:

)(

)(

: Barognosis test

:Sterognosis test

Graphesthesia test ,,

Texture recognition /
,, )(

Bell's palsy
Bell's palsy , .
.
-
Bell's .
palsy 15 30 100,000 ,
.
, .40 .
, 8%.

Bell's palsy
.
. , )
.(Bell's phenomenon ,
.
, .
, .
, . 3
. -
, . , 85%
3 .

Bell's palsy ) ( geniculate
- .
.,
1 , Bell's
palsy . , " ,
1 .
Bell's palsy : )(
)( . : ,Guillain-Barre
, , ) Ramsay Hunt
( , . ,
, .Bell's palsy
, , , .
,
. Ramsay Hunt
, .
) Guillain-Barre(
. , , -

 . ) ,multiple sclerosis ,(
. ,
, , .
, . ,
, .
, Bell's palsy
.

, Bell's
.palsy , , .
,
. ,
.
, . , 10%
,Bell's palsy A1C
) ,
.(30 ,
. , .
-
, .

. ,
10 , 60 3 .

.

.

1 ,Bell's palsy
acyclovir .valacyclovir
New England Journal of Medicine 2007
Bell's Palsy
. 2004 2006
496 17- , 88% .
16 ) ,(44
, - 72
. , , ,
, , ,multiple sclerosis , ,
. 4 :
) 25 ( )( , ) 400 5
( )( , .
- 10
9.
3 , ),(83%
) .(63.6%

 ) (71.2% ) .(75.7%
, )
(94.4% ) .(81.6%
, 79.7% 3 92.7% 9 .

.

Bell's Palsy 3 9 .
.

. 85%
3 , 71% , . 29% ,
12% . ,
. ,
- . ,
,
.
,
.

,
. ,
3% 15% . .
, -
.Bell's palsy
.

, Bell's palsy
.
.
.
) (Botox

Rancho Los Amigos Scale

1-3

 4
, 6-5
.
. , 7
8

Rancho Los Amigos Scale

I. No Response
A person at this level will:

not respond to sounds, sights, touch or movement.

II. Generalized Response

A person at this level will:

begin to respond to sounds, sights, touch or movement;

respond slowly, inconsistently, or after a delay;
responds in the same way to what he hears, sees or feels. Responses may
include chewing, sweating, breathing faster, moaning, moving and/or
increasing blood pressure.

III. Localized Response

A person at this level will:

be awake on and off during the day;

make more movements than before;
react more specifically to what he sees, hears or feels. For example, he may
turn towards a sound, withdraw from pain, and attempt to watch a person move
around the room;
react slowly and inconsistently;
begin to recognize family and friends;
follow some simple directions suck as "Look at me" or "squeeze my hand";
begin to respond inconsistently to simple questions with "yes" or "no" head
nods.

IV. Confused-Agitated
A person at this level will:

be very confused and frightened;

not understand what he feels, or what is happening around him;
overreact to what he sees, hears or feels by hitting, screaming, using abusive
language, or thrashing about. This is because of the confusion;
be restrained so he doesn't hurt himself;
be highly focused on his basic needs; ie., eating, relieving pain, going back to
bed, going to the bathroom, or going home;
may not understand that people are trying to help him;
not pay attention or be able to concentrate for a few seconds;
have difficulty following directions;
recognize family/friends some of the time;
with help, be able to do simple routine activities such as feeding himself,
dressing or talking.

V. Confused-Inappropriate, Non-Agitated
A person at this level will:

be able to pay attention for only a few minutes;

be confused and have difficulty making sense of things outside himself;
not know the date, where he is or why he is in the hospital;
not be able to start or complete everyday activities, such as brushing his teeth,
even when physically able. He may need step-by-step instructions;
become overloaded and restless when tired or when there are too many people
around; have a very poor memory, he will remember past events from before
the accident better than his daily routine or information he has been told since
the injury;
try to fill in gaps in memory by making things up; (confabulation)
may get stuck on an idea or activity (perseveration) and need help switching to
the next part of the activity;
focus on basic needs such as eating, relieving pain, going back to bed, going to
the bathroom, or going home.

VI. Confused-Appropriate
A person at this level will:

be somewhat confused because of memory and thinking problems, he will

remember the main points from a conversation, but forget and confuse the
details. For example, he may remember he had visitors in the morning, but
forget what they talked about;
follow a schedule with some assistance, but becomes confused by changes in
the routine;
know the month and year, unless there is a serious memory problem;
pay attention for about 30 minutes, but has trouble concentrating when it is
noisy or when the activity involves many steps. For example, at an intersection,
he may be unable to step off the curb, watch for cars, watch the traffic light,
walk, and talk at the same time;
brush his teeth, get dressed, feed himself etc., with help;
know when he needs to use the bathroom;
do or say things too fast, without thinking first;
know that he is hospitalized because of an injury, but will not understand all the
problems he is having;
be more aware of physical problems than thinking problems;
associate his problems with being in the hospital and think he will be fine as
soon as he goes home.

VII. Automatic-Appropriate
A person at this level will:

follow a set schedule

be able to do routine self care without help, if physically able. For example, he
can dress or feed himself independently; have problems in new situations and
may become frustrated or act without thinking first;
have problems planning, starting, and following through with activities;
have trouble paying attention in distracting or stressful situations. For example,
family gatherings, work, school, church, or sports events;
not realize how his thinking and memory problems may affect future plans and
goals. Therefore, he may expect to return to his previous lifestyle or work;
continue to need supervision because of decreased safety awareness and
judgement. He still does not fully understand the impact of his physical or
thinking problems;
think slower in stressful situations;
be inflexible or rigid, and he may be stubborn. However, his behaviors are
realted to his brain injury;
be able to talk about doing something, but will have problems actually doing it.

VIII. Purposeful-Appropriate
A person at this level will:

realize that he has a problem in his thinking and memory;

begin to compensate for his problems;
be more flexible and less rigid in his thinking. For example, he may be able to
come up with several solutions to a problem;
be ready for driving or job training evaluation;
be able to learn new things at a slower rate;
still become overloaded with difficult, stressful or emergency situations;
show poor judgement in new situations and may require assistance;
need some guidance making decisions;
have thinking problems that may not be noticeable to people who did not know
the person before the injury.

extension

flexion

Glasscow coma scale

5
6

.
.3-15

 15 3 .
" -" . cortex
" -" .
:

delirium /.
The modified Ashworth scale
0. No increase in muscle tone

1. Slight increase in tone with a catch and release or minimal resistance at

end of range
2. As 2 but with minimal resistance through range following catch
3. More marked increase tone through ROM
4. Considerable increase in tone, passive movement difficult.
5. Affected part rigid

.Ashworth
- .
.
=0 ,-
=1
= +1
=2 , .
=3 .
=4 .

 :
:APGAR - 5' ) (0,1,2

) Activity(

) Pulse(

)Grimas , (

) Appearance (
2

,,
,

100 100

) Respiratory (.

= 10 , < 8 .

,8- 10' .

3 ) ( :
" :(Asymetrical Tonic Neck Reflex (ATNR " -
, .
2-5' 6-8' ) ;
- ,CNS-' " ( .
-.
:(Symetrical Tonic Neck Reflex (STNR :
.

 . - 5' , 9' . ,
.Bunny Hopp -
:(Tonic Labyrinthic Reflex (TNR " " . -
FLEX , EXT . 6'.

SPINA BIFIDA
-

? ,NURAL TUBE DEFECT 4

.

.
.

:
SPINA BIFIDA OCULLA
o
. ,.
o

SPINA BIFIDA CYSTICAL

MENINGOCELE ,CSF

MYELOMENINGOCELE ,

,
LIPOMENINGOCELE ,

,
ARNOLD CIARI DEFORMATY

CSF ,
, - , ,,
, ,.

, , ,.

,US , .
o
.
,
o
. .CT, MRI

.
o
CSF SHUNT .
24-48.

79% , 5 5% .
o
, ,.
, , ,UMN
o
.
-

, ,

,S2-S4 5%
o
.
o

UMN

. IQ
o
.
o

TETHERD CORD SYND

TRINGOMIALIYA

, OP

MYELOMENINGOCELE
-

-
. , ,
o

T10 , . 8'
o
.
T12 , HIKING ,
o

L1-L2 ,
o
. , ADD
ABD .
.
- L3-L4 , AFO+
o
.KFO

 S1-L5
o
. ,
, .AFO
S2 , ,
o
.

SPINA BIFIDA
-

6
UMN
o
3 3 .
.

6-9
o

9-12
, .
o
.

\ , 18

, ,
.

,
o
.
o

 T12 L3 ,

20-30 4-5 ,
.

. UMN
. QUAD .

WEEFIM, PEDI

, .

.

.UMN

, KARKAS 0-3
, , , .

ROM , L2-L4

, ... ".

,ADL '.

, , , , ,

, , )(

, ,ROM
,

MS- MULTIPLE SCILUROSIS

MS ,

:
)(inflammatory demyelination

, .

MS MRI ,

, -.

MS
" T

.
Myelin Basic Protein(MBP), Myelin :

(Oligodendricytes glycoprotein (MOG

-Oligoclonal bends 90%-75%.

IL2, TNF alpha, INF gama:

: 30%-25% 5%.

:, HSV 6 ,.EBV ,

: .

:MS -
:Relapsing remitting MS

,
) .(remission
85-90%.

: - , :-.

:Secondary progressing

, ) (Relapsing .

19 RRMS 15.

:Primary progressing

10-15%
, ,"
.
Progressive Relapsing

5%.
:

:
-Paresthesia ) (

)( . / ,
) ( , .

 :Dysesthesia

,
hyperalgesia and allodynia
:
optic neuritis

25%- 36% .
, ,.
Diplopia MS- 15%

, )
, (INO , .
. .
Nystagmus

.
, " .

- 30% . .
.
: . ),

( , .
:

- ).(Uthoffs

:
1/3 90% . MS

 ,
" ,
, ,
:

stride
double support phase
?? Cadence .
) :
(
) :

,
) , .
sway- .
: .clearance in swing

(anklefoot orthosis (AFO

(knee-ankle-foot orthosis (KAFO

-MRI .

(Evoked Potentials (EP VEP, SEP .BERA

.CSF

: , , . - , ,.

: , . - ,.

- , , .

- : , .

- . .

- . .

- ,

- .

- , . : ,.

- : .

(Kurtzke Expanded Disability Status score (EDSS

, , ,

, , .

-1 .

-2 .

-3 .

-4 500'

-6 .

-7 5' ) (

-8 .

-9 .

-10.

EDSS steps 1.0 to 4.5 refer to people with MS who are fully ambulatory. EDSS
steps 5.0 to 9.5 are defined by the
impairment to ambulation.
The clinical meaning of each possible result is the following:
0.0: Normal Neurological Exam

1.0: No disability, minimal signs on 1 FS

1.5: No disability, minimal signs on 2 of 7 FS
2.0: Minimal disability in 1 of 7 FS
2.5: Minimal disability in 2 FS
3.0: Moderate disability in 1 FS; or mild disability in 3 - 4 FS, though
fully ambulatory
3.5: Fully ambulatory but with moderate disability in 1 FS and mild
disability in 1 or 2 FS; or moderate disability in 2 FS; or mild disability in 5
FS
4.0: Fully ambulatory without aid, up and about 12hrs a day despite
relatively severe disability. Able to walk without aid 500 meters
4.5: Fully ambulatory without aid, up and about much of day, able to
work a full day, may otherwise have some limitations of full activity or
require minimal assistance. Relatively severe disability. Able to walk
without aid 300 meters
5.0: Ambulatory without aid for about 200 meters. Disability impairs
full daily activities
5.5: Ambulatory for 100 meters, disability precludes full daily activities
6.0: Intermittent or unilateral constant assistance (cane, crutch or
brace) required to walk 100 meters with or without resting
6.5: Constant bilateral support (cane, crutch or braces) required to
walk 20 meters without resting
7.0: Unable to walk beyond 5 meters even with aid, essentially
restricted to wheelchair, wheels self, transfers alone; active in wheelchair
about 12 hours a day
7.5: Unable to take more than a few steps, restricted to wheelchair,
may need aid to transfer; wheels self, but may require motorized chair for
full day's activities
8.0: Essentially restricted to bed, chair, or wheelchair, but may be out
of bed much of day; retains self care functions, generally effective use of
arms
8.5: Essentially restricted to bed much of day, some effective use of
arms, retains some self care functions
9.0: Helpless bed patient, can communicate and eat
9.5: Unable to communicate effectively or eat/swallow
10.0: Death due to MS

 : GBS

)AIDP) acute inflammatory de-myelinating polyneuropathy

(acute motor axonal neuropathy (AMA

-.
,
. .
.
AMAN .

.
acute motor sensory axonal neuropathy GBS
, .

acute motor axonal neuropathy .

Miller Fisher syndrome

.1

.2

) CN-III- (

.3


: Syringomyelia .
, , .CSF
. arnold chiari
.malformation
: < , , ,
. .

:Additional Syndromes

.Conus Medullris Syndrome

.Cauda Equina Syndrome

Conus Medullaris syndrome

".
, L1 - " ,
.LMNL -

Cauda equine syndrome

.LMNL -
- conus - ,
- .
.
MMT


.1 ) ( - complete .incomplete
, ' .
.
, .
.2 ) (
.
- ,
) ( "
.
, , , ) (MS, GB'.
)Cauda Equina
= (Synd . Sx --
,Lx
.
.3 - Tx - .T12
:
- ./
) , , ,
(.
)
, , (.
. ,
.
':
" Autonomic Hypertension/Dysreflexia
) - C1).( T6-7
( ,
.

 .
, )( ,
.
: , ,
). , , , )
: " ,/ ,
/ , ) ,
( , (flashing ,( ,
.

,
. .
. , . , ,
.
T6-7
. .
" "" . Orthostatic Hypotension
. ) ( .
T6.
: , , ,
. ,
: " .
' .
.
.4 - .
"
.

 ) : ,
(complete

C1-2

" . ,
)
.(complete ,
) ,
(.

C3

- ,
) " C3-5 C4
( . - .

C4

Trapezius (C1 , - (3Lavetor -

) intercostals "
scapula (T2-12 . ,
, ) -
).(C3-5

 - (.
- ,
. "
) "( ,
" / .
) (.
.C4

C5

Biceps )
C5-6), Deltoid
)C5-6),
Supinator
)(C5-6

.
-
Triceps
.

C6

Triceps ) .
C6-7-8), FCR
" " ,
)C6-7),
/ ,
ECR )C6-
,
.(8
, ,
/ ,
"
.

C7

,Triceps" .
+ ,
+
./ ,

) (push-up ,
,
" .
".
.C6-

)
biceps/ ,(deltoid/
.
" - "
. )
( "
.
" .
/ /.

C8

"
.

" )( ,
+
.

T1-6

- ! ) ( .
) (.

T6-9

.

.

"
= .

T10-L1

) ( ,
".

Cauda
Equina

.T10-L1 -

" .ADL -

) : * :
* .
" * .
elevation 90 ,
* . T5
* . T5-
10 .Hip Flex 60 * . T10-L1 - Hip
.Flex 30 * . L1 - .Hip Flex
(.

:
o

)/(

:
o

- ) , (.

)" (
) -(I"
o
) (.
: " -
alignment " // , -
" ) laminectomy (.
: / / .SPIKA /
.
-
o
. " : .
. )' , ,( .
. .

 " -
.
-
o
. , .
- .

.
- II .
" - "Automatic Hand
, ) "automatic hand" - .ext - "
.flex (
.ext ,DF
.FLX
:
, ,
, .
" . ,
. ,
. ,
- .
, ,
".
" "
.

) -/+(

) ,(
)< 500'(

 .
.
.
.
: , '.
-

:
- .

" , " ROM ," " .

- ,

.
-

. .
.
)//

(.
-

.
) (:

.
.
.
.

:
" .
.

(HKAFO- (Hip-Knee-Ankle-Foot Orthoses

) ( .
, . .

 .swing to // swing throw - ,swing to

. !

-Reciprocal Gait Orthoses) RGO) +

.
. . , ,.
, .

(KAFO- (Knee-Ankle-Foot Orthosis ..

.(AFO- (Ankle-Foot Orthosis DF .

) (:
, , ,
.1
. ,
.
: ,
.
: . -.
.2

- .
: , .

.3

. .
+ .
: , .
: ,
) -(.

 .FES- Functional Electrical Stimulation -

.

) : complete - (

C1-4

) Tilt -(.

C5-8

.standing frame/ :
.

T1-5

, / .
,HKAFO//KAFO .swing to

T6-8
-

, ) KAFO), swing to
.

T9-12
-

, ),(KAFO
swing to .swing threw

T12-L3

, ,KAFO swing to/threw

.
. " .
.

"

L4-5

" , , ,AFO

Quada
eqina

Decortication
internal capsule - cerebral -

hemisphere
Decorticate posturing indicates that there may be damage to areas including the cerebral

hemispheres, the internal capsule, and the thalamus.[12] It may also indicate damage to themidbrain

Decerebration

Midbrain -

Decortication

Decerebrate posturing indicates brain stem damage, specifically damage below the
level of the red nucleus (e.g. mid-collicular lesion). It is exhibited by people with
.lesions or compression in the midbrain and lesions in the cerebellum

Sensory Homunculus

(Behavioral Inattention Test (BIT

)
(

.1 : .

.2

, .

.

: BIT - 15 --

"" : , ,
, , .

9 :

, , , , ,
, , .

. .
- ,
. /.
.

.

. ,

.

' )' / ,
( . , '
. /

/ .

: UVN

.UVN-
. .

. , UVN
)( . ,
.
, )

 (
.
.

. 129-
.
,129-
)
( , .

.

- 67 ,
)
( / .

.
.1 :
.2 .
/
. /.