LITHUANIAN UNIVERSITY OF HEALTH SCIENCES LUHS LIBRARY REPOSITORY

Ligonių po nugaros smegenų pažeidimų funkcinės būklės ir sutrikusios veiklos korekcija, taikant ergoterapiją, ankstyvuoju reabilitacijos laikotarpiu

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dc.contributor.author Mingaila, Sigitas
dc.date.accessioned 2017-08-21T08:09:47Z
dc.date.available 2017-08-21T08:09:47Z
dc.date.issued 2006
dc.identifier.uri http://repository.lsmuni.lt/handle/1/60012
dc.description.abstract LIST OF ABBREVIATIONS FIM - Functional Independence Measure. P - Significance level. CI - Confidence interval. df -degrees of freedom SD - Standard deviation. OR - Odds ratio. AOTA - American Occupational Therapy Association. COPM - Canadian occupational performance measure. NS - Not significant. ASIA - American Spinal Cord Injury Association. 1. Introduction About 140 – 150 people suffer from traumatic spinal cord injury in Lithuania annually. Also, there are frequent cases of non-traumatic spinal cord injury caused by hernia of intervertebral disc, tumours and disorders of spinal cord circulation. Spinal cord injury causes motor, sensor and autonomic dysfunctions, as well as bowel and bladder dysfunctions which are considered to be the main factors causing disability. Patients after spinal cord injury face disorders of daily living, decrease of work and leisure possibilities. Reintegration after rehabilitation period is very important as more than 50 % of spinal cord injuries appear among people of 16 – 30 years. Rehabilitation period of such people is a long-lasting process which aims at readjustment of all activity areas. During rehabilitation process it is essential to foresee the aims which are influenced by the level and grade of injury, as well as age and gender of patients. Occupational therapy, as a part of complex rehabilitation, is applied for the solution of problems of activity disorders of patients after spinal cord injury. Purposeful practice applied by occupational therapists is directed to the improvement of functional state as well as to the increase of activity and participation. The effectiveness of rehabilitation depends on the relation between a therapist and a patient, reliance, motivation and active participation in rehabilitation team work [4]. The main aim of occupational therapy is to train independence and adjustment to the changed possibilities and demands of a patient. In developed countries, where complex rehabilitation is ensured in all stages, the majority of people after spinal cord injury reintegrates successfully and is paid for the job. Still some part of patients with spinal cord injury is socially isolated due to activity disorders with pleasure of life disturbed. Physical, social and cultural environment which differs due to the development level of a country is considered to be the most influential to these patients. Independence and social integration of patients after spinal cord injury mostly depend on the effectiveness of rehabilitation applied. The examination and correction of factors which make influence on the effectiveness of rehabilitation and occupational therapy is one of the ways to improve rehabilitation effectiveness of patients. A number of studies have been conducted where effectiveness of complex rehabilitation to patients after spinal cord injury has been analyzed, yet few studies have been conducted where the effectiveness of separate rehabilitation parts, as occupational therapy, has been discussed. No researches have been found with analysis of effectiveness of occupational therapy in patients after spinal cord injury depending on injury level, grade and patients’ age and gender. Occupational therapy is considered to improve functional state of patients after spinal cord injury and help for the correction of activity disorders in early rehabilitation. Aim of study: To evaluate the functional state and correction of activity disorders in patients after spinal cord injury applying occupational therapy in early rehabilitation considering level, grade of injury and as well as age and gender of patients. Goals of study: 1. To evaluate functional state and dominant activity disorders of patients after spinal cord injury in early rehabilitation. 2. To determine the major goals of occupational therapy and form complexes of occupational therapy means for the correction of activity disorders of patients with spinal cord injury. 3. To estimate effectiveness of occupational therapy in patients after spinal cord injury considering its grade, level, age and gender of patients. 4. To identify factors, influencing effectiveness of occupational therapy in early rehabilitation. Novelty of the research in science Functional state of patients after spinal cord injury in early rehabilitation was evaluated and dominant activity disorders were identified, depending on the level and grade of injury as well as on age and gender of patients in the study. The results showed that motor dysfunctions, which are the result of spinal cord injury, determine disorders of bathing, dressing, locomotion and bowel and bladder control. Major goals of occupational therapy in early rehabilitation of patients with complete spinal cord injury include promotion and training of their independence applying technical rehabilitation aids. In the case of incomplete spinal cord injury the major goal of occupational therapy is supposed to be independence training with the principle of feedback ensured. Effectiveness of occupational therapy, depending on the level and grade of spinal cord injury as well as on age and gender of patients, was estimated in the study. It was determined, that expected independence level in early rehabilitation is more likely to be reached in the case of complete cervical and thoracic-lumbar spinal cord injury. The following activities, in which recovery of independence appears to be the fastest, were identified: locomotion, eating and grooming. Also, the activities were identified during the process of which patients were in great need of help at the end of early rehabilitation stage. These are the following: bathing, bowel-and-bladder control and locomotion (stairs). The following factors with negative influence on effectiveness of occupational therapy were identified: female gender, thoracic-lumbar spinal cord injury. Practical implementation 1. The study showed that application of occupational therapy, depending on the level and grade of injury a swell as on age and gender of patients, improves the functional state and independence level of patients significantly in early rehabilitation. 2. The findings also showed the importance of motivation formation and technical aids of rehabilitation as a necessary part of occupational therapy in patients after spinal cord injury. It was determined that independence level achieved during the process of occupational therapy depended not only on the level and grade of injury but also on age, gender, adjacent diseases and complications. 2. MATERIAL AND METHODS 2.1. Characteristics of contingent The research contingent consisted of 136 patients (men – 71.3% , women – 28.7%), rehabilitated in Neurorehabilitation unit at Kaunas University of Medicine in 1999 – 2005 after spinal cord injury. Table 1. Distribution of patients according to the level of spinal cord injury and gender. Gender Level of injury Men n, (%) Women n, (%) Total: n, (%) Cervical 46(83.6) 9(16.4) 55(40.4) Thoracic – lumbar 51(63) 30(37) 81(59.6) Total: 97(71.3) 39(28.7) 136(100) 26.61; df=1; p=0.01 According to the level of spinal cord injury (see table 1) the majority of patients 81 (59.6%) suffered from thoracic - lumbar spinal cord injury. 83.3 % of men and 16.4 % of women suffered from cervical spinal cord injury. Thoracic-lumbar spinal cord injury was identified in 63 % of men and 37 % of women. Table 2. Distribution of patients after spinal cord injury according to gender and age. Age group Gender 16-29y. n, (%) 30-44y. n, (%) 45-60y. n, (%) 61y. and over n, (%) Mean±SD Total: n, (%) Men 32(33) 26(26.8) 22(22.7) 17(17.5) 41.4±16.8 97(71.3) Women 11(28.2) 7(17.9) 15(38.5) 6(15.4) 43.6±16.1 39(28.7) Total: 43(31.6) 33(24.3) 37(27.2) 23(16.9) 42.0±16.6 136(100) 23.7; df=3; p>0.05 The research findings of distribution of patients after spinal cord injury according to gender and age (see table 2) show, that the cases of spinal cord injury were the most frequent in the age group of men from 16 to 21 years - 32 (33 %) and in the age group of women from 45 to 60 years - 15 (38.5 %). Average age of men is 41.4±16.8 years and 43.6±16.1 years of women. Average duration of early rehabilitation period for patients after spinal cord injury was 69.3±22.8 days (see table 3). Evaluation of rehabilitation duration according to character of injury showed, that the longest rehabilitation duration was in the case of complete thoracic-lumbar spinal cord injury – 74.7±24.0 days. Table 3. Distribution of patients according to injury character and duration of early rehabilitation. Level and grade of injury Average±SD of rehabilitation duration Cervical ASIA-A 69.9±14.8 Cervical ASIA-B,C 63.5±25.4 Thoracic-lumbar ASIA-A 74.7±24.0 Thoracic-lumbar ASIA-B,C 68.3±21.4 Total: 69.3±22.8 In early rehabilitation period complications were identified in 86 patients after spinal cord injury (see table 4). The most frequent complications were chronic pain (55.8 %), urinary track infections (43 %), spasticity (30.2 %) and pressure ulcers (20.9 %). Table 4. Distribution of patients with complications identified (n=86) according to character of complications. Complications Patients with complications (n, %) Respiratory disorders 3 (3.5) Dyspepsia 4 (4.6) Tromboembolic complications 3 (3.5) Orthostatic reactions 5 (5.8) Spasticity 26 (30.2) Urinary track infections 37 (43) Pain 48 (55.8) Pressure ulcers 18 (20.9) Table 5. Distribution of patients according to gender and causes of spinal cord injury Reason of injury Gender Car accidents n, (%) Diving n, (%) Falls n, (%) Violence n, (%) Circulation disorders n, (%) Tumours n, (%) Other n, (%) Total: n, (%) Men 24 (24.7) 13 (13.4) 40 (41.2) 2 (2.1) 2 (2.1) 5 (5.2) 11 (11.3) 97 (71.3) Women 11 (28.2) 0 (0) 11 (28.2) 0 (0) 5 (12.8) 4 (10.3) 8 (20.5) 39 (28.7) Total: 35 (25.7) 13 (9.6) 51 (37.5) 2 (1.5) 7 (5.1) 9 (
dc.language.iso lit
dc.subject Rehabilitation
dc.subject Ergoterapija
dc.subject Occupational therapy
dc.subject Reabilitacija
dc.subject Nugaros smegenų pažeidimas
dc.subject Spinal cord injury
dc.title Ligonių po nugaros smegenų pažeidimų funkcinės būklės ir sutrikusios veiklos korekcija, taikant ergoterapiją, ankstyvuoju reabilitacijos laikotarpiu
dc.title.alternative Correction of functional state and activity disorders of patients with spinal cord injury applying occupational therapy in early stage of rehabilitation
dc.type Daktaro disertacija


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