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A survey of attendance care for high-risk patients and patients with decubitus in choice facilities in the Czech Republic and in the Federal Republic of Germany
LANGOVÁ, Petra
Current situation: Even at the present time of the 21st century, decubitus is still considered to be a serious health complication which attacks all age groups of patients and reduce their quality of life (Boughen, 2012). Aims: The main aim of the research was to find out if the nursing treatment of patients who are at risk of pressure ulcer development or patients suffering bedsores in the Czech Republic is comparable to the treatment provided to similarly ill patients in Germany. Procedure: In order to find out necessary data, the quantitative research method was selected, during which an anonymous questionnaire both in Czech and German languages was issued and consequently submitted to general stuff nurses working at standard hospital departments. Research area: During the research survey, the general stuff nurses working in internal, surgery and rehabilitation departments in three Czech hospitals and two German hospitals. Results: The survey results showed that in the Czech Republic the Norton Scale for predicting the pressure ulcer risk is used most often, while in Germany the Braden Scale is most frequent method. The respondents, however, are equally convinced that regular inspections of skin as well as active searching for causation factors are far more suitable and helpful. Moreover, the survey revealed that the German colleagues determine the risk of developing bedsores by using the scale more frequently compared to the nurses in the Czech Republic. Significant differences in statistics were obvious in the frequency of the individual treatment interventions, especially in the areas of turning and repositioning the patient according to Bobath concept, self-dependence training, the skin assessment, as well as in the area of education. The research results showed the fact that Czech nurses statistically far more often use antiducubitus tools and materials, which are considered unsuitable or are not recommended by foreign guidelines. It was as well obvious from the research survey that the Czech nurses use compensational tools and devices when treating their patients more often compared to German hospitals. The survey results further showed that the choice of local therapeutic material used in particular working places vary considerably. While there is a more numerous utilization of materials containing silver and Tender Wet hydro-active super absorb cushions in the Czech Republic, stuff nurses in Germany prefer transparent polyurethane covers, secondary absorbing covers and polyurethane foams. Conclusions and suggestions for the practice: As far as the material availability is concerned, we are still far behind the advanced countries. However, we excel in quality as well as in the professional qualification of the nursing stuff. Prevention measures in the area of pressure ulcers are on the same level. Suggested changes and recommendations are: Suitable choice of the equipment, tools and devices. Immediately start with the self-dependence training within the rehabilitation treatment exercises and to use suitable compensational aids and utilities. It is as well advisable to create an individual body movement plan. To engage the whole multi-discipline team in the treating process for the patient. To educate the patient correctly. To ensure precise treatment documentation. Not to focus only on the assessment scale for prediction pressure ulcer risk but to carry out regular inspections of skin and search for the causation factors actively. To carry out the fading hyperaemia test in practice. Not to confuse sitting in a wheelchair and mobilisation. Verify and legalise the recommended procedures with the support of audits on pressure ulcer prevention and treatment.
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Carpal tunnel syndrome in spinal patients
Zmeškalová, Petra ; Špaňhelová, Šárka (advisor) ; Lepšíková, Magdaléna (referee)
The aim of this work is confirming of incidence carpal tunnel syndrom in patients with spinal cord lesion. This ailment stem from repetitive loading of hands on propulsion of mechanical wheelchair. Work contains the causes of biginning, risk factors for patients, prevention, conservative and operation therapy. Thesis involves characteristic of patient after spinal cord injury, seat and wheelchair propulsion. The practice task contains case report of patient and suggestion of therapy for her. Powered by TCPDF (www.tcpdf.org)
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Physiotherapy for patients with Spinal Muscular Atrophy - therapeutic use methods and assistive devices to delay neuromuscular spinal deformities
KUBIČKOVÁ, Karolína
In my bachelor work I look into the problems of the spinal muscular atrophy, assess both the effect of physiotherapy performed and utilization of compensation aids to control the progression of the disease. SMA presents an autosomal recessive genetic progressive disease of neuromuscular system, in the course of which muscular hypotonia, even atrophy develops. This process origins in a gradual deterioration of motoneutrons of frontal spinal corners. SMA ranks among rare hereditory diseases when both parents of the affected patient are bearers of a defective gen, although the illness doesn´t manifest in them themselves. The illness, in its medium and more advanced forms, starts usually its occurence in an early childhood. The rapidity of SMA progression differs in every individual. The patiens who suffer from this illness are mostly dependent on a wheelchair and their lifetime is substantially limited. Neither pathogenesis, nor treatment are currently known.One of major problems, which are brought by the illness, is the start of a backbone neuromuscular deformities which gradually deteriorates. A progressing scoliosis is often so significant that a surgical treatment becomes inevitable because compression of internal organs reaches such a condition that a conservative treatment is not sufficient any more. The patiens often complains of a back and hip painfulness. Viewed by physiotherapy, it seems inevitable to select a correct, individual therapy for every affected person and to recommend them suitable compensation aids. In particular, the choice of a wheelchair must be done with a proper care. Especially the quality of the sitting part and the part catering for a sufficient stability of the body, present the most important items to check while selecting a wheelchair. The importance of a proper wheelchair results from the fact that the SMA patiens spend in it most of their lifetime and that´s why the comfort of usage and the limitation of both backbone deformities and pelvis obliquities appears so important.In the theoretical part of my work I focused on the definition of SMA disease. I stated the classification of SMA and the therapy options. Next, I mentioned the physiotherapy methods, which are most often employed in therapy and compensation aids, which are inevitable for the SMA patiens and present a slowdown of the disease progression. A high quality and suitably selected compensation aid participates in a partial deceleration of occurence or progression of neuromuscular deformation of the backbone.This bachelor thesis aims at monitoring of physiothrapy application chances in SMA. It examines if the illness can be partially affected by employing physiotherapeutical methods. In addition, it deals with the availability and effectivity of compensation aids.
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Physiotherapy Achilles tendo rupture incurred during sport
BERNÁ, Kateřina
The Bachelor thesis deals with the theme of "Physiotherapy of rupture of the Achilles tendon due to sport". The rupture of the Achilles tendon is most common by young men who are dedicated to professional or solely amateur sporting activity. Pathologies of the Achilles tendon are becoming more common due to an increase in sports facilities and better access to leisure sports. In the case of a tendon injury, the patient is forced to undergo treatment. Currently there are three ways of treatment: conservative, optative, and miniinvasive treatments by percutaneous technique. The latter two techniques are a popular choice among active people and athletes. The theoretical part summarizes the knowledge of the Achilles tendon, the anatomy, physiology and biomechanics. This part also deals with the emergence of rupture (its causes), clinical contexts and tests. Finally, there is a description of the various types of therapy of rupture, physiotherapy and possible contraindications during treatment. In the theoretical part, I also included a set of preventive measures which make it possible to prevent injuries. The importance of these principles is in the fact that their compliance is disappearing in the field of professional sports. The practical part was processed by qualitative research and includes targets and research questions, methods of work, the course of therapy and a description of the processed results in the form of case reports of patients. The task of set target is suggestion and realization of individual physiotherapy in patients with rupture of Achilles tendon. The research question focuses on monitoring changes in the investigated parameters after physiotherapy. The methodology section includes a characteristic of the study sample which consists of two patients diagnosed with total rupture of the Achilles tendon, both were treated at the Department of Rehabilitation of the Hospital in České Budějovice, JSC. Patients suffered an injury during sport activities (basketball, football) and subsequently they underwent operations in the form of an open operation. In this part of thesis a description of the input and output tests will be found. First, data was collected from anamnestic of patiens. Each examination of kinesiology analysis were then evaluated. The techniques of data collection were interviews and observations. The process of physiotherapy treatments recorded several local problems, which were necessary to focus while therapy was in occuring: swelling of the surrounding tissues, limitation of movement, change of soft tissue in the ankle and instep, weakened musculature leg and thigh, and rigidity of Achilles tendon. It was also necessary to conduct reeducation of walk and proprioception training with patients. After application provided physiotherapy treatment was observed in two patients improvement of values of somatometric measurements (circumference thigh, calf muscle, ankle, head of metatarsals), momentum in the ankle joint in dorsiflexion and plantarflexion and improve of muscle strength especially in the m. quadriceps femoris and m. triceps surae. Tasks of the thesis were fulfilles and the research question is answered. Results will be made public for professional physiotherapy public and the results should be useful for clinical practice of physiotherapists and for students in modern physiotherapy techniques in the diagnosis.
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Redcord on a wheelchair
MENDLOVÁ, Olga
Diploma thesis deals with a suspension system of cords and slings called Redcord. Redcord helps physiotherapists as their auxiliary third hand. Redcord has a wide range of application. The main goal of the thesis is to develop and test training units in Redcord for spinal patients on a wheelchair in the Rehabilitation Institute Kladruby. This goal was successfully realized and the group exercise in Redcord were implemented between the procedures of the rehabilitation program. The study also discusses the effectiveness of exercise in Redcord, the evaluation of different dosage of load and monitoring the progression of a group training. The group exercise in Redcord for spinal patients on a wheelchair is effective, because it allows the same exercise training for patients with different level of spinal cord lesion and different stability of the trunk. This is possible thanks to the various dosage of load in Redcord. The feedback from spinal patients has been verified by subjective evaluation in the form of a questionnaire supplemented with a interview.
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Physiotherapy in patients after injuries of the spine and spinal cord
HAJNÁ, Petra
In connection with our lifestyle every year in our country but also abroad there is a growing number of people with spinal cord injuries. The spinal cord injury usually occurs while a spinal injury, where the spinal canal is compressed by luxated vertebra or bone fragments. Affected are more often young people, especially men. The most common causes are falls from height, accidents and sports injuries. A person with this condition not only has limitations in terms of loss of movement or sensitivity but is often threatened by various health complications. Therefore a complex care and intensive rehabilitation is very important, which is in the Czech Republic secured by the spinal program lasting 6-9 months. Rehabilitation is needed not only in the acute period after injury, but has a unique place in the chronic stage of spinal cord injury as well. The aim of this thesis was to explore issues of trauma and spinal cord injury from the perspective of physiotherapy. Based on the defined targets following research questions have been determined. What kinds of physiotherapy procedures may be used onpatients in the subacute stage and what procedures in the chronic stage of spinal cord lesion. A qualitative research in the form of case reports has been executed. Data was obtained from interviews, observation, document analysis and kinesiological analysis. Standard tests related to the spinal lesion were performed, only the most relevant tests and the results that were found during therapy in case reports were entered. The sample included four patients. Two patients in the subacute and two patients in the chronic stage of spinal cord injury lesion etiology. The research was conducted at the Spinal Unit Department of Traumatic Surgery, University Hospital Brno and at the Rehabilitation and restoration center Borovany. Physiotherapy in subacute phase of spinal cord injury is directed at the prevention of pressure sores, contractures, pain, maintaining optimal mobility of joints, focusing on respiratory rehabilitation, maintenance and strengthening of preserved motor potential, activation of the motor transient spinal cord lesion with efforts to activate the motor skills in the most distally way, improving the overall physical condition. The aim is to use and support functional ability of the patient to the fullest extent and quality with the subsequent effort to develop alternative mechanisms.Of the special methods the ones on the neurophysiological basis are the most commonly used treatment methods. An important part is the gradual verticalization of the patient, training equilibrium reactions such as training seat, support for upper limb, keeping in certain positions and functional training, thus the mobility on the bed, self-care, transfers, training wheel chair control, practicing functional replacement grip. Patients return to life with a big handicap, are often dependent on the assistance of others, learn to use a wheelchair and other aids. They have years of life ahead in which they have to cope with the conditions subsequent their injury. In the chronic period, it is important to maintain physical fitness, preventpossible complications, especially pressure sores and joint contractures. Physiotherapist addresses the consequences of overloading the exposed muscles, monitors the vertebral problems, joint pain or muscle imbalance. During this period, patients can attend ambulant physiotherapy or use maintenance stays in rehabilitation centers. The purpose of the study was to mention the basic and the most important areas in the care of spinal patients and to highlight the importance of physiotherapy comprehensive care not only within the spinal program, but also from the perspective of the long-term care of these patients as the rehabilitation should accompany the patient's whole life.
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Possibilities of application fitness in physioteraphy in patients with spinal lesion
ŠEVECOVÁ, Zuzana
The number of persons who suffered spinal cord injuries, as well of physical therapists who are interested in exercising in a fitness centre and in other fitness activities. This fact results in integration of these activities into physical therapy programmes and therapeutic stays intended for persons with spinal cord lesion. Incorporation of fitness activities into physical therapy programmes is common particulary in the USA. The aim of this thesis was to study the influence and contribution of fitness activities for muscle disbalances in the area of the torso and for the posture with patients suffering from spinal cord lesion and futher to identify the possibilities of incorporating fitness activities into physical therapy programmes for wheelchair bound persons. With respect to the aim of thesis defined in this manner, I have summarized the fact on spinal cord lesions in relation to torso muscle disbalances with spinal cord lesion in the theoretical part of the theses. Subsequently, I have tried to collest the existing facts on fitness, including the definition of fitness, the importance of physical activities and muscle strengthening for wheelchair bound persons. I have also focused on basic principles, terms and exercises and I have analysed its incorporation into the exercise programmes for wheelchair bound persons. In the practical part of the thesis, I have used the qualitative casuistic-based research method. The research was carried out in the Rehafit Physical Therapy Centre in Prague. Two test persons were selected: a man and a woman with diagnosed spinal cord lesion. The woman has been diagnosed with Th11-12 paraplegia, the man has been diagnosed with C4-5 tetraplegia. Both patients with spinal cord lesion are of similar age and suffered the spinal cord injury approximately at the same time. With the observed patients, there has been an influence of muscle disbalance detected in the area of torso, inprovement of posture and stability of seated positions, increase of muscle power, as well as improvement of overall physical conditions. The results of the research show that incorporation of fitness activities into physical therapy programmes in the period following the period of termination of the intensive physical tehrapy has a undeniable imporatnce for patients with spinal cord lesion, particularly for affecting the posture and muscle disbalnces.
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Evaluation of wheelchair adjustments and their impact on proper propulsion pattern upper extremities and sitting posture in patients with spinal cord lesions
Dáňová, Petra ; Pfeiffer, Jan (advisor) ; Neuwirthová, Svatava (referee)
Title: Evaluation of wheelchair adjustments and their impact on proper propulsion pattern upper extremities and sitting posture in patients with spinal cord lesions. Objectives: The objective of this work was to evaluate the adjustments of wheelchair and to determine their impact on the work of the upper limbs and posture while sitting. This work was done on a group of patients with spinal lesions with their own wheelchairs. Another objective was to assess how education of proper propulsion pattern and form and type of a grip of handrim affects the correct propulsion pattern. Methods: In the group of 26 patients with spinal cord injuries in different levels of the spinal cord, I tested the adjusments of wheelchair, in particular the centre of gravity and maximum seat height from the ground. I also investigated what education on correct propulsion pattern the patients received, and observed any home-made adjustments to handrim, as well as patients' techniques of handrim grip. Finally, I examined how the subjects drove his/her wheelchair. During all the tests, I recorded video and photo documentation. The results were statistically evaluated using the Fisher test. Results: Despite the fact that only a small group was investigated, I showed the effect of wheelchair seatings on the correct posture. I...
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Influence of stress upon the quality of the provided nursing care at the emergency ambulances.
JAMBOROVÁ, Lenka
I have selected the topic of my bachelor thesis ``The effect of stress on quality of nursing care provided by nurses in acute care facilities`` as I have been always interested in work of nurses in acute care facilities and in mental demands imposed on nurses as a result of such work. Stress is a set of responses by the organism to internal and external impulses, which disturb regular functioning of the organism; stress is an individual response to excessive physical, emotional or intellectual requirements . Communication is viewed as a significant aspect in healthcare. It is a fundamental and integral part of healthcare provided by nurses. Effective communication favorably contributes to recovery of patients as it alleviates fear and confusion and helps to mitigate anxiety and stress. Although we sometime fail to realize that, we assess patients immediately after they arrival to the surgery. We notice whether the patient communicates, whether he/she is nervous, whether his/her appearance is neat and we can see that the patient is in a wheelchair or on crotches. The current nursing standards require a nurse to be a recognized expert in her independent sphere of action. The burnout syndrome is described as a condition of mental and physical exhaustion, most frequently observed in the so-called helping professions. In Czech literature the burnout syndrome has been most frequently mentioned in connection with persons in nursing professions, where the work consists of serving to other people. In the research for my bachelor thesis I have used a qualitative survey using inquiry with a questionnaire. The questionnaire was developed for nurses working in acute care facilities. The survey was conducted in hospitals in České Budějovice, Jindřichův Hradec, Prague Motol, in a psychiatric institution in Jihlava and outpatient clinic in Telč, always subject to approvals granted by the respective head nurses. This thesis sought to find out whether the stress influences the quality of nursing care provided by nurses in acute care facilities. All the three hypotheses - number 1: Stress affects quality of the provided nursing care; number 2: Stress affects health condition of nurses in acute care facilities; and number 3: Good team at the workplace favorably influences work in acute care facilities - have been confirmed . This means that the objective of the work has been achieved. My thesis may be used as a supporting source material for education of medical personnel in hospital practice.
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