diplomsko delo
Luka Zavec (Author), Tine Kovačič (Reviewer), Tina Grapar Žargi (Mentor)

Abstract

Uvod: Multipla skleroza je kronična avtoimuna nevrodegenerativna bolezen osrednjega živčnega sistema, ki najpogosteje prizadene mlajše odrasle. Zanjo so značilne vnetne demielinizacije z aksonskimi okvarami, ki lahko vodijo v zelo kompleksne in nepredvidljive nevrološke izpade. Motnje v hoji predstavljajo enega izmed najbolj omejujočih vidikov bolezni, zato je usmerjanje rehabilitacije k izboljšanju mobilnosti pri tovrstni populaciji ključnega pomena. Pri pacientih s hujšimi omejitvami je še posebej obetavna robotsko podprta vadba, ki je pogosto opredeljena kot v nalogo usmerjena metoda. Tovrstno vadbo hoje omogoča Lokomat, ki je definiran kot pristop z eksoskeletom, kjer sta nadzirana medenica in kinematika kolenskega sklepa, telesna teža pa je razbremenjena. Namenjen je intenzivni rehabilitacijski terapiji hoje pri odraslih in pediatričnih bolnikih s hudo do zmerno prizadetostjo hoje in funkcionalne mobilnosti. Namen: Namen diplomskega dela je bil na podlagi pregleda znanstvene in strokovne literature ugotoviti učinkovitost robotsko podprte vadbe hoje z uporabo Lokomata pri pacientih z multiplo sklerozo v primerjavi s konvencionalnimi pristopi. Metode dela: Uporabljena je bila deskriptivna metoda pregleda literature. Znanstveni članki so bili iskani v podatkovni bazi PubMed v novembru 2023. Vključeni so bili članki kontroliranih kliničnih raziskav in randomiziranih kontroliranih kliničnih raziskav, ki so preučevali vpliv uporabe Lokomata pri pacientih z multiplo sklerozo. Rezultati: V pregled smo vključili osem raziskav, v katere so zajeli 321 preiskovancev. Sedem raziskav je preiskovalno skupino primerjalo s kontrolno, ki je izvajala konvencionalno terapijo hoje ali pa prejemala fizioterapevtsko obravnavo v kombinaciji z vadbo hoje. Primerjava med skupinama je v treh raziskavah pokazala statistično značilnejše izboljšanje hitrosti in vzdržljivosti hoje za Lokomat. Le v eni raziskavi so to zabeležili na področju ravnotežja. Lokomat je v primerjavi s konvencionalnim pristopom prikazal tudi statistično značilno izboljšanje moči ekstenzorjev kolena ter kadence in dolžine koraka. Razprava in zaključek: Na podlagi rezultatov lahko zaključimo, da robotsko podprta vadba hoje z Lokomatom lahko vpliva na izboljšanje hitrosti, vzdržljivosti in ostalih parametrov hoje pri bolnikih z multiplo sklerozo. Pozitivne učinke je prikazal tudi konvencionalni pristop, vseeno pa je lahko vključevanje vadbe hoje z Lokomatom v program rehabilitacije učinkovita izbira pri bolnikih z MS. Potrebne so nadaljnje raziskave za določitev optimalne kombinacije parametrov vadbe z Lokomatom.

Keywords

diplomska dela;fizioterapija;multipla skleroza;Lokomat;hoja;

Data

Language: Slovenian
Year of publishing:
Typology: 2.11 - Undergraduate Thesis
Organization: UL ZF - University College of Health Studies
Publisher: [L. Zavec]
UDC: 615.8
COBISS: 200071939 Link will open in a new window
Views: 57
Downloads: 18
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Other data

Secondary language: English
Secondary title: Effects of robot-assisted gait training in multiple sclerosis patients – literature review
Secondary abstract: Introduction: Multiple sclerosis is a chronic autoimmune neurodegenerative disease of the central nervous system, most commonly affecting young adults. It is characterized by inflammatory demyelination with axonal damage, which can lead to highly complex and unpredictable neurological deficits. Gait disturbances represent one of the most limiting aspects of the disease, making directing rehabilitation towards improving mobility in this population crucial. For patients with severe limitations, robot-assisted training, often defined as task-oriented, holds particular promise. Such gait training is facilitated by the Lokomat, defined as an exoskeleton approach where pelvis and knee kinematics are controlled, and the patient's weight is supported. It is designed for intensive gait rehabilitation therapy in adults and pediatric patients with severe to moderate gait impairments and functional mobility. Purpose: The purpose of this diploma work was to determine the effectiveness of robot-assisted gait training using the Lokomat compared to conventional approaches in patients with multiple sclerosis based on a review of scientific and professional literature. Methods: A descriptive method of literature review was used in this diploma. Scientific articles were searched in the PubMed database in November 2023. Included were articles of controlled clinical trials and randomized controlled clinical trials examining the impact of Lokomat use in patients with multiple sclerosis. Results: Eight studies involving a total of 321 subjects were included in this review. Seven studies compared the intervention group with a control group that underwent conventional gait therapy or received physiotherapy combined with gait training. In three studies, Lokomat showed statistically significant improvements in gait speed and endurance compared to the control group, one study reported such improvements in balance. Lokomat also demonstrated statistically significant improvements in knee extensor strength, cadence and step length compared to conventional approaches. Discussion and Conclusion: Based on results, it can be concluded that robot-assisted gait training with Lokomat can improve speed, endurance, and other gait parameters in patients with multiple sclerosis. Positive effects were also demonstrated with conventional approaches; however, incorporating Lokomat gait training into rehabilitation programs can be an effective choice for MS patients. Further research is needed to determine the optimal combination of Lokomat training parameters.
Secondary keywords: diploma theses;physiotherapy;multiple sclerosis;Lokomat;gait;
Type (COBISS): Bachelor thesis/paper
Study programme: 0
Thesis comment: Univ. v Ljubljani, Zdravstvena fak., Oddelek za fizioterapijo
Pages: 26 str., [3] str. pril.
ID: 24473709