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Physiotherapy in patients with Femoral neck fractures
PRINCOVÁ, Pavlína
This bachelor thesis focuses on physiotherapy for patients with fracture of the femur bone in the neck of the femur. The femur is the strongest and longest bone in the human body, securing the stability of the latter. A femoral neck fracture is a fracture in the narrowest place of the bone, where the long femur bone goes over to the head of femur, connecting the femur bone with the acetabulum. Considering the influence of high energetic effects on the bone, the most often during sports or accidents, fractures might occur with younger individuals. However, the fractures are more frequent with older individuals: especially women are more prone to these, in context with influence of postmenopausal osteoporosis. In the Czech Republic, according to statistics, approximately 10.000 individuals per year suffer from this injury, with a clear predominance of women. For 20% of all Czech women aged 60-65 years, there is a strong probability of falling at least once a year. With women aged 80-84 years, this probability increases to one third (Trča, Kudrna, Hořejší, 2008). The theoretical part of this work describes the anatomy of the femur and the pelvic bone building up a hip joint. Further on, biomechanics of the hip joint, including etiology, classification and diagnosis of the femur together with the possibility of operative or conservative medical treatment, are considered. The practical part is based on qualitative research, using observation and interviews. Out of observation methods, the following were chosen: aspection, palpation, goniometrical and anthropometrical examination, examination of walking, muscle shortening and muscle strength that are observed at the beginning, during and at the end of the therapy. Patients of Traumatologic Department of the Hospital of Ceske Budejovice a.s. were chosen for this research.Two groups of patients are being observed: The first group consists of a man treated in conservative way and a woman with 1.5 year old femur fracture, originally treated by osteosythesis, indicated for total endoprosthesis out of a reason of a necrosis. These both patients were being observed for 6 weeks. The second group - a woman treated by osteosynthesis ? proximal femoral nail and a man with total endoprosthesis - were being observed for 8 days of therapy treatment in an early stage after the surgical intervention. Prior to starting the therapy, all patients were informed about the methods and targets of the therapy.The aim of the work is to map physiotherapeutic methods used for treatment of patients after femoral neck fracture, including a short term and a long term plan. The short term plan is especially focused on retreat of swelling and pain, restoring the muscular strength and movement and on training of walking with two crutches. The long term plan goal is approaching the same quality of life preceding the injury, especially by securing a better stability as prevention of falling down.All studied patients show a relatively quick improvement of the swelling and of the pain, especially these patients treated operatively. Verticalization of the patient is another important element, which is allowed by the classical treatment not earlier than after six weeks being confined to bed. Compared with this method, the operative method is more advantageous, allowing an earlier descend of the bed, helping avoiding such complications as thromboembolic disease, pneumonia or forming decubitus.The main objective of this bachelor thesis is not to evaluate a better and more efficient treatment method for the corresponding case - the sample of patients being not representative enough for such a purpose, but to remind and sum up the different used methods and means of physiotherapy.
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The Utilisation of the Feldenkrais Method in patients with backache without radicular irritation
HOUSKOVÁ, Marcela
I chose the topic The Utilisation of the Feldenkrais Method in patients with backache without radicular irritation for my bachelor thesis. The method bears the name of its author Moshé Feldenkrais, who started to develop his conception after his own injury during the Second World War. Feldenkrais Method of somatic education is an approach employing the process of learning by means of movement. It is based on presumption that a human being has four basic constituents: feelings, thinking, sensual perception and movement, which are present to each human action, and which interact with one another, which results in the fact that influencing of one constituent causes changes in the others. The method has two basic approaches: group lessons Awareness Through Movement and Functional Integration. Backaches are now classified among so called ?civilisation diseases?, which is mostly given by today?s life style ? sedentary jobs, stress, lack of movement, which lead to numerous improper stereotypes leading later to pain occurrence. The spine and back in general, which are the most loaded parts in terms of posture maintenance against gravity are usually the first to be affected by chronic pain. Back pains are said to be the most frequent cause of inability to work. The thesis is structured in two parts. The theoretical part mainly deals with the Feldenkrais Method. At the beginning I introduce the author by his brief biography explaining the process of the conception development. Then I describe the principles and basic elements of the method like self-awareness, somatognosia, organic learning. Chapters containing indications and contraindications, possibilities and course of education in the field of Feldenkrais Method follow. The next part informs on two basic teaching methods, which are a group form ?Awareness Through Movement? and individual ?Functional Integration?, where I compare the first one with conventional exercises and the latter with classic manual techniques. In the last part dedicated to the Feldenkrais Method I am trying to outline the possibilities of applying Feldenkrais Method to chronic pain treatment. The following chapter of the theoretical part deals with the phenomenon of pain. In the last part I summarize the most frequent causes and consequences of backache and their schematic categorisation. The practical part contains the goals of the thesis, methodology description, research sample characteristic and the research results processed in the form of case studies. Quantitative research method was chosen for data collection and processing. Two patients with pains in cervical, respective lumbar spine were chosen. Anamnesis was taken from the patients and basic physiotherapeutic examination, which is recorded in the input and output kinesiological analyses, was performed. The research results aren´t so significant because of small testing group, but in my opinion the Feldenkrais Method might become a part of therapy for chronic pain treatment, as both the patients subjectively perceived improvement after the exercises, which is also obvious from objective examination recorded in the output kinesiological analysis. The fact that the research was based on just a small sample of probands however does not enable us to generalize the results. Remarkable improvement of perception and awareness of own body and work with it occurred in both the women, which was obvious on improved breath stereotype and mastering of localized breathing, which had been a big problem for both the patients before. Another improvement was in higher spine movement and particularly reduction of backache in both the patients. Improvement of psychical condition is surely another indicator of the method effectiveness.
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Rehabilitation treatment of patients with severe movement disorders
STEINBAUEROVÁ, Iveta
Current status: The numbers of patients with some sort of movement disorder (mostly caused by genetic load, unhealthy lifestyle, falls and collapses, carelessness during sport activities and also car crashes) grows every year and the rehabilitative treatment becomes increasingly important. Subject: The objective of this study is to determine whether nursing staff actively approach rehabilitative treatment care according to the development and improvement of the patients mobility. Following four hypotheses were defined to achieve the objectives. H1: rehabilitative treatment treatment of patients with severe movement disorders is conducted in a multidisciplinary team. H2: The effectiveness of the treatment is continuously recorded in the nursing documentation. H3: Nursing management inspects the rehabilitations treatment. H4: The nursing staff plan their rehabilitative treatment actions according to the progress and improvement of the patients' condition. Methodics: To ensure the data required for this bachelor thesis, was used a quantitative research survey using questionnaires. The questionnaire consisted of several parts and was composed of 30 questions, which were later used for identification of the respondents and subsequently to confirm or refute the hypotheses. A total of 60 questionnaires were distributed (100%) with a 88% return rate. For further data analysis was then used 53 (100%) questionnaires. Participants: The survey was answered by nurses employed in the inpatient physiotherapeutic wards of the following hospitals: Nemocnice České Budějovice a.s., Nemocnice Tábor a.s., Nemocnice Písek a.s., Nemocnice Havlíčkův Brod, Městská nemocnice Plzeň Privamed a.s. and Institute of Oncology and Physical Rehabilitation Na Pleši s.r.o. Nurses filled the survey voluntarily, anonymously and with approval of the Directors of nursing and head nurses. Results: The research part was focused on collaboration with the multidisciplinary team. The answers indicate that the nursing staff collaborate with all team members (see grafh no. 23). Mostly, they cooperate with physiotherapist (100%) and with physician (96%). Also 96% of respondents admitted they cooperates with other nurses (see graph no. 24). The hypothesis was confirmed. One of the other objectives was the question of regular and continuous recording of the documentation. This hypothesis was also confirmed according to the obtained data: nursing staff regularly updates the progress into the documentation during their shift each day (see graph no. 18). Most nurses (90%) make records into the general nursing documentation, but there is one health facility in my list of participants with specialised physical rehabilitation documentation. According to the data received from survey, nursing management performs inspections of the rehabilitative treatment (see graph no. 25). Checks are performed by head nurses or ward nurses. In most cases the inspections take place at regular intervals or at random without notice. Thus, this hypothesis was also confirmed. Last surveyed areas was whether nursing staff plan their treatment interventions based on development of the patients' condition. Of the 53 nurses, 85% of them reported that they plan their intervention based of the patients' progress (see graph no. 16). The most commonly used interventions are positioning, education about self-sufficiency and mobility aids. The hypothesis was confirmed. Conclusion: The obtained results show that all of my hypotheses were confirmed and objective of this thesis fulfilled. In case of interest, the results of this research may be provided to all personnel responsible for quality assurance of provided healthcare and to head and ward nurses of all participating facilities as well. Results of this thesis may be provided also to students interested in this issue.
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Influencig painful menstruation with the help of physiotherapy
VACKOVÁ, Zuzana
This bachelor thesis deals with how physiotherapy can influence a painful menstruation. The aim of this thesis is to describe how women can utilise physiotherapeutic methods, which can be practised at home, while experiencing difficulties with a painful menstruation. Another aim was to determine how these methods influence muscles of the pelvic floor. Research question is focused on subjective perception of this therapy by women. Although the aim of this thesis is to describe physiotherapeutic methods applicable even at home, I also decided to include methods of physical therapy which cannot be practised without specialised equipment. There are a lot of methods in the field of physiotherapy which can somehow influence and mitigate pain during menstruation, and a lot of other methods can be found in other fields of medicine. Due to a limited extent of my thesis, I wasn't able to focus on all approaches, only on the most used. All therapeutic procedures, which women would like to include in their life, should be consulted with a professional who shall explain an outcome of this therapy, who shall show them how to use this therapy properly and who shall point out errors which should be avoided. A part of my thesis also focuses on methods that aren't closely connected with physiotherapy, but which can nicely add to it. For my research part of my thesis, three young women with a long-term menstrual pain have been selected. At the beginning of my research, they were all using hormonal contraception. Detailed anamnestic data were collected from a direct and a semi-structured interview. During the first meeting, a kinesiological analysis was created, probands were examined and therapy started. After that, an exercise unit was checked and errors were corrected. At each therapy, interviews were conducted with probands and they were asked if some exercises hadn't been too difficult and if they hadn't caused them pain. For a therapy of this group of women, a set of exercises was selected, which contained some elements from a method of Ludmila Mojžíšová, dynamic neuromuscular stabilization and spiral dynamics. During the research, probands P1 a P3 reacted fairly well to the selected therapy. Considerable remission of difficulties and also general contentment during regular appointments were apparent. A noticeable progress wasn't, however, experienced by a proband P2. This fact was mainly due to her stress experienced in her school. Even with this very small sample of women, it is possible to register an influence of therapy on a peace of mind, therefore, it is imperative that physical and mental aspects of this therapy are not separated.
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Therapy with corset in patients with scoliosis
ČERMÁKOVÁ, Michaela
For my bachelor thesis I selected the topic "Brace Treatment for Scoliosis Patients". Scoliosis is defined as a three-dimensional deformity of the spine with side curvatures in the frontal, sagittal and transverse planes at the same time. A scoliotic curvature is accompanied by deformations of vertebras, changes in ribs and spatulas and changes in the position of crista iliaca. One of the conservative scoliosis treatment options is brace treatment. Brace treatment aims at generating a positive effect on the curvature and, most of all, at preventing its further development in the period of an individual's growth. Brace treatment is a controversial method to a certain extent, considering a large number of diverse opinions of doctors, orthopaedists and physiotherapists concerning the treatment with torso orthoses. The theoretical part summarizes the findings relating to scoliosis, including anatomical structures influenced in scoliosis. It contains information on basic terminology, scoliosis classification, diagnostics and treatment options. The thesis is focused particularly on conservative treatments but also provides information on possible surgical treatments. Introduction into the issue of brace treatment is addressed in more detail. The history, kinds of braces, manufacture, and the principles of the effect of torso orthoses are outlined there. The practical part of the thesis includes objectives, description of the method, characteristics of the set and particularly the processed results presented in the form of case histories. The data were obtained in a qualitative research. The research involved two patients suffering from idiopathic scoliosis with indicated brace treatment in the Rehabilitation Department of the Hospital of České Budějovice. The girls were selected on the basis of their diagnosis and brace indication. The medical history of the probands was gained and the initial and final kinesiological analyses were performed. The analyses consisted of a visual static and dynamical examination, palpation examination, evaluation with a plumb line, and examination of hypermobility, gait and breathing mechanism. Both patients had the length of their lower limbs measured. The three-month research was aimed at creating a physiotherapeutic procedure for individual patients and outlining the effect of brace treatment on the overall effectiveness of the treatment. The research has confirmed the necessity of an individual approach to each patient suffering from scoliosis. Seemingly similar curvatures may show a completely different development and require a different therapeutic approach. It follows from the research that the best results may be achieved in patients if a combination of several various methods is used. Particularly auto-correction in front of a mirror, Vojta's reflex locomotion and de-rotational breathing proved successful in my research. Auto-correction in front of a mirror before and after the treatment was found particularly beneficial because the patients themselves could observe the changes of their posture during the treatment. In my experience, the use of Vojta's reflex locomotion always served as an excellent preparation for the following exercises because the abdominal wall, autochthonous muscles and ribs become activated and the breath wave is rearranged. Since both patients suffer from scoliosis with a considerable rotation element, the application of de-rotational breathing showed to be suitable because it brought visible results in each treatment for each patient. The brace treatment influences the effectiveness of the entire treatment particularly by not allowing the patient to keep a pathological posture all day long. This fact makes the work with a patient easier and has an effect on the patient's auto-correction. The bachelor thesis may be used in clinical practice of physiotherapists. The thesis may also be used as an educational material for patients.
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Results of one-sided endurance of a kinetic apparatus in volleyball players and possibilities of a therapy
CHALUPOVÁ, Andrea
The one-sided load of volleyball players leads to occurence of pathokinesiologic changes of the locomotive system. The objective of the bachelor thesis is to ascertain whether volleyball players suffer from locomotive system disorders due to the one-sided overload and whether it is possible to make up a uniform compensatory set of exercises as a therapy. The objective of the theoretical part is to ascertain what functional disorders of the body system occur in connection with the one-sided load of volleyball players, what muscular dysbalances accompany the disorders and what physiotherapeutic procedures can influence them. The objective of the practical part is to use the obtained theoretical findings as the basis for making-up a set of compensatory exercises as a proposed therapy applied within the scope of case reports. The practical part involved a qualitative research using the techniques of interviews and observation, and included two case reports of randomly selected professional volleyball players. Examination of the probands has confirmed the one-sided load of the locomotive system manifested in insufficiency of the deep stabilization system and functional disorders in the area of the shoulder joint. Focused on activation of the deep stabilization system and including shoulder-blade stabilization features, two individual therapeutic plans were made up and undertaken by both the probands in accordance with the charakter of the specific movement activity of volleyball players. The final examination has shown objective improvement of the function of the posture stabilization system of one of the men. Activation of the deep stabilization system with stabilization of the shoulder joint within the specific movement activities of volleyball players appears to be a suitable basis of the compensatory exercises preventing the one-sided load of the locomotive system. The therapy requires an individual approach. For further research in this area I propose measurement of the muscular actvity by means of electromyography and focusing on co-activation of stabilizers of the shoulder joint within the specific movement activity of volleyball players.
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Case report of physiotherapeutic care of a patient after arthroscopy stabilization of shoulder
Štyglerová, Zuzana ; Novotná, Irena (advisor) ; Satrapová, Lenka (referee)
Title: Case report of physiotherapeutic care of a patient after arthroscopy stabilization of shoulder Summary: This bachelor's dissertation discusses a case report of physiotherapeutic care of a patient after shoulder arthroscopy because of labral tears in glenohumeral articulation. In the first, theoretical, part, anatomic structures, kinesiology shoulder joint are described. Furthermore, the most common problems in the shoulder girdle, the possibility of solving these dificulties and also discussed physiotherapy approaches for patients undergoing shoulder arthroscopy. In the second, special, part, a case report is described. It contains anamnesis, initial kinesiologic examination, course of the therapy, final kinesiologic examination and evaluation of the therapy. Keywords: case report, shoulder arthroscopy, physiotherapy, shoulder joint. Author: Zuzana Štyglerová Supervisor: Mgr. Irena Novotná Year: 2011
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Special physiotherapeutic procedures as a part of the recovery for patients after stroke
KŘIVÁČEK, Jan
The thesis deals with {\clq}qSpecial physiotherapeutic procedures as a part of the recovery for patients after stroke.`` While in the most developed countries there was, in last 10 - 20 years, recorded a significant decline in a mortality of stroke thanks to a consistent prevention, the Czech Republic still belongs among countries with the high mortality. Nevertheless a large part of strokes is a result of an improper lifestyle in a combination with a lack of the physical activity and other factors. Just a use of an aerobic training is often a neglected part of the convalescence, although there is an obvious link of the cardiovascular performance with a function of the neuro-musculo-skeletal apparatus as well as psychological features. A goal of this bachelor thesis was to verify a relevance and effectiveness of the aerobic training as a part of physiotherapy at patients after stroke. The thesis deals, in the theoretical part, with an etiology, risk factors, a prevention and a clinic symptomatology of stroke and individual approaches to a subsequent complex rehabilitation. Then there are pointed out principles of a stress diagnosis, a reaction of the organism to the stress, changes of cardiovascular, ventilatory functions and the aerobic training.In the experimental part I used a quantitative research with methods: an interview,anamnesis, status praesens, evaluation of hemiplegia after Chedoke, a direct observation, case reports and a secondary data analysis. The research was conducted at patients after stroke hospitalized in Neurological a Rehabilitation wards of the Hospital in České Budějovice. Results of the research showed a certain trend of measured values within a meaning of the adaptability to the training programme and a positive contribution to the overall rehabilitation process. The thesis could be used as a study and information material for the general public as well as for students of medical and paramedical disciplines, last but not least as a preventive measure against stroke.
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