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Možnosti využití elektrotaktilní stimulace jazyka u pacientů s degenerativní cerebelární ataxií
Název práce v češtině: Možnosti využití elektrotaktilní stimulace jazyka u pacientů s degenerativní
cerebelární ataxií
Název v anglickém jazyce: Electrotactile sensory substitution in patients with degenerative cerebellar
ataxia
Klíčová slova: Biologická zpětná vazba, senzorická substituce, cerebelární ataxie, poruchy rovnováhy, elektrotaktilní stimulace jazyka
Klíčová slova anglicky: Biofeedback, Sensory substitution, cerebellar ataxia, postural disorders, tongue electrotactile stimulation
Akademický rok vypsání: 2009/2010
Typ práce: diplomová práce
Jazyk práce: čeština
Ústav: Klinika rehabilitace a tělovýchovného lékařství (13-432)
Vedoucí / školitel: doc. PhDr. Ondřej Čakrt, Ph.D.
Řešitel: skrytý - zadáno a potvrzeno stud. odd.
Datum přihlášení: 15.02.2011
Datum zadání: 15.02.2011
Datum a čas obhajoby: 02.06.2011 13:00
Datum odevzdání elektronické podoby:04.05.2011
Datum odevzdání tištěné podoby:22.04.2011
Datum proběhlé obhajoby: 02.06.2011
Oponenti: MUDr. Jaroslava Paulasová - Schwabová, Ph.D.
 
 
 
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Předběžná náplň práce
Úvod: Biologická zpětná vazba (biofeedback) na podkladě senzorické substituce představuje nový přístup v rehabilitaci pacientů s poruchami rovnováhy. Přístroj BrainPort je založen na elektrotaktilní stimulaci jazyka (ESJ). Tato inovativní technologie byla primárně vyvinuta pro pacienty s periferními vestibulárními lézemi, kteří po absolvování konvenční terapie nedosáhli uspokojivé kompenzace. ESJ má perspektivní využití i v terapii centrálních vestibulárních poruch. V naší práci se zabýváme účinky terapie s přístrojem BrainPort na rovnováhu u pacientů s degenerativní cerebelární ataxií. Zajímá nás, zda její efekt přetrvává měsíc po ukončení rehabilitačního programu.
Metody: Metodiku jsme uplatnili u 6 pacientů s degenerativní cerebelární ataxií verifikovanou klinickým vyšetřením, posturografií a genetickým vyšetřením nebo verifikací cerebelární léze dle MRI. Pacienti absolvovali 12denní intenzivní rehabilitační program s přístrojem BrainPort. Terapie byly prováděny 2krát denně. Náplní byl nácvik stability, kdy se pacienti učili vhodnou posturální korekcí udržet signál na středu jazyka. Pro zhodnocení efektu terapie jsme použili posturografické vyšetření, standardizované klinické testy - BESTest, Dynamic Gait Index (DGI) a standardizované dotazníky - The Activities-Specific Balance Confidence Scale (ABC) a Dizzines Handicap Inventroy (DHI). Vyšetření bylo provedeno před začátkem terapie, na jejím konci a měsíc po ukončení rehabilitace.
Výsledky: Práce prokazuje, že po ukončení programu dochází ke zlepšení rovnováhy. Naše studie nepotvrdila přetrvání pozitivního vlivu měsíc po ukončení terapie.
Závěr: Potvrdili jsme možnost ovlivnění rovnováhy u pacientů s degenerativní cerebelární ataxií. Úloha rehabilitace v terapii mozečkových lézí je stále diskutabilní a je třeba dalších studií. Bylo by vhodné náš výběr rozšířit o další pacienty a srovnávat vliv terapie pomocí ESJ s výsledky klasického balančního tréninku bez BrainPortu.
Předběžná náplň práce v anglickém jazyce
Introduction: Biofeedback based on sensory substitution is a new method to treat patients with postural disorders. BrainPort provides tongue electrotactile stimulation. This innovative technique was developed for vestibular dysfunction of peripheral origin. Primarily for patients who had no benefits from conventional rehabilitation. Tongue electrotactile stimulation seems to be useful for central vestibula dysfunction as well. We are dealing with effect of BrainPort in therapy of degenerative cerebellar ataxia. We are interested in whether the effects persist for one month after the rehabilitation program.
Methods: The methods are applied in 6 patients with degenerative cerebellar ataxia, verified by clinical testing, posturography, and genetic testing or verification of cerebellar lesions by MRI. Patients underwent an 12-day intensive rehabilitation program with BrainPort. Treatment was carried out 2 times a day. Patients were learning appropriate postural corrections to maintain signal in the middle of the tongue. To assess the effect of therapy we used posturography, standardized clinical tests – BESTest, Dynamic Gait Index (DGI) and standardized questionnaires - The Activities-Specific Balance Confidence Scale (ABC) and Dizzines Inventroy Handicap (DHI). The examination was performed before therapy, at the end and after month.
Results: This work shows that there is balance improvement after the program. Our study didnt affirm positive effect one month after treatment.
Conclusion: We confirmed the possibility of influencing the balance in patients with degenerative cerebellar ataxia. The role of physiotherapy in the treatment of cerebellar lesions is still controversial and needs further studies. It would be appropriate to expand our selection of other patients and to compare the effect of therapy with ESJ with the results of classical training without BrainPort.
 
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