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Complex rehabilitation after replacement of anterior cruciate ligament of knee joint and return to preoperative acitivites
BOOROVÁ, Pavla
As the topic of my bachelor thesis I chose "Comprehensive rehabilitation after replacement of the anterior cruciate ligament of the knee joint and return to preoperative activities". I chose this topic because the rupture of LCA is very common especially with athletes with whom I would like to work in the future. Another reason was the fact that I have a personal experience with the LCA rupture and I would like to get more into this issue. The anatomy, biomechanics and kinesiology of the knee joint is described in the theoretical part. I consider the chapter in which I deal with the mechanism of LCA injury interesting. I believe that this information could be beneficial not only for athletes. An important chapter the treatment of LCA injury is the one, where I describe both operative and conservative treatment and a chapter dedicated to physiotherapy after LCA sculpture, where I describe the various stages of rehabilitation and the techniques and procedures used. For the practical part I chose the method of qualitative research. The research group contained a total of four patients after LCA rupture. Two of them were treated operatively, and two conservatively. The therapy with surgically treated patients took place between 5th -10th postoperative week, and monitoring conservatively treated patients lasted 4 weeks. All patients were athletic people aged 32 to 52 years. Initial and final kinesiological examinations and appropriate therapy were performed within research. The aim of this work was to determine an appropriate rehabilitation plan that was optimal for patients after LCA surgery and to map alternative methods of treatment for LCA injury. The results of the research show that in the surgically solved patients regular exercise primarily resulted in an increase in joint extent, muscle strength and stability in the knee joint. In the conservatively solved patients we managed to ensure a better stability of the knee joint above all, which was most affected in both patients. This work can be used as a study material for physiotherapists in their clinical practice or for physiotherapy students interested in this issue.
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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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