Vpliv intenzivne obravnave na hojo pri odraslem s spastično obliko cerebralne paralize - študija primera : diplomsko delo

Vrhovnik, Žan (author), Tomc Žargi, Tina (mentor), Palma, Polona (reviewer)

Uvod: Cerebralna paraliza je neprogresivna motnja, ki nastane zaradi okvare nerazvitih možganov. Povzroči motorične motnje, ki so pogosto združene s kognitivnimi motnjami. Hoja je ena najpogosteje prizadetih funkcij oseb s CP. Večina raziskav o učinkovitosti intenzivnih terapevtskih intervencij za izboljšanje hoje obravnava otroke in mladostnike, medtem ko so spremembe, dosegljive v odrasli dobi, slabo raziskane. Namen: Namen raziskave je bil ovrednotiti spremembe hoje pri odrasli osebi s cerebralno paralizo po obdobju intenzivne terapevtske obravnave. Metode dela: Izvedli smo študijo primera. Vključen je bil 22-letni moški preiskovanec s spastično diplegijo, razvrščen v prvo stopnjo po sistemu GMFCS. Meritve smo izvedli pred in po fizioterapevtski obravnavi. Uporabili smo vprašalnik RAND-36, modificirano Ashworthovo lestvico, test hoje na 10 metrov (hitrost, kadenca), meritve dolžinskih spremenljivk hoje, časovno merjeni test vstani in pojdi ter šestminutni test hoje. Fizioterapevtska obravnava je potekala trikrat tedensko in je obsegala 50 enot, ki so vključevale funkcijsko vadbo hoje, učenje hoje, vadbo za povečanje mišične sile, hojo na prostem in igro z loparjem (padel). Rezultati: Po fizioterapevtski obravnavi smo zabeležili klinično pomembne izboljšave. Hitrost sproščene hoje se je povečala za 11,6 % (0,16 m/s), hitrost hitre hoje pa za 28,6 % (0,54 m/s). Kadenca se je pri sproščeni hoji povečala za 11 korakov na minuto, pri hitri hoji za 32 korakov na minuto. Prehojena razdalja pri šestminutnem testu hoje se je podaljšala za 179 metrov (31,1 %), čas pri testu vstani in pojdi pa se je skrajšal za 0,99 sekunde (19,6 %). V domeni telesnega delovanja vprašalnika RAND-36 smo zabeležili izboljšanje za 25 točk. Spastičnost po modificirani Ashworthovi lestvici je ostala nespremenjena. Zmanjšala se je tudi variabilnost dolžine in širine desnega koraka med hitro hojo. Razprava in zaključek: Rezultati kažejo, da je intenzivna, v funkcijo usmerjena terapevtska obravnava pri odraslem s spastično obliko CP privedla do klinično pomembnih izboljšav v hitrosti hoje, vzdržljivosti hoje, funkcijski premičnosti in kakovosti življenja, in sicer brez sprememb v spastičnosti. Ugotovitve podpirajo smiselnost izvajanja intenzivnih programov tudi v odrasli dobi in dopolnjujejo še razmeroma omejeno literaturo na tem področju. Zaradi narave študije primera rezultatov ni mogoče posploševati, zato so za posplošitev ugotovitev potrebne nadaljnje raziskave z večjim vzorcem in dolgoročnim spremljanjem.

• Language: Slovenian
• Keywords: diplomska dela, fizioterapija, cerebralna paraliza, odrasli, intenzivna obravnava, hoja, študija primera
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [Ž. Vrhovnik]
• Year: 2026
• Number of pages: VIII, 25 str., [8] str. pril.
• PID: 20.500.12556/RUL-186673
• UDC: 615.8
• COBISS.SI-ID: 290040323
• Publication date in RUL: 04.09.2026

Secondary language

• Language: English
• Title: The impact of intensive treatment on gait in an adult with spastic cerebral palsy - a case study : diploma work

Abstract

Introduction: Cerebral palsy is a non-progressive disorder caused by damage to the immature brain. It results in motor impairments that are often accompanied by cognitive deficits. Gait is one of the most commonly affected functions in individuals with CP. The majority of research on the efficacy of intensive therapeutic interventions for gait improvement focuses on children and adolescents, while the changes attainable in adulthood remain poorly investigated. Purpose: The aim of this study was to evaluate gait changes in an adult with cerebral palsy following a period of intensive therapeutic treatment. Methods: A case study design was employed. A 22-year-old male with spastic diplegia, classified as GMFCS level I, participated. Assessments were conducted before and after the physiotherapy treatment. Outcome measures included the RAND-36 questionnaire, the Modified Ashworth Scale, the 10-Metre Walk Test (speed, cadence), spatial gait parameters, the Timed Up and Go test, and the Six-Minute Walk Test. The physiotherapy treatment was conducted three times weekly and comprised 50 sessions, including functional gait training, gait practice, muscle strengthening exercises, outdoor walking, and racquet sport, padel. Results: Clinically significant improvements were observed following the physiotherapy treatment. Comfortable gait speed increased by 11.6% (0.16 m/s), and fast gait speed increased by 28.6% (0.54 m/s). Cadence increased by 11 steps per minute during comfortable walking and by 32 steps per minute during fast walking. The Six-Minute Walk Test distance increased by 179 metres (31.1%), and the Timed Up and Go time decreased by 0.99 seconds (19.6%). The physical functioning domain of the RAND-36 questionnaire improved by 25 points. Spasticity, assessed with the Modified Ashworth Scale, remained unchanged. Reduced variability in right step length and width during fast walking was also observed. Discussion and conclusion: The results indicate that intensive, function-oriented therapeutic treatment in an adult with spastic CP led to clinically significant improvements in gait speed, gait endurance, functional mobility, and quality of life, without changes in spasticity. The findings support the implementation of intensive programmes in adulthood and contribute to the limited literature in this field. Due to the case study design, the results cannot be generalised, and further research with larger samples and long-term follow-up is warranted to enable broader generalisation of the findings.

• Keywords: diploma theses, physiotherapy, cerebral palsy, adults, intensive treatment, gait, case study