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민 오
5 years ago
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1 1. 교과서 - 1 -

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6 2. 원리가. 건강과질병에관한카이로프락틱의학의시각 1) Health vs. Disease 가 ) Health : Balance (1) Physical (2) Chemical (3) Mental 나 ) Disease : Unbalance (1) Physical (2) Chemical (3) Mental - 6 -

7 (4) Disease ( 진단 ) ( 가 ) 문진 1 주증상 2 통증의성격 onset(when) duration acute/subacute/chronic mild/moderate/severe 3 직업력 4 외상유무 ( 나 ) ROM 1 Range of motion - 7 -

8 ( 다 ) Palpation 1 ( 라 ) Physical examination ( 마 ) Lab 1 UA 2 CBC 3 CRP 4 RA 5 ESR 6 Uric acid 7 Alk. Phosphatase ( 바 ) X-ray 1 C-spine AP open mouth view - 8 -

9 Lateral AP flexion extension 2 L-spine Lateral AP Flexion Extension 3 Pevis AP 4 특히대퇴골두가나오도록촬영 ( 사 ) 체온열검사 1 EZ776 2 인정비급여 3 IRIS 8000 ( 아 ) 심박변이도검사 (Heart Rate Variability Test) 1 자율신경계의상태를반영 2 일명스트레스테스트 3 인정비급여 4 FY894 ( 자 ) CT ( 차 ) MRI ( 카 ) 근전도검사 다 ) Subluxation - 9 -

10 (1) 과거 : Bone out of Place (2) 현재 : 우리몸에발생하는질환뿐만아니라이상반응까지도... (3) 원인 : Stress ( 가 ) Physical ( 나 ) Chemical ( 다 ) Mental 2) 검증할수있는원리가 ) 인체의구조와상태가어떻게인체의기능과치료에영향을미치는가를제시나 ) 유물론적관점다 ) 척추교정치료를통하여 Subluxation 을없애면그것이생리학적인기능에영향 (1) 항상성라 ) 과학적연구가가능 (1) 객관화가가능

11 마 ) Axis (1) reversible (2) displacement ( 가 ) Translation ( 나 ) Rotation 바 ) Posture analysis

12 (1) 시진 (2) digital camera ( 가 ) 포토샵프로그램이용 (3) posture program활용사 ) X-ray 분석 (1) Listing ( 가 ) vertebral body 기준 ( 나 ) spinous process 기준 3) 검증할수없는은유가 ) 정신-육체관계가치료과정과건강유지에서하나의수단나 ) Holistic 나. 교정치료 1) 교정치료 = 均衡의治療 = Balance ( 내환경의유지 (Homeostasis)) 2) 이론적배경가 ) 미국 Dr. White & Panjabi : 축나 ) D.C Don Harrison : CBP (1) 다 ) SOT (1) D.C De Janette

13 (2) 라 ) Deversified (1) ersified.html 마 ) Gonstead (1) chniques.html 바 ) AMCT (1) 사 ) etc. 3) Full Spine Technique 다. 원리 1) Set up 2) Skin Pull 3) LOC (Line of correction) = LOD (Line of Drive) 4) High Speed 5) Low Amplitude 6) Open wedge ( 닫아주는쪽으로 )

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16 7) Mechanical forces acting on connective tissue 가 ) Loads 나 ) Newton's laws of motion

17 다 ) Facet joint

18 라. vertebral subluxation complex 1) 변위--> 병태생리--> 병리 2) 원리가 ) 변위의교정은정상적인생리기전을회복나 ) 가역적병리를변화 3) 1. 신경병태생리가 ) Neuropathophysiology

19 (1) irritation--> facilitation ( 가 ) anterior horn 1 muscles hypertonic ( 나 ) lateral horn 1 sympathetic vasomotor ( 다 ) Posterior horn 1 sensory (2) pressure--> degeneration ( 가 ) atrophy ( 나 ) sympathetic atonia ( 다 ) anesthesia (3) decreased axoplasmic flow 4) 2. 운동병리가 ) Kinesiopathology (1) hypomobility --> fixation theory ( 가 ) H.Gillet (2) Hypermobility ( 가 ) Illi (3) loss of joint play ( 가 ) J. Mennel 5) 3. 근육병리가 ) Myopathology

20 (1) spasm ( 가 ) compensation ( 나 ) facilitation 1 visceromotor reflex ( 다 ) Hilton's law (2) atonia 6) 4. 조직병리가 ) Histopathology (1) cellular flow of inflammatory process (2) edema within intervertebral foramen, impeding flow of circulating fluids 7) 5. 생체역학적변화가 ) Biochemical change (1) L.A.S(Selye) from local tissue damage or further G.A.S (2) Histamines (3) Prostaglandines (4) kinins 3. 효과가. Pain relief 나. Restoration of range of motion

21 다. Relief of disability 라. Return to activities of daily living 마. Muscle strengthening 바. Improved gait 사. Improved posture 4. Complication 가. Classification 1) Transient 가 ) 교정후 4시간정도에발생하고약 24시간안에사라짐나 ) Local pain or discomfort 다 ) Stiffness 라 ) Headache 마 ) Tiredness / fatigue 바 ) radiating pain or discomfort 2) Substantive reversible impairment 가 ) Cervical spine (1) disc herniation / prolapse (2) nerve root compression (3) cervical and upper thoracic spine strain

22 나 ) Thoracic spine (1) minor vertebral body compression fracture (2) posterior element fracture without loss of structurral integrity (3) pneumothorax (4) Shoulder girdle, thoracic spine and rib cage strain 다 ) Lumbar spine (1) minor vertebral body compression fracture (2) posterior element fracture without loss of structurral integrity (3) disc herniation / prolapse (4) nerve root compression (5) Shoulder girdle, thoracic spine and rib cage strain 3) Substantive non-reversible impairment 가 ) Cervical spine (1) unresolved disc herniation / prolapse / extrusion (2) unresolved radiculopathy 나 ) Thoracic spine (1) significant vertebral body compression fracture (2) posterior element fracture with disruption of the spinal canal 다 ) Lumbar spine

23 (1) significant vertebral body compression fracture (2) unresolved disc herniation / prolapse / extrusion (3) posterior element fracture with disruption of the spinal canal (4) unresolved radiculopathy 4) Serious non-reversible impairment 가 ) Cervical spine (1) death (2) cerebrovascular accident (3) spinal cord compression 나 ) Thoracic spine (1) spinal cord compression 다 ) Lumbar spine (1) Cauda equina syndrome 나. Causes 1) Incorrect patient selection 가 ) lack of diagnosis 나 ) lack of awareness of possible complications 다 ) Inadequate palpatory assessment 라 ) Lack of patient consent 2) Poor technique

24 가 ) excessive force 나 ) excessive amplitude 다 ) excessive leverage 라 ) inappropriate combination of leverage 마 ) incorrect plane of thrust 바 ) poor patient positioning 사 ) Poor operator positioning 아 ) Lack of patient feedback 5. Contraindications 가. Absolute 1) Bone 가 ) tumour (1) metastatic 나 ) infection (1) Tbc 다 ) metabolic (1) osteomalacia 라 ) congenital (1) dysplasias 마 ) Iatrogenic

25 (1) long term corticosteroid medication 바 ) Inflammatory (1) severe RA 사 ) Traumatic (1) fracture 2) Neurological 가 ) cervical myelopathy 나 ) cord compression 다 ) Cauda equina compression 라 ) nerve root compression with increasing neurological deficit 3) Vascular 가 ) diagnosed vertebrobasilar insufficiency 나 ) diagnosed carotid artery artery dysfunction 다 ) Aortic aneurysm 라 ) Bleeding diatheses (1) haemophilia 4) Lack of a diagnosis 5) Lack of patient consent 6) Patient positioning cannot be achieved because of pain or resistance

26 나. Relative 1) Adverse reactions to previous manual therapy 2) Disc herniation or prolapse 3) inflammatory arthritides 4) pregnancy 5) spondylosis 6) spondylolisthesis 7) osteoporosis 8) anticoagulant or long-term corticosteroid use 9) advanced degenerative joint disease and spondylosis 10) vertigo 11) psychological dependence upon HVLA thrust technique 12) ligamentous laxity / hypermobility 13) arterial calcification 6. 주의할점

27 가. 대개경추교정후합병증발생이생길수있다 1) 빈도가 ) 1/10000~1/ 나. Maigne's test 1) 환자를앉히고머리를신전회전시킨뒤에그자세를약 15~40 초유지 2) 좌, 우확인 3) 원리가 ) 머리를신전, 회전시키면인위적으로 vertebral artery 를압박 4) positive 로나오면교정을하지않는것이좋다. 다. Predispositons to Cerebrovascular accidents

28 1) Headaches, migraine 2) dizziness 3) sudden severe head or neck pain 4) hypertensive 5) cigarette smoking 6) oral contraceptives 7) obesity 8) diabetes 라. Clinical signs and symptoms of cerebrovascular episodes 1) vertigo, dizziness, giddiness, light headedness 2) drop attacks, loss of consciousness 3) diplopia 4) dysarthria 5) Dysphagia 6) Ataxia of gait 7) Nausea, vomiting 8) numbness on one side of the face 9) Nystagmus

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