Physiotherapy in patient after subdural hematoma

Uvod: Subduralni hematom je zbiranje krvi med zunanjo in srednjo možgansko ovojnico (duro mater in arahnoideo). Je najpogostejši zaplet po travmatskih poškodbah glave, hkrati pa eden najnevarnejših, saj je smrtnost več kot 50%. V program zgodnje rehabilitacije je vključen fizioterapevt, ki s postopki lokomotorne in respiratorne fizioterapije vzdržuje / izboljšuje pacientovo koordinacijo, ravnotežje, gibljivost, mišično zmogljivost, samostojnost, funkcijsko sposobnost in respiratorno funkcijo. Namen: Namen diplomskega dela je predstaviti fizioterapevtsko obravnavo in njeno učinkovitost pri pacientu po subduralnem hematomu ob pridruženih drugih pomembnih internističnih obolenjih. Obravnava je kritično analizirana z vidika uspešnosti glede na končne rezultate / meritve in z vidika ustreznosti glede na diagnozo pacienta v primerjavi z raziskavami in poročili svetovne znanstvene literature. Metode dela: Diplomsko delo je poročilo o primeru pacienta. Predstavljena je deset dnevna fizioterapevtska obravnava z opisom fizioterapevtskih postopkov, uporabljenih v času zgodnje rehabilitacije. Ti so primerjani s priporočili iz ustrezne strokovne literature v slovenskem in angleškem jeziku, iskane v znanstvenih spletnih bazah in knjižnicah. Rezultati: V primeru pacienta po subduralnem hematomu s pridruženimi diagnozami so bili izbrani cilji skladni s težavami, ugotovljenimi iz medicinske dokumentacije, z meritvami, testiranji in ocenami. Pacient je izboljšanje dosegel pri naslednjih izvedenih meritvah in ocenah: ocena somatosenzorične funkcije, ocena funkcijske zmogljivosti vsakdanjih aktivnosti, ocena ravnotežja in telesne drže, ter ocena sposobnosti hoje. Največji napredek pa je bil viden pri hoji (s pripomočkom). Razprava in sklep: Po končanih desetih obravnavah je bila večina postavljenih kliničnih ciljev dosežena (pravilno premikanje po postelji in posedanje preko roba postelje, izboljšanje koordinacije in ravnotežja, vertikalizacija in izboljšanje funkcijskih aktivnosti, odprava splošne mišične oslabelosti in izboljšanje mišične zmogljivosti leve strani telesa, ohranjanje dobre periferne prekrvavitve in predihanosti pljuč in ohranjanje oz. povečanje gibljivosti ter s tem preprečiti nastajanje kontraktur), kar kaže na ustrezno izbiro uporabljenih metod in tehnik lokomotorno in respiratorne fizioterapije (vaje za ohranjane gibljivosti, vaje za izboljšanje koordinacije, vaje za izboljšanje ravnotežja, vaje za izboljšanje mišične zmogljivosti, dihalne vaje, učenje posedanja in premikanja po postelji ter zdravstvena vzgoja).Introduction: Subdural hematoma is the collection of blood between the outer and middle (brain) meningeal envelopes (dura mater and arachnoid). It is the most common complication of traumatic brain injuries and at the same time one of the most dangerous, as mortality is more than 50%. Early rehabilitation programme also includes physiotherapist, who maintains / increases the coordination, balance, mobility, muscular capacity, autonomy, functionality and respiratory function with appropriate procedures of locomotor and respiratory physiotherapy. Purpose: The purpose of this diploma work is to present the physiotherapeutic treatment and its effectiveness done on a patient who suffered subdural hematoma and other important joined internal diseases. The treatment is critically analysed in terms of performance on final results / measurements and from the point of view of relevance to patients’ diagnosis. It is also compared with already done researches and reports from world’s scientific literature. Methods: The diploma work is a case report of a patient. A ten days physiotherapeutic treatment with a description of methods and techniques used during early rehabilitation is presented. These are compared with recommendations from relevant professional scientific literature in Slovene and English language. The literature was searched in scientific web-based databases and libraries. Results: The goals in case of this patient (after subdural hematoma and other diagnosis) was complaint with the problems identified from medical history, with measurement, testing and assessments. The patient improves scores on every preformed measurement and tests (measurements of: somatosensory function, functional ability of daily activities, balance and body posture and measurement of walking ability), but the biggest improvement was made in walking (with accessory), where he improved the walking distance and the pattern of walking. Discussion and conclusion: After all ten treatments, most of the clinical goals were reached (correct movement along the bed and sitting over the bed edge, improving coordination and balance, verticalization of the patient and improvement of functional activities, eliminating general muscular weakness and improving muscular capacity of the left side of the body, maintaining good pulmonary suppuration, maintaining or increasing mobility and thereby preventing the muscles to shrink), which shows us, that the appropriate choice of methods and techniques of locomotor and respiratory physiotherapy was made. These methods included exercises for preserving mobility, exercises for improving coordination, balance exercises, exercises for improving muscular performance, breathing exercises, learning the correct way of sitting up and moving on the bed and health education