ORDIN nr.

762 din 31 august 2007 pentru aprobarea criteriilor medico-psihosociale pe ba a carora se stabileste incadrarea in grad de handicap !"I#!N#$ "INI%#!R&' "&N(II) *+"I'I!I %I !,+'I#+#II D! %+N%! Nr. 762 din 31 august 2007 "INI%#!R&' %+N+#+#II -&.'I(! Nr. 1.//2 din 1/ noiembrie 2007 -&.'I(+# IN$ "ONI#OR&' O*I(I+' nr. 001 din 27 decembrie 2007 In temeiul art. 02 alin. 314 din 'egea nr. 22052006 pri6ind protectia si promo6area drepturilor persoanelor cu handicap) cu modi7icarile si completarile ulterioare) a6and in 6edere pre6ederile$ - art. 12 din 8otararea ,u6ernului nr. 30152007 pri6ind organi area si 7unctionarea "inisterului "uncii) *amiliei si !galitatii de %anse9 - art. 7 alin. 324 din 8otararea ,u6ernului nr. 06252006 pri6ind organi area si 7unctionarea "inisterului %anatatii -ublice) cu modi7icarile si completarile ulterioare) ministrul muncii) 7amiliei si egalitatii de sanse si ministrul sanatatii publice emit urmatorul ordin$ +R#. 1 %e aproba (riteriile medico-psihosociale de incadrare in grad de handicap) pre6a ute in ane:a;4 care 7ace parte integranta din pre entul ordin. --------;4 +ne:a se publica ulterior in "onitorul O7icial al Romaniei) -artea I) nr. 001 bis in a7ara abonamentului) care se poate achi itiona de la (entrul pentru 6an ari si relatii cu publicul al Regiei +utonome <"onitorul O7icial<) .ucuresti) sos. -anduri nr. 1. +R#. 2 +utoritatea Nationala pentru -ersoanele cu 8andicap) (omisiile de e6aluare a persoanelor adulte cu handicap) (omisiile pentru protectia copilului si Directiile generale de asistenta sociala si protectia copilului =udetene) respecti6 ale sectoarelor municipiului .ucuresti 6or duce la indeplinire pre6ederile pre entului ordin. +R#. 3 -re entul ordin se publica in "onitorul O7icial al Romaniei) -artea I. "inistrul muncii) 7amiliei si egalitatii de sanse) -aul -acuraru "inistrul sanatatii publice) ,heorghe !ugen Nicolaescu

(+-. 1 *&N(#II'! "!N#+'! I. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- '+ -!R%O+N!'! (& D!?>O'#+R! IN(O"-'!#+ + *&N(#II'OR "!N#+'! %I -%I8O%O(I+'! ;4 ;#; @AAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC

DAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G -+R+"!#RI G !6aluarea comportamentului adapti6 respecti6$ G G *&N(#ION+'I G a. ni6elul de de 6oltare bio-psiho-comportamentala)G G G b. capacitatea de in6atare 3HI) memorie) atentie4) G G G c. adaptarea sociala G G G Instrumente de lucru$ G G G I. e:amen psihiatric) G G G II. teste psihometrice) G G G III. ancheta sociala G DAAAAAAAAAAABAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G 8+NDI(+- G- Intar ierea mintala usoara 3HI - 10-115704 G G &%O+R+ G &%OR G- -re inta capacitate de comunicare orala si scrisa) G G G Gdar mani7esta o intar iere de 2-3 ani in e6olutia G G G Gscolara) 7ara ca aceasta sa 7ie determinata de carenteG G G Geducati6e) di7icultati de in6atare si gandire G G G Gde7icitara. (arentele se mani7esta numai in ca ul G G G Gsolicitarii intelectuale. G G G G- %e pot antrena in acti6itati simple. G G G G- -ot des7asura acti6itati lucrati6e daca bene7icia a G G G Gde ser6icii de spri=in. G DAAAAAAAAAAAEAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G 8+NDI(+- G- Intar ierea mintala usoara 3HI - 10-115704) asociataG G "!DI! G "!DI& Gasociata cu o alta de7icienta sen oriala) epilepsie) G G G Gtulburari comportamentale sau autism. In 7unctie de G G G Gse6eritatea de7icientei asociate se 6a trece la G G G Ghandicap accentuat sau gra6.;;4 G G G G- Intar ierea mintala moderata 3HI - 31-104 G G G GIsi insusesc cu di7icultate operatiile elementare insaG G G Gpot in6ata sa scrie si sa citeasca cu6inte scurte9 au G G G Gdeprinderi elementare de autoser6ire si se adaptea a G G G Gla acti6itati simple de rutina9 au capacitati de G G G Gautoprotectie su7iciente) putand 7i integrati in G G G Gcomunitate si sa des7asoare acti6itati lucrati6e in G G G Gconditii prote=ate. G DAAAAAAAAAAAEAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G 8+NDI(+- G- Intar ierea mintala accentuata 3HI - 21-324 G G+((!N#&+#+ G+((!N#&+# G- +daptarea la situatii noi nu se reali ea a con7orm G G G ;;;4 G6arstei cronologice. G G G G- -ersoana are un ritm de de 6oltare lent) curba de G G G Gper7ectionare este pla7onata) a6and loc bloca=e G G G Gpsihice. G G G G- %unt capabili sa e7ectue e sarcini simple sub G G G Gsupra6eghere) au ne6oie de ser6icii de spri=in si se G G G Gpot adapta la 6iata de 7amilie) comunitate. G DAAAAAAAAAAAEAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G 8+NDI(+- G- Intar ierea mintala pro7unda - 3HII214 G

G ,R+>+ G ,R+> G- "inima de 6oltare sen iti6o-motorie) reactionea a G G G Gla comen i simple indelung e:ecutate) au ne6oie de G G G Gasistenta permanenta 7iind incapabili de autoconductieG G G Gsi autocontrol. G G G G- Necesita asistent personal. G JAAAAAAAAAAAKAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; ---------;4 %e re7erea la retardul mintal si tulburarea autista Intar ierea mintala este caracteri ata prin 7unctionare intelectuala semni7icati6 sub medie 3un HI sub 70 cu debut inaintea 6arstei de 10 ani4) precum si prin de7icite sau deteriorari concomitente in acti6itatea adaptati6a in cel putin doua din urmatoarele domenii$ comunicare) autoingri=ire) 6iata de 7amilie) aptitudini sociale u de resursele comunitatii) autoconducere) aptitudini scolare 7unctionale) timp liber) sanatate si siguranta. #ulburarea autista este o tulburare per6a i6a de de 6oltare caracteri ata prin$ deteriorarea calitati6a in interactiunea sociala) deteriorari calitati6e in comunicare precum si patternuri stereotipe si restranse de comportament) preocupari si acti6itati. !ste de asemenea caracteri ata de intar ieri) cu debut inaintea 6arstei de 3 ani) in cel putin unul din urmatoarele domenii$ - interactiune sociala - limba=)asa cum este utili at in comunicarea sociala - =oc imaginati6 sau simbolic Relatiile interpersonale generea a an:ietate mai ales cand inter6ine contactul cu persoane necunoscute. +n:ietatea generea a si schimbarile ambientale. +ceste persoane nu au abilitatile a7ecti6e si cogniti6e care ar a6ea ca re ultat 7ormarea deprinderilor de relationare interpersonala normala 3retragere patologica in sine4. ;;4 -ro7un imea de7icientei asociate determina incadrarea in categoria de persoana cu handicap) in 7unctie de intensitatea tulburarilor 7unctionale generate de structura sau structurile a7ectate. ;;;4 In masura in care nu e:ista un alt handicap asociat care sa necesite ingri=ire speciala sau tulburari comportamentale. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAA AAAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G-+R#I(I-+R! - N!(!%I#+#IG DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAA AAAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- De 6olta) de regula) aptitudini sociale G- Necesita pregatire in G G &%OR G si de comunicare in timpul anilor G conditii speciale9 G G G prescolari) au o deteriorare minima in G- +u ne6oie de spri=in G G G ariile sen iti6o-motorii 9 G pentru initiere si G G G- -ot achi itiona cunostinte scolare G insertie sociala pe G G G corespun atoare ni6elului clasei a >I-a)G piata muncii pentru a G G G capata aptitudini sociale si pro7esio- G dobandi abilitati de G G G nale adec6ate pentru autointretinere) G trai independent9 G G G pot trai satis7acator in societate G- "onitori are si masuriG G G daca nu e:ista o tulburare asociata9 G educati6e in ca ul G G G- &neori asocia a tulburari de comportamentG celor cu comportament G G G care pot atinge intensitatea unor acte G de6iant. G G G antisociale) aditii de substante G G G G psihoacti6e. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAA AAAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- -ot bene7icia de pregatire pro7esionala G- +u ne6oie de spri=in G G "!DI& G si) cu supra6eghere moderata) pot a6ea G pentru insusirea unei G

G G gri=a de ei insisi9 G meserii) in 7unctie deG G G- -ot e7ectua acti6itati lucrati6e G abilitati5aptitudini. G G G- +u ne6oie de ser6icii de spri=in. G Implicarea agentiei deG G G G 7ormare pro7esionala G G G G este necesara pentru G G G G insertia sociala pe G G G G piata muncii. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAA AAAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- +u o de 6oltare psihomotorie redusa9 G- -ot des7asura acti6i- G G+((!N#&+#G- -ot dobandi deprinderi igienice G tati simple9 G G G elementare9 G- +u ne6oie de spri=in G G G- -ot e7ectua sarcini simple. G pentru a e7ectua acti-G G G G 6itatile pentru care G G G G au 7ost pregatiti. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAA AAAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- +u ne6oie de asistenta permanenta. G- Necesita asistent G G ,R+> G G personal. G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; II. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN R!,R!%I+ 3D!#!RIOR+R!+4 *&N(#II'OR IN#!'!(#&+'!;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - e:amen psihiatric9 G- scor ""%! M 219 G- scor ""%! 11-209G- scor ""%! 10-129 G- scor ""%! N/9 - teste psihologice G- deteriorare G- tulburari de me-G- atro7ie corticala G-atro7ie corticala 3""%!49 Gcogniti6a) atro7ieGmorie si tulburariGgenerali ata Gmarcata cerebral) - e6aluarea degradarii Gcorticala usoara 5Gpsihice de inten- Gaccentuata9 G7ara tulburari intelectuale 3ID(49 Ggenerali ata9 Gsitate usoara9 G- uitarea numelor) Gmotorii9 - (#9 R"N9 G- uita e6enimente-G- accentuarea Gnumerelor de G- dementa - ancheta sociala. Gle recente9 Gtulburarilor de Gtele7on) adreselor9 G+l heimer G- necesitatea de Gmemorie9 G- uitarea con6ersa- Gatro7ie corticala Ga repeta de mai G- deteriorare Gtiei recente) a Gmarcata in lobii Gmulte ori o rela- Gsociala moderata Ge6enimentelor G7rontali si Gtare in 6ederea Gcu di7icultati in Gcurente9 Gparietali O triada Gmemorarii9 Gacti6itatea G-sarcini netermi- Gsimptomatica9 G- e itare in a Gpro7esionala. Gnate deoarece nu G- uitarea numelor Graspunde la G Gstie de unde sa Gcelor apropiati9 Gintrebari. G Gle reia. G- uitarea datelor G G G Gpersonale9 G G G G- incapacitate

G G G Gde memorare9 G G G G- deteriorarea G G G G=udecatii) a G G G Gcontrolului G G G Gpulsional9 G G G G- triada patognoG G G Gmonica 3agno ie) G G G Gapra:ie) a7a ie4 AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; ---------------;4 %e re7era la demente atro7ico-degenerati6e 3dementa senila) dementa in boala +l heimer)boala -icP4) boli care a7ectea a primar) direct si selecti6 creierul) caracteri ate prin$ - pierderea abilitatilor intelectuale su7icient de se6era pentru a inter7era cu acti6itatile sociale si pro7esionale9 - deteriorarea gandirii abstracte9 - tulburari ale acti6itatii corticale superioare$ a7a ie) apra:ie) agno ie) di7icultati constructionale9 - modi7icarea personalitatii9 - starea de constienta clara. Dementa presenila-degradarea progresi6a a 7unctiilor cogniti6a) 6oliti6a si prose:ica 7ara triada simptomatica 3agno ie) apra:ie) a7a ie4 - se considera dementa presenila atunci cand tulburarile apar dupa 6arsta de 20-21 de ani si dementa senila atunci cand tulburarile apar dupa 6arsta de 60 de ani. Dementa +l heimer-dementa atipica cu debut precoce sau tardi6) cu atro7ie cerebrala generali ata) predominant 7rontala si lobi temporali si triada simptomatica 3agno ie) apra:ie) a7a ie4. *unctiile psihice superioare sunt pierdute) 7unctiile neurologice clasice) ca si cele 6iscerale) sunt pastrate. Dementa -icP- 7orma mai rara) a7ectea a regiunile 7rontale si temporale ale corte:ului. !6oluea a cu apatie pronuntata si tulburari de memorie. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G-ot des7asura acti6itati 7ara G%pri=in pentru a 7i mentinuti in G G &%OR Gsuprasolicitari 7i ice5psihice) Gacti6itate sau pentru des7asura- G G Gin conditii de con7ort psihic si Grea acesteia la domiciliu sau in G G G7i ic) in mediu colecti6. Gcolaborare. G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G-ot des7asura acti6itati G%pri=in pentru a 7i mentinuti in G G "!DI& Gspeciali ate) a6and ne6oie de Gacti6itate sau pentru des7asura- G G Gindrumare periodica. Grea acesteia la domiciliu sau in G G G Gcolaborare. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GDependenta partiala pentru G%pri=in in des7asurarea acti6ita-G G+((!N#&+#Gautoser6ire) ingri=ire) 6iata Gtilor cotidiene si implicare in G G Gsociala) autodeterminare G6iata sociala prin asigurarea G G G Gparticiparii la anumite actiuni G G G Gpre7erate. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF

G8+NDI(+- GDependenta totala de ingri=irile GNecesita asistent personal. G G ,R+> Gprimite din a7ara) limitarea in GNecesita ingri=iri la domiciliu G G Grelationare sociala) lipsa de Gsau ser6icii sociale speciali ateG G Gautodeterminare G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; III. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- '+ -!R%O+N!'! (& #&'.&R+RI D! -!R%ON+'I#+#!;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - !:amen psihiatric GDecompensari de GDecompensari mai G- Decompensari G- -ersoane cu - !:amen psihologic$ Gscurta durata cu Gdese 32-35an4) de G7rec6ente 3peste Gcomportament testarea 7unctiilor G7rec6enta rara Gdurata mai lunga) G25an4 de intensitateGsociopat) 7ara cogniti6e) a7ecti6e) a G31-25an4) de in- Gne6rotice) cu e:a-Gpsihotica) e6entualeGcontrol al s7erei comportamentului si a Gtensitate ne6ro- Gcerbari comporta- Gelemente deteriora- Ginstinctuale) personalitatii 3prin Gtica) cu remisiuniGmentale) e6entual Gti6e) e7icienta Ga7ecti6e si teste psihometrice si Gbune) spontan sau Gcu asocierea Gterapeutica slaba) Gcomportamentale9 probe proiecti6e49 Gsub tratament. Gconsumului de Gasociere cu consumulG- Nu-si recunosc - +ncheta sociala. G Gsubstante to:ice. Gde substante to:ice.Gde7icitul G G#ulburarile pot 7iG- Di7icultate ma=oraGstructural G Gcompensate partialGde relationare G- +u) in general) G Gprin tratament. Gsocio-pro7esionala) Ghotarare =udecatoG G#ipuri$ paranoid) Gcon7lictualitate Greasca de punere G Gschi oid) antiso- Gmarcata) esecuri Gsub interdictie. G Gcial) anancast. Grepetate la locul deG G G Gmunca) schimbarea G G G G7rec6enta a locului G G G Gde munca. G G G G- #ipuri$ paranoid) G G G Gschi oid) antisocialG AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; N. a. In stabilirea de7icientei 7unctionale se 6or a6ea in 6edere$ - tipul tulburarii de personalitate) - 7rec6enta si intensitatea decompensarilor 3de tip psihotic4) - durata decompensarilor) - raspunsul terapeutic si calitatea remisiunilor) - integrarea socio-comunitara si pro7esionala) - pro7esiunea) - to:ico7ilia asociata.

b. !ste necesara o anamne a minutioasa corelata cu ancheta sociala) urmarindu-se obtinerea de date) atat pri6ind acti6itatea pro7esionala 3ruta pro7esionala-mobilitatea pro7esionala4 cat si comportamentul longitudinal in 7amilie si societate. c. !:amenul psihologic aduce date pri6itoare la posibilele elemente deteriorati6e) cat si in e6identierea trasaturilor dominante in ca ul tulburarilor mi:te de personalitate. ----------------;4 %e re7era la tipurile de tulburari de personalitate 3boli structurale-psihopatii4$ - #ulburare de personalitate paranoida9 - #ulburare de personalitate schi oida9 - #ulburare de personalitate antisociala9 - #ulburare de personalitate instabil-emotionala - de tip impulsi6 si - de tip borderline9 (aracteri ate prin$ 1. controlul incomplet al s7erelor a7ecti6-6olitionale si instincti6e) 2. nerecunoasterea de7icitului structural) 3. incapacitatea de integrare armonioasa si constanta in mediul social. In practica se intalnesc aspecte clinice polimor7e care asocia a doua sau mai multe trasaturi di armonice reali and tablouri simptomatologice comple:e - tulburari de personalitate mi:te 3polimor7e4. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G-oate presta orice acti6itate G- -articipare 7ara restrictii - G G &%OR Gpro7esionala in 7unctie de cali- Gacti6itatea pro7esionala intr-un G G G7icare cu e6itarea celor care Gloc de munca accesibil) a6and un G G Gimpun responsabilitate si contactGrol psihoterapeutic important9 G G Gcu publicul G- "onitori are medico-psiho-soci-G G G Gala pentru pre6enirea decompensa-G G G Grilor de tip psihotic. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- -ot e7ectua numeroase acti6i- G- -articipare cu conditia reali- G G "!DI& Gtati pro7esionale in 7unctie de G arii unui climat pro7esional G G Gcali7icare) 7ara suprasolicitare Gtolerant din partea conducerii siG G Gpsihica) intr-o ambianta relatio-Gcolecti6ului de munca) 7ara G G Gnala adec6ata9 Gtensiuni psihice in scopul G G G- #rans7erul acti6itatilor de Ginsertiei pro7esionale sau menti-G G G6ar7) de responsabilitate si mai Gnerii in acti6itati organi ate9 G G Gales deci ionale) altor membri G- "onitori are medico-psiho- G G Gai echipei. Gsociala. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G-ot e:ecuta nenumarate acti6itatiG*acilitarea relatiilor interper- G G+((!N#&+#Gpro7esionale in 7unctie de cali- Gsonale in colecti6ul de lucru) inG G G7icarea insusita sau in curs de G6ederea insertiei sociale. G G G7ormare) 7ara solicitare psihica G G G Gaccentuata) responsabilitati sau G G G Gcontact cu publicul. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G-ot des7asura acti6itati lucrati-G- Necesita un mediu psiho-socio- G

G ,R+> G6e si au ne6oie de ser6icii de G7amilial suporti6 si asigurarea G G Gspri=in. Gaccesului la ser6icii speciali- G G G G ate G G G G- Necesita asistent personal. G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; I>. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- '+ -!R%O+N!'! (& #&'.&R+RI +'! DI%-O?I#I!I %I -R!>+'!N# D! ,+NDIR! ;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - !:amen psihiatric GIn 7orme clinice GIn remisiuni cu GIn 7ormele catato- GIn 7ormele cu e6o3aprecierea clinica a Gre iduale) stabi- Gdisparitia 7enome-Gnice) de organi ate Glutie progredienta intensitatii tulburarii Glite cu prudenta Gnelor delirante siG3hebre7renice4) Gse6era a personapsihice si a G Ghalucinatorii Gparanoide) Glitatii si a prognosticului G Gpremitand reluareaGnedi7erentiate. Gcomportamentului) apropiat al a7ectiunii49 G Gacti6itatii la un G Gcu potential - !:amen psihologic$ G Gni6el in7erior GN. In 7ormele care Gantisocial testare a 7unctiilor G G Gau instituita G cogniti6e) a7ecti6e) a G G Ginterdictia) G comportamentului si G G Ghandicap gra6 G a personalitatii 3prin G G G G teste psihometrice si G G G G probe proiecti6e49 G G G G - In6estigatii sociale G G G G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; -----------------;4 %e re7era la $ - psiho e cu debut precoce 3copilarie- adolescenta9 e:. schi o7renia)boli a7ecti6e49 - a7ectiuni psihice ma=ore 3psiho e4 gre7ate pe o intar iere mentala) indi7erent de gradul acesteia si de 6arsta solicitantului9 - psiho e la care se retine o componenta ereditara indubitabila9 - psiho e la care se asocia a o tulburare de personalitate 3structurala4. - psiho e ma=ore) idi7erent de 6arsta) la persoane 7ara 6enituri. N. De retinut$ 1. Debutul psihotic poate 7i necaracteristic si) ulterior) se pune diagnosticul de a7ectiune psihica ma=ora. Debutul este repre entat de prima consultatie a6uta de pacient la un ser6iciu de psihiatrie 37isa de consultatie este utila4. 2. %chi o7renia) in 7a a acti6a 3producti6a4) este caracteri ata prin$

a. idei delirante) halucinatii) incoerenta) autism) catatonie) a7ect plat sau e6ident inadec6at 3discordant49 b. idei delirante) bi are9 c. halucinatii proeminente9 d. in timpul puseului - munca) relatiile sociale si autoingri=irea sunt a7ectate ma=or9 e. nu poate 7i stabilit un 7actor organic care a initiat sau mentinut tulburarea. 3. 'a e6aluarea gradului de handicap in schi o7renie se 6or a6ea in 6edere$ a. 7orma clinica $ catatonica) hebe7renica) paranoida) nedi7erentiata) re iduala) simpla si depresia post schi o7renica. -rimele patru 7orme sunt cele mai se6ere si au un potential handicapant ma=or9 b. tipul de e6olutie$ - subcronica sau cronica) cu sau 7ara episoade de acuti are9 - in remisiune 3cand o persoana cu schi o7renie nu mai pre inta nici un semn de tulburare49 c. cooperararea la monitori area medicala si e7icienta actiunilor psihoterapeutice9 d. climatul 7amilial si sociopro7esional. 2. 'a e6aluarea gradului de handicap in psiho ele a7ecti6e se 6a a6ea in 6edere$ - mania cronici ata) 7ormele bipolare) ciclotimia rapida) depresia se6era cronica. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G--ot presta acti6itati in condi- G- %pri=in pentru mentinerea in G G &%OR Gtii de con7ort psihic si 7i ic Gacti6itate - acti6itati organi- G G Gdin punct de 6edere al ambiantei G ate) accesibile9 G G Grelationale si materiale. G- "onitori area medico-psihosoci-G G G-%unt contraindicate acti6itatileGala la ser6iciul teritorial de G G Gcare implica suprasolicitare Gde psihiatrie. G G Gpsihica) stresante si cu respon- G G G Gsabilitate ridicata. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- -ot des7asura acti6itati) cu G- %pri=in pentru mentinere in G G "!DI& Gprogram integral sau partial) in Gacelasi loc de munca sau pentru G G Gacelasi loc de munca. %chimbarea Ge6entuala schimbare a locului G G Glocului de munca se 6a 7ace numaiGde munca9 G G Gdaca acesta este corespun ator G- *acilitarea relationarii inter-G G Gdin punctele de 6edere ale soli- Gpersonale in colecti6ul de lucru9G G Gcitarii psihice si al relatiilor G- %pri=in pentru monitori area G G Ginterpersonale9 Gmedico-psihosociala. G G G- !6itarea pro7esiunilor cu risc G G G Gde acuti are a tulburarii. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- Nu pot des7asura acti6itati G- %pri=in 7amilial pentru respec-G G+((!N#&+#Gpro7esionale organi ate) Gtarea tratamentului de speciali- G G Gindi7erent de natura si ni6elul Gtate) cooperare la acti6itatile G G Gde solicitare9 Gde psihoterapie sau5si terapie G G G- !6entual acti6itati in sectii Gocupationala9 G G Gde ergoterapie-terapie ocupatio- G- +sigurarea unui climat comuni- G G Gnala) cu rol psihoterapeutic9 Gtar si 7amilial de intelegere) G G G- +u a7ectata partial capacitateaGspri=in) 7ara 7actori stresanti G G Gde autodeterminare si autoser6ireGpsihoa7ecti6i. G G G- Nu necesita supra6eghere perma-G G G Gnenta din partea altei persoane. G G

DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- +u pierduta capacitatea de G- "onitori are medico-psiho-soci-G G ,R+> Gautodeterminare) autoser6ire) Gala permanenta. G G Gautoingri=ire. G- Necesita asistent personal. G G G G- Necesita ser6icii speciali ate.G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; (+-. 2 *&N(#II'! %!N?ORI+'! I. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR >!D!RII;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAC G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ G *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAF G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G G &%OR G "!DI& G +((!N#&+# G ,R+> G AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAF - +cuitatea 6i uala G152 Q0)1 - 153Q0)3G >+O intre 152 G >+O intre 1512Q0)00G>+O sub I521I0)02 G 3calitatea 6ederii4 G3253) 152) 1534 G 30)214-1510 30)14G32m4 -1521Q0)02 32m4G32m4 cecitate G mono-binoculara 3cu cea G G G Grelati6a G mai buna corectie) la G G G G>+OQpmm pl) 7plQ G ochiul cel mai bun4 G G G Gcecitate absoluta G Re7ractrometrie oculara G G G G G 3autore7ractometru G G G G G dioptron4 G G G G G G G G G G - (amp 6i ual 3manual4 G Normal GRedus concentric GRedus concentric in G#ubular) in =urul G la ochiul cel mai bun G Gin =urul punctuluiG=urul punctului de Gpunctului de 7i- G G Gde 7i:atie la G7i:atie la 10 - 30 G:atie 30-10 grade4G G G30 - 20 grade Ggrade G G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAF - (amp 6i ual In 7unctie de structura oculara a7ectata G computeri at ;;4 G AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAF - -erceptia luminii la G G G G G stimuli 6i uali;;;4 G G G G G G G G G G - -otentiale 6i uale G Normal G Normal G -otentiale G 'ipsa perceptie G e6ocate 3-!>4 G G G modi7icate G luminoasa G G G G G G - !lectroretinograma G Normal G Normal G Retina inca G #raseu stins G 3!R,4 G G G 7unctionala G 3retina G G G G G ne7unctionala4 G

AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAL ;%#; ------------------;4 In a7ectiunile cronice primar si secundar oculare) in7lamatorii) heredodegenerati6e) degenerati6e) traumatice) tumorale) 6asculare cu e6olutie cronica-progresi6a sub tratament speci7ic sau cu sechele mor7o7unctionale handicapante. (ataracta cu indicatie chirurgicala 6a 7i e6aluata dupa inter6entia operatorie. >icii de re7ractie) de acomodare) nistagmusul. ;;4 (ampul 6i ual computeri at o7era relatii pri6ind sensibilitatea retinei cu modi7icari speci7ice structurii 7unctiilor 6i uale a7ectate e7ecti6 3are programe prestabilite in 7unctie de diagnosticul clinic4. ;;;4 -!> si !R, utili ate in aprecierea starii 7unctionale a retinei 3teste obiecti6e4. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice pro7esie G*ara restrictii G G &%OR G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G-ro7esiuni care nu comporta G*ara restrictii G G "!DI& Gpericlitate oculara sau supraso- G G G Glicitare 6i uala. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- 'imitari in orientarea spati- G- +sigurarea de lupe maritoare G G+((!N#&+#G ala) in acomodarea la trecerea G pentru reperele prelucrate9 G G G de la lumina la intuneric si G- +7isarea cu litere mari a G G G in6ers9 G instructiunilor de munca si de G G G- -ro7esiuni care nu comporta G protectie a muncii9 G G G periclitate oculara sau G- Iluminat mai puternic G G G suprasolicitare oculara. G compensator. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- Di7icultati ma=ore de orientareG- "arcarea drumului de acces spreG G ,R+> G in spatiu. G locul de munca9 G G G- -ot des7asura acti6itati G- %chimbarea sistemului de alarmaG G G lucrati6e. G- +=ustarea ambiantei luminoase9 G G G G- 'oc de munca prote=at pentru G G G G regasirea materiei prime si a G G G Guneltelor) e6entual cu =alonarea G G G Gdrumului mainii9 G G G G- "ontarea de aparatoare in G G G G onele periculoase pentru munca9 G G G G- In7ormarea in munca sa se 7aca G G G G6erbal sau in .raille9 G G G G- Necesita a=utor regulat. G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; II. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR +&?&'&I;4

;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G *+R+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G D!*I(I!N#+ G &%O+R+ G "!DI! G +((!N#&+#+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G IN*IR"I#+#! G 8+NDI(+G 8+NDI(+G 8+NDI(+G G &%OR G "!DI& G +((!N#&+# AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA +udiometrie 3subiecti6a - G%caderea sau G-ierdere auditi6a G-ierdere auditi6a G- -ierderea audiliminara sau supraliminaraGabolirea Gbilaterala intre Gbilaterala intre Gti6a peste 70 d. sau audiometrie 6ocala si Gunilaterala a G20-20 d. G21-70 d. prote abilaGcare se prote ea a obiecti6a cu potentiale Gau ului G G Ggreu asociata cu e6ocate4) impedansmetrie G#ulburari de au G G Gtulburari psihice si otoemisiuni acustice Gbilaterale cu G G Gsi de limba=9 Gpierdere intre G G G- %urditate G0-20 d. G G Gcongenitala sau G G G Gdobandita inaintea G G G Gachi itionarii G G G Glimba=ului insoG G G Gtita de mutitate G G G G3surdocecitate cu G G G Gdemuti are slaba5 G G G Gnula4) cu pierdere G G G Gpeste /0d.3co7o a4 AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; --------------;4 In a7ectiunile cronice auditi6e de cau a di6ersa$ in7lamatorie) in7ectioasa) to:ica) 6asculara) heredodegenerati6a) traumatica) tumorala - congenitale sau dobandite precoce 3copilarie5 adolescenta4 insotite de hipoacu ie 3tip transmisie) neurosen oriala) mi:ta4) prote abile sau neprote abile sau cu surditate 3co7o a4) cu sau 7ara tulburari de comunicare 3surdomutitatesurdocecitate4. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate G*ara restrictii G G &%OR G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate G*ara restrictii G G "!DI& G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G+cces la ma=oritatea locurilor deG+sigurarea unor sisteme optice deG G+((!N#&+#Gmunca) cu conditia e6itarii Gsemnali are inlocuindu-le pe celeG

G Gacti6itatilor de comunicare Gsonore) atat in scopul protectieiG G Gcu publicul. Gmuncii) cat si de asigurare a G G G Gunui 7lu: tehnologic normal) cu G G G Gpreluarea sarcinilor de G G G Gsupra6eghere. G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; III. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR >!%#I.&'+R!;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+>;4 AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA !6aluarea re7le:elor$ GDi7erente 7unctio-GDi7erenta intre GOrtostatismul este GOrtostatismul este - 6estibulo-ocular Gnale la probele Gcele doua 6esti- Gposibil dar di7icil Gimposibil in cri a) 3electronistagmogra7ie49 Gpro6ocate intre Gbule la probele Gde mentinut) Ginsotit de tulbu- 6estibulo-spinal Gcele 2 6estibule Gpro6ocate Gnistagmus spontan) Grari 6egetati6e. 3posturo-gra7ie Gde cel putin 20R Gdepaseste 30R Gdi7erenta mare intreG-robele spontane dinamica computeri ata G8ipo5hiper G3nistagmus spontanG6estibule 3tulburariGsi pro6ocate3daca si cranio-corpo-gra7ie4 Ge:citabilitate Gsau de6iatii nete4Gcalitati6e ale Gse pot practica4 G6estibulara G Gtraseului electro- Gsunt net po iti6e. Gbilaterala G Gnistagmogra7ic4) G#ulburari 7unctioG G Gtulburari 7unctio- Gnale echi6alente G G Gnale echi6alente cu Gcu 00-100R;4 G G G60-00R G G G G G-entru perioade G G G Glimitate de 6-12 G G G Gluni) in 7unctie G G G Gde durata si G G G Gre6ersibilitatea G G G Gtulburarilor ma=oG G G Gre de echilibru la G G G Gactiunile de G G G Grecuperare. AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; ----------------;4 In a7ectiunile cronice 6estibulare) precum si a cailor acestora) congenitale sau contractate precoce. N.$ In general tulburarile 6estibulare peri7erice au un caracter pasager) tran itoriu. #ulburarile de echilibru sur6in cand e:ista o di7erenta 7unctionala mai mare de 20 - 30 R intre cele doua 6estibule. ;#;

@AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate G*ara restrictii G G &%OR G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate GRestrictie pentru acti6itatile G G "!DI& G Gcare se des7asoara la inaltime G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- 'ocuri de munca - 7ara supraso-G+daptarea locului de munca) G G+((!N#&+#G licitare posturala si deplasariGast7el incat sa nu 7ie supraso- G G G posturale de durata sau care Glicitata postura ortostatica sau G G G impun alternanta rapida in Gsa o 7acilite e prin mi=loace G G G 6ariantele posturale9 Gsuplimentare de spri=in) scaune G G G- %unt accesibile) in general) Gadaptate) etc. G G G muncile statice) acti6itatile G G G G de birou5 mestesugaresti. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- %pri=in pentru autoser6ire) G- Necesita asistenta de G G ,R+> G ingri=ire si autogospodarie in G specialitate. G G G acti6itatile de ba a ale 6ietiiG- Necesita asistent personal. G G G de i cu i. G G G G- -entru perioada in care G G G G ortostatismul si mobili area nuG G G G se pot reali a. G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; (+-. 3 *&N(#II'! *ON+#ORII %I D! (O"&NI(+R! >!R.+'+ !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ >O(II;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAEAAAAA AAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA - !:amen OR' G- Dis7onie i olata GDiplegie recurentiala in G- #raheostoma permanenta - !:amen laringoscopic G 3raguseala49 Gpo itie de abductie sau G7ara laringectomie. - !:amen histopatologic G- >oce bitonala 3pare a Gadductie 3cu pastrarea G- #raheostoma cu larin- -robe 6entilatori Gcoarda 6ocala - recu- G6ocii dar cu tulburari deGgectomie) determinata de

- +ncheta

Grentiala) unilaterala4 Grespiratie4) in 7unctie Gprocese maligne sau G Gsi de speci7icul pro7esi-G drobirea laringelui. G Gunii 3pro7esionisti ai G- +blatia laringelui cu G G6ocii4 Gtraheostoma permanenta G G Gsi lipsa crigmo7onatiei) G G Gcu tulburari de 6orbire) G G Gde 6entilatie si) G G Ge6entual) de nutritie) G G Gtinand seama de cau a G G Gcare a determinat G G Ga7ectarea structurala. AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAKAAAAA AAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; -------------------;4 %e re7era la tulburarile 7onatorii determinate de a7ectarea laringelui) cau ate de$ - steno e post traumatice) - pare e sau parali ii 3cor i 6ocale - n. recurentiali4) - procese tumorale benigne) maligne) - procese in7lamatorii cronice) trenante sau repetiti6e. *unctia 7onatorie poate 7i tulburata incepand cu ca6itatea bucala 3stomatolalie4 si pana la organul 7onator principal) laringele) sub 7orma de $ - 6oce bitonala in parali ie recurentiala) - dis7onie prin 7ormatiuni tumorale) - a7onie consecuti6a ablatiei laringelui. (uanti7icarea tulburarilor 7onatorii se 7ace in raport de inteligibilitatea 6ocii de la usoara si pana la accentuata) cand este 6orba de a7onie. In stabilirea gradului de handicap se 6or a6ea in 6edere si$ - speci7icul pro7esiei 3pro7esionisti ai 6ocii4) - e7ectul terapiei) - e6entualele recidi6e 3nodului cor i 6ocale) polipi - recidi6e tumorale benigne sau maligna4. N. *unctiile mentale ale limba=ului) de articulare) tulburarile de limba= 6orbit - mutitatea) limba= slab cu toate incercarile de reeducare 3labiolectura4 sunt pre6a ute la capitolele respecti6e. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI;4 G -+R#I(I-+R! - N!(!%I#+#I;4 G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala G+sigurarea unui loc de munca cu G G &%OR G7ara suprasolicitare 7i ica mare)Gsolicitare redusa) in conditii deG G Gin conditii de microclimat Gmicroclimat) 7ara 6ariatii termi-G G Gadec6at) 7ara 6ariatii termice) Gce) curenti de aer) prea umed. G G Gmediu prea rece sau prea cald sauG G G Guscat) 7ara curenti de aer) G G G Gume eala. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala G+sigurarea unui loc de munca cu G G "!DI& G7ara suprasolicitare 7i ica mare)Gsolicitare redusa in conditii de G

G Gin conditii de microclimat Gmicroclimat) 7ara 6ariatii termi-G G Gadec6at) 7ara 6ariatii termice) Gce) curenti de aer) prea umed. G G Gmediu prea rece sau prea cald sauG"onitori are medicala la ser6i- G G Guscat) 7ara curenti de aer) Gciul de OR') tratament adec6at. G G Gume eala. G G G G-entru pro7esionisti ai 6ocii G G G G3pro7esori) a6ocati) solisti) G G G Gcantareti 6ocali s.a.4)schimbareaG G G Glocului de munca 7ara solicitareaG G G G6ocei) in conditii 7a6orabile de G G G Gmicroclimat - conditii ambientaleG G G Gla locul de munca sau pro7esiei. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G+u capacitatea de autoser6ire si G"onitori are medico-psiho-socialaG G+((!N#&+#Gautoingri=ire conser6ate. Gla ser6iciul OR') de logopedie) G G G Gsi psihologie teritoriala. G G G G%pri=in 7amilial si e6entual G G G Gcomunitar pentru unele acti6itatiG G G G3de autogospodarire4. G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; -----------------;4 In principiu) a7ectarea 6ocii pentru anumite pro7esii si locuri de munca poate 7i hotaratoare) in timp ce) in altele) unde nu e:ista mesa= 6orbit) munca se poate des7asura normal. (+-. 2 *&N(#II'! %I%#!"&'&I (+RDIO>+%(&'+R) 8!"+#O'O,I() I"&NI#+R %I R!%-IR+#OR +. *&N(#II'! %I%#!"&'&I (+RDIO>+%(&'+R I. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR INI"II;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - !S, de repaus 9 G I( NTha I G I( NTha II G I( NTha III G I( NTha I> - #est de toleranta la DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA e7ort 3##!49 G- -ersoana este G- -ersoana este G- -ersoana pre inta G- -ersoana este - !cogra7ie bidimensiona- Gasimptomatica in Gasimptomatica in Gsimptome limitatoareGsimptomatica in la) ecogra7ie Doppler 9 Gtimpul acti6itatiiGconditii de Gde prestare a acti- Grepaus) apar semne

- (ateterism cardiac) Gu uale sau5si Grepaus) e7ectuea aG6itatii ilnice de Gde I(() gradul de angiogra7ie Gpro7esionale 9 Gacti6itati ilniceGintretinere) pre- Ga7ectare cardiaca - "onitori are tensiune G- #ulburari de Gu uale) dar nu G inta semne de I(( Gintre 01-100R) arteriala 3#+4 Gritm si conducere Gpoate 7ace Gcorectabile sub Gire6ersibila la - !:amen 7und de ochi 3*O4Gminore) in7luen- Ge7orturi 7i ice Gtratament 9 Gtratament 9 Gtate de tratamen- Gprelungite 9 G- (ardiostimulare G- #ulburari de ritm Gtul speci7ic. G- #ulburari de Ge7icienta cu tulbu- Gsi de conducere G Gritm sau5si de Grari 7unctionale la Ggra6e) nein7luenG Gconducere repeti- Ge7orturi mici) chiarGtate de tratament G Gti6e care necesitaGsi in repaus 9 G- (ardiostimulare G Gtratament sustinutG- +ritmii !% ce nu Gine7icienta. G Gcontinuu la care Gpot 7i controlate G G Gtoleranta de e7ortGprin tratament si G G Geste limitata de Ginduc tulburari G G Gaparitia tulbura- Ghemodinamice mani- G G Grilor 7unctionale G7este accentuate G G Gla e7orturi de Gin e7ort. G G Gintensitate mare G G G Gsau medie. G G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA ;%#; --------------;4 1. In a7ectarea primara a 7unctiei contractile a inimii$ - (ardiomiopatiile primare) primiti6e sau idiopatice$ - ("- dilatati6a sau congesti6e) - ("- hipertro7ica sau obstructi6e) - ("- restricti6a sau obliteranta. 2. In a7ectarea secundara a 7unctiei contractile a inimii$ - +ngiopatii congenitale cianogene sau necianogene operate sau neoperate cu insu7icienta cardiaca cronica clinic mani7estata$ - D%+) D%>) (oarctatie aorta %teno a de aorta) %teno a de artera pulmonara asociata cu D%>) - #etralogia *allot) transpo itii de 6ase mari) - +tre ia de tricuspida) anomalia !bstein. - >al6ulopatii$ de etiologie di6ersa) complicate sau decompensate neoperate sau operate 3prote ate4) contractate precoce. 3. In a7ectarea ritmului si conducerii cardiace$ - #ulburari de ritm si de conducere persistente si se6ere contractate precoce 3purtator de pacemaPer4. 2.(omplicatii post-transplant cardiac. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala G-articipare 7ara restrictii G G &%OR G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala GNu se pot adapta la e7ort 7i ic G G "!DI& Gcare nu necesita e7ort 7i ic mareGde intensitate mare si durata. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF

G8+NDI(+- G'imitarea capacitatii de adaptareG"asuri de adaptare a utila=elor G G+((!N#&+#Gla e7ort 7i ic 3pro7esional si Gpentru reducerea e7ortului 7i ic G G Gcasnic4 Gnecesar) e6itarea po itiei G G G G7ortate in munca) deplasarii G G G Gposturale pe distante mari pe G G G Gplan inclinat)urcarea de scari. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G'imitare ma=ora a capacitatii de G- Necesita asistent personal. G G ,R+> Gautoingri=ire si autogospodarire)G- Necesita ser6icii speciali ate.G G Gde mentinere a starii de sana- G G G Gtate) de comunicare si partici- G G G Gpare la 6iata de 7amilie. G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; II.!>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR +R#!R!'OR '!,+#! D! *'&U&' %+N,&IN a. (ON%#RI(#I+ %I5%+& O.%#R&(#I+ +R#!RI+'+ 3+R#!RIO-+#II O.'I#!R+N#! - #RO".+N,IO-+#II O.'I#!R+N#! - .O+'+ .&R,!R b. +N,IN!&RO-+#II -RI"+R! 3.O+'+ R+VN+&D4;4 c. 'I"*!D!"&' -RI"+R;;4 ;#; @AAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G-+R+"!#RII *&N(#ION+'I G- Oscilometria9 G G G- !cogra7ia intra6asculara9 G G G- !:amen Doppler9 G G G- R"N9 G G G- +ngiogra7ia cu substanta de contrast9 G G G- -letismogra7ia prin impedanta9 G G GN.. 1. !6aluare in 7unctie de gradul de ischemie peri-G G G7erica) modul de aparitie al claudicatiei intermitenteG G Gsi intensitatea tulburarilor ischemico-necrotice9 G G G 2. !6aluare dupa clasi7icarea 'eriche-*ontaine. G DAAAAAAAAAAAABAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G 8+NDI(+- G+rteriopatie obliteranta std. IIa si std. IIb cu G G &%O+R+ G &%OR Gclaudicatie intermitenta sau constrictia arteriala G G G Ge6aluata prin metode de laborator 3parametri G G G G7unctionali4. G DAAAAAAAAAAAAEAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G 8+NDI(+- G+rteriopatie obliteranta stadiul III cu claudicatie G G "!DI! G "!DI& Gintermitenta in repaus) dureri in decubit. G G G G+rteriopatie obliteranta stadiul I> cu amputatie gambaG G G Gunilateral prote ata. G G G G.R cu cri e 6aso-spastice 7rec6ente) cu dureri) G G G Gciano a degetelor mainii si pareste ii. G G G G'im7edemul primar cu de7ormarea unilaterala globala G G G Ga membrului in7erior. G DAAAAAAAAAAAAEAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G 8+NDI(+- G+rteriopatie obliteranta stadiul I> cu$ G

G+((!N#&+#+ G +((!N#&+#G +mputatii de membre unilaterale sau bilaterale greuG G G G prote abile sau neprote abile$ G G G G - +mputatie de coapsa 3bont mai mic de 6 cm.4 greu G G G G prote abila) de articulatie co:o-7emurala9 G G G G - +mputatie bilaterala a membrului pel6in de la G G G G ni6elul gambelor9 G G G G - +mputatie unilaterala asociata cu anchilo e si G G G G calusuri 6icioase contralateral. G G G G+rteriopatie obliteranta stadiul I> cu amputatie gambaG G G Gunilateral neprote ata) cu tulburari tro7ice cutanate G G G Gla membrul contralateral. G G G G+ngioneuropatiile primare 3..R.4 7orme a6ansate. G G G G'im7edemul primar bilateral cu de7ormare globala a G G G Gmembrului in7erior) cu tulburari de statica si mers. G DAAAAAAAAAAAAEAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G 8+NDI(+- G+rteriopatie obliteranta stadiul I> cu$ G G ,R+>+ G ,R+> G - +mputatie a ambelor coapse 3imposibilitatea G G G G reali arii ortostatismului 7ara car=e49 G G G G - 'ipsa prin de articulatie a unui membru pel6in) G G G G asociata cu anchilo a membrului pel6in opus9 G G G G - 'ipsa prin de articulatie a unui membru pel6in) G G G G asociata cu amputatie sau de articulatie G G G G de membru toracic9 G G G G - +mputatia membrului toracic unilaterala cu G G G G reducerea prehensiunii contralateral9 G G G G - +mputatie a ambelor membre toracice 3de la G G G G di7erite ni6eluri4 cu redori stranse ale G G G G articulatiilor cu imposibilitatea reali arii G G G G gestualitatii pro7esionale si u uale. G JAAAAAAAAAAAAKAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; ;4 - (aracteri ate prin spasm al arteriolelor de la ni6elul degetelor si) oca ional) al altor e:tremitati) prag sca ut pentru aplicatii reci sau orice cau a care acti6ea a simpaticul sau eliberarea de catecolamine9 - In 7ormele se6ere se pot 7orma trombo e ale articulatiilor mici care pot 7a6ori a aparitia de necro e cu amputatii 3pierderi tisulare4 la ni6elul 7alangelor degetelor) mai rar la police9 - +7ectea a mai ales se:ul 7eminin9 - -atogenia este incerta. ;;4 - (aracteri at prin acumularea e:cesi6a de lichid lim7atic si tume7ierea tesutului cutanat datorita obstructiei) distrugerii sau hiperpla iei 6aselor lim7atice9 - -oate sur6eni la nastere) adolescenta sau mai tar iu) pe parcursul 6ietii9 - "ai 7rec6enta la 7emei si de obicei unilateral9 - !dem di7u cu de7ormarea membrului in7erior sau superior in 7a ele inaintate) 7ara modi7icari cutanate sau semene de insu7cienta 6enoasa. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF G8+NDI(+- G+cti6itatile indicate si accesibile) ca si limitarile in 7unctie de G G &%OR Gintesitatea de7icientei 7unctionale precum si restrictiile si G DAAAAAAAAAFser6iciile necesare pentru participare sunt pre entate la (ap 7) G

G8+NDI(+- Gsubcap. III - !6aluarea gradului de handicap in a7ectarea 7unctiilorG G "!DI& Gmotorii)a staticii si mobilitatii - locomotiei) sau5si gestualitatiiG DAAAAAAAAAF G G8+NDI(+- G G G+((!N#&+#G G DAAAAAAAAAF G G8+NDI(+- G G G ,R+> G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; .. *&N(#II'! %I%#!"&'&I 8!"+#O'O,I( De retinut$ - In a7ectiunile care e6oluea a in pusee) e6aluarea se 6a 7ace in perioadele de remisiune) luandu-se in considerare insa) ca element important) 7rec6enta si durata episoadelor acute 3con7irmate prin documente medicale4. - %e 6a tine seama de posibilitatea tratamentului) durata acestuia) e7ectele produse si persistenta lor in timp. - !6aluarea 7unctionala se 7ace la 6 - 12 luni. - In situatia aplicarii tratamentului citostatic) imuno-supresor si radioterapeutic) in e6aluare se 6or a6ea in 6edere atat e7ectele ne7a6orabile ale acestora cat si tulburarile 7unctionale determinate de a7ectiunea hematologica propriu- isa. - In ca de transplant de madu6a osoasa) e6aluarea se 6a 7ace la 6 luni de la reali area transplantului. I. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +NO"+'II +'! (!'&'!'OR 8!"+#O-O!#I(! 3*&N(#II'OR D! -ROD&(!R! + %+N,!'&I %I +'! "+D&>!I O%O+%!4; 1. 'eucemii acute;; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - hemoleucograma GIn remisiunile GIn remisiunile G-+7ectiune GIn 7ormele completa Gdurabile de 2-1 Gdurabile sub 2-1 Ge6oluti6a cu Gaccentuate care -7rotiu de sange peri7ericGani) sub re er6a Gani Gcomplicatii si Gdetermina - mielograma G6eri7icarilor G Graspuns Gimobili area si - acid uric G7unctionale) G Gnesatis7acator la Gpierderea - creatinina Ganual G Gtratament. Gcapacitatii de - computer tomogra7 G G G-Recadere dupa Gautoser6ire) prin - lichid ce7alorahidian G G G3-2 ani 3recadere Gcomplicatii 3'(R4 G G Gre istenta la Ggra6e) - transamina e G G Gtratament4. Gire6ersibile AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#;

; 1. 'eucemii acute 2. 'eucemia granulocitara cronica 3. 'eucemia lim7oida cronica 2. -olicitemia 6era 3.oala >aWue 4 1. #rombocitemia hemoragica 6. "ielo7ibro a cu metapla ie medulara 7. %indromul mielo-displa ic 0. +nemiile aplastice ;; a. -roli7erare maligna a celulelor hematopoetice) caracteri ata prin oprirea lor in di7erentiere si maturatie) asociata sau nu cu trecerea celulelor blastice in sangele peri7eric. (aracterul esential 3ma=or4 de diagnostic Q pre enta de celule blastice peste 30R din totalul celulelor medulare la punctie sau biopsie osoasa. b. Intensitatea de7icientei 7unctionale este determinata de caracterul malign al bolii) de anemia insotitoare) de hemoragii) de in7ectii) precum si de alte complicatii ca$ meningita leucemica) in7iltrate craniene) pulmonare sau ne7ropatia urica. 2. 'eucemia granulocitara cronica; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - clinic$ GIn 7ormele usoare GIn 7ormele cu GIn 7a e accentuate GIn 7a a blastica - splenomegalie9 Gcu remisiuni de Ge6olutie lenta) Gsi de G37inala4 - ca in - hepatomegalie Glunga durata) Gcu remisiuni Gmetamor7o are Gleucemiile acute 3usoara49 Gclinice si Gtrecatoare dar Gblastica cu G - dureri osoase. Gcitologice. Grepetate) cu Gcomplicatii se6ere) G - paraclinic$ G Gcomplicatii Gleucocito a care nu G - hemoleucograma$ G Gmoderate Graspunde la G leucocito a marcata cu G G3litia a renala4 Gtratament G de6iere la stanga G G G G - anemie in grad G G G G 6ariabil9 G G G G - mielograma$ madu6a G G G G hiperpla ica) G G G G predominand G G G G granulocitara9 G G G G - acid uric) creatinina9 G G G G - ecogra7ie renala G G G G 3abdominala4 G G G G - e:amen citogenetic. G G G G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#;

; a. +7ectiune neopla ica hematologica din grupa bolilor mieloproli7erati6e cronice) caracteri ata prin cresterea e:cesi6a a granulocitelor9 b. +re o e6olutie medie de 2 ani) dar supra6ietuirea poate atinge 11-20 de ani9 c. Remisiunile in 7a a cronica produse de tratament) au durate de luni si ani9 d. De7icienta este determinata de caracterul malign) de complicatii 3hipersplenism) splina tumorala cu 7enomene de compresiune abdominala) in7arcte splenice) hemoragii) in7ectii s.a.4 3. 'eucemia lim7atica cronica; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAEAAAAA AAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA - clinic$ GIn stadiul 0 sau I) candGIn stadiul II) cand GIn leucemia lim7atica - transpiratii nocturne) Gapar adenopatii) Gapare hepatomegalia Gcronica stadiul III si - astenie 7i ica) Ge6olutie stationara pe Gsau5si splenomegalia cu GI> cu anemie I11gr R - scadere ponderala) Gtimp indelungat) raspunsGremisiuni de G8b) hematocrit sub 33R) - adenopatii) G7a6orabil la tratament. Gminimum 3 ani sub Gtrombocitopenie 3sub - hepato-splenomegalie. G Gtratament. G100.000 mmc4) cu - paraclinic$ G G Graspuns terapeutic slab - hemoleucograma$ G G Gsi prognostic lim7ocito a X 30.000 mmc G G Gne7a6orabil. - mielograma$ in7iltratii G G G lim7ocitare in madu6a osoasaG G G ce depasesc 30R 3criteriu G G G ma=or4) G G G - electro7ore a proteine si G G G test (oombs. G G G AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAKAAAAA AAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; ; !ste o a7ectiune primara a tesutului lim7atic in care se produce acumularea si proli7erarea unei clone maligne de lim7ocite blocate in maturatie. 2. -olicitemia 6era 3.oala >aWue 4; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+>

AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - clinic$ GIn 7a a GIn 7a a GIn 7a a policitemicaGIn metapla ia - splenomegalie9 Gpolicitemica in Gpolicitemica 7ara Gcu sechele Gmieloida - hepatomegalie9 Gremisiune clinica Gremisiune) cu Gpersistente prin Gpostpolicitemica si - 8#+ Gsi citologica) cu Gcomplicatii Gcomplicatii Gde leucemie acuta - e:amen G8# intre 20-21R) Gmoderate 38#+) Gtrombotice Gcu complicatii neurologic Gtrombocite sub Ghemoragice sau G3neurologice) Gse6ere neurologice - paraclinic$ G200.000 mmc Gtrombo e Gcardiace) hepatice4 Gsau cardiace) care - hemograma G Greduse4) cu 8# de Gsau in 7a a de Gimpiedica completa$ G G10R) cu Gmetapla ie) Gautoser6irea. - nr. hematii G Gsplenomegalie Gpostpolicitemica) cuG - 8b gr. R G Gmoderata) cu Gsplenomegalie G - nr. leucocite G Gsaturatie de 8bO32Gtumorala) 7ibro a G - nr. trombocite G Gnormala) cu Gmedulara e:tinsa) G - 8# G Gtrombocito a Gtablou sang6in cu G - mielograma G Gpeste 200.000 Gleucoeritroblasti) G sau5si G Gmmc si Gmasa eritrocitara G - punctie osoasa G Gleucocito a peste Gnormala sau G - teste de coagulare G G12.000 mmc5 Gsca uta. G - ecogra7ie G G G G cardiaca G G G G - saturatia cu O324 a G G G G 8b din sangele G G G G arterial3daca este G G G G ca ul4 G G G G - eritropoietina G G G G serica sau urinara G G G G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; ; !ste o a7ectiune hematologica 3din cadrul bolilor mieloproli7erati6e4 caracteri ata prin proli7erarea e:cesi6a a celulelor din seria rosie !6oluea a in trei 7a e - 7a a policitemica in care sunt posibile remisiuni clinice si citologice pana la 20 ani) - 7a a de metapla ie mieloida postpolicitemica) - 7a a de leucemie acuta postpolicitemica. 1. #rombocitemie hemoragica esentiala sau primara; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAEAAAAA AAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA - nr. trombocite Q crescute GIn 7a e de remisiune GIn 7ormele cu GIn 7ormele cu mai mult de 600.0005mmc) Gclinica si hematologica Gcomplicatii Gcomplicatii trombotice 7ara o cau a identi7icabila Gcu trombocite de Gtrombotice si5sau Gsi5sau hemoragice

3in7ectie) neoplasm sau G200.000 mmc. Ghemoragice remise si Gse6ere) cu sechele hematologice49 G Gcu remisiune citologica Gpersistente) cu - mielograma Q hipercelularaG G3trombocite 200.000 Gtrombocito a peste cu hiperpla ie G Gmmc4 cu G600.000 mmc) megacariocitara9 G Gsplenomegalie Gre istente la tratament. - masa eritrocitara normala G Gmoderata. G 3sub 36 ml5Pg corp la . si G G G sub 32 ml5Pg corp la *49 G G G - absenta 7ibro ei e:tinse aG G G madu6ei9 G G G - splenomegalie) in e6olutieG G G atro7ie splenica9 G G G - agragate trombocitare. G G G AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAKAAAAA AAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; ; a. !ste o anomalie hematologica 3din bolile mieloproli7erati6e cronice4 caracteri ata prin proli7erare megacariocitelor) ceea ce conduce la cresterea numarului de trombocite in sange. b. Diagnosticul se pune pe$ - trombocite X600.0005mmc - masa eritrocitara normala) ba o7ilie pre enta - splenomegalie %e pot obtine) prin tratament) remisiuni pe durate 6ariabile. 6. "ielo7ibro a cu metapla ie mieloida; ;#; ;*ont /; AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAA AAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ "!DI! G D!*I(I!N#+ -+R+"!#RI G G +((!N#&+#+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAA G 8+NDI(+- "!DI& G 8+NDI(+G G +((!N#&+# AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAA AAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAA - splenomegalie moderata sau giganta9 GIn 7a e proli7erati6e 7araGIn 7a a de - hemograma 38b sca uta) 8t sca ut) Gcomplicatii. Ginsu7icienta medulara reticulocito a) nr. leucocite normal sau G Gcu pancitopemie) sca ut) 7ormula leucocitara de6iata la G Gcu sindrom anemic) stanga si ba o7ilie4 7rotiu sangehematii G Ghemoragic si Yin picaturaZ9 G Gin7ectios. - mielograma 3biopsie medulara din G G creasta iliaca$ tablou leucoeritroblastic G G si mielo7ibro a49 G G - In 7a ele a6ansate Q insu7icienta G G medulara Q pancitopenie cu$ G G - %indrom anemic G G - %indrom in7ectios G G - %indrom hemoragic. G G - +cid uric9 G G - (reatinina9 G G - %ideremie G G

AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAA AAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAA ;%#; ; a. !ste o a7ectiune neopla ica) hematologica din grupa bolilor mieloproli7erati6e cronice) caracter ata prin$ - 8iperproductie de celule hematopetice9 - 8ipeproductie de celule stromale 37ibroblasti4. b. %upra6ietuirea este) in medie) de 1-7 ani) cu limite intre 1-20 ani. 7. %indromul mielo-displa ic; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+5,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+#5,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAEAAAAA AAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA - +nemie cu semne de GIn remisiuni complete) GIn remisiuni partiale) G- In anemie re7ractara hipo:ie anemica si cu Gclinice si citologice) Gde durata medie) cu Gsimpla sau cu e:ces de modi7icari mor7ologice Gin anemii simple) Gre ultate 7a6orabile Gblasti) cu 8b sub 0 cu macrocito a) Gre7ractare. Gla tratament) in Ggr5dl) cu tratament poichilocito a) siderocite G Ganemiile re7ractare) Gine7icient9 in sangele peri7eric9 G Gin leucemia G- In anemii cu e:ces de - "egaloblasto a) G Gmielomonocitara Gblasti in trans7ormare sideroblasti patologici G Gcronica) in 7a e Gcare preced leucemia multinucleati in madu6a G Gcronice 7ara Gacuta9 osoasa. G Gcomplicatii. G- In leucemia - "ielograma cu coloratii G G Gmielomonocitara cronica speciale. G G Gin perioada de acuti are G G Ga a7ectiunii. AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAKAAAAA AAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; ; a. !ste 7orma de insu7icienta medulara datorata imposibilitatii maturarii celulare din seriile mieloide9 b. %unt incluse stari preleucemice cu anemie re7ractara simpla sau cu sideroblasti inelari sau cu e:ces de blasti si leucemia cronica mielomonocitara9 c. Durata de 6iata 1-3 ani. 0. +nemiile aplastice; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+5,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+#5,R+>

AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAEAAAAA AAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA - 8emograma GIn 7orme usoare GIn 7ormele medii) G- In 7orme cronice care completa Gsau remisiuni totale G7ara tendinte Gnecesita trans7u ii - 8ematocrit 38#4 Gale acestora. Ge6oluti6e) 7ara Grepetate) cu hemosidero a - 8emoglobina 38b4 G Gcomplicatii sau in Gciro a hepatica si cu - Numar trombocite G G7a ele de Gdiabet aharat9 - "ielograma sau G Gremisiune partiala. G- In 7ormele se6ere cu punctie osoasa) G G Gcomplicatii gra6e9 biopsie G G G- In 7orme ce necesita - %ideremie G G Gtrans7u ii repetate) - ,licemie G G Gatat in perioade acute - -robe de insu7icienta G G Gcat si 2 ani dupa hepatica G G Gobtinerea unei remisiuni. AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAKAAAAA AAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; ; a. (aracteri ate prin citopenie peri7erica si medulara cu hipo sau acelularitate. b. -ot a6ea aspect de$ - +nemie eritroida pura 3eritroblastopenie4 cu reticulocite I1R - +pla ie granulocitara 3agranulocito a4 in care granulocitele sunt I1005ml - +pla ie megacariocitara in care trombocitele sunt sub 20.0005ml c. (omplicatii$ in7ectii) hemoragii) mielodispla ie) leucemie acuta in 7a ele tardi6e d. Remisiunile sunt rare) dar pot 7i partiale sau totale. e. In 7ormele se6ere mortalitate este X 00R) din care peste 10R mor in primul an de e6olutie II. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ (+-+(I#+#II %+N,!'&I D! + #R+N%-OR#+ OUI,!N ;#; ;*ont /; AAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAA AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAA G G G G +N!"I! *!RI-RI>+; G +N!"I! G +N!"II G G "!,+'O.'+%#I(+;; G 8!"O'I#I(!;;; AAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAA AAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAA G- 8b O 8# sca ute9 G- 8b O 8# sca ute9 G(linic$ G- (8!" I30R9 G- #rombo-leucopenie9 G- -aloare9 G- >!" I00 microni9 G- %cad reticulocitele9 G- %ubicter con=uncti6al -+R+"!#RI G- %ideremie I10 micrograme G- In 7rotiu macrocite9 G sau5si tegumentar9 *&N(#ION+'IG la 100ml9 G- "ielograma$ modi7icari deG- %plenomegalie cu57ara G- "ielograma$ absenta G tip megaloblastic pe toateG hepatomegalie. Ghemosiderinei medulare si G seriile. G-araclinic$ Ga sideroblastilor. G+lte semne$ G- 8b O 8# sca ute9 G- In6estigatii pentru G- ,losita 8unter) G- Reticulocite crescute Gdeterminarea cau ei G- "ani7estari neurologice) G-"ielograma arata hiper G G- +naclorhidrie histamino- G-pla ie eritroblastica G G re istenta) Gcu in6ersarea G G- ,astrita atro7ica) Graportului ,5!9 G G- #est %chilling cu 6alori G-.ilirubinemie crescuta G G sca ute 3normal 0-21R4) Gin special indirecta9 G G- >itamina .3124 in G- &robilinogen pre ent9 G G sange I 100mg R. G- #este de hemoli a

G G- +cid 7olic-do are G AAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAA AAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAA ;%#; De retinut$ a. +nemiile repre inta bolile sistemului eritocitar determinate de scaderea hemoglobinei si5sau a masei eritrocitare totale care) prin scaderea capacitatii de transport a O324 de catre sange) determina di7erite grade de hipo:ie tisulara sau celulara. b. Daca se ia ca parametru 6aloarea hemoglobinei) se considera$ - >alori normale Q 12 g5dl 3[24 la barbati9 13 g5dl 3[24 la 7emei 36alorile 6aria a in 7unctie de 6arsta4 - +nemie usoara la 8b intre 10-12 g5dl9 - +nemie medie la 8b intre 0-10 g5dl9 - +nemie se6era la 8b sub 0 g5dl. c. In aprecierea de7icientei 7unctionale se tine seama de$ - %e6eritatea anemiei9 - Necesitatea trans7u iilor repetate9 - Raspunsul la tratament si caracteristicile bolii primare care a generat anemia. ;#; ;*ont /; AAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAA AAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G &%O+R+ G "!DI! G +((!N#&+#+5,R+>+ DAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAA AAAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+#5,R+> AAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAA AAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA G*orme usoare cu 8b intre G*orme moderate cu 8b G- +nemie se6era cu 8b sub G10-12 grR) cu raspuns Gintre 0-10 grR cu raspunsG 0 grR9 +N!"II Gimediat si persistent la G7a6orabil la tratament) G- *orme cu complicatii) Gtratament corespun ator. G7ara complicatii. G trombo e) hemoragii G G Grepetate) mielodispla ie9 G G G- *orme care necesita G G Gtrans7u ii 7rec6ente. AAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAA AAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; ; !ste o anemie hipocroma microcitara in care tulburarea de ba a o repre inta scaderea cantitatii de 7ier din hematii. ;; !ste o anemie datorata tulburarii di6i iunii celulare prin scaderea sinte ei +DN urmare unui de7icit de 6itamina .31245de acid 7olic. ;;; a. %e produc prin li a e:cesi6a a eritrocitelor9 b. Durata de 6iata a eritrocitelor scade la 00-/0 ile in hemoli e usoare) pana la 1-10 ile in hemoli e se6ere9 c. *orme de anemie hemolitica$ - s7erocito a ereditara) - eliptocito a ereditara) - hemoglobinuria paro:istica nocturna) - hemoglobinopatii 3tala emia ma=ora si minora4) - en imopatii)

- autoimune) - methemoglobinopatii. III. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ %I%#!"&'&I 'I"*OID; 1. .oala 8odgPin;; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA (linic$ G*ormele in GIn 7ormele cu G-*ormele in e6olutieGIn 7ormele - adenopatii peri7erice Gremisiune Gremisiune Gin perioadele de Gdiseminate cu si5sau po7unde9 Gcompleta. Gincompleta. Gacuti are 3cel putinGcase:ie - hepatosplenomegalie9 G G G6 luni de la Gneopla ica care - 7ebra9 G G Ginitierea tratamen- Gimpiedica - prurit9 G G Gtului 7a ei acute49 Gautoser6irea) - scadere ponderala9 G G G- In 7ormele cu Gautoingri=irea si -araclinic$ G G Gcomplicatii Gautogospodarirea. - biopsie ganglionara G G G6iscerale. G 3criteriu ma=or49 G G G G - electro7ore aG G G G imunelectro7ore a9 G G G G - hemoleucograma9 numar G G G G de trombocite9 G G G G - >%89 G G G G - *ibrinogenemie. G G G G - (# pentru stadiali are. G G G G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; N... !6olutia cuprinde 2 stadii$ - %tadiul I 31!4 Q a7ectarea unei singure grupe ganglionare sau a unui organ 6isceral prin contiguitate9 - %tadiul II 32!4 Q a7ectarea a doua grupe ganglionare de aceeasi parte a dia7ragmului cu57ara a7ectarea unui organ 6isceral prin contiguitate9 - %tadiul III 33!4 Q a7ectarea de grupe ganglionare supra si subdia7ragmatice9 - %tadiul I> 32!4 Q determinari 6iscerale 3e:amen$ madu6a osoasa) 7icat etc.4 produse prin diseminare hematogena. ; %e re7era la$ 1. .. 8odgPin 2. 'im7oame NonhodgPiniene 3. "ielomul multiplu 2. ..\aldenstrom 3macroglobulinemia4

;; a. !ste determinata de proli7erarea maligna a unei clone celulare) probabil din seria lim7oida cu 7orme de celule gigante tip %#!N.!R, R!!D) paralele cu de 6oltarea unei reactii celulare polimor7e granulomatoase. b. -ost terapeutic pot apare remisiuni de lunga durata) care pot 7i complete 3disparitia ganglionilor si a semnelor biologice4 sau incomplete 3disparitia sau reducerea adenopatiilor cu >%8 si 7ibrinogen crescute4. 2. 'im7oame NonhodgPiniene 3'N84; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA (linic$ GIn 7ormele cu GIn remisiuni G- In 7ormele cu GIn 7ormele cu - *ebra9 Gcelule mici) cu Gincomplete si Gremisiuni Gin6a ie - -ierdere ponderala9 Gremisiune de Gde durate mai Gincomplete) de Gmedulara) - +denopatii 370R din Gdurata crescuta. Gscurte) mai ales Gscurta durata9 Ghepatica) sistem ca uri49 G Gin 7omele cu G- (ele rapid e6olu- Gner6os central - %plenomegalie 330R din G Gmalignitate Gti6e 3in special Gcare impiedica ca uri49 G Gmedie. G'N8 cu malignitate Gautoser6irea) - 8epatomegalie 330-10R G G Gmare49 Gautoingri=irea si din ca uri4. G G G- In determinarile Gautogospodarirea. -araclinic$ G G G6iscerale. G - !:amen histologic G G G G 3criteriu ma=or4$ G G G G - 'N8 cu lim7ocite G G G G mici cu e6olutie G G G G lenta de cati6a ani) G G G G - 'N8 cu malignitate G G G G medie) G G G G - 'N8 cu malignitate G G G G mare) cu prognostic G G G G sumbru. G G G G - >%89 G G G G - *ibrinogenemie9 G G G G - !lectro7ore aG G G G imunoelectro7ore a9 G G G G - 8emoleucograma9 G G G G - Numar trombocite9 G G G G - !:amen neurologic9 G G G G - R"N9 G G G G - (omputer tomogra79 G G G G - !cogra7ie hepatica. G G G G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; ; +nomalie neopla ica cu proli7erarea unei clone maligne de celule apartinand sistemului imunitar. *ace parte din sindromul lim7oproli7erati6 cronic.

!6olutie in patru stadii 36e i .. 8odgPin4. 3. "ielomul multiplu; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA (riterii ma=ore$ GIn stadiul I) GIn stadiul II) GIn stadiul III) cu GIn 7ormele cu - -lasmocito a tisulara9 Gin remisiune) Gcu 7racturi Gcomplicatii Gsindrom de - -lasmocito a medulara Gdupa tratament. Gconsolidate Gosoase) renale) Gcompresiune peste 30R9 G Gcorect) cu anemieGin7ectioase etc. Gmedulara sau - (omponenta " 3Ig,X3)1 G Gusoara) cu G Gparali ii sau grR) G Ga7ectare renala G Ginsu7icienta Ig+X2grR) eliminare de G Gincipienta. G Grenala gra6a) proteina G G G Gceea ce conduce .ence ]ons 3.]4X2gr522h4. G G G Gla pierderea (riterii minore$ G G G Gcapacitatii de - -lasmocito a medulara G G G Gautoser6ire) a intre 10-30R9 G G G Gcapacitatii de - (omponenta " cu 6alori G G G Gautoingri=ire si a mai sca ute decat in G G G Gcapacitatii de criteriile ma=ore9 G G G Gautogospodarire. - 'e iuni osoase9 G G G G - %caderea imunoG G G G globulinelor normale. G G G G - 8emoleucograma)calcemie)G G G G creatinina) ac uric. G G G G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; N. In remisiuni$ - scade componenta monoclonala cu 10-71R si eliminarea proteinei .] in urina cu /0R) - se stabili ea a le iunile osoase si - se normali ea a calciul seric. !6olutie stadiala 3trei stadii4$ I. 8bX12grR a. (a seric normal b. 'e iuni osoase absente c. Ig, sub 1grR) Ig+ sub 3grR d. -roteina .] in urina sub 2gr522h II. Intermediar intre I-III III. 8bI0grR (a seric peste 12mgR (omplicatii speci7ice

; a. -rodusa de proli7erarea maligna a celulelor plasmocitare) caracteri ata prin le iuni osoase) tulburari in metabolismul imunoglobulinelor) insu7icienta medulara si insu7icienta renala. b. *racturi patologice) sindrom de compresiune medulara) insu7icienta renala) in7ectii) sindrom hemoragipar) sindrom de hipercalcemie) sindrom de hiper6asco itate. c. Durata medie de 6iata in 7ormele netratate este de peste 7 luni) la cei tratati) peste 30 de luni. 2. .oala \aldenstrom 3macroglobulinemia4; ;#; ;*ont /; AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAA AAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ "!DI! G D!*I(I!N#+ -+R+"!#RI G G +((!N#&+#+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAA G 8+NDI(+- "!DI& G 8+NDI(+G G +((!N#&+# AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAA AAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAA (linic$ G-In perioada de remisiune9G- In 7orme a6ansate cu -+denopatii9 G- In 7orme cu anemie Gsindrom hemoragic ce - 8epatosplenomegalie9 G moderata9 Gduce la anemii - *enomene hemoragipare cutaneomucoase9 G- In 7ormele cu determi- Gpronuntate9 - %indrom de hiper6asco itate sanguina9 G nari 6iscerale reduse. G- In 7orme complicate - #ulburari de memorie si orientare9 G Gcu insu7icienta - %omnolenta. G Gcardiaca sau -araclinic$ G Ginsu7icienta renala. - +nemie cu pre enta de rulouri de G G hematii pe 7rotiu9 G G - (restere mare a proteinemieiG G !lectro7ore a proteine G G - (reste >%89 G G - (resterea Ig" si a 6asco itatii serice9 G G - #este psihologice 3cogniti6e49 G G - &ree) creatinina) acid uric. G G - "edulograma9 G G - -.O G G AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAA AAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAA ;%#; ; a. !ste produsa prin proli7erarea maligna a seriei lim7o-plasmocitare si se e:prima prin hiperpla ia organelor lim7oide) cresterea monoclonala de Ig" si 7enomene de hiper6asco itate sang6ina9 b. +pare de obicei la 6arstnici9 c. Durata supra6ietuirii este 6ariabila. I>. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR D! (O+,&'+R!; 1. -urpura trombocitopenica idiopatica 3-#I4;; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+

*&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA (linic$ G*orme in G*orme in GIn 7ormele se6ere cuGIn 7ormele -%angerari cutaneomucoase9Gremisiuni cu Gremisiune Gtrombocite sub Gse6ere cu - +bsenta splenomegaliei. Gtrombocite mai Gincompleta cu G10.0005mmc) cu Gsangerari in -araclinic$ Gmult de Gtrombocite intre Gsangerari la traume G%N() cu de7icit - Numar trombocite in G110.0005mmc. G70.000Gminime sau spontan. Gmotor de tip sangele peri7eric$ G G110.0005mmc. G Gparetic sau plegic. trombocitopenie cu G G G G numar mai mare de G G G G megacariocite9 G G G G - "ielograma 3punctie G G G G osoasa4$ megacariocite G G G G normale sau crescute in G G G G madu6a osoasa9 G G G G -Determinare de anticorpi G G G G antitrombocitari9 G G G G - #este de coagulare- G G G G sangerare. G G G G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; De retinut$ a. la un numar de trombocite mai mare de 100.0005mmc nu apar sangerari) b. intre 30.000-10.0005mmc apar sangerari la traume minime) c. trombocite sub 30.0005mmc -apar sangerari cutaneo-mucoase) d. trombocite sub 10.0005mmc -se constituie sindromul hemoragic generali at cu risc crescut de hemoragii in %N(. ; %e re7era la$ 14 -urpura trombocitopenica idiopatica 3-#I4 24 %indroame hemoragice prin de7icit de 7actori plasmatici ai coagularii 8emo7ilia + si . 34 +lte sindroame hemoragice prin de7icit de 7actori plasmatici ai coagularii 24 .. >on \illebrand 14 #rombo7ilii ereditare 3primare4 ;; a. !ste un sindrom hemoragic produs prin trombocitopenie imuna datorata anticorpilor antitrombocitari) ceea ce produce distrugerea prematura a trombocitelor in sistemul macro7agic. b. Durata de 6iata) in ma=oritatea ca urilor) este normala) mortalitatea 7iind mai mica de 10R. 2. %indroame hemoragice prin de7icit de 7actori plasmatici ai coagularii 8emo7ilia + si . prin de7icit de 7actor >III si IU ai coagularii + 7ost tratata la (ap. 7 - !6aluarea a7ectarii 7unctiilor de statica) locomotie sau5si gestualitate - prin care de6in handicapante 3. +lte sindroame hemoragice prin de7icit de 7actorii plasmatici ai coagularii ;#;

;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ %INDRO+"! G &%O+R+ G "!DI! G +((!N#&+#+5,R+>+ 8!"OR+,I(! DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+#5,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAEAAAAA AAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA - De7icit de 7actor I 3hipo GIn 7ormele 7ara GIn 7ormele medii GIn situatia hemoragiilor sau a7ibrogenemia4 si Gcomplicatii G7ara limitarea Gintracraniene) in raport de7icit de 7actor II Ghemoragice. Gortostatismului) Gde intensitatea si 3hipoprotrombinemie4) au G Glocomotiei sau5si Gsechelele motorii de tip de obicei o e6olutie G Ggestualitatii. Gparetic sau plegic. benigna9 G G G - %indrom O^ren G G G 3hipoproaccelerinemie4 G G G in general benign9 G G G - -arahemo7ilie +le:ander G G G cu hemoragii articulare G G G mici) putin importante9 G G G -De7icit de 7actor UIII) in G G G general benign dar pot G G G apare hemoragii G G G intracraniene. G G G AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAKAAAAA AAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; 2. .oala >on \illebrand 3.6\4; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAEAAAAA AAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA - #% alungit9 GIn ca uri GIn 7ormele in care GIn 7ormele cu hemoragii - %caderea ni6elului Gasimptomatice cu Gepisoadele Gse6ere ce sur6in dupa 7actorului >III ( si a Gmodi7icari Ghemoragice sur6in Gtraumatisme minore) in 7actorului 6\3+g49 Ghematologice de mica Grelati6 7rec6ent dar Ghemartro e sau - De7icienta agregarii Gintensitate sau in Graspund 7a6orabil Ghematoame pro7unde) plachetare. Gsituatia unor Gla tratament. Gcare necesita tratamente (linic$ Ge6enimente G Gsubstituti6e prelungite. - e6enimente hemoragice Ghemoragice mucocutanate G G di6erse cutaneo-mucoase) Gce sur6in rar G G

in 7orme usoare ale bolii9 Gsi raspund prompt la G G - hemartro e sau hematoame Gtratament. G G pro7unde) in 7ormele se6ere9G G G - hemoragii se6ere dupa G G G traumatisme ) inter6entii G G G chirurgicale sau e:tractii G G G dentare. G G G G G G N.. Intensitatea mani7esta- G G G rilor hemoragice poate G G G scadea cu 6arsta sau in G G G cursul sarcinii. G G G %unt si ca uri asimptomaticeG G G De7icienta 7unctionala este G G G determinata de$ G G G - *rec6enta si gra6itatea G G G mani7estarilor hemoragice) G G G - %echelele pe care le G G G produc) G G G - Raspunsul la tratament. G G G AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAKAAAAA AAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; ; a. !ste o de7icienta ereditara a 7actorului 6\ cu transmitere de tip autosomal si e:presie 7enotipica 6ariabila chiar si intre membrii aceleasi 7amilii. b. *actorul 6\ asigura ade iunea plachetelor la colagenul subendotelial de golit) transportul si stabilitatea in plasma a 7actorului >III al coagularii 3>III (4. c. #ratamentul se instituie odata cu instalarea accidentelor hemoragice sau) pro7ilactic) in ca ul unor e:plorari in6a i6e) de e:tractii dentare sau inter6entii chiurgicale. d. 8emoragiile pot 7i stopate prin tratament medicamentos. In cele se6ere se recurge la substitutie 3plasma proaspata congelata) crioprecipitate concentrate de * >III ( si *6\4. 1. #rombo7ilii ereditare 3primare4; #rombo e unice sau recurente 36enoase sau5si arteriale4 sau predispo itii pentru accidente trombotice generate de o stare latenta si permanenta de hipercuagulabilitate plasmatica de cau a ereditara. "utatiile genetice implica$ - +nomalii ale unor 7actori de coagulare 3mutatia genei protrombinei si a genei 7actorului > si re istenta la proteina ( acti6ata4) - De7icienta inhibitorilor naturali ai coagularii 3proteina () proteina %) anitrombina III s.a.4) - +nomalii ale li ei cheagului 3dis7ibrinogenemia) de7icienta plasmogenului si a inhibitorului sau4) - 8iperhomocisteinemia. %tudii populationale au e6identiat 7rec6enta ridicata a anomaliilor protrombinei) a 7actorilor >) a hiperhormocisteinemiei si a inhibitorilor proteinei () proteinei % si a antitrombinei III. #ransmiterea este de tip autosomal. +ccidentele trombotice pot sa apara din mica copilarie sau la adultii tineri. %unt mai 7rec6ente la hemo igoti sau la dublu hetero igoti. -ot a7ecta preponderent teritorii 6enoase pro7unde 3ca6a in7erioara) me enterica) cerebrale) renale) hepatice4. *actori predispo anti pentru precipitarea accidentelor 6asculare sunt$ sarcina) lau ia) contracepti6ele orale) traumatismele sau mane6rele chirurgicale laborioase. Dupa diagnostic) pacientii trebuie anticoagulati toata 6iata. ;#; ;*ont 0;

AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA D!*I(I!N#+ "!DI! G D!*I(I!N#+ +((!N#&+#+ G D!*I(I!N#+ ,R+>+ AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA 8+NDI(+- "!DI& G 8+NDI(+- +((!N#&+# G 8+NDI(+- ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA In 7ormele cu trombo e de GIn 7ormele cu accidente GIn 7ormele cu accidente trombotice intensitate redusa) unice sau Gtrombotice repetate) in care se Gcu sechele durabile) in special recurente) care nu lasa sechele Gimplica teritorii 6enoase Gcerebrale care impiedica durabile. Gpro7unde) in 7ormele cu necro a Gautoser6irea) autoingri=irea si Gcutanata Gautogospodarirea. AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; ; De7icienta 7unctionala este determinata de$ - 7rec6enta si intensitatea accidentului trombotic) - teritoriile 6enoase a7ectate) - mani7estarile clinice speci7ice) - tratamentul anticoagulant de 7ond ce predispune la e6enimente hemoragice) - sechelele induse de accidentele trombotice. >. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- '+ -!R%O+N!'! (& #R+N%-'+N# "!D&'+R 3%tatus post transplant - auto sau allo transplant4 ;#; @AAAAAAAAAAABAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC GD!*I(I!N#+ G 8+NDI(+- G'a 7ormele 7ara complicatii 3apreciate de medicul G G "!DI! G "!DI& Gcurant4. G G G G G G G G G DAAAAAAAAAAAEAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G 8+NDI(+- G%tatus post auto sau allo transplant de celule %tem G G+((!N#&+#+ G+((!N#&+# Ghematopoetice in care hematopoe a post transplant este G G G Gcu de7icit 3gre7are cu de7icit4. %e e6identia a$ G G G G - #rombocitopenie 3usoara-moderata4) G G G G - 'eucopenie 3usoara-moderata4) G G G G - +nemie 3usoara-moderata4 - care nu necesita G G G G tratament substituti6 in conditii ba ale prin G G G G hipopla ie medulara datorata unei gre7e insu7iciente G G G Gin ceea ce pri6este cantitatea de celule %tem continuteG DAAAAAAAAAAAEAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G 8+NDI(+- G%tatus post auto sau allo transplant de celule %tem G G ,R+>+ G ,R+> Ghematopetice in care e:ista complicatii legate de G G G Gregimul de conditionare$ G G G G- cataracta secundara corticoterapiei si5sau iradierii G G G Gcorporale totale9 G G G G- complicatii neurologice tardi6e) secundare iradierii G G G Gcraniene) chimioterapiei sau neuroto:icitatii unor G G G Gmedicamente9 G G G G- dis7unctii pulmonare) cardiace) hepatice si5sau G

G G Grenale) considerate a 7i secundare procedurii G G G G3tratament si5sau regimului de conditionare49 G G G G- boala maligna a carei aparitie poate 7i legata de G G G Gprocedura de transplantare 3iradiere corporala totala) G G G Gde7icienta imuna secundara transplantului) in7ectiilor)G G G Gmedicatiei imunosupresoare49 G G G G- e:istenta bolii de gre7a contraga da) indi7erent de G G G G7orma si5sau intinderea sa 3organele interesate4 in G G G Gca ul allo transplantului9 G G G G- hematopoe a post transplant cu de7ect 3gre7are cu G G G Gde7ect4 cu bi- sau pancitopenie moderata5se6era G G G G3trombocitopenie) leucopenie sau anemie4 care necesita G G G Gtratament substituti6 lunar) prin hipopla ie medulara G G G Gdatorita unei gre7e insu7iciente in ceea ce pri6este G G G Gcantitatea de celule %tem continute. G JAAAAAAAAAAAKAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I; G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G'ocuri de munca cu solicitari G-articipare 7ara restrictii cu G G &%OR Genergetice de intensitate redusa Gconditia monitori arii medicale G G Gsi medie. Gsi administrarii tratamentului G G G Gadec6at alterarii sistemului G G G G hematologic. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- +cti6itati cu solicitari de G- "asuri de reducere a e7ortului G G "!DI& Gintensitate redusa si medie) G7i ic prin utili area unor G G Gcu program normal sau redus) 7araGau:iliare tehnico-mecanice de G G Ge:punere la to:ice cu actiune pe Gridicare si transport a G G Gsistemul hematopetic) 7ara risc Ggreutatilor9 G G Gde traumati are 7i ica) 7ara G- +daptarea utila=ului de lucru G G Ge:punere la 7actori 7i ici Gpentru a reduce solicitarea G G Gne7a6orabili de mediu9 Gposturala) gestuala si po itia G G G- (apacitatea de adaptare la G7ortata in munca9 G G Ge7ort este limitata partial9 G- +=ustarea mediului 7i ic G G G- %e recomanda e6itarea Gambiant pentru a se e6ita G G Gsuprasolicitarii cu acti6itati Ge:punere la un microclimat cu G G Gsuplimentare la locul de munca. Gsubstante to:ice cu actiune pe G G G Gsistemul hematopetic) cu risc de G G G Gtraumati are) accidentare9 G G G G- +sigurarea unui loc de munca G G G G7ara regim impus cu posibilitateaG G G Galimentatiei 7ractionate 3mese G G G Gmici si repetate49 G G G G- %pri=in pentru monitori area G G G Gmedicala. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- +u in general limitata G- %pri=in pentru posibilitatea G G+((!N#&+#Gcapacitatea de e7ectuare a unor Ge7ectuarii unor acti6itati de G G Gacti6itati organi ate datorita Gcolaborare pentru pro7esiunile cuG

G Gcapacitatii reduse de adaptare Gpregatire superioara) cu rol G G Gla e7ort9 Gpsihoterapeutic) dupa principiul G G G- (onser6area) in cea mai mare GYcum si cat poateZ9 G G Gparte) a capacitatii de G- %pri=in pentru monitori area G G Gautoser6ire si autoingri=ire. Gmedicala si asigurarea G G G Gtratamentului) in 7unctie de G G G Gtulburarile mor7o7unctionale. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- 'ipsa capacitatii de a presta G- Necesita asistent personal. G G ,R+> Gorice acti6itate pro7esionala) G- %pi=in 7amilial si comunitar G G Gindi7erent de ni6el de solicitareGpentru cooperarea la monitori- G G Gsi conditiile de des7asurare9 G area medicala) la ser6iciile de G G G- 'ipsa capacitatii de auto- Gspecialitate) ambulatorii sau G G Gingri=ire autoser6ire si Gspitalicesti9 G G Gautogospodarire. G- %pri=in pentru asigurarea G G G Gtratamentului substituti6 G G G Gcorespun ator si urmarirea G G G Ge7icientei. G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; ; !lemente 6alabile in toate a7ectarile 7unctiilor sistemului hematologic 3indi7erent de structura a7ectata4 (. *&N(#II'! %I%#!"&'&I I"&NI#+R !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN %INDRO"&' I"&NOD!*I(I#+R (RONI( DO.+NDI# ; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - #estul in7ectiei 8I> GIn in7ectia 8I> GIn stadiul clinicoG*ormele cu de7icien-GIn 7ormele cu po iti6 3+c anti- 8I>49 Gasimptomatica Gimunologic +2) Gta globala accentua-Gde7icienta globala - %tabilirea categoriei Gcu test 8I> Gin7ectie 8I> Gta) cu mani7estari Ggra6a) cu imunologice ba ata pe Gpo iti6 3pentru Gsimptomatica Gdi6erse datorita Gmani7estari 6ariate numarul de lim7ocite G+c anti-8I>4. G3categoria .1 si Gimuno-depresiei 3de Gsi cu e6olutie (D2 si pe procentul G(ategoria +1 G+24 cu mani7estariGe:emplu$ candido a) Gprogresi6a 3de acestora din totalul G Gclinice datorita G7ebra mai mult de o Ge:emplu$ lim7ocitelor 3(D(+tlanta5 G Gin7ectiei sau Gluna si repetata) Gleucoence7alopatie 1//24 G Gscaderii imunita- Gherpes ?oster Gmulti7ocala) - (ategorii) dupa celule G Gtii celulare) Grecidi6ant) neuro- Gsepticemii recu(D324 [ _5l G Gde e:$ Gpatii peri7erice) Grente cu salmonella 1. Q M 100 G G- +ngiomato a) Gin7lamatii sau Gneti7oidica) 2. Q 200-2// G G- (andido a oro- Gabcese pel6ine) Gto:oplasmo a 3. Q I200 indicator G G 7aringiana) Gpneumonii recurente4Gcerebrala) celular de %ID+9 G G- (andido a Gcare se corelea a cuGsindromul de

- In6estigatii 6ariate in G G6ul6o-6aginala) Gstadiile clinico- Gemaciere 8I>) 7unctie de modi7icarile G G- 8erpes ?oster) Gimunologice +2) .1 G7ebra continua) structurale speci7ice G G- #rombocitopenie Gsi .2 la adulti O Gdiaree cronica4) in7ectiei 8I> si celor G G idiopatica) Gcon7irmare de catre Gcorespunde stadioportuniste9 G G- .oli in7lamato- Glaborator a in7ecti-Gilor clinico- In6estigatii sociale. G Grii pel6ine. Gei 8I>. Gimunologice G G G G+3) .3) (1) (2 si G G G G(3 la adult) G G G Gsuprapunandu-se cu G G G Gdiagnosticul de G G G G%ID+. G G G G!ste obligatorie G G G Gcon7irmarea de G G G Gcatre laborator a G G G Gin7ectiei 8I> AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; N. In %ID+ stadiul clinico-imunologic (3) indi7erent de complicatiile speci7ice si in7ectiile oportuniste este necesara recomandara asistentului personal sau a indemni atiei de insotitor. ; %e re7era la sindromul imunode7icitar cronic dobandit Q in7ectia 8I>-%ID+ !6aluarea de7icientei globale in sindromul prin de7icit imunitar dobandit se 7ace dupa ultimile criterii clinico-imunologice emise de (D( 3(entrul de (ontrol al .olilor4) de la +tlanta in anul 1//3) pentru adulti) si in anul 1//2 pentru copii In e6aluare trebuie a6ute in 6edere$ a. stadiul clinico-imunologic al in7ectiei 8I>-%ID+ 3intensitatea supresei imunologice4 b. in7ectiile speci7ice bolii %ID+ - intensitatea tulburarilor 7unctionale c. in7ectiile oportuniste gre7ate pe organisme 7ara aparare 3re istenta 7oarte saa uta sau absenta4 %ID+ este o problema cu precadere medicala in ultimele 7a e) care timp de ani de6ine o problema sociala) educati6a) comunitara) cu largi implicatii ec onomice. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- Orice acti6itate pro7esionala) G-articipare 7ara restrictii) G G &%OR G 7ara limitari. Gcu necesitatea de monitori are G G G- (apacitatea de prestatie Gmedicala la %er6iciul de boli G G G pro7esionala pastrata. Gin7ectioase pentru testare si G G G Gtratament adec6at) daca este G G G Gca ul. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G+cti6itati pro7esionale cu G-articipare cu conditia$ G G "!DI& Gsolicitare redusa) cu norma G- asigurarii unui loc de munca G G Gintreaga sau =umatate de norma) Gcu solicitare redusa) G G Gin conditii de con7ort. G- dispensari arii pentru G G G Gtratament speci7ic antiretro6iralG G G Gsi particulari at mani7estarilor.G

DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GDupa recuperarea episodului acut G-articipare cu conditia$ G G+((!N#&+#Gsub tratament antiretro6iral) G- asigurarii unui loc de munca G G Gacti6itati pro7esionale cu G cu solicitare redusa) G G Gsolicitare redusa) cu norma G-dispensari arii pentru tratamentG G Gintreaga sau =umatate de norma) G speci7ic antiretro6iral si G G Gin conditii de con7ort. G particulari at mani7estarilor. G G G- %unt accesibile) in general) G G G Gmuncile statice) acti6itatile G G G Gde birou5mestesugaresti. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GIn stadiile +3) .3) (1) (2$ GIn stadiile +3) .3) (1) (2$ G G ,R+> G-dupa recuperarea episodului G-articipare cu conditia$ G G Gacut sub tratament antiretro6iralG- asigurarii unui loc de munca G G Gsi speci7ic acti6itati Gcu solicitare redusa) G G Gpro7esionale cu solicitare G-dispensari arii pentru tratamentG G Gredusa) cu norma intreaga sau G speci7ic antiretro6iral si G G G=umatate de norma) in conditii G particulari at mani7estarilor. G G Gde con7ort9 G G G G- sunt accesibile) in general) GNecesita asistent personal. G G Gmuncile statice) acti6itatile G G G Gde birou5mestesugaresti. G%upra6eghere medicala permanenta.G G G G G G G'a persoanele cu %ID+ stadiul (3-G G G Gpierderea totala a capacitatii G G G Gde a e7ectua acti6itati de G G G Gautoser6ire) autoingri=ire si G G G Gautogospodarire din cau a G G G Gtulburarilor 7unctionale se6ere G G G Gsi progresi6e. G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; D. *&N(#II'! %I%#!"&'&I R!%-IR+#OR !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR %I%#!"&'&I R!%-IR+#OR; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - !6aluarea 6entilatiei G>!"% M 60R G>!"% 1/-20R G>!"% Q 20-30R G>!"% Q I 30 R pulmonare 3metoda G-aO324 N 70mm8g G-aO324Q6/-60mm8g G-aO324Q 1/-21 mm8g G-aO324 I 31mm8g spirogra7ica si G3hipo:ie usoara4. G3hipo:ie medie4. G-aO324Q22-31 mm8g G-a(O324 X 70mm8g

pneumotahogra7ica4 Q G G G 3se6era4 G3hipo:ie gra6a4 se6eritatea dis7unctiei G G G3hipo:ie G8ipercapnie 6entilatorii G G Gaccentuata5 GI(( dreapta 3(-(4. 3reducere >!"% 7ata de G G G se6era4. G 6aloarea teoretica sau G G G G scaderea 6entilatiei G G G G ma:ime49 G G G G - !6aluarea globala a G G G G schimburilor ga oase G G G G 3ga anali a sangelui G G G G arterial) in repaos G G G G si e6entual in G G G G conditii de e7ort4;;9 G G G G - +precierea adaptarii G G G G la e7ort G G G G 3teste de e7ort4 Q G G G G capacitatea ma:ima de G G G G prestatie;;;9 G G G G - "ecanica pulmonara9 G G G G - -letismogra7ie G G G G determinarea re istentei G G G G la 7lu: G G G G - !:amen radiologic9 G G G G - !S,9 G G G G - (#) R"N 3daca este G G G G ca ul49 G G G G - !:amen histologic G G G G 3daca este ca ul4. G G G G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; ; 1. In a7ectiunile respiratorii cronice) contractate precoce 3copilarie) adolescenta pana 26 ani4) care determina tulburari 7unctionale permanente sau care risca sa de6ina permanente) de e:emplu$ astmul bronsic) anomalii congenitale) agene ie pulmonara partiala) .-O() pneumopatii interstitiale 7ibro ante di7u e) bronsiecta ii supuratii bronhopulmonare) tuberculo a pulmonara acti6a) tuberculo a pulmonara operata) sindromul post tuberculos9 2. (ancerul bronho-pulmonar9 3. #ransplantul pulmonar. ;; %e poate determina$ - presiunea partiala a O324 in sangele arterial sistemic `-aO324a->alori normale$ 70-100mm 8g - presiunea partiala a (O324 in sangele arterial sistemic `-a(O324a->alori normale$ 31-21 3in medie 20 mm 8g4 - saturatia O324 a 8b in sangele arterial sistemic `%aO324a->alori normale Q /1R ;;; - reducere usora 110-110 ^ - reducere medie 110-00 ^ - reducere accentuata 00-31 ^ - reducere gra6a I 31^ ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G%e 6or e6ita acti6itatile cu G+sigurarea unor conditii de microG

G &%OR Gsolicitari energetice e:cesi6e) Gsi macroclimat adec6at in scopul G G Gin mediu cu 6ariatii termice si Gpre6enirii mani7estarilor G G Gno:e respiratorii. Gspastice bronsice - agra6arii G G G Gtulburarilor 7unctionale in G G G G7unctie de structura anatomica G G G Ga7ectata. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G(apacitate redusa de adaptare G- "asuri de adaptare a locului G G "!DI& Gla e7ort. Gde munca pentru a reduce e7ortul G G G%unt indicate acti6itati 7ara G7i ic necesar9 G G Gsuprasolicitare 7i ica) in mediu G- -reocupare pentru ameliorarea G G Gde con7ort) 7ara e:punere la Gmicroclimatului pro7esional in G G Gintemperii) no:e respiratorii Gca ul e:istentei unor 7actori G G G3pra7-pulberi4) de e:emplu$ Gne7a6orabili la locul de munca. G G Gacti6itati de birou cu pregatire G G G Gsuperioara sau medie sau G G G Gacti6itati mestesugaresti. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- %unt indicate acti6itati G!ste necesara$ G G+((!N#&+#Gstatice cu solicitare 7i ica G- diminuarea e7ortului 7i ic prinG G Gredusa. Gmi=loace au:iliare tehnicoG G G- !ste limitata ma=or capacitateaGmecanice de ridicare si G G Gde adaptare la e7ort 7i ic Gtransportare a greutatilor9 G G Gdatorita hipo:iei. G- asigurarea unor conditii de G G G- %e 6or e6ita e:punerea la microGmicro si macroclimat corespun- G G Gsau macroclimat necorespun ator) G ator) 7ara no:e repiratorii - G G Gdeplasarile posturale pe distanteGmediu uscat) umed) rece) cu G G Gmari sau urcarea de G6ariatii termice) cu pra7 G G Gtrepte) care implica e7ort si G3pulberi noci6e bronho-pulmonare4G G Gagra6ea a insu7icienta G- spri=in) din partea agentilor G G Grespiratorie. Geconomici) pentru monitori are G G G Gmedicala. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G'ipseste in totalitate sau G- Necesita asistent personal. G G ,R+> Gaproape in totalitate capacitateaG- #rebuie sa se asigure o:igeno- G G Gde autoser6ire si autoingri=ire Gterapia permanenta 3daca este G G Gdin cau a insu7icientei Gca ul4. G G Grespiratorii mani7este5se6ere G G G Gsi complicatiilor secundare G G G G3(-(4) nein7luentate de actiunileG G G Grecuperatorii particulari ate G G G Gstructurii respiratorii a7ectate.G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; (+-. 1 *&N(#II'! %I%#!"&'&I DI,!%#I>) "!#+.O'I( %I !NDO(RIN I. a. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ &NOR *&N(#II +'! %I%#!"&'&I DI,!%#I> 3D! DI,!%#I!) %!(R!#I!) +.%OR.#I!-+%I"I'+#I!4; ;#;

;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I;; DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - Indicele ponderal G-Denutritie cu G- %indrom de G-+nemie se6era 3sub G- +nemie se6era 3starea de nutritie4;;;9 Gde7icit ponderal Gmalabsorbtie cu G7 grR8b49 G3sub 7 gr. 8b R4 -8emograma 38b grR49 Gintre 20-21R9 Gde7icit ponderal G- Dereglari se6ere Gre istenta la - !6aluarea malabsorbtiei$G-+nemie usoara. Gintre 21-30R9 Gde resorbtie) Gtratament9 - -roteinemie) G G-+nemie cu 8b GmalabsorbtieG- %tare de case:ie - Ionograma) G Gintre 7-10 grR. Gmalasimilatie) cu G3malabsorbtie si - ,licemie) G G Gdenutritie peste Gmalasimilatie pro- +mila emie) G G G30R9 Ggresi6a si se6era4 - +mila urie9 DAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA - !cogra7ie abdominala9 GIn steno ele eso7agiene con7irmate GIn steno ele GIn tumorile - !:amen radiologic Gradiologic) cu mani7estarile de mai Geso7agiene stranse Gmaligne gastroduodenoGsus care nu se remit complet la Gcu gastrostroma9 Ginoperabile sau intestinal9 Gtratament 3dilatatii4 si necesita G#" gastrice cu Goperabile cu - !ndoscopie esoGtratament chirurgical. Ggastrostroma pentru Grecidi6e locogastro=e=unala G-entru perioade limitate) pana la Galimentatie9 Gregionale sau in 3e6entual cu Grecuperare cu restabilirea G#" de colon) rect) G7a e de biopsie ecoghidata49 Gtulburarilor de nutritie. Gsigmoid si alte Ggenerali are. - (olonosigmoidoscopie9 G Gsegmente intestinaleG - Rectoscopie9 G Gcu colostoma9 G - Irigogra7ie9 G G(ancerul pancreatic G - (#-R"N9 G Gcu re ectii partialeG - !:amen histopatologic. G Gsau totale) in G G Gtratament de G G Gsubstitutie. G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; ; %e re7era la$ - unele tumori maligne ale tubului digesti6) operabile sau neoperabile$ - ,astrectomie larga pentru +DS cu gastrostoma9 - #" oro-7aringo-eso7ago-gastrice sau ale unor segmente intestinale inoperabile sau in 7a e de generali are. - Re ectia unor segmente intestinale pentru #" cu colostoma) anus iliac) sigma anus sau anus contra lateralis 3de7initi6e4) - pancreatectomie partiala sau totala pentru #") - steno e eso7agiene stranse) de cau a di6ersa) care necesita dilatatii) eso7agoplastii) prote are) gastrostoma pentru alimentatie. ;; -arametrii 7unctionali se 6or selecta in raport de segmentul de tub digesti6 a7ectat) modi7icarile mor7ologice si biochimice induse) precum si de datele antropometrice in 7unctie de care se stabileste echilibrul ponderal. ;;; Indicele ponderal ideal se stabileste dupa 7ormula 'orenc $

UQ+ cm-100- 3+cm-110452) unde +cm Q inaltimea indi6idului in cm ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GIndependenta in e:ercitarea G-articipare 7ara restrictii G G &%OR Gacti6itatilor pro7esionale G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G+cti6itati 7ara e7ort 7i ic mare)G- +sigurarea unor locuri de muncaG G "!DI& Gin mediu 7ara 6ariatii de G7ara e7ort 7i ic mare) 7ara G G Gtemperatura precum si 7ara Ge:puneri la un micro sau G G Gsubstante to:ice digesti6e) Gmacroclimat necorespun ator9 G G Gin ritm liber. G- +sigurarea unor pau e pentru G G G Ghranire. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- +cti6itati 7ara e7ort 7i ic) G- "asuri de reducere a e7ortului G G+((!N#&+#Gin mediu 7ara 6ariatii de G7i ic si de e6itare a acti6itatiiG G Gtemperatura) precum si 7ara Gin mediu ne7a6orabil) in scopul G G Gsubstante to:ice digesti6e) in Gpre6enirii agra6arilor9 G G Gritm liber9 G- "asuri pentru a=ustarea G G G- +cti6itati care nu impun Gmediului ambiant 7i ic9 G G Gdeplasari posturale) mers pe G- Regim de munca adec6at pentru G G Gplan inclinat. Gasigurarea meselor 7ractionate9 G G G G- "asuri igienico-sanitare. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- Necesita a=utor periodic pentruG- Necesita asistent personal. G G ,R+> Gigiena corporala) autoser6ire si G- +=utor pentru acti6itatile G G Gpentru acti6itatile de i cu i. Gcotidiene 3autogospodarire4 G G G Gpentru perioade 6ariabile) in G G G G7unctie de e6olutie) agra6area G G G Gstructurilor a7ectate) raspunsul G G G Gla tratament) cooperarea la G G G Gactiunile medico-sociale de G G G Grecuperare9 G G G G- +sigurarea de pungi speciale G G G Gpentru persoanele cu gastrostoma)G G G Gcolostoma. G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; I. b. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR 8!-+#I(!; ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+

*&N(#ION+'I;; DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - +namne a9 GIn 7ormele G- In 7ormele G- In 7ormele acti6e G- (iro e hepatice - !:amen clinic9 Gstabili ate sau Gmoderat acti6e Gde hepatite cronice)G3clasa (hild -ugh - !cogra7ie abdominala9 Gpersistente) Gsau ciro e Gcu semnele clinice G(4 cu hipertensiune - 3!: radiologic Gnee6oluti6e) cu Ghepatice Gspeci7ice 37icat Gportala eso7agian49 GhepatoGcompensate) Gmare5mic) indurat) Gireductibila) - !: endoscopic9 Gsplenomegalie G3(hild -ugh +4 Gsau5si Ghemoragii - (#-R"N9 Gmoderata) 7ara G7ara 7enomene de Gsplenomegalie4 cu Gdigesti6e repetate - -unctie bioptica Gsemne de Ghipertensiune G7enomene de G3rupere de 6arice hepatica9 Ginsu7icienta Gportala9 Ghipersplenism) Geso7agiene sau prin - !: histopatologic9 Ghepatica 3teste G-#este paracliniceGecogra7ie cu Gtulburari de cra a - 8emograma completa9 Gbiologice in Galterate la ni6el Gmodi7icari imagisti-Gsanguina4) cu - Indice de protrombina9 Glimite normale sauGmediu9 Gce caracteristice G7enomene de - !lectro7ore a) Gslab po iti6e) G- -urtator de Gsi teste biologice Gence7alopatie imunelectro7ore a) Gdominant G+g8.s sau +c8>(. Galterate Ghepatica) cu pre enta de anticorpi) Gde acti6itate G Gsemni7icati69 Gepisoade de - !n imograma9 Gme enchimala4. G Gpurtator de +g8.s Ginsu7icienta -.ilirubinemie) glicemie) G G Gsau +c8>() raspuns Ghepatica acuta si creatininemie9 G G Gpartial sau 7ara Ginsu7icienta -Determinare +c8>( in ser9G G Graspuns la actiunileGhepato-renala9 -Determinare +g8.s in ser9G G Gde recuperare. G- +denocarcinom G G G Ghepatic sau cancere N.. 70-00R dintre G G G- (iro e hepatice) Gprimiti6e hepatice hepatitele cronice si 20R G G Gdecompensate Gcu agra6are progredintre ciro e au G G Gparenchimatos Gsi6a si pierdere drept cau e >8(. G G Gsau5si 6ascular) cu Gponderala continua. G G G6arice eso7agiene G+u pierduta capaciG G G3radiologic sau Gtatea de autoser6iG G Gendoscopic4 cu Gre si necesita G G Gsemne de Gingri=ire permanenG G Ghipertensiune Gta din partea G G Gportala 3circulatie Galtor persoane. G G Gcolaterala sau5si G G G Gascita4 cu 7rec6en- GN.. In transplantul G G Gta periodica) Ghepatic 3total sau G G Greductibila. Gpartial4 in primele G G G3clasa (hild -ugh G12 luni) apoi in G G G. si (4 G7unctie de bilantul G G G Gclinic si parclinic G G G Gpostoperator in G G G Gdinamica) de G G G Ge6entualele G G G G7enomene de G G G Grespingere si G G G Gcomplicatii G G G Gpostoperatorii. AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#;

; %e re7era la$ a7ectiuni cronice hepatice indi7erent de etiologie$ -hepatite cronice si C X contractate precoce3copilarie adolescenta -ciro e hepatice L pana la 26 ani4 -cancer hepatic primar sau secundar) -transplant hepatic total sau partial. ;; -arametrii 7unctionali se 6or selecta in raport de structurile si 7unctiile hepatice a7ectate si de natura a7ectiunii. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G-ot des7asura orice acti6itate G- -articipare 7ara restrictie G G &%OR Gpro7esionala cu e6itarea G cu e6itarea locurilor de munca G G Glocurilor de munca care impun G cu solicitari 7i ice mari9 G G Ge7ort 7i ic mare si contact cu G- +sigurarea unor conditii de G G Gsubstante hepatoto:ice. G microclimat pro7esional G G G G corespun ator) 7ara 7actori G G G G noci6i G G G G 3substante hepatoto:ice4. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G>or 7i orientati sau indrumati G-reocupare pentru orientarea G G "!DI& Gpro7esional spre locuri de munca Gpro7esionala sau indrumarea spre G G Gadec6ate) 7ara solicitari 7i ice Glocuri de munca 7ara solicitare G G Gsi psihice mari) sarcini G7i ica si psihica mare) ritm G G Gsuplimentare) munca in ture) Gliber) 7ara ture de noapte) G G Gmunca de noapte) in ritm impus) Gintr-un microclimat 7ara 7actori G G Gprecum si intr-un mediu Gnoci6i 3hepatoto:ici4. G G Ginadec6at) cu 7actori to:ici. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G 8+NDI(+-G- #ulburarile 7unctionale de G- Necesita spri=in pentru G G+((!N#&+#Gintensitate accentuata contrain- Ge7ectuarea acti6itatilor G G Gdica prestarea oricarei Gcotidiene care solicita e7ort G G Gacti6itati pro7esionale9 G7i ic si deplasari posturale9 G G G- +u conser6ata capacitatea de G- %pri=in pentru monitori area G G Gautoser6ire) autoingri=ire si) Gmedico-sociala. G G Gin mod limitat) pe cea de G G G Gautogospodarire. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- 'ipseste capacitatea de G- Necesita asistent personal. G G ,R+> Gprestare a unei acti6itati G- %pri=in pentru cooperare la G G Gpro7esionale indi7erent de G monitori are medicala. G G Gni6elul de solicitare si G G G Gconditiile de munca9 G G G G- 'ipseste capacitatea de G G G Gautoser6ire) autoingri=ire si G G G Gautogospodarire. G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#;

II. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ &NOR *&N(#II "!#+.O'I(!;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G+((!N#&+#+5,R+>+ *&N(#ION+'I;;4 DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+- G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G +((!N#&+#5,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA 1. !:amene paraclinice$ G- In 7ormele cu GA In 7ormele care GIn 7ormele G- In 7ormele cu a. -glicemie b =eun) Gechilibru Gse pot echilibra Gde echilibrate Gcomplicatii repetate) peste 130 mg5dl9Gglicemic cu Gdin punct de Gmetabolic) Gspeci7ice b.-glicemie 6enoasa dupa Gpro7il glicemic G6edere glicemic Ginstabile) cu57ara G3microangiopatice4 testul de toleranta la Gcon6enabil) 7ara G- (u tulburari de G7enomene de Gmani7este pe un gluco a 3daca este ca ul4 Gcomplicatii Greglare Gdecompensare Gorgan tinta sau pe de cel putin 170mg5dl G37unctia renala Gsimpaticopar- Gmetabolica 3tip Gmai multe organe 3sageata hiperglicemica4 Gnormala) *O Gsimpatic GhipoglicemicGpredilecte sau cu sau 130mg5dl dupa 2 ore9 Gnormal) e:amen G-8ipotensiune Gcetocetonic4) Gmicroangiopatie c.-glico urie de minimum Gneurologic Gortostatica9 Gnecomplicate) Gperi7erica 1gr la mie in urina din Gnormal) indici G- (u complicatii Gpentru perioada G3artropatia 22 de ore9 Goscilometrici Gincipiente Gnecesara G(harcot-picior -e:amen sumar urina Gnormali49 Gmicroangiopatice) Gechilibrarii. Gdiabetic4- in 3densitate) albumina) G- Necesar de Gcu modi7icari G G7unctie de corpi cetonici49 Ginsulina Gnesemni7icati6e G Gintensitatea -do are albumina in urina Gadministrat in G3microalbuminurie G Gtulburarilor 3daca este ca ul49 Gdoua pri e. Gin repaos do abilaG Gmor7o7unctionale. -creatinina) uree) acid G Gla e7ort4 G G uric9 G G- Necesar de G GN.. -entru -e:men o7talmologic 3*O) G Ginsulina G Ge6aluare 6e i +>) camp 6i ual49 G Greparti at in treiG Gcriteriile -e:amen neurologic9 G Gpri e. G Gstabilite pentru -oscilometrie- eco G G G Ga7ectarea 7unctiei Dopller-indice oscilome- G G G Grespecti6e tric membre in7erioare G G G G37unctiei 6i uale) 2. !:amen clinic G G G Gurinare) de G G G Gmobilitate) G G G Gstatica si G G G Glocomotie4 AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; ----------;4 %e re7era la diabetul aharat tip I) =u6enil sau al adultului tanar pana la 26 ani4. N.. Diabetul aharat tip I este o boala metabolica) de cele mai multe ori determinata genetic) cu e6olutie cronica stadiala) in care lipsa sau scaderea insulinei e7iciente determina scaderea gluco ei celulare urmata de hiperglicemie care) daca nu este corectata) antrenea a perturbari ale metabolismului lipidic) protidic si ale echilibrului hidro-electrolitic. +ceste perturbari) dupa o perioada 6ariabila) in 7unctie de o serie de

7actori 7a6ori anti5determinanti) medico-psiho-sociali) conduc la aparitia complicatiilor metabolice) cardio6asculare) o7talmologice) renale) in7ectioase. - (u cat diabetul este depistat la o 6arsta mai tanara 3copilarie4) cu atat prognosticul este mai re er6at ;;4 >or 7i selectate si apro7undate in6estigatiile paraclinice in 7unctie de echilibrul metabolic si decelarea complicatiilor speci7ice 3microangiopatii cu locali are oculara) renala si placuta neuro-motorie4 N.. - !:amenele paraclinice de la pct. 1) lit. a) b si c au importanta ma=ora pentru controlul terapeutic. - !:amenul clinic in diabetul tip I necomplicat are importanta minora. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G G- +sigurarea unui loc de munca G G &%OR G- 'oc de munca corespun ator) Gadec6at) in aceeasi pro7esie sau G G Gcu solicitare energetica redusa Gindrumare pro7esionala spre G G Gsi psihica medie) in conditii Gacti6itati care nu se des7asoara G G Gambientale corespun atoare9 Gla inaltime) langa 7oc) unelte inG G G- !6itarea acti6itatii in ture) Gmiscare si care nu impun G G Gmunca de noapte) la inaltime) Gsuprasolicitare 6i uala9 G G Glanga 7oc) unelte in miscare) G- %unt contraindicate G G Gsiguranta circulatiei9 Gacti6itatile care pot periclita G G G- Ritm liber cu pau e de masa Gsiguranta circulatiei9 G G Gpentru administrarea insulinei. G- +sigurarea pau ei de masa G G G Gpentru mese 7ractionate si G G G Gadministrarea necesarului de G G G Ginsulina9 G G G G- "onitori area medicala la G G G G(entrul +ntidiabetic 3(+D4 G G G Gpentru urmarirea echilibrului G G G Gmetabolic si pre6enirea aparitieiG G G Gcomplicatiilor speci7ice. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G G G"!DI& G G G GN.. -entru adolescenti) orientarea si 7ormarea pro7esionala pentru G G Gpro7esiuni care$ G G G - nu impun suprasolicitarea anali atorului 6i ual 3acti6itati G G G de preci ie4 G G G - impun acti6itati in mediu cald) G G G - se des7asoara la inaltime) G G G - impun deplasari posturale 7rec6ente) G G G - necesita solicitare 7i ica si psihica intensa. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GIncapacitate tran itorie de G- +=utor din partea G G+((!N#&+#Gdes7asurare a oricarei acti6itatiG7amiliei pentru respectarea G G Gpro7esionale pe perioada necesaraGregimului alimentar si G G Gechilibrarii metabolice) Gadministrarea la timp a G G Gstabilirii necesarului de Gcantitatii de insulina9 G G Ginsulina si de hidrati de carbon G- "onitori are la (+D pentru G G G3regim igienodietetic4. Gechilibrare si pre6enirea G G G Gcomplicatiilor speci7ice. G G G G G

G G GN.. Dupa echilibrarea G G G Ghomeosta iei glicemice) G G G Gindrumarea sau orientarea G G G Gpro7esionala spre locuri G G G Gde munca sau pro7esiuni G G G Gcompatibile cu respectarea G G G Gindicatiilor si G G G Gcontraindicatiilor pre6a ute G G G Gpentru persoanele cu handicap G G G Gusor si mediu. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G%tabilite pentru a7ectarea G- >e i capitolele respecti6e9 G G,R+> G7unctiilor$ 6ederii) urinare) G- Necesita asistent personal. G G Gmobilitatii) staticii si G G G Glocomotiei. G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; III. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR !NDO(RIN! 1. !6aluarea gradului de handicap in hiper7unctia hipo7i ara 3tumora hipo7i ara secretanta de ,8 hormon de crestere4;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA !:amen endocrin$ GIncadrare in G-#umora G-#umora hipo7i ara G#umora hipo7i ara - modi7icarea 7i ionomiei9Gtablou clinic si Ghipo7i ara oprita Ge6oluti6a) a7lata Gcu$ - cresterea de 6olum a Gparaclinic Gin e6olutie) Gin tratament G- sechele e:tremitatilor9 Gincomplet) in Gspontan sau dupa Gantihormonal Go7talmologice - 6isceromegalie9 Gtratament Gtratament speci7icGcomple: sau Ggra6e - sindrom clinic tumoral Gsimptomatic. G3Roentgen terapie)G-#umora hipo7i ara G3cecitate practica cerebral9 G Ghormonoterapie Grecent stabili ata Gsau - tulburari de metabolism G Gantisecretorie Gcu tulburari Gabsoluta4 sau glucidic 3D? tip II49 G Gsau inter6entie Ghormonale G- tulburari - tulburari hormonale G Gchirurgicala49 Gsecundare) partial Gneurologice secundare paraclinic9 G G-*ara semne Gechilibrate prin Ggra6e sau - crestere hormon ,8 in G Gneurologice sau Gtratament G- tulburari ser si in '(R9 G Go7talmologice9 Gsubstituti6 sau Gmetabolice - (#) R"N si radiogra7ie G G- #ulburari G-#umora hipo7i ara Ggra6e 3case:ie de sea turceasca G Gechilibrate prin Goprita in e6olutie Ghipo7i ara4 care tumora hipo7i ara in std. G Gtratament Gdupa tratament sau Gnecesita ingri=ire I-I> 38ardT49 G Ghormonal Gspontan) insa cu Gpermanenta din !:amen o7talmologic$ G Gsubstituti6. Gsechele Gpartea altei

- #ulburari de camp G G Gneurologice) Gpersoane. 6i ual) G G Go7talmologice sau G - 8emianopsie) G G Gendocrine G - %cotoame9 G G Gaccentuate sau G !:amen neurologic$ semne G G G-#umora hipo7i ara G de hipertensiune G G Gcu e:amen G intracraniana9 G G Ghistopatologic de G !!,9 G G Gmalignitate) in G !:amen histopatologic. G G Gtratament speci7ic G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; --------;4 %e re7era la acromegalie - tumora hipo7i ara secretanta de ,8 3hormon de crestere4 la adult. 2. !6aluarea gradului de handicap in hipo7unctia hipo7i ara a. Nanismul hipo7i ar;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAEAAAAA AAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA (linic si paraclinic$ G-#ulburari de G-#ulburari de G- #ulburari de - hipotro7ie staturala9 Ggestualitate si Ggestualitate Ggestualitate si - antropometrie armonioasa9 Glocomotie usoare9 Glocomotorii de Glocomotorii accentuate9 - schelet gracil9 G- #alie 1)2/-1)20 m9 Gintensitate medie9 G-#alie sub 1)2/ m9 - musculatura hipotro7ica9 G--er7ormante G- #alie 1)3/ -1)30 m9 G- -er7ormante - 7acies in7antil9 Gintelectuale G--er7ormante Gintelectuale - do ari hormonale 3hormon Gnormale. Gintelectuale Gnormale9 ,8) gonadotropi) tiroidieni)G Gnormale. G-De7icit al hormonilor corticotropi49 G G Ghipo7i ari$ - masuratoarea taliei9 G G G- ,onadotropiQ - teste psihologice 3HI49 G G Gin7antilism - !S,) tensiune arteriala. G G Gse:ual) G G G- #ireoptropiQmi:edem G G Gsecundar) G G G- (orticotropi G G GQ hipotensiune G G Garteriala Q G G Gper7ormanta de e7ort G G Gsca uta. G G G G G GN.. Intensitatea G G Gtulburarilor hormonale G G Gasociate se cuanti7ica

G G Gdupa criteriile G G Gstabilite pentru G G Ga7ectarea 7unctiei G G Grespecti6e. G G G AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAKAAAAA AAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; -----------;4 %e re7era la insu7icienta hipo7i ara de ,8 3hormon de crestere4 sau tulburari la ni6elul receptorilor peri7erici prin ,8 insu7icient in perioada de crestere somatica cu hipotro7ie staturala armonioasa) pre entand un de7icit statural mai mare de 3 deri6atii standard 33D%4 7ata de media de inaltime pentru generatia respecti6a de 6arsta) uneori asocieri de insu7icienta hipo7i ara pluritropa 3panhipopituitarism4. b. (ondrodispla ia;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAKAAAAA AAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA !:amen clinic$ GIn e6aluarea de7icientei 7unctionale si a gradului de handicap se - 8ipotro7ie staturala9 G6or a6ea in 6edere$ - +ntropometrie di armonica9G - criteriile stabilite pentru a7ectarea mobilitatii articulare) - 8ipotro7ia e:tremitatilor G 3artropatia condrodispla ica determina tulburari de toracale si pel6iene9 G reali are a 6ariantelor posturale si a gestualitatii4) - "obilitatea articulatiilorG - criteriile de inaltime pre entate in insu7icienta hipo7i ara scapulohumerale-co:o7emuraleG 3nanismul hipo7i ar4. limitate prin artropatii G secundare9 G !:amene paraclinice$ - G pre entate la nanismul G hipo7i ar. G AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; --------;4 8ipotro7ie staturala disarmonica prin lipsa receptorilor pentru ,8 la ni6elul cartila=elor de crestere ale e:tremitatilor toracale si pel6iene) cu artropatii secundare. c. %indrom %heehan;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+

*&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA !:amen endocrin$ GInsu7icienta GInsu7icienta GInsu7icienta GInsu7icienta - semne de hipotiroidie9 Ghipo7i ara Ghipo7i ara cu Ghipo7i ara cu Ghipo7i ara se6era - semne de hipogonadism) Gneinsotita de Gcomplicatii Gtulburari Gcu tulburari hipogonadotropi9 Gcomplicatii. Gcompensate cu Gendocrino-metaboliceGendocrine si - insu7icienta G Gtratament Gaccentuate) Gmetabolice gra6e cortico-suprarenala G Ghormonal Gnecompensate Gsi complicatii cronica9 G Gsubstituti6. Gclinic si biologic Gcardio6asculare si - hipoanabolism care G G Gsub tratament Gneuropsihice care poate merge pana la G G Gsubstituti6 Gconduc la case:ie9 G G Gcomple:) asociat Gpierderea Do ari hormonale G G Gcu complicatii Gcapacitatii de speci7ice9 G G Gmetabolice Gautoingri=ire) !:amen neurologic9 G G G3pierdere Gautoser6ire si !S,9 G G Gponderala Gautogospodarire. !:amen psihic. G G Gprogresi6a4) G G G Gcardio6asculare si G G G Gneuropsihice. G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; ----------;4 %e re7era la insu7icienta hipo7i ara primara 3sindrom %heehan4 - a7ectiune uni sau) mai 7rec6ent) pluritropa) e:primata prin tulburari clinice si hormonale. 3. !6aluarea gradului de handicap in insu7icienta hipo7i ara posterioara) prin de7icit total5partial de 6asopresina 3+>-4;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAEAAAAA AAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA (linic si paraclinic$ GIn 7ormele care GIn diabetul insipid G-ost tumoral sau - Diure a Q 3l 522h9 Graspund la tratamentul Gle ional sau tumoral) Gpostoperator) re istente - densitate urinara sub Gcu 6asopresina sau Gcompensat in tratament Gla tratament cu 10109 Ganalogi. Gsubstituti6 cu G6asopresina sau analogi) - subi ostenurieG G6asopresina Gasociate cu complicatii osmolaritate G G3adiuretin4. Gneurologice si hormonale urinaraI 300m!W5l G G Gsecundare.

- -(learence-ul apei libere G G G po iti69 G G G - proba de sete cu test la G G G 6asopresina 3adiuretin4 G G G po iti6 G G G - in etiologia tumorala9 G G G - in6estigatii hormonale9 G G G - (#) R"N. G G G AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAKAAAAA AAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; ----------;4 %indrom clinic de poliurie) polidipsie cu densitate urinara sub 1010 prin de7icit total5partial de 6asopresina 3+>-4 sau lipsa actiunii tisulare a +>-. 2. !6aluarea gradului de handicap in insu7icienta tiroidiana;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA (linic$ G8ipotiroidismul GInsu7icienta GInsu7icienta GInsu7icienta - "etabolic$ crestere Gsubclinic) Gtiroidiana clinic Gtiroidiana cu Gtiroidiana se6era ponderala) in7iltrarea Ge6identiat prin Gmani7esta) in Gcomplicatii Gcu tegumentelor) anemie Gdo ari hormonale Gtratament Gpersistente G6iscerali ari - cu secundara9 G3#%8 crescut4 7araGhormonal G3cardio6asculare si Gcomplicatii - Neuropsihic$ lentoare Ge:presie clinica Gsubstituti6) cu Gmetabolice4 sau Gcardio6asculare si psihica) 7rilo itate9 Gmani7esta sau Gcomplicatii Gle iuni degenerati6eGneurologice gra6e) - (ardio6ascular$ Goligosimptomatic) Gcardio6asculare Gner6oase si Ginsu7icienta cardiomiopatie G7orme usoare cu Gsi Gosteoarticulare Gcardiaca mi:edematoasa) Graspuns la Gmetabolice Gneechilibrate sau Gcongesti6a insu7icienta Gsubstitutia Gechilibrabile. Gsechelare) Gireductibila) cardiaca9 Ghormonala) in G Gdecompensate la Gpolisero ite) - Nanism di armonic cu Gdo e minime. G Gtratament speci7ic. Gence7alopatie. intar iere mentala G G G G 3mi:edem congenital4) G G G G do ari hormonale G G G G speci7ice [gusa9 G G G G -araclinic$ G G G G - #334) #324 sca ute) -.I G G G G sca ut9 G G G G - #%8 crescut 3mi:edemul G G G G primar49 G G G G - %cintigrama tiroidiana G G G G 3lipsa tiroidei in G G G G

disgene ia tiroidiana) G G G G imagine neomogena G G G G in gusa multinodulara49 G G G G - RI( sca ut sau absent9 G G G G - !S, 3tulburari de G G G G conducere) bradicardie) G G G G micro6olta=49 G G G G - !cogra7ie cardiaca G G G G 3cord marit49 G G G G - 8b) 8# sca ute 3anemie G G G G secundara49 G G G G - Radiogra7ie cord-plaman G G G G 3indice cardio-toracic G G G G crescut49 G G G G - .iochimie$ G G G G - 8iperlipoproteinemie) G G G G - 8ipercolesterolemie9 G G G G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; --------;4 %e re7era la$ - mi:edemul primar cu 6iscerali are9 - mi:edemul congenital 3disgene ie tiroidiana4. %indrom clinic determinat de scaderea cantitatii de hormoni tiroidieni la ni6elul receptorilor celulari ceea ce determina in7iltrarea tesuturilor cu consecintele respecti6e) handicapante. 1. !6aluarea gradului de handicap in a7ectarea 7unctiei paratiroidei a. 8iper7unctie paratiroidiana;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA (linic$ G8ipercalcemie G8iperparatiroidismG8iperparatiroidism G8iperparatiroidism - 'e iuni scheletale Gserica Goperat) cu secheleGoperat) 7orma Gcu 7racturi 3osoase4) oase Gasimptomatica sau Gosoase sau renale Gosteodistro7ica cu Gmultiple si lungi si 6ertebre$ Gcu tablou clinic Gnee6oluti6e) cu Gtulburari Gde7ormari osase cu - *racturi spontane) Goligosimptomatic. Gtulburari de Glocomotorii Gde7icienta - Osteoporo a cu arii de G Glocomotie si Gacentuate prin Glocomotorie gra6a. deminerali are si G Ge:cretie medie. Gde7ormari osoase G - *ormarea de chisturi G G Gsi 7orma G osoase9 G G Gne7rolitia ica G - #ulburari renale$ G G Gmoderata cu IR( G poliurie) litia a9 G G Gstadiul de R+*. G - #ulburari gastroG G G G

intestinale9 G G G G - #ulburari neuropsihice9 G G G G -araclinic$ G G G G - (alcemie peste 11mgR G G G G 3repetata49 G G G G - (alciurie peste G G G G 200mgR522h9 G G G G - *os7atemie sca uta G G G G 3sub2)1mgR49 G G G G - *os7ata a alcalina G G G G crescuta 3in G G G G le iuni osoase49 G G G G - -#8 seric 3imunodo are4 G G G G cu ni6el crescut in G G G G conditiile calcemiei G G G G crescute sau normale9 G G G G - !S,$ scurtare G G G G inter6al H#9 G G G G - !:amen radiologic$ G G G G - ,eode osoase sau5si G G G G lacune diseminate9 G G G G - *racturi) calusuri9 G G G G - Osteoporo a G G G G generali ata9 G G G G - 'itia a renala G G G G 3ne7rocalcino a49 G G G G - &lcer gastric. G G G G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; N.. -entru e6aluarea gradului de handicap mediu) accentuat si gra6 6e i criteriile stabilite in a7ectarea 7unctiilor osteo-musculo-articulare si ale miscarilor a7erente precum si a 7unctiilor urinare. ----------;4 %e re7era la hiperparatiroidismul primar 3boala RecPlighausen4) caracteri at prin$ secretie e:cesi6a si autonoma de parthormon 3-#84 de catre una sau mai multe glande paratiroide 3de obicei tumorale4) adenoame) care produc$ - hipercalcemie serica) - hipo7os7atemie) - re orbtie osoasa e:cesi6a. b. 8ipo7unctie paratiroidiana;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+#

AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAEAAAAA AAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA (linic$ G#etanie latenta G#etanie cronica cu G#etanie cronica cu cri e - 8ipere:citabilitate G3spasmo7ilie4 in Gmani7estari clinice si Gacute 7rec6ente) neuromusculara9 Gtratament speci7ic cu Gcri e relati6 7rec6ente Gnein7luentate de - (ri e spontane de Gmani7estari sporadice. Gsub tratament speci7ic. Gtratament. contractura G G G musculara) locali ate pe G G GN.. "ani7estari mai grupuri musculare sau G G Grar intalnite in generali ate9 G G Ga7ectarea primiti6a a - (ri e de contractura G G Gglandelor paratiroide. musculara pro6ocate de G G G hiperpnee9 G G G - %emne mecanice de G G G hipere:citabilitate G G G neuromusculara G G G 3semnul (h^osteP si \eiss G G G po iti6e49 G G G - #ulburari tro7ice G G G 3cataracta in 7ormele G G G cronice) indelungate4 G G G -araclinic$ G G G - (a total si5sau ionic G G G sca ut9 G G G - "g total si5sau ionic G G G sca ut9 G G G - !", po iti6. G G G AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAKAAAAA AAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; --------;4 %e re7era la$ hipoparatiroidismul primar 3tetanie4) caracteri at prin scaderea ni6elului sang6in de parathormon 3-#84 in urma le arii primiti6e a glandelor paratiroide. 6. !6aluarea gradului de handicap in a7ectarea glandei suprarenale - Insu7icienta corticosuprarenala cronica) primara 3.oala +ddison4;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAEAAAAA AAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA (linic$ GIn 7orma compensata G- Insu7icienta (%R GInsu7icienta (%R - +stenie) adinamie) Gclinic si hormonal) sub Gcronica cu Gcronica decompensata) 7atigabilitate9 Gtratament substituti6. Gdecompensari repetate Gre istenta la tratament) - ,returi) 6arsaturi) dureriG Gsau Gcare necesita ingri=ire musculare9 G G- Insu7icienta (%R Gpermanenta din partea

- %cadere ponderala) G Gcronica cu re er6e Galtei persoane. deshidratare9 G Ghormonale labile) G - "elanodermie9 G Gpartial echilibrate sub G - 8ipotensiune arteriala. G Gtratament sau G -araclinic$ G G- Insu7icienta (%R G - Do ari hormonale G Gcronica uni sau G speci7ice9 G Gbilateral operata) in G - Ionograma$ G Gtratament substituti6 G - NacO sca ut) G Gcontinuu) pana la G - ScO crescut) G Gechilibrare. G - ,licemie$ hipoglicemie G G G serica9 G G G - #est stimulare cu +(#8 G G G 3cortrosTn4 negati6. G G G AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAKAAAAA AAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; -------;4 %e re7era la insu7icienta corticosuprarenala primara cronica 3(%R4) datorita distrugerii ambelor corticosuprarenale 3peste 00R4) care determina$ - scadere hormoni glucocorticoi i9 - scadere hormoni mineralocorticoi i9 - scadere hormoni androgeni adrenali. 7. !6aluarea gradului de handicap in insu7icienta gonadica a. Insu7icienta gonadica primara 3primiti6a4;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAA AAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ &%O+R+ G D!*I(I!N#+ -+R+"!#RI G G "!DI! *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAA G 8+NDI(+- &%OR G 8+NDI(+G G "!DI& AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAA AAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAA %indrom clinic caracteri at prin 7ormarea G*orme clinice cu tablou G*ormele clinice cu de7icitara a testiculelor datorita unor Goligosimptomatic) Gtulburari de de7ectiuni cromo omiale9 Gcompensat prin substitutieGde 6oltare musculara Disgene ie a tubilor semini7eri Gcu hormoni se:oi i) 7ara Gsi osteoporo a determinate de anomalii ale 7ormulei Gscaderea capacitatii de Gse:oiodopri6a cu cromo omiale. Ge7ort 7i ic sau 7ara Gscaderea capacitatii #ablou clinic$ Gtulburari psihice Gde e7ort 7i ic si - *enotip masculin9 Ghandicapante. Gprin tulburari - +spect enucoid9 G Gneuropsihice de - +spect in7antil5normal9 G Gintensitate medie. - #esticule mici9 G G - ,inecomastie9 G G - Obe itate [9 G G - De7icit intelectual de intensitate G G 6ariabila -araclinic$ G G

- %permatograma - a oospermie9 G G - 8. gornadotropi serici crescuti9 G G - #estosteron plasmatic sca ut. G G AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAA AAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAA ;%#; --------;4 %e re7era la$ insu7icienta gonadica primiti6a) disgine ii gonadale 3mai 7rec6ent4 cu simptomatologie 6ariabila) in 7unctie de$ - tipul gonadic9 - 6arsta instalarii9 - intensitatea insu7icientei gonadice9 - cau a insu7icientei gonadice. b. Insu7icienta gonadica prin disgene ii gonadale cu 7enotip 7eminin 3%indromul #urner4;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAA AAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# AAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAEAAAAA AAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAA #ablou clinic$ G- *orme clinice cu G- *orme cu hipotro7ie G- *orme clinice cu - 8ipotro7ie staturala Ghipotro7ie staturala Gstaturala intre 130-13/ Ghipotro7ie staturala disarmonica9 Gintre 120-12/ cm.9 Gcm. cu tulb Gsub 120 cm) - *acies caracteristic9 G- *orme 7ara Glocomotorii) de Gmal7ormatii - Organe genitale e:terne Gmal7ormatii somatice Greali are a 6ariantelor Gcardio6asculare) in7antile9 Ghandicapante. Gposturale si de Gscaderea accentuata - In7ertilitate9 G Gprehensiune Ga capacitatii de - "al7ormatii somatice$ G G3gestualitate4 de Gprestatie 7i ica sau cardiace) renale) surditate9G Gintensitate medie9 Gprin tulburari - %emne de hipotiroidie. G G- *orme cu tulburari Gneuropsihice #ablou paraclinic$ G G7unctionale somatice Gaccentuate. - Do ari hormonale G G3cardio6asculare) G speci7ice9 G Grenale4 si tulburari G - !stradiol plasmatic G Gpsihice de intensitate G sca ut9 G Gmedie. G - 8ormoni gonadotropi G G G crescuti9 G G G - ,licemie$ tulburari de G G G glicoreglare9 G G G - !:amen psihologic$ HI G G G 3cel putin intelect G G G liminar49 G G G - +udiograma G G G 3hipoacu ie5surditate4. G G G

DAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAA AAAAAAAAAAAAAAAAAA GN.$ In e6aluarea gradului de handicap se 6or a6ea in 6edere si$ G - (riteriile de la insu7icienta hipo7i ara 3antehipo7i ara49 G - (riteriile de la nanismul hipo7i ar9 G - (riteriile de la insu7icienta tiroidiana9 G - (riteriile pre6a ute la a7ectarea 7ibrei miocardice9 G - (riteriile pre6a ute la a7ectarea 7unctiilor mentale 3nede 6oltarea G globala a 7unctiilor mentale49 G - (riteriile pre6a ute la a7ectarea 7unctiilor urinare. AAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; -----------;4 +7ectiune determinata de un de7icit al cromo omului U cu cariotip 21Ua) - sindromul #urner 3digene ii gonadale cu 7enotip 7eminin4. 0. !6aluarea gradului de handicap in a7ectarea 7unctiei tiroidiene din proli7erarile maligne;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAA AAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAA AAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAA (linic$ G- In timpul tratamentului G- In 7ormele - ,landa tiroida marita) dura) cu57ara Gcomple:) chirurgical si Ginoperabile adenopatii sau nodul 7erm) tiroidian9 Gradioi otopic9 Gsau - ,anglioni laterocer6icali 3palpabili49 G- In 7ormele operate cu G- #ratate chirurgical - #ablou metabolic consumpti6. Grecidi6e locale sau cu Gsau5si i otopic) in -araclinic$ Gsechele de echilibrate subG7a e de diseminare - %cintigrama tiroidiana 3imagini Gtratament continuu. Gcu metasta e neomogene sau lacunare49 G G3pulmonare) - RI( - hipocaptare sau 6alori normale9 G Gosoase etc.4. - Do ari hormonale complementare G G 3hiper7unctionalitate49 G G - -unctie bioptica tiroida - e:amen G G histopatologic9 G G - !:amen radiogra7ic pulmonar si osos G G pentru 7ormele metastatice. G G AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAA AAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAA ;%#; ---------;4 %e re7era la$

- cancerul tiroidian operat recent sau cu sechele metabolice sau pulmonare) de echilibrate) sub tratament continuu) - 7ormele inoperabile sau5si tratate chirugical sau5si i otopic in 7a e de diseminare. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G G+u redusa capacitatea de adaptareG G &%OR G Gla e7ort. !ste necesar sa se G G G Gdiminue e e7ortul 7i ic prin$ G G G G- masuri de adaptare a utila=elorG G G Gla locul de munca) G DAAAAAAAAAF G- a=ustarea mediului ambiental G G8+NDI(+- G-ot des7asura acti6itati cu G7i ic) G G "!DI& Gsolicitari 7i ice de intensitate G- masuri tehnico-mecanice de G G Gredusa) in po itie predominant Gridicare si transport al G G Gse and) care nu necesita 6arianteGgreutatilor) G G Gposturale) deplasari posturale) G- masuri pentru e6itarea po itieiG DAAAAAAAAAFintr-un micro5macro-climat G7ortate in munca sau deplasarilorG G8+NDI(+- Gde con7ort organic. Gposturale pe distante mari) pe G G+((!N#&+#G Gplan inclinat sau urcare pe scariG G G GIn aceste situatii trebuie sa se G G G Gasigure un mi=loc de transport G G G Gadec6at. G G G G- e6itarea sarcinilor G G G Gsuplimentare. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G+u limitata partial sau total G- %pri=in pentru compensarea G G ,R+> Gcapacitatea de a e7ectua Gpierderii partiale sau totale a G G Gacti6itati pro7esionale. Gcapacitatii de autoingri=ire si G G G Gautogospodarire. G G G G- Necesita asistent personal9 G G G G- "onitori are medicala. G G G G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; N.. -entru 7unctiile care) pe langa limitarea capacitatii de adaptare la e7ort au si alte dis7unctii) de obicei comple:e) 6e i$ (riteriile de la a7ectarea mobilitatii-locomotiei) (riteriile de la a7ectarea 7unctiilor mentale) pentru ca urile cu de7iciente prin nede 6oltarea globala intelectuala 3pot e:ecuta sarcini in raport de ni6elul lor de integrare si comportamentul adoptat de 7amilie si comunitate4. (+-. 6 *&N(#II'! &RO,!NI#+'! I. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR D! *I'#R+R! %I %!(R!#I! R!N+'+) D! (O'!(#+R! %I %#O(+R! + &RIN!I IN >!?I(+ &RIN+R+;4

;#; ;*ont 0; @AAAAAAAAAAAAAAAABAAAAAAAAAAAABAAAAAAAAAAAABAAAAAAAAAAAABAA AAAAAAAAAABAAAAAAAAAAAABAAAAAAAAAAAAC G-+R+"!#RI G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G G*&N(#ION+'I G &%O+R+ G "!DI! G "!DI!5 G +((!N#&+#+ G ,R+>+ G +((!N#&+#+ G G G G G +((!N#&+#+ G G G 5,R+>+ G G DAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAA AAAAAAEAAAAAAAAAAAAF G G 8+NDI(+- G 8+NDI(+- G 8+NDI(+- G 8+NDI(+- G 8+NDI(+- G 8+NDI(+G G G &%OR G "!DI& G "!DI&5 G +((!N#&+# G ,R+> G +((!N#&+# G G G3IR( %td. I4G3IR( %td. IIG +((!N#&+# G3IR( %td. G3IR( %td. I>G 5,R+> G G G G 7a a a4 G3IR(% %td. G III G de uremie G3IR( %td. > G G G G G II 7a a b4Gpreuremic4 G terminala4 Gde uremie G G G G G G G Gdepasita4;;4G GAAAAAAAAAAAAAAAAKAAAAAAAAAAAAKAAAAAAAAAAAAEAAAAAAAAAAAAEAAA AAAAAAAAAKAAAAAAAAAAAAKAAAAAAAAAAAAF G GIn 7unctie G G G Gde tolerantaG G G Gindi6iduala G G G Ga IR( si G G G GsimptomatoloG G G Ggia G G G Gclinica G G DAAAAAAAAAAAAAAAABAAAAAAAAAAAABAAAAAAAAAAAAEAAAAAAAAAAAAEAA AAAAAAAAAABAAAAAAAAAAAABAAAAAAAAAAAAF GDensitate G I1021 G N1022 G I1017 G 1010-1011 G N1010 G>ariabila G Gurinara G G G G G G G DAAAAAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAA AAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAF G&ree sanguina G G G G G G G G3mg5dl4 G I10 G I10 G 10-100 G X100 G 300-100 G I100 G DAAAAAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAA AAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAF G(reatinina G G G G G G G Gsanguina3mg5dl4 G Normal G 1.1-2.1 G 3-2 G X2.1 G X6 G >ariabila G DAAAAAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAA AAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAF G8b gr5dl G 12-11 G 12-13 G 10-12 G 0-10 G 0 G >ariabila G DAAAAAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAA AAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAF G(l uree 3ml5min4G Normal G 70-X26 G 26-20 G 20-2.1 G 7.1-1.2 G >ariabila G DAAAAAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAA AAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAF G(l creatinina G G G G G G G G3ml5min4 G 120-70 G 70-X20 G 20-30 G 20-X12 G I7.1 G >ariabila G DAAAAAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAEAA AAAAAAAAAAEAAAAAAAAAAAAEAAAAAAAAAAAAF GNr ne7roni G G G G G G G G7unctionali 3R4 G 100-X10 G 10-X31 G 31-X21 G 21-10 G I10 G I10 G

DAAAAAAAAAAAAAAAAEAAAAAAAAAAAAKAAAAAAAAAAAAKAAAAAAAAAAAAKAA AAAAAAAAAAKAAAAAAAAAAAAKAAAAAAAAAAAAF G%umar urina9 G G GDo are albumina G G Gin urina G Daca este ca ul G G(#) R"N) G In 7unctie de structura a7ectata G Gcistoscopie9 G In 7unctie de structura a7ectata G G!:. G G Ghistopatologic G G JAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAL ;%#; -------;4 %e re7era la$ 1. #oate a7ectiunile cronice renale) congenitale sau dobandite) de etiologie multipla) cu a7ectare primara sau secundara renala) locali ate la ambii rinichi sau intr-unul singur) in ca de rinichi unic congenital sau dobandit. De e:emplu$ - (au e mal7ormati6e 3agene ie renala unilaterala) hipopla ii renale) rinichi polichistic) rinichi in potcoa6a) duplicare ureterala) hidrone7ro a etc.49 - (au e tumorale9 - 8ipertensiune arteriala reno6asculara9 - .oli renale sau pielone7rita pe rinichi unic congenital sau chirurgical cu 7enomene de IR(. +7ectiuni renale cu e6olutie progresi6a) care au ca e:presie 7unctionala insu7icienta renala cronica. 2. Re ectia totala a 6e icii urinare pentru cancer) cu implantare de uretere 3indi7erent unde este implantul4 - pierderea 7unctiei de colectare si stocare a urinei de catre 6e ica urinara. Insu7icienta renala cronica e6oluea a stadial) indi7erent de structura a7ectata si de cau ele ei in 1 stadii. ;#; @AAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G %tadii G Insu7icienta 7unctionala G DAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF G%td. I G- *unctia renala normala in repaos) usor alterata in conditii G G- de deplina Gde suprasolicitare9 G Gcompensare G- 8omeosta ie hidroelectrolitica si acido-ba ica normala9 G G G- -robe 7unctionale renale normale9 G G G- Rata de 7iltrare glomerulara 3(learance-ul creatininei G G Gendogene4Q120-70ml5min G G G- Nu e:ista anemie. G DAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF G%td. II G- *unctia renala normala in repaos prin inter6entia G G- insu7icientaGmecanismelor compensatorii 3hipertro7ia 7unctionala a G Grenala Gne7ronilor restanti) hipertensiune) poliurie compensatorie) G Gcompensata Gretentie a otata49 G Ga. 7a a G- -robe 7unctionale renale putin sau moderat modi7icate9 G Gpoliurica G- 8omeosta ie modi7icata moderat 3in 7a a b49 G Gb. 7a a R+* G- Rata de 7iltrare glomerulara 3(learance-ul creatininei G G Gendogene4Q6/-20ml5min G G G- +nemie usoara sau moderata. G

DAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF G%td. III G- *unctia renala a7ectata in repaos9 G G- IR( G- 8omeosta ie constant alterata9 G Gdecompensata G- Rata de 7iltrare glomerulara 3(learance-ul creatininei G G3preuremie4 Gendogene4Q3/-22ml5min G G G- +nemie moderata. G DAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF G%td. I> G- *unctia renala gra6 alterata9 G G- de uremie G- 8omeosta ie gra6 alterata prin cresterea semni7icati6a a G Gterminala Gprodusilor de retentie a otata9 G G G- Rata de 7iltrare glomerulara 3(learance-ul creatininei G G Gendogene4Q22-12ml5min G G G- +nemie medie sau se6era. G DAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF G%td. >;4 G%upra6ietuirea este asigurata prin mi=loace de substitutie a G G- de uremie G7unctiei renale. G Gdepasita G(onstantele statice si dinamice renale sunt 6ariabile in G G G7unctie de metoda de epurare e:trarenala$ G G G - hemodiali a 3epurare e:tracorporeala49 G G G - diali a peritoneala 3epurare intracorporeala4 sau G G G - transplantul renal. G JAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; --------;4 ,radul de handicap in stadiul > 3uremie depasita4 este 6ariabil. In e6aluare se 6or a6ea in 6edere$ - e7icienta metodelor de epurare e:trarenala 3grad IR(49 - aparitia de complicatii speci7ice ne7ropatiei de 7ond9 - patologia indusa de tehnica de epurare e:trarenala. In starile post transplant de rinichi$ - 8andicap gra6 in primele 12 luni) datorita posibilitatii de aparitie a 7enomenelor de respingere) cu reluarea programului de hemodiali a9 - &lterior e6aluarea gradului de handicap se 7ace in 7unctie de gradul de restabilire a 7unctiei renale. In e6aluare se 6a tine seama si de e7ectul tratamentului imunosupresor) psihicului si cooperararea pacientului. II. !>+'&+R!+ ,R+D&'&I D! 8+NDI(+- IN +*!(#+R!+ *&(#II'OR &RO,!NI#+'! 1. Neoplasme urogenitale operate cu recidi6e locoregionale sau la distanta sau inoperabile) in 7a e de generali are. 2. Neoplasme mamare inoperabile in 7a a de generali are) sau operate cu recidi6e locale sau5si la distanta. ;#; @AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAC G G G G G D!*I(I!N#+ +((!N#&+#+5 G

G D!*I(I!N#+ ,R+>+ G G G G G DAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAF G G G G G 8+NDI(+- +((!N#&+#5 G G 8+NDI(+- ,R+> G G G G G DAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAF G G GIn 7unctie de aparitia recidi6elor locoregionale sau determinarilor la G Gdistanta) precum si de starea de nutritie - obligatorie ancheta sociala cu G Gobiecti6e preci ate de comisie G JAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAL @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- +cti6itati 7ara suprasolicitareG%pri=in pentru$ G G &%OR G7i ica) intr-un microclimat 7ara G- asigurarea conditiilor de muncaG G G6ariatii termice 3temperaturi G3microclimat4 adec6ate9 G G Ge:treme4) umiditate) to:ice G- acti6itate pe acelasi loc de G G Grenale) trepidatii. Gmunca sau) e6entual) G G G Gschimbarea locului de munca9 G G DAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAFIn IR( I> si IR( > spri=in G DAAAAAAAAAF Gpentru$ G G8+NDI(+- G G- acti6itatile cotidiene) ale G G"!DI& GIn general acti6itati G6ietii de i cu i9 G G Gintelectuale) munci de birou) G- transport la si de la centrul G G Gstatice sau de colaborare Gde hemodiali a9 G G G3acti6itati la domiciliu4. G- transportul materialelor de G DAAAAAAAAAF- (u conditia respectarii Gepurare intracorporeala 3de la G G8+NDI(+- Gprogramului de hemodiali a5 Gunitatea sanitara la G G+((!N#&+#Gdiali a peritoneala sau 5si Gdomiciliu49 G G G- (u asigurarea monitori arii G- suplinirea capacitatii de G G Gclinice) paraclinice si Gautoser6ire sau autoingri=ire G G Gterapeutice la centrul care Gin ca ul complicatiilor induse G G Ga e7ectuat transplantul renal Gde procedura de epurare sau G G Gsau la unitatile sanitare la Gde agra6area structurilor de G G Gcare sunt in e6identa G7ond. G G Gpersoanele cu diali a peritonealaG G G Gsi hemodiali a. G G G G G G G DAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAF G DAAAAAAAAAF G G G8+NDI(+- G G G G,R+> GIn ca ul e:istentei unor G'a persoanele cu re ectii totale G G Gcomplicatii secundare) Gde 6e ica urinara$ spri=in pentruG G Gine7icientei metodei de epurare Gasigurarea pungilor de colectare G

G Ge:trarenala sau transplant renal Ga urinei si pentru schimbarea lorG G Gne7unctional - lipseste Gin conditii aseptice G G Gcapacitatea de reali are a G G G Gunor acti6itati aducatoare de G G G G6enit si chiar a acti6itatilor G G G Gcotidiene de autoingri=ire - G G G Gautogospodarire. G G G GIdem pentru persoanele cu G G G Gre ectie totala de 6e ica) cu G G G Gtumuori maligne uro-genitale cu G G G Grecidi6e loco-regionale sau G G G Gdeterminari la distanta. G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; (+-. 7 *&N(#II'! N!&RO-"&%(&'O-%(8!'!#I(! %I +'! "I%(+RI'OR +*!R!N#! I. !>+'&+R! ,R+D D! 8+NDI(+- IN +*!(#+R!+ "O.I'I#+#II +R#I(&'+#II'OR %I O+%!'OR;4 1. +7ectiuni osteo-articulare congenitale sau contractate precoce ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I;;4 DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA - !:amen ortopedic9 GIncadrarea in grad de handicap usor) mediu) accentuat sau gra6 se - !:amene radiogra7ice) Greali ea a particulari at in 7unctie de$ segment a7ectat si) G - intensitatea tulburarilor de postura sau5si gestualitate9 e6entual) contralateral) G - locali area unilaterala sau bilaterala a deteriorarii in 7unctie de limitarea G 3anomaliei49 7unctionala secundara G - membrul sau membrele a7ectate9 3articulatii) coloana G - consecintele secundare 3la articulatiile supra=acentei) 6ertebrala49 G coloana 6ertebrala49 - (# 3e6entual - in G - capacitatea respiratorie a7ectata secundar9 7unctie de structura G - e:istenta tulburarilor neurologice secundare de tip a7ectata49 G paretic5plegic9 - #estari biometrice9 G - in raport de gestualitatea si deser6irea necesara9 - #estarea mobilitatii G - capacitatea de mobili are cu mi=loace protetice) ortetice) articulare9 G mi=loace speciale de deplasare9 - !:amen oscilometric9 G - limitarea prehensiunii si manipulatiei9 - !:amen eco - Doppler9 G - capacitatea de autoser6ire. - %pirometrie. G G G

;;4 %electarea se 7ace G in 7unctie de anomalie) G structura a7ectata si G cau ele care le-au G determinat G 3etiologia lor4. G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; -------;4 %e re7era la anomalii si structuri a7ectate) respecti6 la$ 1. - bolile constitutionale ale oaselor 3de e:. acondrodispla ia49 - mal7ormatii 3de e:. amielia unui membru) totala sau partiala) toracal sau pel6in) sindactilie49 - de7ormari rahitice cu tulburari de postura9 - lu:atie congenitala de sold 3unilateral sau bilateral4 cu co:artro a secundara si5sau modi7icari ale coloanei 6ertebrale9 - redori si anchilo e congenitale post traumatice sau dupa osteoartrita #.() redori stranse mono sau bilaterale de sold) genunchi sau combinate) in po itii 6icioase) asociate sau nu cu parali ii ner6oase9 - lipsa policelui sau a patru degete) bilateral9 - anchilo e ale pumnului ) coatelor sau umerilor9 - pseudartro e 3gamba) coapsa) antebrat) brat - neoperabile4 2. 8emo7ilia + si .) boala congenitala care apare la se:ul masculin prin de7icit de 7actor >III 38emo7ilia + 4 si 7actor IU 38emo7ilia .4) in 7ormele cu mod7icari ale mecanicii articulare sau in 7ormele cu anchilo e in po itii 6icioase si amiotro7ii care impiedica mobili area 3locomotia4 sau5si autoser6irea. 3. (olageno e$ a. poliartrita reumatoida 3-R4$ boala imunoin7lamatorie cronica progresi6a care a7ectea a) cu predilectie) articulatiile mici ale membreleor) simetric si distructi69 b. sclerodermia$ cu tulburari cutanate speci7ice) care reduce gestualitatea datorita sclerodactiliei9 c. dermatomio ita. d. lupusul eritematos sistemic. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate G*ara restrictii G G &%OR G G G G G G G G G G G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate G*ara restrictii G G"!DI& G G G G G G G G G G G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G G G G+((!N#&+#G G G G G G G G G G- +sigurare de mi=loace G

G G Gcompensatorii 3protetice) G G G Gortetice etc.4) adaptate in G G G'ocuri de munca 7ara solicitare Graport de sec6entele muncii G G Gposturala sau5si gestuala) 7ara G3pense) carlige etc.4 in raport G G Gdeplasari in teren) in 7unctie deGde membrul sau membrele a7ectate9G DAAAAAAAAAFstructura5structurile a7ectate cuG- "i=loace speciale de deplasare G G8+NDI(+- Glimitarile 7unctionale secundare.G3baston) cadru) scaun rulant) G G+((!N#&+#G Gmasini adaptate etc.49 G G G G- Reorgani area procesului de G G G Gproductie) adaptarea locuintei G G G Gpentru a 7acilita integrarea G G G Gsociala9 G G G G- %pri=in pentru acti6itatile G G G Gcotidiene - instrumentale in G G G Gca ul persoanelor cu de7iciente G G G Ggra6e. G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; 2. 8emo7ilia + si .;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - !:amen ortopedic9 GIn 7ormele usoare)G- In 7ormele G- In 7ormele se6ere G- In 7ormele - !:amen radiogra7ic) G7ara tulburari Gmedii cu sangerariGcu artropatii Gse6ere cu segment a7ectat si) Ghemoragice. Gminore) 7ara Gcronice) cu Ganchilo e in e6entual) contralateral) G Gdeterminari Gmodi7icari Gpo itii 6icioase) in 7unctie de limitarea G Garticulare sau Gire6ersibile ale Gcu amiotro7ii care 7unctionala secundara G G- In 7ormele cu Gmecanicii Gimpiedica 3articulatii) coloana G Gartropatii Garticulare) Gautoser6irea si 6ertebrala49 G Gnecomplicate care Gcare necesita Gmobili area. - (# 3e6entual - in G Gnecesita tratamentGadministrari G 7unctie de structura G Gantihemo7ilic Grepetate de G a7ectata49 G Gperiodic. Gpreparate G - R"N9 G G Gantihemo7ilice si G - #estari biometrice9 G G Gtrans7u ii G - #estarea mobilitatii G G G7rec6ente. G articulare9 DAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAA KAAAAAAAAAAAAAAAAAAA - !:amen oscilometric G - !:amen eco - Doppler9 G - %pirometrie9 G - Determinarea 7actorilor GN.. In e6aluare se 6a tine seama si de a7ectarea altor structuri care

plasmatici ai coagularii$ Gpredispun la sangerare. - 7actorul >III) G - 7actorul IU. G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; -------;4 %indrom hemoragic produs prin de7icit de 7actori plasmatici ai coagularii. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala G-articipare 7ara restrictii) cu G G &%OR Gintr-un loc de munca 7ara risc deGconditia e6itarii riscului de G G Gtraumatism 7i ic. Gaccidentare. G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala G-articipare 7ara restrictii) cu G G"!DI& Gintr-un loc de munca 7ara risc deGconditia e6itarii riscului de G G Gtraumatism 7i ic. Gaccidentare. G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- +cti6itati 7ara solicitare G%pri=in pentru$ G G+((!N#&+#G7i ica mare sau cu risc de G - asigurarea unui loc de munca G G Gtraumati are indi7erent de G adec6at care sa pre6ina G G Gintensitate si cau e. G traumati area 7i ica) acti6area G G G- %unt limitate acti6itatile careG hemartro ei si cronici arii G G Gsuprasolicita postura G artropatiei speci7ice) G G Gortostatica) deplasarile G - 7acilitarea mobili arii G G Gposturale prelungite) G 3baston) cadru) orte e etc.4) G G Gmentinerea 7ortata a unei G - monitori area acti6itatii G G G6ariante posturale si cele in G medicale 3dispensar) G G Gmediu cu trepidatii. G administrarea de produse G G G G antihemo7ilice) e7ectuarea de G G G G trans7u ii - in 7unctie de G G G G situatie4. G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GIntensitatea tulburarilor G- %pri=in permanent din cau a G G,R+> G7unctiei locomotorii) Gpierderii capacitatii de G G Gire6ersibila) nein7luentata de Gautoser6ire) autoingri=ire si G G Gtratamentul speci7ic limitea a Gautogospodarire9 G G Gtotal sau aproape total G- %pri=in pentru pierderea G G Gcapacitatea de mobili are) Gautonomiei - capacitatea de G G Gautoser6ire) autoingri=ire si Gmobili are9 G G Gautogospodarire. G- %pir=in pentru 7acilitarea G G G Gdeplasarii in interiorul sau5si G G G Ge:teriorul locuintei in G G G G7unctie de necesitati. G G G G- Necesita asistent personal. G

JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; 3. (olageno e a. -oliartrita reumatoida 3-R4;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAA - >%8 crescut9 GIn -R la debut$ GIn -R stadiul I) GIn -R 7orme se6ere GIn -R gra6a stadiul - -roteina ( reacti6a G- redori matinale GII5III Gstadiul III si GI>$ crescuta9 Gla ni6elul G- moderat acti6e$ GIII5I>$ le iuni Gle iuni - *ibrinogen seric Garticulatiilor G- redori matinale9Gdistructi6e Gosteorarticulare crescut9 Gperi7erice9 G- dureri la Gcartilaginoase sau Gcu de7ormari si - !lectro7ore a$ G-mobili area Gmobili area Gosoase9 Ganchilo e 3degete) hipergamaglobulinemie Garticulatiilor Garticulatiilor Gde7ormari ale Gpumni) coate) Gperi7erice 7ara Gperi7erice Gdegetelor9 Gsolduri) genunchi - I," si I,, mult Gdureri9 Gsi in repaos9 Gsublu:atii9 Gin semi7le:ie) crescute9 G- 7ara semne G- 7orta de Gderi6atii a:iale Gtibiotarisene cu - *actor reumatoi i Gobiecti6e Gprehensiune G3cubitale ale Gde7ormarea pre enti$ Gpatologice9 Gredusa9 Gmainilor49 Gantepiciorului49 - \aler Rose G- testarea G- reducerea medie Gatro7ia muschilor cuGlimitarea aproape po iti6) Gmobilitatii Ga mobilitatii Ga7ectarea Gtotala sau totala - 'ate:$ po iti69 Garticulare Garticulare9 Gprehensiunii9 Ga gestualitatii - !: radiologic9 G3mobilitate G- testele de Gsemne radiologice Gsau5si a posturii - (#-R"N. Gnormala4. Gacti6itate Gcaracteristice si deGsi deplasarilor G G3e6olutie4 Glaborator speci7ice9Gposturale9 G Gpo iti6e) dar nu Gcapacitate Gcapacitatea de G Gobligatoriu. G7unctionala Gautoser6ire G G Glimitata9 Gpierduta. G G Gautoser6ire partial G G G Ga7ectata. G G G G G G G G G GN.. (lasa GN.. (lasa GN.. (lasa GN.. (lasa G7unctionala I G7unctionala II G7unctionala III G*unctionala I> G3%teinbrocPer4 - G3%teinbrocPer4 - G3%teinbrocPer4 - G3%teinbrocPer4 Gcapacitatea Gcapacitata Gpermite numai o Gin7irmitate G7unctionala G7unctionala Gmica parte din Gimportanta Gcompleta Gnormala cu Gocupatiile casnice G- persoana G3capacitate Ge:ceptia Gsi autoser6ire. Gimobili ata Gnormala de a-si Ghandicapului G Gla pat sau in Ge:ecuta Gdurerii si G G7otoliu) care nu Gpro7esiunea4. Gredorii la una G Gse poate ocupa G Gsau mai multe G Gde propria

G Garticulatii. G Gingri=ire sau G G G Go 7ace cu 7oarte G G G Gmare di7icultate. AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA ;%#; -------;4 Diagnosticul se stabileste atunci cand sunt satis7acute patru din cele sapte criterii ale +sociatiei de Reumatoligie +mericane 3+R+4$ - redori matinale) - artrite la trei sau mai multe articulatii) - artrita mainilor) - artrita simetrica a mainilor) - noduli reumatoi i) - 7actori reumatoi i in ser) - semnele radiologice caracteristice. b. %clerodermia 3a7ectiunea tesutului con=uncti64 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I;4 DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA - *enomene de tip RaTnaud9G!6aluarea gradului de handicap se 7ace in 7unctie de 7orma clinica) - In7iltratii dure ale Grespecti6 de intensitatea tulburarilor de gestualitate) renale) respiratorii 7etei) trunchiului) Gsi de nutritie) pre6a ute pentru a7ectarea structurilor) pre entate la membrelor9 Gcapitolele in cau a. - #este circulatorii G peri7erice9 G - #este 7unctionale G renale9 G - #este 6entilatorii9 G - .iopsie musculara. G G G ;4 In 7unctie de 7orma G clinica$ G - -rogresi6a cu G sindactilie) G - -rogresi6a cu tulburari G 6iscerale) G - -rogresi6a edematoasa. G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA ;%#;

c. Dermatomio ita;;4 ;#; ;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAA D!#!R"IN+R!+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ -+R+"!#RI'OR G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> AAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAA - !dem in 152 superioara aGIn con7ormitatea cu criteriile pre entate la (ap. 2$ e6aluarea gradului de 7etei9 Ghandicap in a7ectarea 7unctiei muschilor. - De7icit muscular de G grade di7erite 3de la G 7atigabilitate pana la G incapacitatea de a ridica G bratul si coapsele49 G - #este en imatice G 3transamina a) G creatin7os7oPina a) G lacticodehidrogena a49 G - #raseu !", caracteristicG pentru a7ectare 7ibrelor G musculare9 G - .iopsia - necro e G 7ocale. G AAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA ;%#; ----------;;4 +7ectiune in cadrul larg al miopatiilor in7lamatorii ideopatice) cu etiologie multi7actoriala 3in7ectioasa) autoimuna si 6asculo-ischemica-6asculitica4. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G(apacitate 7unctionala completa G- %unt necesare masuri G G &%OR Gcu posibilitatea de a e:ecuta Gpro7ilactice$ e6itarea 7rigului) G G Gnormal pro7esiunea. Gume elii) curentilor de aer la G G G Glocul de munca9 G G G G- Dispensari are la medicul de G G G G7amilie sau reumatologie) G G G Gambulatorii de specialitate G G G Gpentru controale periodice9 G G G G- -ro7ila:ia in7ectiilor acute siG G G Gtratarea in7ectiilor cronice G G G Gpentru a pre6eni progresiunea G G G Galterarilor 7unctionale. G

DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- (apacitate 7unctionala normala G- %unt necesare masuri G G"!DI& Gcu e:ceptia handicapului durerii Gpro7ilactice$ e6itarea 7rigului) G G Gsi redorii la una sau mai multe Gume elii) curentilor de aer la G G Garticulatii9 Glocul de munca9 G G G- 'imitarea gestualitatii G- Dispensari are la medicul de G G Gpro7esionale si a mersului9 G7amilie sau reumatologie) G G G- +cti6itati cu solicitari 7i iceGambulatorii de specialitate G G Greduse 7ara deplasari posturale Gpentru controale periodice9 G G Gpe distante mari) 7ara ridicarea G- -ro7ila:ia in7ectiilor acute siG G Gde greutati) urcat-coborat scari9Gtratarea in7ectiilor cronice G G G- &nele limitari in acti6itatile Gpentru a pre6eni progresiunea G G Gcotidiene) casnice. Galterarilor 7unctionale9 G G G G- "asuri pentru asigurarea unui G G G Gloc de munca 7ara solicitare G G G G7i ica5trepidatii) in conditii G G G Gde microclimat corespun ator sau G G G Gschimbarea locului de munca) G G G Grecali7icare pro7esionala dupa G G G Gca ) in 7unctie de 6arsta) G G G Gprocesele e6oluti6e si G G G Graspunsul la tratamentul G G G Gaplicat. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- (apacitate 7unctionala limitataG- In general a7ectarea G G+((!N#&+#Gpermitand numai o parte din Gaccentuata a posturii) a G G Gacti6itatile casnice si Gdeplasarilor posturale G G Gautoser6irea9 G3mobili area4) alternanta G G G- Imposibilitatea e7ectuarii unorGposturala) gestualitatea G G Gacti6itati pro7esionale in sistemGprehensiunea si manipulatia - 7acG G Gorgani at9 Gimposibila participarea la G G G- !6entuale acti6itati de Gacti6itati pro7esionale9 G G Gcolaborare in 7unctie de G- Necesita spri=in pentru G G Gde7icitul de prehensiune9 G7acilitarea mobili arii 3baston) G G G- %e 6a a6ea in 6edere 7aptul ca$Gscaun rulant49 G G G- se ridica cu greutate de pe G- "onitori are periodica medicalaG G Gscaun) chiar si cu spri=in) G G G G- nu poate ridica si transporta G G G Ggreutati) G G G G- de:teritatea se reali ea a cu G G G Gdi7icultate. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- In7irmitate importanta G- %uplinirea pierderii in G G,R+> Gpersoana cu handicap imobili ata Gtotalitate a capacitatii de G G Gla pat sau in 7otoliu9 Gautoser6ire) autoingri=ire si G G G- Nu se poate ocupa de propria saGautogospodarire9 G G Gingri=ire sau o 7ace cu G- Dependenta sociala permanenta9 G G G7oarte multa di7icultate9 G- Necesita asistent personal. G G G- Necesita ingri=ire si G G G Gsupra6eghere permanenta) nu poateG G G Gsta con7ortabil pe scaun) nu se G G G Gpoate ridica din po itia se and G G G Gin cea ortostatica9 G G

G G- Nu pot pastra ortostatismul G G G Gnespri=init si 7ara a=utor9 G G G G- Nu se pot imbraca) de braca) G G G Gnu-si pot taia alimentele9 G G G G- (apacitatea de autoser6ire si G G G Gautoingri=ire este a7ectata G G G Gma=or. G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; II. !>+'&+R! ,R+D D! 8+NDI(+- IN +*!(#+R!+ "O.I'I#+#II (O'O+N!I >!R#!.R+'!;4 1. %pondilita anchilo anta 3%+4 ;#; @AAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G-+R+"!#RI G- !:amen radiologic;;4$ G G*&N(#ION+'IG - radiogra7ie ba in) G G G - radiogra7ia altor one interesate) G G G - tomogra7ie - #() R"N G G G - scintigrama osteo-articulara9 G G G- In6estigatii biologice$ G G G - >%8 crescuta) G G G - electro7ore a cu hiperal7aglobuline crescute si usoara G G G hipergama globulinemie) G G G - proteina ( reacti6a po iti6a) G G G - 7ibrinogen in sange crescut) G G G - imunelectro7ore a serica I,+ crescuta) G G G - 7actori reumatoi i negati6i) G G G - antigen 8'+ .3274;;;4 pre ent9 G G G- -robe paraclinice $ G G G - testarea mobilitatii coloanei 6ertebrale si a articulatiilor G G G mari) G G G - spirometrie) G G G - e:amen o7talmologic) G G G - e:amen neurologic. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G- %acroileita gr. I> sau5si punti 6ertebrale intre doua corpuri G G&%O+R+ G6ertebrale9 G DAAAAAAAAAAAF- *ara semne in7lamatorii clinice9 G G8+NDI(+- G- Rectitudinea sau redoarea coloanei D'9 G G&%OR G- "obilitatea coloanei (D' in limite 7i iologice sau o reducuere G DAAAAAAAAAAAFcu 20R din 6alorile 7i iologice ale 7le:iei) e:tensiei) inclinari G G Glaterale dreapta si stanga9 G G G- %emne biologice de in7lamatie 3in puseele acute4 $ >%8 usor G G Gcrescut) 7ibrinogen usor crescut) proteina ( absenta) antigen G G G8'+ .3274 po iti6) G G G- *ara a7ectare oculara9 G G G- *ara dis7unctie respiratorie. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G*orma centrala$ G

G"!DI! G- generali area sindesmo7itilor cu 7ormare de punti la un numar G DAAAAAAAAAAAFimportant de discuri 6ertebrale9 G G8+NDI(+- G- mobilitatea coloanei (D'$ reducere cu 10R din 6alorile G G"!DI& G7i iologice ale 7le:iei) e:tensiei) inclinari laterale) rotatii9 G DAAAAAAAAAAAF- redoare matinala coloana (D' persistenta9 G G G- de7icienta 6entilatorie restricti6a usoara9 G G G- 7ara de7icienta 6i uala sau cu de7icienta usoara. G G G*orma peri7erica$ G G G- articulatii peri7erice a7ectate de proces in7lamator cronic) G G G7rec6ent asimetric) cel mai des la genunchi9 G G G- tendinite) 7ascita plantara) G G G- mobilitatea articulatiilor peri7erice redusa cu 30- 20R din G G G6alorile 7i iologice9 G G G- semnele biologice moderat crescute9 G G G- antigen 8'+ .3274 po iti6. G JAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL @AAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC GD!*I(I!N#+ G*orma centrala$ G G+((!N#&+#+ G- cu prinderea coloanei (D'9 G DAAAAAAAAAAAF- 7i:area coloanei cer6icale in 7le:ie in mod ire6eresibil) G G8+NDI(+- Gin puseele acute9 G G+((!N#&+# G- de7icienta 6entilatorie medie de tip restricti69 G DAAAAAAAAAAAF- de7icienta 6i uala medie prin sechele de iridociclita9 G G G- a7ectarea mobilitatii coloanei 6ertebrale cu peste 70R din G G G6alorile 7i iologice 3urca si coboara scarile dar cu di7icultate4 G G G*orma mi:ta$ G G G- cu prinderea coloanei (D'9 G G G- cu prinderea centurilor scapulo-humerale si co:o-7emurale) G G Gbilateral9 G G G- de7icienta 6entilatorie medie sau accentuata de tip restricti69 G G G- de7icienta 6i uala medie prin a7ectare oculara sechelara G G Giridociclitei9 G G G- a7ectarea 7unctionalitatii articulatiilor peri7erice pana G G Gla 00R din 6alorile 7i iologice 3se deplasea a cu greutate cu G G Gbaston sau car=e si pe distante mici49 G G G*orma peri7erica$ G G G- cu prinderea articulatiilor mari$ co:o-7emurale) genunchi) G G Garticulatia coatelor) pumn si degete9 G G G- a7ectarea 7unctiilor articulatiilor peri7erice cu peste 00-01R G G Gdin 6alorile 7i iologice. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G*orma centrala$ G G,R+>+ G- cu prinderea centurilor toracice si pel6iene) G DAAAAAAAAAAAF- cu prinderea umerilor 3anchilo a in adductie4) G G8+NDI(+- G- cu prinderea co:o-7emurala bilateral cu tendinta la anchilo e) G G,R+> G- de7icienta 6entilatorie se6era de tip restricti6. G DAAAAAAAAAAAF*orma peri7erica$ G G G- cu anchilo a pumnilor) coatelor - in semi7le:ie) anchilo a G G Gtibio-tarsiana in eWuin) G G G- cu de7ormarea accentuata a antepiciorului. G G G*orma mi:ta$ G G G- 7orma se6era cu57ara a7ectarea gra6a a acuitatii 6i uale. G

G GN.. G G G-ersoanele cu %+ stadiul I> se deplasea a cu mare di7icultate si G G Gspri=inite. %unt in imposibilitatea reali arii acti6itatilor G G G6ietii ilnice de autoser6ire si ingri=ire. Necesita G G Gasistent personal. G JAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; ----------;4 %e re7era la$ 1. %pondilita anchilo anta 3%+4) 7orma centrala) peri7erica sau mi:ta 3centrala si peri7erica4 - a7ectiune in7lamatorie cronica care a7ectea a preponderent coloana 6ertebrala) procesul in7lamator debutand 7rec6ent la ni6elul articulatiilor sacro-iliace si progresea a ascendent. 2. (i7oscolio e si scolio e de7ormante- idiopatice) cu grad mare de curbura) operate sau nu) care impiedica capacitatea respiratorie normala si5sau cu tulburari neurologice 3parapare e) paraplegii4 ;;4 -rincipalul criteriu de diagnostic po iti6 poate consta) in 7unctie de e6olutie) in$ - %acroileita gr. III 3moderata4$ sclero a si osteocondensare ale articulatiilor9 - sacroileita grad I>$ anchilo a cu disparitia spatiilor articulare9 - aparitia de punti inter6ertebrale `initial D3114-D3124) '314-'324a - sindesmo7ite 3osi7icari interligamentare4) ulterior se generali ea a - aspect <trestie de bambus<9 - a7ectarea articulatiilor interapo7i are cu tendinta la pensare si anchilo e care pot lua aspect de <sina de tram6ai< ;;;4 +ntigenul 8'+ .3274$ are semni7icatie predispo anta pentru a7ectiune9 este pre ent la 00-/0R dintre persoane. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala. G-articipare 7ara restrictie) G G&%OR G-ot de7asura acti6itati 7i ice) Gnecesita$ G G Gnu au probleme cu mobili area) G- monitori are medicala) G G Gurcatul si coboratul de scari G- controale periodice) G G Gsi ridicarea de greutati. -ot G- cure balneare si G G Gdes7asura acti6itati casnice G- program de Pinetoterapie. G G G3sociale si ale 6ietii ilnice4 G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala cu G- +sigurarea unui loc de munca G G"!DI& Ge6itarea suprasolicitarilor Gaccesibil pentru pre6enirea G G Ggestuale) posturale Ge6olutiei spre stadii superioare9G G Gortostatismul sau mersul G- %pri=in din partea G G Gprelungit) ridicarea de greutati)Ganga=atorilor si al 7amiliei G G Gintr-un mediu adec6at) 7ara Gpentru aplicarea masurilor G G Gcurenti de aer) 6ariatii termice)Gpro7ilactice$ G G Gtrepidatii. G - dispensari are medic de G G G G 7amilie sau ser6iciul de G G G G reumatologie) G G G G - program de Pinetoterapie G G G G 3gimnastica medicala4) G G G G - e6entual schimbarea locului G G G G de munca pentru acti6itati 7araG G G G e7orturi 7i ice) 7ara G

G G G ortostatism prelungit) in mediuG G G G cu curenti de aer) ume eala) G G G G po itii 6icioase - 7i:e in G G G G timpul muncii. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- +cti6itati 7ara suprasolicitareG-articipare in conditii de G G+((!N#&+#Gposturala) 7ara deplasari Gmonitori are medicala si G G Gprelungite sau care sa impuna Gpro7esionala$ G G G6ariante posturale9 G- Internare in sectii de G G G- +cti6itati 7ara suprasolicitareGreumatologie in puseele acute) G G G7i ica si 6i uala. Gpentru tratament particulari at G G GIn general au redusa capacitatea Gsi controlat9 G G Gde e7ectuare a oricarei G- Dispensari are medic de 7amilieG G Gacti6itati pro7esionale Gsau specialist reumatolog pentru G G Gorgani ate) cu program normal) Gcontrol periodic9 G G G- +u limitata posibilitatea de a G- -rogram de Pinetoterapie la G G Greali a ma=oritatea acti6itatilorGdomiciliu sau dispensar) G G Gnecesare 6ietii ilnice si Gambulatoriu de specialitate9 G G Gpentru cele de autoser6ire G- %chimbarea locului de munca sauG G G3e:$ aplecat) imbracat5de bracat)Gorientare pentru munci 7ara e7ortG G Gtransport greutati49 G7i ic) ortostatism prelungit) G G G- +u limitata capacitatea de G7rig) curenti de aer) ume eala) G G Gmobili are 3se deplasea a cu Gpo itii 6icioase) G G Ggreutate cu baston4 precum si Gsuprasolicitarea 6ederii. G G Gposibilitatea de mentinere GIn timpul muncii$ G G Gindelungata a po itiei G- %pri=in din partea G G Gortostatice sau se ande si a Ganga=atorilor pentru asigurarea G G G6ariantelor posturale9 Gunui loc de munca adaptat9 G G G- (apacitatea de e7ort 7i ic - G- +=utor din partea 7amiliei G G Gredusa. Gpentru reali area unor acti6itatiG G G Gnecesare ingri=irii si G G G Ggospodaririi 36ietii cotidiene4. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- -ierderea totala a capacitatii G- Necesita asistent personal9 G G,R+> Gde munca) de autoser6ire sau5si G- Necesita spri=in pentru G G Gde orientare spatiala9 Gobtinerea unor mi=loace de G G G- 'imitarea ma=ora a capacitatii Gdeplasare 3baston) 7otoliu rulantG G Gde mobili are9 Getc.4 G G G- 'imitarea ma=ora a G- +sistenta medicala la G G Gposibilitatii de reali are a Gdomiciliu) particulari ata. G G Gacti6itatilor 6ietii cotidiene) G G G Ginstrumentale si de G G G Gautoingri=ire. G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; 2. (i7oscolio e idiopatice ;#; @AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAABAAAAAAAAAABA AAAAAAAAABAAAAAAAAAAC GD!#!R"IN+R!+ GD!*I(I!N#+GD!*I(I!N#+GD!*I(I!N#+GD!*I(I!N#+G G-+R+"!#RI'OR G&%O+R+ G "!DI! G+((!N#&+#+G,R+>+ G

G*&N(#ION+'I DAAAAAAAAAAEAAAAAAAAAAEAAAAAAAAAAEAAAAAAAAAAF G G8+NDI(+- G8+NDI(+- G8+NDI(+- G8+NDI(+- G G G&%OR G"!DI& G+((!N#&+# G,R+> G DAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAKAAAAAAAAAAKA AAAAAAAAAKAAAAAAAAAAF G- Radiogra7ii coloana 6ertebrala) GIncadrarea in grad de handicap se G Gumeri si sold) in raport de Greali ea a in raport de e:istenta si G Gconsecintele secundare9 Gintensitatea tulburarilor de postura) G G- #omogra7ie 3#(4) R"N9 Glocomotorii) respiratorii si motorii - G G- !:amen ortopedic9 Gcon7orm criteriilor stabilite in a7ectarea G G- !:amen neurologic9 Gstructurilor respectic6e. G G- #estatrea mobilitatii coloanei G G G 6ertebrale9 G G G- #estarea mobilitatii G G G articulatiilor mari9 G G G- -robe 6entilatorii. G G JAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL @AAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAA AAAAAAAAAAABAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G G DAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAA AAAAAAAAAAAEAAAAAAAAF G8+NDI(+-G+cti6itati accesibile si participare e7ecti6a in 7unctie G8+NDI(+-G G &%OR Gde intensitatea de7icientei 7unctionale si gradul de G"!DI& G DAAAAAAAAFhandicap pre entate in a7ectarea 7unctiilor motorii) DAAAAAAAAF G8+NDI(+-Gstatice si locomotiei. G8+NDI(+-G G+((!N- G G,R+> G G#&+# GOrientarea pro7esionala a tinerilor spre locuri de munca G G G Gaccesibile) concomitent cu monitori area medicala adec6ata G G G Gpentru pre6enirea consecintelor secundare. G G JAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAKAAAAAAAAL ;%#; III. !>+'&+R! ,R+D D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR "O#ORII 3+ %#+#I(II %I "O.I'I#+#II - 'O(O"O#I!I %+&5%I ,!%#&+'I#+#II4 1. +mputatii; ;#; @AAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G-+R+"!#RI G!:amen ortopedic9 G G*&N(#ION+'IG!:amen radiologic$ G G G- bont) G G G- articulatia supra=acenta) contralateral) coloana 6ertebrala) G G G in 7unctie de locali are) pentru e6aluarea consecintelor G G G handicapului locomotor9 G G G#estarea bontului9 G G G#estarea 7unctionalitatii prote ei si a membrului5membrelor9 G G GIndici oscilometrici9 G G G#estari biometrice particulari ate structurii a7ectate9 G G G#estarea mobilitatii articulare9 G G G#estari musculare9 G

G G#estarea mobilitatii coloanei 6ertebrale. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF G*ara G+mputatie totala sau partiala a degetelor de la unul sau G Gde7icienta Gambele picioare9 G DAAAAAAAAAAAF%e 6a e6alua in 7unctie de tulburarile secundare. G GIn7irmitateG G GlocomotorieG G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GDe7icienta locomotorie usoara$ G G&%O+R+ G +mputatie 'is7ranP) G DAAAAAAAAAAAF +mputatie (hopart) G G8+NDI(+- GDe7icienta de manipulatie usoara$ G G&%OR G 'ipsa prin amputatie a 1-3 degete 3in a7ara policelui49 G G G 'ipsa ultimilor 7alange de la toate degetele de la o mana. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GDe7icienta locomotorie medie$ G G"!DI! G +mputatie gamba unilaterala 3la orice ni6el49 G DAAAAAAAAAAAF +mputatie coapsa- bont prote at) prote a 7unctionala) 7ara G G8+NDI(+- G consecinte secundare. G G"!DI& GDe7icienta de manipulatie medie$ G G G 'ipsa degetelor de la o mana9 G G G De articulatie radio-carpiana9 G G G +mputatia membrului toracic$ antebrat-brat) de la di7erite G G G ni6ele) in raport de 6arsta) cau a si cu gestualitatea si G G G deser6irea necesarp. G G G N.. -entru perioade limitate) in 6ederea adaptprii la G G G unimanualitate) trans7er gestualitate - handicap accentuat. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GDe7icienta locomotorie accentuata$ G G+((!N#&+#+ G +mputatie coapse - bont greu prote abil sau neprote abil sau cu G DAAAAAAAAAAAF prote a ne7unctionala9 G G8+NDI(+- GDe articulatie co:o-7emurala9 G G+((!N#&+# G +mputatie bilaterala membru pel6in) de la ni6elul gambelor- G G G prote ate) prote e 7unctionale9 G G G De7icienta de manipulatie accentuata$ G G GDe articulatie scapulo-humerala9 G G G +mputatia membrului toracic unilaterala cu reducerea G G G prehensiunii contralateral. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GImposibilitatea reali arii ortostatismului - de7icienta G G,R+>+ Glocomotorie gra6a-$ G DAAAAAAAAAAAF'ipsa prin amputatie a ambelor coapse) prote ate sau neprote ate9 G G8+NDI(+- G'ipsa prin de articulatie a unui membru pel6in asociat cu G G,R+> Ganchilo a membrului pel6in opus9 G G G'ipsa prin de articulatie sau prin amputatie a unui membru pel6in)G G Gcu amputatie sau de articulatie de membru toracal9 G G G+mputatie bilaterala a membrelor pel6ine de la ni6elul gambelor - G G Gprote ate ine7icient sau neprote ate. G G GN.. -entru perioade limitate in 6ederea prote arii si adaptarii G G Gla prote a. G G G G

G GImposibilitatea reali arii gestualitatii si manipulatiei$ G G G+mputatii ambele membre toracice de la di7erite ni6ele cu57ara G G Gredori stranse ale articulatiilor. G JAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; ; %e re7era la$ a. +mputatii congenitale) contractate precoce 3copilarie-adolescenta4) unilateral sau bilateral de membru in7erior sau superior) indi7erent de ni6el) de articulatie membru pel6in) de articulatie membru toracal) prote abile) neprote abile sau greu prote abile. b. +mputatii de membru superior sau in7erior) unilateral sau bilateral 3prote abile) prote abile ine7icient) greu prote abile) neprote abile4) indi7erent de 6arsta si statut. N.. +mputatii cu di7icultati de reali are a ortostatismului) mersului ori gestualitatii. In e6aluarea de7icientei 7unctionale se 6or a6ea in 6edere$ (au a care a condus la indicatia de amputatie$ a4 distrugerea unui membru prin stri6ire) b4 pierderea 6asculari atiei) c4 gangrene de cau e 6ariate 3arteriopatii) diabet aharat) embolii4) d4 durere se6era de cau a circulatorie) e4 tumori maligne) 74 in7ectie necontrolabila terapeutic9 %tarea bontului$ scurt9 cu cicatrici 6icioase9 cu calus 6icios9 cu ne6roame hiperalgice) cu le iuni tro7ice) 7istule cronice9 cu sechele comple:e9 Ni6elul amputatiei) la membrul sau membrele a7ectate. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala G-articipare 7ara restrictii. G G &%OR G7ara limitari) cu e:ceptia celor GNecesita schimbarea locului G G Gcare solicita gestualitate Gde munca in ca ul unor pro7esiuni G G G7ina) de preci ie. G3e:$ pianist) 6iolonist s.a.4. G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice pro7esie cu e:ceptia celor G+sigurarea unui loc de munca G G"!DI& Gcare solicita$ Gaccesibil. G G G- ortostatism si deplasari G*ormare si indrumare pro7esionala G G G posturale prelungite) Gin 7unctie de 6arsta persoanelor G G G- bimanualitate. Gcare si-au pierdut G G G Gbimanualitatea) cu re7erire la G G G Gmuncile manuale G G G G- necali7icate. G G G G+sigurare cu prote e) orte e) G G G Gprote e estetice di7erentiate in G G G G6ederea acti6arii in 6iata G G G Gsociala 7ara restrictii. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- 'ocuri de munca 7ara solicitareG*urni are de mi=loace protetice) G G+((!N#&+#G 7i ica) 7ara deplasari si Gde adaptare a utila=elor) G

G G 6ariante posturale sau5si Greorgani area muncii la ne6oie) G G G gestuale) in 7unctie de Gcu atribuirea sarcinilor ce nu G G G deteriorarile Gpot 7i indeplinite altor G G G mor7o7unctionale. Gmembri ai colecti6ului. G G G N.. In elaborarea programelor G-entru de7icientii locomotori G G G de recuperare se 6or a6ea in Gposturali$ G G G 6edere$ GIn a7ara prote arii adec6ate si G G G - locali area si ni6elul Gadaptarii locului de munca G G G amputatiei) Gast7el incat sa nu 7ie G G G - cau ele care au produs-o) Gsolicitata postura pe care nu o G G G - e7icienta prote arii) Gpoate reali a) se recomanda G G G - 6arsta) G7acilitarea prin mi=loace G G G - pregatirea generala si Gsuplimentare de spri=in 3scaune G G G pro7esionala - in Gadaptate ergonomic4 sau G G G 7unctie de care se Gpermiterea cu usurinta a G G G recomanda$ Gmodi7icarilor posturale impuse G G G - schimbarea locului de munca Gde munca) prin balustrade sau G G G sau Gmanere de spri=in. G G G - 7ormare pro7esionala pentru G#rans7erul unor comen i ale G G G munci statice) accesibile Gmasinii de la picior la mana G G G handicapului postural sau5siGsau automati area comen ilor G G G de gestualitate. Grespecti6e. G G G G-entru cei care au asociata G G G Ga7ectarea mobilitatii G G G Gcoloanei 6ertebrale$ sisteme G G G Gmecanice de mane6rare a G G G Ggreutatilor si carucioare de G G G Gtransport de inaltimea G G G Gbancului de lucru ast7el G G G Gincat trans7erul greutatilor G G G Gde pe carucior pe banc si G G G Gin6ers sa se 7aca prin G G G Galunecare. G G G G-entru persoanele cu G G G Gde7icienta 7i ica cu G G G Ga7ectarea gestualitatii$ G G G G!ste posibila) dupa ca ) G G G Gprote are sau orte are) G G G Ge6entual prote e de munca G G G Gadaptate in raport cu G G G Gsec6entele muncii 3pense) G G G Gcarlige etc4) schimbarea G G G Glateralitatii si adaptari G G G Gale utila=ului) ca de pilda G G G Gtrans7erul comen ilor de la G G G Go mana la alta sau de la G G G Gmana la picior) schimbarea G G G Gsistemului de parghii ale G G G Gcomen ilor pentru scaderea G G G Ge7ortului 7i ic. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF G8+NDI(+- GIdem handicap accentuat G- Idem handicap accentuat9 G G,R+> G G- Dupa prote are) adaptare la G G G G prote e5orte e$ G G G G - asigurarea de mi=loace de G

G G G deplasare pentru persoanele G G G G cu de7icienta posturala G G G G 3baston sau cadru pentru cele G G G G cu amputatii unilaterale) G G G G 7otoliu rulant) carucioare G G G G pentru cele cu amputatii G G G G bilaterale49 G G G G - asigurarea de mi=loace de G G G G autoser6ire sau5si de munca G G G G pentru cei cu pierderea G G G G bilaterala a gestualitatii9 G G G G - spri=in total pentru ingri=ireG G G G si acti6itatile cotidiene) G G G G de autogospodarire. G G G G Necesita asistent personal. G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; 2. +7ectiuni neurologice; ;#; @AAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAA AAAAAAAAAAAAAAAAAAAC G-+R+"!#RI G!:amen neurologic9 G G G*&N(#ION+'IG!co Doppler9 G G G G(#) R"N cerebral9 G G G G!:amen o7talmologic 3acuitate G G G G6i uala) campimetrie) G G G G7und de ochi49 G G G G!S,9 G %e stabilesc in 7unctie G G G!!,9 G structura 5structurile G G G,licemie) G a7ectate. G G G#este de coagulare9 G G G G8emoleucograma completa9 G G G G+ngiogra7ie carotidiana9 G G G G!chocardiogra7ie. G G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAA AAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GDe7icit motor minim la un membru sau care nu a7ectea a G G&%O+R+ Gprehensiunea) manipulatia. G DAAAAAAAAAAAF#ulburari de coordonare si echilibru usoare. G G8+NDI(+- G%e poate deplasa) mersul 7iind posibil dar cu oscilatii. G G&%OR G G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G De7icit motor al unui membru in7erior sau al ambelor membre G G"!DI! Gin7erioare dar care nu a7ectea a des7asurarea acti6itatilor G DAAAAAAAAAAAF6ietii cotidiene sau pro7esionale9 G G8+NDI(+- G %e deplasea a cu usoara di7icultate pe distante lungi sau cu G G"!DI& Gdi7icultate moderata pe distante scurte) dar 7ara spri=in) G G Gputand des7asura acti6itati pro7esionale normale) in G G G7unctie de natura pro7esiei. G G G De7icit motor la un membru superior care a7ectea a minimum G G Gmobilitatea) gestualitatea si prehensiunea. G G G Di7icultati de coordonare si de manipulatie nein7luentate de G G Gde7icitul motor. %e poate deplasa 7ara spri=in pe distante G

G G6ariabile) cu di7icultate) cu oscilatii 36e i criteriile de la G G Ga7ectarea 7unctiei de coordonare4. G G G #ulburari usoare de 6orbire$ di artrie) balbism) alte tulburari G G Gale 6orbirii speci7ice unor a7ectiuni neurologice 36e i G G Gcriteriile de la a7ectiunile respecti6e$ boala -arPinson) G G Gmiastenia gra6is s.a.4. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G De7icienta locomotorie accentuata. %e poate deplasa spri=init G G+((!N#&+#+ Gin baston 3spri=in unilateral4 sau nespri=init) dar cu mare G DAAAAAAAAAAAFdi7icultate. Nu poate reali a mersul normal) nici chiar pe G G8+NDI(+- Gdistante scurte. G G+((!N#&+# G De7icit motor total al unui membru superior ce a7ectea a G G Gacti6itatea pro7esionala si cea cotidiana sau de7icit motor G G Gbilateral moderat. G G G #ulburari accentuate de coordonare$ se deplasea a cu spri=in G G Gunilateral sau nespri=init dar cu mare greutate) cu ba a de G G Gsustinere largita) cu tendinta la de6iatii in ca ul asocierii G G Gunor tulburari 6estibulare de intensitate medie 36e i G G Gcriteriile de la a7ectarea 7unctiilor de coordonare4. G G G #ulburari de 6orbire de tipul a7a iei e:presi6e moderate. G G G -ermite) in ca ul in care nu se asocia a de7icit de locomotie) G G Gde manipulatie) de coordonare) e:ercitarea acti6itatilor 6ietii G G Gcotidiene si) e6entual) e7ectuarea unor acti6itati speci7ice G G Gpro7esiunii. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GDe7icit gra6 de locomotie$ G G,R+>+ G - persoana nu se poate deplasa nici cu spri=in nici 7ara G DAAAAAAAAAAAF spri=in)7iind dependenta de un mi=loc de transport adec6at G G8+NDI(+- G 37otoliu rulant) alte dispo iti6e4 sau este imobili at la pat9 G G,R+> G - nu isi poate indeplini acti6itatile 6ietii cotidiene) nu-si G G G poate asigura e:istenta prin acti6itatea pentru care a 7ost G G G pregatita9 G G G - nu se poate autoser6i9 G G G - necesita asistent personal. G G GN.. -ersoanele cu paraplegii) parapare e 7orte pot presta G G Gacti6itati legate de capacitatea si de pregatirea intelectuala) G G Gbene7iciind de o asistenta sociala adec6ata si de pre enta G G Gasistentului personal deoarece necesitatile sunt mult sporite G G Gdin punct de 6edere material) social) psihologic etc. G JAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; ; %e re7era la$ a. +7ectiuni neurologice congenitale sau contractate precoce cu tulburari posturale si gestuale de intensitate 6ariata) de e:emplu$ - mal7ormatii congenitale 3e:$ mielomeningocelul) porence7alia) hidroce7alia) microce7alia49 - sechele neurologice 3 pare e) parali ii etc.4 - dupa meningoence7alopatii in7antile9 - le iuni traumatice ale %N(9 - sechele dupa sindrom ischemic medular cu parapare e sau plegii) tertrapare e sau tetraplegii) monopare e sau monoplegii9 - sechele dupa traumatisme cerebrale se6ere9 - parali ii de ple: brahial9 - le iuni de ner6i peri7erici care produc tulburari de manipulatie) uni sau bilaterale9

- tulburari neurologice sechelare cu de7icit tip bi-tri-tetraparetic5plegic cu57ara tulburari tro7ice) a7ectand deplasarea si gestualitatea normala sau tulburari de tip epileptic ori alte tulburari de 7ocar9 - sechele dupa poliomielita si a7ectiuni medulare in7ectioase9 - parali ii cerebrale$ e:. hemiplegie-hemipare a in7antila) paraplegie-parapare a spastica in7antila) boala 'ittle9 - tumori cerebrale benigne care determina prin e:tensie tulburari de 7ocar) tumori maligne. b. +ccidentele 6asculare cerebrale 3+>(4$ hemoragice) trombotice sau embolice) cu di6erse locali ari) cu de7icite locomotorii secundare) dis7a ie5a7a ie sau5si tulburari s7incteriene indi7erent de 6arsta si statut) la persoanele cu$ - %echele +>( care au drept cau e o mal7ormatie congenitala 6asculara9 - %echele +>( embolice dupa 6al6ulopatii reumatismale contractate precoce sau congenitale9 - %echele +>( din angiocardiopatiile congenitale9 - %echele +>( din cardiomiopatiile primiti6e 3idiopatice sau primare49 - %echele +>( din 8#+ reno-6asculara9 - De7icite motorii din a7ectiunile hemoragipare 3cuagulopatii) trombocitopenii s.a.4) din a7ectiuni hematologice 3policitemia 6era49 - De7icite motorii ale unor neopla ii - primar sau secundar cerebrale - de sistem ner6os) osteoarticular) parti moi. c. -arapare e5paraplegii) tetrapare e5tetraplegii) monopare e5monoplegii - indi7erent de etiologie 3traumatica) 6asculara) in7ectioasa) tumorala) degenerati6a etc.4) indi7erent de 6arsta si statut. N.. %tructurile a7ectate indi7erent de data contractarii) cau a) locali are) pot determina tulburari$ - ale staticii) mobilitatii - locomotiei sau5si ale manipulatiei 3gestualitatii4 sau5si de coordonare si echilibru sau5si de 6orbire) cu implicatii di7erite) in 7unctie de predominanta lor si limitarea la 6iata sociala) comunitara si 7amiliala. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice munca cu program normal) G-articipare 7ara restrictii cu G G&%OR Gcu e6itarea celor care impun Gconditia monitori arii medicale) G G Gacti6itatea la inaltime. Ge6itarea acti6itatii la inaltime G G G Gsau care impune 6ariatii G G G Gposturale mari si deplasari pe G G G Gdistante mari. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala - G %pri=in pentru asigurarea G G"!DI& Gloc de munca 7ara suprasolicitareGlocului de munca adec6at in G G Gposturala) acti6itati G6ederea des7asurarii acti6itatii G G Gpreponderent statice) 7ara Gcu program normal sau redus sau) G G Gdeplasari posturale) 7ara Gdaca nu este posibil) schimbarea G G Gsuprasolicitare 7i ica si Glocului de munca9 G G Gpsihica) in conditii de con7ort G"onitori are medico-sociala. G G Gorganic) 7ara relatii cu G G G Gpublicul daca sunt asociate G G G Gtulburari de 6orbire. G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G In general nu pot presta G +sigurare mi=loace de deplasareG G+((!N#&+#Gacti6itati pro7esionale datorita G3baston) car=e) cadru) 7otoliu G G Gintensitatii a7ectarii 7unctiilorGrulant - in 7unctie de intensi- G G Gmotorii sau5si de manipulatie) Gtatea de7icitului motor la G G Gcoordonare) 6orbire9 Gmembrele superioare sau5si G G G In ca ul de7icitelor motorii Gin7erioare49 G

G Gde tip paraparetic) tetraparetic)G +sigurare dispo iti6e de mers G G Gsunt posibile acti6itati adaptateG3orte e4 in special pentru G G Gcu solicitari 7i ice reduse) Gpersoanele cu sechele dupa G G G7ara deplasari posturale) in Ga7ectari de neuroni motori G G Gconditii de con7ort organic. Gperi7erici9 G G G G %pri=in 7amilial si comunitar G G G G3in 7unctie de ca si situatie4 G G G Gpentru e7ectuarea unor G G G Gacti6itati cotidiene si de G G G Gingri=ire. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G Intensitatea a7ectarii 7unctiei G Necesita asistent personal. G G,R+> Gmotorii 7ace imposibila G "onitori are medicala la G G Gdes7asurarea oricaror acti6itati Gdomiciliu pentru recuperare 3(*"4G G Gpro7esionale) acti6itati Gsi pentru pre6enirea le iunilor G G Gcotidiene) de autoingri=ire) Gde decubit. G G Gautogospodarire9 G +sigurarea mi=loacelor de G G G In ca ul persoanelor cu Gtransport adec6at 3carucioare - G G Gparapare e 7orte) paraplegii) Galte dispo iti6e4 sau de G G G7ara a7ectarea 7unctiilor Gmobili are 37otoliu rulant4. G G Gintelectuale 3in situatii G -entru cei care sunt incadrati G G Gparticulare4 este posibil si Gin munca si 7olosesc 7otoliul G G Gindicat acces pentru prestarea Grulant- este necesara a=ustarea G G Gpro7esiunilor cu pregatire Gbancului de lucru si a spatiului G G Gsuperioara) acti6itati legate Gde sub banc) precum si G G Gde pregatirea intelectuala) in Geliberarea cailor de acces G G Gritm liber) bene7iciind de Gpentru a permite persoanei cu G G Gasistent personal. Ghandicap sa a=unga la locul de G G G Gmunca. G G G G Organi area planului de lucru G G G Gast7el incat sa regaseasca in G G G Garia de munca materia prima si G G G Guneltele necesare. G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; 3. +7ectiuni demielini ante - degenerati6e; ;#; ;*ont 0; @AAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAA AAAAABAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAC G G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G G -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ G G *&N(#ION+'I DAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAA EAAAAAAAAAAAAAAAAAAF G G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G G G &%OR G "!DI& G +((!N#&+# G ,R+> G DAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAA AAAAAEAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAF G - !:amen G In 7ormele GIn 7ormele cliniceGIn 7ormele clinice GIn 7ormele cu G G neurologic;;9 G oligosimptomaticeGcu perioade de Gcu e6olutie Ge6olutie continua G G - !:amen G cu$ Gremisiune) cu Gprogresi6a sau cu Gcare conduc la G G o7talmologic9 3+>) G - %indrom Gtulburari usoare Gpusee acute Gpierderea G

G campimetrie) *O49 G bipiramidal 7rustGsi medii de mers G-7rec6ente$ Gautonomiei G G - !N,9 G - %indrom Gdeplasare posibilaG- tulburari Glocomotorii) G G - -!> auditi6e si G 6estibular 7rust9G7ara spri=in) cu Gaccentuate de mers) G7acand G G 6i uale9 G - %indrom Gmentinerea$ Gmers di7icil) Gdependenta G G - Diplopie pro6ocata9 G cerebelos 7rust) G- sindromului Guneori cu spri=in Gpersoana de o G G - Imunoglobulina , G Gpiramidal) Gunilateral9 Galta persoana G G in '(R si sange9 G sustinute pe G- sindromului G- tulburari de G3partial G G - R"N) (#. G e:amen R"N G6estibular) Gechilibru9 Gsau total4) G G G sau (#. G- sindromului G- tulburari de Gdatorita$ G G ;; !:amen G Gcerebelos) Gcoordonare9 Ga. sindromului G G neurologic complet G G-arametrii G- tulburari de Gpiramidal 6ariat$ G G cu preci area G G7unctionali Gmanipulatie9 G- hemiplegie G G 7ormei de e6olutie G Gcon7irma G- sindromul Gdr5stg) G G si a sindroamelor G Ga7ectiunea Gpiramidal tip G- paraplegiG G a7ectate) respecti6 G Gdemielini anta Gparetic9 Geparapare a G G sindromul pur sau G G3modi7icari *O) G- cerebeloGaccentuata) G G combinate. G G-!>) diplopie) G6estibular9 G- tetrapare a - G G G G!N,) R"N) (#) G- tulburari Gtetraplegie9 G G G GIm, in sange G6i uale Gb. sindromului G G G Gsi '(R4 G3diplopie) G6estibuloG G G G Gmodi7icari (>49 Gcerebelos G G G G G- tulburari de Gcu tulburari G G G G Gsensibilitate. Gde statica G G G G G Gsi echilibru G G G G G Ggra6e. G JAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAA AAAAAKAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAL ;%#; ; %e re7era la leucone6ra:ita$ sinonime - sclero a in placi) ence7alopatie diseminata cronica) ence7alopatie peria:iala di7u a) boala De6ic 3o7talmoneuromielita4) indi7erent de 7orma clinica. N.. Diagnosticul po iti6 se sustine pe$ - simptome si tulburari tran itorii ca$ o7talmopare e) de7icite piramidale sau de sensibilitate) sindroame medulare acute) a7ectarea altor ner6i cranieni) combinatii de semne subiecti6e si obiecti6e9 - diagnosticul sa cuprinda 7orma clinica de e6olutie si sindroamele respecti6e 3combinate sau pure4. ;#; *orme clinice$ - 7orme cu recaderi si remisiuni) - 7orma primar generali ata) - 7orma secundar progresi6a. %indroame$ - %indromul motor$ - paraparetic 3paraplegic4 spastic) - hemiparetic 3hemiplegic4 spastic) - monoparetic sau tetraparetic 3tetraplegic4 spastic. - %indromul ata:ic$ - ata:ie prin tulburari cerebeloase9 - ata:ie prin tulburari 6estibulare9 - ata:ie prin tulburari de sensibilitate pro7unda. - %emne oculare caracteristice$ - o7talmopare e9 - tulburari de acuitate 6i uala si camp 6i ual9 - modi7icari *O$ decolorare papilara globala sau numai temporala 3mai 7rec6ent4. ;%#;

;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G +cti6itati cu program normal in G +sigurarea unui loc de munca G G&%OR Glocuri de munca care nu impun Gaccesibil in po itie dominant G G Gdeplasari posturale prelungite Gse and) 7ara suprasolicitare G G Gsau o gestualitate rapida si cu G7i ica si ritm impus. G G Gpreci ie. G "onitori area medicala pentru G G G Gpre6enirea agra6arii de7icitului G G G Gmotor) 6estibular si cerebelos. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G +cti6itati cu program normal G -articipare cu conditia G G"!DI& Gsau redus) cu solicitari mici Gasigurarii unor locuri de munca G G Gsau medii) 7ara ritm impus) care G7ara solicitari 7i ice mari) G G Gnu solicita miscari de preci ie Gdeplasari posturale prelungite G G Gsi rapide din partea membrelor Gsi gestualitate rapida si de G G Gsuperioare si in7erioare) Gpreci ie9 G G Gintr-un microclimat de con7ort G "onitori are permanenta pentru G G Gorganic. Gprelungirea duratei remisiunii G G G Gsi pentru pre6enirea aparitiei G G G Gpuseelor acute. G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G In general) intensitatea G -entru persoanele cu pregatire G G+((!N#&+#Gtulburarilor 7unctionale Gsuperioara$ spri=in pentru G G Glimitea a prestarea oricarei Ge7ectuarea unor acti6itati de G G Gacti6itati pro7esionale Gcolaborare in 7unctie de G G Gorgani ate. -ot) e6entual) Gposibilitatile psiho-7i ice si G G Ge7ectua acti6itati de colaborare Gde suportul 7amilial9 G G Gin ritm liber) cu e7ect G %pri=in pentru obtinerea G G Gpsihoterapeutic9 Gmi=loacelor de deplasare G G G !ste conser6ata capacitatea G3baston) car=e) scaun rulant G G Gde autoingri=ire. Gs.a.4) partial pentru G G G Gacti6itatile de autoingri=ire G G G Gsi autogospodarire si pentru G G G Gmonitori area medicoG G G Gsociala. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G Datorita intensitatii G Necesita asistent personal. G G,R+> Gtulburarilor de postura) de mers)G +sigurarea de mi=loace de G G Ggestualitate sau5si de 6edere) Gmobili are 3cadru) 7otoliu G G Gnu pot presta nici o acti6itate9 Grulant) carucior4 pentru G G G (apacitatea de autoser6ire Gdeplasare in cadrul locuintei9 G G Gpartial5total a7ectata9 G Dispensari area medicala 3la G G G (apacitatea de mobili are$ Gdomiciliu sau) cand este necesar)G G Gde la mers cu spri=in bilateral Gla ser6iciul de specialitate4. G G Gprin 7orte proprii) pana la G G G Gimobili are9 G G G G 'imitarea gestulitatii pana G G G Gla imposibilitatea e:ecutarii G G

G Gunor miscari cu membrul G G G Grespecti69 G G G G +7ectarea 6ederii pana la G G G Gcecitate relati6a si absoluta. G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; I>. !>+'&+R! ,R+D D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR "&%(8I'OR; 1. !6aluare grad de handicap in distro7ia musculara progresi6a 3D"-4 si 7ormele ei ;#; @AAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G-+R+"!#RI G!:amen neurologic$ G G*&N(#ION+'IG - de7icit motor in 7unctie de 7orma clinico-genetica) G G G indi7erent daca debutul este distal sau pro:imal) a7ectarea G G G grupelor musculare se generali ea a9 G G GDe7icitul motor are ca e:presie$ G G G - amiotro7ii progresi6e-simetrice9 G G G - retractii tendinoase9 G G G - RO# 6ii. G G G-araclinic$ G G G - cresterea acti6itatii unor en ime glicolitice 3de e:$ 'D849 G G G - biopsia musculara este sugesti6a) e6identia a modi7icari G G G de tip miogen9 G G G - !",$ G G G - absenta acti6itatii bioelectrice spontane) G G G - diminuarea amplitudinii ma:ime a traseelor9 G G G - reducerea duratei medii a potentialelor. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GDe7icit motor 7rust. G G&%O+R+ G+miotro7ii simetrice distal si pro:imal nesemni7icati6e. G DAAAAAAAAAAAF G G8+NDI(+- G G G&%OR G G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GDeplasarea cu di7icultate prin scaderea per7ormantei de G G"!DI! Gortostatism si mers prelungit si prin tulburari de preci ie G DAAAAAAAAAAAFsi 6ite a a miscarilor. G G8+NDI(+- G G G"!DI& G G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GDeplasare cu mare di7icultate prin 7orta proprie) nespri=init G G+((!N#&+#+ Gsi cu spri=in. G DAAAAAAAAAAAFImposibilitatea e7ectuarii aproape a oricariei gestualitati G G8+NDI(+- Gpro7esionale. G G+((!N#&+# GDi7icultati de respiratie. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G-ersoana nedeplasabila prin 7orta proprie. G G,R+>+ G#ulburari de gestualitate bilateral. G DAAAAAAAAAAAF-ierderea capacitatii de autoser6ire. G

G8+NDI(+- G#ulburari mari de deglutitie si respiratie. G G,R+> G G JAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; ; %e re7era la$ 1. Neuromiopatii$ a7ectarea unitatii motorii 3a 7ibrei musculare striate4) a placii neuromusculare) ner6ului motor si ner6ului motor spinal - cu amiotro7ii si determinare genetica$ a. D"-$ - *orma se6era 3Duchenne)4 - *orma benigna 3.ecPer49 b. *enotipul Duchenne - 7orma centurilor9 c. D"- 7orma$ - *acio-scapulo-humerala) - Distala) - Oculo-7aringiana. 2. "iotonii 3determinate genetic4 - este implicat un de7icit de membrana celulara$ a. miotonia congenitala 3#hompson4) b. distro7ia miotonica 3%teinert4. 3. -olimio ita primiti6a 3cu le iuni musculare de tip in7lamator4 2. "iastenia 3boala sinapsei neuro-musculare4 1. .oli degenerati6e si heredodegenerati6e ale %N( 3boli genetice cu aspect anatomo-patologic de tip degenerati64$ a. amiotro7ia neuronala (harcot - "arie #ooth) b. sclero a laterala amiotro7ica 3%'+4) c. eredoata:ia spinocerebeloasa *riedreich) d. heredo-ata:ia cerebeloasa -ierre "arie. 6. +nomalii si mal7ormatii musculare congenitale) daca impiedica statica si locomotia 3de e:$ hipertro7ii) redori) retractii musculare mutilante4. 2. !6aluare grad de handicap in miotonii; ;#; @AAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G-+R+"!#RI GIn miotonia #hompson G G*&N(#ION+'IG!:amen neurologic$ G G G - distributia 7enomenului mitotonic la 7le:orii degetelor) G G G muschii policelui) a musculaturii orbiculare) pleoape si pe G G G parcursul e6olutiei - hipertro7ii musculare di7u e la toate G G G grupele musculare) cu predominanta la membrele in7erioare G G G 3aspect haltero7il4. G G G!:amen paraclinic$ G G G - !",$ cresterea progresi6a a amplitudinii potentialelor cu o G G G 7rec6enta de 20510 cicli5sec 3criteriul patognomonicQ7enomen G G G de incal ire4 G G GIn distro7ia miotonica %teinert G G G!:amen neurologic$ G G G - amiotro7ii musculare distale la membrele superioare si G G G in7erioare9 G G G - muschii 7onatori) cu modi7icarea 6ocii9 G G G - muschiului cardiac9 G G G - atro7ie gonadica. G G G!:amene paraclinice$ G G G - microscopia electronica e6identia a a7ectarea arhitecturii G

G G mio7ibrilelor) care apar sterse9 G G G - microscopia optica e6identia a alternanta de 7ibre musculare G G G atro7iate cu 7ibre hipertro7iate) de organi area G G G mio7ibrilelor9 G G G !", - descarcari spontane repetiti6e) in sal6e) asociate G G G cu modi7icari ale unitatii motorii de tip miopatic9 G G G !n imograma serica 3'D8) *(S) #,O) #,- - sunt sca ute sau G G G normale4. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GIn 7ormele usoare cu mani7estari 7ruste care nu a7ectea a G G&%O+R+ Gcapacitatea 7i ica de prestatie. G DAAAAAAAAAAAF G G8+NDI(+- G G G&%OR G G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G%caderea 7ortei musculare distale la membrele superioare9 G G"!DI! GOboseala precoce9 G DAAAAAAAAAAAF%caderea 7ortei si 6ite ei de e:ecutare a miscarilor9 G G8+NDI(+- G%caderea capacitatii 7i ice de prestatie la e7ort) G G"!DI& Gmanipularea de greutati. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GDeplasare cu di7icultate9 G G+((!N#&+#+ G#ulburari de manipulatie si gestualitate bilateral9 G DAAAAAAAAAAAF#ulburari de 6edere si de 6orbire. G G8+NDI(+- G G G+((!N#&+# G G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GIn 7ormele clinice cu e6olutie indelungata care conduc la G G,R+>+ Gdeplasarea di7icila sau la imobili are datorita atro7iilor G DAAAAAAAAAAAFmusculare marcate) cu tulburari respiratorii) tulburari de G G8+NDI(+- Gdeglutitie) 7onatie) alimentatie. G G,R+> G G JAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; ; %unt caracteri ate printr-o lentoare a rela:arii musculare dupa contractie 6oluntara) 7enomenul diminuand progresi6 dupa repetarea contractiei 6oluntare 37enomen de incal ire4. 3.!6aluare grad de handicap in polimio ita primiti6a; ;#; @AAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G-+R+"!#RI G !", Q caracteri ata printr-un traseu constand din acti6itate G G*&N(#ION+'IGbioelectrica spontana repre entata de potentiale de 7ibrilatie) G G Gpotentiale poli7a ice care apar la contractii 6oluntare) G G Gacti6itate repetiti6a cu 7rec6enta rapida) e6ocate de stimularea G G Gmecanica a muschilor. G G G +-$ aspect histologic greu de di7erentiat de cel al G G Gdistro7iilor musculare. G

DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G G G&%O+R+ G G DAAAAAAAAAAAF G G8+NDI(+- G G G&%OR G G DAAAAAAAAAAAF G GD!*I(I!N#+ G G G"!DI! G G DAAAAAAAAAAAF G G8+NDI(+- G (riterii de incadrare in grad de handicap asemanatoare G G"!DI& G cu cele din distro7ia musculara progresi6a) cu preci area G DAAAAAAAAAAAF ca e6olutia este ondulanta) cu agra6ari si remisiuni spontane G GD!*I(I!N#+ G si terapeutice. G G+((!N#&+#+ G G DAAAAAAAAAAAF G G8+NDI(+- G G G+((!N#&+# G G DAAAAAAAAAAAF G GD!*I(I!N#+ G G G,R+>+ G G DAAAAAAAAAAAF G G8+NDI(+- G G G,R+> G G JAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; ; %e caracteri ea a printr-o simptomatologie dureroasa cu traseu !", polimor7 si le iuni musculare de tip in7lamator. %unt delimitate trei tipuri de polimio ita$ a. -olimio ita primiti6a incompleta) ;#; b. -olimio ita din colageno e) Ctrebuie luate in considerare c. -olimio ita paraneopla ica. Gcriteriile stabilite Lpentru a7ectiunile respecti6e. ;%#; 2. !6aluare grad de handicap in miastenie; ;#; @AAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G-+R+"!#RI G(linic$ G G*&N(#ION+'IG - de7icitul motor miastenic se produce prin rela:area G G G progresi6a a muschiului care 7ace e7ortul si prin diminuarea G G G progresi6a a 7ortei) iar repaosul re7ace 7orta musculara9 G G G - o caracteristica a 7enomenului miastenic Q de7icitul G G G miastenic este mai accentuat in a doua parte a ilei9 G G G - RO# pre ente sau usor diminuate. G G G-araclinic$ G G G - proba de e7ort) care caracteri ea a sau e6identia a de7icitul G G G motor9 G G G - testul cu miostin sau tensilon ameliore a de7icitul dar de G G G scurta durata9 G G G - !",$ cu stimularea ner6ului cubital si culegerea G

G G potentialului e6ocat din eminenta hipotenara. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GN.. 'a incadrarea in grad de handicap trebuie sa se tina G G&%O+R+ Gseama de intensitatea de7icitului miastenic) care se poate G DAAAAAAAAAAAFmani7esta prin$ G G8+NDI(+- G 1. tulburari oculare 3strabism) diplopie) pto a palpebrala G G&%OR G si chiar imposibilitatea con6ergentei49 G DAAAAAAAAAAAF 2. tulburari de 7onatie 3dis7onie) na onare) di artrie4) G GD!*I(I!N#+ G care apar sau se accentuea a la e7ort9 G G"!DI! G 3. tulburari de deglutitie) la inceput pentru solide) apoi G DAAAAAAAAAAAF lichide si in ca uri gra6e pentru sali6a9 G G8+NDI(+- G 2. tulburari de masticatie$ apar mai mult sau mai putin G G"!DI& G precoce) pot merge pana la de7icit total si se pot asocia G DAAAAAAAAAAAF cu caderea mandibulei9 G GD!*I(I!N#+ G 1. atingerea musculaturii 7aciale) de7ormarea mimicii G G+((!N#&+#+ G 37acies-ul miastenic caracteristic49 G G G 6. a7ectarea musculaturii ce7ei) trunchiului si membrelor G G8+NDI(+- G poate sa produca$ G G+((!N#&+# G - caderea capului - necesita mentinerea barbiei cu mana) G DAAAAAAAAAAAF - trecerea din clinostatism la ortostatism) poate 7i G GD!*I(I!N#+ G imposibila sau se e:ecuta cu di7icultate 3cu e7ort mare4) G G,R+>+ G 7. interesarea membrelor in7erioare se remarca initial la G DAAAAAAAAAAAF urcatul si coboratul scarilor) iar ulterior si la mersul G G8+NDI(+- G pe ni6el plat) G G,R+> G 0. tulburari respiratorii$ e:primate prin dispnee) sunt G G G obiecti6ate de reducerea capacitatii 6itale. G G GDe7icitul miastenic) indi7erent de mani7estare) se poate G G Gameliora la tratamentul medicamentos corespun ator. G G G ,radul de handicap se e6aluea a in 7unctie de intensitatea G G G de7icientelor 7unctionale) dupa criteriile pre entate pentru G G G a7ectarea 7unctiilor respecti6e) re6ersibilitatea si G G G re istenta la tratamentul medicamentos speci7ic. G JAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; ; !ste o boala a sinapsei neuromusculare care se caracteri ea a prin oboseala e:cesi6a si de7ect al musculaturii striate ce apare la e7ort si se recuperea a) partial sau total in repaos si sub actiunea unor substante anticolinestera ice. 1. !6aluare grad de handicap in a7ectiunile degenerati6e si heredo - degenerati6e ale %N( ;#; @AAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G-+R+"!#RI Ga4 +miotro7ia neuronala (harcot - "arie #ooth$ G G*&N(#ION+'IG- atro7ii musculare simetrice distale$ G G G- la membrul in7erior aspect de picior de cocos9 G G G- la membrul superior 153 in7erioara antebrat - aspect de G G G atro7ii in manusa G G G- tulburari de sensibilitate de tip poline6ritic9 G G G- tulburari 6egetati6e - hipersudoratie9 G G G- tulburari endocrine 3insu7icienta gonadica49 G G G- e:amen bioptic$ atro7ii musculare de tip neuronal alternand G G G cu one hipertro7ice. G

G Gb4 %clero a laterala amiotro7ica 3%'+4$ G G G- amiotro7ii distale) simetrice) progresi6e9 G G G- semne piramidale 3spasticitate osteo-tendinoasa) .abinschi G G G pre ent49 G G G- 7enomene bulbare 3tulburari de 7onatie) de deglutitie) G G G atro7ii ale limbii) atro7ii simetrice ale 7etei49 G G G- !",$ aspect Q dener6are9 G G G- microscopie electronica$ interuperi la ni6elul mio7ibrilelor) G G G stergerea arhitecturii) depo it de glicogen9 G G G- microscopia optica$ depo ite de lipo7uscina. G G Gc4 !redoata:ia spinocerebeloasa *reidreich$ G G G- ata:ie cerebeloasa 3mers ebrios) cu ba a de sustinere largita) G G G di artrie) 6orbire lenta) RO# abolite precoce49 G G G- amiotro7ii distale 3aspect picior de cocos sau picior scobit49 G G G- !", aspect de denere6are9 G G G- biopsie$ aspect de degenerescenta a:onala G G Gd4 !redoata:ia cerebeloasa -ierre "arie$ asemanator eredoata:iei G G G *reidreich) cu semne piramidale mai e6idente si tulburari de G G G sensibilitate pro7unda mai reduse) RO# 6ii. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G%caderea usoara a per7ormantelor de ortostatism si mers prelungit)G G&%O+R+ Gin preci ia si 6ite a miscarilor 3reali area gestualitatii4. G DAAAAAAAAAAAF G G8+NDI(+- G G G&%OR G G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G"obili are cu greutate9 G G"!DI! G%caderea per7ormantelor de ortostatism si mers prelungit9 G DAAAAAAAAAAAF%cade preci ia si 6ite a miscarilor 3a7ectarea medie a G G8+NDI(+- Gmanipulatiei si gestualitatii4. G G"!DI& G G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G-ersoana se deplasea a cu mare di7icultate prin 7orta proprie) G G+((!N#&+#+ Gnespri=init si cu spri=in9 G DAAAAAAAAAAAFNu poate e7ectua e7icient gesturi pro7esionale) cele cotidiene G G8+NDI(+- Gsunt pastrate9 G G+((!N#&+# GDi7icultati de respiratie. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ GIn 7ormele cu e6olutie indelungata care duc la$ G G,R+>+ Gdeplasarea di7icila sau la imobili are datorita atro7iilor G DAAAAAAAAAAAFmusculare sau5si la G G8+NDI(+- G tulburari marcate de respiratie) G G,R+> G tulburari marcate de deglutitie) G G G tulburari marcate de alimentatie) G G G imposibilitatea reali arii acti6itatilor de autoingri=ire G G G si autogospodarire. G JAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; 6. !6aluare grad de handicap in mal7ormatii musculare; ;#;

@AAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G-+R+"!#RI G#este biometrice si musculare9 G G*&N(#ION+'IGDinamometrie pentru aprecierea 7ortei musculare - in 7unctie de G G Glocali are si tipul de sechela. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G G G&%O+R+ G G DAAAAAAAAAAAF G G8+NDI(+- G G G&%OR G G DAAAAAAAAAAAF Incadrarea in grad de handicap se reali ea a in 7unctie de G GD!*I(I!N#+ Glimitarea sau pierderea capacitatii de reali are a staticii) G G"!DI! Gmobilitatii sau5si gestualitatii. G DAAAAAAAAAAAF !6aluare in con7ormitate cu criteriile stabilite pentru G G8+NDI(+- Gpersoanele cu miopatii. G G"!DI& G G DAAAAAAAAAAAF G GD!*I(I!N#+ G G G+((!N#&+#+ G G DAAAAAAAAAAAF G G8+NDI(+- G G G+((!N#&+# G G DAAAAAAAAAAAF G GD!*I(I!N#+ G G G,R+>+ G G DAAAAAAAAAAAF G G8+NDI(+- G G G,R+> G G JAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; ; %e re7era la persoane cu anomalii si mal7ormatii congenitale sau contractate precoce 3copilarie adolescenta4) de e:$ hipertro7ii) redori) retractii musculare mutilante) care impiedica statica si locomotia. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala cu G%pri=in pentru asigurarea unui G G&%OR Ge6itarea celor care necesita Gloc de munca 7ara e7ort 7i ic G G Ggestualitate cu 6ite a si Gmare) deplasari posturale G G Gpreci ie si deplasari posturale Gprelungite sau) e6entual) pentru G G Gprelungite. Gschimbarea locului de munca. G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala cu G%pri=in pentru asigurarea unui G G"!DI& Ge6itarea celor care necesita Gloc de munca 7ara e7ort 7i ic G G Gmiscari cu 6ite a si preci ie si Gmare) deplasari posturale G G Gdeplasari posturale prelungite. Gprelungite sau) e6entual) pentru G

G G%unt contraindicate acti6itatile Gschimbarea locului de munca. G G Gcare impun 7inete) repere mici) G G G Gritm impus. G G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G+cti6itati cu e7ort 7i ic G-articipare in ca ul asigurarii G G+((!N#&+#Gneinsemnat) in postura Gunui loc de munca accesibil) G G Gpredominant se and) care nu G7ara e7ort 7i ic de intensitate G G Gnecesita 7inete) 6ite a) Gmare si medie) ortostatism G G Gcomple:itate si alternanta Gprelungit) deplasari posturale) G G Ggestuala. Gcare sa necesite suprasoclicitareG G GDe e:emplu$ munci de birou pentruGgestuala. G G Gcei cu pregatire superioara sau G%a 7ie scutite de e7orturi G G Gmedie. G7i ice mari. -entru aceasta sa seG G G Gutili e e sisteme mecanice de G G G Gmanipulare a greutatilor) sa se G G G Gmonte e sisteme de sustinere a G G G Gmainii pentru a e6ita oboseala G G G Gmusculara. G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G+u pierduta capacitatea de GNecesita asistent personal. G G,R+> Gautoser6ire) autogospodarire si G%pri=in pentru asigurarea unor G G Gautoingri=ire. Gmi=loace de deplasare 3baston) G G G Gcadru) 7otoliu rulant) carucior4.G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL ;%#; >. !>+'&+R! ,R+D D! 8+NDI(+- IN +*!(#+R!+ *&N(#II'OR D! (OORDON+R!; ;#; @AAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAC G-+R+"!#RI G!:amen neurologic$ tablou dominat de trei semne cardinale$ G G*&N(#ION+'IG 1. tremorul 3ritm lent) apare in repaus) uneori in mentinerea G G;; G unei atitudini - tremur postural4. G G G +spect caracteristic la membrele superioare - <numararea G G G banilor<) <rasucirea tigarilor<) iar la membrele in7erioare - G G G <pedalare<) <batut tactul<. G G G 2. rigiditate - 6arianta particulara de hipertonie -) G G G interesea a toate grupele musculare) predominand la radacina G G G membrelor - e6identiata prin 7enomenul de roata dintata9 G G G 3. bradi sau aPine ie 3apare imobil) cu acti6itate gestuala G G G saraca4. !6identiata prin proba marionetelor) batutul G G G tactului) pensa digitala cu 7iecare deget. G G G +spectul caracteristic$ 7acies 7i=at) imobil) atitudinea G G G caracteristica a capului si trunchiului 3inclinate4) mers G G G cu pasi mici) tulburari de 6obire. G G G!:amen obiecti6$ RO# 6ii) tulburari de motilitate oculara) G G Gtulburari 6egetati6e 3sialoree) hipercrinie4) tulburari psihice. G G G!:amene paraclinice$ G G G -!,) (# Q atro7ie corticala cu locali are in general 7rontala G G G si) uneori) hidroce7alie9 G G G !!, Q modi7icari di7u e e:primate prin acti6area undei #heta) G

G G predominand 7rontotemporal9 G G G !",$ decelea a caracteristicile 7i iologice ale tremuraturii G G G 3descarcari ritmice de 2-7 cicli5sec49 G G G Determinari biochimice 3do area dopaminei in '(R si urina G G G sau5si sanguin4. G G G G G G;; Di7erente nesemni7icati6e in 7unctie de structura a7ectata G G G care a determinat tulburarea de coordonare. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G%emne putin caracteristice) tulburari 6egetati6e) 7orme cu tremor G G&%O+R+ Gcu caracter locali at la membrele superioare 3hemisindrom G DAAAAAAAAAAAF-arPinson4) hipertonie discreta. %emnul Noica si tremur G G8+NDI(+- Gdiscret) e6identiat prin !",. G G&%OR G G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G%imptomatologie subiecti6a si modi7icari obiecti6e G G"!DI! Gcaracteristice. %unt de intensitate medie si tind sa G DAAAAAAAAAAAFde6ina permanente) in7luentate partial de tratament. G G8+NDI(+- G G G"!DI& G G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G*ormele la care predomina tremorul sau cele aPinetoG G+((!N#&+#+ Ghipertonice) la care simptomatologia este permanenta) G DAAAAAAAAAAAFin7luentata partial de terapie) insotite de tulburari de G G8+NDI(+- Glocomotie) statica si mers) de tulburari de manipulatie) G G+((!N#&+# Gdeglutitie) 7onatie si 6orbire. G DAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAF GD!*I(I!N#+ G*ormele clinice cu e6olutie indelungata care pot duce la G G,R+>+ Gimobili are. -ot 7i insotite de tulburari psihice si de G DAAAAAAAAAAAF6orbire 3a7a ie e:presi6a4. G G8+NDI(+- GDe7iciente de deglutitie si respiratie permanente) re istente G G,R+> Gla di6erse 6ariante terapeutice. G G G G JAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAL ;%#; ; %e re7era la$ a. %indroamele e:trapiramidale) de cau a di6ersa) postence7alitice) 6asculare) medicamentoase) to:ice) tumorale9 b. .oala -arPinson 3parali ie agitata49 c. (oreea cronica 8untington 3sindromul de neostriat-putamino-caudat4) care produce sindromul distonodisPinetic) tulburari locomotorii si gestuale) ce impiedica acti6itatea normala. .oala ereditara) cu debut de regula la 30-31 de ani. #ulburari 7unctionale asemanatoare sindromului e:trapiramidal) bolii -arPinson) cu deosebirea ca miscarile in6oluntare sunt mai ample si tulburarile psihice e6oluea a spre dementa lent progresi6a9 d. .oala \ilson - degenerescenta hepato-lenticulara 3sindromul de panstriat cu ata:ie) coreeo-ateto a cu a7ectarea posturii si gestualitatii4. +7ectiune metabolica cu determinare genetica) caracteri ata prin acumularea de cupru in %N() 7icat) cornee) rinichi) cu doua entitati$ - .oala \ilson - debut la 7-11 ani) dominata de rigiditate e:trapiramidala) 7acies hipomimic) bradiPine ie) puerilism) degradare in6oluti6a progresi6a.

- .oala \estphall - %trumpell - debut la 21-20 de ani) tablou clinic dominat de tremuratura ce declansea a spasme in musculatura opo itionala) de o 6iolenta mare) degradare psihica) modi7icari biochimice 3cupremia poate 7i sca uta4. ;#; @AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAC G G +(#I>I#+#I - 'I"I#+RI G -+R#I(I-+R! - N!(!%I#+#I G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- GOrice acti6itate pro7esionala cu G-articipare 7ara restrictii) cu G G&%OR Glimitarea celor care impun Gconditia asigurarii incadrarii G G Gpreci ie) 7inete in miscari) Gsau indrumarii pro7esionale spre G G Gsuprasolicitare 7i ica si Gun loc de munca adec6at. G G Gpsihica. G G G G G G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- +cti6itati pro7esionale care G- !ste necesar sa li se asigure G G"!DI& Gnu impun deplasari prelungite) Gun sistem de 7i:are si ghida= G G Gortostatism indelungat) miscari Gcare sa le permita e:ecutarea G G G3gesturi4 de 6ite a si preci ie. Gsarcinilor de munca. G G G- %unt indicate acti6itatile G- !6itarea acti6itatilor de G G Gstatice) cu solicitari 7i ice G7inete) cu repere mici. G G Greduse) in conditii de con7ort G- +sigurarea unui climat rela:antG G Gmicroambiental. G necon7lictual) in cadrul G G G Gcolecti6ului de munca si in G G G G7amilie. G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G- %unt incapabili de prestarea G- Necesita spri=in pentru G G+((!N#&+#Goricaror acti6itati pro7esionale.Gobtinerea de mi=loace de G G G- +utoser6irea este partial Gdeplasare 3baston) car=e) scaun G G Ga7ectata. Grulant49 G G G- %e pot deplasa cu mare G- "onitori area e6olutiei G G Gdi7icultate prin 7orte proprii) Gtulburarilor 7unctionale in G G Gnespri=init sau cu spri=in Gconditii de tratament corect G G Gunilateral. Gadministrat si sustinut. G G G G G DAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAF G8+NDI(+- G G- Necesita asistent personal. G G,R+> G- -ierderea capacitatii de G G G Gautoser6ire si autoingri=ire. G G G G- Nedeplasabili prin 7orte G G G Gproprii - este mobili at numai G G G Gcu a=utorul altei persoane. G G G G- #ulburarile de limba= 7ac G G G Gimposibila stabilirea relatiilor G G G Gcu mediul incon=urator. G G G G- #ulburarile de deglutitie si G G G Grespiratie permanente) impun G G G Gasistarea din partea altei G G G Gpersoane. G G JAAAAAAAAAKAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAL

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;*ont 0; AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAABAAAAAAAA AAAAAAAABAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAA G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ G D!*I(I!N#+ +*!(#I&N! -+R+"!#RI G &%O+R+ G "!DI! G +((!N#&+#+ G ,R+>+ *&N(#ION+'I DAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAA AAAAAAAAAAAAA G 8+NDI(+G 8+NDI(+G 8+NDI(+G 8+NDI(+G &%OR G "!DI& G +((!N#&+# G ,R+> ABAAAAAAAAAAAAABAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAEAAAAAAAA AAAAAAAAEAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAA G G%e 6or selecta G-soria is G-soria is cronicG-soria is G*ormele maligne G Gin 7unctie de Glocali at) Gcu acuti ari Ggenerali at sau Gde psoria is G -soria is Gmani7estarile Gsensibil la G7rec6ente. Gartropatic Gpustulos cu pusee G Gstructurale$ Gtratament. G Gnein7luentat de Gsubintrante) ca si G G- !:amen 7i ic G G Gtratament. Gin cel artropatic) DAAAAAAAAAAAAAFamanuntit9 DAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAFcu tulburari gra6e G G- !:amen G GIn 7ormele GIn 7ormele croniceGde gestualitate) G Gdermatologic9 G Gcronice cu Ggenerali ate cu Glocomotie. G G- !:amen biopticG Ge6olutie Graspuns inconstantG DG -em7igus G3in ca ul in G Gprelungita. Gsi in6i ibil la G eG Gcare sugerea a G G Gtratament) cu G rG Gmalignitate49 G G Greactii ad6erse G mG G- -unctieG G Gsi complicatii G aDAAAAAAAAAAAAAF- biopsie9 DAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAF tG G- !:amen G GIn 7ormele cu GIn 7ormele cu G oG Gmicroscopic G GhiperPerato a GhiperPerato a G G Gasupra produ- G Gla plante sau5siGgenerali ata) G eG Gselor obtinute G Gpalme care Gepidermolitice G G Ihtio a Gdupa ra uire9 G Glimitea a G3eritrodermia G G ereditara G- (ulturi- G Gortostatismul Gihtio i7orma G G Gantibiograma9 G Gsau5si Gcongenitala G G G- >i uali area G Ggestualitatea. Gbuloasa4 cu G G Gpielii in cameraG G Ge6olutie G G Gintunecata cu G G Gindelungata) care G G Glampa \ood9 G G Gnecesita tratamentG G G- #este de G G Gindelungat M 1 an.G DAAAAAAAAAAAAAFimuno7luoresDAAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAKAAAAAAAAAAAAAAAAAAKAAAA AAAAAAAAAAAAAA G Gcenta G- In 7ormele eso7agiene cu stricturi eso7agiene9 G G3imunelectro- G- In 7ormele retiniene cu de lipire de retina9 G!pidermoli a G7ore a49 G!6aluare grad de handicap in 7unctie de intensitatea tulburarilor de G buloasa G- ,licemie9 Gnutritie 3de7icit ponderal4 si de a7ectarea 7unctiilor G G- !:amen Gacuitatii 6i uale - 6e i criterii de e6aluare grad de handicap in G Gradiologic Ga7ectarea 7unctiei 6i uale. G G3in ca ul G DAAAAAAAAAAAAAFcomplicatiilor GAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAABAAAAA AAAAAAAAAAAAA G Garticulare GIn 7ormele GIn 7ormele cu GIn 7ormele cu GIn 7ormele cu G Gsecundare4. Gincipiente Gmodi7icari Galterari a6ansate Gtulburari mari de

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2. #umori maligne ale pielii) de e:. melanomul ;#; ;*ont 0; @AAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAA AAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAC G G GN!&RO*I.RO- G #&"ORI G G G G"+#O?+ G "+'I,N! G G G GR!(S'IN,8+ G +'! -I!'II G G G G &%!N G G G D!R"+#O?! G D!R"+#O"IO?I#+ G G G G G G G G DAAAAAAAAAAABAAAAAAAAAAAAAEAAAAAAAAAAAAABAAAAAAAAAAAAAEAAAA AAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAF G+cti6itati-G-articipare -G +cti6itati -G -articipare G+cti6itati - G+cti6itati G Glimitari G necesitati G limitari G Glimitari5 Glimitari5 G G G G G necesitati G-articipare -G-articipare G G G G G Gnecesitati Gnecesitati G @AAAAAAAAAEAAAAAAAAAAAEAAAAAAAAAAAAAEAAAAAAAAAAAAAEAAAAAAAA AAAAAEAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAF G &%OR GOrice G-articipare GOrice G-articipare G G G G Gacti6itate G7ara Gacti6itate G7ara G G G G G7ara Grestrictii. G7ara limitariGrestrictii. G G G G Glimitari. G G G G G G DAAAAAAAAAEAAAAAAAAAAAEAAAAAAAAAAAAAEAAAAAAAAAAAAAEAAAAAAAA AAAAAF G G G"!DI& GOrice G*ara restric-GOrice G*ara G G G G Gacti6itate Gtii cu Gacti6itate inGrestrictii cuG G G G Gcu e6itareaGconditia de Gconditii de Gasigurarea G G G G Ge:punerii Ga se asigura Gcon7ort Gigienei G G G G Gla soare) Go Gorganic. Gpersonale. G-re entate laGIn raport de G G G6ariatii Gimbracaminte G G Gpersoanele cuGstructura) 7unctiile G G Gtermice. Gadec6ata. G G Ga7ectari ale Ga7ectate si G G G G-reocup G G Gunor 7unctii Gintensitatea G G G Gare pentru G G Gneurologice) Gde7icientei G G G Gautoingri=ireG G Gpsihice) Gsau de7icientelor G G G Gsi igiena G G Glocomotorii Gpe care le generea a) G G G Gpersonala. G G Gsi de Gpierderea capacitatii G DAAAAAAAAAEAAAAAAAAAAAEAAAAAAAAAAAAAEAAAAAAAAAAAAAEAAAAAAAA AAAAAFNutritie. Gde autoser6ire si de G G+((!N#&+#G-+cti6itatiG+sigurarea G+cti6itati G"asuri G Gautoingri=ire. G G Gin conditiiGunui mediu G7ara supraso-Gcompensato G G G G Gde con7ort Gsocio7amilialGlicitare Grii sau G G G G Gorganic) Gsi de igiena G7i ica) Gadaptari ale G G G G Ge6itarea Gpersonala Ggestuala O5- Glocului de G G G G Gmediului Gcare sa nu Gposturala in Gmunca G G G G Gprea cald) Gagra6e e Gconditii Gpentru G G G G Gumed) uscatGa7ectarea Gambientale Greducerea G G G G Gcu G7unctiilor Gadec6ate. Ge7ortului G G G G Gsubstante Gde protectie G G7i ic) G G G G Giritante Gsi G Ggestual)O5- G G G G Gpentru Greparatorie G Gpostural. G G G G Gpiele. Gale pielii. G G G G G G G-+cti6itatiG G G G G G

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