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Case study of physiotherapy treatment of a patient with the diagnosis of syringomyelia
Čapková, Šárka ; Hašková, Andrea (advisor) ; Haspeklová, Lenka (referee)
Title of bachelor's thesis: Case study of physiotherapy treatment of a patient with the diagnosis of syringomyelia Objectives: Gain of theoretical knowledge about the diagnosis of syringomyelia and subsequent case study formulation of a patient with this diagnosis during continuous work placement. Methods: The first part of the bachelor thesis contains theoretical knowledge about the diagnosis of syringomyelia, focused on its definition, classificaton, epidemiology, etiopatogenesis, diagnostics, symptomatology, therapy, physiotherapy treatment and prognosis. The second part includes a complete case study of my physiotherapeutic treatment of selected patient with the diagnosis of syringomyelia. Conclusions: Physiotherapy treatment proved effective in alleviation from pain and other problems but the possibilities of complex treatment were very limited due to progression of the ailment. Key words: syringomyelia, hydrosyringomyelia, syringobulbia, degenerative ailment of spine, progressive myelopathy, neuromuscular deformities of spinal column, scoliosis, physiotherapeutic methods
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Changes of posturality after operation according Nuss
Počtová, Barbora ; Bitnar, Petr (advisor) ; Čech, Zdeněk (referee)
Background: Pectus excavatum is the most common deformation of the chest, affecting mainly boys. The etiology is unclear. Objective: The aim of this study is to characterize the patients with pectus excavatum and clarify changes of posture after surgical correction by Nuss. Method: 19 patients (17.3 ± 1.9 years) with pectus excavatum chest deformity were tested a day before and 6 months after surgical correction of the chest according to Nuss. Testing included: clinical examination of range of motion in the shoulder and hip joint, range of motion of the spine Thomayer test, Shober and Stibor distances, as well as paraclinic test mCTSIB on Balance Master ® System and the questionnaire method by means of Pectus Excavatum Evaluation Questionnaire. Statistical significance was determined at 0.05. Results and Discussion: The results show that the correction of the chest has a significant influence on the evaluation of and satisfaction with appearance, increases range of motion of shoulder joints and spine, and positively affects postural stability and balance. Conclusion: A simple and non-invasive tests have shown that the effect of correction of the chest is not just a cosmetic nature and can be an incentive to continue to study this issue.
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Skiascopic and skiagraphic examination of the spine with a focus on scoliosis
DOSTÁL, Martin
The spine is the body's support system and a supporting pole to the whole skeleton, therefore it is important to take good care of it to prevent its deformities, such as scoliosis. Scoliosis is a serious illness which can appear at a really young age. Nowadays, it's timely detection and early treatment is achieved through not only expert orthopaedic check-up, but mainly through radiological examination, mostly skiagraphy. In my bachelor thesis named "Skiascopic and skiagraphic examination of the spine with a focus on scoliosis" I deal with skiagraphic and fluoroscopic options of examining the spine, the issues of scoliosis in general and with specific statistical analysis of incidents of scoliotic changes recorded at the Radiological clinic of the University hospital Brno, at the department of adult medicine. In the introduction, I explain the basic anatomy of the spine including the movement possibilities of individual spinal parts, such as tilting or rotation. The differences between cervical, thoracic and lumbar part of the spine, and their individual vertebrae, are described. In the next part, I focus on the basic principles of skiagraphy and fluoroscopy. It's important to realise what these examination techniques involve, how they work and why are they indispensable parts of examination process of scoliosis. The origin of x-rays and its types are explicated. I also devote a little subchapter to digitalisation, because in modern medicine, it's gradually replacing original technology of recording on film screens, and its use requires minor adjustements of the skiagraphy procedure. The third part of the bachelor thesis focuses on individual skiascopic and skiagraphic examinations of the spine. I describe procedures of skiagraphy of the cervical, thoracic and lumbar part of the spine including the projection of the sacrum. I mention special skiagraphic methods performed in the process of intentional detection or observation of scoliotic changes, including telemetric pictures composed into the long format. From the skiscopic examinations, I marginally chose myelography and discography, application of which is currently almost none thanks to modern examination methods such as computed tomography and magnetic resonance imaging. In the next chapter, I'm finnaly dealing with the topic of scoliosis itself. The basic classification according to aetiology is shown, I also explain the difference between idiopathic, congenial and neuromuscular scoliosis. Also, I clarify by what reference is the scoliosis' curvature measured and what terms are used to describe scoliosis. The chapter concludes by brief explanation of therapy used for scoliosis. The second part of the thesis includes my research. I present the goals of the work and anticipated hypothesis. I explain where and in what conditions the data collection took place, including description of the process of telemetrical screening at the forementioned workplace in Brno. I also present outcome achieved by statistical processing of data, including my commentary based on hypothesis and acquired experience. In the discussion, I compared incidents of scoliosis today according to my research with professional literature focused on scoliosis. Furthermore, I mentioned options of spinal issues prevention, including related illnesses. I also enclose suggestion of utilization of my work in practice, which, as I hope, will be a usefull addition to clinical research for University hospital Brno. In the last part of my dissertation, I summarize all my findings from the thesis and enclose, along with the list of used literature and internet links, attachments in the form of expertly described radiographs of scoliotical spines, which I obtained, with the consent of the staff, also ati the University hospital Brno.
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Autochthonous Musculature and its effect on Scoliotic Hold
VRÁNOVÁ, Barbora
This bachelor thesis deals with the influence of autochthonous musculature on scoliotic posture. The term autochthonous musculature means the deepest layer of back muscles situated along the spine. Autochthonous musculature is one of the components of the spine stabilization system. Together with the diaphragm, the transverse abdominal muscle and with the pelvic floor muscles it supports particularly the lumbar spine. The function of the autochthonous musculature is to set correct mutual position of two adjacent vertebrae and thus prevent the spine from incorrect loading. Its dysfunction may lead to scoliotic body posture. The thesis consists of a theoretical and a practical parts. The theoretical part explains the term autochthonous musculature and scoliotic posture. It also contains tests examining autochthonous musculature and selected conceptions and methods of its activation. The aim of the thesis was to elaborate case studies of patients with scoliotic body posture and to compare their condition in the input and the output examination before and after proposed and applied kinesiotherapy, to map the concrete influence of autochthonous musculature weight training on scoliotic posture of the monitored patients. Research questions were based on the aims: whether better position of the spine axis could be observed in the patients and whether autochthonous musculature weight training had positive impact on scoliotic posture. The practical part was based on qualitative research method. Data collection was performed by means of elaboration of case studies using the methods of interview, observation and kinesiological analysis. The case studies include the anamnesis taken, the input and output kinesiological analysis, a short-term therapy plan, description of the therapy course and a long-term therapy plan. The research sample consisted of four probands of different age. All the patients suffer from scoliotic body posture. The therapy lasted 10 weeks. Slight improvement of scoliotic body posture was achieved during the applied therapies by activation of the deep stabilization system of the spine, not only the autochthonous musculature. The deep stabilization system always works as a whole and activation just one of its components is impossible. This is why we cannot say that autochthonous musculature has positive influence on scoliotic posture. The results however show that the posture can be improved by activation of the deep stabilization system of the spine.
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Imaging methods in assesment of the scoliotic children spine deformities
HLADÍKOVÁ, Ilona
Long-term effects of static load and lack of physical activity in children leads to the formation of poor posture, which is nowadays more and more often. Orthopedic deformity arising in childhood is usually reflected the after-effects in adulthood. It is useful and important these deformities early recognition and capture in order to prevent the progression of many diseases. In that radiology has an irreplaceable role. The work entitled " Imaging the investigation scoliosis spinal child deformity" approaching the issue of damage to children´s spine scoliosis mainly children, and thein investigation by imaging methods. At the beginning of my work, I reminded the anatomy and physiology of the spine. Then I described the division and types of scoliosis. The rapid development of imaging techniques and new in the last few decades have brought about changes in imaging the spine. I described the principle of the methods that are applied in the examination of the spine. Great progress for the entire radiology and changes in working practices radiology assistants brought digitization. Therefore, for the mention in my work and I compare it with conventional analog radiology. Investigation of children have thein own characteristics and pediatric radiology I devoted a separate chapter. In chapter radiation protection, I described the basic principles of protection against harmful ionizing radiation, I mentioned the valid legislation, the basic units and quantities in radiation protection. The aim of my thesis is to test children´s scoliosis spine, to compare the frequency of examination methods of diagnosis. As the second goal I set to compare the radiation exposure in children´s spine examination on an analog meter compared to tests on digital devices. The first objective is building on the hypothesis that even today, despite the development of new diagnostic methods such as CT, MR, ultrasound, radiographic examination remains the priority children´s spine. The second objective I hypothesized that due to the digitization of the radiation dose to the patient during the examination decreased. Quantitative research was conducted at University Hospital Motol. Number of examined children´s backbone has shown that the vast majority of children with deformities of the spine radiography was investigated. Hypothesis number one is hereby confirmed. To meet the second objective, I selected group of 30 children diagnosed with idiopathic scoliosis, which in 2008 was on the unit Chiralux 2 (6a) conducted an analog image of the spine. In the same way, I chose a group of 30 children examined in the first half of 2013 on the same site digital radiography unit at Siemens Ysio 2 Fluorospot Compact. This was possible because in 2009 there was a baby Radiodiagnostics FN Motol direct digitization. The parameters used in tests I averaged a further mathematically processed. Hypothesis number two was also fulfilled, since calculations have shown that the examination of the spine digital radiography, radiation to the child about 31,3% lower. In my work I have in addition included the calculation of radiation doses received by the mammary gland during radiographic examination of the spine in the AP and PA projection. It turned out that the values are significantly different. This finding is in terms of radiation protection relatively important, since the ICRP in its recommendation to increase the value of tissue weighting factor for the mammary gland. Investigation of children imaging using ionizing radiation is the radiation dose to the child. Radiology assistant by its qualified work experience and contribute to this burden is as low as possible.
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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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Physiotherapy in skoliosis
KOLIBÍKOVÁ, Šárka
Abstract The title and focus of my bachelor thesis is Physiotherapy in Scoliosis. This topic has been selected intentionally since it is related to me personally, having had problems with my back since childhood. Scoliosis is a three-dimensional spinal deformity. Besides frontal plane, there are also sagittal and transversal plane variations, described as vertebral rotation and torsion. The curve can be simple, double, or even triple in some cases of idiopathic scoliosis. The main goal in scoliosis therapy is to prevent further progression of scoliotic changes, or, if possible, to improve the defect of the spinal position. The other important factor with an effect on scoliosis is substitution of incorrect postural and movement patterns with correct ones. An individual approach to each subject is applied during exercises. Many special therapeutic gymnastic methods have been developed with potential positive effects on scoliosis, but without leading to its healing, such as the methods of: Klapp, von Niederhöffer, Gocht-Gessner, Ludmila Mojžíšová, Roswita Brukow, Schroth, Scharrl, hippotherapy, Reflex Locomotion (Vojta therapy), therapy based on basal programs, exercises on balls, electric stimulation, corset therapy{\dots} If the traditional approach to treatment is not successful or the patient came late with an already significantly developed deformity, corrective surgery and stabilisation is necessary. A decision on surgery is a key moment for both the physician and patient or child{\crq}s parents. Surgery aims to straighten the curve as much as possible and to keep this erection permanently. In my research, I used the Schroth based method. It is a special method for treatment of multicurved profile dislocation and static changes of the scoliotic body. One of the key roles is the usage of corrective pads, pillows or foam balls which are placed in such a way as to help the best possible correction of the curvature. Patients perform their exercises in this position, with targeted breathing gymnastics {--} derotation by breathing. Relaxation and stretching exercises are also useful in this method. I have conducted "research" in two adolescent patients with diagnosed scoliosis. The exercise group was active for half a year, every two weeks. Therapy by Mrs. Schroth is very demanding and requires extensive synergy and motivation of the patient. Results of my study indicate that both patients have achieved correction of their scoliotic posture. They have a better perception of their body and there is a visual cosmetic improvement, which is also an important result.
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