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SPECIFICS OF PHYSIOTHERAPY OF PATIENTS TRANSFERRED AFTER ORTHOPEDIC OPERATIONS DIRECTLY ON THE SO-CALLED SPA BUNK
JOHANUSOVÁ, Lucie
This bachelor thesis addresses the specificity of physiotherapy of patients, transferred to a so-called spa bed, after orthopedic surgery. Among the most performed orthopedic surgeries are the total hip replacement and the total knee replacement. Arthrosis is the most common reason for the implantation of joint replacements. It is a painful and life-aggravating disease which has a tremendous impact on the patient's quality of life. In order to lower the risk of the patient having to take a revision surgery of joints, a promptly initiated rehabilitation is necessary. It has to be intensive and professionally conducted. The present time-tested trend of rehabilitation treatment is a prompt comprehensive care, which takes place in a spa resort in the form of a direct transfer "from one bed to another", i.e. the patient is transported directly from the hospital to a spa resort. Often, patients would get to a spa resort with delay, while already having intercurrent problems like vertebrogenic and other problems. This thesis is divided into a theoretical part and a practical part. The theoretical part includes the anatomy of the hip joint and the knee joint, the description of the joint replacements including the indications and the contraindications, the specifications of particular types of hip and knee joint replacements and possible complications after surgery. The most important topics of the theoretical part are stated in the last chapters. The individual therapeutic rehabilitation methods, which have a positive impact on the health status of the patient after surgery, spa therapy and physical therapy included, are discussed and described in those chapters in detail. A qualitative research strategy and a personal case study technique (case history), with the use of a secondary data analysis, were used in the practical part. This strategy was carried out on three chosen patients, who after being discharged from a hospital after surgery had continued their treatment in a spa resort, i.e. a so-called direct transfer from a hospital bed to a spa. The research was conducted in Berta's spa resort in Třeboň, where the patients were transferred on the tenth day after surgery. On their first therapy session, all patients had their personal history taken and data from their medical documents was added. The practical part also includes a pre-therapy and a post-therapy kinesiologic analysis which included visual inspection, palpation, goniometric and anthropometric examination of the knee and hip joint area. Furthermore, a muscle test and an examination of shortened muscle groups related to the knees and hip joints, created by Janda, were conducted. The gait, stereotypes and neurologic functions were also examined. Following the evaluation of the pre-therapy data, the patients were introduced to the short-term therapeutic plan. The results were acquired by comparing the pre-therapy data and the data which was obtained during the last therapy session from the post-therapy kinesiologic analysis. The rehabilitation in the spa resort consisted of different treatment procedures each day and the patients were getting medical attention and care from doctors, nurses and physiotherapists. In each therapy, we focused on removing the problems at hand and only after that we moved to correcting other imperfections. After the completion of the therapy, the patients stated a decline of pain and an improved balance of the extremity and the whole body. The data of the chosen patients shows improvement of muscle strength, decreasing of swelling and widening of range of motion. These results were achieved thanks to a comprehensive rehabilitation and a positive attitude of the patients.
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The importance of regular fitness activities before planned orthopedic surgery
KOTLABOVÁ, Sandra
The bachelor thesis deals with the influence of regular fitness activities before the scheduled orthopedic surgery. The thesis discusses the use of special methods of physiotherapy and physical therapy to help patients prepare for their surgery and post-operative rehabilitation. The most common scheduled orthopedic surgery in the Czech Republic is a total hip joint prosthesis, it is applied up to 10 000 refunds anually. The total hip joint prosthesis is followed by a less frequent knee joint prosthesis. Implementation of any suitably chosen fitness activity before the surgery may be very useful and desirable for the patient.The current knowledge of the anatomy and biomechanics of bearing joints of the lower limb - knee and hip is summarized in the theoretical part of the thesis. This part also describes the joint compensation in detail. After that, there is mentioned the development of compensations in the course of history, as well as the different types of prosthesis and inserted components. Last but not least, there are described surgical approaches of implantation of the compensation. The theoretical part also includes appropriate physiotherapeutic procedures and methods of physical therapy that can be applied in a pre-operative period. The aim of this thesis is to explore whether regular fitness activities applied before the surgery have an impact on the course of post-operative rehabilitation. The qualitative research method was used to achieve the objectives in the practical part. The collect the data there were used case reports, interview, observation and photographic documentation. Three patients participated in the research, all diagnosed with osteoarthritis of the joint, two of them of the hip joint and one of them of the knee joint. Not a single one of those patients was cured by the conservative treatment, so they all were recommended for surgical treatment consisting of the replacement of the damaged joint. At the first meeting the medical history and the kinesiological analysis were taken. After evaluating the input data, patients were acquainted with therapeutic method. The therapy continued for one month, three times a week. After ending the therapy, the output kinesiology analysis was taken. Each of the patients told her subjective opinion about the course of the therapy and the changes experienced after treatment. All data were recorded and subsequently evaluated. During the therapy local findings were threated at the first place. Specifically the limited joint mobility, swelling of soft tissues around the joints and shortened or weakened muscles. They were used sensomotor techniques that are suitable for correction of flat foot or hallux valgus. The stabilization techniques PNF and activation HSS were used to strengthen the entire trunk and to restore the stabilizing function of the diaphragm. This was followed by the strengthening of the upper limbs to prepare them for future walking on crutches. The last point after the treatment of local findings was the setting of the joint in proper movement stereotype. When the therapy was finished, patients reported a mild pain relief and greater stability of their limb and the entire body. The collected data show also an improvement of the muscle strength of damaged joints for at least half a degree The indicator of the progress is the comparison of the goniometric examination before and after the therapy. The joint mobility was incresed. Surgical procedures were carried out without any complications and subsequent rehabilitation was with no problem for our patiens.
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The possibilities of physiotherapy treating children with evolutionary hip joints disorders
PEŠTUKOVÁ, Lucie
This bachelor thesis deals with the possibilities of physiotherapy treating children with evolutionary hip joint disorders. The theoretical part describes general background related to the issue. The content of the theoretical part brings a summary of findings related to the anatomic-physiologic relation of the hip joint, describes diagnostics and treatment of children affected by hip dysplasia and summarizes knowledge based on motor development of a child in relation to hip joints. Development Dysplasia of the Hip (DDH) belongs to the most frequent disorders of infant locomotor system and brings numerous morphological deviations that might include simple instability, subluxated or luxated femoral head or other serious pathologies. Therapy choice is then different, depending on the character of diagnosed deformities, and influences individual growth during development. Numerous factors contribute to DDH occurrence, originally the genetic factor used to be considered the main factor, new researches however mention influence of mechanic factors in prenatal live (e.g. foetus position during birth) as well as in postnatal live (e.g. forced deflection of legs immediately after birth or tight wrapping of an infant in swaddling clothes) and of higher hip capsular laxity. DDH treatment has undergone lots of changes during development. The Czech Republic is one of few states paying special attention to early detection and therapy. Research into the issue is linked to great figures like Zahradníček, Frejka, Pavlík and many more. Screening tests already start at maternity wards and continue to the following weeks of life in our conditions. Deviations are detected through clinical examinations performed by a paediatric orthopaedist and are based on images taken by various imaging methods. Therapy possibilities differ according to the joint damage character. Less serious hip joint deformities are treated by conservative methods including treatment with abduction aids including e.g. Frejka Pillow, Pavlík Stirrups and others. Surgery interventions and hospitalization have to be applied to more serious cases. DDH treatment is relatively successful nowadays and starts immediately after pathology detection. Nevertheless there are mixed opinions on treatment requirements among specialists. A lot of orthopaedists are satisfied with conservative treatment immediately after detection. Influence of this kind of therapy has its justification and its irreplaceable importance backed by numerous studies. Today?s physiotherapy tends to offer children with diagnosed DDH supportive rehabilitation methods that might enrich conservative treatment set by an orthopaedist. Cooperation with physiotherapists after successful treatment of children with DDH not only after surgical operations, but also after conservative treatment application is also developing. Children are often left to their own development after removal of abduction aids, which may be dangerous for future interplay of muscles (not activated before) after a long period of movement restriction. Qualitative research method in the form of elaborated case study of one patient with diagnosed DDH was chosen for the practical part. The thesis includes an introductory as well as final kinesiological analysis, description of the therapy course, the evaluation itself, communication with the mother and the physiotherapist in charge of the rehabilitation. The aim of the thesis was to point out the inseparable role of physiotherapy in treatment of children with DDH, to propose possible rehabilitation techniques for DDH treatment and to outline the way how Vojta method affects congenital hip joint disorders.
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Possibilities of physiotherapy in patients with complications after total hip endoprosthesis in
FEREBAUEROVÁ, Martina
There is an increase of number of the total hip joint prosthesis arthroplasties in last years and also the patient age limit is falling down. This leads (for prosthesis determined lifetime) also to the increasing of the number of re-surgeries because of aseptic release. This kind of surgery is for patient more strenuous than primary surgery and so brings higher risks of the possible complications. Complications are not rare even after the primary surgery of the total hip joint prosthesis arthroplasy. Most frequented complication is higher mentioned aseptic release, which results from the organism reaction to the abrasive PE particles, which fall off the worn joint. Next highly frequented complication is the infection in the total prosthesis area, where the cause could be local or global. The next feared complication is the luxation of the prosthesis after total hip arthtroplasty. This luxation is very soring and the nerve damages are possible. The nerve damage is potential also due the surgery. Next complications: thrombosis embolism, different length of the limbs, active scar tissues, lymphedema, heterotopic ossification, periprosthetic fractures, mechanical damage of the artificial hip components. According to the time of complication occurrence may be complications sorted as: pre-surgery, early, late. Target of this work is mapping of the physiotherapeutic procedures used at the patients with the complications after the total hip joint prosthesis arthroplasty. Next target is the processing of casuistries and physiotherapeutic plan forming by chosen complications. As research array were chosen three probands with different complications. The first proband is patient after re-implatation of total hip joint arthroplasty because of infection, second proband is diagnosed different limb length, third is patient with the active scar tissue. Therapy has been treated by every single proband individually and was fitted individually according to patients diagnosis. Due whole therapy was the unit for comprehensive physical training and physiotherapeutic procedures set to contemporary probands condition. This consists of theoretic part and practical part. Theoretic part deals with topics as hip joint anatomy, hip joint aloplastic and complications, which could because of aloplastic occurred, re-implantation of total prosthesis athroplatsty and in meant problematic used physiotherapeutic procedures. The qualitative research was chosen for the practical part of work. Results are worked out as casuistries using the methods of interview, spectating, secondary data analysis and kinesiological testing. The physiotherapeutic plan design is based to initial kinesiological test. Therapy was treated according to this plan. The output kinesiological test was worked out in the end of therapy and after results evaluation was designed long-term physiotherapeutic plan. The therapy was treated 4-5 weeks to every patient. The results say that by all patients came improvement of the movement extent in the operated hip joint, also to the pain reduce or pain elimination, increasing of the muscle power and the walking stereotype. However, some of the pathological movement stereotypes and muscle shorting still remain or were just partially reduced. Altogether, with the total hip joint prosthesis arthroplasty patients with different complications are connected strong muscular dysbalances and disrupted stereotypes of movement and walking. These changes are caused by antalgic position in the joint. Shortly, if the hip joint is long-term affected, then will be the affect evinced on the global deportment.
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Specifics of nursing care of children affected by developmental dysplasia of the hip
MÁLKOVÁ, Veronika
This thesis is dealing with the nursing care in children with developmental dysplasia of the hips. It is focused on it´s specifics. The results of the thesis show that the role of the nurse is important and includes preparations and assistence during the examination. In the nursing care includes especially hygienic care, education, emphasis on prevention of complications. The nurse preforms practical demonstrations of ortopaedics aids. Within the operation care and during hospitalization the empasis is laid on all mentioned above and also on the support of the child - relief of the pain, fear and anxiety.
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Quality of life in patients before and after total hip replacement
ŠIDÁKOVÁ, Alena
The objective of this thesis is to assess quality of life of patients before and after total hip replacement. To determine HRQoL {--} Health Related Quality of Life I used standardized questionnaire SF-36 which assesses eight basic qualities (domains) of life. This thesis has 2 parts: a theoretical part and a practical part. Anatomy of the hip, total hip replacement, quality of life in general and quality of life in chronic diseases are described in the theoretical part. The practical part was prepared using quantitative research, the technique of anonymous questionnaire SF-36. The respondents were clients of the orthopaedic outpatient clinic of hospital in Klatovy. The final sample comprised 18 women and 11 men. Results were recorded in electronically. The Department of Clinical Pharmacology of hospital in České Budějovice provided evaluation of the results. Data obtained about probands were compared with results of Oxford Healthy Life Survey and also with each other. The results were made into well-arranged graphs and charts. The structure of charts is uniform, the value from research and the value from Oxford (always 100%) are stated next to each other. Results obtained from the practical part can be used to supplement education materials which relate to this issue. The results are very encouraging. Quality of life after total hip replacement has improved. Especially in the domain of bodily pain (P) where the probands reached the results of 86.79%. The difference between Oxford {--} 100 % (healthy population) is therefore only 13.21 %. Probands achieved best result in domain General health perceptions (GHP) 141.38 %. Two hypotheses were stated in the introduction. Hypothesis 1 was: Quality of life of patients will improve after total hip replacement. Hypothesis 2 was: Consumption of analgesics will decrease after the surgery. Both hypotheses were confirmed. Obviously, the results in some domains will remain lower compared to healthy population but the overall quality of life of patients after total hip replacement has improved. The objective of the thesis was accomplished. Resources used are listed in the conclusion of the thesis. Appendix includes for example the questionnaire SF-36 or information leaflet with obtained data (pain reduction, improvement in certain domains of quality of life etc.) which will be used to educate patients in waiting rooms in outpatient clinics.
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The Nurse{\crq}s Role in Relieving Pain in Patients Suffering from Coxoarthrosis.
JANÍKOVÁ, Radka
The objective of the paper is to underscore the nurse{\crq}s role in this problem area, and the importance of the nurse{\crq}s ability to familiarize patients with the side effects of medication and offer them alternative methods of pain relief. At present, we are briefed on the anatomy and physiology of the hip joint, describe the problems arising from coxoarthrosis and the treatment thereof. We focus on the patient and on the nurse{\crq}s role in taking care of such patients with particular emphasis of alleviating these patients` pain. Five goals were set out for us: Mapping ways of finding information about patients with coxoarthrosis. Mapping information that is available to patients with coxoarthrosis in the area of pain relief. Mapping the role that a nurse can play in relieving the patient{\crq}s pain from the patient{\crq}s perspective. Creation of educational material for patients with coxoarthrosis. Application of educational material for patients with coxoarthrosis. We have set out research issues before ourselves: How do patients obtain relevant information? What information is available to patients with coxoarthrosis in the area of pain relief? What role can a nurse play in relieving the patient{\crq}s pain, from the perspective of patients with coxoarthrosis? Do patients with coxoarthrosis use and benefit from educational material about pain relief? In order to attain our goals, we conducted qualitative research. Using a data collection technique, we opened a non-standardized dialogue with 10 patients suffering from coxoarthrosis waiting for total hip replacement and coming for checkups to the orthopedic outpatient clinic in Třebíč. Initially, a discussion was held with each respondent, followed by educational enlightenment, handing out of educational material, whereupon a second discussion was held that was simultaneously used as feedback. Our research investigation answered certain question marks that we formulated into hypotheses and one answer. Analysis of the results led to the following hypotheses. Hypothesis 1: Educational process has effect on the way of finding information on relieving pain in patients with coxoarthrosis. Hypothesis 2: Education focused on relieving pain in patients with coxoarthrosis has a positive effect patients{\crq} knowledge. Hypothesis 3: Patients with coxoarthrosis view the role of nurses as providers of information on pain relief. Analysis of the results helped us formulate the answer to research question 4, as follows: Answer 1: Patients use educational material for pain relief and use the skills acquired through education. However, they still prefer personal contact with the nurse to acquiring information from educational material. The results of our research indicate that the role of a nurse as educationalist and information provider, as well as actual educational are quite necessary. It is, however, important to remember that education is a process that is constantly developing and adjusting it to the needs of the educated subject is therefore very important. The lesson to learn from this paper for clinical practice and for work in medical and social fields is that the role of nurses as educationalists and information providers is as substantial as educational enlightenment in the area of pain relief in patients with coxoarthrosis. Presumed application of this paper in practice as part of educational material on pain relief in patients suffering from hip joint arthrosis with coxoarthrosis.
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Physiotherapy after total hip joint replacement
ŠUHÁJKOVÁ, Pavla
Pain in a hip joint can dramatically affect the chance of having active life. The recent years have seen a significant progress in the results achieved while implanting artificial hip joints. This type of operation is simultaneously becoming increasingly more often especially when we take into consideration the increasing age of population. Implanting total hip joint replacement results in improving the quality of life, which can only be achieved through interdisciplinary collaboration of doctors, complex rehabilitation treatment, and positive approach of the subject alone. The aim of this bachelor?s thesis was to process case reports of patients after total hip joint replacements and to put together rehabilitation plans for these subjects. With the established objective in mind, the author summarizes outcomes dealing with the issues relating to total hip joint replacement, physiotherapy, occupational therapy, and spa treatment following such operation. The research part of the bachelor?s thesis was accomplished by qualitative research. Data were collected by observing, interviewing and analysing documents. The data were gathered by individual in-depth interview and using case reports, which included author?s own observations, a draft of rehabilitation plan and implementation of the therapy, and subsequent outcomes from the assessment of therapy. The research corpus comprised of two patients who underwent a planned total hip joint replacement because they had been suffering from advanced primary coxarthrosis. The research was carried out at an in-patient orthopaedic department of the Hospital Pelhřimov in March 2011, when the subjects were being hospitalised. Quality and appropriately managed rehabilitation allows quicker improvement in the patient?s health following the operation. It is used as a prevention of complications, it improves engagement of functional potential in the operated joint and it consolidates appropriate motion stereotypes. The outcomes of the research confirm that such pre-operational and post-operational rehabilitation carried out during the stay in hospital leads to a decrease or complete removal of pain, an increase in joint?s mobility and muscular power, getting used to walking on flat surfaces and up and down staircases, and the level of independency in everyday activities.
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Effectiveness of early Physiotherapy After the Operation Total Acetabulofemoral Articulation
MALECHOVÁ, Kateřina
In the bachelor thesis called Effectiveness of an early physiotherapy after an operation of the total hip joint replacement, there are theoretical bases related to the given issue in the first part. In the research part there are worked up case studies of two clients who had the same disease, were operated in the orthopaedic ward at the Hospital of České Budějovice and a total hip joint endoprosthesis was made to them. The aim of the thesis is a complex evaluation of physiotherapy methodologies at the patients after an operation of the total hip joint endoprosthesis and an evaluation what could be improved in this issue, so that the postoperative rehabilitation could be a little more efficient. At each patient during the hospitalization were differences in the success of the therapy. In conclusion it is possible to say, that an important role in the effectiveness of the postoperative treatment is a completing of a preoperative rehabilitation. The patient, who completed the preoperative rehabilitation, better managed a verticalization, walking and self-sufficiency after the operation in contrary to the patient who did not complete the preoperative rehabilitation. The significant problem was that she would have had to commute for the preoperative rehabilitation and it was a problem for the patient. Patients waiting for the operation of the hip joint replacement are often constrained by a pain while walking and they are discouraged by a thought to commute to the preoperative rehabilitation. I propose to carry out the preoperative rehabilitation already during the hospitalization, several days before the operation. The thesis can serve as a theoretical study background for students from Medical universities or it can become, in terms of physiotherapy, an inspiration in a clinical practice at physiotherapists engaged in those issues.
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