Rehabilitation of amputees represents a complex process during the course of which an amputee receives professional aid and support, so as to adapt to the use of prosthesis, i.e. an artificial ...supplement for the lost body part. The process aims at achieving an independent performance of the amputee in all areas of everyday life and as high quality of life as possible. The rehabilitation encompasses not only the pre-amputation, postoperative, pre-prosthetic and prosthetic stage, within which an amputee is provided with a prosthetic
aiding device, but also the subsequent long-term monitoring and follow-up. The implementation of the rehabilitation process runs in line with the biopsychosocial model and requires a multidisciplinary and an interdisciplinary approach, so as to achieve a successful reintegration of an amputee and allow for a lifestyle resembling the pre-amputation one as much as possible.
The article brings the causes and types of amputation, the principles
underpinning contemporary amputation surgery, prosthetics and rehabilitation during preoperative, postoperative, pre-prosthetic and prosthetic stages, as well as the stage goals and MOs of their attainment. Principles of evaluation of prosthetic rehabilitation outcomes in limb amputees, which make use of appraisal questionnaires, have been discussed as well.
Adult deformities of the spine, especially in older population, significantly contribute to morbidity of these patients. Although the spectrum of causes is diverse, most often these are newly formed ...deformations based on degenerative changes of the spine. Apart from pain, feelings of tension and other unpleasant symptoms of adult deformity, they result in biomechanical disorders, reduced mobility, and sometimes neurological deficits. Overall, spinal deformities in adults cause significant disability and poor quality of life (physical and psychological), while on the other hand, they are relatively neglected in everyday practice. Therefore, in this paper we give a narrative review of the latest findings on etiopathogenesis, clinical picture, imaging diagnostics, treatment (conservative and surgical), and postoperative rehabilitation of patients with adult spine deformities of the most common causes.
SAŽETAK
Adultne deformacije kralježnice značajno pridonose morbiditetu, napose starije popupacije. Iako je spektar uzroka raznolik najčešće se radi o novonastalim deformacijama na temelju ...degenerativnih promjena kralježnice. Osim bolova, osjećaja napetosti i drugih neugodnih simptoma, adultne deformacije rezultiraju biomehaničkim poremećajima, smanjenom pokretljivosti, a ponekad i neurološkim deficitima. Sveukupno, deformacije kralježnice u odraslih osoba uzrokuju značajnu onesposobljenost i lošiju kvalitetu života (fizičku i psihičku), dok su s druge strane u svakodnevnoj kliničkoj praksi relativno zanemarena patologija odrasle dobi. Stoga u ovom radu dajemo natativni pregled najnovijih spoznaja o etiopatogenezi, kliničkoj slici, slikovnoj dijagnostici, liječenju (konzervativnom i kirurškom) i postoperativnoj rehabilitaciji bolesnika s adultnim deformacijama najčešćih uzroka.
Vratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. ...Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralježnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Prvi dio se odnosi na dijagnostiku, a drugi, njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke procedure. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici.
Neck pain is one of the most prevalent musculoskeletal diseases which results in considerable pain and disability, and has a great impact on individual level, as well as on health-care system, and ...overall society. Causes of neck pain are different, and prevailing aetiology are mechanical reasons associated with degenerative changes of cervical spine. We are witnessing various diagnostic and therapeutic approaches for these patients. The Croatian Society for Vertebrology of the Croatian Medical Association is presenting a comprehensive narrative review and guidelines for the diagnosis and treatment of neck pain, focusing on the most prevalent causes. The guidelines are the result of consensus of experts of different background, based on the best available evidence. Part 1 relates to diagnosis, while the complementary Part 2 relates to treatment. For the diagnostic part (Part 1) the guidelines encompass: clinical features and evaluation (including questionnaires), laboratory tests, imaging, neurophysiology tests, and minimally invasive diagnostic procedures. The management part (Part 2) includes: pharmacology treatment, physical exercise, traction, manual therapies, physical therapy modalities, orthotics, minimally invasive therapeutic interventions, surgical treatment, rehabilitation after surgical procedures, and psychiatric approach. These are the first Croatian guidelines for neck pain intended in the first place for the physicians’ professional community.
Neck pain is one of the most prevalent musculoskeletal diseases which results in considerable pain and disability, and has a great impact on individual level, as well as on health-care system, and ...overall society. Causes of neck pain are different, and prevailing aetiology are mechanical reasons associated with degenerative changes of cervical spine. We are witnessing various diagnostic and therapeutic approaches for these patients. The Croatian Society for Vertebrology of the Croatian Medical Association is presenting a comprehensive narrative review and guidelines for the diagnosis and treatment of neck pain, focusing on the most prevalent causes. The guidelines are the result of consensus of experts of different background, based on the best available evidence. This part (Part 1) relates to diagnosis, while the complementary part (Part 2) relates to treatment. For the diagnostic part (Part 1) the guidelines encompass: clinical features and evaluation (including questionnaires), laboratory tests, imaging, neurophysiology tests, and minimally invasive diagnostic procedures. The management part (Part 2) includes: pharmacology treatment, physical exercise, traction, manual therapies, physical therapy modalities, orthotics, minimally invasive therapeutic interventions, surgical treatment, rehabilitation after surgical procedures, and psychiatric approach. These are the first Croatian guidelines for neck pain intended in the first place for the physicians’ professional community.
Vratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. ...Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralješnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Ovaj prvi dio odnosi se na dijagnostiku, a drugi njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke postupke. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici.
The aim of this study was to determine the number of D-type personality patients in the group with a history of myocardial infarction (MI) and the influence of comprehensive in-hospital cardiac ...rehabilitation (iCR) on their psychological status (PS). The study included 316 consecutive patients aged 18 to 65 with MI in the last six months admitted into the programme of iCR. Surgical revascularized patients, clinically unstable patients and patients with sever chronic diseases and disorders were excluded. At the beginning and in the end of iCR diagnostic exam, hematological/biochemical blood analysis, ergometric testing was conducted. At the beginning and four weeks after the finish of the iCR estimation of PS was conducted. Distress scale 14 (DS14) questioner was used for that purpose. In the period of three weeks, patients were included in the programme of comprehensive iCR. Out of 316 patients in the study group 83.2% were male, while 16.8% were female. Average age of the patient was 51.3 +/- 7.2. When being admitted to iCR 42.7% patients had characteristics of D-type personality. Those patients had substantially lower level of body mass and body mass index. In the same time there were no differences among groups in risk factors, values of clinical, laboratory and diagnostic parameters. During iCR study group had more complications in comparison to the control group. At the end of iCR substantial rise of functional capacity of patients, improvement of lipid profile and lowering of glycaemia was recorded. Also at the end of iCR antiarrhythmics and psychopharmaceutical medicaments were more often prescribed to the patients in the study group. Four weeks after the iCR share of D-type personality patients was 41% and 71% of study group patients kept their D-type structure.
Rehabilitacija osoba s amputacijom donjih udova kompleksan je proces u kojem se osobi koja je doživjela gubitak uda pomaže da se, uz stručnu podršku, adaptira na protezu kao artificijelni nadomjestak ...izgubljenog dijela te da uz primjenu proteze postigne maksimalno moguću neovisnost u svim područjima života, sa što boljom kvalitetom življenja. Rehabilitacija obuhvaća razdoblje od amputacije, koja može biti posljedica ozljede ili bolesti, kroz postoperacijsku i predprotetičku fazu do protetičke faze rehabilitacije u kojoj se provodi protetička opskrba, ali i kasniju fazu dugotrajnog praćenja. Medicinsku rehabilitaciju nužno mora pratiti adekvatna psihološka i socijalna rehabilitacija, po biopsihosocijalnom modelu, kako bi se ostvario konačni cilj rehabilitacije, a to je uspješna reintegracija osobe u život sa stilom koji je što sličniji onom koji je prethodio amputaciji.
U radu su prezentirani uzroci i vrste amputacije, načela suvremene protetike i rehabilitacije osoba s amputacijom donjih udova tijekom predoperacijske, postoperacijske, predprotetičke i protetičke faze s ciljevima rehabilitacije u pojedinim fazama, načinima njihova ostvarivanja, kao i načelima psihosocijalne rehabilitacije. Također su prezentirani evaluacijski upitnici i načela Međunarodne klasifikacije funkcioniranja, onesposobljenosti i zdravlja (MKF) za procjenu rezultata rehabilitacije osoba s amputacijom donjih udova.
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