{"id":26301,"date":"2023-04-22T21:26:02","date_gmt":"2023-04-22T14:26:02","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26301"},"modified":"2023-04-22T21:26:02","modified_gmt":"2023-04-22T14:26:02","slug":"bai-nao-chan-doan-luong-gia-tien-luong-muc-tieu-phcn","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/bai-nao-chan-doan-luong-gia-tien-luong-muc-tieu-phcn\/","title":{"rendered":"Ba\u0323i na\u0303o &#8211; Ch\u1ea9n \u0111o\u00e1n, l\u01b0\u1ee3ng gi\u00e1, ti\u00ean l\u01b0\u1ee3ng, l\u00e2\u0323p m\u1ee5c ti\u00eau PHCN"},"content":{"rendered":"<p><strong>Ba\u0323i na\u0303o<\/strong><b>\u00a0(cerebral palsy)<\/b>\u00a0l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn v\u1eadn \u0111\u1ed9ng, tr\u01b0\u01a1ng l\u1ef1c c\u01a1 ho\u1eb7c t\u01b0 th\u1ebf. N\u00f3 \u0111\u01b0\u1ee3c g\u00e2y ra do c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e3o \u0111ang trong th\u1eddi k\u1ef3 ph\u00e1t tri\u1ec3n (n\u00e3o ch\u01b0a tr\u01b0\u1edfng th\u00e0nh), g\u1eb7p \u1edf thai nhi tr\u01b0\u1edbc giai \u0111o\u1ea1n \u0111\u01b0\u1ee3c sinh ra.<\/p>\n<p><b>D\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh b\u1ea1i n\u00e3o<\/b> xu\u1ea5t hi\u1ec7n s\u1edbm, trong th\u1eddi k\u1ef3 s\u01a1 sinh ho\u1eb7c \u0111\u1ed9 tu\u1ed5i m\u1eabu gi\u00e1o. Th\u00f4ng th\u01b0\u1eddng, b\u1ec7nh ba\u0323i na\u0303o l\u00e0m gi\u1ea3m kh\u1ea3 n\u0103ng v\u1eadn \u0111\u1ed9ng li\u00ean quan \u0111\u1ebfn c\u00e1c ph\u1ea3n x\u1ea1 b\u1ea5t th\u01b0\u1eddng, c\u00e1c chi tr\u1edf n\u00ean m\u1ec1m nh\u0169n ho\u1eb7c co c\u1ee9ng, t\u01b0 th\u1ebf b\u1ea5t th\u01b0\u1eddng, kh\u00f3 v\u1eadn \u0111\u1ed9ng, \u0111i l\u1ea1i kh\u00f4ng v\u1eefng, ho\u1eb7c k\u1ebft h\u1ee3p c\u00e1c tri\u1ec7u ch\u1ee9ng tr\u00ean.<\/p>\n<p>Ba\u0300i vi\u00ea\u0301t sau se\u0303 cung c\u00e2\u0301p th\u00f4ng tin cho vi\u00ea\u0323c ch\u1ea9n \u0111o\u00e1n, l\u01b0\u1ee3ng gi\u00e1, ti\u00ean l\u01b0\u1ee3ng v\u00e0 thi\u1ebft l\u1eadp m\u1ee5c ti\u00eau phu\u0323c h\u00f4\u0300i ch\u01b0\u0301c n\u0103ng \u0111\u01b0\u01a1\u0323c tham kha\u0309o t\u01b0\u0300 <em>Quy\u1ebft \u0111\u1ecbnh s\u1ed1 5623 \/Q\u0110-BYT ng\u00e0y 21\/9\/2018 c\u1ee7a B\u1ed9 tr\u01b0\u1edfng B\u1ed9 Y t\u00ea\u0301.<\/em><\/p>\n<figure id=\"attachment_26315\" aria-describedby=\"caption-attachment-26315\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-26315\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1653020823_03778_bai-nao-1jpg-300x200.jpg\" alt=\"Ba\u0323i na\u0303o\" width=\"300\" height=\"200\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1653020823_03778_bai-nao-1jpg-300x200.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1653020823_03778_bai-nao-1jpg.jpg 724w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-26315\" class=\"wp-caption-text\">Ba\u0323i na\u0303o<\/figcaption><\/figure>\n<h2><strong>1. Ch\u1ea9n \u0111o\u00e1n s\u1edbm ba\u0323i na\u0303o<\/strong><\/h2>\n<h3><strong>1.1. T\u1ea1i sao c\u1ea7n ph\u1ea3i ch\u1ea9n \u0111o\u00e1n s\u1edbm?<\/strong><\/h3>\n<p>Ch\u1ea9n \u0111o\u00e1n s\u1edbm cho ph\u00e9p \u00e1p d\u1ee5ng k\u1ecbp th\u1eddi v\u1edbi c\u00e1c can thi\u1ec7p s\u1edbm ph\u00f9 h\u1ee3p v\u1edbi ch\u1ea9n \u0111o\u00e1n khi c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c t\u00ednh m\u1ec1m d\u1ebbo th\u1ea7n kinh cao nh\u1ea5t.<\/p>\n<p>\u0110\u1ed9 tu\u1ed5i b\u00ecnh qu\u00e2n \u1edf tr\u1ebb \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 ba\u0323i na\u0303o l\u00e0 19 th\u00e1ng tu\u1ed5i. \u0110\u1ed9 tu\u1ed5i ch\u1ea9n \u0111o\u00e1n thay \u0111\u1ed5i t\u1eeb 1 tu\u1ea7n t\u1edbi 3 tu\u1ed5i v\u1edbi c\u00e1c tr\u1ebb c\u00f3 khi\u1ebfm khuy\u1ebft v\u1eadn \u0111\u1ed9ng n\u1eb7ng v\u00e0 t\u1eeb 1 tu\u1ea7n \u0111\u1ebfn 5 tu\u1ed5i v\u1edbi nh\u1eefng tr\u1ebb c\u00f3 khi\u1ebfm khuy\u1ebft v\u1eadn \u0111\u1ed9ng nh\u1eb9 ho\u1eb7c trung b\u00ecnh (McIntyre v\u00e0 c\u1ed9ng s\u1ef1, 2011).<\/p>\n<p>C\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n s\u1edbm ba\u0323i na\u0303o m\u1ed9t c\u00e1ch ch\u00ednh x\u00e1c (McIntyre v\u00e0 c\u1ed9ng s\u1ef1, 2011). Ch\u1ea9n \u0111o\u00e1n s\u1edbm \u0111\u01b0\u1ee3c xem l\u00e0 th\u1ef1c h\u00e0nh t\u1ed1t v\u00ec n\u00f3 cho ph\u00e9p c\u00e1c h\u1ed7 tr\u1ee3 \u0111i\u1ec1u tr\u1ecb can thi\u1ec7p s\u1edbm b\u1eaft \u0111\u1ea7u s\u1edbm khi n\u00e3o c\u1ee7a tr\u1ebb v\u1eabn c\u00f2n m\u1ec1m d\u1ebbo v\u00e0 do \u0111\u00f3 t\u0103ng c\u01b0\u1eddng t\u1ed1i \u0111a c\u00e1c k\u1ebft qu\u1ea3 ph\u00e1t tri\u1ec3n c\u1ee7a tr\u1ebb. Hai n\u0103m \u0111\u1ea7u ti\u00ean c\u1ee7a tr\u1ebb r\u1ea5t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n v\u1ec1 nh\u1eadn th\u1ee9c v\u00e0 v\u1eadn \u0111\u1ed9ng v\u00ec n\u00e3o \u0111ang tr\u1ea3i qua t\u00ednh m\u1ec1m d\u1ebbo t\u1ef1 ph\u00e1t li\u00ean t\u1ee5c (Morgan v\u00e0 c\u1ed9ng s\u1ef1, 2013).<\/p>\n<p>Tr\u1ebb ba\u0323i na\u0303o \u0111\u1ea1t kho\u1ea3ng 90% ti\u1ec1m n\u0103ng v\u1eadn \u0111\u1ed9ng th\u00f4 c\u1ee7a ch\u00fang v\u00e0o l\u00fac 5 tu\u1ed5i v\u00e0 th\u1eadm ch\u00ed c\u00f2n s\u1edbm h\u01a1n \u0111\u1ed1i v\u1edbi nh\u1eefng tr\u1ebb b\u1ecb khi\u1ebfm khuy\u1ebft tr\u1ea7m tr\u1ecdng h\u01a1n (Hanna v\u00e0 c\u1ed9ng s\u1ef1, 2009). \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i b\u1eaft \u0111\u1ea7u c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t c\u00e1c li\u1ec7u ph\u00e1p can thi\u1ec7p s\u1edbm, t\u00edch c\u1ef1c, l\u1eb7p l\u1ea1i, h\u01b0\u1edbng nhi\u1ec7m v\u1ee5 c\u1ee5 th\u1ec3 cho tr\u1ebb nh\u1ecf b\u1ecb b\u1ea1i n\u00e3o (McIntyre v\u00e0 c\u1ed9ng s\u1ef1, 2011; Morgan v\u00e0 c\u1ed9ng s\u1ef1, 2013).<\/p>\n<p>Ch\u1ea9n \u0111o\u00e1n s\u1edbm c\u0169ng cho ph\u00e9p b\u1ed1 m\u1eb9 v\u00e0 gia \u0111\u00ecnh c\u00f3 th\u1ec3 ti\u1ebfp c\u1eadn v\u1edbi nh\u1eefng h\u1ed7 tr\u1ee3 v\u1ec1 tinh th\u1ea7n v\u00e0 \u0111i\u1ec1u n\u00e0y r\u1ea5t quan tr\u1ecdng trong th\u1eddi \u0111i\u1ec3m d\u1ec5 b\u1ecb t\u1ed5n th\u01b0\u01a1ng nh\u01b0 v\u1eady.<\/p>\n<h3><strong>1.2. Ch\u1ea9n \u0111o\u00e1n ba\u0323i na\u0303o<\/strong><\/h3>\n<p>Ch\u1ea9n \u0111o\u00e1n ba\u0323i na\u0303o bao g\u1ed3m:<\/p>\n<ul>\n<li>H\u1ecfi b\u1ec7nh s\u1eed v\u00e0 x\u00e1c \u0111\u1ecbnh c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1<\/li>\n<li>Kh\u00e1m th\u1ea7n kinh<\/li>\n<li>L\u01b0\u1ee3ng gi\u00e1 v\u1eadn \u0111\u1ed9ng chu\u1ea9n ho\u00e1\n<ul>\n<li>V\u1eadn \u0111\u1ed9ng Chung c\u1ee7a Prechtl (Prechtl\u2019s General Movement) \u0111\u01b0\u1ee3c ch\u1ec9nh s\u1eeda cho b\u00e9 &lt;4 th\u00e1ng (\u0111\u00e1nh gi\u00e1 t\u00ednh ch\u1ea5t c\u1ee7a c\u00e1c c\u1eed \u0111\u1ed9ng t\u1ef1 ph\u00e1t)<\/li>\n<li>L\u01b0\u1ee3ng gi\u00e1 Ph\u00e1t tri\u1ec3n cho Tr\u1ebb nh\u1ecf (Developmental Assessment of Young Children, DAYC) cho tr\u1ebb t\u1eeb 6 \u0111\u1ebfn 12 th\u00e1ng tu\u1ed5i (b\u1ea3ng c\u00e2u h\u1ecfi b\u1ed1 m\u1eb9 v\u1ec1 v\u1eadn \u0111\u1ed9ng t\u1ef1 \u00fd)<\/li>\n<\/ul>\n<\/li>\n<li>H\u00ecnh \u1ea3nh h\u1ecdc th\u1ea7n kinh<\/li>\n<li>Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t, bao g\u1ed3m c\u00e1c b\u1ec7nh l\u00fd ti\u1ebfn tri\u1ec3n<\/li>\n<\/ul>\n<p><em>Ba\u0323i na\u0303o\u00a0\u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n b\u1eb1ng bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng d\u1ef1a tr\u00ean s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a m\u1ed9t r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng g\u00e2y ra do t\u1ed5n th\u01b0\u01a1ng n\u00e3o, ho\u1eb7c s\u1ef1 ph\u00e1t tri\u1ec3n b\u1ea5t th\u01b0\u1eddng c\u1ee7a n\u00e3o \u1edf tr\u1ebb nh\u1ecf. Ch\u1ea9n \u0111o\u00e1n b\u1ea1i n\u00e3o \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi b\u00e1c s\u0129 (nh\u01b0 l\u00e0 b\u00e1c s\u0129 \u0111a khoa, b\u00e1c s\u0129 nhi khoa, b\u00e1c s\u0129 th\u1ea7n kinh nhi, b\u00e1c s\u0129 phu\u0323c h\u00f4\u0300i ch\u01b0\u0301c n\u0103ng &#8211; PHCN).<\/em><\/p>\n<p>Tuy nhi\u00ean, c\u00e1c k\u1ef9 thu\u1eadt vi\u00ean VLTL, k\u1ef9 thu\u1eadt vi\u00ean H\u0110TL, \u0111i\u1ec1u d\u01b0\u1ee1ng ho\u1eb7c c\u00e1c chuy\u00ean gia y t\u1ebf kh\u00e1c c\u00f3 th\u1ec3 l\u00e0 nh\u00e2n vi\u00ean y t\u1ebf \u0111\u1ea7u ti\u00ean nh\u00ecn th\u1ea5y tr\u1ebb v\u00ec nh\u1eefng lo ng\u1ea1i c\u1ee7a b\u1ed1 m\u1eb9 r\u1eb1ng tr\u1ebb kh\u00f4ng ph\u00e1t tri\u1ec3n b\u00ecnh th\u01b0\u1eddng. V\u00ec v\u1eady \u0111i\u1ec1u quan tr\u1ecdng l\u00e0 c\u00e1c nh\u00e2n vi\u00ean y t\u1ebf kh\u00e1c c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a ba\u0323i na\u0303o v\u00e0 bi\u1ebft khi n\u00e0o c\u1ea7n chuy\u1ec3n tr\u1ebb \u0111\u1ebfn m\u1ed9t b\u00e1c s\u0129 chuy\u00ean khoa \u0111\u1ec3 \u0111\u01b0\u1ee3c l\u01b0\u1ee3ng gi\u00e1 th\u00eam v\u00e0 ch\u1ea9n \u0111o\u00e1n.<\/p>\n<p><em><strong>C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1<\/strong><\/em><\/p>\n<p>H\u1ecfi b\u1ec7nh s\u1eed c\u1ea7n bao g\u1ed3m c\u00e1c c\u00e2u h\u1ecfi s\u00e0ng l\u1ecdc li\u00ean quan \u0111\u1ebfn s\u1ee9c kho\u1ebb c\u1ee7a ng\u01b0\u1eddi m\u1eb9, th\u1eddi k\u1ef3 mang thai, l\u00fac sinh v\u00e0 sau sinh. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 b\u1ecb ba\u0323i na\u0303o c\u00f3 th\u1ec3 \u1edf ng\u01b0\u1eddi m\u1eb9 ho\u1eb7c \u1edf tr\u1ebb.<\/p>\n<p>C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 thu\u1ed9c m\u1eb9 bao g\u1ed3m:<\/p>\n<ul>\n<li>B\u1ec7nh tuy\u1ebfn gi\u00e1p<\/li>\n<li>Nhi\u1ec5m tr\u00f9ng trong thai k\u1ef3<\/li>\n<li>Ti\u1ec1n s\u1ea3n gi\u1eadt<\/li>\n<li>Ch\u1ea3y m\u00e1u trong ba th\u00e1ng gi\u1eefa ho\u1eb7c ba th\u00e1ng cu\u1ed1i<\/li>\n<li>\u0110a thai (sinh \u0111\u00f4i ho\u1eb7c nhi\u1ec1u h\u01a1n) C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 thu\u1ed9c tr\u1ebb bao g\u1ed3m:<\/li>\n<li>Sinh non<\/li>\n<li>H\u1ea1n ch\u1ebf t\u0103ng tr\u01b0\u1edfng trong t\u1eed cung<\/li>\n<li>C\u00e2n n\u1eb7ng l\u00fac sinh th\u1ea5p<\/li>\n<li>Bi\u1ebfn c\u1ed1 g\u00e2y thi\u1ebfu oxy c\u1ea5p trong t\u1eed cung<\/li>\n<li>B\u1ec7nh l\u00fd n\u00e3o t\u1eeb v\u1eeba \u0111\u1ebfn n\u1eb7ng<\/li>\n<li>Co gi\u1eadt \u1edf tr\u1ebb s\u01a1 sinh<\/li>\n<li>Nhi\u1ec5m tr\u00f9ng s\u01a1 sinh<\/li>\n<li>H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft<\/li>\n<li>V\u00e0ng da<\/li>\n<\/ul>\n<p>C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh \u1edf tr\u1ebb sinh \u0111\u00fang k\u1ef3 (\u1edf c\u00e1c n\u01b0\u1edbc ph\u00e1t tri\u1ec3n), bao g\u1ed3m (McIntyre v\u00e0 c\u1ed9ng s\u1ef1, 2012)<\/p>\n<ul>\n<li>C\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 nhau thai<\/li>\n<li>C\u00e1c khi\u1ebfm khuy\u1ebft b\u1ea9m sinh<\/li>\n<li>H\u00edt ph\u00e2n su<\/li>\n<li>\u0110\u1ebb b\u1eb1ng d\u1ee5ng c\u1ee5\/ m\u1ed5 l\u1ea5y thai c\u1ea5p c\u1ee9u<\/li>\n<li>Ng\u1ea1t khi sinh<\/li>\n<li>H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p<\/li>\n<\/ul>\n<p>M\u1ed9t t\u1ef7 l\u1ec7 nh\u1ecf tr\u1ebb b\u1ecb ba\u0323i na\u0303o sau m\u1ed9t th\u00e1ng tu\u1ed5i. Tr\u01b0\u1eddng h\u1ee3p n\u00e0y th\u01b0\u1eddng l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a \u0111\u1ed9t qu\u1ef5, c\u00f3 th\u1ec3 x\u1ea3y ra t\u1ef1 ph\u00e1t ho\u1eb7c do c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan \u0111\u1ebfn b\u1ec7nh l\u00fd kh\u00e1c ho\u1eb7c can thi\u1ec7p y t\u1ebf (ACPR Group 2009). \u1ede Vi\u1ec7t Nam, c\u00e1c nhi\u1ec5m tr\u00f9ng th\u1ea7n kinh, \u0111\u1eb7c bi\u1ec7t vi\u00eam m\u00e0ng n\u00e3o, c\u00f3 th\u1ec3 g\u00e2y b\u1ea1i n\u00e3o \u1edf tr\u1ebb nh\u1ecf.<\/p>\n<p><strong><em>L\u01b0\u1ee3ng gi\u00e1 th\u1ea7n kinh<\/em><\/strong><\/p>\n<p>Th\u0103m kh\u00e1m th\u1ea7n kinh tr\u1ebb nh\u1ecf theo Hammersmith (HINE) l\u00e0 m\u1ed9t l\u01b0\u1ee3ng gi\u00e1 th\u1ea7n kinh cho tr\u1ebb t\u1eeb 2 \u0111\u1ebfn 24 th\u00e1ng tu\u1ed5i, bao g\u1ed3m c\u00e1c m\u1ee5c v\u1ec1 ch\u1ee9c n\u0103ng c\u00e1c d\u00e2y th\u1ea7n kinh s\u1ecd n\u00e3o, t\u01b0 th\u1ebf, v\u1eadn \u0111\u1ed9ng, tr\u01b0\u01a1ng l\u1ef1c v\u00e0 c\u00e1c ph\u1ea3n x\u1ea1. Ph\u01b0\u01a1ng ph\u00e1p l\u01b0\u1ee3ng gi\u00e1 n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 l\u01b0\u1ee3ng gi\u00e1 tr\u1ebb nh\u1ecf c\u00f3 nguy c\u01a1 b\u1ec7nh l\u00fd th\u1ea7n kinh, c\u1ea3 sinh non v\u00e0 sinh \u0111\u00fang k\u1ef3. HINE x\u00e1c \u0111\u1ecbnh c\u00e1c d\u1ea5u hi\u1ec7u s\u1edbm c\u1ee7a b\u1ea1i n\u00e3o \u1edf tr\u1ebb nh\u1ecf b\u1ecb t\u1ed5n th\u01b0\u01a1ng n\u00e3o l\u00fac s\u01a1 sinh.<\/p>\n<p>C\u00e1c l\u1ee3i \u00edch c\u1ee7a HINE bao g\u1ed3m:<\/p>\n<ul>\n<li>D\u1ec5 th\u1ef1c hi\u1ec7n v\u00e0 c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng<\/li>\n<li>C\u00f3 \u0111\u1ed9 tin c\u1eady gi\u1eefa nh\u1eefng ng\u01b0\u1eddi quan s\u00e1t t\u1ed1t, ngay c\u1ea3 \u1edf nh\u1eefng nh\u00e2n vi\u00ean ch\u01b0a c\u00f3 kinh nghi\u1ec7m<\/li>\n<li>HINE kh\u00f4ng ch\u1ec9 x\u00e1c \u0111\u1ecbnh tr\u1ebb c\u00f3 nguy c\u01a1 b\u1ecb b\u1ea1i n\u00e3o m\u00e0 c\u00f2n cung c\u1ea5p th\u00eam th\u00f4ng tin v\u1ec1 lo\u1ea1i v\u00e0 m\u1ee9c \u0111\u1ed9 tr\u1ea7m tr\u1ecdng c\u1ee7a di ch\u1ee9ng v\u1eadn \u0111\u1ed9ng\n<ul>\n<li>Tr\u1ebb nh\u1ecf c\u00f3 t\u1ed5ng \u0111i\u1ec3m \u226456 v\u00e0o l\u00fac 3 th\u00e1ng v\u00e0 \u226465 v\u00e0o l\u00fac 12 th\u00e1ng c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao (~90%) cho ph\u00e1t tri\u1ec3n b\u1ea1i n\u00e3o<\/li>\n<li>\u0110i\u1ec3m &lt;40 li\u00ean quan \u0111\u1ebfn b\u1ea1i n\u00e3o kh\u00f4ng \u0111i l\u1ea1i \u0111\u1ed9c l\u1eadp (GMFCS III-V)<\/li>\n<li>\u0110i\u1ec3m gi\u1eefa 40-60 li\u00ean quan \u0111\u1ebfn b\u1ea1i n\u00e3o \u0111i l\u1ea1i \u0111\u1ed9c l\u1eadp (GMFCS I-II)<\/li>\n<\/ul>\n<\/li>\n<li>Th\u01b0\u1eddng cho ph\u00e9p x\u00e1c \u0111\u1ecbnh c\u00e1c d\u1ea5u hi\u1ec7u b\u1ea5t th\u01b0\u1eddng s\u1edbm li\u00ean quan \u0111\u1ebfn c\u00e1c v\u1ea5n \u0111\u1ec1 kh\u00e1c c\u1ee7a ch\u1ee9c n\u0103ng th\u1ea7n kinh nh\u01b0 khi\u1ebfm khuy\u1ebft th\u1ecb gi\u00e1c do t\u1ed5n th\u01b0\u01a1ng n\u00e3o ho\u1eb7c b\u1ea5t th\u01b0\u1eddng cho \u0103n<\/li>\n<\/ul>\n<p>(Romeo v\u00e0 c\u1ed9ng s\u1ef1, 2008, Romeo v\u00e0 c\u1ed9ng s\u1ef1, 2016)<\/p>\n<p><em>HINE c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi b\u00e1c s\u0129 (v\u00ed d\u1ee5 b\u00e1c s\u0129 \u0111a khoa, b\u00e1c s\u0129 nhi khoa, b\u00e1c s\u0129 th\u1ea7n kinh nhi), k\u1ef9 thu\u1eadt vi\u00ean VLTL ho\u1eb7c k\u1ef9 thu\u1eadt vi\u00ean H\u0110TL. HINE c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi m\u1ed9t b\u00e1c s\u0129 v\u1edbi m\u1ee5c \u0111\u00edch ch\u1ea9n \u0111o\u00e1n.<\/em><\/p>\n<p><em><strong>L\u01b0\u1ee3ng gi\u00e1 v\u1eadn \u0111\u1ed9ng<\/strong><\/em><\/p>\n<p><em>L\u01b0\u1ee3ng gi\u00e1 c\u00e1c V\u1eadn \u0111\u1ed9ng Chung c\u1ee7a Prechtl:<\/em><\/p>\n<p>Ba\u0323i na\u0303o\u00a0c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c ngay t\u1eeb 3 th\u00e1ng tu\u1ed5i b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng L\u01b0\u1ee3ng gi\u00e1 c\u00e1c V\u1eadn \u0111\u1ed9ng Chung (GMs). C\u00e1c GM l\u00e0 m\u1ed9t quan s\u00e1t qua video v\u1ec1 c\u00e1c v\u1eadn \u0111\u1ed9ng t\u1ef1 ph\u00e1t c\u1ee7a tr\u1ebb nh\u1ecf, \u0111\u01b0\u1ee3c ghi l\u1ea1i b\u1edfi m\u1ed9t ng\u01b0\u1eddi l\u01b0\u1ee3ng gi\u00e1 \u0111\u00e3 \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n.<\/p>\n<p>C\u00e1c GM \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n ba\u0323i na\u0303o cao (Spittle v\u00e0 c\u1ed9ng s\u1ef1, 2009).<\/p>\n<ul>\n<li>M\u1ed9t \u0111i\u1ec3m s\u1ed1 b\u1ea5t th\u01b0\u1eddng c\u1ee7a c\u00e1c v\u1eadn \u0111\u1ed9ng &#8220;\u0111\u1ed3ng v\u1eadn g\u00f2 \u00e9p&#8221; tr\u01b0\u1edbc 8 tu\u1ea7n tu\u1ed5i \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh tu\u1ed5i theo sau b\u1edfi m\u1ed9t \u0111i\u1ec3m s\u1ed1 b\u1ea5t th\u01b0\u1eddng c\u1ee7a c\u00e1c v\u1eadn \u0111\u1ed9ng &#8220;kh\u00f4ng c\u00f3 v\u1eadn \u0111\u1ed9ng t\u1ef1 ph\u00e1t&#8221; v\u00e0o tu\u1ea7n tu\u1ed5i th\u1ee9 10-20 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh tu\u1ed5i c\u00f3 gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n 98% b\u1ecb b\u1ea1i n\u00e3o<\/li>\n<li>C\u00e1c GM (\u0111\u1eb7c bi\u1ec7t l\u00e0 &#8220;kh\u00f4ng c\u00f3 v\u1eadn \u0111\u1ed9ng t\u1ef1 ph\u00e1t&#8221;) k\u1ebft h\u1ee3p v\u1edbi c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a ch\u1ee5p C\u1ed9ng h\u01b0\u1edfng t\u1eeb (\u0111\u1eb7c bi\u1ec7t l\u00e0 t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng) c\u00f3 gi\u00e1 tr\u1ecb d\u1ef1 \u0111o\u00e1n 100% b\u1ecb ba\u0323i na\u0303o (Spittle v\u00e0 c\u1ed9ng s\u1ef1, 2008).<\/li>\n<\/ul>\n<p>\u0110\u00e0o t\u1ea1o v\u1ec1 GMs \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi t\u1ed5 ch\u1ee9c General Movements Trust <a href=\"http:\/\/general-movements-trust.info\/\">http:\/\/general-<\/a> <a href=\"http:\/\/general-movements-trust.info\/\">movements-trust.info\/<\/a><\/p>\n<p>GM c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh b\u1edfi b\u1ea5t k\u1ef3 chuy\u00ean gia y t\u1ebf ho\u1eb7c s\u1ee9c kho\u1ebb n\u00e0o \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o v\u1ec1 c\u00e1ch l\u01b0\u1ee3ng gi\u00e1.<\/p>\n<p><em>L\u01b0\u1ee3ng gi\u00e1 Ph\u00e1t tri\u1ec3n Tr\u1ebb nh\u1ecf (DAYC):<\/em><\/p>\n<p>L\u01b0\u1ee3ng gi\u00e1 Ph\u00e1t tri\u1ec3n Tr\u1ebb nh\u1ecf (DAYC) l\u00e0 m\u1ed9t b\u1ea3ng c\u00e2u h\u1ecfi \u0111\u01a1n gi\u1ea3n kh\u00f4ng c\u1ea7n ph\u1ea3i \u0111\u00e0o t\u1ea1o, nh\u00e2n l\u1ef1c ho\u1eb7c thi\u1ebft b\u1ecb. L\u01b0\u1ee3ng gi\u00e1 n\u00e0y l\u00e0 m\u1ed9t \u0111o l\u01b0\u1eddng t\u1ef1 s\u1eed d\u1ee5ng, tham kh\u1ea3o gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng v\u1ec1 s\u1ef1 ph\u00e1t tri\u1ec3n tr\u1ebb nh\u1ecf trong giai \u0111o\u1ea1n s\u1edbm t\u1eeb l\u00fac sinh \u0111\u1ebfn 5 tu\u1ed5i 11 th\u00e1ng.<\/p>\n<p>C\u00e1c l\u0129nh v\u1ef1c ph\u00e1t tri\u1ec3n \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp \u0111\u1ebfn trong c\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc ph\u00e1t tri\u1ec3n l\u00e0 nh\u1eadn th\u1ee9c, giao ti\u1ebfp, ph\u00e1t tri\u1ec3n t\u00ecnh c\u1ea3m-x\u00e3 h\u1ed9i, ph\u00e1t tri\u1ec3n th\u1ec3 ch\u1ea5t v\u00e0 h\u00e0nh vi th\u00edch \u1ee9ng.<\/p>\n<p>M\u1ee9c gi\u1ea3m hai \u0111\u1ed9 l\u1ec7ch chu\u1ea9n trong \u0111i\u1ec3m v\u1eadn \u0111\u1ed9ng DAYC gi\u1eefa 6-12 th\u00e1ng tu\u1ed5i c\u00f3 gi\u00e1 tr\u1ecb d\u1ef1 b\u00e1o b\u1ea1i n\u00e3o 83% (Novak, 2014).<\/p>\n<p>L\u01b0u \u00fd: \u0110\u1ecbnh chu\u1ea9n b\u00ecnh th\u01b0\u1eddng c\u1ee7a DAYC \u0111\u00e3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean m\u1ed9t m\u1eabu tr\u1ebb em Hoa K\u1ef3. B\u1ea3ng c\u00e2u h\u1ecfi hi\u1ec7n ch\u1ec9 c\u00f3 s\u1eb5n t\u1eeb nh\u00e0 xu\u1ea5t b\u1ea3n b\u1eb1ng ti\u1ebfng Anh.<\/p>\n<p><em>B\u1ea3ng c\u00e2u h\u1ecfi v\u1ec1 c\u00e1c \u0111\u1ed9 tu\u1ed5i v\u00e0 c\u00e1c giai \u0111o\u1ea1n (ASQ,):<\/em><\/p>\n<p>B\u1ea3ng c\u00e2u h\u1ecfi v\u1ec1 c\u00e1c \u0111\u1ed9 tu\u1ed5i v\u00e0 c\u00e1c giai \u0111o\u1ea1n (ASQ) l\u00e0 m\u1ed9t b\u1ea3ng c\u00e2u h\u1ecfi \u0111\u01b0\u1ee3c ho\u00e0n th\u00e0nh b\u1edfi ph\u1ee5 huynh v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc ph\u00e1t tri\u1ec3n chung.<\/p>\n<p>C\u00e1c l\u0129nh v\u1ef1c ph\u00e1t tri\u1ec3n \u0111\u01b0\u1ee3c \u0111\u1ec1 c\u1eadp trong c\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc ph\u00e1t tri\u1ec3n n\u00e0y l\u00e0 v\u1eadn \u0111\u1ed9ng th\u00f4, v\u1eadn \u0111\u1ed9ng tinh, gi\u1ea3i quy\u1ebft v\u1ea5n \u0111\u1ec1, c\u00e1 nh\u00e2n-x\u00e3 h\u1ed9i v\u00e0 m\u1ed9t ph\u1ea7n chung \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c m\u1ed1i quan t\u00e2m lo l\u1eafng chung c\u1ee7a ph\u1ee5 huynh.<\/p>\n<p>ASQ c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh nh\u1eefng tr\u1ebb em c\u1ea7n \u0111\u01b0\u1ee3c l\u01b0\u1ee3ng gi\u00e1 th\u00eam, tuy nhi\u00ean gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng b\u1ea1i n\u00e3o c\u1ee7a n\u00f3 ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft r\u00f5. B\u1ea3ng c\u00e2u h\u1ecfi n\u00e0y \u0111\u00e3 c\u00f3 s\u1eb5n b\u1eb1ng ti\u1ebfng Vi\u1ec7t (Singh v\u00e0 c\u1ed9ng s\u1ef1, n\u0103m 2017).<\/p>\n<h3>Khuy\u1ebfn c\u00e1o:<\/h3>\n<p><em>ASQ c\u1ea7n \u0111\u01b0\u1ee3c t\u1ea5t c\u1ea3 c\u00e1c nh\u00e2n vi\u00ean y t\u1ebf s\u1eed d\u1ee5ng \u0111\u1ec3 c\u1ea3i thi\u1ec7n vi\u1ec7c ph\u00e1t hi\u1ec7n s\u1edbm tr\u1ebb nh\u1ecf c\u00f3 nguy c\u01a1 b\u1ecb b\u1ea1i n\u00e3o. Nh\u1eefng tr\u1ebb \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 c\u00f3 nguy c\u01a1 ho\u1eb7c b\u1ecb ch\u1eadm ph\u00e1t tri\u1ec3n n\u00ean \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ebfn b\u1ec7nh vi\u1ec7n tuy\u1ebfn trung \u01b0\u01a1ng, t\u1ec9nh ho\u1eb7c huy\u1ec7n (c\u00e1c khoa PHCN c\u1ee7a b\u1ec7nh vi\u1ec7n) ho\u1eb7c Trung t\u00e2m PHCN chuy\u00ean bi\u1ec7t (c\u00f4ng l\u1eadp v\u00e0 t\u01b0 l\u1eadp) \u0111\u1ec3 l\u01b0\u1ee3ng gi\u00e1 v\u1ec1 th\u1ea7n kinh v\u00e0 v\u1eadn \u0111\u1ed9ng \u0111\u1eb7c hi\u1ec7u cho b\u1ea1i n\u00e3o.<\/em><\/p>\n<h3>Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/h3>\n<p>T\u1ea5t c\u1ea3 tr\u1ebb b\u1ecb nghi ng\u1edd ho\u1eb7c gi\u1ea3 \u0111\u1ecbnh b\u1ecb t\u1ed5n th\u01b0\u01a1ng n\u00e3o n\u00ean \u0111\u01b0\u1ee3c ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI). MRI l\u00e0 k\u1ef9 thu\u1eadt h\u00ecnh \u1ea3nh h\u1ecdc th\u1ea7n kinh ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh b\u1ec7nh sinh c\u1ee7a b\u1ea1i n\u00e3o &#8211; t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng \u1edf tr\u1ebb c\u00f2n non (WMDI) bao g\u1ed3m nhuy\u1ec5n n\u00e3o ch\u1ea5t tr\u1eafng quanh n\u00e3o th\u1ea5t, c\u00e1c t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t x\u00e1m \u1edf s\u00e2u, c\u00e1c d\u1ecb d\u1ea1ng, c\u00e1c c\u1ed5 nh\u1ed3i m\u00e1u, v\u00e0 c\u00e1c t\u1ed5n th\u01b0\u01a1ng v\u1ecf n\u00e3o v\u00e0 d\u01b0\u1edbi v\u1ecf (Rosenbaum v\u00e0 c\u1ed9ng s\u1ef1, 2007). C\u1ea7n l\u01b0u \u00fd r\u1eb1ng 12-14% tr\u1ebb b\u1ea1i n\u00e3o s\u1ebd c\u00f3 MRI b\u00ecnh th\u01b0\u1eddng (McIntyre v\u00e0 c\u1ed9ng s\u1ef1, 2011) v\u00e0 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh b\u1ea1i n\u00e3o kh\u00f4ng n\u00ean ph\u1ee5 thu\u1ed9c ho\u00e0n to\u00e0n v\u00e0o MRI.<\/p>\n<h3>C\u00e1c Khuy\u1ebfn c\u00e1o:<\/h3>\n<ul>\n<li><em>C\u1ea7n x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n s\u1edbm b\u1ea1i n\u00e3o l\u00e0 \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u. C\u00e1c khoa PHCN c\u1ea7n thi\u1ebft l\u1eadp v\u00e0 duy tr\u00ec m\u1ed1i quan h\u1ec7\/li\u00ean k\u1ebft ch\u1eb7t ch\u1ebd v\u1edbi c\u00e1c khoa kh\u00e1c c\u1ee7a b\u1ec7nh vi\u1ec7n, \u0111\u1eb7c bi\u1ec7t l\u00e0 s\u1ee9c kho\u1ebb b\u00e0 m\u1eb9, s\u1ea3n ph\u1ee5 khoa, nhi khoa, th\u1ea7n kinh v\u00e0 y h\u1ecdc c\u1ed5 truy\u1ec1n, \u0111\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i cho vi\u1ec7c gi\u1edbi thi\u1ec7u v\u00e0 ch\u0103m s\u00f3c c\u00e1c tr\u1ebb c\u00f3 nguy c\u01a1 cao v\u1ec1 b\u1ea1i n\u00e3o v\u00e0 ch\u0103m s\u00f3c li\u00ean t\u1ee5c tr\u1ebb b\u1ea1i n\u00e3o.<\/em><\/li>\n<li><em>\u0110\u1ec3 t\u1ea1o thu\u1eadn l\u1ee3i cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n s\u1edbm \u1edf tr\u1ebb d\u01b0\u1edbi 4 th\u00e1ng tu\u1ed5i, c\u1ea7n s\u1eed d\u1ee5ng L\u01b0\u1ee3ng gi\u00e1 C\u00e1c V\u1eadn \u0111\u1ed9ng Chung c\u1ee7a Prechtl v\u00e0 Th\u0103m kh\u00e1m Th\u1ea7n kinh Tr\u1ebb em theo Hammersmith (HINE). C\u1ea7n x\u00e1c \u0111\u1ecbnh v\u00e0 \u0111\u00e0o t\u1ea1o c\u00e1c b\u00e1c s\u0129 v\u00e0\/ho\u1eb7c c\u00e1c nh\u00e2n vi\u00ean y t\u1ebf ch\u00ednh v\u1ec1 c\u00e1c v\u1eadn \u0111\u1ed9ng chung. Th\u01b0\u1eddng th\u00ec c\u00e1c chuy\u00ean gia n\u00e0y l\u00e0m vi\u1ec7c trong c\u00e1c c\u01a1 s\u1edf ch\u0103m s\u00f3c \u0111\u1eb7c bi\u1ec7t s\u01a1 sinh v\u00e0 c\u00e1c \u0111\u01a1n v\u1ecb s\u01a1 sinh.<\/em><\/li>\n<li><em>\u0110\u1ec3 t\u1ea1o thu\u1eadn l\u1ee3i cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n s\u1edbm \u1edf c\u00e1c tr\u1ebb t\u1eeb 4 th\u00e1ng tu\u1ed5i tr\u1edf l\u00ean, c\u1ea7n s\u1eed d\u1ee5ng Th\u0103m kh\u00e1m Th\u1ea7n kinh Tr\u1ebb em theo Hammersmith (HINE) v\u00e0 L\u01b0\u1ee3ng gi\u00e1 Ph\u00e1t tri\u1ec3n c\u1ee7a Tr\u1ebb nh\u1ecf (DAYC). C\u00f3 th\u1ec3 xem x\u00e9t s\u1eed d\u1ee5ng B\u1ea3ng C\u00e2u h\u1ecfi v\u1ec1 \u0110\u1ed9 tu\u1ed5i v\u00e0 c\u00e1c Giai \u0111o\u1ea1n (ASQ) b\u1edfi v\u00ec n\u00f3 hi\u1ec7n c\u00f3 s\u1eb5n b\u1eb1ng ti\u1ebfng Vi\u1ec7t, tuy nhi\u00ean th\u00f4ng tin thu \u0111\u01b0\u1ee3c n\u00ean lu\u00f4n \u0111i k\u00e8m v\u1edbi HINE\u00a0 v\u00ec ASQ kh\u00f4ng ph\u00e2n bi\u1ec7t gi\u1eefa ch\u1eadm ph\u00e1t tri\u1ec3n v\u00e0 b\u1ea1i n\u00e3o.<\/em><\/li>\n<\/ul>\n<h2>\u00a02. T<strong>i\u00ean l\u01b0\u1ee3ng b\u00ea\u0323nh ba\u0323i na\u0303o<\/strong><\/h2>\n<p>Tr\u1ebb b\u1ea1i n\u00e3o c\u00f3 ti\u00ean l\u01b0\u1ee3ng kh\u00e1 t\u1ed1t. C\u00f3 m\u1ed9t s\u1ed1 th\u00f4ng \u0111i\u1ec7p v\u1ec1 ti\u00ean l\u01b0\u1ee3ng ch\u1ee7 y\u1ebfu c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia s\u1ebb v\u1edbi b\u1ed1 m\u1eb9 \u0111\u1ec3 h\u1ed7 tr\u1ee3 h\u1ecd v\u1edbi c\u00e1c th\u00f4ng tin ch\u00ednh x\u00e1c<\/p>\n<h3><strong>2.1. Khuy\u1ebft t\u1eadt su\u1ed1t \u0111\u1eddi<\/strong><\/h3>\n<ul>\n<li>B\u1ea1i n\u00e3o l\u00e0 t\u00ecnh tr\u1ea1ng khuy\u1ebft t\u1eadt su\u1ed1t \u0111\u1eddi<\/li>\n<li>T\u00ecnh tr\u1ea1ng khuy\u1ebft t\u1eadt t\u0103ng khi tr\u1ebb l\u1edbn l\u00ean<\/li>\n<li>S\u1ef1 l\u00e3o ho\u00e1 x\u1ea3y ra s\u1edbm h\u01a1n<\/li>\n<li>L\u1eadp k\u1ebf ho\u1ea1ch PHCN ph\u1ea3i xem x\u00e9t tu\u1ed5i tr\u01b0\u1edfng th\u00e0nh<\/li>\n<\/ul>\n<h3><strong>2.2. Tu\u1ed5i th\u1ecd b\u00ecnh th\u01b0\u1eddng cu\u0309a ng\u01b0\u01a1\u0300i ba\u0323i na\u0303o<\/strong><\/h3>\n<ul>\n<li>H\u1ea7u h\u1ebft tr\u1ebb b\u1ea1i n\u00e3o s\u1ebd c\u00f3 tu\u1ed5i th\u1ecd b\u00ecnh th\u01b0\u1eddng<\/li>\n<li>5-10% tr\u1ebb b\u1ea1i n\u00e3o s\u1ebd ch\u1ebft trong th\u1eddi th\u01a1 \u1ea5u<\/li>\n<li>Nguy c\u01a1 t\u1eed vong s\u1edbm t\u0103ng l\u00ean khi k\u00e8m theo b\u1ec7nh \u0111\u1ed9ng kinh, khuy\u1ebft t\u1eadt v\u1ec1 tr\u00ed tu\u1ec7 v\u00e0 khi\u1ebfm khuy\u1ebft th\u1ec3 ch\u1ea5t tr\u1ea7m tr\u1ecdng<\/li>\n<li>Nguy c\u01a1 t\u1eed vong s\u1edbm gia t\u0103ng n\u1ebfu tr\u1ebb c\u00f3 t\u00ecnh tr\u1ea1ng kh\u00f3 nu\u1ed1t n\u1eb7ng<\/li>\n<\/ul>\n<h3><strong>2.3. Ti\u00ean l\u01b0\u1ee3ng v\u1ec1 \u0111i l\u1ea1i cu\u0309a ng\u01b0\u01a1\u0300i ba\u0323i na\u0303o<\/strong><\/h3>\n<ul>\n<li>H\u1ea7u h\u1ebft tr\u1ebb s\u1ebd \u0111i \u0111\u01b0\u1ee3c: 60% s\u1ebd \u0111i l\u1ea1i \u0111\u1ed9c l\u1eadp (GMFCS I-II), 10% s\u1ebd \u0111i v\u1edbi m\u1ed9t d\u1ee5ng c\u1ee5 tr\u1ee3 gi\u00fap \u0111i l\u1ea1i (GMFCS III) v\u00e0 30% tr\u1ebb s\u1eed d\u1ee5ng xe l\u0103n (GMFCS IV-V)<\/li>\n<li>Tr\u1ebb b\u1ecb khi\u1ebfm khuy\u1ebft v\u1ec1 th\u1ec3 ch\u1ea5t, ch\u1ee9c n\u0103ng ho\u1eb7c nh\u1eadn th\u1ee9c c\u00e0ng nhi\u1ec1u th\u00ec c\u00e0ng g\u1eb7p kh\u00f3 kh\u0103n trong \u0111i l\u1ea1i<\/li>\n<li>N\u1ebfu tr\u1ebb c\u00f3 th\u1ec3 ng\u1ed3i v\u00e0o l\u00fac 2 tu\u1ed5i, tr\u1ebb c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng \u0111i m\u00e0 kh\u00f4ng c\u1ea7n h\u1ed7 tr\u1ee3 \u1edf tu\u1ed5i l\u00ean 6<\/li>\n<li>N\u1ebfu tr\u1ebb kh\u00f4ng th\u1ec3 ng\u1ed3i nh\u01b0ng c\u00f3 th\u1ec3 l\u0103n l\u1eadt v\u00e0o l\u00fac 2 tu\u1ed5i, c\u00f3 kh\u1ea3 n\u0103ng l\u00e0 tr\u1ebb c\u00f3 th\u1ec3 \u0111i m\u00e0 kh\u00f4ng c\u1ea7n tr\u1ee3 gi\u00fap \u1edf tu\u1ed5i l\u00ean 6<\/li>\n<li>N\u1ebfu tr\u1ebb kh\u00f4ng th\u1ec3 ng\u1ed3i ho\u1eb7c l\u0103n \u1edf \u0111\u1ed9 tu\u1ed5i 2 tu\u1ed5i, tr\u1ebb h\u1ea7u nh\u01b0 kh\u00f4ng th\u1ec3 \u0111i l\u1ea1i m\u00e0 kh\u00f4ng c\u1ea7n tr\u1ee3 gi\u00fap<\/li>\n<\/ul>\n<h3><strong>2.4. Ti\u00ean l\u01b0\u1ee3ng v\u1ec1 kh\u1ea3 n\u0103ng n\u00f3i cu\u0309a tre\u0309 ba\u0323i na\u0303o<\/strong><\/h3>\n<ul>\n<li>1\/4 tr\u1ebb b\u1ea1i n\u00e3o s\u1ebd kh\u00f4ng n\u00f3i \u0111\u01b0\u1ee3c do \u0111\u00f3 c\u1ea7n l\u01b0\u1ee3ng gi\u00e1 v\u00e0 t\u0103ng c\u01b0\u1eddng l\u1eddi n\u00f3i s\u1edbm<\/li>\n<li>Kho\u1ea3ng 1\/2 tr\u1ebb b\u1ea1i n\u00e3o c\u00f3 m\u1ed9t s\u1ed1 kh\u00f3 kh\u0103n n\u00e0o \u0111\u00f3 v\u1edbi c\u00e1c th\u00e0nh ph\u1ea7n c\u1ee7a giao ti\u1ebfp<\/li>\n<li>Kho\u1ea3ng 1\/3 tr\u1ebb b\u1ea1i n\u00e3o c\u00f3 nh\u1eefng kh\u00f3 kh\u0103n c\u1ee5 th\u1ec3 v\u1ec1 l\u1eddi n\u00f3i v\u00e0 ng\u00f4n ng\u1eef<\/li>\n<li>Th\u1ea5t v\u1ecdng trong giao ti\u1ebfp c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c r\u1ed1i lo\u1ea1n h\u00e0nh vi<\/li>\n<li>Tr\u1ebb c\u00e0ng khi\u1ebfm khuy\u1ebft n\u1eb7ng v\u1ec1 th\u1ec3 ch\u1ea5t, ch\u1ee9c n\u0103ng ho\u1eb7c nh\u1eadn th\u1ee9c th\u00ec c\u00e0ng d\u1ec5 b\u1ecb kh\u00f3 kh\u0103n v\u1ec1 l\u1eddi n\u00f3i v\u00e0 ng\u00f4n ng\u1eef<\/li>\n<li>\u0110\u1ed9ng kinh kh\u00f4ng ki\u1ec3m so\u00e1t c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn nh\u1eefng kh\u00f3 kh\u0103n v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c h\u00ecnh th\u1ee9c giao ti\u1ebfp, bao g\u1ed3m c\u1ea3 l\u1eddi n\u00f3i<\/li>\n<li>M\u1ed9t tr\u1ebb b\u1ea1i n\u00e3o th\u1ec3 co c\u1ee9ng hai b\u00ean, lo\u1ea1n \u0111\u1ed9ng ho\u1eb7c th\u1ea5t \u0111i\u1ec1u d\u1ec5 g\u1eb7p kh\u00f3 kh\u0103n v\u1ec1 ng\u00f4n ng\u1eef v\u00e0 l\u1eddi n\u00f3i h\u01a1n l\u00e0 nh\u1eefng tr\u1ebb b\u1ea1i n\u00e3o th\u1ec3 co c\u1ee9ng m\u1ed9t b\u00ean<\/li>\n<\/ul>\n<h3><strong>2.5. S\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a c\u00e1c t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe ph\u1ed1i h\u1ee3p \u1ea3nh h\u01b0\u1edfng t\u1edbi ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh B\u1ea1i n\u00e3o h\u1ea7u nh\u01b0 lu\u00f4n lu\u00f4n k\u00e8m theo v\u1edbi c\u00e1c t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe ph\u1ed1i h\u1ee3p<\/strong><\/h3>\n<ul>\n<li>C\u1ea7n th\u01b0\u1eddng xuy\u00ean ti\u1ebfn h\u00e0nh s\u00e0ng l\u1ecdc c\u00e1c t\u00ecnh tr\u1ea1ng s\u1ee9c kh\u1ecfe ph\u1ed1i h\u1ee3p v\u00e0 x\u1eed tr\u00ed nh\u1eefng t\u00ecnh tr\u1ea1ng n\u00e0y n\u1ebfu c\u00f3<\/li>\n<\/ul>\n<h3><strong>2.6. Ti\u00ean l\u01b0\u1ee3ng v\u1ec1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng<\/strong><\/h3>\n<ul>\n<li>D\u01b0\u1edbi 2 tu\u1ed5i, c\u00e1c ti\u00ean l\u01b0\u1ee3ng m\u1ee9c \u0111\u1ed9 n\u1eb7ng l\u00e0 kh\u00f4ng ch\u00ednh x\u00e1c \u0111\u1ebfn 42% \u2013 v\u1eadn \u0111\u1ed9ng t\u1ef1 \u00fd v\u1eabn \u0111ang ph\u00e1t tri\u1ec3n v\u00e0 t\u00ecnh tr\u1ea1ng t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u00f3 th\u1ec3 v\u1eabn \u0111ang ti\u1ebfn tri\u1ec3n c\u00f9ng v\u1edbi qu\u00e1 tr\u00ecnh myelin ho\u00e1.<\/li>\n<li>Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb (MRI) c\u00f3 th\u1ec3 cung c\u1ea5p m\u1ed9t s\u1ed1 th\u00f4ng tin \u0111\u1ec3 d\u1ef1 b\u00e1o ch\u1ee9c n\u0103ng \u2013 c\u00e1c t\u1ed5n th\u01b0\u01a1ng m\u1ed9t b\u00ean th\u01b0\u1eddng g\u00e2y bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng nh\u1eb9 h\u01a1n; c\u00e1c t\u1ed5n th\u01b0\u01a1ng ch\u1ea5t tr\u1eafng quanh n\u00e3o th\u1ea5t th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn nh\u1eefng khi\u1ebfm khuy\u1ebft v\u1ec1 v\u1eadn \u0111\u1ed9ng nh\u1eb9 h\u01a1n (ngh\u0129a l\u00e0 th\u01b0\u1eddng tr\u1ebb c\u00f3 th\u1ec3 \u0111i \u0111\u01b0\u1ee3c) nh\u01b0ng \u0111i\u1ec1u n\u00e0y kh\u00f4ng ph\u1ea3i lu\u00f4n lu\u00f4n \u0111\u00fang, trong khi c\u00e1c d\u1ecb t\u1eadt n\u00e3o, c\u00e1c t\u1ed5n th\u01b0\u01a1ng v\u1ecf n\u00e3o, d\u01b0\u1edbi v\u1ecf, v\u00e0 h\u1ea1ch n\u1ec1n th\u01b0\u1eddng g\u00e2y ra nh\u1eefng khi\u1ebfm khuy\u1ebft v\u1ec1 v\u1eadn \u0111\u1ed9ng n\u1eb7ng h\u01a1n (ngh\u0129a l\u00e0 kh\u00f4ng th\u1ec3 \u0111i \u0111\u01b0\u1ee3c)<\/li>\n<\/ul>\n<h3>2.7. <strong>S\u1eed d\u1ee5ng C\u1ed9ng h\u01b0\u1edfng t\u1eeb \u0111\u1ec3 d\u1ef1 b\u00e1o ti\u00ean l\u01b0\u1ee3ng<\/strong><\/h3>\n<ul>\n<li>Kh\u00f4ng ch\u1ec9 d\u1ef1a v\u00e0o C\u1ed9ng h\u01b0\u1edfng t\u1eeb \u0111\u1ec3 ti\u00ean l\u01b0\u1ee3ng tr\u1ebb b\u1ea1i n\u00e3o<\/li>\n<li>Xem x\u00e9t nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 c\u1ee7a b\u1ea1i n\u00e3o v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u tr\u00ean C\u1ed9ng h\u01b0\u1edfng t\u1eeb (n\u1ebfu \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n) khi th\u1ea3o lu\u1eadn v\u1ec1 ti\u00ean l\u01b0\u1ee3ng v\u1edbi tr\u1ebb v\u00e0 ph\u1ee5 huynh ho\u1eb7c ng\u01b0\u1eddi ch\u0103m s\u00f3c tr\u1ebb<\/li>\n<li>K\u1ebft h\u1ee3p th\u00f4ng tin thu th\u1eadp \u0111\u01b0\u1ee3c v\u1ec1 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1, h\u00ecnh \u1ea3nh h\u1ecdc th\u1ea7n kinh v\u00e0 l\u01b0\u1ee3ng gi\u00e1 ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng (\u0111\u1eb7c bi\u1ec7t l\u00e0 th\u0103m kh\u00e1m th\u1ea7n kinh tr\u1ebb em theo Hammersmith) \u0111\u1ec3 ti\u00ean li\u1ec7u v\u1ec1 m\u1ee9c \u0111\u1ed9 tr\u1ea7m tr\u1ecdng v\u00e0 ti\u00ean l\u01b0\u1ee3ng.<\/li>\n<\/ul>\n<p>(Novak, 2014; NICE, 2017)<\/p>\n<h3>Khuy\u1ebfn c\u00e1o:<\/h3>\n<p><em>T\u1ea5t c\u1ea3 c\u00e1c nh\u00e2n vi\u00ean y t\u1ebf l\u00e0m vi\u1ec7c v\u1edbi tr\u1ebb b\u1ea1i n\u00e3o v\u00e0 gia \u0111\u00ecnh c\u1ea7n quen thu\u1ed9c v\u1edbi nh\u1eefng th\u00f4ng \u0111i\u1ec7p v\u1ec1 ti\u00ean l\u01b0\u1ee3ng n\u00e0y \u0111\u1ec3 c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 th\u00f4ng tin cho gia \u0111\u00ecnh tr\u1ebb.<\/em><\/p>\n<h2><strong>3. L\u01b0\u1ee3ng gi\u00e1 v\u00e0 thi\u1ebft l\u1eadp m\u1ee5c ti\u00eau phu\u0323c h\u00f4\u0300i ch\u01b0\u0301c n\u0103ng (PHCN) \u01a1\u0309 tre\u0309 ba\u0323i na\u0303o<\/strong><\/h2>\n<p>X\u00e2y d\u1ef1ng quan h\u1ec7 h\u1ee3p t\u00e1c th\u1ef1c s\u1ef1 v\u1edbi gia \u0111\u00ecnh c\u00f3 \u00fd ngh\u0129a t\u00edch c\u1ef1c v\u1edbi qu\u00e1 tr\u00ecnh PHCN n\u00f3i chung v\u00e0 \u0111\u1eb7c bi\u1ec7t l\u00e0 v\u1edbi vi\u1ec7c x\u00e1c \u0111\u1ecbnh nh\u1eefng m\u1ee5c ti\u00eau n\u00e0o s\u1ebd \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft trong qu\u00e1 tr\u00ecnh PHCN. M\u1ed9t m\u1ee5c ti\u00eau c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 m\u1ed9t m\u1ee5c \u0111\u00edch c\u1ee5 th\u1ec3 v\u00e0 c\u00f3 th\u1ec3 \u0111o l\u01b0\u1eddng \u0111\u01b0\u1ee3c. M\u1ee5c \u0111\u00edch ch\u00ednh c\u1ee7a \u0111i\u1ec1u tr\u1ecb l\u00e0 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau v\u00e0 c\u00e1c m\u1ee5c ti\u00eau \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp \u0111\u1ec3 l\u00e0m gi\u1ea3m c\u00e1c gi\u1edbi h\u1ea1n trong ho\u1ea1t \u0111\u1ed9ng v\u00e0 s\u1ef1 tham gia (Bower, 2004). T\u1ea5t c\u1ea3 c\u00e1c th\u00e0nh vi\u00ean trong nh\u00f3m tham gia t\u00edch c\u1ef1c \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c s\u1ef1 \u0111\u1ed3ng thu\u1eadn v\u1ec1 c\u00e1c m\u1ee5c ti\u00eau PHCN t\u1ed5ng th\u1ec3. \u0110i\u1ec1u n\u00e0y l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng \u0111\u1ea1t \u0111\u01b0\u1ee3c c\u00e1c k\u1ebft qu\u1ea3 b\u1ec1n v\u1eefng v\u00e0 t\u00edch c\u1ef1c, v\u00ec m\u1ecdi\u00a0ng\u01b0\u1eddi \u0111\u1ec1u \u0111\u1ed3ng \u00fd v\u1ec1 nh\u1eefng m\u1ee5c ti\u00eau n\u00e0o \u0111\u1eb7c bi\u1ec7t quan tr\u1ecdng \u0111\u1ed1i v\u1edbi gia \u0111\u00ecnh v\u00e0 v\u1edbi tr\u1ebb (Harty, Griesel &amp; van der Merwe, 2011).<\/p>\n<p>C\u00e1c nh\u00f3m ph\u1ee5c h\u1ed3i c\u1ea7n s\u1eed d\u1ee5ng c\u00e1c l\u0129nh v\u1ef1c ho\u1ea1t \u0111\u1ed9ng v\u00e0 tham gia c\u1ee7a ICF nh\u01b0 l\u00e0 m\u1ed9t ng\u00f4n ng\u1eef chung \u0111\u1ec3 gi\u00fap x\u00e1c \u0111\u1ecbnh c\u00e1c m\u1ee5c ti\u00eau quan tr\u1ecdng cho gia \u0111\u00ecnh v\u00e0 tr\u1ebb. ICF cho ph\u00e9p xem x\u00e9t c\u1ea3 y\u1ebfu t\u1ed1 c\u00e1 nh\u00e2n, c\u0169ng nh\u01b0 c\u00e1c y\u1ebfu t\u1ed1 ho\u00e0n c\u1ea3nh, v\u00e0 \u0111i\u1ec1u n\u00e0y l\u00e0 c\u1ea7n thi\u1ebft trong c\u00e1c ti\u1ebfp c\u1eadn PHCN th\u00e0nh c\u00f4ng.<\/p>\n<p>Hai ph\u01b0\u01a1ng ph\u00e1p thi\u1ebft l\u1eadp m\u1ee5c ti\u00eau \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 \u0110o l\u01b0\u1eddng Kh\u1ea3 n\u0103ng Ho\u1ea1t \u0111\u1ed9ng Canada (COPM, Canadian Occupational Performance Measure) v\u00e0 Thang \u0111i\u1ec3m \u0110\u1ea1t M\u1ee5c ti\u00eau (GAS, Goal Attainment Scaling). Trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p ch\u00fang c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi nhau.<\/p>\n<h3><strong>3.1. \u0110o l\u01b0\u1eddng kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n ho\u1ea1t \u0111\u1ed9ng Canada (COPM) \u01a1\u0309 b\u00ea\u0323nh nh\u00e2n ba\u0323i na\u0303o<\/strong><\/h3>\n<p>(Law, Baptiste, Carswell, McColl, Polatajko &amp; Pollock, 1990)<\/p>\n<p>\u0110o l\u01b0\u1eddng kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n ho\u1ea1t \u0111\u1ed9ng c\u1ee7a Canada (COPM) l\u00e0 m\u1ed9t bi\u1ec7n ph\u00e1p \u0111o l\u01b0\u1eddng c\u00e1 nh\u00e2n ho\u00e1 nh\u1eb1m l\u01b0\u1ee3ng gi\u00e1 kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n ho\u1ea1t \u0111\u1ed9ng m\u00e0 c\u00e1 nh\u00e2n \u0111\u00f3 c\u1ea3m nh\u1eadn trong c\u00e1c l\u0129nh v\u1ef1c t\u1ef1 ch\u0103m s\u00f3c, s\u1ea3n xu\u1ea5t v\u00e0 gi\u1ea3i tr\u00ed. \u0110o l\u01b0\u1eddng n\u00e0y \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf \u0111\u1ec3 ph\u00e1t hi\u1ec7n thay \u0111\u1ed5i trong c\u1ea3m nh\u1eadn c\u1ee7a b\u1ea3n th\u00e2n v\u1ec1 kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n ho\u1ea1t \u0111\u1ed9ng c\u1ee7a h\u1ecd theo th\u1eddi gian. COPM \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c l\u0129nh v\u1ef1c c\u00f3 v\u1ea5n \u0111\u1ec1 v\u00e0 cung c\u1ea5p \u0111\u00e1nh gi\u00e1 v\u1ec1 c\u00e1c \u01b0u ti\u00ean c\u1ee7a trong th\u1ef1c hi\u1ec7n ho\u1ea1t \u0111\u1ed9ng, \u0111\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n ho\u1ea1t \u0111\u1ed9ng v\u00e0 s\u1ef1 h\u00e0i l\u00f2ng li\u00ean quan \u0111\u1ebfn c\u00e1c l\u0129nh v\u1ef1c c\u00f3 v\u1ea5n \u0111\u1ec1 \u0111\u00f3 v\u00e0 \u0111o l\u01b0\u1eddng s\u1ef1 thay \u0111\u1ed5i trong c\u1ea3m nh\u1eadn c\u1ee7a v\u1ec1\u00a0 kh\u1ea3 n\u0103ng th\u1ef1c hi\u1ec7n theo th\u1eddi gian.<\/p>\n<p><em><strong>Ti\u1ebfn h\u00e0nh<\/strong><\/em><\/p>\n<p><u>Ng\u01b0\u1eddi l\u01b0\u1ee3ng gi\u00e1:<\/u> C\u00f4ng c\u1ee5 n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi b\u1ea5t k\u1ef3 th\u00e0nh vi\u00ean c\u1ee7a nh\u00f3m ph\u1ee5c h\u1ed3i.<\/p>\n<p><u>C\u00e1ch th\u1ef1c hi\u1ec7n: <\/u>\u0110\u1ea3m b\u1ea3o r\u1eb1ng phi\u00ean b\u1ea3n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0 phi\u00ean b\u1ea3n s\u1eeda \u0111\u1ed5i d\u00e0nh cho tr\u1ebb em. Ch\u1ecdn b\u00e1o c\u00e1o t\u1eeb ph\u1ee5 huynh ho\u1eb7c t\u1eeb tr\u1ebb cho ph\u00f9 h\u1ee3p. L\u01b0\u1ee3ng gi\u00e1 bao g\u1ed3m m\u1ed9t quy tr\u00ecnh 5 b\u01b0\u1edbc \u0111\u01b0\u1ee3c l\u1ed3ng gh\u00e9p trong m\u1ed9t cu\u1ed9c ph\u1ecfng v\u1ea5n b\u00e1n c\u1ea5u tr\u00fac, t\u1eadp trung v\u00e0o x\u00e1c \u0111\u1ecbnh c\u00e1c ho\u1ea1t \u0111\u1ed9ng trong t\u1eebng l\u0129nh v\u1ef1c ho\u1ea1t \u0111\u1ed9ng m\u00e0 mu\u1ed1n, c\u1ea7n ho\u1eb7c \u0111\u01b0\u1ee3c mong mu\u1ed1n th\u1ef1c hi\u1ec7n.<\/p>\n<p><u>Th\u1eddi gian<\/u>: 15-30 ph\u00fat, ph\u1ecfng v\u1ea5n b\u00e1n c\u1ea5u tr\u00fac.<\/p>\n<p><u>Ghi ch\u00fa:<\/u> COPM \u0111\u00e3 \u0111\u01b0\u1ee3c d\u1ecbch sang 24 ng\u00f4n ng\u1eef kh\u00e1c nhau. N\u00f3 hi\u1ec7n kh\u00f4ng c\u00f3 s\u1eb5n b\u1eb1ng ti\u1ebfng Vi\u1ec7t tuy nhi\u00ean c\u00f3 kh\u1ea3 n\u0103ng s\u1ebd c\u00f3 b\u1ea3n d\u1ecbch.<\/p>\n<h3><strong>3.2. Thang \u0111i\u1ec3m \u0111\u1ea1t m\u1ee5c ti\u00eau (GAS)<\/strong><\/h3>\n<p>Thang \u0111i\u1ec3m \u0110\u1ea1t M\u1ee5c ti\u00eau (GAS) bao g\u1ed3m c\u00e1c m\u1ee5c ti\u00eau c\u00e1 nh\u00e2n ho\u00e1, \u0111\u01b0\u1ee3c t\u1ea1o ra b\u1edfi ng\u01b0\u1eddi b\u1ec7nh theo thang \u0111o 5 \u0111i\u1ec3m. GAS \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u00e1c d\u1ecbch v\u1ee5 ho\u1eb7c m\u1ed9t ch\u01b0\u01a1ng tr\u00ecnh c\u00e1 nh\u00e2n ho\u00e1 d\u1ef1a tr\u00ean vi\u1ec7c \u0111\u1ea1t \u0111\u01b0\u1ee3c c\u00e1c m\u1ee5c ti\u00eau d\u00e0nh cho c\u00e1 nh\u00e2n.<\/p>\n<p>Thang \u0111i\u1ec3m n\u00e0y \u0111\u00f2i h\u1ecfi ng\u01b0\u1eddi \u0111i\u1ec1u tr\u1ecb ph\u1ea3i \u0111\u01b0\u1ee3c \u0111\u00e0o t\u1ea1o v\u00e0 c\u00f3 nhi\u1ec1u kinh nghi\u1ec7m \u0111\u1ec3 thi\u1ebft l\u1eadp \u0111\u1ea7y \u0111\u1ee7 c\u00e1c m\u1ee5c ti\u00eau. Vi\u1ec7c \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c c\u1ee7a ng\u01b0\u1eddi \u0111i\u1ec1u tr\u1ecb v\u1ec1 \u1ea3nh h\u01b0\u1edfng c\u1ee7a can thi\u1ec7p v\u00e0 kh\u1ea3 n\u0103ng c\u1ee7a ng\u01b0\u1eddi \u0111i\u1ec1u tr\u1ecb thi\u1ebft l\u1eadp c\u00e1c m\u1ee5c ti\u00eau th\u1ef1c t\u1ebf, ch\u00ednh x\u00e1c c\u00f3 th\u1ec3 kh\u00f3\u00a0 x\u00e1c \u0111\u1ecbnh.<\/p>\n<p><em><strong>Ti\u1ebfn h\u00e0nh<\/strong><\/em><\/p>\n<p><u>Ng\u01b0\u1eddi l\u01b0\u1ee3ng gi\u00e1:<\/u> C\u00f4ng c\u1ee5 n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh b\u1edfi b\u1ea5t k\u1ef3 th\u00e0nh vi\u00ean n\u00e0o trong nh\u00f3m ph\u1ee5c h\u1ed3i, tuy nhi\u00ean n\u00f3 th\u01b0\u1eddng \u0111\u01b0\u1ee3c c\u00e1c k\u1ef9 thu\u1eadt vi\u00ean VLTL v\u00e0 c\u00e1c k\u1ef9 thu\u1eadt vi\u00ean H\u0110TL s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u1eb7t m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u00e1nh gi\u00e1 s\u1ef1 can thi\u1ec7p.<\/p>\n<p><u>C\u00e1ch th\u1ef1c hi\u1ec7n<\/u>: M\u1ed9t thang \u0111o m\u1ee5c ti\u00eau 5 m\u1ee9c \u0111\u01b0\u1ee3c x\u00e2y d\u1ef1ng, th\u01b0\u1eddng qua ph\u1ecfng v\u1ea5n ng\u01b0\u1eddi b\u1ec7nh\/gia \u0111\u00ecnh, m\u1ed7i m\u1ee5c ti\u00eau \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y theo c\u00e1c m\u1ee9c \u0111\u1ed9 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau v\u1edbi nh\u1eefng m\u00f4 t\u1ea3 v\u1ec1 k\u1ebft qu\u1ea3 d\u1ef1 ki\u1ebfn. C\u00e1c m\u1ee5c ti\u00eau \u0111\u01b0\u1ee3c ph\u00e2n t\u1eeb k\u1ebft qu\u1ea3 k\u00e9m thu\u1eadn l\u1ee3i nh\u1ea5t \u0111\u1ebfn k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t, v\u1edbi m\u1ee9c k\u1ebft qu\u1ea3 mong mu\u1ed1n n\u1eb1m \u1edf m\u1ee9c gi\u1eefa. C\u00e1c m\u1ee5c ti\u00eau c\u1ea7n tu\u00e2n theo c\u00e1c nguy\u00ean t\u1eafc \u0111\u1eb7t m\u1ee5c ti\u00eau TH\u00d4NG MINH (SMART):<\/p>\n<ul>\n<li>C\u1ee5 th\u1ec3 (Specific)<\/li>\n<li>\u0110o l\u01b0\u1eddng \u0111\u01b0\u1ee3c (Measurable)<\/li>\n<li>C\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c (Achievable)<\/li>\n<li>Th\u1ef1c t\u1ebf (Realistic)<\/li>\n<li>Th\u1eddi gian x\u00e1c \u0111\u1ecbnh (Timed)<\/li>\n<\/ul>\n<p><u>Th\u1eddi gian:<\/u> Kho\u1ea3ng 20 \u0111\u1ebfn 30 ph\u00fat \u0111\u1ec3 thi\u1ebft l\u1eadp c\u00e1c m\u1ee5c ti\u00eau, 10 ph\u00fat \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 l\u1ea1i \u0111\u1ea1t m\u1ee5c ti\u00eau.<\/p>\n<p><u>Ghi ch\u00fa: <\/u>C\u00f3 s\u1eb5n v\u00e0 kh\u00f4ng t\u00ednh ph\u00ed t\u1eeb<\/p>\n<ul>\n<li>McDougall, J. v\u00e0 King, G. (2007) Thang \u0111i\u1ec3m \u0111\u1ea1t M\u1ee5c ti\u00eau: M\u00f4 t\u1ea3, t\u00ednh thi\u1ebft th\u1ef1c v\u00e0 c\u00e1c \u1ee9ng d\u1ee5ng trong c\u00e1c d\u1ecbch v\u1ee5 \u0111i\u1ec1u tr\u1ecb Nhi khoa. (\u1ea4n b\u1ea3n L\u1ea7n th\u1ee9 2). London, ON: Trung t\u00e2m tr\u1ebb em Thames<\/li>\n<li>Turner-Stokes, L. (2009) &#8220;Thang \u0111i\u1ec3m \u0111\u1ea1t m\u1ee5c ti\u00eau (GAS) trong ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng: h\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh.&#8221; Clinical Rehabilitation, 23, 4, 362-370.<\/li>\n<\/ul>\n<p><em><strong>C\u00e1c Khuy\u1ebfn c\u00e1o:<\/strong><\/em><\/p>\n<ul>\n<li><em>GAS l\u00e0 m\u1ed9t c\u00f4ng c\u1ee5 \u0111\u01b0\u1ee3c qu\u1ed1c t\u1ebf c\u00f4ng nh\u1eadn \u0111\u1ec3 thi\u1ebft l\u1eadp v\u00e0 \u0111\u00e1nh gi\u00e1 c\u00e1c m\u1ee5c ti\u00eau. C\u1ea7n c\u00f3 nhi\u1ec1u kinh nghi\u1ec7m v\u00e0 \u0111\u00e0o t\u1ea1o. Kh\u1ea3 n\u0103ng s\u1eed d\u1ee5ng GAS c\u1ee7a c\u00e1c nh\u00e0 l\u00e2m s\u00e0ng c\u1ea7n \u0111\u01b0\u1ee3c ph\u00e1t tri\u1ec3n d\u1ea7n theo th\u1eddi <\/em><\/li>\n<li><em>C\u00e1c d\u1ecbch v\u1ee5 PHCN c\u1ea7n tham gia v\u00e0o vi\u1ec7c thi\u1ebft l\u1eadp m\u1ee5c ti\u00eau h\u1ee3p t\u00e1c bao g\u1ed3m tr\u1ebb, gia \u0111\u00ecnh v\u00e0 nh\u00f3m PHCN \u0111a chuy\u00ean ng\u00e0nh.<\/em><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Ba\u0323i na\u0303o\u00a0(cerebral palsy)\u00a0l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn v\u1eadn \u0111\u1ed9ng, tr\u01b0\u01a1ng l\u1ef1c c\u01a1 ho\u1eb7c t\u01b0 th\u1ebf. N\u00f3 \u0111\u01b0\u1ee3c g\u00e2y ra do c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e3o \u0111ang trong th\u1eddi k\u1ef3 ph\u00e1t tri\u1ec3n (n\u00e3o ch\u01b0a tr\u01b0\u1edfng th\u00e0nh), g\u1eb7p \u1edf thai nhi tr\u01b0\u1edbc giai \u0111o\u1ea1n \u0111\u01b0\u1ee3c sinh ra. D\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh b\u1ea1i n\u00e3o xu\u1ea5t hi\u1ec7n s\u1edbm, [&hellip;]<\/p>\n","protected":false},"author":42,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[10,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ba\u0323i na\u0303o - Ch\u1ea9n \u0111o\u00e1n, l\u01b0\u1ee3ng gi\u00e1, ti\u00ean l\u01b0\u1ee3ng, l\u00e2\u0323p m\u1ee5c ti\u00eau PHCN<\/title>\n<meta name=\"description\" content=\"Ba\u0323i na\u0303o \u0111\u01b0\u1ee3c g\u00e2y ra do c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e3o \u0111ang trong th\u1eddi k\u1ef3 ph\u00e1t tri\u1ec3n, g\u1eb7p \u1edf thai nhi tr\u01b0\u1edbc giai \u0111o\u1ea1n \u0111\u01b0\u1ee3c sinh ra.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ba\u0323i na\u0303o - Ch\u1ea9n \u0111o\u00e1n, l\u01b0\u1ee3ng gi\u00e1, ti\u00ean l\u01b0\u1ee3ng, l\u00e2\u0323p m\u1ee5c ti\u00eau PHCN\" \/>\n<meta property=\"og:description\" content=\"Ba\u0323i na\u0303o \u0111\u01b0\u1ee3c g\u00e2y ra do c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e3o \u0111ang trong th\u1eddi k\u1ef3 ph\u00e1t tri\u1ec3n, g\u1eb7p \u1edf thai nhi tr\u01b0\u1edbc giai \u0111o\u1ea1n \u0111\u01b0\u1ee3c sinh ra.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/bai-nao-chan-doan-luong-gia-tien-luong-muc-tieu-phcn\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-22T14:26:02+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/1653020823_03778_bai-nao-1jpg-300x200.jpg\" \/>\n<meta name=\"author\" content=\"Minh Nguyen Phuong Hong\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Minh Nguyen Phuong Hong\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"19 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/bai-nao-chan-doan-luong-gia-tien-luong-muc-tieu-phcn\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/bai-nao-chan-doan-luong-gia-tien-luong-muc-tieu-phcn\/\",\"name\":\"Ba\u0323i na\u0303o - Ch\u1ea9n \u0111o\u00e1n, l\u01b0\u1ee3ng gi\u00e1, ti\u00ean l\u01b0\u1ee3ng, l\u00e2\u0323p m\u1ee5c ti\u00eau PHCN\",\"isPartOf\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-22T14:26:02+00:00\",\"dateModified\":\"2023-04-22T14:26:02+00:00\",\"author\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/03b2d0bc3d50ddac2db2720cc5f983e5\"},\"description\":\"Ba\u0323i na\u0303o \u0111\u01b0\u1ee3c g\u00e2y ra do c\u00e1c t\u1ed5n th\u01b0\u01a1ng n\u00e3o \u0111ang trong th\u1eddi k\u1ef3 ph\u00e1t tri\u1ec3n, g\u1eb7p \u1edf thai nhi tr\u01b0\u1edbc giai \u0111o\u1ea1n \u0111\u01b0\u1ee3c sinh ra.\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/bai-nao-chan-doan-luong-gia-tien-luong-muc-tieu-phcn\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/bai-nao-chan-doan-luong-gia-tien-luong-muc-tieu-phcn\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/bai-nao-chan-doan-luong-gia-tien-luong-muc-tieu-phcn\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Ba\u0323i na\u0303o &#8211; 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