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Physiotherapy for patients with LCA rupture during surgical and conservative therapy
PÍCHA, Radek
The bachelor thesis deals with the issue of an anterior cruciate ligament (ligamnetum cruciatum anterius ? LCA) trauma. The anterior cruciate ligament is an important stabilizer of the knee joint. During the LCA lesion serious biomechanical changes occur. The LCA trauma most frequently happens due to forced hyperextension or rotation of the knee joint. Nowadays this injury is quite frequent, in the sports medicine it occurs in the incidence of 1 / 1750 inhabitants. The therapy of the injured LCA has been very efficient recently mainly due to modern approaches both in the medicine and the following rehabilitation. The thesis contains the analysis of the anatomy and biomechanics of the knee joint, the next part describes LCA trauma mechanisms, methods of its examination and possibilities of the successive therapy. One part of the thesis is focused on the comparison of the conservative and the surgical therapy, there are described the circumstances under which it is decided which one of these therapies will be chosen. It is necessary to mention that the most important criterions for the proper therapy choice are the individual needs of the patient. The basic aim of the thesis is the comparison of the efficiency of therapeutic procedures for particular patients and the assembly of the short-term and the long-term treatment plans. The practical part of the thesis is processed by the qualitative research method. Three probands after the surgical therapy and two probands after the conservative therapy were examined. The observation and the therapy for surgically treated patients were carried out between the second and the sixth post-operative week, the examination for conservatively treated patients was carried out for six weeks. Patients were predominantly athletes in the age of 18 ? 24 years. They passed the initial and the final kineziologic examinations and the rehabilitation therapy; the treatment efficiency was rated by the Lysholm score. The initial Lysholm score for surgically treated patients varied between 32 and 34 points and after the therapy it increased to 48 ? 75 points. For conservatively treated patients the initial score varied between 73 and 76 points and the final score was 76 ? 81 points. There is one more important detail in the thesis ? the anthropometry results. The quadriceps femoris perimeter increase was around 1,5cm and the triceps surae perimeter increase was around 1cm. The final examination showed that the majority of the patients is missing minimally 1cm in the quadriceps femoris perimeter compared to the healthy leg. The similar indicator has been found also for the muscular strength testing. The examination was focused mainly on the knee joint extensors and flexors testing. All patients proved the increase of the muscular strength; surgically treated patients reached muscular strength maximally 4+. The short-time rehabilitation plan is initially based on the edema and pain elimination. Subsequent rehabilitation step is the training of the walking with the help of French canes and the knee joint motion range recovery and its stabilization. The aim of the long-term rehabilitation plan is the gradual return to social and sport activities. The basic factor of the long-term rehabilitation plan is good muscular training. In the conclusion it is important to mention that it is not possible to state which therapy (surgical or conservative) is more suitable or efficient, during the decision making process it is necessary to consider individual needs of a particular patient. The thesis may be utilized in the clinical practice of physiotherapists for the improvement of the care of the patient who is diagnosed with rpt. LCA.
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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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The nutrition specifics of patients with chronic renal failure in pre-haemodialysis and haemodialysis programmes.
PAVLÍKOVÁ, Andrea
Chronic renal insufficiency tends to worsen gradually until it gets to the stage of kidney failure, often despite the prescribed adequate treatment. The duration of this period of nephrology dispensarization may differ. Kidneys lose their cleaning ability within ten years, which leads to accumulation of metabolism waste products in the body. If the primary renal disease graduates to the final stage the patient depends on substitute kidney therapy in the form of haemodialysis, peritoneal dialysis or transplantation. Kidney failure treatment depends on the stage of renal function impairment. Modification of eating habits is also closely related to this fact. In the first stage of insufficiency the diet does not substantially differ from normal healthy nourishment principles. Only later gradual limitation of intake of the individual nutrients is necessary. The aim of the bachelor thesis was to map specific requirements for nourishment of patients suffering from chronic kidney failure that have not been included in a dialysis programme yet, contrary to individuals who already visit a dialysis centre and regularly undertake blood cleaning process. A lot of professional literature had to be studied to obtain necessary information for preparation of adequate diet regimen. Scientific bibliographic publications by Czech as well as foreign authors were used as the source on the one hand and the latest findings resulting from randomized multicentric studies had to be found in journals specialized in kidney diseases and nourishment on the other hand. Nourishment recommendations for patients with chronic kidney failure, which are divided into low-protein diet in conservative therapy and limitation of nutrient intake in patients included in the haemodialysis programme, were elaborated upon the obtained information.
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Differences in nursing care of patients after operations of fractures of the pelvis and in the conservative treatment after a pelvic injury.
ADAMČÍKOVÁ, Hana
The thesis is divided into the theoretical and practical parts. The theoretical part deals with fractures of the pelvis, which may be treated in the conservative manner, i.e. by the ligamentum of the pelvis. The ligamentum of the pelvis may be a temporary solution, or it is left until the fracture heals up, or by an operation. Further, nursing care is analysed here, ranging from the admission of the client to the department to his/her discharge. It points out differences in the care of clients in the conservative treatment and in the operational therapy. The research investigation was conducted in the hospitals in České Budějovice and Prachatice. The quantitative research was used for the bachelor thesis, in the form of an anonymous questionnaire, and additionally the qualitative research was conducted in the form of observation. The questionnaire was made up for nurses and contained 32 questions. The observation took place in the intensive care unit, where I had the opportunity to observe 6 nurses at work, and thus check up on the results of the graphs.
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