Vpliv vidne povratne informacije v kronični fazi kapi in ortotična oskrba spastičnega uda : diplomsko delo

Ogris, Ana (author), Lampe, Tomaž (mentor), Pavlović, Monika (co-mentor), Fošnarič, Miha (reviewer)

Uvod: Kap je eden vodilnih dejavnikov zmanjšanja kakovosti življenja v moderni družbi. Za osebe, ki se po kapi soočajo s parezo udov je ključna pravilna rehabilitacija za povrnitev gibalnih funkcij. Eden od kliničnih pristopov je tudi terapija z ogledalom, ki naj bi na podlagi vidne povratne informacije ponovno aktivirala spastične mišice. Namen: Naš cilj je bil ugotoviti ali terapija z ogledalom prispeva k izboljšanju stanja pri osebi v kronični fazi kapi in kakšne možnosti ortotične oskrbe prihajajo v poštev za našo preiskovanko. Metode dela: V raziskavo smo vključili starejšo pacientko, ki je pred več kot štirimi leti prestala hemorargično možgansko kap. Izvedli smo mesečni rehabilitacijski program, tri terapije na teden, ki je temeljil na terapiji z ogledalom. Merili smo čas, v katerem je preiskovanka opravljala zastavljene vaje. Z uporabo modificirane Ashworthove lestvice in motoričnega indeksa smo ocenili stanje pred in po izvedbi terapije. Naše rezultate smo primerjali s predhodno izvedenimi študijami drugih avtorjev, ki smo jih ocenili kot ustrezne in primerljive naši raziskavi. Rezultati: Povprečna dolžina terapije je bila med 15 in 20 minutami – odvisno od zahtevnosti nalog v tistem tednu. Ugotovili smo izboljšanje oz. zmanjšanje porabljenega časa, za dokončanje funkcionalnih nalog med posameznimi serijami na terapijo. Končni rezultat raziskave pa žal ni pokazal izboljšanja spastičnosti ali motorike na paretičnem zgornjem udu v meri, ki bi jo lahko dokazali z merilnimi lestvicami, ki smo jih uporabili. Razprava in zaključek: Naše ugotovitve po sami terapiji in pregledu literature kažejo, da je terapija z ogledalom učinkovitejša v zgodnji fazi rehabilitacije po kapi. V tem obdobju lahko dosežemo največ plastičnih sprememb v možganih in posledično takrat prihaja do največjih napredkov. V kronični fazi kapi pa se stanje zgodnje rehabilitacije predvsem vzdržuje do mere, ki je bila dosežena. Pri naši preiskovanki bi kot alternativo uvedli statično ortozo za podlaket in zapestje, s katero bi postopoma zmanjševali spastičnost prstov leve roke. Tudi drugi avtorji so dosegli sklep, da terapija z ogledalom deluje, vendar neznačilno več kot običajna rehabilitacija s funkcionalnimi nalogami brez ogledala. Terapija z ogledalom ostaja vodilna oblika na področju zdravljenja fantomske bolečine pri amputiranih osebah.

• Language: Slovenian
• Keywords: diplomska dela, ortotika in protetika, terapija z ogledalom, rehabilitacija po kapi, ortoza za zgornji ud, povišan mišični tonus
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [A. Ogris]
• Year: 2022
• Number of pages: 28 str., [1] str. pril.
• PID: 20.500.12556/RUL-140582
• UDC: 617.3
• COBISS.SI-ID: 121844995
• Publication date in RUL: 16.09.2022

Secondary language

• Language: English
• Title: Impact of visual feedback on a stroke patient in a chronic phase and orthotic care of spastic extremity : diploma work

Abstract

Introduction: Stroke is one of the main reasons for lower quality of life in modern society. For patients suffering from limb paresis, proper and immediate rehabilitation is the key to recovery. Mirror therapy is considered an alternative way to restore muscle strenght based on visual feedback. Purpose: We aimed to find out wheather mirror therapy contributes to better rehabilitaion outcomes in patients in the chronic stroke phase. We also studied the options of orthotic care for our subject. Methods: Our subject was an elderly woman who suffered a hemorrhagic stroke four years ago. She participated in a rehabilitation program, based on mirror therapy, three times a week for one month. We measured the time our subject completed the tasks during the therapy. We checked her spasticity and movement status before and after therapy using modified Ashworth scale and Motricity index. Our results were compared with other similar studies, which we determined to be appropriate for our therapy plan. Results: The average therapy time was 15 to 20 minutes – depending on the level of difficulty over the course of the weeks. There were improvements in time between the three series she completed in one session. Unfortunately, the final results for spasticity and motricity showed no progress. Discussion and conclusion: We concluded that mirror therapy is a better option for patients in the acute stroke phase, when more plastic changes can occure in the brain, and as a result, this is when the greatest progress is made. In the chronic phase the goal is to maintain or improve this condition. We would recommend the use of a static forearm orhosis to our patient. With this medical device we could gradually improve the position of the spastic fingers of the left hand. The authors of the articles we used for this review reported modest progress in stroke patients who participated in mirror therapy, but it was not significantly different from the original functional therapy without a mirror. Therefore, mirror therapy remains a leading approach to the management of phantom pain in amputees

• Keywords: diploma theses, orthotics and prosthetics, mirror therapy, rehabilitation after stroke, upper limb orthosis, increased muscle tone