言语和吞咽障碍的康复
第二节 关节 挛缩及其康复
第三节 压疮及其康复
第四节 膀胱、肠道康复

第八章 常见伤、病、残患者的康复
第一节 脑卒中康复
第二节 颅脑损伤康复
第三节 脊髓损伤康复
第四节 周围神经病损康复
第五节 脑性瘫痪康复
第六节 骨折康复
第七节 颈椎病康复
第八节 肩周炎康复
第九节 手外伤康复
第十节 腰椎间盘突出症康复
第十一节 截肢康复
第十二节 慢性阻塞性肺病康复
第十三节 心脏康复
第十四节 骨质疏松症康复
第十五节 癌症康复
第十六节 残疾及康复

第九章 精神疾病康复
第一节 概述
第二节 精神病患者的生活行为康复训练措施
第三节 精神障碍的住院康复
第四节 精神障碍的社区康复
第五节 精神分裂症患者的康复

第十章 老年病康复
第一节 老年病康复目标与要点
第二节 慢性支气管炎康复
第三节 老年性支气管哮喘
第四节 老年支气管扩张症
第五节 慢性肺炎
第六节 冠心病康复
第七节 老年高血压
第八节 老年脑动脉硬化症
第九节 高脂血症
第十节 老年性溃疡病
第十一节 老年性糖尿病
第十二节 老年前列腺肥大症
第十三节 老年慢性腰腿痛
第十四节 老年痴呆
第十五节 帕金森病
第十六节 躯体各部疾病康复锻炼

第十一章 中医康复
第一节 概述
第二节 中医康复护理的辨证施护
第三节 传统康复护理方法
第四节 心理康复护理法
第五节 运动康复护理法

第十二章 社区康复
第一节 社区康复概念
第二节 社区康复护理
参考文献
Book Abstract

（一）大脑的可塑性
胚胎发育阶段神经网络形成的诸多变化、后天发育过程中功能依赖性神经回路的突触形成、神经损伤与再生（包括脑移植）以及脑老化过程中神经元和突触的各种代偿性改变等。
1.发育期可塑性
中枢神经系统在发育阶段如受到外来干预（如感受器、外周神经或中枢通路的损伤），相关部位的神经联系会发生明显的异常改变。中枢神经系统的损伤如发生在发育期或幼年，功能恢复情况比同样的损伤发生在成年时要好。研究表明，中枢神经可塑性有一个关键时期，在这一关键时期以前，神经对各种因素更敏感，在这一时期之后，神经组织可变化的程度则大大降低。胚胎发育期脑内神经回路的形成一般而言是由基因控制的。但这一时期神经回路的联系是相对过量的，胚胎期这种过量的神经连接在形成成熟的神经网络之前，必须经过功能依赖性和刺激依赖性调整的修饰过程。因此，即使是在发育期，环境因素与基因同样对发育期神经系统可塑性起决定性的影响。
2.成年损伤后可塑性
在发育成熟的神经系统内，神经回路和突触结构都能发生适应性变化，如突触更新和突触重排。在神经损伤反应中，既有现存突触的脱失现象，又有神经发芽形成新的突触连接。神经损伤反应还可以跨突触地出现在远离损伤的部位。例如，外周感觉或运动神经损伤可以引起中枢感觉运动皮质内突触结构的变化和神经回路的改造；一侧神经损伤也可以引起对侧相应部位突触的重排或增减。
神经学家在长期临床实践中，发现脑在损伤后，功能是有可能或有条件恢复的。例如，脑卒中后的偏瘫，如给予训练和药物治疗，肢体功能就可逐步恢复或改善。这说明大脑皮质具有重组能力，皮质的重组能力很可能是脑损伤后功能恢复的神经基础。
脑卒中后中枢神经的可塑性可能与下列因素有关：中枢神经的兴奋和抑制平衡被打破，抑制解除；神经元的联系远大于大脑的实际功能联系；原有的功能联系加强或减弱；神经元的兴奋性改变，解剖结构的变化，此过程需较长时间，包括新的轴突末梢发芽和新突触的形成。感觉和运动皮质定位域的功能重组可能出现在几个小时或几天之后。单个丘脑皮质神经元的轴突由密到疏伸展可达Imm或更多一些，在正常功能下的皮质，稀疏的突触联系可能发挥的效应很小，但当其优势皮质的活动不存在时，兴奋传人联系可能被释放出来，从而使这个定位域出现激活反应，功能重组得以完成。皮质功能重组的结构特征是新生的突触小结以及突触的形状、数量、大小、形式等在定位域的可塑性变化。皮质下中枢也存在功能重组，脊神经或背根离断后，其脊髓背角定位域的神经元对外周皮肤感受野刺激完全不发生反应，而经几周恢复后，对外周皮肤感受野刺激发生反应，即背角定位域出现功能重组。
3.突触传递的可塑性
遗传和后天环境因素共同决定了中枢神经系统的结构复杂性。人们很早就注意到，生活环境的改变的确可以引发起神经系统结构和功能的不同变化。在不断变化的环境下生长的动物，由于接受较多环境信息的刺激，其神经系统发育程度、突触数量、树突的长度和分支，以及胶质细胞数量等远远胜过生活在贫乏环境下生长的动物。人们可以推测在环境不断变化的刺激下，神经元之间的相互联系增强，甚至于建立某些新的联系。
这些观察结果表明，后天经验和学习等非病理因素能够影响神经元和突触的组织结构和生理效能。现已知道，成年动物的神经系统尽管通常不具备增殖和分裂能力，即不能再产生新的神经元，但神经元却持续拥有修饰其显微形态（如产生新的树突棘）和形成新的突触连接的能力。这种能力是中枢神经系统可塑性的基础。
……

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