|
|
The role of the nurse in providing multidisciplinary care in spinal units
HARAZINOVÁ, Lucie
The aim of this master's thesis is to map the role of the nurse in the spinal unit, describe the collaboration of multidisciplinary team members in the spinal unit and describe the needs of the hospitalized patients. To meet these objectives, a total of five following research questions were set: "What is the role of the nurse in the care of patients in the spinal unit?", "What are the specifics of nursing care of patients in the spinal unit?", "What is the composition of the multidisciplinary team in the spinal unit?", "How does the cooperation between these workers take place?" and "What are the needs of patients hospitalized in the spinal unit?". The theoretical part of the thesis is designed to provide the reader with a comprehensive overview of the issue of spinal cord injury. At the very beginning, it defines the basic anatomical and physiological conditions of the nervous system, spine and spinal cord. Injury of these structures is the subject of other chapters, which discuss the causes, symptoms, diagnosis and treatment options in more detail. It also describes the development of spinal units in the Czech Republic and abroad. It defines a multidisciplinary team, whose work is an integral part of the care of a patient with a spinal cord injury. The nursing care chapter is devoted to areas that require a specific approach by nurses in patients with spinal cord injury. A qualitative research study was chosen for the empirical part of the thesis. Data collection took place using a semi-structured interview with thirteen nurses from selected spinal units. After finding out their personal information, they were asked a total of twenty-nine questions focused on the functioning of the spinal unit, characteristics of provided multidisciplinary care and the nurses' experience of the patients' condition and needs. The obtained information was subsequently transcribed and processed with the open coding method and colouring text. For easier orientation in the results of the interviews, four categories and seventeen subcategories were created, which clearly present the answers to the above research questions. It was found that the informants perceive their role in the spinal unit mainly as a nurse-caregiver. The cooperation of the multidisciplinary team is conditioned by various forms of verbal and non-verbal information exchange, for example during ward rounds, by change-of-shift handoff, operational meetings or information boards. Most of the nurses rate this cooperation as effective and mostly problem-free. The results also show that the needs of patients are closely related to mobility restrictions and long-term hospitalization. Most often, these are physiological needs and the need for contact with the society. This master's thesis points out the importance of a multidisciplinary and sensitive approach to patients with a spinal cord injury, who experience many worries and tense moments in their return to everyday life. The results may serve as educational material not just for students of healthcare professions, but also for the medical staff themselves. An output of the thesis is a manual for new nurses on spinal units, which aims to make them easier to integrate and prepare for the significant specifics about the nursing care for patients with spinal cord injury.
|
|
|
Study of mechanisms influencing inflammatory and neurodegenerative processes and their subsequent treatment in ALS and spinal cord injury
Vargová, Ingrid ; Jendelová, Pavla (advisor) ; Jiruška, Přemysl (referee) ; Balaštík, Martin (referee)
Study of mechanisms influencing inflammatory and neurodegenerative processes and their subsequent treatment in models of ALS and spinal cord injury The mechanisms of neurodegeneration during spinal cord injury (SCI) and amyotrophic lateral sclerosis (ALS) are complex and poorly understood, which is why it's troublesome to counteract them with effective therapies. This thesis explores the pathways of autophagy, endoplasmic reticulum (ER) stress, and the mammalian target of rapamycin (mTOR) pathway that regulates these mechanisms in models of both SCI and ALS. Upregulation of autophagy and the mTOR pathway in an in vivo contusion SCI injury model was confirmed. The mTOR inhibition led to upregulation of autophagy, reduction of inflammation, and recovery in acute SCI. Upregulated autophagy was discovered in the SOD1G93A rat model of ALS. By treating the ALS rats with human mesenchymal stem cells, prolonged survival of the animals and preservation of motor neurons (MNs) possibly occurred through modulation of autophagy. The involvement of the mTOR pathway in the degeneration of MNs was further explored in the context of astrocytes. Pleckstrin homology like domain family A member 3 (PHLDA3), a newly discovered repressor of the mTOR pathway, was found to lead to ER stress if overexpressed in astrocytes...
|
|
|
The Impact of Erigo Robotic System Therapy in Patients after Spinal Cord Injury
Tůmová, Kateřina ; Pětioký, Jakub (advisor) ; Janatová, Markéta (referee)
The Impact of Erigo Robotic System Therapy in Patients After Spinal Cord Injury Abstract: This bachelor thesis aims to shed light on the effects of Erigo robotic system therapy in patients after spinal cord injury. Currently, careful attention is devoted to research seeking new ways to cure or treat spinal cord injury. Even though we are just beginning to understand neuroregeneration processes, new rehabilitation robotic systems and devices are gradually starting to occupy a significant role especially in early rehabilitation after spinal cord injury. The first part of this thesis describes spinal cord injuries with a focus on health implications and complications the injured person has to come to terms with. Employing robot-assisted therapy in early rehabilitation stages can prevent a number of problems. By doing so, such therapy can improve the patients' functional condition, self-reliance their recovery and return to ordinary life. The use of robotic systems is becoming a standard in many rehabilitation facilities. This bachelor thesis will focus on the frequently used Erigo robotic system and on evaluating the effects of Erigo therapy. The thesis will describe the functions of the Erigo and its advantages. Moreover, several aspects of focus and evaluation criteria will be identified. These aspects will...
|
|
|
Experimental model of the ventral spinal cord lesion in rats.
Štěpánková, Kateřina ; Machová Urdzíková, Lucia (advisor) ; Martončíková, Marcela (referee)
A spinal cord injury (SCI) is a damage to the spinal cord that causes permanent or temporary changes in motor and sensory functions. In humans, the traumatic impact to spinal cord is mostly directed from the ventral part of the spinal column, even though SCI models are principally directed from the dorsal part of the spinal column due to easier surgery. The aim of the work described in this thesis was to develop clinically more relevant, easily reproducible and relatively inexpensive model of the ventral spinal cord lesion in rats which replicates SCI in humans as closely as possible by its pathology, completeness, level and regeneration. For the surgery we used a modification of a balloon- compression technique. The balloon of the 2F embolectomy Fogarty's catheter was placed to the anterior epidural space via laminectomy at the level of T10 and when the final position of the catheter was achieved at the spinal level T8 in front of the anterior median fissure, a balloon was rapidly inflated with 10 μl or 15 μl of water for 5 minutes. Other two groups - laminectomy only and ventral placement of the catheter without inflation were used as controls. The motor functions were evaluated by the BBB test and ladder walking test. In BBB test we observed significantly impaired motor functions in the 15 μl...
|
|
|
The use of induced pluripotent stem cells in the treatment of spinal cord injury and ALS.
Gajdoš, Roman ; Jendelová, Pavla (advisor) ; Vargová, Lýdia (referee)
Induced pluripotent stem cells (iPSCs) have become a new phenomenon of regenerative medicine. It is obvious that they share some common characteristics with embryonic stem cells (ESCs) such as stemness potential, self-renewal p., differentiation p. iPSCs retain their epigenetic memory, allowing becoming patient-specific and so it is not necessary to apply immunosuppressants. The use of ESCs is controversial, because their acquisition is associated with embryo destruction. As a cell source for iPSCs derivation we can use any somatic cells, however, fibroblasts are preferably used due to their easy availability. With transcriptional reprogramming cocktail (OCT4, SOX2, KLF4, c- MYC / OCT4, SOX2, NANOG, LIN28) we can obtain required iPSCs line, which is then further differentiated into neural precursors (NPCs). These cells can be grafted into lesion site, where they can facilitate regeneration by several mechanisms (cell replacement, protective effect, facilitation the expression of trophic factors). Nevertheless, here we are still dealing with the risk of tumorogenesis or low cell derivation efficiency that limits the use of iPSCs in clinical practice. In this thesis we will therefore mainly focus on the therapeutic potential of iPSCs in preclinical studies, their use in the treatment of...
|
|
|
Behavioral testing of animals after experimental spinal cord injury.
Freislebenová, Hana ; Machová Urdzíková, Lucia (advisor) ; Kriška, Ján (referee)
Spinal cord injury is one of the most serious injury that leads to a decrease in the quality of life both physically and mentally. Although there is currently no effective treatment, great efforts are being made to develop new treatments. The effectiveness of experimental treatment is verified by behavioral tests performed on animal models, where rats are the most suitable ones for this type of injury. Behavioral tests are divided into several groups depending on what the testing is focused on. Locomotor tests examine the function of a locomotive apparatus, motor tests are used to determine the function of skeletal muscles not primarily involved in locomotion, sensory and motor tests test the functionality of sensory and motor apparatus and their interconnection, sensory tests are designed to test responses to sensory stimuli. Electrophysiological tests and functional magnetic resonance imaging are part of a series of special tests that use artificially induced electrical stimuli to measure muscle activity. This thesis is focused on detailed description of selected behavioral tests, their functionality and comparison of their advantages and disadvantages.
|
|
|
Mesenchymal stromal cells and biological scaffolds for neural tissue regeneration
Kočí, Zuzana ; Kubinová, Šárka (advisor) ; Filová, Eva (referee) ; Zach, Petr (referee)
Despite tremendous progress in medicine, injuries of the adult central neural system remain without satisfactory solution. Regenerative medicine employs tissue engineering, cellular therapies, medical devices, gene therapy, or growth factors with the aim to bridge the lesion, re-establish lost connections and enhance endogenous repair in order to restore neural function. The aim of my thesis was to evaluate therapeutic potential of two approaches, transplantation of human mesenchymal stromal cells (hMSCs) and biological scaffolds derived from extracellular matrix (ECM) for neural regeneration, particularly in models of spinal cord injury (SCI). First, hMSCs from various sources - bone marrow (BM), adipose tissue (AT) and Wharton's jelly (WJ) - were isolated and characterized in vitro. All cell types met the minimal criteria for MSC phenotype and displayed similar properties in terms of their surface marker expression, differentiation potential, migratory capacity, and secretion of cytokines and growth factors. On the other hand, the cell yield from WJ and AT was significantly higher, and MSCs isolated from these tissues proliferated better than from BM. Therapeutic effect of intrathecal application of hWJ-MSCs was then evaluated in SCI compression model in rats. The effect of low (0.5 million) and...
|
|
|
Development of extracellular-matrix scaffolds for CNS repair
Výborný, Karel ; Kubinová, Šárka (advisor) ; Hampl, Aleš (referee) ; Vandrovcová, Marta (referee)
Výborný, Karel. Vývoj materiálů na bázi extracelulární matrix pro léčbu centrálního nervového systému. [Development of extracellular-matrix scaffolds for CNS repair]. Praha, 2020. 105 stran, 3 přílohy. Dizertační práce (Ph.D.). Univerzita Karlova, 2. lékařská fakulta, Ústav experimentální medicíny, AV ČR v.v.i. Abstract Brain and spinal cord injury are a serious traumata and despite intensive research, there is still no effective treatment for patients. One of the studied approaches is to use various biomaterials to repair the damaged neural tissue. The aim of this thesis is to study the regenerative and neurotrophic effects of injectable extracellular matrix (ECM) hydrogels prepared by decellularization from porcine tissue (brain, spinal cord, bladder) and human umbilical cord (UC) in reconstruction of damaged neural tissue of the brain and spinal cord in rats. We characterized ECM hydrogels in terms of mechanical and rheological properties, structure and composition, cell adhesion, migration and proliferation. In a model of spinal cord hemisection, we compared the regenerative effect of ECM hydrogels derived from porcine spinal cord and urinary bladder. We found no benefits of tissue specific ECM prepared from the tissue of neural origin in terms of its neurotrophic properties in vitro or in vivo....
|
|
|
Natural biomaterials and mesenchymal stem cells in regeneration of spinal cord injury
Kekulová, Kristýna ; Kubinová, Šárka (advisor) ; Krulová, Magdaléna (referee) ; Filová, Elena (referee)
Spinal cord injury is a serious trauma and despite intensive research there is still no effective treatment for patients. The aim of this thesis is to study new possibilities of spinal cord injury therapy in animal models. We have focused on the use of natural materials, stem cells, gene therapy and the possibility of combining these approaches. The effect of extracellular matrix (ECM) based materials prepared by decellularization of porcine spinal cord and porcine urinary bladder on tissue regeneration after acute hemisection of the spinal cord was investigated. Another tested material was a hydrogel based on hyaluronic acid modified with RGD adhesion peptide, which was applied acutely and subacutely into the hemisection lesion. We have shown that both types of biomaterials have positive effect on regeneration of the spinal cord tissue by bridging the lesion and promotion of axonal ingrowth. In addition, ECM hydrogels promote the growth of blood vessels into the lesion site. The combination of hydrogels with mesenchymal stem cells derived from human umbilical cord (hWJ-MSCs) had synergistic effect, but since only a limited number of cells could be incorporated into hydrogels, this effect was not associated with improvement in motor skills. The limitation of ECM hydrogels is their rapid...
|
|
|
Blood pressure and heart rate variability when verticalizating tetraplegics
Čeloudová, Kateřina ; Kříž, Jiří (advisor) ; Radvanský, Jiří (referee)
An autonomic dysfunction caused by spinal cord injury may have a significant impact on quality of life, especially in cases of lesions occuring above the sixth spinal segment. In these cases also cardiovascular system control is damaged in a different extent, which is subsequently presented by e.g. persisting bradycardia, heart frequency inadequate reaction to strain and stress or by huge variations of blood pressure values, which the situation complicate even more. The fact that cardiovascular diseases take now the frontmost place in causes of mortality of people with spinal cord injury is another evidence how important this topic is. The main aim of my thesis was to describe impacts of autonomic injury on cardiovascular functions and to try to objectify them using heart rate and blood pressure variability. Twenty-one patients of Motol University Hospitalv Spinal Unit with spinal cord lesion above Th6 segment and ten healthy people as a control group participated in the study. We created suitable conditions for highlighting disrupted cardiovascular functions of urgent spinal patients by modification of the standardized Head Up Tilt Test (HUTT). The heart rate and blood pressure values were continuously monitored by Finapres device before, during and also after verticalization on a tilt table....
|
guest ::
