Tat ca cafc r6i loan co tron tren c6 th€ gi}.ptrong 't6n thuong than kinh
trung uong va t6n thuongvung du6i ngua cua than kinh ngoai bien.
8. Rei loan chirc nang than kinh SQ

- Khi benh nhan t6n thucng nao, thuong kern thee tan thuong mQt sO'
day than kinh 89 do nhan cac day nay narn trong nao, bieu hien bang
. trieu chung va r6i loan chuc nang cac day d6.
"
••

T~n thucng d~y I: m1(~ha: gia~ khuu :iac, ~ang ,khUU, ,aDkhuu,

\

Ton thucng day II: mu, gram thi luc gram thi truong nhin.

)

.

__

.

+ T6n thucng day III, IV, VI: Ii~t co van nhan, sa mi mat, mat phan
xa d6ng ttt vdi anh sang

I

"


day la nhung bi€u hi~n lam sang thtidng g~p trong b~nh ly h~
. thftn kinh. Ph at hi~n dfty
nhung bi€u hi~n d,6, Iti\1ng gia chinh xac
r6i lo~n chuc nang ky thu~t vien se co nhung yeu to' c~n thiet d~ d~
ra ke ho~ch phvc h6i, ch9n phudng phap tri li~u thich h\1p d~t hi~u
qua cao trong dieu tri, d6ng thdi giup tien Iti\1ng va thee d6i tie'n
tri€n dieu trio
.

du

LUQNG GIA

1. Trinh bay giai phft u cd ban h~ th~n kinh.
2. Trinh bay cac thay d6i ve tinh th~n, v~n d9ng, cam giac va dinh
dtiang cd khi e6 t6n thtidng th~n kinh trung tidng va ngo~i bien.
3. Trinh bay each kham va phat hi~n mQt 86 phan x~ binh thtidng va
b~nh IS khi co t6n thtidng thftn kinh.
4. Trinh bay cae bi€u hi~n r6i lo~n cd tron va cae r6i lo~n chuc nang
day thftn kinh 89 trong b~nh ly thftn kinh.

35


VAT
. LY TRI..LIEU, - PHUC. Hill CHile NANG
TAl BIEN MACH
. MAu NAo
MVC TIEU
1. Nguyen nhan, trieu chung lam sang d.c mach m au nao va vd mach

- M~ch rna tj va ~ rnau tran ra ngoai.
- Do cao huyet ap.
- Do xd vua d9ng m~eh.
B~nh ua chay mau cung c6 th~ gay xuat huyet nao nhu b~nh b~eh
cflu cap, b~nl?-Hemoglobin, xuat huyet giam b~eh eflu b~nh $eholein
Henoek.
36


3. Trieu ch((ng

lam S~H;g

3.1. Tac mech mtiu nao

. Giai dean khoi pha t

c

- 'I'rieu chung xuilt hien tu tu qua nhieu narn.
- Chu yeu' benh nhan th[y nhirc d~u, hoa mat chong mat, co th~ co
cam giac di cam thoang qua.
- Giarn van dong chan tay, chan tay giclen khokhan

ngucng nghiu.

Roi loan cam giac d tay chan ben liet: ngori tay, ngori chan te te nhu _ _kien bo hoac dau nhu kim cham.
- Noi kho hoac noi ngong.
. Giai dean liet: day la bi~u hien cua Iiet than kinh trung uong giai
dean sdrn.


m0ch mau nao xay ra QQt ngQt va ni[tng, b~nh nhun thttdng hon
me ngay tu d&u.
('~;_'
ij~l~

c1hal

37


- Nguyen nhan:
+ 'rang huyet ap.

+ Di dang mach m au riao (u mach, phdng d9ng mach).
- Yeu ta thuan lei:
+ Sinh heat co th~ khong dieu d9.
+ Sinh heat vat chat qua mire (an uang qua no say).
+ Lao dong' trf DC gbing sire.
+ Tinh than ding thang.
Vi trf vd mach: vd mach vung bao trong, nhan xarn trung
thuy nao, nao giua, ti~u nao.

uong

'I'rieu chtrng
- Sau g&ng sire d9t ngot benh nhan thay hoa m&t ch6ng mat, nhuc d~u
du doi vung tran, gay va 2 ben thai ducng kern theo non mua, mat
tai, sau vai phut c6 th~ di vao hon me.
+ Benh nhan khorig dap ung vdi kich thich


mem:

keo dai til sau khi hi tai bien den 2_--=-3 tuAn sau:


+ Van dQng chi lanh (chi tren, chi dudi),
41

!

. 48 gid dfl.u·
~

- Benh nhan hon me sau.
- Mat tai nhct.
R6i loan n~ip thd ki~u _~:

.
T;(~ ,Jv vh-)
1

,)"\~~U

.---7

",'{~'n,~~)

- Tim dap yeu, nhip khong dgu, mach cham khong b~t duoc.
- S6t cao 40DC - 41DC.

6.1. Ml.jc dich PHCN

Giup h9 thich nghi vai di chung con lq_i.
- Giup b~nh nhan lam nghe Cll ho?c h9C 1 nghe maio
- Giup b~nh nhan sll' dl,lng thanh thq_ocac d\lng C\l trq giup
- Giup b~nh nhan t\1 d9c l~p di chuy~n tit noi nay sang ndi khac.
- Giup b~nh nhan t\1 sinh hOq_thang ngay.
Giup b~nh nhan t~p luy~n ch6ng teo cd cung khap va bien d~ng
khap.
6.2. Phuong

phap PHCN

. Nguyen uic PH CN
- PHCN sam khi

bi li~t.

- V~n d9ng d nhieu tu the khac nhau: tu the n~m, tu the ngoi, tu the
dung, tti the di.
- Chi dinh v~n d9ng dung tuy thea l\1c cd.
. Cac phudng phap PHCN

40


,1

+ Dong vien benh nhan d~ thich nghi vdi cuoc song maio
+ Huang nghiep cho benh nhan neu con tre.


1. £)~i Cltdng t6n thircnq tuy sang
1.1. Djnh nghia

T6n th ucng tuy song la tinh trang benh ly gay nen liet hoac giam van
dQng 4 chi hoac 2 chi dudi tuy thea vi tri t6n thuong, kern thea cac roi lean
khac nhu roi 10?n cam giac, ho hap bang quang, ducng rUQt, dinh duang.
1.2.

Y nghia

cua PHCN

T6n thuang tuy s6ng ngay mQt gia tang, PHCN cho b~nh nhan rat ton
kem va ~6ng phu, doi hoi can bQ ph\lc h6i va gia dinh, ba~ than ngudi tan
t~t phai co quyet tam cao, kien tri t~p luy~n thi moi thanh cong dUQc.
PHCN t6n thuang tuy song la dung cac bi~n phap y h9C, xa hQi h9C,
giao d\lc h9C, kinh te va ky thu~t ph\lc h6i chilc nang nh~rn dam bao cho h9
hQi nh?p va tai hQi nh~p xii hQi. C6 co hQi binh dAng tham gia VaGhOq_t
dQng trong gia dinh, xa hQi e6 eUQcsong. binh thudng toi da so vai hoan
eanh ella h9.
."

45


2. Nguyen nhan gay t6n thLtdng tuy song

2.1. Do ctuin thuO'ng
- Tai nan giao thong.


L\tA 1') B :

Chay mau.

'1iILM

_2)

But tuy,
2.2. Cec b~nh eua tuJi scfng
- Viern tuy ciit ngang.
- U tuy song.
- Xo tuy rai rae,
- C6t tuy viern c (6

- Li~t ed hoanh gay kh6 khan ho hflp.

C6

- Giam s\i dieu tie't m6 hoi va nhi~t dQ.



It.;

I

)ZL

/~t~~

'] ( t§ c~
_

-1~~

n

11;1 -

(
- (\

/J evut[

-

-

1c~1t +L~\
C1~~\- ,b C'Vl~
r


BI;JngdLlai

83 - 4 - 5

12

Gan ban chan
Da h~u mon, cd Mnh hang

Y nghfa eua cae mtit tur song bj ton thU'O'ng
LU9ng gia chue nang giua mue t6'n thtidng tuy song va kha nang
phve h6i eua b~nh nhan.
. LU9ng gia xe m cd nao li~t, cd nao kh6ng li~t, phfrn cd th~ nao li~t,
ph§.n nao kh6ng li~t.

Tu d6 de ra dtige mve tieu c§.n PHCN cho ngtidi t6'n thtidng tuy song.
T4- VLTl...

49


· M9t sO'kha nang benh nhan c6 th~ dat duoc.

d rmrc C4 trd len: rat kh6 khan cho van d9ng.

-

Neu t6'n thuorig


- Giam dau.··
- H? s6t.
- Khang sinh ch6ng b9i nhiem.
4.2. fJieu trj nguyen Ilhan
- Do chan thlid~g: b6 b9t, phliu thu~t.
Do b~nh t~t: dung thu6c khang sinh.

50


5. V~t Iy tr] li~u - phuc hoi chtrc nang

5.1. Mvc dich vQt

ly tr] Ii~u

- phvc ho'j cht1'c nang

- T~p nhirng co li~t dang h6i phuc d~ tang luc co.
Chong loet.
Tap nhimg co khong li~t d~ thay the cd liet.'
N gan ngua bien dang khdp,

t",

"

.~
.


ngon tay.
Chi dLioi: v~n d(>ng th\l d(>ng khop hang, khop g6i, khop c6 chan, ban
chan.
- T~p thd b\lng, t~p thd ng\ic: tac d\lng, tang dung tich ph6i, gian nd
Mng ngl;ic.
- T~p

v6 rung 16ng ngl;ic: tac d\lng long ddm.

- T~p ho co hi~u qua: ch6ng x~p ph6i, thoat ddm ra ngoai, ch6ng viem
ph6i.
T~p Ian l~t tu tti the n&m nglta sang tu the n&m nghieng.
. Giai doq.n II: t~ p ng6i cho b~nh nhan
51


- T'ap ngdi c6 tro giup,

BUQc day vao cuoi giuong, earn dau day cuon dan roi benh nhan tu
ngoi day,
- Tap ng6i kh6ng tro giiip:
Benh nhan narn chong 2 tay, xe dich dan tung tay r6i t.u ngoi day,
- T$:p thang bang' d tu the' ngoi.
+ Dua tay ra trudc,

+ Dua tay len tren.
+ Dua tay sang ngang.
+ Giu thang bang than minh kh6ng cho d6 xuong,
- Tap di chuyen tu giuong sang xe Ian tay va tu xe Ian tay len giuong.
- 'I'ap di chuyen tu xe Ian tay xuong dern va tu d~m len xe Ian tay.


LU~NG GIA
1. Trinh bay nguyen nhan, tri~u chung, tie'n tri~n, bie'n chung t6n th-

uong tuy song.
2. Trinh bay muc dich - phucng phap PHCN t6n thucng tuy song thea
3 giai dean.
,",

~,.

VAT
CHUC NANG-. LY TRI..LIEU-· PHUC-Hih
.
LIET• THAN KINH VII 'NGOAI• BIEN'I

.~') ) '"
I,
,\l_ ,I,"" ~~L-I" rrJ_;"(

vlU

'-

"4

-th~~(C/'itO-

i/y\{;0
•


,

Ml)C TIEU
1. Nguyen

nhan, trieu chung, tie'n tri~n, bien chung cua li~t mat
ngoai bien.
2. Dieu tri, phuc h6i chuc nang cho benh nhan li~t VII ngoai bien.
,.,

"

NOI DUNG

L~t~ rrt~~{
)~

hLP"1{~

hL~t ,)_C~;;O ~~
mku~ rc ~

"(

,,1'1~~7~
daq rt K ~a 1,
ctu«

b~ /)l')Cd:

- U d(k nen S9. U canh nho xucng budm, u tuyen mang tai.
Do lanh: la nguyen nhan lanh tinh thucng khoi hcan toan it d~ lai
di chung.
Do virus.
2. Tri~u chUng

Liet mat ngoai bien bi~u hi~n liet toan b9 mra mat benh nhan:
2.1. V~n d9n9
. Luc nghi ngoi: b9 mat dd dfin, mat duong net tu nhien.

Quan sat ve mat thay mat 8l.,1 carl dai:
+ Truong luc cd m~t ben li~t giam lam mep s~ xuang, m~t nhAm

khong kin, khe milt ben li~t r9ng hdn ben lanh, long may ben li~t
h? thap xuang, ranh mui rna ben li~t mat, nhan trung l~ch sang
bEmlanh.
+ Nlioc b9t thlidng chay ra

a

mep ben li~t, an uang hay vltdng viii
thuc an hay d9ng l;;tid rna ben li~t.

. Khi thljc hi~n d9ng tac
54


I.

I.

- Hai phan xa tren chung to cho ta thay benh nhan bi liet mat ngoai
bien.
- Tuy nhien can phai chu y trong trucng hop liet VII ngoai bien ca hai
ben ta se thay mat benh nhan v~n can d6i nhung kh6ng bieu 19 duoc
tinh cam, hai mat, benh nhan x~ xu6ng, kh6ng lam duoc d$ng tac co'
y, co dau hieu Charles-Bell ca hai ben.
- Trong truong hop li~t VII ngoai bien co curig thi ben liet co cung lai
neri mat bi keo lech ve ben liet. Nhung khi lam cac d9ng tac co' y thi
co mat vfln yeu, hoac kh6ng lam duoc. V~n co dau hieu CharlesBell.
-.~

_. -

2.3. Cam giac
- Vi so' soi cam giac cua day VII rat it nen khi liet, cam giac ngoai da
benh nhan kh6ng bi r6i loan mac du mQt so benh nhan cam thay te
cung nua mi[tt.
Khi dung ngon tay an van mi[tt hoi[tc dung am thoa d~ thu thay cam
giac sau bi r6i 10q_nnh~.
- D6i khi co bi~u hi~n mat vi giac 2/3 trtioc ltiBi ben li~t, (thi'i b&ng
mu6i, dtidng ... ).
- M9t so' it trtidng h
- Thie'u oxy do ngat nude, ngQ dQchoi (khiCO,

CO2···)·

.'

2.4~Khong r6 nguyen nhan
3. Oa'u hi~u nh~n biet sam bal nao
- N gay tu hie mdi de ra tre mem nheo.
- Tre ph at tri~n cham so vdi cac tre khac,
- Cha me thuorig kh6 be Am.
- D~u tre bi ru, khong ng~ng len ducc.
- Tre bu sac, bu kh6, khong mut duoc hoac d~y Iudi ra. - C6 th~ c6 d9ng kinh.
- Tre thuong nghe kh6, nhin kh6.
- Tre thay d6i tinh tinh bat thucng.
4. Phan loai
4.1. Theo the"lam sang

. Th~ co cung: thu'dng giitpnha't.
- Tang trudng It;tc cd (khi ta v~n d9ng g~:p du6i tay chan tha'y kh6, tre
cling lq_iva chong lq_isuc g~p du6i).
Ban tay luon nftm ch~t.
Ban chan du6i cheo, cung dd.
- Phan Xq_gan xtidng tang mq_nh khi go bua phan X? vao goi thi tre
rung gi~t mq_nh.

tre

___
- -==_l2~c_biet

den trucng ... LOl;1inay kh6ng d.n phuc h6i chuc nang ..
. LOl;1ivua
Benh nhan thieu kha nang tl,i cham soc va di chuyen, co khiern khuyet
ve tieng noi,
Nguoi benh can duoc phuc.hoi
chile nang.
..
.- .. ~ .. -..
I..
..
- .. _ -

----

. LOl;1inang:
Kha nang tlJ cham soc, di chuyen va di chuyen cua nguoi benh rflt
kern. Nguoi benh phai ducc phuc h6i chuc nang.
Tom lai: du phan loai thea each nao, tren thuc te kho ~rna nhan dinh
duoc mot th€ benh ro r~t d6i vdi mot tre bai nao vi cac bieu hien thuong da
dang, phuc tap. Tuy nhien dl,ia VaGcaGh ph an lOq_itr€m rna vi~c chAn doan
de ra chtidng trinh ph\1c h6i chilc nang, vi~c thea d5i, danh gia ket qua
PHCN dtiqc d~ dang hdn.
5. Cac mac phat tri~n binh thlfdng cua h~ than kinh trung lfdng

Loai khong ehfm
- Cae phan,x
Phan xli!trLlanghIe e6 doi xung.r "';jCV'1CAGlA P'

Tuy song

Than nao

Nao giCta

,,~ n~s
::-:=--==::::;;;-;-_

- ._-

._-_.

Ket qua mue phat
tri~n v~n d9n9

M((ephat tri§n ph~1nXli!tLlangvng

M((etrLldng thimh
eua hE;!TKTW

..

-_ .

"'

\' t'V.t\.,~.1

.:2)..,.. Rich thich phan xa: kich thich VaG

long ban chan:

.

'3) - K~t qua:
Co) 'I're kh6ng thay d6i vi tri.
(+) Chan bi kich thich co len.) ~~ ;clL~.

~) ~ Darih gia ket qua:

/

.

..

Binh thuong.
~

C +)

a tre

0

tir 0 den 4 thang tu6i.

Tren i'thang tu6i.

.

xoay trong, ban chan g?P m~t long (vi trf htBi keo dien hinh).

L\) -

Danh gia ket qua: ~t1QQg_(+)

,
---~

.,~.==~~.-- .....==

62

dfu_~thang

tu6i.

Tren 2 thang tu6i rna (+) la dau hi~u'ch~m phat tri~n.

--.._--_._-------

-----~

..-..


-l1rtphan X? bat du6i


ben mat. tre du6i (do tang -trucng luc co
n~.o~ co ~u6~, tron~ khi tay va chan- b~!!_
dOl dl~n g?P'l,~
cl'L{M) ,
A

Zl t

'J1lf (

Danh gia ket qua:
Binh thuong (+) tu 0 .
. Ph an

iii -

X~

.:2"1--: Kich

thich

pha~

/"

1;>

~,_/-c:~