Markey K L
San Antonio Orthopaedic Group, Texas.
Sports Med. 1991 Dec;12(6):407-17. doi: 10.2165/00007256-199112060-00006.
'Functional rehabilitation' is an embellishment of the traditional concepts of rehabilitation which are motion and strength. Functional rehabilitation incorporates the concepts of agility, proprioception, and finally the confidence of the individual when performing whatever task he or she wishes to undertake. The determinants of rehabilitation include the patient, the type of injury the knee has sustained as well as its surgical treatment, and how innovative the director of rehabilitation is. The principles of rehabilitation include joint motion and stability as well as muscular endurance and strength. These should be considered during the immobilisation phase, the surgical and postsurgical phase, and continued through the early healing, late healing and final healing stages. The rehabilitation director must advance activity to levels of ever increasing complexity. Various modalities of rehabilitation such as bracing, passive motion machines and muscle stimulation units should be added in an effort to achieve a painless course. This course is progressive as long as errors of rehabilitation are avoided, including overtraining and too rapid a progression resulting in injury or reinjury. Realistic goals must be firmly established in the mind of the patient and the director at the outset. Determinants of rehabilitation are a guide to the reality of reaching a functional level. The functional activity programme depends upon knee stability, successful completion of lesser activities and healing of the injury or the surgery. Progressing from less difficult to more difficult activities before the patient is ready usually results in an injury or reinjury. Therefore, constant assessment of the performance level of the patient must be made before advancing to more demanding activities. Conservative and surgical treatment programmes for functional rehabilitation are essentially the same except for the time factors involved. The times of completion of different levels of activity are generally longer in the surgical programme. Time alone is not the signal for advancement from one programme to another. Attention should be paid to range of motion, strength, fluidity of performance of functional activities as well as functional testing.
“功能康复”是对传统康复概念（即运动和力量）的一种拓展。功能康复纳入了敏捷性、本体感觉的概念，最终还包括个体在执行其希望承担的任何任务时的信心。康复的决定因素包括患者、膝盖所受损伤的类型及其手术治疗，以及康复主任的创新能力。康复原则包括关节活动度和稳定性，以及肌肉耐力和力量。在固定阶段、手术及术后阶段都应予以考虑，并贯穿早期愈合、晚期愈合和最终愈合阶段。康复主任必须将活动推进到日益复杂的水平。应增加各种康复方式，如支具、被动运动器械和肌肉刺激装置，以努力实现无痛康复过程。只要避免康复错误，包括过度训练和进展过快导致受伤或再次受伤，这个过程就是渐进的。从一开始就必须在患者和主任心中牢固确立现实可行的目标。康复的决定因素是达到功能水平这一现实情况的指南。功能活动计划取决于膝盖的稳定性、较简单活动的成功完成以及损伤或手术的愈合情况。在患者尚未准备好时就从较简单的活动进展到更困难的活动，通常会导致受伤或再次受伤。因此，在推进到要求更高的活动之前，必须不断评估患者的表现水平。功能康复的保守治疗和手术治疗方案除了所涉及的时间因素外基本相同。手术方案中完成不同活动水平的时间通常更长。时间本身并不是从一个方案推进到另一个方案的信号。应关注活动范围、力量、功能活动执行的流畅性以及功能测试。
