Přístupy ovlivňující chronickou spasticitu u klientů s mozkovou obrnou

Abstract

Chronická spasticita je výrazným symptomem mozkové obrny. Ovlivňuje nejen celkovou kvalitu života této cílové skupiny, ale také výkon běžných denních činností, úroveň samostatnosti a míru soběstačnosti klientů. Cílem příspěvku bylo předložit relevantní dohledané poznatky o pro- blematice spasticity (včetně bolestivých stavů) u klientely s mozkovou obrnou a sumarizovat po- znatky o možných přístupech uplatňovaných v oblasti redukce (eliminace) této symptomatologie

Cerebral Palsy (earlier in the Czech MKN-10 classified as “children’s cerebral pal- sy” – “dětská mozková obrna” − DMO) is a lifelong condition and considered the most frequent cause of restricted mobility in childhood. It is also a major health and social problem. Among the factors negatively affecting this quality of life is a complex array of unpleasant symptoms that interfere with the performance of ordinary everyday activities. These certainly include chronic spasticity, including painful states. In this text we use the term “cerebral palsy”, to mean “child cerebral palsy”, and thus respect the updated version of the MKN-10 using the new form of the medical diagnosis defining this physical disability. This paper draws on research of relevant published studies in academic periodi- cals (or where relevant monographs) with the aim of presenting an overview of findings relating to the problem of chronic spasticity in clients with a medical di- agnosis of cerebral palsy, and the possibility of influencing it by various different approaches. Relevant documents in full-text form were obtained by searches in the accessible licenced BMČ (Bibliographia Medica Čechoslovaca) database avail- able online in the Medvik Portal, and by using the Google Scholar search engine, as well as by exploiting the accessible interfaces of academic articles reviewed by periodicals accessible in Czech sites and libraries. The method was use of key- words and their combinations including Boolean operators. The main approaches with positive results in eliminating or reducing spasticity as a long-term phenomenon in the target group of children include physiotherapy, splinting, proprioreceptive neuromuscular facilitation, senso-motoric stimulation, hydrokinesio-therapaty and others. Among pharmo-therapeutic approaches we should mention first and foremost local treatment by botulinum toxin, the ad- ministration of peroral muscle relaxants (benzodiazepams, tizanidin, baclofen - intratecally or applied by a pump). Now should we forget surgical approaches – corrective operations, neuro-surgical procedures, orthopaedic procedures, selec- tive dorsal rizothomy or supplementary approaches (for example hippo-rehabil- itation, hippotherapy, canistherapy, positioning with dogs and suchlike), or re- cently developed new approaches (magnetic stimulation, electrical stimulation, robotic treatment etc.). Choice of approach is always highly individual, depending on many specific fac- tors and criteria (on the side of the client, possibilities and availability and so on). The main aim always remains the elimination of painful states, improvement of functional self-sufficiency in locomotion, self-service and overall improvement of the quality of life. Most of the authors concerned with CP therapy also agree that treatment must be truly comprehensive and involve and effectively functioning and mutually complementary multidisciplinary team.