• Konspekt
• Patologie. Klinická medicína

BACKGROUND: The recovery of autonomic functions and the ability to reproduce in particular is of the highest priority to individuals with spinal cord injury (SCI). The potential of epidural spinal cord stimulation (ESCS) for promoting recovery of sensorimotor functions in the chronic phase of SCI has long been studied. In recent years, several studies have emerged confirming the positive effect of ESCS also on the cardiovascular system and neurogenic bladder and bowel. However, the potential of ESCS in restoring sexual function, especially ejaculation, has not yet been addressed. CASE REPORT: Two cases of people with chronic sensorimotor complete SCI in the 4th thoracic spinal segment are presented. Both men were also diagnosed with severe erectile dysfunction and anejaculation. Thanks to ESCS, Participant 1 successfully restored the ejaculatory reflex using PVS in his home environment. His outcome was subsequently verified under clinical conditions. During ESCS, Participant 1 was also able to achieve ejaculation by masturbation; moreover, he conceived a child naturally without the need for IVF. In Participant 2, we then demonstrated the same effect of ESCS on the restoration of the ejaculatory reflex when targeting the stimulation to the same spinal segment. CONCLUSION: This is the first report on the potential of ESCS for restoring the ability to ejaculate in individuals with complete SCI. Confirmation of these results could significantly reduce the need for assisted reproduction and improve the quality of life of men after SCI in the future.

• MeSH
• dospělí MeSH
• ejakulace * fyziologie   MeSH
• epidurální prostor MeSH
• erektilní dysfunkce etiologie   terapie   patofyziologie   MeSH
• hrudní obratle MeSH
• lidé MeSH
• míšní stimulace * metody   MeSH
• poranění míchy * komplikace   patofyziologie   terapie   rehabilitace   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Článek prezentuje českou verzi vyšetřovacího protokolu podle konceptu Dynamická neuromuskulární stabilizace (DNS) a jeho využití v klinické praxi. V úvodní části je DNS protokol porovnán s vyšetřovacím protokolem podle konceptu Mechanická diagnostika a terapie a podle konceptu Functional Movement Screen z hlediska „intra-rater“ a „inter-rater“ reliability. Následně je prezentována kazuistika pacientky, u níž bylo pro funkční vyšetření pohybového systému využito kombinace vyšetřovacího DNS protokolu, přístrojového vyšetření posturální stabilizace pomocí DNS Brace a krátké verze dotazníku bolesti McGillovy univerzity. Pacientka byla těmito metodami vyšetřena před zahájením terapie a po 6 týdnech terapie. Výsledky subjektivního hodnocení pacientky a klinického vyšetření terapeutem pomocí DNS protokolu a DNS Brace potvrdily pozitivní efekt terapie. Uvedená kombinace vyšetření pomocí DNS protokolu, DNS Brace a standardizovaného dotazníku bolesti může být vhodným vyšetřovacím postupem u pacientů s muskuloskeletálními poruchami.

This article presents the Czech version of the examination protocol according to the Dynamic Neuromuscular Stabilization (DNS) concept and its use in the clinical practice. In the introductory part, the DNS protocol is compared with the examination protocols according to the Mechanical Diagnosis and Therapy and Functional Movement Screen in terms of “intra-rater” and “inter-rater” reliability. A case report presenting complex functional assessment of a patient using a combination of DNS examination protocol, DNS Brace to evaluate postural stabilization, and a short version of the McGill University Pain Questionnaire is presented within this paper. The patient was examined by the combination of the three methods before therapy and after six weeks of the therapy. The results of the patient‘s subjective assessment and the therapist‘s clinical examination using the DNS protocol and DNS Brace confirmed a positive effect of the therapy. The combination of the DNS protocol, DNS Brace and a standardised pain questionnaire may be an appropriate examination procedure for patients with musculoskeletal disorders.

• Klíčová slova
• dynamická neuromuskulární stabilizace,
• MeSH
• fyzikální vyšetření metody   MeSH
• hodnocení výsledků péče pacientem MeSH
• klinické protokoly * MeSH
• lidé MeSH
• měření bolesti MeSH
• mladý dospělý MeSH
• neuromuskulární nemoci diagnóza   MeSH
• pohybová aktivita MeSH
• postura těla MeSH
• posturální rovnováha * MeSH
• reprodukovatelnost výsledků MeSH
• terapie cvičením metody   MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• srovnávací studie MeSH

Senzorická integrace se podílí na optimálním provedení pohybu. Při opakovaném neideálním příjmu informací z okolního prostředí může docházet k narušení procesu motorického učení. Dominantním lidským smyslem je zrak. Vizuální informace jsou na úrovni centrálního nervového systému (CNS) integrovány se vstupními informacemi z jiných smyslových orgánů a kontinuálně ovlivňují motorickou činnost. V současné době se v oboru rehabilitace i ve sportu používá pojem neurovizuální systém (NVS), který zohledňuje propojení osy oči–mozek–tělo. Článek shrnuje recentní informace o NVS a představuje možnosti diagnostiky NVS v klinické praxi, jako je testování zrakové ostrosti, motility očí a blízkého bodu konvergence. Na základě dostupné literatury jsou popsány indikační skupiny pacientů, u kterých by mohl být neurovizuální trénink (NVT) efektivní součástí rehabilitace, i možnosti využití u sportovců v rámci sportovního tréninku. Součástí publikace jsou dvě kazuistiky, které demonstrují vyšetření NVS a využití NVT v klinické praxi u adolescenta s poruchou pozornosti a vrozenou diplopií a u mladé tenistky s bolestmi hlavy.

Sensory integration plays a crucial role in the smooth execution of movements. However, the repeated intake of suboptimal information from our surroundings can disrupt the motor learning process. Sight stands out as the dominant human sense, providing visual information that is integrated at the central nervous system (CNS) level. This integration occurs alongside inputs from other sensory organs, constantly influencing motor activity. The term “neuro-visual system” (NVS) is now widely recognized in the fields of rehabilitation and sports, highlighting the crucial eye–brain–body axis connection. This article provides an overview of recent findings on the NVS exploring diagnostic procedures relevant to NVS in clinical settings. These procedures include tests for visual acuity, eye motility, and the near point of convergence. Drawing on existing literature, it identifies specific patient groups for whom neuro-visual training (NVT) could significantly enhance rehabilitation outcomes. Additionally, it discusses the potential benefits of NVT for athletes as an integral part of their sports training regimen. Included in the publication are two case studies illustrating NVS assessment and the application of NVT in clinical practice. The first case involves an adolescent with attention disorder and congenital diplopia, and the second, a young tennis player suffering from headaches. These examples underscore the practical value of NVS diagnostics and neuro-visual training in addressing specific health and performance issues.

• Klíčová slova
• neurovizuální trénink, Senaptec, RightEye, senzorická integrace, neurovizuální systém,
• MeSH
• cvičení * MeSH
• mladiství MeSH
• oči - fyziologické jevy MeSH
• oči anatomie a histologie   patofyziologie   MeSH
• poruchy zraku * diagnóza   rehabilitace   MeSH
• sporty MeSH
• zrakové testy metody   přístrojové vybavení   MeSH
• Check Tag
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• přehledy MeSH

BACKGROUND: There is growing evidence for the effectiveness of mirror therapy (MT) on pain reduction in patients with type I complex regional pain syndrome (CRPS I). AIM: To evaluate the efficacy of MT on pain reduction and hand function in subjects with unilateral upper extremity CRPS I. DESIGN: Randomized controlled trial with control group cross-over (half cross-over design). SETTING: Subjects with CRPS I were outpatients of a university hospital and cooperating centers. All patients carried out the daily exercise at home. POPULATION: Subjects with unilateral upper extremity CRPS I meeting the Budapest diagnostic criteria. METHODS: Subjects were randomly divided into two groups. Group A (N.=13) carried out a ten-minute MT exercise daily, for a total duration of six weeks. Group B (N.=14) acted as a control group for six weeks followed by six weeks of MT with the same characteristics as Group A. Upper extremity active range of motion, strength, dexterity, limb volume, affected-to-unaffected hand temperature difference, and health-related quality of life were evaluated before and after each period. Daily records on the visual analogue scale were used for pain evaluation. Effectiveness was calculated using mixed-effects modelling for between-group comparisons and within-group variability, and identification of significant predictors. RESULTS: Twenty-three females and four males with an average age of 56.1±9.6 years completed the study. Except for the affected-to-unaffected hand temperature difference, both groups consistently demonstrated significant or near-significant improvements in measured parameters after MT period. The improvements were evident upon an intergroup comparison of Group A and the control period of Group B as well as longitudinally within Group B. No significant improvement was found during the control period. CONCLUSIONS: Principles focused on mirror visual feedback to the central nervous system can sustain promising therapeutic potential as part of the treatment for pain reduction and hand function in CRPS I patients. CLINICAL REHABILITATION IMPACT: MT can be considered as part of the therapeutic regimen employed for the treatment of CRPS I.

• MeSH
• bolest MeSH
• horní končetina MeSH
• komplexní regionální syndromy bolesti * terapie   MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• senzorická zpětná vazba MeSH
• Sudeckův syndrom * terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: Abdominal bracing is a maneuver widely used by rehabilitation specialists and sports trainers to improve spinal stability. This study aimed to investigate how lifting tasks with and without abdominal bracing affect the respiratory function of the diaphragm. METHODS: M-mode ultrasonographic assessment of diaphragmatic motion combined with spirometry was performed on 31 healthy adults. Participants were asked to breathe continuously whilst lifting a load with spontaneous abdominal muscle contraction (natural loaded breathing) and abdominal bracing (AB loaded breathing). RESULTS: Pearson's correlations revealed strong correlations between ultrasonography and spirometry measures (p < 0.001) for all types of breathing: tidal breathing (r = 0.709, r2 = 0.503), natural loaded breathing (r = 0.731, r2 = 0.534) and AB loaded breathing (r = 0.795, r2 = 0.632). Using paired-samples t-tests, the natural loaded breathing ultrasonography revealed more caudal diaphragm positions during inspiration (p < 0.001) but not during expiration (p = .101). Spirometry demonstrated lower lung volumes (L) at the end of inspiration and expiration (p < 0.001), with no changes in total lung volume (p = 0.06). The AB loaded breathing ultrasonography revealed more caudal diaphragm positions during inspiration (p = 0.002) but not during expiration (p = 0.05). Spirometry demonstrated lower lung volumes at the end of inspiration (p < 0.001), expiration (p = 0.002), and total lung volumes (p = 0.019). CONCLUSION: This study demonstrated that abdominal bracing performed during a lifting task reduces lung volume despite an increase in diaphragmatic motion. Diaphragm excursions strongly correlate with lung volumes even under postural loading. TRIAL REGISTRATION: The study was prospectively registered on 8 April 2021 at ClinicalTrials.gov with identification number NCT04841109.

• Publikační typ
• časopisecké články MeSH

The pathogenesis of gastroesophageal reflux disease (GERD) is multifactorial. The severity of abnormal reflux burden corresponds to the dysfunction of the antireflux barrier and inability to clear refluxate. The crural diaphragm is one of the main components of the esophagogastric junction and plays an important role in preventing gastroesophageal reflux. The diaphragm, as a skeletal muscle, is partially under voluntary control and its dysfunction can be improved via breathing exercises. Thus, diaphragmatic breathing training (DBT) has the potential to alleviate symptoms in selected patients with GERD. High-resolution esophageal manometry (HRM) is a useful method for the assessment of antireflux barrier function and can therefore elucidate the mechanisms responsible for gastroesophageal reflux. We hypothesize that HRM can help define patient phenotypes that may benefit most from DBT, and that HRM can even help in the management of respiratory physiotherapy in patients with GERD. This systematic review aimed to evaluate the current data supporting physiotherapeutic practices in the treatment of GERD and to illustrate how HRM may guide treatment strategies focused on respiratory physiotherapy.

• MeSH
• dechová cvičení MeSH
• gastroezofageální junkce MeSH
• gastroezofageální reflux * MeSH
• lidé MeSH
• manometrie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• systematický přehled MeSH

OBJECTIVES: The diaphragm changes position and respiratory excursions during postural loading. However, it is unclear how it reacts to lifting a load while breath-holding or breathing with simultaneous voluntary contraction of the abdominal muscles (VCAM). This study analyzed diaphragm motion in healthy individuals during various postural-respiratory situations. METHODS: 31 healthy participants underwent examination of the diaphragm using M-mode ultrasonography, spirometry, and abdominal wall tension (AWT) measurements. All recordings were performed simultaneously during three consecutive scenarios, i.e., 1. Lifting a load without breathing; 2. Lifting a load and breathing naturally; 3. Lifting a load and breathing with simultaneous VCAM. RESULTS: Using paired-samples t-tests, lifting a load without breathing displaced the diaphragm's expiratory position more caudally (P < .001), with no change noted in the inspiratory position (P = .373). During lifting a load breathing naturally, caudal displacement of the diaphragm's inspiratory position was presented (P < .001), with no change noted in the expiratory position (P = 0.20) compared to tidal breathing. Total diaphragm excursion was greater when loaded (P = .002). Lifting a load and breathing with VCAM demonstrated no significant changes in diaphragm position for inspiration, expiration, or total excursion compared to natural loaded breathing. For all scenarios, AWT measures were greater when lifting a load (P < .001). CONCLUSION: In healthy individuals, caudal displacement and greater excursions of the diaphragm occurred when lifting a load. The postural function of the diaphragm is independent of its respiratory activity and is not reduced by the increase in AWT.

• MeSH
• bránice * diagnostické zobrazování   fyziologie   MeSH
• dýchání * MeSH
• lidé MeSH
• svalová kontrakce MeSH
• ultrasonografie MeSH
• vydechnutí MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Intra-abdominal pressure (IAP) is an important mechanism stabilizing the spine and trunk. IAP regulation depends on the coordination of abdominal muscles, diaphragm and pelvic floor muscles. OBJECTIVE: To determine the differences in abdominal wall tension (AWT) of various postural positions, first without any correction, then after verbal and manual instructions according to Dynamic Neuromuscular Stabilization (DNS) principles. METHODS: In a cross-sectional observational study, thirty healthy individuals (mean age = 22.73 ± 1.91 years) were fitted with two Ohmbelt sensors contralaterally above the inguinal ligament and in the upper lumbar triangle. AWT was measured during five postural positions: sitting, supine with legs raised, squat, bear and hang position. First, spontaneous AWT was measured, then again after manual and verbal instructions following DNS principles. RESULTS: AWT increased significantly with DNS instructions compared to spontaneous activation. Both sensors recorded significant increases (p < .01; Cohen's d = -1.13 to -2.06) in all observed postural situations. The increase in activity occurred simultaneously on both sensors, with no significant differences noted in pressure increases between the sensors. The greatest activation for both sensors occurred in the bear position. Significant increases in activity were identified for both sensors in the supine leg raise position and in the bear position compared to spontaneous activation in sitting (p < .001). There were no statistically significant differences (for both sensors) between women and men in any position. CONCLUSION: The amount of AWT significantly increases after verbal and manual instructions according to DNS. The greatest abdominal wall activation was achieved in the bear position.

• MeSH
• břišní stěna * MeSH
• břišní svaly MeSH
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• postura těla fyziologie   MeSH
• průřezové studie MeSH
• šikmé svaly břišní MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

BACKGROUND: Anorectal dysfunction (ARD), especially bowel incontinence, frequently compromises the quality of life in multiple sclerosis (MS) patients. The effect of rehabilitation procedures has not been clearly established. OBJECTIVE: To determine the effect of an individualized rehabilitation approach on bowel incontinence and anorectal pressures. METHODS: MS patients with ARD underwent 6-months of individually targeted biofeedback rehabilitation. High resolution anorectal manometry (HRAM) and St. Mark's Fecal Incontinence Scores (SMIS) were completed prior to rehabilitation, after 10 weeks of supervised physiotherapy, and after 3 months of self-treatment. RESULTS: Ten patients (50%) completed the study. Repeated measures analysis of variance (ANOVA) demonstrated significant improvement in the SMIS questionnaire over time [14.00 baseline vs. 9.70 after supervised physiotherapy vs. 9.30 after self-treatment (p = 0.005)]. No significant improvements over time were noted in any HRAM readings: maximal pressure [49.85 mmHg baseline vs. 57.60 after supervised physiotherapy vs. 60.88 after self-treatment (p = 0.58)], pressure endurance [36.41 vs. 46.89 vs. 49.95 (p = 0.53)], resting pressure [55.83, vs 52.69 vs. 51.84 (p = 0.704)], or area under the curve [230.0 vs. 520.8 vs. 501.9 (p = 0.16)]. CONCLUSIONS: The proposed individualized rehabilitation program supports a positive overall effect on anorectal dysfunction in MS patients.

• MeSH
• biofeedback (psychologie) MeSH
• fekální inkontinence * etiologie   MeSH
• kvalita života MeSH
• lidé MeSH
• manometrie MeSH
• pilotní projekty MeSH
• roztroušená skleróza * komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH