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.
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.
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.
Spazam kao pozitivni simptom oštećenja gornjih motoneurona uslijed teške traumatske ozljede mozga, ukoliko se ne počne liječiti rano nakon oštećenja neurona, može biti uzrok kontraktura. U ovoj je ...prospektivnoj studiji istraživano djelovanje fizioterapije i botulinum toksina A u liječenju kontraktura koljena u pacijenata kod kojih sama fizioterapija nije dovela do smanjenja kontraktura i tonusa mišića. U studiju je bilo uključeno 26 pacijenata koji su imali kontrakturu u jednom ili oba koljena (ukupno 30 koljena), a kod kojih se tonus mišića i kontraktura koljena nisu umanjili nakon tromjesečne fizioterapije. Nakon aplikacije botulinum toksina A i nastavka fizioterapije, kod pacijenata je došlo do značajnoga poboljšanja pokretljivosti u koljenu, kao i do smanjenja spazma u mišićima u koje je bio apliciran botulinum toksin A. Primjenom botulinum toksina A i fizioterapijom mogu se značajno umanjiti kontrakture koljena koje su bile otporne na fizioterapiju, čime je izbjegnuto operativno liječenje i poboljšana aktivnost i participacija bolesnika u aktivnostima svakodnevnoga života.
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 mas 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.
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