Spartūs socialiniai pokyčiai skatina ieškoti moksliškai pagrįstų sprendimų, susijusių su pagalba vienai iš jautriausių socialinių grupių – šeimoms, auginančioms ankstyvojo amžiaus vaikus, turinčius raidos problemų, ir šiems vaikams.Ankstyvojo amžiaus vaikai (nuo gimimo, kol jie pradeda lankyti ugdymo įstaigą), kurie turi raidos sutrikimų arba rizikos veiksnių sutrikimams išryškėti. Šiems vaikams dažniausiai reikia įvairių specialistų teikiamos kompleksinės pagalbos (medicininės, ugdomosios, socialinės, psichologinės), taip pat šių vaikų šeimoms būtina parama ir palaikymas, informacija apie vaiko negalę, pagalbos būdus ir pan. Lietuvoje, kaip ir daugelyje kitų Europos šalių, tokio pobūdžio pagalba teikiama ankstyvosios reabilitacijos tarnybose. Pastaraisiais metais ir tėvai, ir specialistai teigia, kad svarbu ne tik teikti pagalbą vaikui (pvz., taikyti kineziterapiją, teikti logopedo pagalbą ir pan.), bet ir skatinti psichosocialinį vaiko ir šeimos atsparumą, vidinę darną, taip pat įgalinti šeimą, kad ji pati galėtų spręsti savo problemas ir įveikti dėl vaiko negalės iškylančius sunkumus. Tarnybos (šiuo atveju ankstyvosios reabilitacijos) specialistų komanda turėtų užtikrinti, kad būtų prieinama šeimai ir vaikui reikalinga specialistų ir tėvų savitarpio pagalba, kad būtų galima rasti reikiamos informacijos ir pan. Svarbu, kad šeima dėl vaiko raidos sunkumų netaptų priklausoma nuo specialistų ir jų teikiamos pagalbos, turėtų galimybę rinktis ir pati spręsti savo reikalus... [toliau žr. visą tekstą] / Fast social changes stipulate searching for the scientifically substantiated decisions, which are related with assistance, which is provided for one of the most sensitive social group, i.e. for the families, which grow their children of the early age, who have problems with evolution, and for such children. These are the children of the early age (since their birth until they start to attend the upbringing institution) with the evolution derangement or with the factors of risk for revealing of such derangements. Such children are usually in need of the complex aid, which is provided by various specialists (medical, educational, social and psychological); besides, the families, in which such children grow, are in need of support and assistance, of the knowledge about the child’s ailment, of the ways of the aid rendering, etc. In Lithuania as well as in many other European countries such aid is rendered by the early rehabilitation services. Within the recent years both the parents and the specialists state that it’s important not only to provide the child with the aid (for example, application of kinesitherapy, rendering of the logopedist’s aid, etc.), but also to stimulate the child’s and the family’s psychological resistance and internal harmony as well as to empower the family so that the family itself could settle its problems and overcome the difficulties, which arise through the child’s ailment. The team of the specialists of the service (in this case – of the early... [to full text]

Bakalauro darbe analizuojamas tėvų, auginančių vaikus su Dauno sindromu, požiūris į ankstyvąją reabilitaciją. Suformuluotas tyrimo tikslas, kuriuo siekiama išnagrinėti tėvų požiūrį į ankstyvosios reabilitacijos tarnybą ir joje teikiančias abilitacijos paslaugas. Tyrimas buvo atliktas interviu metodu, kuriame sutiko dalyvauti 9 motinos, kurios augina vaikus su Dauno sindromu ir galėjo atsakyti į klausimus apie šių vaikų motorinės raidos ypatumus ir gautą ankstyvąją pagalbą. Interviu metodu buvo siekiama išsiaiškinti tėvų požiūrį į gautą ankstyvąją specializuotą pagalbą ir kaip tai paveikė vaikų, turinčių Dauno sindromą, motorinę raidą. Taip pat siekiama ištirti, kokią pagalbą iš specialistų gavo patys tėvai ir kokį vaidmenį tėvai atliko Ankstyvosios reabilitacijos tarnyboje. / This written work of Bachelor degree analyses parent‘s attitude towards early rehabilitation of their children with Down‘s syndrome. The aim of the research is to explore parent‘s view on the rehabilitation service and what kind of services it provides. The research was conducted using a method of interviews. There were 9 mothers who have children with Down‘s syndrome. These mothers were surveyed about the children‘s motor development characteristics and early support which was received. During these interviews there were every endeavour to find out parent‘s attitude towards early and specialized support which was received. In addition, it was examined how this kind of support affected motor development of children with Down‘s syndrome. Moreover, arranged interviews helped to examine what kind of support parents received and what role parents played in the Early rehabilitation service.

The aim of the research is to examin the specialists from the Early Rehabilitation services (ERS) and the patients parents‘ attitude towards services for children quality, and introduce recommendations how to improve parents‘ and specialists‘ cooperation while accomplishing the services for children. Methodology. The anonymous questioning was made with 100 parents whose children were visiting specialists of Early Rehabilitation in 3 public medical institutions in Kaunas. The questionnaire used in the research was composed on the base of SERVQUAL methodology. One part of the questionnaire gave possibility to find parents‘ expectations towards servises for children quality, the next part satisfaction in services they get. The evaluation was made in differences which are in parents‘ expectations and satisfaction in the quality of servises they get in the aspect of dimensions (evidence, response, security, empathy). Linkert scale was used for answers. The statistical package SPSS version 13.0 for Windows was used to conduct data analysis. Results. In parent‘s opinion, services quality expectations got less point (mean score 2,80±0,44) than their satisfaction of the service provided (mean score 2,80±0,44) Therefore, the satisfaction of the service provided by ERS was beyond expectations. The largest quality gap was observed in the response, the smallest – in the dimensions of evidence. The parents‘ expectations were: to consult specialists of ERS at the desirable time... [to full text]

Introdução: Rupturas do tendão calcâneo (TC) afetam 18 em 100.000 pessoas todos os anos. A mobilização precoce vem sendo preconizada como uma estratégia eficaz para acelerar o processo de recuperação funcional. Entretanto, a escolha do método de reabilitação após o reparo cirúrgico permanece controversa devido à ausência de evidências clínicas. Objetivo: Verificar o efeito de intervenções aceleradas e tradicionais de fisioterapia em indivíduos que realizaram sutura do TC, por meio de revisão sistemática com metanálise. Metodologia: A busca incluiu as bases de dados MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, Scopus, Science Direct, Lilacs, PEDro, além de busca manual de artigos científicos até início de janeiro de 2014. Foram incluídos ensaios clínicos randomizados e não randomizados comparando intervenções aceleradas e tradicionais após sutura do TC sobre as variáveis: força muscular, amplitude de movimento (ADM) e capacidade funcional do tornozelo. Dois revisores independentes avaliaram os estudos de acordo com critérios de inclusão e exclusão pré-estabelecidos. Resultados: Dos 2194 artigos identificados, 8 estudos foram incluídos. A revisão sistemática evidenciou alta variabilidade entre os estudos em relação as intervenções de fisioterapia. Quanto à metanálise, realizamos a avaliação dos desfechos no período de 6 meses de pós-operatório devido a ausência de dados dos mesmos em outros períodos. Na comparação entre diferentes intervenções de fisioterapia não foram observadas melhoras significativas em relação a variável força muscular (-19,66; IC95%: -74,03 a 34,71) assim como na ADM de flexão plantar (-0,05; IC95%: -3,07 a 2,97) e flexão dorsal (1,94; IC95%: -2,12 a 5,99). Conclusão: A intervenção acelerada de fisioterapia não apresentou melhora significativa da força muscular e na ADM após sutura do TA aos 6 meses de pós-operatório. / Introduction: Achilles tendon (AT) ruptures affect 18 in 100,000 people each year. Early mobilization has been recommended as an effective strategy for accelerating functional recovery. However, the choice of the best rehabilitation method after surgical repair remains controversial due to the absence of clinical evidence. Objective: To investigate the effect of traditional and accelerated rehabilitation protocols on plantiflexores muscular strength, ankle range of motion (ROM) and ankle functional capacity in subjects who underwent Achilles tendon suture, through a systematic review with meta-analysis. Methodology: The search included MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, Scopus, Science Direct, LILACS, PEDro, and manual search of manuscripts until January 2014. Randomized and non-randomized clinical trials were included comparing traditional and accelerated rehabilitation protocols after AT suturing on the following variables: muscle strength, ankle ROM and functional capacity. Two independent reviewers assessed studies according to inclusion and exclusion criteria previously established. Results: Of the 2194 articles identified, 8 studies were included. High variability between studies in relation to the rehabilitation protocols was observed in the systematic review. As for the meta-analysis, we conducted an evaluation of the outcomes up to 6 months postoperatively due to missing data from these outcomes at other time periods. When comparing the different rehabilitation protocols, no significant improvements were observed in muscle strength (-19.66, 95% CI -74.03 to 34.71) as well as in plantarflexor (-0.05; 95 %: -3.07 to 2.97) and dorsiflexor (1.94, 95% CI: -2.12 to 5.99) ROM. Conclusion: The accelerated protocol showed no significant improvement in muscle strength and ROM at 6 months post-surgical repair of the AT.

Introdução: Rupturas do tendão calcâneo (TC) afetam 18 em 100.000 pessoas todos os anos. A mobilização precoce vem sendo preconizada como uma estratégia eficaz para acelerar o processo de recuperação funcional. Entretanto, a escolha do método de reabilitação após o reparo cirúrgico permanece controversa devido à ausência de evidências clínicas. Objetivo: Verificar o efeito de intervenções aceleradas e tradicionais de fisioterapia em indivíduos que realizaram sutura do TC, por meio de revisão sistemática com metanálise. Metodologia: A busca incluiu as bases de dados MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, Scopus, Science Direct, Lilacs, PEDro, além de busca manual de artigos científicos até início de janeiro de 2014. Foram incluídos ensaios clínicos randomizados e não randomizados comparando intervenções aceleradas e tradicionais após sutura do TC sobre as variáveis: força muscular, amplitude de movimento (ADM) e capacidade funcional do tornozelo. Dois revisores independentes avaliaram os estudos de acordo com critérios de inclusão e exclusão pré-estabelecidos. Resultados: Dos 2194 artigos identificados, 8 estudos foram incluídos. A revisão sistemática evidenciou alta variabilidade entre os estudos em relação as intervenções de fisioterapia. Quanto à metanálise, realizamos a avaliação dos desfechos no período de 6 meses de pós-operatório devido a ausência de dados dos mesmos em outros períodos. Na comparação entre diferentes intervenções de fisioterapia não foram observadas melhoras significativas em relação a variável força muscular (-19,66; IC95%: -74,03 a 34,71) assim como na ADM de flexão plantar (-0,05; IC95%: -3,07 a 2,97) e flexão dorsal (1,94; IC95%: -2,12 a 5,99). Conclusão: A intervenção acelerada de fisioterapia não apresentou melhora significativa da força muscular e na ADM após sutura do TA aos 6 meses de pós-operatório. / Introduction: Achilles tendon (AT) ruptures affect 18 in 100,000 people each year. Early mobilization has been recommended as an effective strategy for accelerating functional recovery. However, the choice of the best rehabilitation method after surgical repair remains controversial due to the absence of clinical evidence. Objective: To investigate the effect of traditional and accelerated rehabilitation protocols on plantiflexores muscular strength, ankle range of motion (ROM) and ankle functional capacity in subjects who underwent Achilles tendon suture, through a systematic review with meta-analysis. Methodology: The search included MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, Scopus, Science Direct, LILACS, PEDro, and manual search of manuscripts until January 2014. Randomized and non-randomized clinical trials were included comparing traditional and accelerated rehabilitation protocols after AT suturing on the following variables: muscle strength, ankle ROM and functional capacity. Two independent reviewers assessed studies according to inclusion and exclusion criteria previously established. Results: Of the 2194 articles identified, 8 studies were included. High variability between studies in relation to the rehabilitation protocols was observed in the systematic review. As for the meta-analysis, we conducted an evaluation of the outcomes up to 6 months postoperatively due to missing data from these outcomes at other time periods. When comparing the different rehabilitation protocols, no significant improvements were observed in muscle strength (-19.66, 95% CI -74.03 to 34.71) as well as in plantarflexor (-0.05; 95 %: -3.07 to 2.97) and dorsiflexor (1.94, 95% CI: -2.12 to 5.99) ROM. Conclusion: The accelerated protocol showed no significant improvement in muscle strength and ROM at 6 months post-surgical repair of the AT.

Introdução: Rupturas do tendão calcâneo (TC) afetam 18 em 100.000 pessoas todos os anos. A mobilização precoce vem sendo preconizada como uma estratégia eficaz para acelerar o processo de recuperação funcional. Entretanto, a escolha do método de reabilitação após o reparo cirúrgico permanece controversa devido à ausência de evidências clínicas. Objetivo: Verificar o efeito de intervenções aceleradas e tradicionais de fisioterapia em indivíduos que realizaram sutura do TC, por meio de revisão sistemática com metanálise. Metodologia: A busca incluiu as bases de dados MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, Scopus, Science Direct, Lilacs, PEDro, além de busca manual de artigos científicos até início de janeiro de 2014. Foram incluídos ensaios clínicos randomizados e não randomizados comparando intervenções aceleradas e tradicionais após sutura do TC sobre as variáveis: força muscular, amplitude de movimento (ADM) e capacidade funcional do tornozelo. Dois revisores independentes avaliaram os estudos de acordo com critérios de inclusão e exclusão pré-estabelecidos. Resultados: Dos 2194 artigos identificados, 8 estudos foram incluídos. A revisão sistemática evidenciou alta variabilidade entre os estudos em relação as intervenções de fisioterapia. Quanto à metanálise, realizamos a avaliação dos desfechos no período de 6 meses de pós-operatório devido a ausência de dados dos mesmos em outros períodos. Na comparação entre diferentes intervenções de fisioterapia não foram observadas melhoras significativas em relação a variável força muscular (-19,66; IC95%: -74,03 a 34,71) assim como na ADM de flexão plantar (-0,05; IC95%: -3,07 a 2,97) e flexão dorsal (1,94; IC95%: -2,12 a 5,99). Conclusão: A intervenção acelerada de fisioterapia não apresentou melhora significativa da força muscular e na ADM após sutura do TA aos 6 meses de pós-operatório. / Introduction: Achilles tendon (AT) ruptures affect 18 in 100,000 people each year. Early mobilization has been recommended as an effective strategy for accelerating functional recovery. However, the choice of the best rehabilitation method after surgical repair remains controversial due to the absence of clinical evidence. Objective: To investigate the effect of traditional and accelerated rehabilitation protocols on plantiflexores muscular strength, ankle range of motion (ROM) and ankle functional capacity in subjects who underwent Achilles tendon suture, through a systematic review with meta-analysis. Methodology: The search included MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, Scopus, Science Direct, LILACS, PEDro, and manual search of manuscripts until January 2014. Randomized and non-randomized clinical trials were included comparing traditional and accelerated rehabilitation protocols after AT suturing on the following variables: muscle strength, ankle ROM and functional capacity. Two independent reviewers assessed studies according to inclusion and exclusion criteria previously established. Results: Of the 2194 articles identified, 8 studies were included. High variability between studies in relation to the rehabilitation protocols was observed in the systematic review. As for the meta-analysis, we conducted an evaluation of the outcomes up to 6 months postoperatively due to missing data from these outcomes at other time periods. When comparing the different rehabilitation protocols, no significant improvements were observed in muscle strength (-19.66, 95% CI -74.03 to 34.71) as well as in plantarflexor (-0.05; 95 %: -3.07 to 2.97) and dorsiflexor (1.94, 95% CI: -2.12 to 5.99) ROM. Conclusion: The accelerated protocol showed no significant improvement in muscle strength and ROM at 6 months post-surgical repair of the AT.

Bakgrund: Att drabbas av en stroke kan orsaka stora konsekvenser för en person som kan leda till fysiska och kognitiva funktionsnedsättningar som förändrar personens aktiviteter i dagliga livet. Arbetsterapeutens fokus på personens aktivitet och delaktighet i meningsfulla aktiviteter har en betydande roll i strokerehabilitering. Syfte: Syftet med studien var att undersöka vilka arbetsterapeutiska interventioner som utförs vid tidig rehabilitering av personer med stroke vid strokeenhet. Metod: Författarna använde en kvantitativ ansats och datainsamlingen utfördes med strukturerade frågeställningar i en webbaserad enkät. Enkätfrågorna utformades utifrån de rekommenderade arbetsterapeutiska interventionerna som finns med i Socialstyrelsens riktlinjer för vård vid stroke. Resultat: Deltagarantalet i studien var 59 och samtliga deltagare var verksamma arbetsterapeuter vid strokeenhet från 16 olika regioner i Sverige. Resultatet visade att interventioner med högre prioritet i Socialstyrelsens riktlinjer inte utförs i större utsträckning än interventioner med lägre prioritet. Tjugofyra procent av deltagarna upplevde att de ej har möjlighet att arbeta utifrån riktlinjerna för vård vid stroke. Slutsats: Deltagarna utförde de interventioner som rekommenderas i riktlinjerna i varierande utsträckning samt utförde även andra interventioner som ej finns med i riktlinjerna. Kravet att utföra evidensbaserad vård i stället för att basera valet av interventioner på beprövad erfarenhet kan liknas vid ett paradigmskifte. För att underlätta den övergången bör möjligheterna att följa de svenska riktlinjerna undersökas vidare samt ett förtydligande kring prioriteringsordningen i riktlinjerna publiceras. / Background: Suffering from a stroke can cause major consequences for an individual which can lead to physical and cognitive disabilities that change the individual’s activites in daily life. The occupational therapist’s focus on the individual’s activity och participation in meaningful activities has a significant role in stroke rehabilitation. Objektive: The purpose of the study was to investigate which occupational therapy interventions that are performed inthe early rehabilitation for individual’s with stroke in stroke units. Methods: The authors used a quantitative approach and the data collection was performed with structured questions in a web-based survey. The questions were designed based on the recommended occupational therapy interventions that are included in the National Board of Health and Welfare’s guidelines för stroke care. Results: The number of participants in the study was 59 and all participants were active occupational therapists at a stroke unit in 16 different regions in Sweden. The results showed that interventions with high priority in the National Board of Health and Welfare’s guidelines are not performed to a greater extent than interventions with lower priority. Twenty-four percent of the participants felt that they did not have the opportunity to work based on the guidelines for stroke care. Conclusion: Participants performed the interventions recommended in the guidelines to varying extent and also perform other interventions not included in the guidelines. The requirement to perform evidence-based care instead of basing the choice of interventions on proven experience can be likened to a paradigm shift. In order to facilitate that transition, the possibilities of following the Swedish guidelines should be examined further and a clarification of the order of priority in the guidelines be published.

Total hip replacement is one of the most common surgeries in orthopedics. Complete hip replacement can be addressed with several different types of surgical approaches. In this work we deal mainly with the anterior and anterolateral approach. The theoretical part of this work summarizes the basic knowledge about the anatomy, kinesiology of the hip joint and the prearthrotic causes leading to complete hip replacement. Furthermore, the types of surgical approaches, types of total endoprostheses are mentioned and the knowledge about soft tissue healing and early postoperative rehabilitation is summarized. The aim of this work is to determine whether rehabilitation will be faster in the first days after surgery in patients operated by the anterior approach, depending on the gentle approach and respect for anatomical structures, compared to the anterolateral approach. We present a group of 24 patients, 12 of whom underwent anterior approach and 12 anterolateral approach. In the practical part we evaluate and compare early postoperative rehabilitation in both approaches. The parameters we evaluate are the muscular strength of abduction, flexion and extension in the hip joint. Furthermore, the passive and active range of motion in the hip joint during abduction, flexion and extension. We also evaluate...

Introduktion: Stroke drabbar över 30000 människor per år i Sverige. Vanliga symptom efter en stroke involverar motoriska problem, spasticitet och mer eller mindre uttalad halvsidesförlamning. Konsensus för rehabilitering är att så tidigt som möjligt utföra rehabilitering med tidig mobilisering och påbörja rörelse- och gångträning. Detta utförs enligt beprövad erfarenhet enligt ett systematiskt konsensusförfarande men det vetenskapliga underlaget bedöms som otillräckligt. Detta skapar frågan hur tidig kan rehabiliteringen påbörjas efter stroke och vilka effekter det medför. Syfte: Syftet med denna studie var att sammanställa konsekvenserna av ökad intensitet och tidigt initierad strokerehabilitering jämfört med ordinär behandling. Metod: Sökning utfördes i databaserna SportDiscuss, PubMed och CINAHL vilket gav sammanlagt 7 relevanta artiklar som inkluderades i studien. Resultat: Riskfaktorer i form av maladaptiva förändringar och ökad dödlighet kunde härledas till en tidigare och intensivare rehabilitering. Detta kunde kopplas mot en neurologisk teorier om hjärnans plasticitet. Konklusion: Denna litteraturstudie har visat på att det finns en indikation på att en tidig intensiv mobilisering och rehabilitering efter stroke kan innebära risker för patientens hälsa. En viloperiod efter stroke försämrar ej möjligheten till att återfå lika god fysisk förmåga som vid tidig rehabilitering. Mer forskning behövs för att hitta en optimal balans mellan vila och fysioterapeutiska behandlingsmetoder för att uppnå en bättre rehabilitering för strokedrabbade patienter.