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Physiotherapy in patients after injuries of the spine and spinal cord
HAJNÁ, Petra
In connection with our lifestyle every year in our country but also abroad there is a growing number of people with spinal cord injuries. The spinal cord injury usually occurs while a spinal injury, where the spinal canal is compressed by luxated vertebra or bone fragments. Affected are more often young people, especially men. The most common causes are falls from height, accidents and sports injuries. A person with this condition not only has limitations in terms of loss of movement or sensitivity but is often threatened by various health complications. Therefore a complex care and intensive rehabilitation is very important, which is in the Czech Republic secured by the spinal program lasting 6-9 months. Rehabilitation is needed not only in the acute period after injury, but has a unique place in the chronic stage of spinal cord injury as well. The aim of this thesis was to explore issues of trauma and spinal cord injury from the perspective of physiotherapy. Based on the defined targets following research questions have been determined. What kinds of physiotherapy procedures may be used onpatients in the subacute stage and what procedures in the chronic stage of spinal cord lesion. A qualitative research in the form of case reports has been executed. Data was obtained from interviews, observation, document analysis and kinesiological analysis. Standard tests related to the spinal lesion were performed, only the most relevant tests and the results that were found during therapy in case reports were entered. The sample included four patients. Two patients in the subacute and two patients in the chronic stage of spinal cord injury lesion etiology. The research was conducted at the Spinal Unit Department of Traumatic Surgery, University Hospital Brno and at the Rehabilitation and restoration center Borovany. Physiotherapy in subacute phase of spinal cord injury is directed at the prevention of pressure sores, contractures, pain, maintaining optimal mobility of joints, focusing on respiratory rehabilitation, maintenance and strengthening of preserved motor potential, activation of the motor transient spinal cord lesion with efforts to activate the motor skills in the most distally way, improving the overall physical condition. The aim is to use and support functional ability of the patient to the fullest extent and quality with the subsequent effort to develop alternative mechanisms.Of the special methods the ones on the neurophysiological basis are the most commonly used treatment methods. An important part is the gradual verticalization of the patient, training equilibrium reactions such as training seat, support for upper limb, keeping in certain positions and functional training, thus the mobility on the bed, self-care, transfers, training wheel chair control, practicing functional replacement grip. Patients return to life with a big handicap, are often dependent on the assistance of others, learn to use a wheelchair and other aids. They have years of life ahead in which they have to cope with the conditions subsequent their injury. In the chronic period, it is important to maintain physical fitness, preventpossible complications, especially pressure sores and joint contractures. Physiotherapist addresses the consequences of overloading the exposed muscles, monitors the vertebral problems, joint pain or muscle imbalance. During this period, patients can attend ambulant physiotherapy or use maintenance stays in rehabilitation centers. The purpose of the study was to mention the basic and the most important areas in the care of spinal patients and to highlight the importance of physiotherapy comprehensive care not only within the spinal program, but also from the perspective of the long-term care of these patients as the rehabilitation should accompany the patient's whole life.
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