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Possibilities of physiotherapy in patients with spastic paresis after stroke
OŠMERA, Martin
This bachelor thesis deals with spastic paresis of the lower limb in patients after a stroke. The thesis describes the problem of spastic paresis and the possibilities of using physiotherapy. A number of physiotherapeutic methods can be used in clinical practice to treat spasticity. One such method is the Guided Self-rehabilitation Contract by J. M. Gracies, which combines static prolonged stretching with the possible application of botulinum toxin and strength training of repetitive active movements (RAP) with home autotherapy. The aim of this thesis is to describe various possibilities of physiotherapy and evaluate the effectiveness of the method according to Gracies in the target group of patients. The Theoretical part focuses on spastic paresis, its origin, description, and characteristics together with the upper motoneuron syndrome (UMN syndrome), in which spasticity is one of its components. The following are individual clinical manifestations and forms of spastic paresis with the possibility of evaluation by clinical scales. The work also mentions a stroke, as one of the possible causes of spasticity. At the end of the theoretical part, pharmacological treatment with selected physiotherapeutic approaches to therapy is presented. The Methodological part describes the process of research implementation. The Practical part is conducted in the form of qualitative research, namely case studies in two probands with spastic paresis of the lower limb after a stroke, in which therapy according to Gracies is indicated. Each proband was subjected to an input and output kinesiological analysis, which included anamnesis, aspect, anthropometry, goniometry, examination of muscle strength, gait tests, Berg Balance Scale and Five-step Clinical Assessment in Spastic Paresis. During the study which lasted more than 6 months, the course of therapy was monitored in each proband. Based on the comparison of kinesiological analyses, was possible to observe a positive effect of the therapy. Proband 1's results are indistinct, despite clear subjective improvement. It was possible to improve movement, condition, and postural stability. Conversely, in some of the monitored muscles, the rate of spasticity worsened. Proband 2's results are significantly improved, despite the chronicity of the condition.
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Methods of a grip evaluation after reconstructive surgery of the spastic hand
Pechová, Petra ; Fialová, Ludmila (advisor) ; Kövári, Martina (referee)
The aim of the thesis was to find out which areas of life of people with hand spasticity may affect the performance of reconstructive surgery. Furthermore, to determine which specific factors involved in the function and dysfunction of the upper limb in people with upper motor neuron syndrome can affect the results of the intervention, and what are the relationships between these factors. The group consisted of 13 people with cerebral type of spasticity. Subjects were examined preoperatively, three months after the intervention, and five months after the intervention. Operations were performed in the wrist-hand and elbow region. Subjects were examined repeatedly by some sensory modality, goniometry, Frenchay arm test, Score for visual evaluation of functional task of the hand, The QuickDASH, modified Ashworth Scale, modified Barthel Index and each person was classified according to The Manual Ability Classification System. There was an elbow contracture release and an improvement in an active motion in the wrist as result of the intervention. The results showed a statistically significant difference in some test scores Frenchay arm test, Score for visual evaluation of functional task of the hand, The QuickDASH and the modified Barthel Index before and after intervention. In a group of people with...
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Standardized examinations of spasticity in physiotherapy
Špačková, Anežka ; Tichá, Monika (advisor) ; Jeníček, Jakub (referee)
Title: Standardized examinations of spasticity in physiotherapy Abstract: This bachelor's thesis is aimed at giving an overview of the most commonly used standardized examinations of spasticity in physiotherapy and their comparison. It deals mainly with the best known methods of examinations that are used in practice. The thesis is divided into two parts - theoretical and practical. In the theoretical part, muscle tone and its regulation and spasticity as one of the upper motor neurone syndrome symptoms are specified. Moreover, the methods of examination (Ashworth scale and its modifications, Tardieu scale and five-step clinical assessment of spastic paresis according to Gracies) are presented and described in detail there. The practical part contains two case reports of patients after a cerebrovascular accident. Examinations and evaluations of spasticity, including Modified Frenchay scale or walk tests, which are described in the theoretical part, are applied to patients. The main contribution of this thesis is to create a comprehensive comparison of standardized examinations of spasticity through studies and my personal experience. Key words: spasticity, upper motor neurone syndrome, examinations and evaluations of spasticity, rating scales, Modified Frenchay scale, walk tests, five-step clinical...
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Therapy of spasticity with botulinum toxin and assessment of the effect by Tardieu Scale
Hochová, Anna ; Angerová, Yvona (advisor) ; Svěcená, Kateřina (referee)
Title: Therapy of spasticity with botulinum toxin and assessment of the effect by Tardieu Scale Abstract: This paper discusses paralysing effect of botulinum toxin which is used to treat spastic muscles in contemporary medicine. The paper focuses on spasticity in patients with disorder of the central nervous system caused most commonly by stroke. At first it deals with theoretical knowledge about physiology of movement, then describes active ingredient and explains the mechanism of its effect. It dedicates a lot of attention to follow-up rehabilitation as an integral part in the management of spasticity. This paper is based on two case histories. A practical part describes in detail patient's condition before and after application of botulinum toxin. A progress of the effect was assessed during periodic meetings. These instruments were used to assess: Tardieu Scale of spasticity and Frenchay arm test. In connection with the application of botulinum toxin is emphasized active co-operation of the patient. It is an essential precondition for positive results in the management of spasticity. Key words: spasticity Tardieu Scale upper motor neuron syndrome Frenchay arm test botulinum toxin kinesiotherapy occupational therapy
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Methods of a grip evaluation after reconstructive surgery of the spastic hand
Pechová, Petra ; Fialová, Ludmila (advisor) ; Kövári, Martina (referee)
The aim of the thesis was to find out which areas of life of people with hand spasticity may affect the performance of reconstructive surgery. Furthermore, to determine which specific factors involved in the function and dysfunction of the upper limb in people with upper motor neuron syndrome can affect the results of the intervention, and what are the relationships between these factors. The group consisted of 13 people with cerebral type of spasticity. Subjects were examined preoperatively, three months after the intervention, and five months after the intervention. Operations were performed in the wrist-hand and elbow region. Subjects were examined repeatedly by some sensory modality, goniometry, Frenchay arm test, Score for visual evaluation of functional task of the hand, The QuickDASH, modified Ashworth Scale, modified Barthel Index and each person was classified according to The Manual Ability Classification System. There was an elbow contracture release and an improvement in an active motion in the wrist as result of the intervention. The results showed a statistically significant difference in some test scores Frenchay arm test, Score for visual evaluation of functional task of the hand, The QuickDASH and the modified Barthel Index before and after intervention. In a group of people with...
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Standardized examinations of spasticity in physiotherapy
Špačková, Anežka ; Tichá, Monika (advisor) ; Jeníček, Jakub (referee)
Title: Standardized examinations of spasticity in physiotherapy Abstract: This bachelor's thesis is aimed at giving an overview of the most commonly used standardized examinations of spasticity in physiotherapy and their comparison. It deals mainly with the best known methods of examinations that are used in practice. The thesis is divided into two parts - theoretical and practical. In the theoretical part, muscle tone and its regulation and spasticity as one of the upper motor neurone syndrome symptoms are specified. Moreover, the methods of examination (Ashworth scale and its modifications, Tardieu scale and five-step clinical assessment of spastic paresis according to Gracies) are presented and described in detail there. The practical part contains two case reports of patients after a cerebrovascular accident. Examinations and evaluations of spasticity, including Modified Frenchay scale or walk tests, which are described in the theoretical part, are applied to patients. The main contribution of this thesis is to create a comprehensive comparison of standardized examinations of spasticity through studies and my personal experience. Key words: spasticity, upper motor neurone syndrome, examinations and evaluations of spasticity, rating scales, Modified Frenchay scale, walk tests, five-step clinical...
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Therapy of spasticity with botulinum toxin and assessment of the effect by Tardieu Scale
Hochová, Anna ; Angerová, Yvona (advisor) ; Svěcená, Kateřina (referee)
Title: Therapy of spasticity with botulinum toxin and assessment of the effect by Tardieu Scale Abstract: This paper discusses paralysing effect of botulinum toxin which is used to treat spastic muscles in contemporary medicine. The paper focuses on spasticity in patients with disorder of the central nervous system caused most commonly by stroke. At first it deals with theoretical knowledge about physiology of movement, then describes active ingredient and explains the mechanism of its effect. It dedicates a lot of attention to follow-up rehabilitation as an integral part in the management of spasticity. This paper is based on two case histories. A practical part describes in detail patient's condition before and after application of botulinum toxin. A progress of the effect was assessed during periodic meetings. These instruments were used to assess: Tardieu Scale of spasticity and Frenchay arm test. In connection with the application of botulinum toxin is emphasized active co-operation of the patient. It is an essential precondition for positive results in the management of spasticity. Key words: spasticity Tardieu Scale upper motor neuron syndrome Frenchay arm test botulinum toxin kinesiotherapy occupational therapy
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Prevention and therapy of spasticity in patients after cerabral apoplexy
TÁBORSKÁ, Žaneta
Spasticity is a manifestation of many neurological diseases, for example an infantile cerebral palsy, a traumatic injury of brain and spinal cord, a multiple sclerosis and a stroke. A genesis of the spasticity is not yet completely clarified and many definitions try to explain it. The spasticity can deepen a disability of patients even with a minimal paresis. The spasticity has a different clinical picture at various diseases of the central nervous system, but even at different patients with the same diagnosis, it also varies in the course of time at one and the same patient. The biggest problem in the treatment of the spasticity is the fact that the treatment, efficient at one patient, can completely fail at the other. A goal of this thesis was to give an overview of current options in a treatment of the spasticity. Therapeutic approaches to reduce the spasticity are usually a part of special kinesio-therapeutic methodologies, which are for example an anti-spastic positioning, a volitionary relaxation, passive movements, an anti-spastic placing (Bobath´s conception), relaxation techniques (PNF), an application of splints, a long-term effect of the heat, an icing and others. On the contrary, it is intensified by pain, pressure sores, a sub-luxation position most often of the shoulder joint, a psychical stress, urinary tract infections etc. In the theoretical part I focused on a control of the muscle tone, pathophysiology, clinical symptomatology, diagnostics and especially prevention and the treatment of the spasticity. In the practical part I investigated an effectiveness of an anti-spastic therapy through the qualitative research. For the data collection it was used an anamnesis, observations (kinesiological analysis), case reports and a secondary data analysis. The research was made at two probands with a brain damage on the vascular basis. I was finding out an effectiveness of selected therapies for individual probands {--} and at the same time its suitable combination. I focused on the area of the upper extremity. At the first patient there was a success, by a suitable combination of individual methods, to positively affect the spasticity and an active momentum of the upper extremity. At the second patient in a chronic stage of spasticity it was managed to influence it always only for a short term and results varied considerably in the course of time. The treatment of the spasticity must be preceded by a thorough knowledge of pathophysiological mechanisms, a neurophysiology and above all a complex kinesiological analysis. The therapeutic approach should be always individual, to respond appropriately to changes in the clinical picture and to use suitable combinations of therapeutic approaches. If the treatment of the spasticity is successful, it positively affects the motor deficit and reduces the patient's disability.
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