9 research outputs found
Flat Foot in Children
Ravno stopalo je stopalo s veÄom dodirnom povrÅ”inom s podlogom zbog smanjenje visine ili potpune odsutnosti medijalnog svoda.
Pedijatrijsko ravno stopalo se najÄeÅ”Äe dijeli na patoloÅ”ko, kruto ravno stopalo i fizioloÅ”ko, fleksibilno ravno stopalo.
PatoloÅ”ko spuÅ”teno stopalo pokazuje odreÄeni stupanj ukoÄenosti i znaÄajno ograniÄenje pokreta subtalarnog zgloba. Äesto uzrokuje poteÅ”koÄe i obiÄno zahtijeva konzerativno ili kiruÅ”ko lijeÄenje. FizioloÅ”ko fleksibilno ravno stopalo je pomiÄno i mekano, predstavlja viÅ”e kozmetiÄki nego funkcionalni problem. Ono Äini ā¼95% sluÄajeva ravnih stopala u djece i pretežno je asimptomatsko. U asimptomatskih pacijenata, nema dokaza koji bi poduprli preventivnu ulogu uložaka, ortoza ili operacija s ciljem odgaÄanja ili uklanjanja eventualnih buduÄih simptoma. Rano postavljanje uložaka, koji podržavaju svod stopala ne utjeÄe na njegovu visinu u kasnijoj dobi.
TeÅ”ki oblici fleksibilnog ravnog stopala tijekom vremena mogu izazivati bolove i funkcionalne probleme i tada zahtijevaju lijeÄenje.
OpÄenita preporuka za prevenciju ravnog stopala je podržavanje prirodnih obrazaca kretanja u dojenaÄkoj dobi koji Äe omoguÄiti pravilan razvoj svodova te hodanje bez obuÄe i reguliranje tjelesne težine.
UnatoÄ Å”irokoj rasprostranjenosti, u literaturu nema usuglaÅ”enih klasifikacija i smjernica za lijeÄenje djeÄjeg ravnog stopala te je potrebno provesti daljnja istraživanja sa ciljem postavljanja univerzalnih smjernica za klasifikaciju, dijagnozu, prevenciju i lijeÄenje ravnih stopala u djece.A flat foot is a foot with a larger contact area with the ground due to a reduction in height or the complete absence of a medial arch. Pediatric flat feet are most commonly divided into pathological, rigid flat feet and physiological, flexible flat feet. Pathologi-cally flat foot shows a certain degree of stiffness and significant limitation of movement of the subtalar joint. It often causes difficul-ties and usually requires treatment either conservatively or surgically. Physiologically flexible flat foot is movable and soft, and is more of a cosmetic than a functional problem. It accounts for ā¼95% of flat feet in children and is predominantly asymptomatic. In asymptomatic patients, there is no evidence to support the preventive role of insoles, orthoses, or surgery to delay or eliminate po-ssible future symptoms. Early placement of insoles, which support the arch of the foot does not affect its height at a later age. Severe forms of flexible flat feet can cause pain and functional problems over time and then require treatment. The general recommendation for the prevention of flat feet is to support natural patterns of movement in infancy that will allow proper development of the arches, walking without shoes and regulating body weight. Despite its wide distribution, there are no harmonized classifications and guide-lines for the treatment of childhood flat feet in the literature, and further research is needed to establish universal guidelines for the classification, diagnosis, prevention and treatment of flat feet in children
Prikaz sluÄaja kroniÄne Bellove pareze: koje su moguÄnosti rehabilitacije?
Bellās palsy, or idiopathic peripheral facial nerve palsy is a neurologic condition characterized by unilateral weakness of facial muscles. The evidence-based guidelines mostly consider the acute treatment of Bellās palsy. However, chronic cases of Bellās palsy are not supported by strong evidence regarding treatment options, except for a weak recommendation to utilize physical therapy. This case report has presented an application of a combination of physical therapy modalities (Mirror Book Therapy, High Intensity Laser Therapy, and Acupuncture) within 10 weeks, to treat a patient with long-term sequelae. This combination of therapies has resulted in a significant improvement in the level of recovery measured by facial grading scales. However, further research is necessary to provide stronger evidence regarding the benefits of this treatment option.Bellova pareza ili periferna idiopatska pareza facijalisa, neuroloÅ”ko je stanje koju karakterizira jednostrana slabost miÅ”iÄa lica. Smjernice za lijeÄenje su uglavnom utemeljene na dokazima o preporukama za lijeÄenje akutnih stadija Bellove pareze. MeÄutim, kroniÄni sluÄajevi Bellove pareze nisu potkrijepljeni dovoljno snažnim dokazima o moguÄnostima lijeÄenja, osim slabe preporuke u smjeru primjene terapijskih vježbi. Ovaj prikaz sluÄaja predstavlja primjenu kombinacije modaliteta fizikalne terapije (akupunktura, laser visokog intenziteta i terapija zrcalom) unutar 10 tjedana, za lijeÄenje bolesnika s dugotrajnim posljedicama Bellove pareze. Ova kombinacija terapija rezultirala je znaÄajnim poboljÅ”anjem razine oporavka mjerenog kliniÄkim ljestvicama. MeÄutim, potrebna su daljnja istraživanja kako bi se pružili snažniji dokazi o prednostima ove kombinacije terapija
GUIDELINES FOR THE CLASSIFICATION, DIAGNOSIS, TREATMENT AND REHABILITATION OF NEWBORNS AND CHILDREN WITH BRACHIAL PLEXUS BIRTH INJURY
PoroÄajno oÅ”teÄenje pleksusa brahijalisa (POPB) je neuromotorna fl akcidna paraliza ruke uzrokovana ozljedom jednog ili viÅ”e korijenova pleksusa brahijalisa (PB) tijekom poroda. UoÄava se obiÄno ubrzo nakon poroda. Incidencija POBP je izmeÄu 0,5 i 4,4 na 1000 poroda. U veÄini sluÄajeva, oÅ”teÄenja brahijalnog pleksusa (OPB) su prolazna i dolazi do spontanog, potpunog oporavka funkcije u prvim tjednima života. Kod neke djece (20 do 30 %) slabost ruke zaostaje i dovodi do živÄano-miÅ”iÄne disfunkcije i trajnog invaliditeta. U literaturi postoje razlike u klasifi kaciji, dijagnozi i lijeÄenju ovog poremeÄaja. Variraju od autora do autora i zasnivaju se na razliÄitim studijama. ZajedniÄki cilj habilitacije je vratiti senzornu i motoriÄku kontrolu, održati i poveÄati opseg pokreta, poveÄati miÅ”iÄnu snagu, potaknuti bilateralnu funkcionalnu aktivnost i sprijeÄiti sekundarne komplikacije. Razlike nastaju u naÄinu ostvarivanja tih zadataka. Dva su osnovna oblika lijeÄenja OBP: konzervativno i kirurÅ”ko. Konzervativno lijeÄenje ukljuÄuje: intenzivnu kineziterapiju, koriÅ”tenje komplementarnih tehnika poput elektrostimulacije, termoterapije, hidrogimnastike, udlaga, injekcija botulin toksina, radne terapije. Rano konzervativno lijeÄenje je glavna opcija u lijeÄenju OBP. Pregledom literature smo primijetili da nema znanstvenih dokaza o nekim habilitacijskom tehnikama koje se koriste u konzervativnom lijeÄenju. Koriste se u brojnim centrima, iako njihova djelotvornost nije dokazana. KirurÅ”ko lijeÄenje OBP-a može biti primarno (neurokirurÅ”ko) i sekundarno (ortopedsko). Postoje razmimoilaženja u literaturi u pogledu potrebe neurokirurÅ”kog lijeÄenju OBP-a kao i o dobi kada ga provesti. Svrha ovog istraživanja bila je uÄiniti pregled literature o klasifi kaciji, dijagnostiÄkoj obradi i habilitaciji POPB-a te odgovoriti na pitanja s kojima se susreÄemo u svakodnevnom radu. Zbog neujednaÄenih stavova u literaturi, na osnovi dostupnih znanstvenih dokaza te osobnih kliniÄkih iskustava, izradili smo vlastite smjernice za klasifi kaciju, dijagnostiku, obradu i habilitaciju novoroÄenÄadi i djece s OPB-om. Älanovi Sekcije djeÄjih fi zijatara pri Hrvatskom druÅ”tvu za fi zikalnu i rehabilitacijsku medicinu na Kongresu fi zikalne i rehabilitacijske medicine u travnju 2022. u Å ibeniku usvojilii su ove smjernice (postupnik) za habilitaciju djece s poroÄajnim oÅ”teÄenjem pleksusa brahijalisa.Brachial plexus birth palsy (BPBP) is a neuromotor fl accid paralysis caused by injury to one or more roots of the brachial plexus (BP) during childbirth. It is usually observed shortly after birth. The incidence of BPBP is between 0.5 to 4.4 per 1000 childbirths. Most cases of BPBP are transient and there is a spontaneous, complete recovery of function in the fi rst weeks of life. In some children (20% to 30%), arm weakness persists and leads to neuromuscular dysfunction and permanent disability. In the literature, there are still variations in the classifi cation, diagnosis and treatment of this disorder. They vary from author to author and are based on different studies. The common guideline for habilitation is to restore sensory and motor control, maintain and increase the range of motion, increase muscle strength, encourage bilateral functional activity, and prevent secondary complications. Differences can be seen in the way these tasks are accomplished. There are two basic forms of BPBP treatment, conservative and surgical. Conservative treatment includes intensive kinesitherapy, use of complementary techniques such as electrostimulation, thermotherapy, hydrogymnastics, use of splints, botulinum toxin injections, occupational therapy, etc. Early conservative treatment is the main option in the treatment of BPBP. By reviewing the literature, we noticed that there is no scientifi c evidence for some habilitation techniques used in conservative treatment. They are used in many centers, although their effectiveness has not been proven. Surgical treatment can be primary (neurosurgical) and secondary (orthopedic). There are disagreements in the literature regarding the need for neurosurgical treatment of PBPB and, if decided upon, the age at which it should be performed. The purpose of this research was to review the literature with the aim of assessing the available information on the classifi cation, diagnosis and habilitation prognosis. Due to uneven attitudes in the literature, based on the available scientifi c evidence and personal clinical experiences, we have created our own guidelines for the classifi cation, diagnosis, treatment and habilitation of newborns and children with BPBP. Members of the Section of Pediatric Physiatrists at the Croatian Society for Physical and Rehabilitation Medicine adopted these guidelines (procedure) for the habilitation of children with brachial plexus birth injury at the Congress of Physical and Rehabilitation Medicine in April 2022 in Å ibenik