Title RAVNOTEŽA I SAMOSTALNOST VERTIKALIZACIJE KOD BOLESNIKA S PREBOLJENIM MOŽDANIM UDAROM Title (english) BALANCE AND INDEPENDENCE OF VERTICALISATION PROCESS IN RECUPERATING STROKE PATIENTS Author Ankica Terze Ćužić Mentor Mira Bučuk (mentor)Committee member Ines Mrakovčić-Šutić (predsjednik povjerenstva)Committee member Zdenka Barićev-Novaković (član povjerenstva)Committee member Mira Bučuk (član povjerenstva)Granter University of Rijeka Defense date and country 2018-09-24, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Svjetska zdravstvena organizacija definira moždani udar kao "naglo nastali žarišni ili globalni neurološki deficit koji traje dulje od 24 sata ili dovodi do smrti, a može se objasniti samo cerebrovaskularnim poremećajem". Ta se definicija danas smatra zastarjelom zbog sintagme 24 sata; naime, smatra se da je dovoljno sat vremena jer već tada se vide strukturalne promjene. Razlikuju se dvije vrste moždanog udara, hemoragijski i ishemijski.
Cilj ovog istraživanja je bio ustanoviti u kojem se periodu tijekom hospitalizacije kod bolesnika s ishemijskim moždanim udarom u području prednje moždane cirkulacije može postići relativno samostalna vertikalizacija, odnosno kada pacijent ima zadovoljavajuću ravnotežu i snagu da mu fizioterapeut minimalno asistira.
Navedeno istraživanje je provedeno na 20 bolesnika hospitaliziranih u Klinici za neurologiju KBC-a Rijeka na osnovu podataka iz medicinske dokumentacije i testiranja ispitanika. U radu su korišteni podaci koji se odnose na: dob, spol, komorbiditete (arterijska hipertenzija i kardiovaskularne bolesti), klasifikaciju moždanog udara te NIHSS Skalu za procjenu težine moždanog udara. Procjena ravnoteže se izvršila Bergovom skalom ravnoteže. Čimbenik uključenja je prvi ishemijski moždani udar neovisno o dobi i spolu. Svi podaci su statistički obrađeni.
U istraživanju je sudjelovalo 20 bolesnika, od toga 10 muškaraca i 10 žena. Prosječna dob bila je 65,8 ± 11,7. Prosječna vrijednost NIHSS Skale bila je 6 ± 3,9. 50% ispitanika bilo je u skupini s lakšim, odnosno težim funkcijskim onesposobljenjem. Kod 90% ispitanika postojali su komorbiditeti koji su faktor rizika za moždani udar. 85% ispitanika imalo je hipertenziju. Ispitanici su se vertikalizirali 3,9 ± 1,6 dan. Rezultat Bergove skale ravnoteže bio je 11,8 ± 4,4. Utvrđena je statistički značajna razlika u dobi s obzirom na težinu funkcijske onesposobljenosti, stariji ispitanici bili su teže onesposobljeni. Statistički značajna razlika utvrđena je u danu vertikalizacije ‒ ispitanici iz skupine teže onesposobljenih kasnije su se vertikalizirali, prosječno 5. dan dok su oni iz skupine lakše onesposobljenosti to uspijevali prosječno 3. dan. Značajna razlika utvrđena je u rezultatima Bergove skale ravnoteže; ispitanici s lakšom funkcijskom onesposobljenošću imali su višu vrijednost odnosno bolju ravnotežu. Stariji pacijenti su imali veće funkcijsko onesposobljenje i lošiju ravnotežu, ali nije pronađena statistički značajna razlika između dobi i dana vertikalizacije. Neurološko oštećenje koje se ocjenjuje NIHSS Skalom je povezano s ravnotežom i vertikalizacijom te prognozom oporavka nakon moždanog udara. Ispitanici koji su imali veće neurološko oštećenje odnosno funkcijsko onesposobljenje imali su lošiju ravnotežu i kasnije su se vertikalizirali. Ravnoteža i vertikalizacija su povezane i s dobi ispitanika, odnosno stariji ispitanici su imali veće funkcijsko onesposobljenje i lošiju ravnotežu. Dobra ravnoteža i samostalna vertikalizacija su preduvjet za neovisnost u aktivnostima svakodnevnog života.
Abstract (english) World Health Organization defines stroke as a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours". That definition is considered outdated today because of a syntagm 24 hours; it is observed that an hour is enough because structural changes are already visible. There are two types of stroke: haemorrhagic and ischemic.
The objective of this research was to determine in which period during the hospitalization of subjects with an ischemic stroke in the area of anterior cerebral circulation can be achieved relatively independent verticalization, meaning when patient has sufficient balance and strenght to receive minimal assistance.
This study was conducted on 20 patients hospitalised in Clinic of Neurology CHC Rijeka based on the data from medical documentation and subject testings. The used data related to: age, sex, comorbidity (arterial hypertension and cardiovascular disease), classification of stroke and National Institutes of Health Stroke Scale (NIHSS) for quantifying severity of stroke. Berg's Balance Scale was used to evaluate the balance. The factor of inclusion was first ischemic stroke regardless of age and gender. All data was statistically analysed.
20 patients participated, 10 men and 10 women. Average age was 65,8 ± 11,7 (mean ± SD) Average value of NIHSS was 6 ± 3,9. 50% of subjects were in a group with less severe that is more severe functional disability. With 90% of subjects there were comorbidities which are a risk factor for a stroke. 85% of subjects had hypertension. Subjects were verticalised 3,9 ± 1,6 day. The result of Berg' Balance Scale was 11,8 ± 4,4. Statistically significant difference was determined in age considering the gravity of functional incapacity, older subjects were severely incapacitated (70,4 ± 11,6 vs 61,1 ± 10,3, p = 0,041). Statistically significant difference was also observed in the day of verticalisation. Subjects from the more severe incapacitated group verticalised later, average the fifth day whilst those from the group of less incapacitated managed that the third day. Significant difference was determined in the results of Berg's Balance Scale: subjects with less functional disability had a higher value i.e. better balance. Older patients had higher levels of functional incapacity and lesser balance, but there is not a statistically significant difference between age and the day of verticalisation.
Neurologic deficit which is measured by NIHSS is associated with balance, verticalisation and the assessment of stroke recovery. Subjects who had more severe neurological damage that is to say functional disability had poorer balance and were verticalised subsequently. Balance and verticalisation are correlated with the age of subject meaning older subjects were more severely functionally disabled and had poorer balance. Proper balance and independent verticalisation are a prerequisite for activities of daily living.
Keywords
ishemijski moždani udar
ravnoteža
samostalna vertikalizacija
vertikalizacija
Keywords (english)
ishemic stroke
balance
independent verticalisation
verticalisation
Language croatian URN:NBN urn:nbn:hr:184:520183 Study programme Title: Graduate university study of Physiotherapy (Biomedicine and Healthcare; clinical medical sciences) Type of resource Text File origin Born digital Access conditions Access restricted to students and staff of home institution Terms of use Created on 2019-01-30 09:38:48
