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Possibilities of physiotherapy in patients with spastic paresis after stroke
OŠMERA, Martin
This bachelor thesis deals with spastic paresis of the lower limb in patients after a stroke. The thesis describes the problem of spastic paresis and the possibilities of using physiotherapy. A number of physiotherapeutic methods can be used in clinical practice to treat spasticity. One such method is the Guided Self-rehabilitation Contract by J. M. Gracies, which combines static prolonged stretching with the possible application of botulinum toxin and strength training of repetitive active movements (RAP) with home autotherapy. The aim of this thesis is to describe various possibilities of physiotherapy and evaluate the effectiveness of the method according to Gracies in the target group of patients. The Theoretical part focuses on spastic paresis, its origin, description, and characteristics together with the upper motoneuron syndrome (UMN syndrome), in which spasticity is one of its components. The following are individual clinical manifestations and forms of spastic paresis with the possibility of evaluation by clinical scales. The work also mentions a stroke, as one of the possible causes of spasticity. At the end of the theoretical part, pharmacological treatment with selected physiotherapeutic approaches to therapy is presented. The Methodological part describes the process of research implementation. The Practical part is conducted in the form of qualitative research, namely case studies in two probands with spastic paresis of the lower limb after a stroke, in which therapy according to Gracies is indicated. Each proband was subjected to an input and output kinesiological analysis, which included anamnesis, aspect, anthropometry, goniometry, examination of muscle strength, gait tests, Berg Balance Scale and Five-step Clinical Assessment in Spastic Paresis. During the study which lasted more than 6 months, the course of therapy was monitored in each proband. Based on the comparison of kinesiological analyses, was possible to observe a positive effect of the therapy. Proband 1's results are indistinct, despite clear subjective improvement. It was possible to improve movement, condition, and postural stability. Conversely, in some of the monitored muscles, the rate of spasticity worsened. Proband 2's results are significantly improved, despite the chronicity of the condition.
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