Autism Physician Handbook Vietnamese

T k l bnh kh ph bin tr em,
nhng vic chn on v iu tr cn

cha ph cp.
Quyn S Tay T K ny c vit rt hay,
rt d hiu nh c nhiu hnh nh minh
ha. Sch rt hu ch cho mi ngi: bc
s, thy c gio, ph huynh ca tr u
c th nhn din c nhng du hiu
gi , a tr n bc s chuyn khoa
khm v chn on sm bnh t k.
y l mt quyn sch tt, cn c ph
bin rng ri, c bit l khng th thiu
trong Nhi khoa, cc nh tr v cc trng
mu gio.
GS.TS.BS Hong Trng Kim

Nguyn Ch nhim B mn Nhi
Trng i Hc Y Dc TP. HCM
Ch tch Hi Nhi khoa TP. HCM
Ph Ch tch Hi Nhi khoa Quc gia Vit Nam
S Tay T K ca Bc S l mt cng trnh

nghin cu khoa hc gip ch cho gio
vin nh tr, mu gio, tiu hc, trung
hc, ph huynh, cc chuyn vin vt l,
S tay
m ng, hng nghip, tm l, x hi, cc
on th thanh nin, ph n... nhn
bit v vn ng gia nh, ngi thn c
tr nghi ng t k, a tr n khm ti
t k
cc khoa tm l bnh vin nhi, cc trung
tm tm thn c chn on v can ca
bc s
thip sm, hu cho cc tr c ha nhp
vi cng ng.
BS. Phm Ngc Thanh

C vn Tm l Khoa Tm l
Bnh vin Nhi ng 1, TP. HCM
www.helpautismnow.com
Nguyn bn: Autism Physician Handbook
Tc gi thc hin v trnh by: Linda Lee, Gim c iu Hnh t chc HANS
Salem, Oregon, USA
2007 Tc gi gi bn quyn
Bn dch Vit ng: S Tay T K ca Bc S

Dch thut: Dung V, Cng Tc X Hi, Ottawa, Canada
Hiu nh: BS. Phm Ngc Thanh, Bnh Vin Nhi ng 1, TP. HCM, Vit Nam
Mc lc
Trang 1 M c l c
Trang 2 Li cm t
Trang 3 Minh ha CHAT
Trang 4-5 Bng kim tra CHAT
Trang 6-23 Nhng triu chng hnh vi ca t k
Trang 7-8 Cc vn x hi
Trang 9 Cc vn giao tip
Trang 10-13 Nhng hnh vi k l, lp i lp li
Trang 14-15 Cc vn vn ng
Trang 16 Nhy cm qu mc
Trang 17-19 Cc vn cm gic
Trang 20 Cc hnh vi t gy thng tch
Trang 21-23 Cc vn an ton
Trang 24 Nhng bnh khc km theo: ri lon tiu ho
Trang 25 Nhng bnh khc km theo: ri lon gic ng,
p ng au, co git
Trang 26 Tc ng ca tr t k trong gia nh
Trang 27 Vai tr can thip v gio dc sm
Trang 28 Nhng chuyn gia c th gip tr t k
Trang 29-33 Gip tr t k thoi mi khi n khm bnh
Trang 34-35 Nhng a ch hu ch cho cha m
1
Li cm t
Ban Gim Hiu Trng Gio dc Chuyn bit Khai Tr xin chn thnh cm
n t chc HANS (Hy Gip Tr T K Ngay By Gi) c nh cho
php chng ti dch tc phm S Tay T K ca Bc S ny qua ting Vit.
Cun sch ny l mt cm nang cho chng ti l nhng bc s, chuyn
gia tr liu, v gio vin nhn bit r hn hi chng t k, chn on v
can thip sm gip tr t k.
Vit Nam trong nhng nm gn y nh c thng tin trn truyn hnh,

truyn thanh, bo ch v trn mng, nhiu ph huynh a con n
bnh vin khm v c t vn nn s tr mang chng t k c
pht hin ngy cng nhiu. Tuy nhin s nhn bit cc du hiu ca t
k trong ngnh y t cng nh gio dc vn cn hn ch, v t liu v t
k bng ting Vit vn cn thiu.
Chng ti xin gii thiu n qu v cun S Tay T K ca Bc S, c

mong ti liu hu ch thit thc ny s c ph bin rng ri Vit
Nam mi gii quan tm hiu bit thm v gp phn can thip, tr liu
v gio dc tr t k hu hiu hn, gip tr sm ha nhp tt vo cng
ng.
TS. BS. Hunh Tn Mm
Sng Lp Trng Gio Dc Chuyn Bit Khai Tr
TP. H Ch Minh, Vit Nam
Mc ch ca t chc HANS l gip cc gia nh c tr

t k bng cch h tr cc bc s v chuyn gia nhn bit,
chn on v tr liu sm chng t k.
Cun S Tay T K ca Bc S ny c hnh thnh gip cc nhn vin

y t tuyn c s chm sc tr c chng t k
V khng c xt nghim sinh ha, t k ch c th c chn on da

trn quan st hnh vi ca tr, v hi cn thn cha m v cuc i ca tr.
Cun s tay ny do iu dng Linda Lee, Gim c iu Hnh ca t

chc HANS, hnh thnh vi s ng gp ca nhiu chuyn gia trong
ngnh gio dc v y khoa.
2007 Tc gi gi bn quyn
2
Lc 18 thng tui, con bn c...
1. Nhn bn v ch bng
ngn tr cho bn
xem vt g khng?
2. Nhn theo khi bn

ch bng ngn tr
mt vt g khng?
3. Dng tr tng tng

chi gi b khng?
Nu tr li KHNG, th con
bn c th c nguy c T K.
Bn nn cho bc s ca b bit
ngay.
Da theo bng CHAT (bng kim t k tr chp chng bit i)

3
Bng Kim Tra CHAT
(CHAT l ch tt ca Bng Kim T K Tr Chp Chng Bit i)
Bng CHAT cn c in khi b c kim tra sc kho lc 18 thng tui
Phn A : do ph huynh in
1. B c thch c u a, lc l trn u gi ca bn khng? c - khng
2. B c quan tm n cc b khc khng? c - khng
3. B c thch leo tro khng? nh leo cu thang? c - khng
4. B c thch chi o hay trn tm khng? c - khng
5. B c bit chi gi b, v d nh pha mt tch nc tr,

bng cch dng mt ci tch v bnh tr bng chi khng? c - khng
6. B c bao gi dng ngn tr ch vt g m b mun

hi XIN hay khng? c - khng
7. B c bao gi dng ngn tay tr ch vt g

m b quan tm khng? c - khng
8. B c bit chi ph hp vi cc chi nh (nh xe -t, cc khi),

m khng b vo ming ngm, khng mn m
hoc nm i khng? c - khng
9. B c bao gi mang mt vt g cho bn xem khng? c - khng
Phn B: do bc s hoc nhn vin y t in

1. Trong lc c bc s khm, b c tip xc mt vi bn khng? c - khng
2. Bn gy s ch ca b, ri th ch vo mt chi v ni
Coi ka, l (ni tn chi)! Nhn mt b. B c nhn theo
vt m bn ang ch khng? c - khng
3. Bn gy s ch ca b, ri bn cho b mt ci tch v mt
m tr chi v bo Con c th pha mt tch tr cho bc khng?
B c bit gi b rt tr, gi b ung khng? c - khng
4. Bn hi b n u? Ch cho bc n i. B c bit ly
ngn tr ch vo n khng? c - khng
5. B c bit xy thp vi cc khi khng? v nu c,

bao nhiu khi? c - khng
B2. chm im c mc ny, bn cn m bo rng b khng ch nhn vo tay bn, m b

cn nhn theo vt m bn ch.
B3. Bn c th chn mt v d v tr chi gi b khc chm im c mc ny.
B4. Nu b cha bit n l g, th bn c th hi b con gu bng u? hoc ch mt vt khc
ngoi tm tay ca b. Cho im c mc ny, nu b nhn vo mt bn lc bn ch con gu.
4
Bng Kim Tra CHAT
(CHAT l ch tt ca Bng Kim T K Tr Chp Chng Bit i)
(tip theo)
Nhng mc chnh ca bng CHAT

Phn A
A5: Chi gi b
A7: Ch lin kt
Phn B
B2: Theo di mt vt c ch bng ngn tr
B3: Gi b
B4: Ch mt vt no
Nhng mc ph ca bng CHAT
Phn A
A1: Chi u a
A2: Quan tm x hi
A3: Pht trin vn ng
A4: Chi x hi
A6: Ch bng ngn tr yu cu
A8: Chi chc nng
A9: Cho xem mt vt g
Phn B
B1: Tip xc mt
B5: Thp vi cc khi
Thm nh nguy c
Nguy c cao Tht bi (tr li KHNG) cc mc A5, A7, B2, B3, B4
Nguy c trung bnh Tht bi mc A7, B4,
(nhng khng thuc nguy c cao)
Nguy c thp Nu khng thuc hai mc nguy c trn
Nhng khuyn co v x tr:

Nhm nguy c cao: Gii thiu tr n mt phng khm pht trin
v khoa gio dc c bit.
Nhm nguy c trung bnh: Kh nghi cao - gii thiu nh trn
Kh nghi thp - kim tra li mt thng sau.
Nhm nguy c thp: Nu c bt k mt cu tr li KHNG, kim tra
li mt thng sau.
5
Nhng triu chng hnh vi ca t k
X hi
Giao tip
Hnh vi k l, lp i lp li
Vn ng
Nhy cm qu mc
Cm gic
T gy thng tch
An ton
6
cc vn x hi
Khng quan tm n cc tr khc ang chi
C v hn hc vi anh ch em
Ngi go khc mt mnh

thay v gi m
Khng lc cha m i
hay lc cha m v nh
7
cc vn x hi
Khng quan tm chi o hay

nhng tr chi tng tc khc
Phn ng mnh khi c

cha m bng, m hay hn
Khng gi tay i b ra khi

ni khi c ngi n b
8
cc vn giao TIp
Tr t k thng khng nhn bit mi trng xung quanh v

kh tip xc mt. V th tr c v khng quan tm n giao tip.
Khi tr cn g, thng cm tay dt chng ta n vt , hay ni
cch khc, tr dng cha m hay ngi ln nh mt cng c
ly cho tr vt tr thch.
Khng nhn bit mi trng xung quanh
Trnh tip xc mt
Cm tay dt ngi khc
9
nhng hnh vi lp i lp li
Vy tay
Nhn lin tc vo
qut trn ang quay
T quay vng vng
Xp cc chi thnh hng di
10
nhng hnh vi lp i lp li
Khng quan tm n
chi, m ch gn b vi mt
s vt dng
Thch bt cc ht bi bay trong

nh nng
Khng bit chi cch ph hp vi chi, m ch thch mt

phn ca chi thi, chng hn ch thch tp trung quay
bnh xe ca mt t chi
11
nhng hnh vi k l bt thng
Lc l, ong a
Tt v bt n lin tc
n nhng vt bt thng nh qun o,

nm hay mn ca
Thch bng ngn tay trc mt
12
nhng hnh vi k l bt thng
Thch chui xung nm di gm cc

vt nng nh di gm ging
Bi trt phn
Thch tm nhng tc ng mnh trn c th
13
Tr t k c nhngcc
vnvn
ngbt
vn ngMt s c th c
thng.
nhng k nng vn ng c bit mt s lnh vc nhng b
khim khuyt nhng k nng vn ng khc.
Phi hp km
Khim khuyt vn ng tinh
i nhn gt chn Khim khuyt cm nhn chiu su

14
cc vn vn ng
Ngay mt s tr c nhng k nng vn ng bnh thng,

cng c th gp kh khn vi nhng hot ng nh p
xe p xe ba bnh, hay li mt xe hi chi.
Vng v
Gi thng bng l thng
Hay nhu nc bt
www.helpautismnow.com Khng bit p xe p ba bnh hay li xe ti chi

15
nhy cm qu mc
Tr t k rt kh chu ng m nhc, ting ng, cc loi mt

vi, v nhng thay i mi trng hay sinh hot.
Cng tip xc nhiu vi cm gic, tr cng c hnh vi phn
ng
16
cc vn cm gic
Rt kh chu khi ct tc
Khng chu buc giy an ton
Khng chu c nhng iu mi l,

nh nn sinh nht hay bong bng
Khng cho tm ra
17
cc vn cm gic
D nn i khi ngi nhng

mi l trong nh
Khng chu c m nhc
Thch quay nhng vt trc mt
Tr c v ic, khng git mnh khi

nghe ting ng to, nhng c lc li
www.helpautismnow.com c v nghe bnh thng
18
cc vn cm gic
Khng chu mc o m khi ra ngoi tri lnh
C th x qun o ca
mnh, nht l x cc nhn
Khng cho thay qun o hiu v cc ng may
www.helpautismnow.com C khi li i mc o m gia ma h

19
cc hnh vi t gy thng tch
p u
T cn m khng bit au
T cu x v co xc da
T bt c nm tc
20
cc vn an ton
Khng bit nguy him
21
cc vn an ton
Khng nhn ra nhng tnh hung

c th lm cho tr b tn thng
22
cc vn an ton
Khng s cao
23
Nhng bnh km vi t k: xo trn tiu ho
Bc s Tim Buie, chuyn gia v bnh tiu ho ti i Hc Harvard v
chng trnh Ladders ca Bnh Vin Massachusetts, Boston thc hin
ni soi cho trn 1000 tr t k. Trong 400 tr u tin bc s thy tn
sut ri lon tiu ho cao hn so vi tr bnh thng.
20% vim thc qun
12% vim d dy
10% vim t trng
12% vim i trng
55% thiu men lactase
Ph huynh nn cho con i khm chuyn khoa tiu ho nu

thy c nhng triu chng sau y
thc n cn nguyn trong phn

tiu chy
ch n hn ch hoc nhy cm to bn
www.helpautismnow.com vi thc n
24
Ri lon gic ng/p ng au/co git
Tr c th thc vi ngy lin m khng bun ng. Tr c v

khng phn bit c ngy m. Tr kh vo gic ng v ng
hoi. Tr c th ch ng mt hai gi. Hu qu l cha m cng
mt ng theo.
Co git gia tng vi tui, cha r nguyn nhn.
Phn ng au gim; khng bit au,

hoc phn ng au qu ng
25
Tc ng ca t k trong gia nh
Vi mt tr t k, sinh hot quy nh hng ngy c th khng

c thc hin. i sng ca cha m v ca nhng a con
khc tr nn cng thng. Gia nh c th cn c t vn v tr
gip.
26
Vai tr ca can thip gio dc sm
Cc nghin cu chng minh l can thip gio dc sm dn n nhng

kt qu tt cho tr v gia nh. Can thip sm c th bao gm vic dy tr
nhn bit nhng g ang xy ra trong mi trng xung quanh, bit ch ,
bit bt chc hnh vi, dn dn ci thin nhng k nng giao tip ca tr.
Gia nh tr cn c gii thiu ti cc trung tm can thip sm c
lng gi nu nghi ng chm pht trin.
Ty theo nhu cu ca tr, s can thip sm c th bao gm tr liu ngn

www.helpautismnow.com ng, tr lu vt l v tr liu hng nghip
27
Nhng chuyn gia c th gip tr t k
1. Chuyn gia pht trin
2. Chuyn gia thm nh v can thip sm*
3. Chuyn gia thm nh thnh gic
4. Chuyn gia tr liu m ng
5. Chuyn gia tr liu vt l
6. Chuyn gia tr liu hng nghip
7. Bc s nhi khoa chuyn v tiu ho v ng rut
8. Chuyn gia thn kinh
9. Bc s tm thn nhi, chuyn gia tm l nhi
10. Nhn vin x hi, tham vn vin gia nh
11. Gio vin khoa s phm chuyn bit
12. Cc trng gio dc chuyn bit*
13. Cc nhm tng tr ph huynh
* Xin xem trang 34-35, nhng a ch hu ch cho cha m
28
Gip tr t k thoi mi khi n khm bnh
Bc s l nhng
ngi c hun
luyn chuyn mn
chn on bnh.
Tr t k thng
khng c v au
m, trng rt bnh
thng v t cc
mc pht trin nhi
khoa.
Tuy nhin tr c
th ng x nh th
c cha m qu
nung chiu.
Tr thng khng c rt mnh m trc mi trng i thay,

trc nhng hon cnh mi, vi ngi l v nhng kinh nghim
mi.
29
bc s nn in thoi
v tham kho vi cha m trc
Nhng li ch bao gm kh
nng:
1. C c lch s r rng t
cha m m khng b s hin
din ca tr chi phi.
2. Hi cha m c ngh
g gip cho vic khm
bnh c th d dng hn.
3. Ni vi cha m em theo
mt vt quen thuc ca
tr h tr tr trong lc khm bnh.
4. Nu tr cn c th mu, nn cho y lnh kem c thuc t
cha m c th bi trc cho tr trc khi n khm bnh.
5. ngh cha m chun b tr bng cch c cho tr nhng
truyn nh i thm bc s v i th mu c ng trn
trang ca t chc HANS, www.helpautismnow.com.
nn lng nghe cha m
Cha m chnh l nhng

chuyn gia bit r con
mnh
Khi c th, bc s iu tr
triu chng th cht nh
i vi tr bnh thng.
Khng chng t k nh
hng n s phn on
ca mnh.
30
nn chun b phng khm
iu dng v y s c th
kim tra trc vi cha m
v vic b tr phng khm,
bao gm:
Phng yn tnh
Phng khng c ca s
Khng c nh sng chi
ngi
Khng m nhc
Nu cn, nn ct nhng vt c th c dng nh v kh.
nn rt ngn thi gian ch i
Hn khm tr u ngy, sm
hn mi pht, tr khng lo
lng bt an khi thy nhiu ngi
l ngoi phng ch i.
Nhng li ch:
Gim thiu nhng nguy c
1. Tr ln ra dy da lm n
2. Lm cho cc gia nh khc
trong phng ch i b chi phi
3. Lm cho cha m bi ri
4. Lm h hi phng ch
Nu c th, nn in thoi hn trc ngy khm
31
nu khng c nh d tnh
Ngi khc c th ngh l

tr b bc i, b b, do
chng ta cn ch
Nhng hnh vi t gy
thng tch nh co cu,
cn, p u
Tr khng bit au l g
Tr khng bit vt g nguy
him, vt g c th gy
thng tch cho tr
Tr qu nhy cm khng cho s vo mnh, khng cho ci qun
o khm bnh
xin ng ngc nhin!
Xin cnh gic v s an

ton ca bn.
Nhiu tr t k khng
bit c l bn hin
din gip tr, m cm
thy b e da. Tr c
th bnh tnh mt lc,
nhng ngay sau c
th bng n:
p u p mnh; co
cn; phun nh nc bt;
m ; bt tc; t kho cht ngi li
Bn hy tn trng khng gian ring t ca tr v tr cn
www.helpautismnow.com khng gian rng hn bnh thng nhng lc .
32
hiu bit v ngn ng hn ch
Mt s tr c th k ton
b truyn phim
Disney nhng khng th
ni tn hoc m t s au
n.
Tr c th kh x l thng
tin c nghe .
lu tc ng ca t k
trn ton gia nh
Nu cn, nn gii thiu

n nhng nhm hi
tho dnh cho anh ch
em, nhm tng tr gia
nh, dch v gip gia
nh c ngh ngi
33
nhng a ch hu ch cho cha m
Trung Tm Phc Hi Chc Nng Thnh ph H Ch MInh

Bnh Vin Nhi Trung ng
ng La Thnh - H Ni Trng Gio Dc c Bit An Phc
204C, in Bin Ph,
Trung Tm Phc Tu Phng 7, Qun 3
67 Ph c Chnh - H Ni T : 083.9320.218
Thanh Xun - H Ni
Trng Gio Dc Chuyn Bit Anh Minh
Lp T Vn Can Thip Sm Phng Thanh 155 X Vit Ngh Tnh
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T: 046.660.3704, D: 0976.976.093 T. 08.38.401.249
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Email: nguyenthanh85.tl@gmail.com Trng Tr Khuyt tt nh Dng
37/3 Khu Ph 3
Trung Tm Sao Mai Phng Tn Chnh Hip - Qun 12
S 4 ng 116 Nhn Ho T. 08.38.910.806
Khi tr c du hiu chm ni hoc c mt s nt, Phng Nhn Chnh, Qun Thanh Xun Trng Ban Mai
biu hin ca chng t k, ph huynh c th T: (84-4)35572569 23/30 ng D2, (gn ng t Hng Xanh)
tham kho danh sch cc a ch thm khm sau: Web: www.morningstarcenter.net Phng 25, Qun Bnh Thnh
tp. H Ch Minh
Thnh ph H NI Trung Tm Phc Hi Chc Nng Tr Em www.truongbanmai.com
VietHealth
Trung Tm Gio Dc c Bit AEIC 39A Xun Diu, Trng Chuyn Bit Bim Bim
S 22A ngch 629/25 Kim M Qun Ty H Can thip cho tr t k/Asperger
Ngc Khnh, Qun Ba nh T: (84-4) 3717 3118 / 3718 6622 381/4/10, Phan Vn Tr,
T: 094.382 .1271 v 04.6273.1067 Email : phcnviethealth@gmail.com; Phng 11, Qun Bnh Thnh
Trang web: mamnonlamnhi.com project02@viethealth.org.vn t: 08 222 97 393 hoc 0919795574.
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Trung Tm An Phc Thnh Phng Khm Tm Thn - Tm L Tr Em Email: diepngo20032007@gmail.com
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Qun Hai B Trng
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Trng Cao ng S Phm Trung ng Trung Tm Nghin Cu Tm L
387 Hong Quc Vit v Tm Bnh L Tr Em - NT Nguyn Khc Vin Trng Cao ng S Phm Trung ng
Ngha Tn, Cu Giy S 22 Ng 6 Vn Phc Thnh Ph H Ch Minh
T: 0437913116 - Fax : T: 04.37264563 Khoa Gio Dc c Bit
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Web: http://canthiepsomtw.edu.vn http://nt-foundation.com dc mm non
http://www1.mamnon.com
Trng Mm Non Cu Vng Xanh Bnh Vin Nhi Trung ng 625/9 X Vit Ngh Tnh,
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Phng Vit Hng - Qun Long Bin T : 803 0056 ;
T: 04.22405687
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Web: www.khanhtam.com.vn Nng cc Tr Khuyt Tt.
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34
nhng a ch hu ch cho cha m
Bnh Vin Nhi ng 2 - Khoa Tm L Chi Hi Tr Liu Tm L Trng Non Trng Chuyn Bit T Thc Thanh Tm
14 L T Trng, 29 Phan Xch Long, 157 B, Phan T
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35
Mt cun s tay minh ha gip bc s
d dng nhn din v chn on sm bnh t k
S Tay T K ca Bc S l mt tp ti liu qy gi,

ghi nhn chi tit, c th, r rng v nhng hnh vi
in hnh ca tr t k. Cc minh ha trnh by sng
ng, d hiu nhng hnh vi v c ch ca tr t k.
Sch gip cho gio vin, ph huynh hoc nhng
ngi lm vic trc tip vi tr t k d khm ph nt
t k qua ci nhn v quan st lc ban u kp thi
chn on, can thip sm cho nhng tr em ny.
V Th Khoi
Hiu Trng Trng Chuyn Bit Gia nh
TP. H Ch Minh
S Tay T K ca Bc S rt cn thit cho chng trnh nghin cu v ging dy v hi chng t

k, v chng trnh ny phi c a vo B mn Nhi ca cc trng i hc y khoa ca Vit Nam.
Khoa chm sc c bit v bnh nhi t k phi c thnh lp ti cc bnh vin ln v ti cc c
s gio dc tr em t k, v phi c to iu kin lm tt nhim v ca mnh.
Bs. Nguyn Huy Dim

Gim c Nh Bo Sanh Dim Phc
TP. H Ch Minh
Sch vit v t k bng ting Vit cn thiu rt nhiu.

S gio vin dy mm non, tiu hc tip nhn rt
nhiu tr t k hc ha nhp nhng trang b v kin
thc nui dy cc em t k cn rt t nn quyn sch
ny l cm nang rt cn thit.
CNKH V Th Thy
Hiu Trng Trng Chuyn Bit Khai Tr
TP. H Ch Minh

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T k l bnh kh ph bin tr em,

nhng vic chn on v iu tr cn

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S Tay T K ca Bc S l mt cng trnh

BS. Phm Ngc Thanh

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