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 study analyses the use of foot orthoses in 125 school children (age 7-16) with foot pain due to sports and other physical activities. The aim of the study was to determine the effectiveness of ...foot orthoses use in school children with foot pain.
Foot orthoses were indicated at the first orthopaedic examination. Using a specifically designed survey we determined the following: the age and sex of the examined children, the clinical state of feet, the persistence of pain, the level of pain using the visual analogue scale at the first and control examination, daily wearing of foot orthoses and satisfaction at the control examination.
We examined 125 school children, 85 boys (average age--11.7 years) and 45 girls (average age--11.1 years). Eighty-seven of them (69%) complained of pain during sports activities, 26 (21%) experienced pain only while walking and 6 examined children complained of constant pain while standing. Sports-related foot pain was most frequently associated with basketball (32%), to be followed by football (26%), athletics (15%), handball (9%), dancing (8%), tennis (5%) and combat sports (3%), whereas the smallest number of children complained of foot pain related to volleyball (2%). With regard to the pain location most of the examinees reported pain in the inner longitudinal arch (20%). Seventy-two of them were wearing foot orthoses during the whole day. The average level of pain at the first examination was 4.5. At the control examination 95 of examinees no longer complained of pain and in the remaining 30 examinees the pain was reduced to the level of 1.7. The majority of the examined children (94) rated their foot orthoses as "excellent" and the lowest mark "good" was given only by two examinees.
Foot orthoses are crucial for treatment of foot pain in school children regardless of pain etiology: foot deformities or/and overuse due to external causes.
Low back pain (LBP) is a very common condition with high costs of patient care. Medical doctors of various specialties from Croatia have brought an up-to-date review and guidelines for diagnosis and ...conservative treatment of low back pain, which should result in the application of evidence-based care and eventually better outcomes. As LBP is a multifactorial disease, it is often not possible to identify which factors may be responsible for the onset of LBP and to what extent they aggravate the patient's symptoms. In the diagnostic algorithm, patient's history and clinical examination have the key role. Furthermore, most important is to classify patients into those with nonspecific back pain, LBP associated with radiculopathy (radicular syndrome) and LBP potentially associated with suspected or confirmed severe pathology. Not solely a physical problem, LBP should be considered through psychosocial factors too. In that case, early identification of patients who will develop chronic back pain will be helpful because it determines the choice of treatment. In order to make proper assessment of a patient with LBP (i.e. pain, function), we should use validated questionnaires. Useful approach to a patient with LBP is to apply the principles of content management. Generally, acute and chronic LBP cases are treated differently. Besides providing education, in patients with acute back pain, advice seems to be crucial (especially to remain active), along with the use of drugs (primarily in terms of pain control), while in some patients spinal manipulation (performed by educated professional) or/and short-term use of lumbosacral orthotic devices can also be considered. The main goal of treating patients with chronic LBP is renewal of function, even in case of persistent pain. For chronic LBP, along with education and medical treatment, therapeutic exercise, physical therapy and massage are recommended, while in patients with a high level of disability intensive multidisciplinary biopsychosocial approach has proved to be effective.
During the period of five years (2000-2004) we monitored 46 patients (25 males and 21 females) who were admitted to Clinical Institute for Rehabilitation and Orthopaedic Aids in Zagreb for the first ...prosthetic rehabilitation following the lower limb amputation which was caused by a tumour. The average age of patients was 51 +/- 17.11 years. According to the pathohistological diagnosis the most common cause of lower limb amputations was osteosarcoma. According to the level of amputation the most frequent was trans-femoral amputation (50%) and the least frequent was knee disarticulation (8.7%). The average number of days from the amputation to the beginning of prosthetic rehabilitation was 108 +/- 67.05. At the time of admission 15.2% of patients had local complications of the stump and 34.8% of patients complained of phantom pain. The average number of days of prosthetic rehabilitation was 35 +/- 7.94. The medium daily use of the prosthesis was 5 hours and the medium walking speed was 12 sec/10 m. At the time of admission for the prosthetic rehabilitation 10.9% of patients used a wheelchair, 8.7% walked with a walker and others with two crutches. At the time of discharge 89.1% of patients were able to walk with a prosthesis and two crutches, 4.4% with one crutch and 6.5% were able to walk without crutches. We can be satisfied with the results of prosthetic rehabilitation because patients regained mobility and full independence in performing their daily activities.
Suvremena rehabilitacija holistički je orijentirana, obuhvaća medicinsku, psihološku i socijalnu dimenziju te počiva na temeljima timskog rada. Restituciju aktivnosti, socijalne participacije i ...podizanje kvalitete života kod osoba s akutnim/kroničnim zdravstvenim problemom nemoguće je ostvariti kroz djelovanje jedne profesije. Preporuka je Europske udruge medicinskih specijalista (UEMS) ostvarivanje zajedničkih ciljeva rehabilitacije kroz interdisciplinarni pristup, što predstavlja izazov s obzirom na tradicionalni pristup. Kako bi se optimizirao učinak rehabilitacije, nužno je objediniti različite zdravstvene i nezdravstvene profesije; liječnike specijaliste, fizioterapeute, radne terapeute, medicinske sestre, protetičare/ortotičare uz suradnju sa psiholozima, socijalnim radnicima te institucijama koje osiguravaju i odobravaju potrebnu zdravstvenu skrb. U većini zemalja Europe prakticira se isključivo interdisciplinarni oblik rada u rehabilitaciji, problemski orijentiran i fokusiran na bolesnika te ekonomski povoljan za zdravstveni sustav. Unatoč stručnim kompetencijama i znanju profesionalaca u rehabilitacijskom timu, postoji nedostatak vještina i adekvatnog stava prema interdisciplinarnom radu. Kao posljedica loše komunikacije, različitog gledišta profesija na uloge, hijerarhiju i suradnju u timu, nerazumijevanja ili neprihvaćanja stručnih kompetencija drugih članova, kompromitiran je interdisciplinarni pristup. Tijekom Domovinskog rata rehabilitacija u Hrvatskoj dobiva zamah i potrebu za interdisciplinarnim radom, gdje se unatoč deficitu potrebnih profesija i nepovoljnim paramedicinskim čimbenicima mijenja strateški pristup s holističkim orijentirom. No Hrvatska i njezin sustav zdravstvene skrbi još uvijek su u tranziciji s evidentnim manjkom svih potrebnih stručnjaka, sudionika u rehabilitaciji. Literatura predlaže interdisciplinarni oblik kao jedini oblik rada u suvremenoj rehabilitaciji, no prakticiranje tog oblika rada u esenciji je izazov. U akademskom obrazovanju posebno mjesto mora zauzimati razvijanje vještina kako bi taj izazov postao ustaljena praksa.
PDF
