The Abstract The Title: Effect of Peroneal Nerve Functional Electrical Stimulation on Gait in Post-stroke Patients The Goal: The aim of this work was to compare two different ways of applying functional electrical stimulation of the peroneal nerve as to their impacts on the gait speed and performance and the spastic paresis of lower leg in adult patients suffering from chronic stages of stroke accompanied by foot drop. The Method: An open, randomized, controlled clinical pilot study combining elements of both controlled and pragmatic experiments in comparing two different clinical approaches to peroneal nerve functional electrical stimulation. With the first group of patients (group A, consisting of 14 subjects), the intervention was carried out as an outpatient, strictly controlled and intense training of gait with electrical stimulation over the period of four weeks, five times a week; the B-group patients (13 subjects) were all provided with their own stimulator which they applied continuously throughout all their daily routines at their homes and community over the equal period of time. The Results: The four-week intervention turned out to cause no statistically significant difference in our two groups in terms of its impact on any of the monitored parameters of the gait speed and performance as well as...

Aim: According to Swedish and Danish law interventions must be based on evidence, and evidence related to rest orthoses in contracture management is limited and inconclusive, making justification of using rest orthoses difficult. The aim is to understand the clinicians’ perceptions of the benefit of rest orthoses when managing wrist and hand contractures, to shape a basis for clinical evidence.Method: A qualitative interview study was made and a total of 13 participants with 2 to 40 years of experience was included. Interviews were transcribed and translated into English. A thematic analysis was undertaken by two researchers. Three themes and seven subthemes were identified and discussed. Results: There was congruence among the participants that rest orthoses can maintain RoM when used but they need to be used at least 6 to 8 hours every day. Combination of botox and rest orthoses has a good effect in many patients with spasticity for maintaining RoM and some function. Many patients gain a benefit in maintaining hygiene, a reduction in pain and easier for patients getting dressed. Conclusion: The interviewed clinicians perceived that rest orthoses can impact pain and prevent contracture formation however evidence was inconclusive, but it merits further research. / Syfte: Enligt svensk och dansk lag måste insatser baseras på evidens, och evidensen relaterad till viloortoser i kontrakturhantering är begränsad och motsägelsefull, vilket gör det svårt att motivera användningen av viloortoser. Syftet är att förstå klinikernas uppfattningar om fördelarna med viloortoser vid hantering av hand- och handledskontrakturer, för att skapa en grund för klinisk evidens. Metod: En kvalitativ intervjustudie genomfördes och totalt 13 deltagare med 2 till 40 års erfarenhet inkluderades. Intervjuerna transkriberades och översattes till engelska varpå en tematisk analys utfördes av två forskare. Tre teman och sju underteman identifierades och diskuterades. Resultat: Det fanns samstämmighet bland deltagarna att viloortoser kan bibehålla rörelseomfång när de används, men de måste användas minst 6 till 8 timmar varje dag. Kombinationen av botox och viloortoser har god effekt hos många patienter med spasticitet för att bibehålla rörelseomfång och viss funktion. Många patienter får fördelar i form av bibehållen hygien, minskad smärta och det blir lättare för patienter att klä på sig.Slutsats: De intervjuade klinikerna ansåg att viloortoser kan påverka smärta och förhindra kontrakturbildning, men evidensen är ofullständiga och kräver ytterligare forskning.

Title: The Use of Physiotherapy in Spasticity Management Objectives: The purpose of this thesis is to provide a summary of present findings on spasticity, with particular regard to its pathophysiological mechanisms and clinical manifestations, and to present an overview of medical and physiotherapeutic approaches applied in its treatment. Furthermore, it aims at making a research in physiotherapeutic methods and techniques used for reduction of spasticity. The thesis shall present relevant studies, provide their comparison and critically evaluate the effect of methods and techniques examined in them. Methods: This thesis is a descriptive analysis based on a literature review. Results: Based on the research findings, it may be concluded that physiotherapy has proven to be effective in reducing spasticity. However, it is not possible to determine whether the techniques to reduce spasticity are more effective than techniques without this primary purpose. The examined studies have shown that the choice of physiotherapeutic practices to reduce spasticity was not influenced by disease etiology. Moreover, the same techniques and methods were applied in pediatric and adult patients, regardless of diagnosis. The relationship between reduced spasticity and change in motor function is unclear and our research...

O Acidente Vascular Encefálico (AVE) freqüentemente ocasiona alterações de equilíbrio, decorrentes de lesões no sistema nervoso central que afetam os aspectos motores, sensoriais e de integração do controle do movimento. Os objetivos deste estudo foram descrever as alterações de equilíbrio em indivíduos hemiparéticos que haviam sofrido AVEs isquêmicos nos 12 meses anteriores (grupo de estudo - GE), em comparação a um grupo de indivíduos saudáveis (grupo controle, GC), e correlacionar medidas observacionais (Escala de Equilíbrio de Berg: EEB; e Sub-Escala de Equilíbrio do teste de Fugl-Meyer: SEE-FM) e laboratoriais (resultados da Posturografia Dinâmica computadorizada - PDC) no GE. Na PDC, foram realizados o teste de organização sensorial e o teste de controle motor. Foram avaliados 21 pacientes que apresentavam alto nível de desempenho funcional (avaliado pelo Índice de Barthel e pela Categoria de Deambulação Funcional, CDF), e comprometimento neurológico leve (avaliado pela escala de AVE do National Institutes of Health, NIHSS) e sensório-motor dos membros inferiores (avaliado pela sub-escala motora de membros inferiores de Fugl-Meyer). O desempenho do GE foi inferior ao do GC em todas as avaliações de equilíbrio. Os resultados da PDC indicaram pior integração das informações visual e vestibular no GE, comparado ao GC. Adicionalmente, os indivíduos do GE apresentaram maior assimetria na distribuição de peso e na força empregada pelos membros inferiores para se recuperarem de desequilíbrios impostos pelo teste. A PDC foi o único instrumento cujos resultados foram associados a comprometimento da dorsiflexão ativa e da propriocepção na articulação do tornozelo. Houve correlação estatisticamente significativa entre o Índice de Barthel e as escalas de equilíbrio, mas não com a PDC. As pontuações na CDF e na sub-escala motora de membros inferiores de Fugl-Meyer se correlacionaram significativamente com todas as medidas de avaliação de equilíbrio. As pontuações na NIHSS não se correlacionaram significativamente com as medidas observacionais nem com os resultados da PDC. Os três instrumentos de avaliação do equilíbrio apresentaram correlação entre si, e com o antecedente de quedas. As informações obtidas através da PDC contribuíram para melhor caracterização das anormalidades de equilíbrio em doentes hemiparéticos após o AVE. / Abnormal balance after stroke can be a consequence of changes in motor, sensory and integrative aspects of motor control. The aims of this study were to describe balance impairments in hemiparetic patients with ischemic strokes in the last 12 months compared to healthy subjects, and to correlate observational scores (Berg Balance Scale and balance subscale of the Fugl-Meyer assessment scale) and laboratory measurements (results of the Computerized Dynamic Posturography CDP) in the stroke group. The Sensory Organization Test and the Motor Control Test were performed in PDC. Twenty-one patients were evaluated. They had high functional levels (evaluated with the Barthel Index and with the Functional Ambulatory Category, FAC), mild neurological deficits (evaluated with the National Institutes of Health Stroke Scale, NIHSS) and mild sensory and motor impairment in the lower limbs (evaluated with the motor subscale of the Fugl-Meyer assessment scale). Patients had lower scores than healthy volunteers in all balance evaluations. CDP results showed worse visual and vestibular integration in the stroke group compared to healthy subjects. Weight and strength asymmetries in the lower limbs were greater in the stroke group. Only CDP results were significantly correlated with ankle dorsiflexion and proprioception. The Barthel Index correlated significantly with balance scales but not with PDC results. FAC and the motor subscale of the Fugl-Meyer assessment scale correlated significantly with all types of balance assessment. NIHSS scores did not correlate with observational scores or CDP results. The three instruments of balance evaluation were significantly correlated with each other and with history of falls after stroke. Information provided by CDP contributed to better characterize balance abnormalities in hemiparetic stroke patients.

Betriebe in Mittelgebirgslagen mit einem hohen Anteil Grassilagefütterung, der damit verbundenen größeren K-Aufnahme sowie höheren DCAD (Dietary-Cation-Anion-Difference) sollten für Gebärparese stärker prädisponiert sein. Ziel dieser Arbeit war es deshalb, Ursachen des Festliegens im Erzgebirge unter Berücksichtigung der DCAD zu ermitteln. Dazu wurden sowohl Fütterungsparameter und die Körperkondition analysiert, als auch Blut- und Harnuntersuchungen ante (a.p.) und post partum (p.p.) durchgeführt. In 21 Betrieben wurden insgesamt 249 Kühe im Zeitraum von 2 Wochen ante partum (a.p.) bis eine Woche p.p. untersucht. Bei 206 gesunden Kühen erfolgte 2 Wochen a.p. eine jeweils einmalige Harn- und Blutentnahmen. Ferner wurden bei 43 peripartal festliegenden Kühen nur Blut- und Harnproben direkt vor der Behandlung analysiert. Die sonographische Ermittlung der Rückenfettdicke (RFD) erfolgte bei je zehn klinisch gesunden Kühen pro Betrieb je 2 Wochen a.p. Die Silageproben (Grundfutteranalyse) wurden hinsichtlich ihrer Inhaltsstoffe untersucht und die DCAD berechnet. Laktationsnummern, Milchleistungen und Krankheitsinzidenzen der Kühe wurden ermittelt. Im Blutserum wurden ß-Hydroxy-Butyrat (BHB), Cholesterol, Bilirubin, Aspartat-Aminotransferase (ASATS), Creatinkinase (CK), Alkalische Phosphatase (AP), Protein (TP), Albumin, Harnstoff, Creatinin, Calcium (Ca), anorganisches Phosphat (Pi), Magnesium (Mg), Natrium (Na), Kalium (K) und im Vollblut die Leukozytenanzahl bestimmt. Im Harn erfolgte die Analyse derselben Mineralstoffe wie im Serum sowie weiterhin des pH-Wertes, der NSBA (Netto-Säure-Basen-Ausscheidung) und des Creatinins. Errechnet wurden die fraktionierten Eliminationen der einzelnen Mineralstoffe, der BSQ (Basen-Säure-QuotienTS) aus den Mengen der Basen, Säuren und Ammoniumionen im Harn sowie der Creatininquotient aus Harn- und Serumcreatinin. Befunde der Klinisch gesunden Kühe zwei Wochen a.p.: Die durchschnittliche RFD der Kühe lag in den Betrieben im Mittel zwischen 19 bis 26 mm. Muskel- und Knochenstoffwechsel charakterisierende Parameter waren physiologisch. Die Mediane der AP-Aktivität im Serum lagen in 15 der 21 Betriebe unter 100 U/l. Energie- und Eiweißstoffwechsel, Leukozytenanzahlen sowie Mineralstoffe in Serum und Harn ergaben keine Hinweise für präpartale Stoffwechselstörungen. Die Mediane von pH-Wert, NSBA sowie K- und Creatininkonzentrationen im Harn überschritten in mindestens fünf Betrieben die Grenzwerte, da die K-Konzentrationen in den Silagen bis fünffach über dem empfohlenen Bereich lagen. Die DCAD lag im Mittel aller Betriebe mit 458 meq/kg T weit über –100 bis +150 meq/kg T. Eine gesicherte Korrelation zur Anzahl der Festlieger bestand nicht. Befunde der Festlieger p.p.: Die Festlieger hatten zu je 60% reduzierte Ca- sowie Pi- und zu 16% verminderte Mg-Konzentrationen. Die Verteilung auf die Gebärparesetypen war wie folgt: Typ I = 42% Typ II= 19%, Typ III = 5%, Typ IV = 12% und Typ V = 21%. Dies entspricht mehrheitlich den Literaturangaben. Die Ca-, Pi- und Mg-Konzentrationen im Harn lagen bei den Festliegern in den physiologischen Bereichen. Die Mehrzahl der Festlieger hatte gleichzeitig erhöhte CK- (74%) und AST-Aktivitäten (53%). In 38% der Fälle war die AP-Aktivität vermindert. Die K- und NSBA-Konzentrationen im Harn der Festlieger zeigten als Folge der reduzierten Futteraufnahme gegenüber den Befunden a.p. eine Abnahme bis in den unteren physiologischen Bereich und z.T. darunter. Störungen des Energiestoffwechsels in Form erhöhter Ketonkörper- (58%) und Bilirubin- (40%) sowie reduzierter Cholesterol- (58%) Konzentrationen hatte die Mehrheit der festliegenden Kühe. Dabei war die kombinierte Ca-Pi-BHB-Stoffwechselstörung die Regel, traf aber nicht in jedem Fall zu. Die moderat veränderten Parameter des Energiestoffwechsels sind offensichtlich Folge der reduzierten Futteraufnahme. Eine Steigerung der Leukozytenzahl als Hinweis auf eine akut-entzündliche Reaktion bestand bei 44% der Festlieger, - die Leukopenie war die Ausnahme. Mit der Leukozytose waren in 36,8% respektive 42,1% der Fälle eine Hypokalz- resp. Hypophosphatämie gekoppelt. Bei dem größeren Teil (47,4%) der Leukozytosen waren die Ca- und Pi-Konzentrationen jedoch physiologisch. Das zeigt in Übereinstimmung mit den klinischen Befunden, dass entzündliche Prozesse und Verletzungen als weitere Ursache des Festliegens angesehen werden mussten. Fazit: Die erhöhte DCAD war in den untersuchten Mittelgebirgsbetrieben kein prädisponierender Faktor für die Gebärparese. Neben den bekannten Ca-Pi-Störungen spielten entzündliche Prozesse dafür eine wichtige Rolle.

Made available in DSpace on 2016-12-08T16:24:14Z (GMT). No. of bitstreams: 1 PGCA12MA103.pdf: 1158484 bytes, checksum: 7070ec0f4d7fc1aba2534da8c5d18609 (MD5) Previous issue date: 2012-02-16 / The crossbreed with the Jersey breed has been used mainly as an alternative to increasing the concentration of milk solids in Holstein herds, and the production capacity of these animals the focus of several studies. However, there are still limited information on many relevant factors to making decision and management of crossbreed herds, such as disease resistance and calving easy, and this is the motivation of this work, which aimed to evaluate the health, immunity and calving difficulty in Holstein x Jersey crossbred cows compared to pure Holstein cows. Data were obtained from a farm located in Carambeí-PR, which has purebred Holstein and crossbred Holstein x Jersey in different proportions of each breed. Data of calving difficulty, retained placenta, gestation length, blood indicators for postpartum metabolic diseases (ketosis and hypocalcemic puerperal paresis) and immunity were collected from July 2010 to June 2011 and data from Somatic Cell Count (SCC) obtained from the official milk recording in the period 2005 to 2010. For calving easy was adopted a scale ranging from 1 (unassisted births) to 5 (extreme difficulty, cesarean or death) and retained placenta when 24 hours elapsed the calving without of the fetal membranes detachment. Concentration of &#946;-hydroxybutyrate (BHBA) in blood as an indicator of ketosis, total and ionic calcium in blood serum as an indicator of hypocalcemic puerperal paresis, and indicators of immunity immunoglobulin G (IgG) and total protein in serum were determined from blood samples collected at calving, being repeated in the ninth week after calving for BHBA. The variables calving easy and retained placenta were evaluated using a generalized linear model with binomial distribution (logistic regression). Variables BHBA, gestation length, total and ionized calcium, total protein and IgG were evaluated using a randomized experimental design, and data subjected to analysis of variance. The CCS data were transformed to somatic cell score (ECS) and subjected to analysis of variance with repeated measures in time. The genetic groups did not affect the calving easy (P = 0.4376), retained placenta (P = 0.7074) and gestation length (P=0.2812). Crossbred cows had higher concentrations of IgG (1.776 versus 1.456 mg / dL) and total protein (7.019 versus 6.525 mg / dL). For the concentration of BHBA, differences occurred only at calving, with higher values for crossbred cows (0.580 versus 0.427 mmol / L). Difference was observed between genetic groups for concentration of ionized calcium (P = 0.082), with crossbred cows presented lower concentration (4.3 versus 3.92 mg / dL). Adult crossbred cows (from 3 years of age at calving), had lower ECS (P <0.0001). It is concluded that crossbred cows have superior performance compared to Holstein cows for somatic cells in milk and immunity indicators and lower for hypocalcemic puerperal paresis and ketosis indicators on the day of calving. Crossbred cows do not have an increased risk of dystocia in relation to pure Holstein cows when mated with pure Holstein bulls / O cruzamento com a raça Jersey vem sendo utilizado principalmente como alternativa para o aumento da concentração de sólidos do leite em rebanhos da raça Holandesa, sendo a capacidade de produção destes animais fruto de diversos estudos. Entretanto, ainda existem limitadas informações sobre diversos fatores relevantes para a tomada de decisão e para o manejo de rebanhos cruzados, tais como resistência a doenças e facilidade de parto, sendo esta a motivação do presente trabalho, o qual objetivou avaliar a sanidade, imunidade e dificuldade de parto de vacas mestiças Holandês x Jersey em relação a vacas puras da raça Holandesa. Os dados foram obtidos de uma propriedade localizada no município de Carambeí PR, a qual possui vacas puras da raça Holandesa e mestiças Holandês x Jersey em diferentes proporções de cada raça. Dados de dificuldade de parto, duração da gestação, retenção de placenta, indicadores sanguíneos para doenças metabólicas pós-parto (cetose e paresia puerperal hipocalcêmica) e de imunidade foram coletados no período de julho de 2010 a junho de 2011 e os dados de Contagem de Células Somáticas (CCS) obtidos do controle leiteiro oficial, no período de 2005 a 2010. Para facilidade de parto adotou-se uma escala de variando de 1 (partos sem auxílio) a 5 (extrema dificuldade, cesariana ou morte) e a retenção de placenta quando transcorridos 24 horas do parto sem desprendimento dos envoltórios fetais. Concentração de &#946;-hidroxibutirato (BHBA) no sangue, como indicador de cetose, cálcio total e iônico no soro sanguíneo, como indicador de paresia puerperal hipocalcêmica, e os indicadores de imunidade Imunoglobulina G (IgG) e proteína total no soro, foram determinados a partir de amostras de sangue coletadas no dia do parto, sendo repetido na nona semana após o parto para BHBA. As variáveis facilidade de parto e retenção de placenta foram avaliadas através de um modelo linear generalizado, com distribuição binomial (regressão logística) As variáveis duração da gestação, BHBA, cálcio total e iônico, IgG e proteína total foram avaliadas através de delineamento experimental inteiramente casualizado, sendo os dados submetidos à análise de variância. Os dados de CCS foram transformados para Escore de Células Somáticas (ECS) e submetidos à análise de variância através de medidas repetidas no tempo. O grupamento genético não afetou a facilidade de parto (P=0,4376), a retenção de placenta (P=0,7074) e a duração da gestação (P=0,2812). Vacas mestiças apresentaram maiores concentrações de IgG (1,776 contra1,456 mg/dL) e de proteína total (7,019 contra 6,525 mg/dL). Quanto à concentração de BHBA, ocorreu diferença somente no dia do parto, com valores mais altos para as vacas mestiças (0,580 contra 0,427 mmol/L). Observou-se diferença entre grupamentos genéticos para concentração de cálcio iônico (P=0,082), com vacas mestiças apresentando concentração mais baixa (4,3 contra 3,92 mg/dL). Vacas mestiças adultas (a partir de 3 anos de idade no momento do parto), apresentaram menor ECS (P<0,0001). Conclui-se que vacas mestiças apresentam desempenho superior em relação às vacas da raça Holandesa para células somáticas no leite e indicadores de imunidade e inferior para os indicadores de paresia puerperal hipocalcêmica e cetose no dia do parto. Vacas mestiças não apresentam risco maior de distocia em relação às puras quando acasaladas com touros da raça Holandesa

O Acidente Vascular Encefálico (AVE) freqüentemente ocasiona alterações de equilíbrio, decorrentes de lesões no sistema nervoso central que afetam os aspectos motores, sensoriais e de integração do controle do movimento. Os objetivos deste estudo foram descrever as alterações de equilíbrio em indivíduos hemiparéticos que haviam sofrido AVEs isquêmicos nos 12 meses anteriores (grupo de estudo - GE), em comparação a um grupo de indivíduos saudáveis (grupo controle, GC), e correlacionar medidas observacionais (Escala de Equilíbrio de Berg: EEB; e Sub-Escala de Equilíbrio do teste de Fugl-Meyer: SEE-FM) e laboratoriais (resultados da Posturografia Dinâmica computadorizada - PDC) no GE. Na PDC, foram realizados o teste de organização sensorial e o teste de controle motor. Foram avaliados 21 pacientes que apresentavam alto nível de desempenho funcional (avaliado pelo Índice de Barthel e pela Categoria de Deambulação Funcional, CDF), e comprometimento neurológico leve (avaliado pela escala de AVE do National Institutes of Health, NIHSS) e sensório-motor dos membros inferiores (avaliado pela sub-escala motora de membros inferiores de Fugl-Meyer). O desempenho do GE foi inferior ao do GC em todas as avaliações de equilíbrio. Os resultados da PDC indicaram pior integração das informações visual e vestibular no GE, comparado ao GC. Adicionalmente, os indivíduos do GE apresentaram maior assimetria na distribuição de peso e na força empregada pelos membros inferiores para se recuperarem de desequilíbrios impostos pelo teste. A PDC foi o único instrumento cujos resultados foram associados a comprometimento da dorsiflexão ativa e da propriocepção na articulação do tornozelo. Houve correlação estatisticamente significativa entre o Índice de Barthel e as escalas de equilíbrio, mas não com a PDC. As pontuações na CDF e na sub-escala motora de membros inferiores de Fugl-Meyer se correlacionaram significativamente com todas as medidas de avaliação de equilíbrio. As pontuações na NIHSS não se correlacionaram significativamente com as medidas observacionais nem com os resultados da PDC. Os três instrumentos de avaliação do equilíbrio apresentaram correlação entre si, e com o antecedente de quedas. As informações obtidas através da PDC contribuíram para melhor caracterização das anormalidades de equilíbrio em doentes hemiparéticos após o AVE. / Abnormal balance after stroke can be a consequence of changes in motor, sensory and integrative aspects of motor control. The aims of this study were to describe balance impairments in hemiparetic patients with ischemic strokes in the last 12 months compared to healthy subjects, and to correlate observational scores (Berg Balance Scale and balance subscale of the Fugl-Meyer assessment scale) and laboratory measurements (results of the Computerized Dynamic Posturography CDP) in the stroke group. The Sensory Organization Test and the Motor Control Test were performed in PDC. Twenty-one patients were evaluated. They had high functional levels (evaluated with the Barthel Index and with the Functional Ambulatory Category, FAC), mild neurological deficits (evaluated with the National Institutes of Health Stroke Scale, NIHSS) and mild sensory and motor impairment in the lower limbs (evaluated with the motor subscale of the Fugl-Meyer assessment scale). Patients had lower scores than healthy volunteers in all balance evaluations. CDP results showed worse visual and vestibular integration in the stroke group compared to healthy subjects. Weight and strength asymmetries in the lower limbs were greater in the stroke group. Only CDP results were significantly correlated with ankle dorsiflexion and proprioception. The Barthel Index correlated significantly with balance scales but not with PDC results. FAC and the motor subscale of the Fugl-Meyer assessment scale correlated significantly with all types of balance assessment. NIHSS scores did not correlate with observational scores or CDP results. The three instruments of balance evaluation were significantly correlated with each other and with history of falls after stroke. Information provided by CDP contributed to better characterize balance abnormalities in hemiparetic stroke patients.

Title: Measurement of lower extremities spasticity in patients with cerebral palsy Objectives: The aim of the theoretical part of this thesis is to evaluate possibilities of lower extremities spasticity measurement in adult patients with cerebral palsy. The main focus was given to the concept of French professor J.-M. Gracies: Five- step clinical assessment in spastic paresis. This unique concept presents differentiation of three main factors of motor impairment that emerge as a result of a lesion to central motor pathways: stretch sensitive paresis, soft tissue contracture and muscle overactivity. Ability to distinguish these factors is crucial for specific treatment indication. Finding a correlation between the Five-step clinical assessment in spastic paresis and muscle activity in gait measured with polyEMG was the main objective in the practical part of the thesis. Methodology: This thesis has a theoretical-empirical character. The theoretical part is in a form of a research on the topic of spasticity diagnosis, focused on cerebral palsy patients. The empirical part of the thesis has a form of pilot quantitative research, which was attended by 6 participants with cerebral palsy (4 men and 2 women; average age 29 years). There were 2 independent measurement made for each of them. Each...

Title: The effect of progressive static stretching on treatment of spastic paraparesis in patients with cerebral palsy Objectives: The goal of this dissertation is to evaluate the effect of progressive static stretching on treatment of spastic paraparesis in patients with paraparetic form of cerebral palsy (CP). Elements chosen for the treatment were those of the therapeutic concept Guided Self-rehabilitation Contract by French professor Jean-Michel Gracies, which is presented in detail in the theoretical part of the dissertation. Methodology: This dissertation has a theoretical-empirical character. First theoretical part of the dissertation is in a form of a research on the topic of spasticity and diagnosis and treatment of spastic paresis according to the concept of J.-M. Gracies. Second experimental part of the dissertation evaluating the effect of the selected treatment for spastic paresis in people with cerebral palsy, has a form of pilot qualitative research, which was attended by 6 participants. At the beginning of the research each participant has undergone an entrance examination that evaluated spasticity using at first an unique assessing protocol Five step clinical assessment and consequently a surface electromyography. Based on this examination, each participant was instructed to follow...

Title: Measurement of lower extremities spasticity in patients with cerebral palsy Objectives: The aim of the theoretical part of this thesis is to evaluate possibilities of lower extremities spasticity measurement in adult patients with cerebral palsy. The main focus was given to the concept of French professor J.-M. Gracies: Five-step clinical assessment in spastic paresis. This unique concept presents differentiation of three main factors of motor impairment that emerge as a result of a lesion to central motor pathways: stretch sensitive paresis, soft tissue contracture and muscle overactivity. Ability to distinguish these factors is crucial for specific treatment indication. Finding a correlation between the Five-step clinical assessment in spastic paresis and muscle activity in gait measured with sEMG was the main objective in the practical part of the thesis. Methodology: This thesis has a theoretical-empirical character. The theoretical part is in a form of a research on the topic of spasticity diagnosis, focused on cerebral palsy patients. The empirical part of the thesis has a form of pilot quantitative research, which was attended by 6 participants with cerebral palsy (4 men and 2 women; average age 29 years). There were 2 independent measurement made for each of them. Each measurement...