341 KB24 KB200820252015Bukovec, Adrijanaštevilka:1letnik:14str. 64-69ISSN:1580-9315COBISSID:2051177URN:URN:NBN:SI:doc-RO1HX3M1slUniverzitetni rehabilitacijski inštitut Slovenije - SočaRehabilitacija (Ljubljana)dihalne mišicemechanical insufflator-exufflatorQuadriplegiarespiratorna fizioterapijaRespiratory Musclesrespiratory physiotherapytetraplegijaRespiratorna fizioterapija pri osebi z okvaro vratne hrbtenjače| case report| prikaz primera| Respiratory physiotherapy for an individual with cervical spinal cord injury|Background: The case of respiratory physiotherapy of a quadriplegic individual with spinal cord injury at level of fifth and sixth cervical vertebra is presented. Methods: Patient history was recorded and clinical observation was performed (vital signs, inspection, palpation, percussion, lung sounds auscultation, assessment of thoracic diaphragm strength, assessment of cough, assessment of breathing pattern at fixed diaphragm, assessment of breathing in different positions and quick swallowing evaluation). Spirometry, maximal inspiratory pressure, maximal expiratory pressure, peak cough flow, measurements of chest wall circumference, ventilatory response index for assessment of dyspnoea and test for assessment of speech and breathing coordination were also performed. The respiratory physiotherapy programme involved techniques for prevention of respiratory complications, enhancement of breathing mechanics and inspiratory capacity, improvement of inspiratory strength and inspiratory endurance. The patient was enrolled in a six-month rehabilitation programme; respiratory physiotherapy was performed five times per week. Results: There was an improvement in breathing pattern, spirometry results, inspiratory and expiratory muscle strength, cough effectiveness, thoracic cage mobility and speech and breathing coordination. The use of mechanical insufflation-exufflation also improved the patient's cough strength. An improvement in the patient's inspiratory muscle endurance was also noted. Conclusions: The programme of respiratory physiotherapy was effective. Marked improvement in respiratory function was noted. In more than a year after the injury there were no respiratory complicationsIzhodišča: V prispevku je opisan primer respiratorne obravnave bolnika po zlomu vratne hrbtenice na ravni petega in šestega vratnega vretenca ter posledično tetraplegijo. Metode dela: Program respiratorne fizioterapije je bil usmerjen predvsem v preprečevanje zapletov pri dihanju, izboljšanje mehanike dihanja, izboljšanje inspiratorne kapacitete, krepitev oslabele dihalne muskulature in izboljšanje vzdržljivosti inspiratornih mišic. Osnovne podatke o bolniku smo zbrali s pomočjo anamneze in kliničnega opazovanja (vitalni znaki, inspekcija, palpacija, perkusija, avskultacija pljuč, ocena moči trebušne prepone, ovrednotenje kašlja, ocena vzorca dihanja pri fiksaciji trebušne prepone, ocena dihanja v različnih položajih in ovrednotenje požiranja). Za natančnejšo fizioterapevtsko respiratorno oceno bolnikovega stanja smo opravili teste spirometrije, meritve moči inspiratornih in ekspiratornih mišic, meritev največjega pretoka med kašljem (angl. peak cough flow - PCF), meritve obsegov prsnega koša, oceno dispneje z lestvico VRI (angl. ventilatory response index) in test za oceno koordinacije govora in dihanja. Fizioterapevtska obravnava je vključevala dihalne vaje, mobilizacijo prsnega koša, vadbo s pripomočki (incentivni spirometer, PEP, IMT), terapijo z insuflator - eksuflatorjem, vadbo na aparatu Respifit S ter izobraževanje svojcev. Bolnik je bil vključen v šestmesečni program rehabilitacije, vadba je potekala pet dni v tednu. Rezultati: Pri bolniku je prišlo do izboljšanja vzorca dihanja, spirometrije, moči inspiratornih in ekspiratornih mišic, moči kašlja, gibljivosti prsnega koša in koordinacije govora in dihanja. Uporaba insuflator - eksuflatorja je ugodno vplivala tudi na čiščenje zgornjih dihal. Izboljšala se je tudi vzdržljivost inspiratornih mišic. Zaključki: Zastavljeni program respiratorne fizioterapije je bil pri bolniku uspešen, saj je prišlo do znatnega izboljšanja respiratorne funkcije. V več kot enem letu po poškodbi ni prišlo do dihalnih zapletovTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaUniverzitetni rehabilitacijski inštitut RS – Soča