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Coordinated rehabilitation segments used in a selected group of individuals with DMO (combined disability) in center ARPIDA in České Budějovice
PYKALOVÁ, Jana
The thesis focuses on coordinated rehabilitation components, which are used at individuals with cerebral palsy (combined disability) in a concrete non state medical institution in České Budějovice. Cerebral palsy is the most frequent neurodevelopmental disease, wherein the health disability may occur in one or more fields. We can find crucial factor in care of individuals with handicap in coordinated rehabilitation, which is currently perceived as an interdisciplinary field seeking the fastest and widest participation of personal with disabilities in all usual activies of society with the use of medical, educational, social and labour resources. A prerequisite for success is a multidisciplinary team (circular support), which consists of experts and parents of individuals with disabilities. The thesis contains theoretical background, where health disbility, coordinated rehabilitation and cerebral palsy is mentioned, at which the occurrence, forms, associated disorders and treatment are described. A separate chapter is devoted to families of individuals with health disability, where I mentioned the reaction of parents on the birth of a child with a disability, the impact of disability on the family and family support. Furthermore I focus on social services for handicapped people and to ARPIDA centre, where my research took place. In the research section there is defined the aim of the thesis, which was to chart a coordinated rehabilitation components, which are used at individuals with cerebral palsy (combined disability) in ARPIDA centre in České Budějovice. The partial target of my thesis was also to compare the usage of coordinated rehabilitation components at individuals under 15 years of age and at individuals over 15 years. According to target of the work there were developed three hypotheses. Thesis research was conducted through quantitative research. To obtain the data, I used the method of questioning. The sample was comprised of individuals with cerebral palsy (combined disability), who attend the centre ARPIDA, while the questionnaires were filled out by their parents. The research undertaken within the thesis, which was supported by rehearsed literature, confirmed the third hypothesis of more often usuage of Vojta reflex locomotion method at individuals with cerebral palsy in the centre ARPIDA compared to individual therapeutic physical training. The remaining two hypotheses were disproved. Statistical survey also shows that care for people with cerebral palsy is a long-term care, where interconnection of services within the coordinated rehabilitation is needed. In the group of individuals under 15 years of age and over 15 years it has been used different coordinated rehabilitation components, this is associated with cerebral palsy, disorders, age and other factors. Problematic remains the job placement of individuals with disabilities, who remain at home without further stimulation possibility. Care and services in the centre ARPIDA were assessed positively. The results and conclusions of the thesis will be used as a feedback centre ARPIDA to map the coordinated rehabilitation components and further to the clearing of needs of single coordinated rehabilitation components in a group of individuals under 15 years of age and over 15 years.
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The effect of an early Reflex locomotion therapy according prof. Vojta in children with postpartum paresis of Brachial plexus and its social influence from the view of parents
PLACHÁ, Milena
The thesis topic is "The influence of the early therapy by reflex locomotion according to Vojta on children with brachial plexus palsy postpartum and its social impact from the perspective of their parents."The brachial plexus (BP) consists of nerve bundles based on radicular segments C5-Th1. Innervate muscles girdle blades, shoulder, arm and hand. When BP is damaged the mobility may be impaired (paresis to plegia of muscles), sensation (hypoesthesia to anesthesia, paresthesia, pain) and vegetative symptoms can appear (discoloration and skin temperature changes, changes in hair, nail brittleness). Types of BP palsy are classified according to clinical and anatomic course. Paresis of upper type (Erb-Duchene) is the most common and has the best prognosis, clinically manifest by the adduction and internal rotation of the upper limb, the elbow in extension, the wrist in flexion,the limb is poor, the gripping reflex present. During the paralysis of the lower type (Déjerine-Klumpke) the wrist flexion is not possible and the hand grip is poor or absent, and when there is a disruption of the cervical sympathetic the Horner's syndrome appears. An isolated paresis of the secondary trunk with disabilities muscles innervated n. Radialis is rare. During the complete lesion BP the whole limb is plegic with anesthesia all dermatomes excluding the inner arm. The complete lesion BP has the worst prognosis. BP perinatal injury arises in connection with childbirth. Despite the knowledge of risk factors we fail to prevent these injuries. With all children with postnatal paresis BP the initiation of conservative treatment is indicated, some children require neurosurgery. With some children a residual limb dysfunction remains after the treatment. Among the consequences we include permanent residual paresis, postural abnormalities, limb bone deformities, contractures of joints, shortened arm. Delays in mental development and cognitive impairment are related to motor disorders. The early and quality diagnosis and the immediate initiation of therapy is the prerequisite for successful treatment. The therapy should prevent the development of pathological patterns of movement and evoke and restore optimum momentum. The main aim is the restoration of innervation and hand function and the second one is the elbow flexion and the third is the arm abduction. Vojta method of reflex locomotion is one of the methods used for conservative treatment of peripheral paresis. In therapy, congenital partial patterns of forward movement global models, which is reflective crawling and reflective rotation, are activated. These patterns are inborn but with children with locomotor disorders these are blocked. By repeated targeted activation we can achieve the correct fixation of the correct models and thus enable their use in spontaneous motor fluctuations and pathological compensatory movements are displaced. Reflex locomotion favorably influences other functions such as posture and its management, neurological status, the development of mental and autonomic functions, and oculomotoric and disproportionate growth. The goal of the treatment is to reduce the disability degree and to minimize the future disability and handicap. Improving the quality of the child´s life leads to improvement of the life quality for the entire family. The theoretical part is devoted to BP palsy therapy and reflex locomotion according to Vojta. First, the function of peripheral nervous system is characterised, the other part is devoted to BP injury - mechanisms of injury, diagnosis, treatment options, BP perinatal injuries and rehabilitation of patients with spinal BP. The chapter dealing with Vojta describes the basic principles of Vojta method - reflexive crawling and reflexive rotation. The final chapter deals with the birth of a handicapped child, the need to support families and individuals affected especially in the psychological and sociological levels.
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