BACKGROUND: The effects of expiratory muscle strength training (EMST) has not yet been investigated in MSA patients. OBJECTIVE: The primary objective was to test the effects of EMST on expiratory muscle strength and voluntary peak cough flow (vPCF) in patients with multiple system atrophy (MSA). The secondary objective was to assess the suitability of the pulmonary dysfunction index as a tool for identifying MSA patients with expiratory muscle weakness and reduced voluntary peak cough flow. METHODS: This was an open label, non-controlled study, with an 8-week intensive home-based EMST protocol. The outcome measures included: maximal expiratory pressure (MEP) and vPCF. The sensitivity and specificity of the index of pulmonary dysfunction in the respiratory diagnostic process were assessed using receiver operating characteristic (ROC) analysis. RESULTS: Fifteen MSA patients were enrolled in the study. Twelve MSA patients completed the training period. After the training period, MEP significantly increased (P = 0.006). Differences in vPCF were not significant (P = 0.845). ROC analysis indicated that the overall respiratory diagnostic accuracy of the index of pulmonary dysfunction had an outstanding capability to detect patients at risk of less effective coughing and an acceptable capability of detecting patients with decreased expiratory muscle strength. CONCLUSIONS: These findings indicate non-significant differences in vPCF after 8 weeks of EMST. The index of pulmonary dysfunction appears to be a promising prognostic screening tool for identifying altered cough efficacy in MSA patients. Test cut-offs may be used to select an appropriate respiratory physiotherapy technique.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- časopisecké články MeSH
This opinion paper reviews the use of the category of "conventional physiotherapy" (CPT) in Parkinson's disease (PD)-relevant reviews and meta-analyses and points out serious inconsistencies within and among them. These are first discussed in general, leading to the conclusion that, in most cases, the category of CPT encompasses a range of incompatible interventions. This undermines previous conclusions about their superiority or inferiority relative to various other treatment modalities. Next, the update to the European Physiotherapy Guidelines is discussed in detail, since it treats CPT as a global and time-independent category per se, ascribing effects in various domains to it. This introduces several important biases into the findings presented in this publication. These are subsequently discussed, and it is concluded that the categorisation of various physiotherapy techniques under the umbrella term of CPT is empty, or even dangerous, and should be abandoned. Other categories are suggested as a replacement, including "Other Physiotherapy Techniques" and "Multimodal Training".
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The efficacy of expiratory muscle strength training (EMST) in patients with multiple sclerosis (MS) is controversial. The current study's primary objective was to test the effects of a progressive and intensive 12 week home based EMST program on expiratory muscle strength and voluntary cough strength. The secondary objective was to determine the retention of EMST benefits. METHODS: Thirty-five severely disabled MS patients (relapsing-remitting MS, n = 15; primary progressive MS, n = 5; secondary progressive MS, n = 15) with Expanded Disability Status Scale (EDSS) 5.0 - 7.0 were included in the study. Within 36 weeks, patients completed 12 weeks of a non-training period, 12 weeks of EMST and 12 weeks of a detraining period. Maximal expiratory pressure (PEmax) and voluntary peak cough flow (vPCF) were assessed 4 times: at week 0 (baseline), week 12 (pre-training), week 24 (post-training), and week 36 (post-detraining). MS patients included in the study were compared to age- and sex-matched healthy subjects. In the healthy controls, the PEmax and vPCF were assessed once to obtain normative data. RESULTS: Twenty-six patients completed the training period (mean age 52.7 ± 10.2, EDSS 5.9 ± 0.6) and were compared to 26 sex- and age-matched healthy subjects (mean age 53.5 ± 5.8). Patients with MS had a lower PEmax (p = 0.002) and vPCF (p = 0.022) at baseline than the healthy control group. In training period, the PEmax and vPCF increased (p = 0.0000; effect size: d = 0.94 and p = 0.0036; d = 0.57 respectively) in comparison with the non-training period (p = 0.0692; d = -0.36 and p = 0.5810; d = 0.11 respectively). Following the 12 weeks detraining period, the PEmax and vPCF declined but remained 16.7% and 5.5% respectively above the pre-training values. No differences were observed in the PEmax and vPCF between the MS group at the post-training and post-detraining timepoint and the healthy control group normative values. CONCLUSIONS: EMST improves expiratory muscle strength and voluntary cough strength in severely disabled MS patients.
Téměř 40 % pacientů s Parkinsonovou nemocí umírá v důsledku pneumonie. Schopnost zajištění hygieny dýchacích cest je u těchto pacientů často přehlížena a není objektivně vyšetřována. K usnadnění a zefektivnění expektorace u pacientů s Parkinsonovou nemocí lze využít vybrané techniky respirační fyzioterapie. Algoritmus volby těchto technik se řídí výsledky vyšetření efektivity expektorace a síly respiračního svalstva.
Up to 40% of patients with Parkinson's disease die due to pneumonia. In Parkinson's disease patients, the ability to maintain airway hygiene is often overlooked and not routinely assessed. Respiratory physiotherapy techniques can be used to make expectoration easier and more effective in these patients. The algorithm of choice of these techniques is governed by the results of cough efficiency and respiratory muscle strength examination.
- Klíčová slova
- expektorace, vrcholový průtok při kašli, síla dýchacích svalů, techniky hygieny dýchacích cest,
- MeSH
- dýchací svaly MeSH
- kašel patofyziologie rehabilitace MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- Parkinsonova nemoc * komplikace rehabilitace MeSH
- rehabilitace metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Klíčová slova
- posturální instabilita,
- MeSH
- ataxie rehabilitace MeSH
- lidé MeSH
- posturální rovnováha MeSH
- roztroušená skleróza * rehabilitace MeSH
- Check Tag
- lidé MeSH
- MeSH
- lidé MeSH
- paréza terapie MeSH
- rehabilitace metody MeSH
- roztroušená skleróza * rehabilitace MeSH
- Check Tag
- lidé MeSH
- MeSH
- ataxie patologie terapie MeSH
- fyzioterapie (techniky) * MeSH
- lidé MeSH
- nemoci nervového systému * klasifikace patologie terapie MeSH
- neurologické poruchy chůze klasifikace patologie terapie MeSH
- paréza klasifikace patologie terapie MeSH
- posturální rovnováha MeSH
- svalová slabost patologie terapie MeSH
- vestibulární nemoci patologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Cévní mozková příhoda patří k nejčastějším akutním stavům v neurologii a je spojena se závažnou disabilitou a vysokou mortalitou. Doporučení pro diagnostiku a léčbu CMP se rychle rozvíjejí zejména díky možnosti mezioborové spolupráce. Mnozí pacienti jsou malnutriční nebo v riziku rozvoje malnutrice ještě před vznikem CMP, proto je důležitý pravidelný nutriční skríning již při přijetí do nemocnice. Zhoršení nutričních parametrů často souvisí se základním onemocněním a hospitalizací. Včasná a přiměřená nutriční podpora, cílená diagnostika a rehabilitace poruch řeči a polykání společně s fyzioterapií mohou přispět ke stabilizaci pacienta, příznivě ovlivnit vývoj komplikací, zlepšit prognózu a kvalitu života. Předkládaný text vychází z doporučení schválených Evropskou společností pro klinickou výživu a metabolizmus a ze zkušeností v ČR.
Stroke is one of the most frequent acute events in neurology and it is associated with severe disability and high mortality. Advances in current diagnostic and therapeutic guidelines reflect the advances in a multidisciplinary approach. Malnutrition or a risk of malnutrition in stroke patients is common and systematic nutrition screening at admission is important. Acute illness and hospitalization can contribute to worsening of nutritional status. Appropriate timing of nutritional support, early capture and rehabilitation of speech and swallowing disorders together with physiotherapy may reduce incidence of complications, improve patient's clinical outcome, prognosis and quality of life. The presented summary is in agreement with consensus of the European Society for Clinical Nutrition and Metabolism and recommended best practice expert consensus in the Czech Republic.
- Klíčová slova
- perkutánní endoskopická gastrostomie, dieta s upravenou texturou stravy,
- MeSH
- cévní mozková příhoda * dietoterapie MeSH
- enterální výživa metody MeSH
- fyzioterapie (techniky) MeSH
- klinická logopedie MeSH
- lidé MeSH
- nutriční stav MeSH
- nutriční terapie metody MeSH
- podvýživa diagnóza terapie MeSH
- poruchy polykání MeSH
- rehabilitace po cévní mozkové příhodě * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- směrnice pro lékařskou praxi MeSH
BACKGROUND: The Freezing of Gait Questionnaire (FoG-Q) is a fast and sensitive assessment tool for freezing (FoG). OBJECTIVE: The objective of the study is for validation of a Czech version of FoG-Q. A further, explorative aim was to examine what FoG-Q indicates about the presence and severity of gait impairment in patients treated with DBS in their full OFF state. DESIGN: The study was a cross-sectional validation study. METHODS: We translated FoG-Q following standardized validation protocol. We assessed 35 patients with PD and STN DBS using history taking, UPDRS, Hoehn and Yahr staging, Mini Mental State Examination, Frontal Assessment Battery, FoG-Q, Short Falls Efficacy Scale International, and Beck Depression Inventory, Second Edition. UPDRS III, clinical and instrumental gait assessment, was repeated OFF MED/DBS OFF and OFF MED/DBS ON. RESULTS: Internal consistency of FoG-Q was excellent (α = 0.91) as well as convergent (significant correlations with UPDRS II item 14, UPDRS III item 29, several TUG parameters, and FoG Score) and divergent validity (no association with UPDRS I). OFF MED/DBS OFF, the total FoG-Q score correlated with UPDRS III items 29, 30, and PIGD subscore, step time variability, and negatively with step length and velocity. LIMITATIONS: Limitation of the study is a relatively small sample size. CONCLUSIONS: In conclusion, the Czech translation of FoG-Q is valid. With respect to gait and balance, FoG-Q does, to a certain extent, reflect the native state of the disease in patients treated with high frequency STN DBS.
- MeSH
- hluboká mozková stimulace * MeSH
- lidé středního věku MeSH
- lidé MeSH
- neurologické poruchy chůze diagnóza MeSH
- Parkinsonova nemoc diagnóza terapie MeSH
- průřezové studie MeSH
- průzkumy a dotazníky * MeSH
- psychiatrické posuzovací škály MeSH
- reprodukovatelnost výsledků MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- validační studie MeSH
