- 1 - Abstract Geriatric palliative care integrates two medical disciplines, namely geriatrics, focused on the diagnosis and treatment of diseases specific to the elderly, and palliative care, which is a comprehensive, active and qualified approach aimed at improving the quality of life of patients and their families in a situation where they suffer life-threatening illnesses. Palliative care is realized through multidisciplinary teams and a nutrition specialist is one of the most important specialization in the care of frail geriatric patients, even though its position in teams is still not firmly established. This work is dedicated to nutrition specialists, aims to introduce them into the issue of geriatric palliative care and to help them with a complex perception of the patients and the application of a palliative approach into nutritional care. It also deals in detail with anorexia and dysphagia, two of the frequent and major symptoms that we encounter in frail geriatric patients. The nutrition specialists can best try to solve these problems. The work should also help other professionals who are involved in providing palliative care, understanding the role of nutrition specialist and its effective use to improve the quality of patient's life. The empirical part describes a case report of almost one...

This diploma thesis deals with the topic of nutritional support in patients with neurological diseases (stroke, craniocerebral trauma, critical-illness-polyneuropathy. The aim of this thesis is to find out, how implemented unified system of nutritional support affects the well-being of patients at neuro-rehabilitation clinic Asklepios Schlossberg Klinikum in Bad König. There were observed 58 patients (33 men and 25 women) during 8 weeks. The theoretical part of this thesis describes basic components of nutrition, energy expenditure and needs, selected neurological diseases, dysphagia, malnutrition and nutrition in intensive neurological care. The practical part of the thesis analyses data obtained by the observation. There are observed changes of body weight, BMI and laboratory values of total protein and albumin in serum. These data are divided by sex, age and type of disease. Based on the results, it was found that although patients due to uniform tube feeding do not have sufficient protein intake, serum total protein and albumin levels increased. This can be caused by eating a uniform diet that contains good quality protein in patients, which suffered from hypoalbunemia at the outset of observation, also by reducing the effect of stress reactions with gradual improvement of the state and...

The Occupational Therapist's Intervention for Adult Patients with Neurogenic Dysphagia Abstract of the Thesis: Dysphagia is a serious disorder, often caused by a cerebrovascular accident; in many cases it may be its only or primary symptom, and even the cause of death. The main objective of this thesis is to raise awareness of swallowing disorders among occupational therapists. Despite the fact that the occupational therapist's intervention for patients with swallowing disorder is common practice among occupational therapists abroad, this issue still is not well known among occupational therapists in the Czech Republic. There is also a considerable lack of Czech literature dealing with swallowing disorders from the occupational therapy point of view. This thesis therefore not only presents theoretical findings in this field but also recommends practical procedures for occupational therapists. The theoretical part of the thesis describes functional anatomy of the swallowing structures and swallowing physiology and pathophysiology. It analyses different causes of dysphagia with a focus on neurological disorders, defines the term dysphagia and other related terms, and briefly explains several classification methods of dysphagia. While the first part of the thesis looks primarily into the diagnostics and...

The diploma thesis deals with the topic of field language and speech therapy for people with dysphagia. The work is divided into four chapters, while the first three define the theoretical framework of the work, the fourth chapter is empirical. The introductory chapter provides an insight into the physiology of swallowing and the anatomy of the orofacial area. The following chapter is devoted to the issue of dysphagia. The final theoretical chapter offers an insight into speech therapy intervention in patients with dysphagia. The fourth chapter presents a mixed design of a research survey focusing on the provision of field speech therapy care for people with dysphagia in the Czech Republic. The main goal of the research survey was to analyze the provision of this care in our country. This was followed by setting partial goals of the work and research questions. Within them, the work tries to analyze the specifics and barriers to the provision of field speech and language therapy care for patients with dysphagia. A questionnaire survey among clinical speech therapists and interviews with some of them was developed. The conclusion of the work is a summary of the results of the research survey supplemented by recommendations for speech therapy practice. The appendix contains a list of contacts of...

This diploma thesis deals with the topic of nutritional support in patients with neurological diseases (stroke and Critical-Illness-Polyneuropathy). The aim of this thesis is to find out, how implemented unified system of nutritional support affects the well-being of patients at neuro-rehabilitation clinic Asklepios Schlossberg Klinik in Bad König. There were observed 55 patients (30 men and 25 women) for 8 weeks. The theoretical part of this thesis describes basic components of nutrition, energy expenditure and needs, selected neurological diseases, dysphagia, malnutrition. The emphasis is put on nutrition in intensive neurological care. The practical part of the thesis analyses data obtained by the observation. There are observed changes of body weight, BMI and laboratory values of total protein, albumin and glycaemia in serum. These data are divided by sex, age, type of disease and initial BMI values. The observed patients had mainly overweight and obesity, which have lost a part of their excess weight due to catabolism. At the beginning of the observation 13 patient had normal BMI value, this number of patients rose to 24 after eight weeks. At the end of the observation the reduction of BMI value was on the average 2.45 units. Based on the results, it was found that although patients due to...

OF THE THESIS This Master's thesis is dedicated to providing a complete account and analysis of activities designed to tackle specific logopaedic difficulties associated with Parkinson's disease. The principal theoretical sections of this thesis are concerned with an in-depth overview of Parkinson's disease and hypokinetic dysarthia (a speech disorder associated with Parkinson's disease), the dynamics of working with a group of senior participants, the Parkinson Society, the place of logopaedic therapy in Society and of specific components of logopaedic therapy aimed at persons with Parkinson's disease. The practical section which follows then proposes and carefully outlines specific activities suitable for such therapy. Activities are classified by their objectives - areas they intend to exercise improve. Designs of two model lessons comprising a combination of the activities proposed in the preceding chapters are included in the final section of the thesis.

The topic of this thesis is discussion of usage of myofunctional therapy on persons with communicative disorders. The main goal is to map the extent and possibilities of this therapy in speech therapy practice. The theoretical part deals with physiology and patophysiology of breathing, sucking, swallowing and the orofacial system. Further, in connection with myofunctional therapy it discusses its historical development, methodical approaches, utilities, therapeutical benefits and possibilities of education on this field. The empirical part contains a quantitative investigation, which analyses the extent and usage possibilities of this therapy by speech-language pathologists in the Czech Republic. Based on the data obtained by a questionnaire distributed to speech-language pathologists it can be stated, that about 20 % of the respondents do not use the myofunctional therapy in practice, while those (with one exception) never took part on an expert training. The offer of the trainings is rated as insufficient. The myofunctional therapy can be used on persons with orofacial disorders regardless of age or communicative disorder. KEYWORDS: myofunctional therapy, communicative disorder, swallowing, dysphagia, bite disorders, orofacial area

Need of nutritional intervention in patients after stroke Summary Aims: To identify how many patients after acute stroke have accurate oral intake of energy and proteins and how is this condition changed after one month of hospitalization. To evaluate the association between dysphagia and food intake. Methods: The evaluation was conducted by observations of food intake, eaten food records, calculating of energy and nutrients intake and comparing to needed energy (by Harris-Benedicts equation) and proteins. GUSS screening tool was used to evaluation of swallowing, ADL test for self-sufficiency assessment. Data included antropometrical indicators (weight, height, arm circumference) and nutritional screenings in Thomayer hospital in Prague. Results: Of the 35 patients, 54 % had adequate oral intake of energy and 23 % adequate intake of proteins in the first week after stroke. Adequate oral intake of energy was indicated in 66 % of patients and adequate intake of proteins in 11 % after one month of hospitalization. There were no significant improvements of oral energy intake (p=0,2891, α=0,05) or protein intake (p=0,1336, α=0,05) after one month of hospitalization. 84,4 % of patients suffered from dysphagia in first week after stroke and 60,6 % after one month of hospitalization. Correlation between inadequate...

The diploma thesis is focused on the issue of acquired dysarthric and swallowing disorders in amyotrophic lateral sclerosis and on multidisciplinary care provided to patients with this disease. Theoretical part of the thesis is divided into three chapters. The introductory chapter presents a summary of current knowledge about amyotrophic lateral sclerosis (ALS). The following two chapters are dedicated to dysarthria and dysphagia and their specifics in ALS. The practical part of the diploma thesis is represented by the fourth chapter which incorporates a research survey focused on multidisciplinary care provided to patients with ALS. The primary aim of the research is to evaluate the multidisciplinary care provided to two selected patients with ALS with a focus on speech and swallowing disorders. The secondary objectives of the research relate to the evaluation of the extent of acquired dysarthric and swallowing disorders of these patients, providing a comprehensive overview of the course and content of the provided care and gathering information to create information brochure for patients with ALS and caregivers. The research approach to achieve the determined objectives of the research survey is creation of case studies using qualitative methods of data collection, which is a structured interview...

This diploma thesis presents an analysis of speech impairments accompanying Parkinson's disease. This paper is divided into two sections - theoretical and practical. The first section gives a brief overview of available Czech and foreign literature and articles about this neurodegenerative disease. The section examines the questions of its aetiology, symptomatology, diagnostics and treatment. There can be found also a description of speech impairment connected with this disease, which is mainly hypokinetic and hyperkinetic dysarthria and dysphagia. It also deals with the problem of other limitations in communication such as facial bradykinesia or speech intelligibility. In the last chapter of theoretical part is described speech therapy and intervention with the emphasis on therapy, diagnostics and the effects of pharmacology an non-pharmacological treatment such as deep brain stimulation on speech performance in Parkinson's disease. The research part analyses speech impairment of people with Parkinson's disease. The aim of this diploma thesis was examination of this speech impairment using the Test 3F: Dysarthria profile and patient's own perception of this specific speech disorder. In this paper are presented eight case studies focusing on speech of clients with Parkinson's disease. The results...