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1
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ุจุณู… ุงู„ู„ู‡ ุงู„ุฑุญู…ู† ุงู„ุฑุญูŠู…ุŒ ุงู„ุญู…ุฏ ู„ู„ู‡ ุฑุจ ุงู„ุนุงู„ู…ูŠู†
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ูˆุงู„ุตู„ุงุฉ ูˆุงู„ุณู„ุงู… ุนู„ูŠูƒ ูŠุง ุฑุจ ุงู„ุฃู†ุจูŠุงุก ูˆุงู„ู…ุณู„ู…ูŠู†ุŒ
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ุณูŠุฏู†ุง ู…ุญู…ุฏูŠ ูˆุนู„ู‰ ุฃู‡ู„ูŠ ูˆุตุญุจูŠู‡ ูˆุณู„ู…ุŒ ุทู„ุงุจู†ุง
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ูˆุทุงู„ุจุงุชู†ุง ุงู„ุฃุนุฒุงุกุŒ ุจู†ูƒู…ู„ ู…ุนุงูƒู… ุงู† ุดุงุก ุงู„ู„ู‡ ุงู„ู„ูŠ ู‡ูŠ
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ุงู„ุฌุฒุก ุงู„ุซุงู†ูŠ ู…ู† ู…ุญุงุถุฑุฉ ุงู„ peripheral nerve
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mobilization ุฃุฎุฑ ุฅุดูŠ ุญูƒูŠู†ุง ููŠู‡ ุงู„ู„ูŠ ู‡ูˆ ุนู† ุชุตู†ูŠู ุงู„
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peripheral nerve injuries ูˆ ู‚ูˆู„ู†ุง ุฅู† ููŠ ุงู†ุฏูŠ
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ุชุตู†ูŠููŠู† ุงู„ุชุตู†ูŠู ุงู„ุฃูˆู„ ุงู„ู„ูŠ ู‡ูˆ ุณู…ู†ู‡ Sedans
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classification ุงู„ู„ูŠ ู‡ูˆ ู‚ุณู… ุตุนุจุงุช ุงู„ peripheral
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nerve injury ุฅู„ู‰ ุซู„ุงุซ ุฃู‚ุณุงู… ุฑุฆูŠุณูŠุฉ ุงู„ู„ูŠ ู‡ูŠ ุฃูˆู„
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ุญุงุฌุฉ ุงู„ neuropraxia ูˆ ุงู„ axonotemesis ูˆ ุงู„
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neurotemesisุงู„ุชุตู†ูŠู ุงู„ุซุงู†ูŠ ุนู†ุฏูŠ ุงู„ู„ูŠ ู‡ูˆ ุจู†ุณู…ูŠู‡
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Sunderland's classification
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ูˆ ุงู„ Sunderland's ู‡ูˆ ุจูŠู‚ุณู…ู‡ุง ู„ุฎู…ุณ ู…ุณุชูˆูŠุงุช ุฑุฆูŠุณูŠุฉ
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ุชู…ุงู…ุŸ first degree, second degree, third degree,
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fourth degree ูˆ ุงู„ fifth degreeุงู„ .. ุงู„ first
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degree ุงู„ู„ูŠ ู‡ูˆ ุจูŠู‚ุงุจู„ ุนู†ุฏูŠ ู„ neuropraxia minimal
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structure disruption complete recovery ู‡ู†ุง ุทุจุนุง
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ู‚ู„ู†ุง ุงู„ู„ูŠ ู‡ูŠ neuropraxia ุงู„ู„ูŠ ุจูŠูƒูˆู† ููŠู‡ ุถุบุท ู…ุคู‚ุช
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ุนู„ู‰ ุงู„ุนุตุจุŒ ุงู„ุถุบุท ู‡ุฐุง ููŠ ุญุงู„ ุงู†ุชู‡ู‰ ุจูŠุฑุฌุน ุงู„ุนุตุจ ุฅู„ู‰
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ูˆุทู†ู‡ ุงู„ุทุจูŠุนูŠ ุจุดูƒู„ ูƒุงู…ู„ุŒ full recovery, complete
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recovery ุงู„ .. ุงู„ second degree ุงู„ู„ูŠ ู‡ูˆ ู…ู‚ุงุจู„ ุนู†ุฏูŠ
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ู„ู„axonotemesis ุงู„ู„ูŠ ู‡ูˆ ุจูŠูƒูˆู† ููŠู‡ ุนู†ุฏู‡ ุถุบุท ูˆุตู„
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ู„ู„axon ู†ูุณู‡ุงู„ complete axonal disruption with
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ovarian degeneration usually complete recovery ูˆ
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ู‡ุฐุง ุจูŠุตูŠุฑ ููŠ .. ูŠุนู†ูŠ ู‡ู… ุชู‚ุฑูŠุจุง ู‚ุณู…ูˆุง ุงู„ .. ุงู„ ..
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ุงู„ axonotomies ุชู…ุงู… ู‡ูˆ ู…ู‚ุงุจู„ู‡ ุงู„ second degreeูˆ ุงู„
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third degree ุฌุงูŠ ู…ุง ุจูŠู† ุงู„ axon ูˆ ู…ุง ุจูŠู† ุงู„
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neurotemesis ูˆ ุงู„ fourth degree ูˆ ุงู„ fifth degree
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ู‡ุฐู‡ ุจุฑุถู‡ ุจุชูƒูˆู† neurotemesis ุทูŠุจ ุงู„ third degree
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may be either axonotemesis or neurotemesis
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disruption of axon and endoneuron ุชู…ุงู… ู‡ู†ุง ุจูƒูˆู† ููŠ
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ุนู†ุฏูŠ ุฅุตุงุจุฉ ู„ู„axon ุฒุงุฆุฏ ุฏุฎู„ ุนู„ู‰ ุงู„ endoneuronูˆ ู‡ู†ุง
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ุจูƒูˆู† ููŠ ุนู†ุฏูŠ poor prognosis without surgery ุตุนุจ
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ุฅู†ู‡ ูŠุฑุฌุน ู„ูˆุถุนู‡ ุงู„ุทุจูŠุนูŠ ุจุฏูˆู† ุงู„ู„ูŠ ู‡ูŠ ุฌุฑุงุญุฉ ุงู„
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fourth degree ุงู„ neurotemesis ุงู„ู„ูŠ ุงุญู†ุง ู‡ู†ุง ุจูƒูˆู†
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ููŠ ุนู†ุฏูŠ complete ุญูƒูŠู†ุง cut ู„ .. ู„ ุงู„ axon ุชู…ุงู…ุŸ
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ู‡ู†ุง ุจูƒูˆู† ููŠ ุนู†ุฏูŠ ู‚ุณู…ู‡ุง ุงู„ fourth degree disruption
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of axon in the neuron and perineuron poor
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prognosis without surgeryู‡ู†ุง ุงู„ู„ูŠ ู‡ูŠ ู‚ุงู„ู„ูŠ ุงู†ู‡ ู‡ู†ุง
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ููŠู‡ ุงู†ุฏู‚ุงุทุน ู„ู„ุฃูƒุณูˆู† ุฒุงุฆุฏ ุงู„ู„ูŠ ู‡ูŠ ุงู„ connective
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tissue ุงู„ู„ูŠ ุญูˆุงู„ูŠู‡ ุชู…ุงู… ุงู„ fifth degree complete
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ูŠุนู†ูŠ ู‡ู†ุง ููŠ ุงู„ fourth degree ุจุชูƒูˆู† partial ..
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partial disruption ูŠุนู†ูŠ ู„ู„ุฃูƒุณูˆู† ูˆ ุงู„ .. ูˆ ุงู„
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connective tissueูŠุนู†ูŠ ุจูƒูˆู† ุฌุฒุฆูŠ ู„ูƒู† ููŠ ุงู„ fifth
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degree ุจุชูƒูˆู† complete structural disruption ูˆู‡ู†ุง
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ุจูƒูˆู† poor prognosis without micro surgery ุจุฏูˆู†
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ุฌุฑุงุญุฉ ุฏู‚ูŠู‚ุฉ ู„ู„ูŠ ุงู„ู„ูŠ ู‡ูŠ ุฅูŠุด ุงู„ุนุตุจ ู„ูŠุด ู„ุฃู† ูƒู„ ุงู„ ..
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ุญุชู‰ ุงู„ุฃุนุถุงุก ุงู„ุฏุงุฎู„ูŠุฉ ุงู„ู„ูŠ ุฏุงุฎู„ ุงู„ุนุตุจ ู†ูุณู‡ุง ูƒู„ู‡ุง
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ู…ู‚ุทูˆุนุฉ ุจุดูƒู„ ูƒุงู…ู„ ูˆู‡ุฐู‡ ุจุฏู‡ุง ุทุจุนุง ุชูˆุตูŠู„ ุจุดูƒู„ ุฏู‚ูŠู‚
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ุนู„ุดุงู† ูŠุฑุฌุน ุงู„ุนุตุจ ุฃูˆ ูŠุตูŠุฑ ููŠ ุนู†ุฏูŠ ุงู„ู„ูŠ ู‡ูˆ ุฅูŠุด ุงู„
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recovery
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ู†ูƒู…ู„ Recovery from nerve injuries ู‡ู„ ุงู„ nerve ู„ูˆ
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ุตุงุฑู„ู‡ ู‚ุทุน ุฃูˆ cut partial ุณูˆุงุก ุฃูˆ complete ู‡ู„ ู…ู…ูƒู†
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ูŠุฑุฌุน ูˆู„ุง ู„ุฃุŸ ู…ู…ูƒู† ูˆู…ู…ูƒู† ู„ุฃ ุญุณุจ ููŠ ุนู†ุฏูŠ ุจุนุถ ุงู„ู„ูŠ ู‡ูŠ
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ุนุงูŠุด ุงู„ู…ุนุงูŠูŠุฑ ุงู„ู„ูŠ ุฃู†ุง ุจู†ุงุก ุนู„ูŠู‡ุง ุจู‚ุฏุฑูŠุนู†ูŠ ุฃุชูˆู‚ุน
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ุฃูˆ ุฃุฎู…ู† ุฃู†ู‡ ูˆุงู„ู„ู‡ ู…ู…ูƒู† ูŠุตูŠุฑ ููŠู‡ end recovery ูˆู„ุง
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ู„ุฃุŸ Nerve tissue that has become irritated from
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tension, compression or hypoxia may not have
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permanent damage and show signs of recovery ู…ู…ูƒู†
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ูŠุตูŠุฑ ููŠู‡ end recoverywhen the irritating factors
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are eliminated ู„ู…ุง ุงู„ุดุบู„ ุงูˆ ุงู„ู…ุณุจุจ ุงู„ู„ูŠ ุณุจุจู„ูŠ
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ุงู„ุถุบุท ุงูˆ ุณุจุจู„ูŠ ุงู„ tension ุงู„ุดุฏ ุงู„ู„ูŠ ููŠ ุงู„ุนุตุจ ุงูˆ ุงูˆ
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ุงุฎุฑ ุงุฎุชูู‰ ู…ู…ูƒู† ุงู†ู‡ ูŠุตูŠุฑ ููŠ ุนู†ุฏูŠ recoveryุฅูŠุด ุจุงู„ุธุจุท
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ุงู„ู…ุญุฏุฏุงุชุŸ when the nerve has been injured,
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recovery is dependent on several factorsุŒ ุฅุฐู† ู‡ูˆ
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ุงู„ recovery ุฃูˆ ุงู„ุชุนุงููŠ ุชู…ุงู… ู„ู„ุนุตุจ ุจูŠุนุชู…ุฏ ุนู„ู‰ ุนุฏุฉ
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ุนูˆุงู…ู„ including ุฃูˆู„ ุญุงุฌุฉ the extent of injury to
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the axelุŒ ู‚ุฏุงุด ุงุชุฃุซุฑ ุงู„ axelุŒ ู‚ุฏุงุด ุตุงุฑ ุนู„ูŠู‡ ..
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ู‚ุฏุงุดูŠุนู†ูŠ ุตุงุฑ ููŠ ู‚ุทุนุŒ ุตุงุฑ ููŠ partialุŒ ุตุงุฑ ููŠ
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completeุŒ ุตุงุฑ ููŠ ุถุบุท ุจุณ ุนู„ูŠู‡ ู„ูุชุฑุฉ ู…ุญุฏูˆุฏุฉุŒ ุตุงุฑ ููŠ
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ุนู„ูŠู‡ ุถุบุท ู„ูุชุฑุฉ ุทูˆูŠู„ุฉุŒ ู‚ุฏุงุด ุจุงู„ุธุจุท ุงู„ extent of
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injuryุŒ ู‚ุฏุงุด severityุŒ ุดุฏุฉ ุงู„ุฅุตุงุจุฉ ุงู„ู„ูŠ ุงุชุนุฑุถ ู„ู‡ุง
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ุงู„ axel and its surrounding connective tissue ูˆ ุงู„
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connective tissue ุงู„ู„ูŠ ุญูˆุงู„ู‡ุงthe nature and level
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of the injury ุทุจูŠุนุฉ ุงู„ุฅุตุงุจุฉ ูˆ ุงู„ level ุงู„ู…ุณุชูˆู‰
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ุชุจุนู‡ุง ู‡ู„ุฌูŠุช ุงู„ุนุตุจ ูŠุง ุฌู…ุงุนุฉ ุงุฐุง ุงู†ู‚ุทุน ู…ุซู„ุง ุงูˆ ุงุชุฃุซุฑ
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ู…ู† ููˆู‚ ุชู…ุงู… ู…ู† ููˆู‚ ูƒู„ ุงู„ู„ูŠ ุชุญุช ุจุชุฃุซุฑ ูƒู„ ุงู„ุนุถู„ุงุช
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00:05:16,700 --> 00:05:19,880
ุงู„ู„ูŠ ุชุญุช ุจุชุชุฃุซุฑ ุตุญ ูˆู„ุง ู„ุฃ ู…ุซู„ุง ู„ูˆ ุฌูŠู†ุง ุนู„ู‰ ุงู„
80
00:05:20,800 --> 00:05:24,920
Plexus ุงู„ู„ูŠ ู‡ูˆ ู‡ุฐุง ุงู„ุฌุฐุน ุชุจุน ุงู„ุนุตุจ ุงู„ู„ูŠ ููŠ ุงู„ุฅูŠุฏ
81
00:05:24,920 --> 00:05:27,720
ุชู…ุงู… ุงู„ู„ูŠ ุจูŠุทู„ุน ู…ู†ู‡ ุงู„ radial nerve ูˆ ุงู„ ulnar
82
00:05:27,720 --> 00:05:30,920
nerve ูˆ ุงู„ medial nerve ูู„ู‚ูŠุช ู„ูˆ ุงู†ุถุฑุจ ุงู„ุนุตุจ ู‡ุฐุง
83
00:05:30,920 --> 00:05:34,640
ู…ู† ููˆู‚ ู…ู† ุงู„ุฌุฐุฑ ุชุจุนู‡ ูƒู„ ุงู„ุนุตุงุจ ุงู„ู„ูŠ ุชุญุชู‡ ู‡ุชุชุฃุซุฑ
84
00:05:34,640 --> 00:05:38,420
ุฅุฐุง ุงู„ level ู…ุณุชูˆู‰ ุชุจุนู‡ ุตุญุŸ ุทูŠุจ ู„ูˆ ุฃุฌูŠู†ุง ุฃู‚ูˆู„ู†ุง ุฅู†
85
00:05:38,420 --> 00:05:42,060
ุงู„ spinal cord ู…ุซู„ุง ุชู…ุงู… ุงู„ุญุจู„ ุงู„ุดูƒูˆูŠ ุตุงุฑ ููŠ ุนู†ุฏู‡
86
00:05:42,060 --> 00:05:46,540
ุฅุตุงุจุฉ ู…ู† ู…ู† ุงู„ู„ูŠ ู‡ูŠ ุงู„ cervical vertebra ู…ู† ุงู„ู„ูŠ
87
00:05:46,540 --> 00:05:50,720
ู‡ูŠ ูู‚ุฑุงุช ุงู„ุฑู‚ุจุฉูƒู„ ุงู„ู„ูŠ ุชุญุช ู‡ูŠูƒูˆู† ู…ุถุฑูˆุจุŒ ู‡ูŠุชุฃุซุฑ
88
00:05:50,720 --> 00:05:54,260
ุจู‡ุฐุง ุงู„ุฅุตุงุจุฉุŒ ู„ูƒู† ู„ูˆ ูƒุงู†ุช ุงู„ุฅุตุงุจุฉ ู…ุซู„ุง ุชุญุชุŒ ููŠ ุนุถู„
89
00:05:54,260 --> 00:05:57,860
.. ููŠ ูู‚ุฑุงุช ุงู„ุฏู‡ุฑ ู…ู† ุชุญุช ุชู…ุงู…ุŒ ูƒู„ ุงู„ู„ูŠ ููˆู‚ ู…ุด
90
00:05:57,860 --> 00:06:03,350
ู‡ูŠุชุฃุซุฑุŒ ู‡ูŠุชุฃุซุฑ ุจุณ ุงู„ู„ูŠ ู‡ูˆ ุชุญุช ู…ุณุชูˆู‰ ุงู„ุฅุตุงุจุฉุทูŠุจ ุงู„
91
00:06:03,350 --> 00:06:06,510
nature of injury ุทุจูŠุนุฉ ุงู„ุฅุตุงุจุฉ ู‡ู„ ุทุจูŠุนุฉ ุงู„ุฅุตุงุจุฉ
92
00:06:06,510 --> 00:06:11,030
ู‡ุฐู‡ ู…ุซู„ุง ูƒุงู†ุช ูู‚ุท ุถุบุท ูˆ ุจุณ ูˆ ุงู†ุชู‡ู‰ ูˆ ู„ุง ู‚ุทุน ูˆุงุญุฏ
93
00:06:11,030 --> 00:06:15,250
ุฃูƒู„ ุณูƒูŠู† ู…ุซู„ุง ูˆ ู‚ุทุนุช ุงู„ุนุตุงุจ ุนู†ุฏู‡ ูˆ ู„ุง ุญุฑู‚ ูˆ ุงู†ุญุฑุฌุช
94
00:06:15,250 --> 00:06:18,890
ุงู„ุนุตุงุจ ุงู„ู„ูŠ ู…ูˆุฌูˆุฏ ููŠ ุงู„ู…ู†ุทู‚ุฉ ู‡ุฐู‡ ูˆ ู„ุง ู…ุซู„ุง ูƒุณุฑ ูˆ
95
00:06:18,890 --> 00:06:22,950
ุงู„ูƒุณุฑ ู‡ุฐุง ุฑุงุญ ุฎุฏุด ุงู„ุนุตุงุจ ุญุณุจ ุทุจูŠุนุฉ ุงู„ุฅุตุงุจุฉ ู†ูุณู‡ุง
96
00:06:22,950 --> 00:06:26,910
the timing and techniques of the repair if
97
00:06:26,910 --> 00:06:32,950
necessary ุทูŠุจ ู‚ุฏุงุด ุงู„ูˆุฌุฏ ุงู„ู„ูŠ ุงุณุชุบุฑู‚ูˆุงุนู„ุดุงู† ูŠู‚ุฏุฑ
98
00:06:32,950 --> 00:06:36,490
ูŠุนู…ู„ ุงู„ุนู…ู„ูŠุฉ ู‡ุฐู‡ ูˆ ูŠุนู…ู„ ุชุตู„ูŠุญ repaired ูŠุนู…ู„
99
00:06:36,490 --> 00:06:40,910
ุงู„ุนู…ู„ูŠุฉ ุนู„ุดุงู† ูŠุดุจูƒ ุงู„ุนุตุจ ุงู„ู„ูŠ ุตุงุฑ ููŠู‡ ุงู„ู‚ุทุงุฑ ุทุจุนุง
100
00:06:40,910 --> 00:06:45,250
ูƒู„ ู…ุง ุทูˆู„ู†ุง ุงุญู†ุง ููŠู‡ ุงู†ู‡ ุงู„ุนู…ู„ูŠุฉ ูƒู„ ู…ุง ุทุจุนุง ูƒุงู†ุช
101
00:06:45,250 --> 00:06:49,390
ูุฑุตุฉ ุงู„ recovery ุจุชูƒูˆู† ุงูŠุด ุถุนูŠูุฉ ูŠุนู†ูŠ ู‡ุฐู‡ ุงู„ุนู…ู„ูŠุงุช
102
00:06:49,390 --> 00:06:53,670
ุจุฏู‡ุง ุณุฑุนุฉ ููˆุฑุง ุนู„ู‰ ุทูˆู„ ูŠุดุจูƒ ุงู„ุนุตุจ ูˆ .. ูˆ ูŠุนู…ู„
103
00:06:53,670 --> 00:06:58,700
ุงู„ุนู…ู„ูŠุฉ ุนู„ุดุงู† ุชู…ุงู… ูŠู†ู…ูˆ ุงู„ุนุตุจ ุจุดูƒู„ ุฃุณุฑุนand the age
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and motivation of the personุŒ ู‚ุฏุงุด ุนู…ุฑ .. ุงู„ุนู…ุฑ
105
00:07:01,720 --> 00:07:05,140
ุงู„ุดุฎุต ู†ูุณู‡ motivationุŒ ุงู„ุญุงู„ุฉ ุงู„ู†ูุณูŠุฉ ุชุจุนุชู‡ุŒ
106
00:07:05,140 --> 00:07:09,020
ุงู„ุญุงู„ุฉ ุงู„ู†ูุณูŠุฉ ุจุชูุฑุฌ ูƒุชูŠุฑ ููŠ ู…ูˆุถูˆุน ุงู„ู„ูŠ ู‡ูŠ ุฅูŠุด ุงู„
107
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recovery ู„ู„ุนุตุจ
108
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ุงู„ nature and level of injury, the more damage to
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00:07:16,200 --> 00:07:18,880
the nerve and tissue, the more tissue reaction and
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00:07:18,880 --> 00:07:23,260
scarring occur ูƒู„ ู…ุง ุงุชุฃุซุฑุช .. ูƒู„ ู…ุง ุงุชุฃุซุฑ ุงู„ุนุตุจ
111
00:07:23,260 --> 00:07:27,620
ุฃูƒุซุฑุŒ ูƒู„ ู…ุง ูƒุงู†ุช ูŠุนู†ูŠ ู‚ุฏุงุด ู…ุซู„ุง ู„ูˆ ู‚ูˆู„ู†ุง ุทูˆู„ ุงู„ุนุตุจ
112
00:07:27,620 --> 00:07:32,700
ุงู„ู„ูŠ ุงุชุฃุซุฑ ุฎู„ูŠู†ุง ู†ู‚ูˆู„ ู…ุซู„ุง ูƒุงู† ุซู…ุงู†ูŠู† ุตุงู†ุชูŠู„ูˆ ..
113
00:07:32,700 --> 00:07:36,600
ู„ูˆ ูƒู„ ู…ุง ูƒุงู† ู…ุซู„ุง ุทูˆู„ ุงู„ุนุตุจ ู…ุชุฃุซุฑ ุฃูƒุชุฑุŒ ูŠุนู†ูŠ ู…ุซู„ุง
114
00:07:36,600 --> 00:07:40,060
6 centimeter ู…ู† 8 centimeter ู‡ู… ุงู„ู…ุชุฃุซุฑูŠู†ุŒ ูƒู„ ู…ุง
115
00:07:40,060 --> 00:07:43,600
ูƒุงู† ููŠ ุนู†ุฏูŠ ุชู„ู ููŠ ุงู„ุฎู„ุงูŠุง ุฃูƒุชุฑุŒ ููŠ .. ููŠ ุงู„ุฎู„ุงูŠุง
116
00:07:43,600 --> 00:07:46,800
ุงู„ุนุตุจูŠุฉ ูˆ ูƒู„ ู…ุง ูƒุงู† ููŠ ุนู†ุฏูŠ ุงุชุฌุงู‡ ู„ู„ุนุตุจ ุฃู† ูŠุตูŠุฑ
117
00:07:46,800 --> 00:07:50,620
ููŠู‡ scarringุŒ ุฅูŠุด ูŠุนู†ูŠ scarringุŸ scarring ูŠุนู†ูŠ
118
00:07:50,620 --> 00:07:56,550
ูŠุชุญูˆู„ ุชู…ุงู… ู„ fibersุŒ ูŠุนู†ูŠ ู‡ุฐุง ู…ุงููŠุด ููŠู‡ ุฑุฌุนุฉุชู…ุงู…ุŸ
119
00:07:56,550 --> 00:07:59,890
ุทูŠุจ also the proximal aspect of the nerve has
120
00:07:59,890 --> 00:08:03,410
greater combination of motor, sensory and
121
00:08:03,410 --> 00:08:09,210
sympathetic fibers, so disruption there result in
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00:08:09,210 --> 00:08:13,190
a greater chance of mismatching the fibers, thus
123
00:08:13,190 --> 00:08:14,590
affecting regeneration
124
00:08:16,880 --> 00:08:20,420
ุฅุฐุง ุงุชุตุงูˆุจ ููŠ ุจุฏุงูŠุชู‡ุŒ ููŠ ุจุฏุงูŠุฉ ุงู„ุนุตุจุŒ ูŠุนู†ูŠ ูˆูŠู†
125
00:08:20,420 --> 00:08:24,320
ุงู„ุนุตุจ ุจุจุฏุฃ ูŠู…ุดูŠ ุชู…ุงู…ุŒ ุจู‚ูˆู„ู„ูŠ ุฅู† ุงู„ุนุตุจ ููŠ ุจุฏุงูŠุชู‡
126
00:08:24,320 --> 00:08:27,780
ุจุชูƒูˆู† ุงู„ุชูุฑุนุงุช ุชุจุนุชู‡ ู…ูˆุฌูˆุฏุฉุŒ ู…ุง ู‡ูˆ ุงู„ุนุตุจ ููŠ ู…ู†ู‡
127
00:08:27,780 --> 00:08:31,900
sensory ุจูŠูƒูˆู† ุทุงู„ุน ูˆ ููŠ ู…ู†ู‡ ุทุงู„ุน motor ูˆ ููŠ ุจูŠูƒูˆู†
128
00:08:31,900 --> 00:08:34,620
ู…ู†ู‡ ุทุงู„ุน ุณู†ุจุซุชูƒุŒ ูŠุนู†ูŠ ุจูŠูƒูˆู† ุทุงู„ุน ู…ู† ุนู†ุฏู‡ ุซู„ุงุซ
129
00:08:34,620 --> 00:08:38,200
ูุฑูˆุนุŒ ุงู„ุซู„ุงุซ ูุฑูˆุน ู‡ุฐู‡ ุจุชู„ุชู‚ูŠ ูˆูŠู†ุŸุจุชู„ุชู‚ูŠ ููŠ ุจุฏุงูŠุฉ
130
00:08:38,200 --> 00:08:41,380
ุงู„ุนุตุจ ุจุนุฏูŠู† ุจุชุจุฏุฃ ุชุชูุฑุน ุทุจ ู„ูˆ ุตุงุฑุช ุงู„ุฅุตุงุจุฉ ููŠ
131
00:08:41,380 --> 00:08:45,360
ุจุฏุงูŠุฉ ุงู„ุนุตุจ ู…ุนู†ุงู‡ ุฐู„ูƒ ุฃู†ู‡ ู‡ูŠุชุฃุซุฑ ุนู†ุฏ ุงู„ sensory ูˆ
132
00:08:45,360 --> 00:08:49,440
ุงู„ motor ูˆูŠู‡ ุงู„ู„ูŠ ู‡ูˆ ุงู„ sympathetic ูู‡ุฐุง ุจูŠุฃุซุฑ ุนู„ู‰
133
00:08:49,440 --> 00:08:53,500
ู†ู…ูˆ ุงู„ุนุตุจ ูˆ ุจูŠุฃุซุฑ ุนู„ู‰ ูุฑุตุชู‡ ููŠ ุญุฏูˆุซ ุงู„ recovery
134
00:08:55,790 --> 00:08:59,810
regeneration is often said to occur at rate of one
135
00:08:59,810 --> 00:09:04,090
millimeter per day ู‡ุฐุง ุฑู‚ู… ู…ุด ู„ุงุฒู… ุชู†ุณูˆู‡ ุฎุงู„ุต ุงู†ู‡
136
00:09:04,090 --> 00:09:08,950
ู‚ุฏุงุด ุงู„ุนุตุจ ูŠู†ู…ูˆ ูŠูˆู…ูŠุง ู„ูˆ ุฃู†ุง ุดุจูƒุช ุงู„ุนุตุงุจูŠู† ุชู…ุงู…
137
00:09:08,950 --> 00:09:12,470
ุตุงุฑ ู…ุซู„ุง ู‚ุทุน ููŠ ุงู„ุนุตุจ ูˆู‚ุฑุจุชู‡ู… ุนู„ู‰ ุจุนุถ ุนู„ุดุงู† ูŠู†ู…ูˆ
138
00:09:12,470 --> 00:09:19,060
ุงู„ุนุตุจ ูŠุดุจูƒ ููŠ ุจุนุถู‡ุจูŠู†ู…ูˆ ุจู‚ุฏุฑ ูˆุงุญุฏ ู…ู„ูŠ ู…ุชุฑ ููŠ ุงู„ูŠูˆู…
139
00:09:19,060 --> 00:09:25,280
ุงู„ูˆุงุญุฏ ูˆุงุญุฏ ู…ู„ูŠ ู…ุชุฑ ููŠ ุงู„ูŠูˆู… ุงู„ูˆุงุญุฏ portraits from
140
00:09:25,280 --> 00:09:31,260
point five to nine ุชู…ุงู… point ู‡ูŠ ุงู„ู…ูุฑูˆุถ point
141
00:09:31,260 --> 00:09:39,040
nine ุชู…ุงู… ู‡ุฐุง ุงู„ู…ูุฑูˆุถ point nine okay
142
00:09:43,540 --> 00:09:46,620
millimeter per day have been reported based on the
143
00:09:46,620 --> 00:09:50,160
nature and severity of the injury ู„ูƒู† ููŠ ู†ุงุณ ุณุฌู„ูˆุง
144
00:09:50,160 --> 00:09:54,600
ูŠุนู†ูŠ ุชู‚ุฑูŠุจุง ู†ุต millimeter per day ู„ุนู†ุฏ point ุชุณุนุฉ
145
00:09:54,600 --> 00:09:59,020
ู…ู† ุนุดุฑุฉ ู„ูƒู† ู‡ูˆ ุงู„ุฑู‚ู… ุงู„ู…ุชูู‚ ุนู„ูŠู‡ ุนุงู„ู…ูŠุง ุงู„ู„ูŠ ู‡ูˆ
146
00:09:59,020 --> 00:10:05,310
ูˆุงุญุฏ millimeterูˆ ุจุชุฎุชู„ู ู…ู† ูˆ ุญุณุจ ู…ุซู„ุง ูƒุจุฑ ุงู„ุณู†
147
00:10:05,310 --> 00:10:10,130
ุชุจุนุชู‡ ุญุณุจ ุงู„ู„ูŠ ู‡ูŠ ุฅูŠุด duration of denervation ุญุณุจ
148
00:10:10,130 --> 00:10:13,390
ุงู„ condition of the tissue and surgery is required
149
00:10:13,390 --> 00:10:17,950
ุญุณุจ ูƒู„ ู‡ุฐู‡ ุงู„ุฃู…ูˆุฑ ุทุจุนุง ุฅู„ู‡ุง ู…ุนุงูŠุฑู‡ุง ุงู„ุฎุงุตุฉ ุงู„
150
00:10:17,950 --> 00:10:21,650
timing and techniques of repair laceration or
151
00:10:21,650 --> 00:10:24,450
crush injuries that disrupt the integrity of the
152
00:10:24,450 --> 00:10:28,940
entire nerve requires surgical repairูŠุนู†ูŠ ูƒู„ ู…ูƒุงู†ุฉ
153
00:10:28,940 --> 00:10:32,240
ุงู„ุฅุตุงุจุฉ ููŠ ุงู„ุนุตุจ ู…ู† ุงู„ุฏุงุฎู„ ู…ุนู†ุงู‡ ุฐู„ูƒ ุฃู† ู‡ุฐุง ุจูŠุญุชุงุฌ
154
00:10:32,240 --> 00:10:36,620
ู„ุฅูŠุดุŸ ู„ุนู…ู„ูŠุฉ ุฌุฑุงุญูŠุฉ surgical repair for optimal
155
00:10:36,620 --> 00:10:40,600
nerve regeneration timing of the repair is
156
00:10:40,600 --> 00:10:44,200
critical as are the skill of the surgeon and
157
00:10:44,200 --> 00:10:47,480
technique used to align the segments accurately
158
00:10:47,480 --> 00:10:52,780
ูŠุนู†ูŠ ุฅุฐุง ูƒุงู† ููŠ ุนู†ุฏูŠ ู‚ุทุน ููŠ ุงู„ุนุตุจ ุชู…ุงู… ู…ู‡ู… ุฌุฏุง ุงู„
159
00:10:52,780 --> 00:10:56,660
time ู‚ุฏุงุด ุงู„ูุชุฑุฉ ุงู„ุฒู…ู†ูŠุฉ ุงู„ู„ูŠ ุจูŠุงุฎุฏู‡ุง ุงู„ู…ุฑูŠุถ ุนู„ุดุงู†
160
00:10:57,180 --> 00:11:01,580
ุชู…ุงู… ูŠุนู…ู„ ุงู„ุนู…ู„ูŠุฉ ุงู„ุฌุฑุงุญูŠุฉุŒ ู„ุงุฒู… ูŠูƒูˆู† ุงู„ูˆู‚ุช ู‚ู„ูŠู„
161
00:11:01,580 --> 00:11:05,560
ุฌุฏุงุŒ ูƒู„ ู…ุง ุฒุงุฏ ุงู„ูˆู‚ุช ูƒู„ ู…ุง ูƒุงู†ุช ูุฑุตุฉ ุงู„ุนุตุจ ููŠ ุงู†ู‡
162
00:11:05,560 --> 00:11:08,740
ูŠุตูŠุฑ ู„ู‡ regenerationุŒ ุงู†ู‡ ูŠู†ู…ูˆ ุงูˆ ูŠุตูŠุฑ recovery
163
00:11:08,740 --> 00:11:13,160
ุจุชูƒูˆู† ุถุนูŠู ุฌุฏุงู‡ุฐุง ุฑู‚ู… ูˆุงุญุฏุŒ ุฑู‚ู… ุงุชู†ูŠู† ู‡ุฐุง ุจูŠุนุชู…ุฏ
164
00:11:13,160 --> 00:11:16,720
ุนู„ู‰ ุงู„ skill of the surgeon ุงู„ู„ูŠ ู‡ูˆ ุงู„ู…ู‡ุงุฑุงุช
165
00:11:16,720 --> 00:11:21,320
ุงู„ุฌุฑุงุญ ู†ูุณู‡ ูˆ ู„ุฐู„ูƒ ุจู†ู„ุงู‚ูŠ ููŠ ุนู†ุฏูŠ ุชุฎุตูŠุตุงุช ุฃุนุตุงุจ
166
00:11:21,320 --> 00:11:26,500
ุงู„ุฌุฑุงุญุงุช ุฃูˆ ุชุฎุตูŠุต ุฌุฑุงุญ ุฃุนุตุงุจ ุทุฑููŠุฉ ุชู…ุงู…ุŸ ู‡ุฐุง ุทุจุนุง
167
00:11:26,500 --> 00:11:29,720
ุจูŠูƒูˆู† ุจูŠุดุชุบู„ ู‡ุฐู‡ ุจู†ุณู…ูŠู‡ุง ุงู„ micro surgery ุงู„ู„ูŠ ู‡ูŠ
168
00:11:29,720 --> 00:11:34,760
ุงู„ุนู…ู„ูŠุงุช ุงู„ุฌุฑุงุญูŠุฉุงู„ุฏู‚ูŠู‚ุฉ ุฌุฏุง ุฌุฏุง ุงู„ู„ูŠ ุจุชู‚ุฏุฑ ุงู†ู‡ุช
169
00:11:34,760 --> 00:11:39,500
ู„ุฃู†ู‡ ุงู„ุฃุนุตุงุจ .. ุงู„ุฃุนุตุงุจ ุจุชูƒูˆู† ุนุจุงุฑุฉ ุนู† ุดุนูŠุฑุงุช
170
00:11:39,500 --> 00:11:42,960
ุตุบูŠุฑุฉ ุฌุฏุง ูˆู‡ุฐู‡ ู„ู…ุง ุงู†ุช ุจุฏูƒ ุชุดุจูƒู‡ุง ููŠ ุจุนุถ ู‡ุงู„ุจุนุถ
171
00:11:42,960 --> 00:11:47,460
ุชู…ุงู… ุฃูˆ ุชุนู…ู„ู‡ุง suturing ุชุฎูŠุทู‡ุง ุฃูˆ ุงู†ูƒ ุชุนู…ู„ู‡ุง
172
00:11:47,460 --> 00:11:52,160
approximation ุชู‚ุฑุจู‡ุง ู„ุจุนุถ ู‡ุงู„ุจุนุถูู‡ุฐู‡ ุจุชูƒูˆู† ุจุฏู‡ุง
173
00:11:52,160 --> 00:11:57,800
ู…ู‡ุงุฑุงุช ุฏู‚ูŠู‚ุฉ ุฌุฏุง ุฌุฏุง ูˆู„ุฐู„ูƒ ุจุชุนุชู…ุฏ ุนู„ู‰ ู…ู‡ุงุฑุฉ ุงู„ุฌุฑุงุญ
174
00:11:57,800 --> 00:12:02,280
ุทูŠุจ different regenerative potential outcomes
175
00:12:02,280 --> 00:12:05,620
following nerve repair have also been reported
176
00:12:05,620 --> 00:12:09,140
based on grouping of specific nerveุจู‚ูˆู„ ู„ูŠ ุงู† ููŠ
177
00:12:09,140 --> 00:12:14,200
ุนู†ุฏูŠ ุจุนุถ ุงู„ุฃุนุตุงุจ ูˆุฌุฏูˆุง ุญุณุจ ุงู„ุชุตู†ูŠู ุงู† ููŠ ุฃุนุตุงุจ
178
00:12:14,200 --> 00:12:19,280
ุจูŠูƒูˆู† ูุฑุตุฉ ุงู„ recovery ููŠู‡ุง ุนุงู„ูŠ ุฌุฏุง ูˆููŠ ุฃุนุตุงุจ
179
00:12:19,280 --> 00:12:23,480
ูุฑุตุฉ ุงู„ recovery ููŠู‡ุง ุจุชูƒูˆู† ุถุนูŠูุฉ ุฒูŠ ุงูŠุด ู…ุซู„ุง ุงู„
180
00:12:23,480 --> 00:12:26,580
excellent regenerative potential ุฒูŠ ุงู„ radial
181
00:12:26,580 --> 00:12:29,080
nerve ูˆ ุงู„ musculocutaneous and femoral nerves
182
00:12:29,080 --> 00:12:32,720
ู‡ุฐูˆู„ ุงู„ุฃุนุตุงุจ ู‡ุฐู‡ ุงู„ radial ูˆ ุงู„ musculocutaneous ูˆ
183
00:12:32,720 --> 00:12:36,920
ุงู„ femoral nerveูุฑุตุฉ ุงู„ regeneration ููŠู‡ุง ุงู„ู†ู…ูˆ
184
00:12:36,920 --> 00:12:40,060
ุงู„ุนุตุจ ู†ูุณู‡ ูˆ ูŠุตูŠุฑ ููŠู‡ recovery ุจุชูƒูˆู† excellent
185
00:12:40,060 --> 00:12:44,080
ู…ู…ุชุงุฒ ุฌุฏุง ุทูŠุจ ุงู„ moderate ุงู„ู„ูŠ ู‡ูŠ ุชู‚ุฑูŠุจุง ู…ุชูˆุณุทุฉ
186
00:12:44,080 --> 00:12:47,840
ุงู„ู„ูŠ ู‡ูŠ ุฒูŠ ุงู„ median ูˆ ุงู„ ulnar ูˆ ุงู„ tbl nerve
187
00:12:47,840 --> 00:12:53,160
ู‡ุฐูˆู„ ุจูƒูˆู† ูุฑุตุฉ ุงู„ regeneration ููŠู‡ู… ู…ุชูˆุณุทุฉุทูŠุจ ุงู„
188
00:12:53,160 --> 00:12:56,280
poor regenerative potential ุงู„ู„ูŠ ู‡ูŠ ุจุชูƒูˆู† ูุฑุตุชู‡ุง
189
00:12:56,280 --> 00:13:00,040
ูƒุชูŠุฑ ุถุนูŠูุฉ ุฃูˆ ุณูŠุฆุฉ ุฌุฏุง ุชู…ุงู… ูˆ ู…ุง .. ู…ุงููŠุด ููŠู‡ุง
190
00:13:00,040 --> 00:13:03,480
ูุฑุตุฉ ู„ู„ regeneration ุงู„ู„ูŠ ู‡ูŠ ุงู„ peroneal nerve ุงู„
191
00:13:03,480 --> 00:13:09,020
peroneal nerve ุงู„ู„ูŠ ู‡ูˆ ุชู…ุงู… ุจูŠุชูุฑุน ู…ู†ู‡ ุงู„ common
192
00:13:09,020 --> 00:13:13,780
peroneal nerve ุชู…ุงู… ุงู„ู„ูŠ ุจุชุบุถูŠ ุทุจุนุง ุงู„ู‚ุฏู… ู…ู†
193
00:13:13,780 --> 00:13:18,940
ุงู„ุฃุณูู„ู‡ุฐู‡ ุงู„ุชุตู†ูŠู ุงู„ู„ูŠ ุญุณุจ ู…ุง ูˆุฌุฏูˆุง ุงู„ุนู„ู…ุงุก ุฃู†ู‡ ููŠ
194
00:13:18,940 --> 00:13:23,060
ุนู†ุฏู‰ ุฃุนุตุงุจ ููŠ ุฅู„ู‡ุง ูุฑุตุฉ ููŠ ุฅู†ู‡ ูŠุตูŠุฑ ููŠู‡ุง
195
00:13:23,060 --> 00:13:26,100
regeneration ู…ู…ุชุงุฒ ุงู„ู„ูŠ ู‡ู‰ ู‚ู„ู†ุง ุงู„ radial ู…ุณูƒูˆู†
196
00:13:26,100 --> 00:13:28,560
ุงู„ูƒุงุชุงู†ูŠูˆุณ ูˆ ุงู„ femoral ุงู„ poor ุงู„ู„ูŠ ู‡ู‰ ุงู„
197
00:13:28,560 --> 00:13:31,360
perennial ูˆ ุงู„ moderate ุงู„ู„ูŠ ู‡ู‰ ุงู„ median ูˆ ุงู„
198
00:13:31,360 --> 00:13:33,360
ulnar ูˆ ุงู„ tibial nerve
199
00:13:36,140 --> 00:13:40,840
ุงู„ age and motivation of the patient ู‡ู„ ููŠ ุฏูˆุฑ ู„ู„
200
00:13:40,840 --> 00:13:45,620
age ุงู„ุนู…ุฑ ูˆ ุงู„ุญุงู„ุฉ ุงู„ู†ูุณูŠุฉ ู„ู„ู…ุฑูŠุถ ุฃูƒูŠุฏ the nervous
201
00:13:45,620 --> 00:13:49,160
system must adapt and relearn use of pathway once
202
00:13:49,160 --> 00:13:52,400
regeneration occurs ู…ู† ุญุฏ ู…ุง ูŠุตูŠุฑ ุนู†ุฏ ุงู„
203
00:13:52,400 --> 00:13:56,480
regeneration ุจุจุฏุฃ ุงู„ุนุตุจ ูŠุญุงูˆู„ ูŠุชุนู„ู… ุฃูˆ ูŠุณุชุนูŠุฏ
204
00:13:56,480 --> 00:14:00,750
ุงู„ุญุฑูƒุฉ ุงู„ู„ูŠ ููŠู‡ูู‚ุฏู‡ุง ุงู„ุญุฑูƒุฉ ุฃูˆ ุงู„ impulses ุงู„ู„ูŠ
205
00:14:00,750 --> 00:14:05,390
ูƒุงู†ุช ุจุชู…ุฑ ู…ู†ู‡ ุนู„ุดุงู† ูŠุบุฐูŠ ุงู„ุนุถู„ุงุช ูˆ ุชุตูŠุฑ ุงู„ุญุฑูƒุฉ
206
00:14:05,390 --> 00:14:10,030
ุงู„ู„ูŠ ูƒุงู†ุช ู…ูˆุฌูˆุฏุฉ ู‚ุจู„ ุงู„ุฅุตุงุจุฉ motivation and age
207
00:14:10,030 --> 00:14:13,190
play a role in this especially in very young and
208
00:14:13,190 --> 00:14:17,850
elderly people ูŠุนู†ูŠ ุงู„ุญุงู„ุฉ ุงู„ู†ูุณูŠุฉ ู„ู‚ูˆุง ุฃู† ุงู„ุญุงู„ุฉ
209
00:14:17,850 --> 00:14:21,910
ุงู„ู†ูุณูŠุฉ ูˆ ุงู„ age ุงู„ุนู…ุฑ ูŠู„ูˆ ุฏูˆุฑ ูƒุจูŠุฑ ุฌุฏุง ููŠ ู‡ุฐุง
210
00:14:21,910 --> 00:14:25,210
ุงู„ู…ูˆุถูˆุน ุทุจุนุง ุงู„ู†ุงุณ ุงู„ young ุงู„ู„ูŠ ู‡ู… ุงู„ุดุจุงุจ ุจูƒูˆู†
211
00:14:25,210 --> 00:14:29,570
ูุฑุตุชู‡ู… ููŠุงู„ .. ุงู„ .. ุงู„ regeneration ุจุชูƒูˆู† ุทุจุนุง
212
00:14:29,570 --> 00:14:34,610
ุฃุนู„ู‰ ู…ู† ุงู„ elderly people ู„ุฃู†ู‡ ุทุจุนุง ุจูŠูƒูˆู† ูŠุนู†ูŠ ุญุณุจ
213
00:14:34,610 --> 00:14:37,770
ุจุถุน ุงู„ุฌุณู… ุจุชูƒูˆู† ูŠุนู†ูŠ ุงู„ุฌู‡ุงุฒ ุงู„ุนุตุจูŠ ุนู†ุฏู‡ ู…ุงููŠุด ุนู†ุฏู‡
214
00:14:37,770 --> 00:14:42,070
ู‡ุงู„ู‚ุฏุฑุฉ ุงู†ู‡ ูŠุนู…ู„ regeneration ุทูŠุจ ุงู„ outcomes of
215
00:14:42,070 --> 00:14:47,730
nerve regeneration ุงู„ outcomes ู‡ุฐู‡ ุงุญู†ุง ุจู†ุชูƒู„ู… ุนู†
216
00:14:47,730 --> 00:14:53,520
ุงู„ู„ูŠ ู‡ูŠ ุจุนุฏ ู…ุง ูŠุตูŠุฑ ููŠ ุนู†ุฏูŠ ุนู…ู„ูŠุงุช ุฌุฑุงุญูŠุฉุงู„ุนู…ู„ูŠุฉ
217
00:14:53,520 --> 00:14:57,020
ุงู„ุฌุฑุงุญูŠุฉ ูŠุง ุฌู…ุงุนุฉ ุจุชุฌูŠุจ .. ุจุชุนุชู…ุฏ ุนู„ู‰ ู…ู‡ุงุฑุฉ
218
00:14:57,020 --> 00:15:01,400
ุงู„ุฌุฑุงุญุŒ ู…ู‡ุงุฑุฉ ุงู„ุฌุฑุงุญ ูˆุนู„ู‰ ุงู„ timingุŒ ุนู„ู‰ ุงู„ูˆู‚ุชุŒ
219
00:15:01,400 --> 00:15:05,860
ุงู„ูˆู‚ุช ุงู„ู„ูŠ ุงุณุชุฎุฏู…ู‡ ุงู„ .. ุงูˆ ุงู„ูˆู‚ุช ุงู„ู„ูŠ ูˆุตู„ ููŠู‡
220
00:15:05,860 --> 00:15:10,920
ุงู„ู…ุฑูŠุถ ู„ู„ู…ุณุชุดูู‰ ูƒู„ ู…ุง ูƒุงู† ุงู„ูˆู‚ุช ู‡ุฐุง ุฃุณุฑุน ูƒู„ ู…ุง
221
00:15:10,920 --> 00:15:13,780
ูƒุงู†ุช ูุฑุตุฉ ุงู„ู…ุฑูŠุถ ุฃูƒุจุฑ ููŠ ุฃู†ู‡ ูŠุตูŠุฑ ููŠ ุนู†ุฏูŠ
222
00:15:13,780 --> 00:15:19,620
regeneration ูˆูŠุตูŠุฑ ููŠ ุนู†ุฏูŠ recoveryุงู„ุงู† ุงุญู†ุง ู‚ูˆู„ู†ุง
223
00:15:19,620 --> 00:15:24,820
ุงู† ุงู„ุนุตุจ .. ุงู„ุนุตุจ ููŠ ุนู†ุฏูŠ ุซู„ุงุซ ุฃูุฑุน ููŠู‡ ุงู„ู„ูŠ ู‡ู…
224
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sensory ูˆ ููŠ ุนู†ุฏูŠ motor ูˆ ููŠ ุนู†ุฏูŠ ุงู„ู„ูŠ ู‡ูˆ ุฅูŠุด ุงู„
225
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.. ุงู„ .. ุงู„ sensory ูˆ ุงู„ motor ูˆ ุงู„ sympathetic
226
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fibers ุทูŠุจุŒ ุงู„ุขู† ู„ูˆ ุดูˆูู†ุง ุงู„ุตูˆุฑุฉ ู‡ุฐู‡ ุชู…ุงู…ุŸdigital
227
00:15:45,350 --> 00:15:49,910
outcomes number one exact reenervation of its
228
00:15:49,910 --> 00:15:54,510
native target organ with return of function ู„ูˆ
229
00:15:54,510 --> 00:15:58,910
ุดูˆูู†ุง ู‡ุฐู‡ ุงู„ุตูˆุฑุฉ ุฃู†ุง ููŠ ุนู†ุฏูŠ ู‡ู†ุง ุงู„ู„ูŠ ู‡ูŠ ุงู„ motor
230
00:15:58,910 --> 00:16:02,670
point ุงู„ู„ูŠ ู…ูˆุฌูˆุฏ ุนู„ู‰ ุงู„ุนุถู„ุฉ ูˆู‡ุฐุง ุงู„ู„ูŠ ู‡ูˆ ุฅูŠุด ุงู„
231
00:16:02,670 --> 00:16:10,060
nerve ุฃู†ุง ุจุฏูŠ ุฃูˆุตู„ ุงู„ู…ูุฑูˆุถ ุฅู† ุงู„ุฌุฑุงุญ ูŠูˆุตู„ุงู„ motor
232
00:16:10,060 --> 00:16:14,980
.. ุงู„ motor ุฃูˆ ุงู„ branch ุชุจุน ุงู„ motor ุงู„ู„ูŠ ููŠ ุงู„
233
00:16:14,980 --> 00:16:19,200
nerve ูŠูˆุตู„ูˆุง ุนู„ู‰ ุงู„ู„ูŠ ู‡ูŠ ุฅูŠุด ุงู„ motor point ุงู„ู„ูŠ
234
00:16:19,200 --> 00:16:22,880
ู…ูˆุฌูˆุฏุฉ ุนู„ู‰ ุงู„ุนุถู„ุฉุŒ ููŠ ุนู†ุฏูŠ sensoryุŒ ู‡ุงูŠ ุจูˆุตู„ู‡ุง ุนู„ู‰
235
00:16:22,880 --> 00:16:28,810
ุงู„ sensoryุŒ ุทูŠุจ ุฅุฐุง ูˆุตู„ ุงู„ motor branchุนู„ู‰ ุงู„
236
00:16:28,810 --> 00:16:32,690
motor point ูˆ ุงู„ sensory branch ุนู„ู‰ ุงู„ sensory
237
00:16:32,690 --> 00:16:37,210
point ุชู…ุงู… ู…ุนู†ุงู‡ ุฐู„ูƒ ุงู†ู‡ ุตุงุฑ ููŠ ุนู†ุฏูŠ ุงู„ู„ูŠ ู‡ูŠ ุฅูŠุด
238
00:16:37,210 --> 00:16:41,190
ุตุงุฑ ููŠ ุนู†ุฏูŠ exact reinervation of its native
239
00:16:41,190 --> 00:16:45,850
target organ ูˆ ุงู„ู„ูŠ ู‡ุฐุง ุจูŠุณุงู‡ู… ููŠ ุนูˆุฏุฉ ุงู„ function
240
00:16:45,850 --> 00:16:49,950
ููŠ ุนูˆุฏุฉ ุงู„ูˆุธูŠูุฉ ุฅุฐุง ู‡ูˆ ุญุท ุงู„ motor ุนู„ู‰ ุงู„ motor ูˆ
241
00:16:49,950 --> 00:16:53,980
ุญุท ุงู„ sensory ุนู„ู‰ ุงู„ sensory ุทูŠุจุงู„ุญุงู„ ุงู„ุชุงู†ูŠ ุงู†
242
00:16:53,980 --> 00:16:56,820
ูŠุตูŠุฑ ููŠ ุนู†ุฏูŠ exact reinervation of its native
243
00:16:56,820 --> 00:17:01,460
target organ but no return of function due to
244
00:17:01,460 --> 00:17:04,340
degeneration of the end organ
245
00:17:09,150 --> 00:17:13,390
ู‡ูˆ ุญุท ุงู„ .. ุงู„ motor branch ุนู„ู‰ ุงู„ motor point ู‡ู†ุง
246
00:17:13,390 --> 00:17:17,690
ุจุณ ุงู„ู…ุดูƒู„ุฉ ุฃู†ู‡ ุงู„ motor branch ู†ูุณู‡ ููŠ ุขุฎุฑู‡ ูƒุงู†
247
00:17:17,690 --> 00:17:22,270
ููŠู‡ degeneration ู…ุงูƒุงู†ุด ููŠู‡ ู†ู…ูˆ ุฃูˆ ูƒุงู† ููŠู‡ ุฎู„ูŠู†ุง
248
00:17:22,270 --> 00:17:28,190
ู†ู‚ูˆู„ ุนุฏู… ุงูƒุชู…ุงู„ ู„ู„ู†ู…ูˆ ู„ู‡ุฐุง ุงู„ branch ูุจุฐู„ูƒ
249
00:17:28,190 --> 00:17:32,090
ู…ุงุญูŠูƒูˆู†ุด ููŠ ุชูˆุงุตู„ ู…ุง ุจูŠู† ุงู„ู„ูŠ ู‡ูˆ ุงู„ branch ู†ูุณู‡ ูˆ
250
00:17:32,090 --> 00:17:37,210
ู…ุง ุจูŠู† ุงู„ motor pointุงู„ุญุงู„ุฉ ุงู„ุชุงู„ุชุฉ wrong receptor
251
00:17:37,210 --> 00:17:41,670
reinervated in the proper territory therefore
252
00:17:41,670 --> 00:17:44,550
improper input ูŠุนู†ูŠ
253
00:17:46,700 --> 00:17:50,520
ุงู„ุญุงู„ุฉ ุงู„ุชุงู„ุชุฉ ุงู†ู‡ ูŠ .. ูŠ .. ูŠุญุท ุนู†ุฏู‰ ุงู„ branch ..
254
00:17:50,520 --> 00:17:54,680
ุงู„ .. ุงู„ motor branch ูŠูˆุตู„ู‡ ููŠู‡ ุงู„ sensory point
255
00:17:54,680 --> 00:17:59,280
ูˆู‡ู†ุง ุทุจุนุง ู‡ูŠูƒูˆู† ููŠ ูŠุฏูŠ ุฎุทุฃ ู…ุด ู‡ูŠุดุชุบู„ ุงู„ุนุตุจ ุฅุฐุง ุฃู†ุง
256
00:17:59,280 --> 00:18:02,420
ุดุจูƒุช ุงู„ู„ูŠ ู‡ูŠ ุงู„ .. ุงู„ motor branch ุนู„ู‰ sensory
257
00:18:02,420 --> 00:18:06,640
ู„ุงุฒู… ุฃุดุจูƒ ุงู„ .. ุงู„ motor branch ุนู„ู‰ ุงู„ motor point
258
00:18:06,640 --> 00:18:10,960
ุงู„ sensory branch ู„ุงุฒู… ูŠู†ุดุจูƒ ุนู„ู‰ ุงู„ sensory point
259
00:18:11,400 --> 00:18:14,940
ุทูŠุจ ู„ูˆ ุดุจูƒ ุงู„ motor branch ุงู„ู„ูŠ ุทุงู„ุน ู…ู† ุงู„ุนุตุจ ููŠ
260
00:18:14,940 --> 00:18:18,420
ุงู„ sensory point ุงู„ู„ูŠ ู…ูˆุฌูˆุฏุฉ ููŠ ุงู„ุนุถู„ุฉ ู…ุนู†ุงู‡ ุฐู„ูƒ
261
00:18:18,420 --> 00:18:23,980
ุงู†ู‡ ู‡ุฐู‡ ุทุจุนุง ู‡ูŠูƒูˆู† ููŠู‡ุง ู…ุดูƒู„ุฉ ูƒุจูŠุฑุฉ ุทูŠุจ ุงู„ุญุงู„ุฉ
262
00:18:23,980 --> 00:18:27,740
ุงู„ุชุงู„ุชุฉ ุงู„ุฑุงุจุนุฉ receptor reinhervation in wrong
263
00:18:27,740 --> 00:18:30,980
territory causing false localization of the input
264
00:18:30,980 --> 00:18:37,950
ุชู…ุงู… ุงู„ู„ูŠ ู‡ูŠุฅู† ู‡ูˆ ูŠุดุจูƒู‡ุง ููŠ ุงู„ู…ู†ุทู‚ุฉ ุงู„ูุงุถูŠุฉ ู‡ุฐู‡
265
00:18:37,950 --> 00:18:41,910
ูŠุดุจูƒ ุงู„ branch ู†ูุณู‡ ููŠ ุงู„ู…ู†ุทู‚ุฉ ุงู„ูุงุถูŠุฉ ู‡ุฐู‡ ุงู„ู„ูŠ
266
00:18:41,910 --> 00:18:45,230
ููŠู‡ุง ุชู…ุงู… ุงู„ู„ูŠ ููŠุด ููŠู‡ุง ุฃุตู„ุง motor point ูˆู„ุง
267
00:18:45,230 --> 00:18:50,910
sensory point ูุจุฐู„ูƒ ุจุชูƒูˆู† ุทุจุนุง ุจูŠุนุทูŠ ุฅุดุงุฑุฉ ุฎุงุทุฆุฉ
268
00:18:50,910 --> 00:18:54,510
ู„ุฃู† ู‡ูŠ ุจุชุฌูŠ ุงู„ุฅุดุงุฑุฉ ู„ุงุฒู… ุชุฌูŠ ุนู„ู‰ ุงู„ receptors ุฅุฐุง
269
00:18:54,510 --> 00:18:57,510
ู…ุง ุฃุฌุช ุนู„ู‰ ุงู„ receptors ู…ุง ุจูƒูˆู† ููŠ ุฅู„ู‡ุง ุฃูŠ ู‚ูŠู…ุฉ
270
00:18:57,960 --> 00:19:02,240
ุงู„ุญุงู„ุฉ ุงู„ุฎุงู…ุณุฉ ุงู„ู„ูŠ ู‡ูŠ no connection with an end
271
00:19:02,240 --> 00:19:06,440
organ ู…ุงููŠุด ุนู†ุฏูŠ ุงุชุตุงู„ ู†ุชูŠุฌุฉ ู…ุซู„ุง ุงู†ู‡ ุงู„ branch
272
00:19:06,440 --> 00:19:13,800
ู†ูุณู‡ ุจูƒูˆู† ู…ู‚ุทูˆุน ู„ .. ูŠุนู†ูŠ ู…ุฏู‰ ุฃูƒุจุฑ ุชู…ุงู… ูˆ ู…ุง ..
273
00:19:13,800 --> 00:19:18,160
ู…ุงุจู†ู‚ุฏุฑ ุงู†ู‡ ุงุญู†ุง ู†ูˆุตู„ู‡ ู„ ุงู„ู„ูŠ ู‡ูˆ ุงู„ุนุตุจ ุงูˆ ู†ูˆุตู„ู‡ ู„
274
00:19:18,160 --> 00:19:22,640
ุงู„ุนุถู„ุฉ ูˆ ุจุฐู„ูƒ ุจูƒูˆู† ุตุนุจ ุนู„ูŠ ุงู† ุงู†ุง ุฃูˆุตู„ู‡ู… ู…ุน ุจุนุถ ูˆ
275
00:19:22,640 --> 00:19:28,480
ุจุฐู„ูƒ ู…ุงููŠุด ุนู†ุฏูŠ ู†ู‡ุงุฆูŠุง ุงูŠ ูุฑุตุฉ ู„ู„ recoveryุทูŠุจ ุงู„
276
00:19:28,480 --> 00:19:35,010
management guidelines recovery from nerve injuryู„ูˆ
277
00:19:35,010 --> 00:19:38,390
ุฃุฌูŠู†ุง ู„ู„ recovery from nerve injury ูŠุนู†ูŠ ูƒูŠู ุจูŠุตูŠุฑ
278
00:19:38,390 --> 00:19:42,070
ููŠ ุนู†ุฏูŠ ุงู„ recovery ุฃูˆู„ ุญุงุฌุฉ ุนู†ุฏูŠ ุซู„ุงุซ ู…ุฑุงุญู„ ู„ู„
279
00:19:42,070 --> 00:19:46,430
recovery ู„ุนูˆุฏุฉ ุงู„ nerve ุฅู„ู‰ ูˆุถุนู‡ ุงู„ุทุจูŠุนูŠ ุฃูˆ ู…ุง ู‚ุจู„
280
00:19:46,430 --> 00:19:50,930
ุงู„ุฅุตุงุจุฉ ุฃูˆ ุนูˆุฏุชู‡ ุฃูˆ ูŠุนู†ูŠ ุชุญุณู† ุงู„ู„ูŠ ู…ู…ูƒู† ูŠุตูŠุฑ ููŠู‡
281
00:19:50,930 --> 00:19:55,190
ุทูŠุจ ุฃูˆู„ ุญุงุฌุฉ acute phase ูˆ ููŠ ุนู†ุฏูŠ recovery phase
282
00:19:55,190 --> 00:19:59,550
ูˆ ููŠ ุนู†ุฏูŠ chronic phase ุฅุฐุง ู‡ู… ุซู„ุงุซ ู…ุฑุงุญู„ ู‡ู… ุซู„ุงุซ
283
00:19:59,550 --> 00:20:00,890
ู…ุฑุงุญู„ ุงู„ acute phase
284
00:20:04,350 --> 00:20:12,310
ูˆ ุงู„ .. ุงู„ recovery phase ูˆ ุงู„ู„ูŠ ู‡ูˆ ุงู„ .. ุงู„
285
00:20:12,310 --> 00:20:16,090
chronic phase ุทูŠุจ ุงู„ acute phase this is the early
286
00:20:16,090 --> 00:20:19,470
after injury or surgery when the emphasis is on
287
00:20:19,470 --> 00:20:22,550
healing and prevention of complication ููŠ ู‡ุฐู‡
288
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ุงู„ู…ุฑุญู„ุฉ ูŠุง ุฌู…ุงุนุฉ ูŠุนู†ูŠ ุงุญู†ุง ุงู„ูŠูˆู… ุงุฌุงู†ูŠ ู…ุฑูŠุถ ุงู„ู…ุฑูŠุถ
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ู‡ุฐุง ุงุชุนุฑุถ ู„ู‚ุทุน ู„ู„ radial nerve ุชู…ุงู…ุŸ ู„ู„ radial
290
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nerveุฑุงุญ ูˆุงู„ู„ู‡ ุฑุงุญ ุนู„ู‰ ุงู„ู…ุณุชุดูู‰ okay ุฏุฎู„ ุนู…ู„ูŠุฉ
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ุฌุฑุงุญูŠุฉ ุดุจูƒูˆู„ู‡ ุงู„ุนุตุจ ุทูŠุจ ุจุนุฏ ู…ุง ูŠุทู„ุน ุงู„ู…ุฑูŠุถ ููŠ ุนู†ุฏูŠ
292
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ุซู„ุงุซ ู…ุฑุงุญู„ ุจู…ุฑ ููŠู‡ู… ุงู„ู…ุฑุญู„ุฉ ุงู„ุฃูˆู„ู‰ ุงู„ู„ูŠ ู‡ูŠ ุงู„
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acute phase ุงู„ู„ูŠ ู‡ูŠ ุงู„ู…ุฑุญู„ุฉ ู…ุง ุจุนุฏ ุงู„ุนู…ู„ูŠุฉ ู…ุจุงุดุฑุฉ
294
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ู…ุงุจุนุฏ ุงู„ุนู…ู„ูŠุฉ ู…ุจุงุดุฑุฉ ูˆ ู‡ู†ุง ุงู„ุชุฑูƒูŠุฒ ููŠู‡ุง ุนู„ู‰ ุงู„
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healing ุนู„ู‰ ุงู„ healing and prevention of
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complications ูŠุนู†ูŠ ุนู„ู‰ ุงู„ุชู‚ุงู… ุงู„ุฌุฑุญ ุงู„ู„ูŠ ู…ูˆุฌูˆุฏ
297
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ุงู„ุชู‚ุงู… ุงู„ุนู…ู„ูŠุฉ ุงู„ู„ูŠ ู‡ูˆ ุนู…ู„ู‡ุง ุงู‡ ู…ุงูŠุตูŠุฑุด ููŠู‡ ุนู†ุฏู‡
298
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complications ู…ุงูŠุตูŠุฑุด ููŠู‡ ุนู†ุฏู‡ ู†ุฒูŠู ู…ุงูŠุตูŠุฑุด ููŠู‡
299
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ุนู†ุฏู‡ contraction ู…ุงูŠุตูŠุฑุด ููŠู‡ ุนู†ุฏู‡ ูˆุงู„ู„ู‡ limitation
300
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ููŠ ุงู„ movement ู…ุงูŠุตูŠุฑุด ููŠู‡ ุนู†ุฏู‡ weakness ููŠ ุงู„
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muscle ู…ุงูŠุตูŠุฑุด ููŠู‡ ุนู†ุฏู‡ scar tissue ู…ุซู„ุงุฃู‡ ูŠุนู†ูŠ ุจุณ
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ุฃู†ุง ููŠ ุงู„ู…ุฑุญู„ุฉ ู‡ุฐู‡ ู…ุงุจุฏูŠุด ูˆ ุงู„ู„ู‡ ุฃู‚ุนุฏ ุฃุดุชุบู„ ู…ุนุงู‡
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ุนู„ุงุฌ ุทุจูŠุนูŠ ูˆ ูƒุฐุง ูˆ ุฃุทูˆู„ ุงู„ุนุตุจ ูˆ ุฃุฑุฌุน .. ู„ุฃ ุฃู†ุง ููŠ
304
00:21:21,030 --> 00:21:24,530
ุงู„ู…ุฑุญู„ุฉ ู‡ุฐู‡ ุจุณ ุจุฑูƒุฒ ุนู„ู‰ ุฃู†ูŠ ุฃู†ุง ุฃู…ู†ุน ุงู„
305
00:21:24,530 --> 00:21:28,730
complication ูˆ ุนู„ู‰ ุฃู†ู‡ ุฃู†ุง ุชู…ุงู… ูŠุตูŠุฑ ููŠ ุนู†ุฏูŠ ุนู…ู„ูŠุฉ
306
00:21:28,730 --> 00:21:33,730
healing ูŠู„ุชู‚ู… ุงู„ุฌุฑุญ ุงู„ู„ูŠ ู…ูˆุฌูˆุฏ ุทูŠุจ ุจู†ุฏุฎู„ ููŠ
307
00:21:33,730 --> 00:21:36,530
ุงู„ู…ุฑุญู„ุฉ ุงู„ุซุงู†ูŠุฉ ุจู†ุณู…ูŠู‡ุง ุงู„ recovery phase ุงู„ู„ูŠ ู‡ูŠ
308
00:21:36,530 --> 00:21:40,730
ู‡ุฐู‡ ุจูŠุจุฏุฃ ุงู„ู„ูŠ ู‡ูŠ ุชุนุงููŠ ุงู„ุนุตุจ ุงู„ู„ูŠ ุงุญู†ุง ุงุดุชุบู„ู†ุงู‡ ูˆ
309
00:21:40,730 --> 00:21:45,330
ุนู…ู„ู†ุงู‡ ุงู„ุนู…ู„ูŠุฉ ูˆ ู‚ุฑุจู†ุงู‡This is when re-innovation
310
00:21:45,330 --> 00:21:50,410
occurs, emphasis is on re-training and re
311
00:21:50,410 --> 00:21:56,170
-education ุฅุฐุง ู‡ู†ุง ุชู…ุงู… ุจุฏู†ุง ู†ุฑูƒุฒ ู‡ู†ุง ุจูƒูˆู† ุงู„ุนุตุจ
312
00:21:56,170 --> 00:22:01,010
ุจุฏุฃ ุงู„ู„ูŠ ู‡ูˆ ุนู…ู„ูŠุฉ ุงู„ re-innovation ูŠุนู†ูŠ ุจุฏุฃุช ุงู„ุนุตุจ
313
00:22:01,010 --> 00:22:05,130
ูŠุดุชุบู„ ุงู„ู„ูŠ ุงุญู†ุง ุนู…ู„ู†ุง ู„ู‡ ุงู„ุนู…ู„ูŠุฉ ุชู…ุงู…ุŸ ูˆ ู‡ู†ุง ุจุฏู†ุง
314
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ู†ุฑูƒุฒ ุนู„ู‰ ุนู…ู„ูŠุฉ re-training and re-educationุฅู† ุฃู†ุง
315
00:22:09,010 --> 00:22:13,430
ุฃุฑุฌุน ุฃุนู„ู… ุงู„ุนุตุจ ุชู…ุงู… ุฅูŠุด ุงู„ุญุฑูƒุฉ ูˆ ุงู„ุนุถู„ุฉ ู†ูุณู‡ุง
316
00:22:13,430 --> 00:22:18,310
ุจุฑุถู‡ุŒ ุฅูŠุด ุงู„ุญุฑูƒุฉ ุงู„ู„ูŠ ูู‚ุฏุชู‡ุง ุนู„ุดุงู† ุชู‚ุฏุฑ ุชุณุชุนูŠุฏู‡ุงุŒ
317
00:22:18,310 --> 00:22:22,330
ูƒูŠู ุฏูŠ ุจุนู…ู„ู‡ุงุŸ ุจุนู…ู„ู‡ุง ุนู† ุทุฑูŠู‚ exercise ู…ุนูŠู†ุฉ ุงู„ู„ูŠ
318
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ู‡ูŠ ุงู„ active exercise ู…ุซู„ุง ุชู…ุงู…ุจุญูŠุซ ุงูˆ ู…ู…ูƒู† ุงุดุชุบู„
319
00:22:27,500 --> 00:22:32,180
passive exercise ู…ุน ุงู„ู…ุฑูŠุถ ุจุญูŠุซ ูู‚ุท ุงู†ูŠ ุงู†ุง ุงู„ู…ุฑูŠุถ
320
00:22:32,180 --> 00:22:37,460
ูŠู‚ุฏุฑ ูŠุณุชุนูŠุฏ ุงู„ุญุฑูƒุฉ ุงู„ู„ูŠ ูู‚ุฏู‡ุง ุงู„ุนุถู„ุฉ ู†ูุณู‡ุง ุชุนุฑู ุงู†
321
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ูˆุงู„ู„ู‡ ูˆุธูŠูุชู‡ุง ุงู†ู‡ุง ุชุนู…ู„ flexion extension ุงุดูŠ ุฒูŠ
322
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ู‡ูŠูƒ ุทูŠุจ ุงู„ chronic phase ุชู…ุงู… this occur when the
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00:22:45,740 --> 00:22:50,380
potential for reinervation has peaked ุงู‡ ูŠุนู†ูŠ ู‡ู†ุง
324
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ู…ุฑุญู„ุฉ ุงู„ู„ูŠ ู‡ูŠ ููŠู‡ุง ุถุนูุงู„ูุฑุตุฉ ุฅู†ู‡ ูŠุตูŠุฑ ููŠ ุนู†ุฏูŠ re
325
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-innovation ูŠุนู†ูŠ ุฌุฏ ู…ุง ุฃู†ุง ุจุดุชุบู„ุŒ ุจุนู…ู„
326
00:23:00,850 --> 00:23:04,550
electrotherapyุŒ ุจุนู…ู„ exerciseุŒ ู„ุฌูŠุช ุฅู†ู‡ ูˆุงู„ู„ู‡
327
00:23:04,550 --> 00:23:11,550
ุงู„ุนุตุจ ู…ุงุดุชุบู„ุด ุฃูˆ ู…ุงุดุชุบู„ุด ุจุงู„ุงุดูŠ ุงู„ู„ูŠ ุฃู†ุง ุชู…ุงู… ู…ุฎุทุท
328
00:23:11,550 --> 00:23:15,570
ู„ู‡ ุฃูˆ ุงู„ู„ูŠ ุญุทุชู‡ ููŠ ู‡ุฏููŠุŒ ุชู…ุงู…ุŸ ูุจู„ุงุฌูŠ ุฅู†ู‡ ููŠ
329
00:23:15,570 --> 00:23:20,010
ุงู„ู…ุฑุญู„ุฉ ู‡ุฐู‡ ูŠุนู†ูŠ ู…ุนู†ุงู‡ ุฐู„ูƒ ุฅู†ู‡ ุงู„ุนู…ู„ูŠุฉ ุจุชูƒูˆู† ุฅูŠุดุŸ
330
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ู…ุง ุฒุจุทุชุด ุฃูˆ ูุดู„ุชุชู…ุงู…ุŸ ูู‡ู†ุง ุจู†ูƒูˆู† ูŠุนู†ูŠ renovation
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00:23:23,750 --> 00:23:27,950
has peaked ูŠุนู†ูŠ ู…ุงููŠุดุด .. ู…ุงููŠุดุด .. ู…ุงุตุงุฑุด ููŠ ุนู†ุฏูŠ
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ุงู„ุนุตุจ ู†ูุณู‡ ู…ุง .. ู…ุงุงุณุชุนุงุฏุด ุงู„ู„ูŠ ู‡ูŠ ุงู„ .. ุงู„
333
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function ุชุจุนุชู‡ ูุตุงุฑ ููŠ ุนู†ุฏูŠ ู…ุดูƒู„ุฉ ู‡ู†ุง ุจูŠุตูŠุฑ ููŠ
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ุนู†ุฏูŠ and there are significant residual deficit
335
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ุฅุฐุง ููŠ ุนู†ุฏูŠ .. ุชู…ุงู…ุŸ ุถุงู„ ุนู†ุฏูŠ ู…ุดูƒู„ุฉ ุฃูˆ ุฅุนุงู‚ุฉุŒ ุถุงู„ุช
336
00:23:44,350 --> 00:23:48,040
ู…ูˆุฌูˆุฏุฉThe emphasis is training compensatory
337
00:23:48,040 --> 00:23:51,260
function ููŠ ู‡ุฐู‡ ุงู„ู…ุฑุญู„ุฉ ุฅูŠุด ุจุฏู‡ ูŠุนู„ู… ุงู„ู…ุฑูŠุถุŸ ุจุฏู‡
338
00:23:51,260 --> 00:23:56,900
ูŠุนู„ู… ุงู„ู…ุฑูŠุถ ุฅู† ู‡ูˆ ุชู…ุงู… compensatory function ูŠุนู†ูŠ
339
00:23:56,900 --> 00:24:03,700
ูˆุธุงุฆู ุชุนูˆูŠุถูŠุฉ ูˆุธุงุฆู ุชุนูˆูŠุถูŠุฉูŠุนู†ูŠ ู…ุซู„ุง .. ู…ุซู„ุง ุฃู†ู‡
340
00:24:03,700 --> 00:24:07,180
ุงู„ู…ุฑูŠุถ ูƒุงู† ุจูŠุณุชุฎุฏู… ุฅูŠุฏู‡ ุตุงุฑ ููŠ ุนู†ุฏู‡ ุฅุตุงุจุฉ ููŠ ุงู„
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radial nerve ุชู…ุงู…ุŸ ููŠ ุงู„ุฅูŠุฏ ุงู„ูŠู…ูŠู† ูุตุงุฑ ููŠ ุนู†ุฏู‡
342
00:24:10,460 --> 00:24:13,480
ุฅูŠุดุŸ ุตุงุฑ ููŠ ุนู†ุฏู‡ ุงู„ุฅุตุงุจุฉ ุฃูˆ ุงู„ู‚ุทุน ููŠ ุงู„ radial
343
00:24:13,480 --> 00:24:16,920
nerve ุจุนู…ู„ ุนู†ุฏูŠ ุนุงู‚ุฉ ุงุณู…ู‡ุง ุฅูŠุดุŸ ุงุณู…ู‡ุง drop hand
344
00:24:16,920 --> 00:24:21,100
ูŠุนู†ูŠ ุณู‚ูˆุท ููŠ ุงู„ูŠุฏ .. ุณู‚ูˆุท ููŠ ุงู„ูŠุฏุทูŠุจ ู„ูˆ ุฃู†ุง ุจุฏุฃ
345
00:24:21,100 --> 00:24:23,820
ุฃู‚ูˆู„ chronic phase ู‡ู†ุง ุฅูŠุด ุจุฏุฃ ุฃุดุชุบู„ ู…ุนุงู‡ุŸ ุจุฏุฃ
346
00:24:23,820 --> 00:24:29,740
ุฃุนู„ู…ู‡ ุฅู†ู‡ ูŠุตูŠุฑ ูŠุณุชุนู…ู„ ุฅูŠุฏู‡ ุงู„ุดู…ุงู„ ุจุฏู„ ุฅูŠุฏู‡ ุงู„ูŠู…ูŠู†
347
00:24:29,740 --> 00:24:32,940
ูˆ ุฃุตูŠุฑ ุฃุนูˆุฏู‡ ุฅู†ู‡ ูˆุงู„ู„ู‡ ู‡ูˆ ูŠู…ุณูƒ ุงู„ุญุงุฌุงุช ู…ุซู„ุง ุฃูˆ
348
00:24:32,940 --> 00:24:36,400
ูŠู…ุณูƒ ุงู„ object ุจุฅูŠุฏู‡ ุงู„ุดู…ุงู„ุŒ ูŠู…ุดูŠ ุดุนุฑู‡ ุจุฅูŠุฏู‡
349
00:24:36,400 --> 00:24:40,500
ุงู„ุดู…ุงู„ุŒ ูŠูƒุชุจ ุจุฅูŠุฏู‡ ุงู„ุดู…ุงู„ุŒ ูŠุฒุฑ ุฌู…ูŠุณู‡ ู…ุซู„ุง ุจุฅูŠุฏู‡
350
00:24:40,500 --> 00:24:44,020
ุงู„ุดู…ุงู„ุŒ ูŠุฑุจุท ุญุฐุงุก ุงู„ู„ู‡ ูŠูƒุฑู…ูƒูˆุง ุจุฅูŠุฏู‡ ุงู„ุดู…ุงู„ุŒ ูŠุนู†ูŠ
351
00:24:44,020 --> 00:24:48,000
ุฃู†ุง ุฅูŠุด ุจุฏุฃ ุฃุนู…ู„ุŸ ุจุฏุฃ ุฃุนู…ู„ ุชุนูˆูŠุถ ู„ู„ูˆุธูŠูุฉ ุงู„ู„ูŠ
352
00:24:48,000 --> 00:24:52,270
ูู‚ุฏู‡ุงุงู„ .. ุงู„ .. ุงู„ุฌุณู… ู†ุชูŠุฌุฉ ุงู„ู„ูŠ ู‡ูˆ ุฅูŠุดุŸ ุงู„ู…ุดูƒู„ุฉ
353
00:24:52,270 --> 00:24:55,810
ุงู„ู„ูŠ ุตุงุฑุช ููŠ ุงู„ุนุตุจุŒ ู†ุชูŠุฌุฉ .. ู†ุชูŠุฌุฉ ุงู„ู…ุดูƒู„ุฉ ุงู„ู„ูŠ
354
00:24:55,810 --> 00:24:59,410
ุตุงุฑุช ููŠ ุงู„ุนุตุจ ุทูŠุจ effective management must
355
00:24:59,410 --> 00:25:02,110
consider not only nerve healing but also
356
00:25:02,110 --> 00:25:05,270
connective tissue healing in general ุฃู†ุง ู…ุงุจุฑูƒุฒ ุจุณ
357
00:25:05,270 --> 00:25:08,730
ุนู„ู‰ ุงู„ุนุตุจุŒ ู„ุฃ ุจุฑูƒุฒ ุนู„ู‰ ุงู„ูƒู„ ุงู„ connective tissue
358
00:25:08,730 --> 00:25:13,830
ุงู„ู„ูŠ ู…ูˆุฌูˆุฏุฉ ุญูˆู„ุงู‡ุŒ ุฅู†ู‡ ูŠุตูŠุฑ ููŠู‡ุง healingู„ุงุฒู… ูƒู„ ุงู„
359
00:25:13,830 --> 00:25:19,150
components ู‡ุฐู‡ ูŠุนู†ูŠ ู‚ุฑุงุนูŠ ุฃู†ู‡ ุตุงุฑ ููŠู‡ุง healing ุทูŠุจ
360
00:25:19,150 --> 00:25:24,910
ุงู„ acute phase ู‡ู†ุง ูŠุนู†ูŠ ุดุฑุญ ู…ูุตู„ ู„ู„ู…ูˆุถูˆุน ุงู„ acute
361
00:25:24,910 --> 00:25:28,090
phase immediately after injury or surgery ุงู„ acute
362
00:25:28,090 --> 00:25:32,010
phase ุจุชุฌูŠ ููˆุฑุง ุจุนุฏ ุงู„ู„ูŠ ู‡ูŠ ุฅูŠุด ุจุนุฏ ุงู„ุฅุตุงุจุฉ ุฃูˆ ุจุนุฏ
363
00:25:32,010 --> 00:25:35,370
ุงู„ุนู…ู„ูŠุฉ ุงู„ู„ูŠ ุงุญู†ุง ุจู†ุนู…ู„ู‡ุงูˆ ููŠ ู‡ุฐู‡ ุงู„ู…ุฑุญู„ุฉ ุจูŠูƒูˆู†
364
00:25:35,370 --> 00:25:39,570
ุงู„ู…ุฑูŠุถ ููŠ ุญุงู„ุฉ immobilization ู…ุง ุจุชุญุฑูƒุด ุงู„ time
365
00:25:39,570 --> 00:25:43,710
dictated by surgeon ุงู† ุงู„ุฌุฑุงุญ ู†ูุณู‡ ู‡ูˆ ุงู„ู„ูŠ ุจูŠุญุฏุฏ
366
00:25:43,710 --> 00:25:48,690
.. ู‡ูˆ ุงู„ู„ูŠ ุจูŠุญุฏุฏ ู‚ุฏุงุด ุงู„ู…ุฏุฉ ุงู„ู„ูŠ ุงู„ู…ุฑูŠุถ ู…ู…ู†ูˆุน
367
00:25:48,690 --> 00:25:52,550
ูŠุชุญุฑูƒ ููŠู‡ุง ุฃูˆ ู…ู…ู†ูˆุน ูŠู‚ุฏู‘ูŠ ุฃูŠ ูˆุธูŠูุฉ ุทูŠุจ movement
368
00:25:52,550 --> 00:25:55,930
amount and intensity dictated by type of injury
369
00:25:55,930 --> 00:25:59,250
and surgical repair ู…ู…ูƒู† ูŠูƒูˆู† ููŠ ุนู†ุฏูŠ ุญุฑูƒุฉ ุจุณูŠุทุฉ
370
00:25:59,250 --> 00:26:02,690
ู‡ู†ุง ู„ูŠุดุŸ ุนู„ุดุงู† ุฃู…ู†ุน ุงู„ deformity ูู‚ุท ุจุณ ุนู„ุดุงู† ุฃู…ู†ุน
371
00:26:02,690 --> 00:26:05,810
ุงู„ deformityูˆ ู‡ุฐู‡ ุญุณุจ ู†ูˆุน ุงู„ุฅุตุงุจุฉ ูˆ ุญุณุจ ู†ูˆุน
372
00:26:05,810 --> 00:26:08,990
ุงู„ุนู…ู„ูŠุฉ ุงู„ู„ูŠ ุนู…ู„ู‡ุง Orthosis may be necessary to
373
00:26:08,990 --> 00:26:12,250
prevent deformities ู…ู…ูƒู† ุฃู†ุง ุฃุณุชุฎุฏู…ู„ู‡ ุฌุจูŠุฑุฉ ู…ุซู„ุง
374
00:26:12,250 --> 00:26:16,450
ุฃูˆ splint ุจู†ุณู…ูŠู‡ุง ุชู…ุงู… ุนู„ุดุงู† ุฃู…ู†ุน ุงู„ู„ูŠ ู‡ูŠ ุฅูŠุด
375
00:26:16,450 --> 00:26:19,760
ุนู„ุดุงู† ุฃู…ู†ุน ุงู„ deformityPatient education
376
00:26:19,760 --> 00:26:23,020
protection of the part ู„ุงุฒู… ุฃุนู„ู… ุงู„ู…ุฑูŠุถ ูˆุณุงุฆู„
377
00:26:23,020 --> 00:26:27,100
ุงู„ุญู…ุงูŠุฉ ูƒูŠู ูŠุญู…ูŠ ุงู„ุทุฑู ุชุจุนู‡ ู…ู† ุงู„ุฅุตุงุจุฉ ูˆู…ู† ุฅู†ู‡
378
00:26:27,100 --> 00:26:31,240
ูŠุนู…ู„ ุญุฑูƒุฉ ุฎุทุฃ ู…ุซู„ุง ู…ู…ูƒู† ุชุณุจุจ ู…ุดูƒู„ุฉ ู„ู„ุนู…ู„ูŠุฉ ู‡ุฐู‡ ุฅูŠุด
379
00:26:31,240 --> 00:26:35,230
ุงุณู…ู‡ุง ุงู„ acute phase ุงู„ recovery phaseุงู„ู„ูŠ ู‡ูŠ ู‡ุฐู‡
380
00:26:35,230 --> 00:26:37,730
ุงู„ู…ุฑุญู„ุฉ ุงู„ู„ูŠ ุฌุงูŠ ููŠ ุงู„ู…ูุต ุชู…ุงู… ุงู„ู„ูŠ ุจูŠุตูŠุฑ ููŠู‡ุง
381
00:26:37,730 --> 00:26:42,410
ุนู…ู„ูŠุฉ ุงู„ู„ูŠ ู‡ูŠ ุฅูŠุด ุฃู† ุงู„ุนุตุจ ุจุฏุฃ ูŠุดุชุบู„ ุฃูˆ ุฃู†ู‡ ูุนู„ุง
382
00:26:42,410 --> 00:26:45,670
ุงู„ุนู…ู„ูŠุฉ ุจุฏุฃุช ุชู†ุฌุญ ุชู…ุงู… ุจุฏุฃ .. ุจุฏุฃ ุงู„ุนุตุจ ูŠู‚ุชุฑุจ ู…ู†
383
00:26:45,670 --> 00:26:49,810
ุจุนุถู‡ ูˆ ุตุงุฑ ูŠู†ุฌู„ ุฅุดุงุฑุงุช ุงู„ุนุตุจูŠุฉ ุชู…ุงู… ุจุดูƒู„ ุทุจูŠุนูŠ
384
00:26:49,810 --> 00:26:52,470
motor retraining muscle hold in the shortened
385
00:26:52,470 --> 00:26:56,300
positionุจุจุฏุฃ ุฃู†ุง ุฃุดุชุบู„ ุงู„ู„ูŠ ู‡ูˆ ู…ุนุงู‡ ุงู„ุนู„ุงุฌ ุงู„ุทุจูŠุนูŠ
386
00:26:56,300 --> 00:27:00,720
ูˆ ุงู„ exercise ุจุณ ู…ุงุจุฏูŠุด ุงู„ู…ุฑูŠุถ ุชู…ุงู… ูŠู…ุฏ ุฅูŠุฏู‡ ู…ุซู„ุง
387
00:27:00,720 --> 00:27:04,380
ุฃูˆ ูŠุนู…ู„ ุงู„ู„ูŠ ู‡ูŠ ุญุฑูƒุงุช ูŠูƒูˆู† ููŠู‡ุง stretchingุŒ ู„ูŠุดุŸ
388
00:27:04,380 --> 00:27:08,060
ุนุดุงู† ู…ุงูŠุนู…ู„ุด stretch ู„ู„ุนุถู„ุฉุŒ ู„ู„ุนุตุจ ู†ูุณู‡ุŒ ูู„ุฐู„ูƒ ุงู„
389
00:27:08,060 --> 00:27:10,800
muscle ู„ุงุฒู… ุชุจู‚ู‰ ููŠ ูˆุถุนูŠุฉ shortened positionุŒ ู‡ูŠูƒ
390
00:27:10,800 --> 00:27:14,480
ุงู„ู…ูุถู„ุŒ ุนุดุงู† ู…ุงุนู…ู„ุด stretch ู„ู…ูŠู†ุŸ ู„ู„ nerve ู†ูุณู‡
391
00:27:15,750 --> 00:27:18,370
desensitization multiple texture for sensory
392
00:27:18,370 --> 00:27:22,830
stimulation ุฃู‡ ุจุฏ ุฃุนู…ู„ desensitization ุฃู†ูŠ ุฃู†ุง
393
00:27:22,830 --> 00:27:27,050
ุฃุจุฏุฃ ุฃุฏุฑุจ ุงู„ู…ุฑูŠุถ ุนู„ู‰ ุงู„ุฅุญุณุงุณ ู„ุฃู† ุงู„ุนุตุจ ุงุญู†ุง ู‚ู„ู†ุงู„ูƒ
394
00:27:27,050 --> 00:27:30,670
ูˆ ููŠู‡ motor ูˆ ููŠู‡ sensory ุชู…ุงู…ุŸู‡ูˆ ููŠู‡ sympathetic
395
00:27:30,670 --> 00:27:34,830
ูˆู„ุฐู„ูƒ ุฃู†ุง ุงู„ .. ุงู„ .. ุงู„ motor ุชู…ุงู… ุจุจุฏุฃ ุฃุนู…ู„ู‡
396
00:27:34,830 --> 00:27:38,790
exercise okay ุนู„ุดุงู† ุฃุชุฃูƒุฏ ุฃู†ู‡ ูˆุงู„ู„ู‡ ุงู„ุนุถู„ุงุช ุดุบุงู„ุฉ
397
00:27:38,790 --> 00:27:41,830
ูˆ ุงู„ุฃู…ูˆุฑ ุชู…ุงู… ุทุจ ูƒูŠู ุชุชุฃูƒุฏ ู…ู† ุงู„ sensoryุŸ ุฅู†ู‡ ุจุฎู„ูŠ
398
00:27:41,830 --> 00:27:47,970
ุงู„ู…ุฑูŠุถ ุชู…ุงู… ู…ุซู„ุง ูŠุญุท ุฅูŠุฏู‡ ุนู„ู‰ ุฃุณุทุญ ู…ุฎุชู„ูุฉู…ุซู„ุง ูŠุญุท
399
00:27:47,970 --> 00:27:51,750
ุฅูŠุฏู‡ ูˆุงู„ู„ู‡ ุนู„ู‰ ุฅุดูŠ ู†ุงุนู…ุŒ ุงู‡ ูŠุชุฃูƒุฏ ุฃู†ู‡ ุงู‡ ุฃุณุฃู„ู‡ ุฃู†ุช
400
00:27:51,750 --> 00:27:56,310
ุญุท ุฅูŠุฏูƒ ุนู„ู‰ ุฅูŠุด ู…ุซู„ุงุŒ ุนู„ู‰ ุฅุดูŠ ู…ุซู„ุง ุนู„ู‰ ู†ุฎุฏุฉ ุงู„ุชุฎุชุŒ
401
00:27:56,310 --> 00:27:59,730
ุงู‡ okay ุงู‡ ู‡ุฐู‡ ู†ุงุนู…ุฉ ู…ู…ูƒู† ุฃุฎู„ูŠ ู…ุซู„ุง ูŠุญุท ุฅูŠุฏู‡ ุนู„ู‰
402
00:27:59,730 --> 00:28:04,370
ูƒุจุงูŠุฉ ุดุงูŠุŒ ุนู„ู‰ ุฃุณุทุญ ู…ุฎุชู„ูุฉ ุจุญูŠุซ ุฃู†ูŠ ุฃู†ุง ุฃุญูุธ
403
00:28:04,370 --> 00:28:06,490
ุงู„ุฅุญุณุงุณ ุงู„ุชุจุนู‡
404
00:28:17,200 --> 00:28:23,200
ูƒูŠู ูŠู…ูŠุฒู‡ุงุŸ ุฅู† ุฃู†ุง ุจุฎู„ูŠู‡ ูŠู…ุณูƒ objects ู…ุฎุชู„ูุฉ ุชู…ุงู…ุŸ
405
00:28:23,200 --> 00:28:26,380
ูˆ ู‡ูˆ ุจูƒูˆู† ู…ุบู…ุถ ุนู†ุงู‡ ูˆ ุฃุณุฃู„ู‡ ุฅูŠุด ุฃู†ุช ุจุงู„ุธุจุท ุงู„ู„ูŠ
406
00:28:26,380 --> 00:28:31,620
ู…ุงุณูƒู‡ุŸ ูƒุจุงูŠุฉุŸ ูƒุงุฒุฉ ู…ูŠู‡ุŸ ุฌู†ูŠุฉ ู…ูŠู‡ุŸ ุณูƒูŠู†ุฉุŸ ุดูˆูƒุฉุŸ
407
00:28:31,620 --> 00:28:34,700
ู…ุนู„ุฌุฉุŸ ุฒูŠ ู‡ูŠูƒ ูŠุนู†ูŠ ุชู…ุงู…ุŸ ู„ุงุฒู… ุฃุถู„ู†ูŠ ุฃู†ุง ุฃุฏุฑุจ
408
00:28:34,700 --> 00:28:39,320
ุงู„ุฅุญุณุงุณ ุนู†ุฏู‡ ุจุฅู†ูŠ ุฃู†ุง ูŠุนู†ูŠ ุฃุนู…ู„ู‡ ุชุฏุฑูŠุจ ุนู„ู‰ objects
409
00:28:39,320 --> 00:28:44,710
ู…ุฎุชู„ูุฉุทูŠุจ ุงู„ chronic phase ุชู…ุงู… ูˆ ู‡ุฐู‡ ู„ู…ุง ุจูƒูˆู† ููŠ
410
00:28:44,710 --> 00:28:49,290
ุนู†ุฏูŠ ุงู„ renovation potential peaked ุงู† ู‡ูˆ ุงู„ุนุตุจ
411
00:28:49,290 --> 00:28:55,110
ู†ูุณู‡ ุฃุตุจุญ ู…ุงููŠุด ุฅู…ูƒุงู†ูŠุฉ ุฃู†ู‡ ูŠุตูŠุฑ ููŠู‡ recovery ุชู…ุงู…
412
00:28:55,110 --> 00:29:00,870
ูˆ ู‡ู†ุง ุจูƒูˆู† ููŠ ุนู†ุฏูŠ ุชู…ุงู… ู„ุงุฒู… ุงู†ุง ุงุนู…ู„ ุชุนูˆูŠุถ ู„ุงู„ู„ูŠ
413
00:29:00,870 --> 00:29:05,690
ู‡ูˆ ุงู„ .. ู„ู„ .. ู„ู„ู…ุดูƒู„ุฉ ุงู„ู„ูŠ ุนู†ุฏู‡ ุงู„ compensatory
414
00:29:05,690 --> 00:29:11,620
functionุทุจุนุง ุชุนูˆูŠุถูŠ ุฒูŠ ู…ุง ู‚ู„ู†ุง ุงู† ู‡ูˆ ูู‚ุฏ ูˆุธูŠูุฉ
415
00:29:11,620 --> 00:29:16,280
ู†ุชูŠุฌุฉ ู‚ุทุน ุงู„ุนุตุจ ู‡ุฐุง ุงูˆ ู†ุชูŠุฌุฉ ุงู„ู„ูŠ ู‡ูˆ ุงู„ุถุบุท ุงู„ู…ุณุชู…ุฑ
416
00:29:16,280 --> 00:29:19,700
ุงู„ู„ูŠ ุณุงุฑุน ุงู„ุนุตุจ ูˆ ุงู„ู„ูŠ ุณุจุจ ุชู„ุจ ููŠู‡ ุงู„ุนุตุจ ูู‡ู†ุง ุจุฏูŠ
417
00:29:19,700 --> 00:29:22,940
ุงุนู…ู„ ุงู„ compensatory function is minimized during
418
00:29:22,940 --> 00:29:25,280
the recovery phase ู…ุง ุชุณุชุฎุฏู… ุงู„ compensatory
419
00:29:25,280 --> 00:29:27,520
function ููŠ ุงู„ recovery phase ู„ุฃ ุงู„ recovery phase
420
00:29:27,520 --> 00:29:33,090
ู‚ู„ู†ุง ุจุณ ุงู†ู‡ุง ุชู…ู†ุน ุงู„ deformitybut is emphasized
421
00:29:33,090 --> 00:29:36,070
when full neurological recovery doesn't occur ู‡ุฐู‡
422
00:29:36,070 --> 00:29:40,450
ุงู„ู…ุฑุญู„ุฉ ุจู†ุณุชุฎุฏู…ู‡ุง ู„ู…ุง ุงุญู†ุง ู†ูู‚ุฏ ุงู„ุฃู…ู„ ุชู…ุงู…ุง ููŠ ุงู†
423
00:29:40,450 --> 00:29:46,390
ุงู„ุนุตุจ ูŠุชุญุณู† ุชู…ุงู… ู‡ุฐู‡ ุทุจุนุง ุงู„ู…ุฑุญู„ุฉ ุงู„ู„ูŠ ุจู†ุณุชุฎุฏู…
424
00:29:46,390 --> 00:29:52,030
ููŠู‡ุง preventive care ู…ู…ูƒู† ุงู†ุง ุงุฑูƒุฒ ุนู„ู‰ ุงู†ู‡ ุงู…ู†ุน ุงู„
425
00:29:52,030 --> 00:29:55,570
preventive care ุงู„ู„ูŠ ู‡ูŠ ุงู…ู†ุน ุงู„ู…ุถุงุนูุงุช ุทูˆูŠู„ุฉ ุงู„ุฃู…ุฏ
426
00:29:55,570 --> 00:29:59,300
ุงู„ู„ูŠ ู…ู…ูƒู† ุชุตูŠุฑ ู†ุชูŠุฌุฉุงู„ู„ูŠ ู‡ูŠ ุฅูŠุด ุงู„ุฅุตุงุจุฉ ุฒูŠ ู…ุซู„ุง
427
00:29:59,300 --> 00:30:02,960
ุญุงู„ุงุช ุงู„ spinal cord injury ุชู…ุงู… ู‡ุฐูˆู„ ุงู„ู†ุงุณ ุจูŠุถู„ู‡ู…
428
00:30:02,960 --> 00:30:06,380
ุนู„ู‰ wheelchair ุทูˆู„ ุงู„ุนู…ุฑ ูู„ุฐู„ูƒ ุฃู†ุง ุจุฏูŠ ุฃุฏุฑุจู‡ู…
429
00:30:06,380 --> 00:30:11,500
ุฏุงูŠู…ุง ุนู„ู‰ ุฅู†ู‡ ูŠุนู…ู„ check up ู„ุฌุณู…ู‡ ุจุญูŠุซ ุฅู† ู‡ูˆ ูŠู…ู†ุน
430
00:30:11,500 --> 00:30:14,040
ุงู„ bed source ู…ุงูŠุตูŠุฑุด ููŠู‡ ุนู†ุฏู‡ ุงู„ู…ุดุงูƒู„ ุงู„
431
00:30:14,040 --> 00:30:17,640
incontinence ุชู…ุงู… ูˆ ุงู„ .. ูˆ ุงู„ urinary retention
432
00:30:17,940 --> 00:30:21,020
ูู‡ุฐู‡ ูƒู„ู‡ุง ุทุจุนุง ุงู†ุง ู„ุงุฒู… ุงุนุทูŠู„ู‡ advices ูˆ
433
00:30:21,020 --> 00:30:24,740
recommendation ุนู„ุดุงู† ู‡ูˆ ูŠุชุฌู†ุจ ุงู„ู„ูŠ ู‡ูŠ ุงู„ู…ุถุงุนูุงุช
434
00:30:24,740 --> 00:30:29,740
ุทูˆูŠู„ุฉ ุงู„ุฃู…ุฏ ู„ .. ุงู„ู„ูŠ ู‡ูŠ ุงูŠุด .. ู„ุชู„ู ุงู„ุนุตุงุจ ูˆ
435
00:30:29,740 --> 00:30:32,540
ุงู„ู…ุดูƒู„ุฉ ุงู„ู„ูŠ ุตุงุฑุช ุนู†ุฏู‡ ุงู„ู„ู‡ ูŠุนุทูŠูƒูˆุง ุงู„ุนุงููŠุฉ ูˆ
436
00:30:32,540 --> 00:30:36,800
ุจู†ูƒู…ู„ ุงู† ุดุงุก ุงู„ู„ู‡ ููŠ ุงู„ุฌุฒุก ุงู„ุชุงู„ุช ู…ู† ุงู„ู…ุญุงุถุฑุฉ