9-2 Komplikált monotrauma illetve fogyatékos személyt ért balesetek következtében kialakult funkciózavar / fogyatékosság miatt szükséges rehabilitáció ellátási program (REP)

Komplikált monotrauma illetve fogyatékos személyt ért balesetek következtében kialakult funkciózavar / fogyatékosság miatt szükséges rehabilitáció ellátási program (REP)

 Ez a REP a következő Rehabilitációs Programhoz tartozik: 

Rehabilitációs Program száma: 9,   Alprogram száma: 2

Egy régiót érintő súlyos, vagy többszörös, vagy szövődményes sérülés esetei és a fogyatékos személyt ért egy régiót érintő sérülése(i) tartoznak ide, amely(ek) önellátási, közlekedési, ill. súlyos ízületi funkciózavart okoz(nak). Ebbe a csoportba tartoznak az időskori vagy/és orsteoporosis talaján kialakuló csípőtáji és gerinctörések (csigolya összeroppanás is).

 

1./ A páciensek állapotának jellemzése

1.1. Baleset és a kialakult károsodás / funkciózavar / fogyatékosság leírása

BNO

FNO “B”

FNO “D”

BNO 1  S 22.0   S22.1 Bordák, szegycsont és háti gerinc törése; S23.0  Mellkas ízületeinek ficama; S32.0   S32.1    S32.4  Ágyéki gerinc és medence törése; S42.2   S42.3   S42.4   S42.8  S52.0  Váll és felkar törése; S52.2  S52.3    S52.4     S52.5    S52.6    S52.7    T11.1  Alkar törése; S62.1   S62.4    S62.7    S72.0  Csukló és kéztörés; S72.1   S72.2   S72.3   S72.4    S72.7  Combcsont törése; S82.0    S82.1   S82.2   S82.3  S82.5    S82.6  S82.7  S83.7  Lábszár törése; S92.0     S92.1   S92.2   S92.3  S92.7     S92.9 Lábtörés; S14.2   S14.3   S14.4  Ideg és gerincsérülés a nyak szintjén; S24.2 Ideg- és gerincsérülés a mellkas szintjén; S34.4 Lumbosacralis plexus sérülése; S44.2    S44.3    S44.4    S44.7  S44.8  Idegsérülés a váll és felkar szintjén; S84.7  Idegsérülés a lábszár szintjén

 A fogyatékosság alapját képező BNO-k társbetegségként kódolandók.

 b710 (ízületi mobilitás)

 b730 (izomerő)

 b770 (járásminta)

b760 (akaratlagos mozgásfunkciók)

d410 (alaptesthelyzet változtatás)

d465 (helyváltoztatás segédeszközzel)

d450 (gyaloglás)

d550 (étkezés)                                                                                                     

BNO3  R26.0-8 Járás és mobilitás zavarai; M24.1 -7 Egyéb ízületi elváltozások; M62.2  M62.4  M62.5 Egyéb izom-rendellenességek; R52.0-9 Fájdalom 

 

1.2. Állapot-súlyosság: A rehabilitációra kerülő személyek állapot-súlyossága a program kezdetén limitek megadásával: közepesen súlyos

FUNKCIONÁLIS ÁLLAPOT

SÚLYOS

KÖZEPESEN SÚLYOS

ENYHE

FNO (az 1.1-nél felsoroltak alapján tól-ig értékek megadása)

A megadott FNO-k közül legalább kettő 3-as vagy 4-es fokozatú

köztes állapot

 

A megadott FNO-k közül legalább egy 2-es, a többi 1-es fokozatú

FIM  / Barthel

Egyéb teszt: Izomerő és /vagy ROM a leginkább érintett izomra /ízületre vonatkozóan vagy

VAS (fájdalom)

<54 / <= 40

54-90  / 45-70      

>90 / >=75

0-2 / norm. tartomány 50%-a

>7

2-3 / norm tartomány 50-75%

4-7

4-5/ norm tartomány >75%

4 alatt

TÁRSBETEGSÉGEK: bármilyen krónikus alapbetegség (obesitas, HT, DM) vagy fogyatékosságot okozó betegség Parkinson kór, Sm, CP, pospolyo, stb.

 

4 vagy több

 

2-3

 

 

1 vagy nincs

Súlyos, ha a fenti három kategóriából legalább kettőben súlyos a minősítés; enyhe, ha legfeljebb egy középsúlyos a fenti három kategóriából; középsúlyos: köztes állapot

 

1.3. Humánerőforrás szükséglet

1.3.1. Ápolói szükséglet: közepes /nagy

1.3.2. Specifikus szakdolgozói szükséglet minimum feltétel szerint (alapcsomag)

Szükség lehet: Bővített csomag: kötözős (antidecub. ellátás és sebkezelés, sporttherapeuta. Hidrotherapeuta.  Munkapszichológus (munkaképes korúak esetén). Egyedi segédeszköz-ellátást végző műszerész

 

1.4. Fogyóanyag szükséglet

1.4.1. Napi átlagos gyógyszer szükséglet: közepes /nagy

Alapbetegség(ek) miatt szükséges gyógyszerek + LMWH, fájdalomcsillapítók, izomlazítók, antidepresszánsok, valamint az átvételkor meglevő szövődmények kezeléséhez szükséges, antibiotikumok, kötözésnél használt szerek (H2O2, Betadine, kenőcsök stb). Tesztcsíkok

1.4.2. Napi átlagos kötszer- egyéb orvosi és orvostechnikai anyag szükséglet: nagy

Alapbetegség(ek), a sérülés jellege és a szövődmények miatt gyakran szükséges:  sebkezeléshez szükséges eszközök, kötszerek, fertőtlenítő szerek, védőruházat, infúziós szerelék, fecskendők, tűk, decub. alátétek, antidecubitus matrac, pelenka, katheter,

1.4.3. Napi átlagos diagnosztikai anyag (fogyóeszköz) szükséglet: közepes 

Alapbetegség(ek) miatt szükséges diagnosztikai anyagok, rutin labor. Rtg, UH (hasüregi, végtagi, ízületi, retentio mérő) EMG, ENG, EKG, vércukor mérő műszer, vérnyomásmérő

 

 

2./ Betegutak leírása

2.1. Hogyan kerül a páciens rehabilitációra?

Baleseti sebészetről, az osztály ambulanciájáról közvetlenül.

2.2. Mi a jellemzője az adott betegcsoportnak a rehabilitációs ellátás időzítésére vonatkozóan?

Jellemzően korai elsőbbségi rehabilitáció, ritkán programozható (az utóbbi általában késői szövődmény vagy tervezett sebészeti beavatkozást követően) 

 

3. A rehabilitációs ellátó helyre vonatkozó kívánalmak leírása

3.1. Az ellátási csomag: alapcsomag / bővített csomag (ha az alapbetegség súlyos mozgásszervi fogyatékosság – HeineMedine, több végtagot érintő paresis, RA, izomatrophia)

3.2. Az ellátási szint: II. Szint

3.3. Az ellátás helyszíne: Fekvőbeteg

3.4. A rehabilitáció várható tartama: 30-90 nap

 

1-3. Ismételt felvétel rehabilitációs céllal elsőbbségi rehabilitáció befejezését követően

Ismételt rehabilitáció válhat szükségessé, ha a primer traumatológiai ellátás és elsőbbségi rehabilitáció után

-        a törésgyógyulás elhúzódása vagy elégtelensége (álízület kialakulása) miatt spongiosa plastica vagy reosteosynthesis, válik szükségessé;

-        a törésgyógyulás során jelentős végtagi tengelyeltérés, csont nekrózis vagy ízületi arthrosis alakult ki, és korrekciós osteotomia vagy endoprotézis beültetés válik szükségessé;

-        a perifériás ideg vagy plexus sérülése nem mutat javulást, és idegtranszplantáció vagy funkcionális rekonstrukciós műtét (izom-ín transzfer) válik szükségessé (lehet másik REP is!)

-        olyan csont- és/vagy lágyrész defektus marad vissza, illetve konzervatív módon nem gyógyuló decubitus alakul ki, ami miatt major plasztikai beavatkozás (csont szegment transzport, myocutan vagy kompozit lebeny, esetleg mikrovaszkuláris módszerrel) válik szükségessé.

-        Konzervatív kezelésre nem oldódó contractura műtéte után 

-        Eszközcsere, vagy eszköz elhagyása után intenzív fizioterápiás céllal

Jellemző

Minősítő

1.2. állapotsúlyosság a betegek 70-90 %-ára jellemzően (N/Kp/k)

közepes

1.3.1. ápolói szükséglet (N/Kp/k)

közepes

1.4.1. gyógyszer szükséglet (N/Kp/k)

Közepes/nagy (a fogyatékosságot okozó alapb. miatt)

1.4.2. kötszer és egyéb orvostechnikai anyag szükséglet (N/Kp/k)

közepes

 

1.4.3. diagnosztikai anyag szükséglet (N/Kp/k)

kicsi

a műtétek után ismételt rehabilitációs felvétel során rutin labor, röntgen és UH diagnosztika (nekrózis esetén MR követés)

3.1. ellátási csomag (alap/bővített)

alapcsomag

rendszerint egy végtagi vagy ízületi korrekció után történik az ismételt rehabilitációs felvétel

3.2. ellátási szint (I/II/III)

I / II

 

3.3. ellátás helyszíne (fekvőbeteg/NK/járóbeteg)

fekvő, nappali kórház, esetleg ambuláns is lehet, ezt jelentős mértékben befolyásolhatja pl., hogy felső vagy alsó végtagi korrekció történt

3.4. ellátás várható tartama (tól – ig)

 

Ismételt rehabilitáció várható tartama az első évben (hét/1. év)

21-35 nap

 

 

Folytatólagos ambuláns ellátásban (kontrollok, döntés a további rehabilitációs szükségletről) milyen programokra lehet szükség a szokványos ellenőrzésen túl?

Program(ok) és protokoll(ok): kéz funkció zavarok (3.2) / fájdalom (4.3) / immobilitás (12.1), elkülönítési szükséglet (13.1 vagy 13.2), OP (4.1) kiegészítőként további prevenció gyanánt

Ellátási szint: I/II

 

12 hónapon belül várható /javasolt /szükségesnek tartott kapcsolódó ellátás: (karbantartás) rekondícionálás – fájdalom vagy ízületi kontractura megelőzés

 

 

 

 

4. A rehabilitációs terápiás program kötelezően elvégzendő és dokumentálandó elemei az adott betegcsoportban

orvosi tevékenység

gyógytorna-fizioterápia

egyéb terápia

I.        Alapcsomag

A minden REP-ben kötelező tevékenységeken felül az alábbiak közül a beteg szükségleteinek megfelelően továbbiak: vegetatív idegrendszer vizsgálata (12006), szenzorium vizsgálata (12000), érzőkör vizsgálat (12004)  

Izokinetikus gyakorlás készülékkel (94631) és/vagy egyéni torna (94701) és / vagy testtájankénti egyéni torna (94504) vagy ízületi mobilizálás (94640) és az alábbiak közül a beteg szükségleteinek megfelelően továbbiak: kontraktúra nyújtás (82151), ízületi mozgások gyakorlása (94630), járáskészség fejlesztés (94406), járás-előkészítés ( 94405), izomerősítő gyakorlatok (94530), gyak. ellenállással szemben (94610), passzív kimozgatás egy testtájon (94601) és/vagy passzív kimozgatás több végtagon (94602) és/vagy manipulációs készség fejlesztése (94408), koordinációs gyakorlatok (94409) (94410), szertorna (94603), Értorna (88860), Gyógyászati segédeszköz használatának betanítása (93493), kryotherápia localis (86121); masszázs kézzel (94712); szelektív ingeráram (86319), Ultrahang (86911), TENS (86634), magnetoterápia (86921)

 

önellátásra oktatás (95530) és / vagy ergoterápia önellátó funkciók begyakorlása (95640) és az alábbiak közül a beteg szükségleteinek megfelelően továbbiak: pszichoterápia (96033), foglalkozásterápia egyéni (95291), foglalkozásterápia csoportos (95290), ergoterápia, írás tanítása (95650), ergoterápia manuális (95610), önellátásra oktatás (95530), ergoterápia önellátó funkciók begyakorlása (95640), segédeszközök adaptációja (95660)

időtartam: nem kötött

időtartam: napi 1-1,5 óra legalább 4-5 féle a felsoroltakból

II.      bővített csomag

 

Víz alatti torna (85521) medencében, kívülről segítve, Testedzés (95490), izomrehabilitáció tornáztató géppel (95993), Izokinetikus gyak. készülékkel (94631), Víz alatti torna egyéni (85520), Víz alatti torna csop. (85513),  Víz alatti torna medence segítve (85521), Víz alatti torna kádban (85512) , Medencefürdő (94880)       

 

időtartam: nem kötött

időtartam: napi 30-45 perc

 

teljes terápia időtartam A+B: 2.5-3 óra / nap, aminek legalább a fele egyéni terápia (ebben a nem kódolható tevékenységek is szerepelnek)

B. Nem kódolható tevékenységek: szociális ügyintézés + Taping technika+ McKenzie technika+ + UH-os vizelet retenciómérés+ Munkapszichológiai vizsgálatok

5. A rehabilitáció eredményességének értékelése

5.1./ Változást jellemző teszteredmények

FIM, Barthel, ROM, izomerő VAS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      

5.2. / Kimeneti jellemző

Foglalkoztatás:

-      távozáskor nyilatkozni kell a munkaképes korúak esetében arról, hogy a sérült alkalmas-e a munkakör betöltésére, ill. milyen feltételek mellett lehetséges ez. (Munkapszich. vizsgálatok és fizikális állapot alapján.)

Oktatás:

-      tanuló, esetében az oktatásba visszatérés időpontja / körülményei; felnőttek/ foglalkoztatott esetében az átképzési szükséglet meghatározása

Szociális szükséglet:

-      idősek esetén valamilyen mértékű gondozás, gyógytorna a háziápolási szolgálat keretében

-      ha nem térhet vissza otthonába az ellátási helyszín és egyéb szociális juttatások

Segédeszköz szükséglet:

-      bel- és kültéren való közlekedéshez, szövődmények megelőzéséhez szükséges eszközök, hygenes eszközökkel ellátva,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

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