Fizioterapevtska obravnava bolnika po prebolelem klopnem meningoradikulitisu : poročilo o primeru

Kolar, Daša (author), Divjak, Mojca (mentor), Zupanc, Aleksander (comentor)

Uvod: Klopni meningoencefalitis je virusna bolezen osrednjega živčevja, ki jo prenašajo okuženi klopi. Večina bolnikov si po preboleli bolezni popolnoma opomore, pri 10 % bolnikov pa se razvijejo ohromitve različnih mišičnih skupin. Namen diplomskega dela je bil prikazati fizioterapevtsko obravnavo bolnika po prebolelem klopnem meningoradikulitisu. Metode: Oseminpetdesetletni bolnik je začel s fizioterapijo šest tednov po izbruhu bolezni. Fizioterapevtska ocena bolnika je bila opravljena s standardiziranimi merilnimi orodji pred in po tritedenski obravnavi. Zajemala je oceno pasivne gibljivosti bolnikovih sklepov, manualno testiranje mišic, oceno funkcij čutil in bolečine, oceno telesne drže, ravnotežja in sposobnosti hoje. Na osnovi rezultatov ocenjevanja so bile prepoznane težave, postavljeni cilji in izbrani ustrezni fizioterapevtski postopki. Fizioterapija je potekala vsak delovni dan, tri tedne zapored. Rezultati: Pri bolniku je v desnem spodnjem udu prišlo do izboljšanja sklepne gibljivosti (notranja rotacija v kolčnem sklepu za 9°, zunanja rotacija v kolčnem sklepu za 10°, fleksija v kolenskem sklepu za 10°, plantarna fleksija v zgornjem skočnem sklepu za 15°), mišične zmogljivosti zunanjih rotatorjev kolčnega sklepa za dve oceni in zmogljivosti fleksorjev kolenskega sklepa za oceno in pol, hipestezija na področju dermatomov L2 in S1 se v času obravnave ni izboljšala, bolečina se je zmanjšala za 10 mm na vidni analogni lestvici za oceno intenzivnosti bolečine, bolnik je izboljšal vzravnavo in simetrijo telesne drže, ravnotežje se je po Bergovi lestvici za oceno ravnotežja izboljšalo za 11 točk, hitrost sproščene hoje se je pri testu hoje na 10 metrov izboljšala za 0,32 m/s, pri šestminutnem testu hoje pa je bolnik izboljšal prehojeno razdaljo za 131 metrov. Razprava in sklep: Rezultati uporabljenih merilnih orodij so pokazali napredek pri skoraj vseh testih, največjega pri izboljšanju ravnotežja in sposobnosti hoje. Predvidevamo, da je fizioterapevtska obravnava pri tem bolniku po prebolelem klopnem meningitisu vplivala na izboljšanje ravnotežja, sposobnosti hoje, sklepne gibljivosti, mišične zmogljivosti in zmanjšanja bolečine.

• Language: Slovenian
• Keywords: klopni meningoencefalitis, pareza spodnjega uda, fizioterapija, rehabilitacija
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2017
• PID: 20.500.12556/RUL-91488
• COBISS.SI-ID: 5239403
• Publication date in RUL: 08.04.2017

Secondary language

• Language: English
• Title: Physiotherapy in patient after tick-borne meningoradiculitis : a single case report

Abstract

Introduction: Tick-borne encephalitis is a viral disease of the central nervous system, transmitted by the infected tick stabs. Most patients fully recover from the disease, whereas 10 % of patients develop paralysis of different muscle groups. Purpose: The aim of this study is to present an example of physiotherapy in patient after tick-borne meningoradiculitis. Methods: A fifty-eight years old patient started physiotherapy six weeks after the outbreak of the disease. Physiotherapeutic assessment was carried out using standardized outcome measures before and after the three-week treatment. It included a goniometric assessment of passive leg range of motion, manual muscle testing, evaluation of sensory functions and pain, assessment of the posture, balance and ability to walk. Based on the results of the evaluation we identified problems, set goals, and selected the appropriate physiotherapeutic methods. Physiotherapy was held every working day, for three consecutive weeks. Results: The patient has improved his range of motion of the right leg joints (internal rotation of the hip joint for 9°, external rotation of the hip joint for 10°, flexion of the knee joint for 10°, plantar flexion of the ankle joint for 15°), his right hip external rotators strength for two grades and his right knee flexors strength for one grade and a half, hypesthesia of the right L2 and S1 dermatomes has not improved during the treatment, the pain has been reduced by 10 mm on a visual analogue scale for pain intensity, the patient has improved body alignment and posture symmetry, his balance has improved for 11 points on the Berg balance scale, and the speed of comfortable walking by the 10 meter walk test has improved for 0,32 m/s, whereby the patient has improved the distance for 131 metres by the six-minute walk test. Discussion and conclusion: The results of the measurement tools have shown progress in nearly all tests, the biggest in improving balance and walking ability. We assume that the physiotherapy programme in this patient after tick-borne meningoradiculitis has improved balance, walking ability, joint mobility, muscle capacity and has reduced pain.

• Keywords: tick-borne encephalitis, paresis of the lower limb, physiotherapy, rehabilitation