Článek představuje možnosti rehabilitační péče (konkrétně fyzioterapie) u osob s roztroušenou sklerózou s těžkým neurologickým deficitem (EDSS ≥ 7,0). Teoretické poznatky jsou ilustrovány daty z naší pilotní studie domácí fyzioterapie u čtyř pacientů.
The article presents the possibilities of rehabilitation care (specifically physiotherapy) for people with multiple sclerosis with severe neurological deficit (EDSS ≥ 7.0). Theoretical findings are illustrated with data from our pilot study of home physiotherapy in 4 patients.
Úvod: Roztroušená skleróza je chronické neurodegenerativní onemocnění na autoimunitním podkladě, v jehož komplexní terapii hrají kromě farmakoterapie nedílnou roli také režimová opatření vč. pohybové aktivity. Mnoha klinickými studiemi byl prokázán pozitivní vliv pravidelné pohybové aktivity na symptomy onemocnění, přesto se však zdá, že jsou osoby s tímto onemocněním nedostatečně pohybově aktivní. Cílem naší studie proto bylo zjistit míru a typ pohybové aktivity, které se osoby s RS v ČR věnují, a jak do jejich pohybového režimu zasáhl vliv pandemie koronaviru. Metodika: Studie byla realizována formou mezinárodního dotazníkového šetření. V rámci této práce jsou prezentovány pouze výsledky od českých pacientů. Výsledky: Celkem se studie zúčastnilo 265 osob s RS (z toho 55 mužů), zastoupeni byli pacienti nově diagnostikovaní až po pacienty v chronickém stadiu (s délkou onemocnění více než 20 let). Většina respondentů (více než 80 %) se věnuje nějaké formě pohybu, přičemž nejčastější aktivitou byly chůze, zdravotní cvičení nebo jízda na kole. Pouze 64 % však naplňuje doporučené množství pohybové aktivity podle guidelines. Během pandemie také významně stouplo využívání moderních technologií při cvičebních aktivitách. Závěr: Informace o běžném pohybovém režimu pacientů mohou pomoci neurologům a rehabilitačním odborníkům lépe plánovat cvičení a pohybové aktivity pro tuto skupinu pacientů.
Introduction: Multiple sclerosis (MS) is a chronic autoimmune neurodegenerative disease. In which, in addition to pharmacotherapy, regimen measures play an integral role in complex therapy, including physical activity. Many clinical studies have demonstrated the positive effect of regular physical activity on on the symptoms of the disease, yet people with the disease seem to be insufficiently physically active. Therefore, the aim of our study was to evaluate the level of and type of physical activity that people with MS in the Czech Republic engage in, and how their exercise regimen was affected by the impact of the coronavirus pandemic. Methodology: The study was realized in the form of an international questionnaire survey. Only results from Czech patients are presented in this paper. Results: A total of 265 people with MS (55 men) participated in the study, from newly diagnosed to chronic stage patients (with disease duration of more than 20 years). The majority of respondents (more than 80%) engaged in some form of exercise, with walking, health exercises or cycling being the most common activities. However, only 64% were meeting the recommended amount of exercise according to the guidelines. The use of modern technology in exercise activities also increased significantly during the pandemic. Conclusion: Information on patients’ usual exercise regimens can help neurologists and rehabilitation professionals to better plan exercise and physical activities for this group of patients.
- MeSH
- COVID-19 MeSH
- dospělí MeSH
- elektrické vybavení a zdroje MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- pohybová aktivita * MeSH
- průzkumy a dotazníky MeSH
- roztroušená skleróza * MeSH
- senioři MeSH
- statistika jako téma MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
Background: Information about the level of physical activities in people with multiple sclerosis (MS) is available from a number of countries, but not from Central European countries. No data has been published from the Czech Republic so far. The aim of our study was to investigate the type and level of physical activities/exercise in people with MS in the Czech Republic, along with the clinical factors that may influence these physical activities. This information can assist nurses in advising on complex patient care. Methods: The clinical assessment included: the Godin–Shephard Leisure Time Physical Activity Questionnaire (GLTEQ), the 25-foot walk test (T25FW), the 2 Minute Walk Test (2MWT), the Fatigue Severity Scale (FSS), and a study-specific questionnaire that reports experience with sports and sport activities or rehabilitation exercises. Results: In our sample of 308 people with MS, 63% reported engaging in some form of physical activity. Men exercise more regularly, while irregular exercise predominates among women. Cycling and swimming are the most popular forms of physical activity for both genders. Only one third of participants exercise several times a week – as per medical recommendations. When comparing the mean values, men are classified as active and women as moderately active (according to the GLTEQ questionnaire scores). In our sample, no strong correlations were found between physical activity level and the clinical characteristics of the patients. Weak correlations were found only for fatigue (r = –0.32), neurological disability (r = –0.22), and walking ability (r = 0.25). Conclusion: Since regular physical activity is considered an integral part of the complex treatment of MS patients, this information can help nurses in counselling patients.
Background:Research in telerehabilitation (TR) in neurology tends to focus on patients with low to moderate disability. For neurology patients with severe mobility limitations, TR can help to enable rehabilitation for people whose mobility limitations make it difficult for them to access rehabilitation facilities. The aim of this study is to evaluate the interest of people with neurological disability caused by multiple sclerosis (MS) in TR services.Methods:This electronic survey targeted individuals with MS, specifically those with a higher level of disability.Results:A total of 355 patients with MS (155 with severe disabilities) participated in this study. There was no difference in interest in rehabilitation between people with mild-to-moderate and severe disabilities (p = 0.1258, confidence interval [CI] = 95%). However, we found a higher interest in upper limb exercises (p = 0.0006, CI = 95%) and balance training (p = 0.0000, CI = 95%) among people with higher disability.Conclusion:The results of this study may help to improve the planning and targeting of TR interventions, where a different focus of intervention is appropriate for patients with different levels of disability. This may enable TR to be maximally tailored to patient capabilities and current greatest limitations. For example, for people with severe disabilities, it is appropriate to focus on training the upper limb function to maintain self-sufficiency and implement interventions to prevent falls.
- MeSH
- lidé MeSH
- omezení pohyblivosti MeSH
- roztroušená skleróza * rehabilitace MeSH
- telerehabilitace * metody MeSH
- terapie cvičením metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Dysphagia is a common symptom of neurological disease, including multiple sclerosis (MS). The DYsphagia in MUltiple Sclerosis (DYMUS) questionnaire was developed as a screening tool for swallowing problems. The purpose of the present study was to validate the Czech version of the DYMUS questionnaire. We validated the questionnaire on a sample of 435 patients with MS and 135 healthy controls (HC) chosen by accidental sampling from larger, long-term studies conducted by the Prague MS Center. For the purposes of this study, we used both electronic (primary method of distribution) and paper-based (backup) versions of the questionnaire. The internal consistency of the whole scale was satisfactory (Cronbach's α =0.833). The DYMUS mean score in HC was 0.215 (standard deviation [SD] = 0.776). Normative data suggested a cut-off value for dysphagia between 1 and 2 points. Principal component analysis (PCA) showed a two-factor structure of the adapted scale. However, the structure did not completely correspond to the originally proposed dimensions of dysphagia for solids and liquids; our data supported dropout of item Q10. Criterion validity was proved by the difference in dysphagia between HC and patients MS (U = 25,546, p < 0.001) and by a positive correlation with the EDSS (Kendall's tau-b = 0.169, p < 0.001) and other patient-reported outcomes. The Czech version of the DYMUS questionnaire is a valid and reliable tool for evaluating swallowing impairment in Czech-speaking patients with MS. Moreover, the questionnaire can be administered electronically, with a paper-based backup.
- MeSH
- hodnocení výsledků péče pacientem MeSH
- lidé MeSH
- poruchy polykání * diagnóza etiologie MeSH
- průzkumy a dotazníky MeSH
- reprodukovatelnost výsledků MeSH
- roztroušená skleróza * komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Poruchy chůze jsou u roztroušené sklerózy (RS) jedním z nejvíce limitujících projevů. Cílem specifické léčby imunomodulačními léčivy (tzv. disease modyfying drugs - DMD) je zastavení, nebo alespoň co největší potlačení aktivity onemocnění. Avšak i přesto se u některých pacientů objeví poruchy chůze. V tom případě je možné nabídnout symptomatickou farmakologickou léčbu nebo léčbu rehabilitační. Ze symptomatických léků je pro terapii poruch chůze určen především léčivý přípravek fampridin (Fampyra®), který je v ČR dostupný od roku 2011. V dubnu 2022 se podařilo pro tento lék získat úhradu ze zdravotního pojištění a je tedy možné, že ošetřující lékaři se nyní budou častěji setkávat s žádostmi o předpis tohoto preparátu. Cílem tohoto článku je shrnout možné benefity tohoto léčiva a popsat specifické podmínky úhrady. Dále budou zmíněny také možnosti rehabilitační terapie poruch chůze.
Gait impairment is among the most limiting symptoms in multiple sclerosis. The goal of specific treatment with immunomodulatory drugs (disease-modifying drugs, DMD) is to halt or at least suppress disease activity as much as possible. Despite this, gait impairment may occur in some patients. In such a case, it is possible to offer symptomatic pharmacological treatment or rehabilitation therapy. Symptomatic drugs intended to treat gait impairment particularly include the medicinal product fampridine (Fampyra®) which has been available in the Czech Republic since 2011. In April 2022, it became possible to receive reimbursement by health insurance for this drug; as a result, attending physicians may now be more likely to encounter requests for prescribing this preparation. The article aims to summarize possible benefits of this drug and describe specific conditions of reimbursement. Also discussed are the options of rehabilitation therapy for gait impairment.
- MeSH
- 4-aminopyridin farmakologie terapeutické užití MeSH
- dospělí MeSH
- lidé MeSH
- neurologické poruchy chůze farmakoterapie rehabilitace MeSH
- relabující-remitující roztroušená skleróza * farmakoterapie komplikace rehabilitace MeSH
- roztroušená skleróza * farmakoterapie komplikace rehabilitace MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
Systematický rešeršní článek popisuje výsledky klinických rehabilitačních a fyzioterapeutických studií, které byly primárně zaměřeny na zlepšení rovnováhy u osob s RS. Byly prohledány databáze medicínské literatury PubMed a PEDro za pomoci kombinace těchto klíčových slov: balance, training, exercise, rehabilitation, multiple sclerosis (rovnováha, trénink, cvičení, rehabilitace, roztroušená skleróza). Za účelem rešerše bylo vyhledáno celkem 183 publikovaných klinických studií, z nichž 104 bylo zařazeno. Vyhledané studie byly zaměřené na různé rehabilitační intervence pro zlepšení rovnováhy. Nejčastěji se jednalo o fyzioterapeutické intervence, balanční trénink, silový trénink, trénink chůze a využití virtuální reality nebo robotiky. Nejvíce efektivní jsou programy zacílené na individuální obtíže na základě vyšetření rovnováhy, vedené buď individuální, nebo skupinovou formou. Pro dosažení dostatečného efektu však musí být balanční trénink dostatečně intenzivní.
This review article summarizes the results from rehabilitation and physiotherapeutic clinical studies with balance intervention in people with MS. The databases of medical literature PubMed and PEDro were searched using a combination of these keywords: balance, training, exercise, rehabilitation, multiple sclerosis. In total 183 papers were screened and 104 papers were included. In available studies, various rehabilitation interventions for balance improvement were used. Most frequently different types of physiotherapeutic approach, balance training, resistance training, gait trainig and virtual reality or robotics. The most effective are balance programs aimed at individual difficulties based on the individual balance assessment or organized in groups. To achieve a sufficient effect, however, balance training must be adequately intensive.
- MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- metaanalýza jako téma MeSH
- posturální rovnováha MeSH
- rehabilitace metody MeSH
- roztroušená skleróza * rehabilitace MeSH
- terapie cvičením metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Multiple sclerosis (MS) is a chronic autoimmune neurodegenerative disease. This disease can manifest itself in many different neurological symptoms such as (gait and balance impairment, sensory deficits, muscle weakness, spasticity, bladder impairment, fatigue, cognitive impairment etc.). For successful disease management not only pharmacological treatment is important, but also a healthy lifestyle including regular physical activity. However, pandemic restrictions limited access to sport facilities and together with home-office regimen, increased the sedentary behaviour in all population. The pandemic level of physical activity in people with MS in the Czech Republic remains unclear. Therefore, using an online cross-sectional survey we aimed to evaluate physical activity (PA) level in people with MS during Covid-19 pandemic. Two hundred ninety-seven persons with MS filled out online survey, 83 % women, with a mean age 43.7 years (SD 11.3). Most respondents had mild to moderate disability (74 %). During pandemic year 2020, 23 % persons with MS ceased their PA, 18 % reduced their PA, 25 % continued their PA as before, 11 % increased their PA, and 20 % did not perform any PA in the past and did not do so during the pandemic. Aerobic activity was the main type of performed PA, followed by health exercise and yoga. Total of 37 % people reported that their fitness level had decreased during the pandemic.
