SANTRAUKA Vilniaus Universiteto Medicinos Fakultetas Reabilitacijos, sporto medicinos ir slaugos institutas Slaugos magistrantūros programa PATYRUSIŲ GALVOS SMEGENŲ INSULTĄ ASMENŲ SLAUGOS POREIKIŲ NAMUOSE ĮVERTINIMAS Slaugos magistro baigiamasis darbas Darbo autorė: Ana Petkevičienė Darbo vadovė: prof. habil. dr. Danutė Kalibatienė Vilnius, 2008 m. Pagrindinės sąvokos: Galvos smegenų insultas, namų slauga, slaugos poreikiai, slaugos ir socialinės paslaugos. Galvos smegenų insultas yra dažna negalios, priklausomybės bei socialinių įgūdžių praradimo priežastis. Nepaisant įgytos negalios, du trečdaliai pacientų, patyrusių insultą, po stacionarinio gydymo grįžta į namus. Atsakomybė už jų priežiūrą namuose tenka šeimos nariams, kurie neturi reikiamos patirties, slaugant tokius pacientus. Darbo tikslas : nustatyti patyrusių galvos smegenų insultą asmenų ir jų šeimos narių slaugos paslaugų poreikį namuose, išvykstant į namus po gydymo ir reabilitacijos stacionare. Darbo uždaviniai: Ištirti , kokių paslaugų ir kaip dažnai pacientai, patyrę galvos smegenų insultą, pageidautų namuose; Įvertinti amžiaus, lyties, išsilavinimo, šeimyninės ir socialinės padėties įtaką slaugos paslaugų į namus poreikiui; Ištirti ir palyginti slaugos poreikio priklausomybę nuo pirmą kartą ar pakartotinai patirto galvos smegenų insulto, gydymo bei gydymo ir reabilitacijos stacionare; Ištirti artimųjų poreikius slaugant šeimos narį, patyrusį galvos smegenų insultą. Medžiaga ir metodika: Tyrimo objektas- asmenų... [toliau žr. visą tekstą] / SUMMARY Vilnius University, Faculty of Medicine Rehabilitation, Sport Medicine and Nursing Institute Nursing Master study program EVALUATION OF CARE/NURSING NEEDS OF PATIENTS’ AFTER STROKE AT HOME Thesis on Master’s Degree in Nursing Author: Ana Petkevičienė Supervisor: Prof. Danutė Kalibatienė, Vilnius University, Faculty of Medicine, Institute of Rehabilitation, Sport Medicine and Nursing Vilnius, 2008 Keywords: encephalon stroke, home care, nursing needs, nursing and social services. Brain stroke frequently is the cause for disability, dependence and loss of social skills. Despite of acquired disability due to stroke, two thirds of patients return back to their homes after treatment in hospital. Responsibility for their nursing at home falls on their family members who lack necessary experience in caring for such patients. Goal of the thesis: to identify the needs of nursing care at home of the persons who had an encephalon stroke and their family members when going home after the in-patient treatment and rehabilitation. The tasks of the thesis: is to investigate what services and how often would be requested by the patients who had an encephalon stroke; to assess the effect of age, sex, education, family and asocial status on the needs of nursing services at home; to investigate and compare the correlation of nursing needs after encephalon stroke sustained for the first time or repeatedly and treatment, and in-patient treatment and rehabilitation; to investigate the needs... [to full text]

Brain insult is one of the main medical – social problems of current concern, both due to the high death-rate and severe residual physical disability caused by this illness. So far, one of the rehabilitation program elements, very widely discussed as a measure helping to recover functional independence of patients suffering from the after-effects of insult, is kinesitherapy. Implementation of the applied physical training in rehabilitation is not widely discussed yet. The objective of this study is to analyze the efficiency of educational experimental motor training program in the development of functional independence. Tasks of this study are as follows: • To assess the functional state of patients suffering from the effects of insult before rehabilitation; • To develop an education kinetic training program; • To assess the change functional state indicators at the end of rehabilitation period. • To assess the efficiency of experimental educational motor training program. This research has been conducted in a Public Institution Mazeikiai Hospital, in the department of in-patient rehabilitation, from 30 September 2004 to 29 December 2005. 80 brain insult patients were covered by this study. All of them were subdivided into two groups of 40 individuals in each: comparison group (CG) and experimental group (EG). A therapy of physical exercises was applied to the control group, while the experimental group underwent experimental educational motor training program. ... [to full text]

The influence of physiotherapy for patients quality of life after stroke ABSTRACT Key words: stroke, quality of life, physiotherapy, Bobath technique. The influence of rehabilitation for patients after stroke helps to recover loss of functional disorder and the activities of daily living. There are created many physiotherapy techniques, which are used for the patients after stroke for the maximum recovery of the functions. Mostly clinical researches analyze the improvement of functional system. Though there are not many researches which analysis the influence of physiotherapy for the quality of life and they are not comprehensive. The purpose of the work: to evaluate patients quality of life after stroke using traditional physiotherapy methods and Bobath technique. The problems of the work: 1) To find out which components of the quality of life physiotherapy has the greater influence. 2) To find out which factors – age, gender, neurological lesion, has the influence for physiotherapy efficiency or for the quality of life. 3) To evaluate which physiotherapy methods has better influence using the traditional physiotherapy or using Bobath technique. The object of the work: 1) Patients quality of life who had stroke and for which was used traditional physiotherapy. 2) Patients who had stroke quality of life and for which was used Bobath technique. The hypothesis of the work: Stroke negatively influences patients’ quality of life – patients’ physical condition, emotional... [to full text]

Stroke is an acute impairment of circulation of blood in the brain and it impairs function of all brain or its separate parts. Furthermore, after stroke shows up paralysis of one body side and especially impairs arm function. That’s why the aim of this study was to evaluate the effect of early physiotherapy for arm function of patients after stroke. The goals of the research was: to evaluate motions of shoulder girdle, hand and complicated motions of arm before physiotherapy; to evaluate motions of shoulder girdle, hand and complicated motions of arm after physiotherapy; to estimate whether additional physiotherapy improved retraining of arm function. The research was performed in neurological department of Siauliai hospital. Sixty patients after cerebrovascular stroke took part in this study. They where grouped in two groups: thirty patients for control group and thirty patients for investigative group. For control group’s patients was applied a traditional physical therapy for retraining arm function. For investigative group besides the traditional physical therapy were applied additional physical therapy procedures accordingly to Carr and Shepherd (1990) for retraining arm function. Study used these research methods: evaluation of motions of shoulder girdle, evaluation of motions of hand, evaluation of complicated motions of arm and mathematical statistics. Arm function was evaluated by motion assessment scale. Several conclusions were made in summary of results of... [to full text]

Šio darbo tikslas: Įvertinti proaktyvios ir reaktyvios strategijų taikymo įtaką pusiausvyrai ir eisenos greičiui pacientams, patyrusiems galvos smegenų insultą. Tikslui pasiekti išsikelti uždaviniai: 1. Įvertinti pusiausvyrą ir eisenos greitį proaktyvios strategijos lavinimo grupės pacientams reabilitacijos pradžioje ir pabaigoje. 2. Įvertinti pusiausvyrą ir eisenos greitį reaktyvios strategijos lavinimo grupės pacientams reabilitacijos pradžioje ir pabaigoje. 3. Palyginti pusiausvyros ir eisenos greičio kaitą tarp grupių reabilitacijos metu. 4. Įvertinti pusiausvyros ir eisenos greičio sąsajas pacientams, patyrusiems galvos smegenų insultą. Metodika: tyrime dalyvavo 32 pacientai patyrę galvos smegenų insultą. Tiriamieji atsitiktine tvarka buvo suskirstyti į tiriamąją ir kontrolinę grupes. Tiriamųjų amžius svyruoja nuo 60 iki 70 metų. Tyrimas atliktas Kauno klinikinės ligoninės FMR skyriuje. Visiems pacientams kiekvieną dieną buvo atlikti du kineziterapijos užsiėmimai. Vieno užsiėmimo metu su visais pacientais dirbama pagal reaktyvią strategiją, o kitas užsiėmimas buvo orientuotas į eisenos ir pusiausvyros gerinimą; su kontroline grupe šio užsiėmimo metu dirbama taikant reaktyvią, o tiriamąja grupe – proaktyvią lavinimo strategiją. Visi tiriamieji prieš ir po reabilitacijos buvo įvertinti „Stotis ir eiti“ testu, pusiausvyros mėginiais pagal Schmitz ir Berg pusiausvyros skale. Apibendrinus rezultatus pateikiamos išvados: 1. Proaktyvi lavinimo strategija pacientams... [toliau žr. visą tekstą] / The aim of this work: to evaluate influence of proactive and reactive strategies towards balance and walking speed of the patients who suffered from the stroke. The tasks of the work: 1. to evaluate balance and walking speed of the patients in the group of proactive strategy at the beginning of rehabilitation and at the end. 2. to evaluate balance and walking speed of the patients in the group of reactive strategy at the beginning of rehabilitation and at the end. 3. to compare the change of balance and walking speed between groups during the rehabilitation. 4. to evaluate the links between balance and walking speed of the patients who suffered from stroke. Methodology: 32 patients who suffered from the stroke took part in the research. They were divided into analyzed and control groups in random order. The age of the patients is from 60 to 70 years. The research was carried out in FMR department Kaunas Clinical hospital. All patients had two physiotherapy periods every day. During one period they have been working according to reactive strategy. The other period was oriented towards the improvement of balance and walking. During the second period patients of control group have been working according to reactive strategy and patients of analyzed group have been working according to proactive strategy. All patients before and after the rehabilitation were evaluated according to “Stand and go” test and balance samples of Schmitz and Berg balance scale. Conclusions: 1... [to full text]

Background. In Lithuania, the stroke is not only medical, but social issue as well, since only 20% of patients suffering stroke remain active in work. Yearly stroke incidence in Lithuania is 7000–8000 cases. Most common outcome of stroke is unilateral paralysis (hemiplegia), followed by disorders of coordination, balance and movements. Due to dysfunctions of movements, self-care, cognition, behavior, and communication, some part of stroke patients remains disabled. They need assistance and care, provided by other people. During rehabilitation it should be applied occupational therapy sessions, since they determine improvement of patient’s independence and enable training of work skills. The evaluation of certain occupational therapy methods is integral part of complex rehabilitation development. There exist several occupational therapy methods and models, enabling to adjust motoric and cognitive dysfunctions; however, in occupational therapy practice there is still a lack of evidence-based evaluation methods for effectiveness of certain occupational therapies, and evaluation of cognitive and motoric functions and disorders of activities by stroke patients. Aim of study: To evaluate dynamics of motoric, cognitive, psychosocial functions and disorders of activities and to evaluate effectiveness of occupational therapy including related factors on early stage of rehabilitation. Goals of study: 1. To estimate dynamics of motoric, cognitive, psychosocial functions and disorders of... [to full text]

Objective: gait of patients after stroke. Stroke is acute vascular disturbance in the brain, which involves sensory and motor systems of the opposite side to the brain lesion. Inability to walk or abnormal gait pattern is one of the biggest problem after cerebral vascular accident, which predispose the stoke survivors to a sedentary lifestyle, which further limits the individual’s activities of daily living and reduces cardiovascular reserves. One of the primary goals for physical therapy is to restore the ability to walk. It is the first step in becoming independent. In this case the main purposes of this study – to evaluate the influence of the physical therapy of gait of stoke patients. The tasks to reach the purpose of this study were: 1) to assess the effectiveness of special active walking exercises in order to regain the gait; 2) to assess the effectiveness of balance exercises in order to regain the gait; 3) to compare the effectiveness of different physiotherapy methods. The study was performed in physical medicine and rehabilitation department of Virsuziglis rehabilitation hospital. Thirty patients after cerebral vascular stoke, took part in this study. They were divided in two groups. The first group’s patients besides the traditional physical therapy performed special active walking exercises. The second group’s patients additionally were applied balance exercises. These used research methods: “Up and Go” test, Berg balance scale, motor assessment scale, Smidt... [to full text]

The aim of this study is the investigation and assessment in subsequent treatment of kinezioterapy rehabilitation for after stroke patients. Measures of functional independence, muscle force and balance tests have been used for this purpose. This study has involved 17 after stroke participants: 10 female and 7 male. The obtained results has showed that the use of physiotherapy rehabilitation in subsequent treatment of functional independence, balanse and muscle force has improved or recovered completely.

Tyrimo tikslas: Veiksnių, įtakojančių kineziterapijos efektyvumą, sergantiesiems GSI, ankstyvuoju ligos laikotarpiu, nustatymas. Kontingentas. Tyrimas buvo atliktas Kauno medicinos universiteto klinikų (KMUK) neurologijos skyriuje. Tyrime dalyvavo 25 ligoniai (17 moterų ir 8 vyrai), kuriems buvo diagnozuotas išeminis galvos smegenų insultas, ūmus ligos laikotarpis. Reabilitologas buvo paskyręs kineziterapiją. Tyrimas buvo atliekamas 2007 m. spalio – 2008 kovo mėn. Pacientai vidutiniškai skyriuje praleido 14 dienų. Tiriamieji buvo suskirstyti į keletą grupių: pagal lytį – vyrai ir moterys, pagal amžių – 50-69 bei 70-87 metų, bei pagal galvos smegenų pusrutulio pažeidimo pusę – kairės ir dešinės. Tyrimo metodai. Reabilitacijos veiksmingumui vertinti pasirinkta paciento bendros funkcinės būklės ( Bartelio indeksas), motorinės funkcijos (Rivermedo judesių įvertinimo skalė), bei pažintinių funkcijų (Trumpas protinės būklės tyrimo testas) pokytis po reabilitacijos. Tyrimo rezultatai parodė, kad ankstyva sergančiųjų galvos smegenų insultu kineziterapija statistiškai reikšmingai pagerino pacientų bendrąją funkcinę būklę, motorinę funkciją bei pažintines funkcijas visose grupėse (pagal amžių, lytį ir galvos smegenų pažeidimo pusę)(p<0,05). Tačiau statistiškai reikšminga lyties, amžiaus, bei galvos smegenų pažeidimo pusės įtaka bendrai funkcinei būklei, motorinei, bei pažintinėms funkcijoms nenustatyta, kaip manoma dėl mažo tiriamųjų skaičiaus. / Aim of the research: Establishment of factors influencing the effectiveness of physiotherapy of people sick with stroke in the early period of illness. Contingent. The research was performed in the Division of Neurology of Kaunas University of Medicine Hospital. 25 patients took part in the research (17 women and 8 men) with the diagnosis of (išeminis) stroke, acute period of the illness. The rehabilitation physician had prescribed physiotherapy. The research was performed in October 2007 – March 2008. The patients spent in the Section on the average 14 days. The exploratory people were divided into several groups: according to the sex – men and women, according to the age – 50-69 and 70-87 years old, and according to the side of the hemisphere of head brains affection – left and right. Methods of the research. In order to evaluate the effectiveness of rehabilitation the alteration of patent’s general state (Barthel Index), motor functions (Rivermead Motor Assessment scale) and cognitive functions (Mini-Mental State Examination) after the rehabilitation were chosen. The results of the research have shown that the early physiotherapy of people sick with stroke statistically significantly improved patients’ general functional state, motor function and cognitive function in all groups (according to the age, sex and the side of the hemisphere of head brains affection) (p<0,05). However statistically significant influence of age, sex and the side of the hemisphere of head... [to full text]

Disertacijoje nagrinėjamos medicininių vaizdų analizės problemos, taikant vaizdų spektrus. Pagrindiniai tyrimo objektai yra galvos kompiuterinės tomogramos bei magnetinio rezonanso angiogramos. Šie objektai yra svarb��s medicininės diagnostikos rezultatai, kurių detali analizė bei interpretacija leidžia parinkti tinkamiausią paciento gydymo būdą. Pagrindinis disertacijos tikslas yra sukurti metodikas ir algoritmus, skirtus automatiniam min÷tų vaizdų apdorojimui bei analizei. Sukurtų algoritmų taikymo sritis yra medicininė programinė įranga. Taip pat disertacijoje siekiama ištirti dažninio ir erdvinio dažninio spektrų taikymo galimybes medicininių vaizdų apdorojime ir analizėje, siekiant aptikti ir pažymėti vaizduose ligų sritis arba kitas specifines sritis. Darbe sprendžiami keli pagrindiniai uždaviniai: smegenų ir išeminio insulto sričių aptikimas tomogramose bei kraujagyslių pėdsakų sričių aptikimas angiogramose. Pirmasis uždavinys suformuluotas, atsižvelgiant į palyginti didelį išeminio insulto paplitimą ir jo diagnostikos aktualumą. Antrasis siejasi su aneurizmos srities aptikimo angiogramose problema. Disertaciją sudaro šeši skyriai, iš kurių paskutinis – rezultatų apibendrinimas. / The main idea of current PhD thesis is an analysis of frequency and joint space-frequency representations of medical images. The objects of investigation are digital images of computed tomography and magnetic resonance angiography of human brain. These objects are essential diagnostic results which require a detail visual analysis and interpretation for the successive selection of treatment. The aim of work covers the development of methods and algorithms suitable for automatic analysis of medical images which may be implemented in medical software. The other purpose encompasses an investigation of Fourier and Haar wavelet transforms in the analysis and processing of medical images. The result of analysis is assumed as an enhancement and segmentation of suspected regions of diseases or other specific regions. There are two main tasks under consideration. First one is an automatic detection of region of brain and ischemic stroke in the images of computed tomography. Second one is a detection of traces of blood vessels in magnetic resonance angiography images. The first task is formulated in the view of wide distribution and high relevance of diagnosis of ischemic stroke. Second task is related with the detection of diseases of blood vessels. The thesis is divided into six chapters including the conclusion’s chapter.