| Abstract | Problemi u funkciji hoda u pacijenata nakon moždanog udara svode se na problem balansa, na smanjenje brzine hoda, smanjenje dužine i ciklusa koraka te oblik asimetričnog uzorka što smanjuje njihovu sposobnost u obavljanju svakodnevnih aktivnosti, a time i njihovo zadovoljstvo samom kvalitetom života.
Cilj istraživanja bio je utvrditi učinkovitost neurofacilitacijskog programa prema Bobath konceptu, kao i kombiniranog tretmana neurofacilitacijske terapije sa dodatnim tretmanom specifičnih mobilizacija na balans i funkciju hoda, te razliku u učinkovitosti provedenih programa.
Ispitanici su raspoređeni u dvije ispitivane skupine po 20 ispitanika. Prva skupina ispitanika bila je u programu neurofacilitacijske terapije kroz pet tjedana, dok je druga skupina ispitanika bila uključena u isti program s dodatnim tretmanom specifičnih mobilizacija mekih tkiva. Razlike kod ispitanika u pojedinim varijablama unutar grupa i između grupa ispitanika u inicijalnom i finalnom mjerenju obrađene su univarijantnom analizom varijance - ANOVA. Uspoređeni su rezultati učinaka dvaju programa neurofacilitacijskog tretmana sa i bez specifičnih mobilizacija mekih tkiva testovima „Berg balance scale“, „Timed up and go testa“ i aktivnog pokreta dorzalne fleksije stopala, fleksije i ekstenzije koljena.
Istraživanje je pokazalo da je u prvoj skupini ispitanika koja je imala neurofacilitacijski tretman u 83,4% varijabli statistički značajnih rezultata u finalnom mjerenju na razini od p<0.05. U drugoj skupini ispitanika tretman neurofacilitacijske terapije kombiniran s tretmanom specifičnih mobilizacija mekih tkiva, pokazao se ključnim za poboljšanje aktivnosti u pokretima stopala i koljena što je značajno doprinijelo učinkovitosti onih varijabli koje u prvoj skupini nisu bile značajne, a to su hod, ustajanje, sjedanje, pa je tako učinkovitost bila značajna gotovo u svim varijablama statičkog i dinamičkog balansa.
Rezultati dobiveni ovim istraživanjem pokazali su značajan doprinos kombiniranog tretmana na sve varijable balansa, funkciju hoda kao i na povećanje fleksibilnosti mišića i tetiva koji su važni za funkciju koljena i skočnog zgloba, a time i na funkciju hoda. |
| Abstract (english) | Introduction: Problems in the function of the stroke patient gait are balance problems, slower walking speed, reducing the step length and the gait cycle, and the asymmetrical gait pattern. They all reduce the patient’s ability to perform everyday activities and result in the patient’s dissatisfaction with the quality of their life. Finding new programmes to improve the quality of the previously used rehabilitation procedures is imperative for members of the team included in movement and gait re-education of stroke patients.
Subjects and methods: The aim of this study is to determine the effectiveness of the neurofacilitaton programme according to the Bobath concept, and a combined treatment consisting of the neurofacilitation therapy and an additional treatment with specific mobilization to improve balance and gait, as well as determining the difference in the effectiveness of the implemented programmes.
40 subjects, successfully tested initially, at least 3 months after suffering a stroke, and after a one-year period, were diagnosed by magnetic resonance imaging. They were suffering from hemiparesis, classified as level 3 according to the Medical Research Council paresis classification. The subjects were randomly divided into two groups consisting of 20 patients. The first experimental group was in the programme of neurofacilitation therapy for 5 weeks, undergoing 45-minute sessions 5 times a week, while the second group was included in the same programme with an additional specific mobilization programme with 20-minute sessions 3 times a week, during 5 weeks. The STATISTICA for Windows ver. 10 StatSoft Inc. statistical software packet was used for data processing. Differences between the respondents in individual variables within groups and between groups in both initial and final measurements were processed by ANOVA, the univariate analysis of variance.
Results: Effects of the two neurofacilitation treatment programmes, with and without specific mobilization of soft tissues, were compared by the Berg Balance Scale, the Timed Up and Go Test and active dorsiflexion of the foot, flexion and extension of the knee. The study showed statistically significant results in the final measurement in 83.4% of variables at the level of p<0.05 in the tested group of patients who only had a neurofacilitation treatment. The variables which did not show significant results were complex activities, such as getting up, walking, rotation, and sitting down, which clearly required additional treatment. The neurofacilitation therapy combined with the specific mobilization of soft tissues, which the second tested group of patients underwent, greatly contributed to the improvement of foot and knee movements resulting in better walking, standing up and sitting down activities, as well as other variables of static and dynamic balance. Results also suggested that there are no statistically significant differences between the two tested groups in the final measurement of the given variables. However, the additional statistical analysis which took into account the period between the initial and final measurements demonstrated a statistical significance and a high tendency to significance in almost 61% of variables indicating the benefit of the combined therapy programme.
Conclusion: Results obtained in this study showed a significant contribution of the combined treatment to all the variables of the static and dynamic balance and gait function, as well as an increase in the muscle and tendon flexibility which is important for knee and ankle functions, thus influencing the gait function, too. |
