Princip lokomo\u010dn\u00ed terapie (a terapie na b\u011b\u017eeck\u00e9m p\u00e1su) je zalo\u017een na plasticit\u011b centr\u00e1ln\u00edho nervov\u00e9ho syst\u00e9mu (CNS) a na fyzik\u00e1ln\u00edm mechanismu neurologick\u00e9 kontroly ch\u016fze. Kortik\u00e1ln\u00ed plasticita je schopnost motor cortexu zm\u011bnit neuronov\u00e9 okruhy \u00fapravou reprezenta\u010dn\u00ed mapy, zm\u011bnou synoptick\u00e9 morfologie nebo mimo jin\u00e9 axon\u00e1ln\u00edch trajektori\u00ed1. T\u011bchto zm\u011bn m\u016f\u017ee b\u00fdt dosa\u017eeno c\u00edlenou terapi\u00ed nebo zku\u0161enostmi.<\/p>\n
Neur\u00e1ln\u00ed m\u00ed\u0161n\u00ed kontroln\u00ed okruhy (s\u00ed\u0165 vnit\u0159n\u00edch neuron\u016f) definovan\u00e9, jako \u201eCentral Pattern Generators\u201c (CPG) jsou schopny aktivovat svaly jak zat\u011b\u017eovan\u00e9, tak odleh\u010den\u00e9 kon\u010detiny nebo kon\u010detiny ve f\u00e1zi zhoupnut\u00ed nez\u00e1visl\u00e9 na korik\u00e1ln\u00ed kontrole. CPG tedy neurologicky \u0159\u00edd\u00ed ch\u016fzi.<\/p>\n
Impulzy z mechanick\u00fdch receptor\u016f (tlakov\u00fdch\/z\u00e1t\u011b\u017eov\u00fdch) v chodidle, stejn\u011b tak, jako impulzy prodlou\u017een\u00ed a tlaku responden\u010dn\u00edch neuromuskul\u00e1rn\u00edch v\u0159eten, receptor\u016f v kloubech a \u0161lach\u00e1ch v ky\u010deln\u00edm kloubu, aktivuj\u00ed hlavn\u00ed slo\u017eku schopnosti ch\u016fze nebo chcete-li lokomo\u010dn\u00ed program. Impulzy jsou aferentn\u011b p\u0159en\u00e1\u0161eny prost\u0159ednictv\u00edm senzorick\u00fdch nervov\u00fdch vl\u00e1ken, zpracov\u00e1ny v CPG v m\u00ed\u0161e a adekv\u00e1tn\u00ed aktivita je op\u011bt aferentn\u011b p\u0159enesena motorick\u00fdmi nervov\u00fdmi vl\u00e1kny do sval\u016f. Intenzita a \u010dasov\u00e9 posloupnosti svalov\u00e9 aktivity lze m\u011b\u0159it a vyhodnotit elektromyograficky (EMG).<\/p>\n
Pro aktivaci odpov\u00eddaj\u00edc\u00edch sval\u016f d\u016fle\u017eit\u00fdch pro ch\u016fzi, je nezbytn\u00e9 iniciovat oboj\u00ed, zat\u00ed\u017een\u00ed chodidla a aferentn\u00ed vstupy z oblasti ky\u010dle. S pomoc\u00ed podp\u016frn\u00fdch p\u00e1s\u016f a \u010d\u00e1ste\u010dn\u00fdm zat\u00ed\u017een\u00edm, dokonce pacienti bez schopnosti st\u00e1t jsou takto schopni aktivovat mechanick\u00e9 receptory na spodn\u00ed plo\u0161e chodidla. Sou\u010dasn\u011b podn\u011bcuje pohybliv\u00e1 plocha b\u011b\u017e\u00edc\u00edho p\u00e1su prota\u017een\u00ed zat\u011b\u017eovan\u00e9 nohy v ky\u010dli. Souvisej\u00edc\u00ed aktivace receptor\u016f p\u0159i prodlou\u017een\u00ed spou\u0161t\u00ed lokomo\u010dn\u00ed program.<\/p>\n
Tr\u00e9nink na b\u011b\u017e\u00edc\u00edm p\u00e1su zlep\u0161uje oboj\u00ed, intenzitu a koordinaci svalov\u00e9 aktivace po\u017eadovan\u00e9 u pacient\u016f s \u010d\u00e1ste\u010dn\u00fdm poran\u011bn\u00edm m\u00edchy.2,3,4,5 U kompletn\u00edch poran\u011bn\u00ed m\u00edchy, byla efektivita tr\u00e9ninku p\u0159\u00edli\u0161 margin\u00e1ln\u00ed k dosa\u017een\u00ed signifikantn\u00edho zlep\u0161en\u00ed v EMG amplitud\u011b a v autonomn\u00edm pohybu p\u0159i ch\u016fzi.<\/p>\n
U pacient\u016f s interferencemi ve schopnosti ch\u016fze po mozkov\u00e9 p\u0159\u00edhod\u011b a traumatick\u00fdch poran\u011bn\u00edch m\u016f\u017ee b\u00fdt autonomn\u00ed schpnosti ch\u016fze dosa\u017eeno d\u0159\u00edve p\u0159i pou\u017eit\u00ed tr\u00e9ninku na b\u011b\u017eeck\u00e9m p\u00e1su ne\u017e p\u0159i aplikaci tradi\u010dn\u00edch terapeutick\u00fdch postup\u016f.6,7 U pacient\u016f s hemi-per\u00e9zami, oboj\u00ed, pr\u016fb\u011bh pohybu a symterie ch\u016fze stejn\u011b jako trv\u00e1n\u00ed f\u00e1ze stoje jsou zlep\u0161eny p\u0159i terapii na b\u011b\u017eeck\u00e9m p\u00e1su.8 Tr\u00e9nink na b\u011b\u017eeck\u00e9m p\u00e1su se uk\u00e1zal jako efektivn\u00ed i pro zlep\u0161en\u00ed tempa ch\u016fze.9<\/p>\n
U t\u011b\u017ece posti\u017een\u00fdch pacient\u016f vy\u017eaduje tradi\u010dn\u00ed terapie na p\u00e1su extr\u00e9mn\u00ed vyp\u011bt\u00ed terapeut\u016f p\u0159i veden\u00ed pacientov\u00fdch nohou, co\u017e \u010dasto vede k jejich st\u00ed\u017enostem na zna\u010dnou bolest v z\u00e1dech, jeliko\u017e jsou terapeut\u00e9 trvale ve skr\u010den\u00e9 ohnut\u00e9 poloze. Vzheldem k t\u011bmto nepohodln\u00fdm pozic\u00edm nejsou schopni terapeut\u00e9 prov\u00e1d\u011bt l\u00e9\u010dbu s \u00fasp\u011bchem. Testy prok\u00e1zaly, \u017ee pouze \u010dast\u00e1 a opakovan\u00e1 cvi\u010den\u00ed lokomo\u010dn\u00edch vzorc\u016f p\u0159i spr\u00e1vn\u00e9m proveden\u00ed terapie vedou ke zlep\u0161en\u00ed schopnosti ch\u016fze6,7. LokoHelp (Pedago) byl vyvinut k automatick\u00e9mu veden\u00ed chodidla pacienta a je tedy prosp\u011b\u0161n\u00fd jak pro fyzioterapeuta, tak pro pacienta. LokoHelp (Pedago) simuluje p\u0159irozenou schopnost ch\u016fze veden\u00edm pacientov\u00fdch nohou a t\u00edm moduluje d\u00e9lku f\u00e1ze stoje a f\u00e1ze zhoupnut\u00ed. Konstrukce LokoHelpu (Pedaga) usnad\u0148uje typick\u00fd valiv\u00fd pohyb p\u0159i ch\u016fzi a odpov\u00eddaj\u00edc\u00ed zat\u00ed\u017een\u00ed. Jeliko\u017e rovnov\u00e1ha a pozice t\u011bla pacienta hraj\u00ed v lokom\u010dn\u00edm programu rovn\u011b\u017e d\u016fle\u017eitou roli, m\u011bl by terapeut aktivn\u011b zasahovat do spr\u00e1vn\u00e9ho p\u0159en\u00e1\u0161en\u00ed t\u011b\u017ei\u0161t\u011b pacienta a hl\u00eddat osu kolena p\u0159i ohnut\u00ed a nata\u017een\u00ed. Ka\u017ed\u00e1 n\u00e1prava \u010di korekce mohou b\u00fdt s pacientem komunikov\u00e1ny \u010di manu\u00e1ln\u011b terapeutem provedeny, bez zp\u016fsoben\u00ed jak\u00e9hokoli fyzick\u00e9ho nap\u011bt\u00ed terapeutovi.<\/p>\n
V jedn\u00e9 uzav\u0159en\u00e9 studii byla srovn\u00e1v\u00e1na u\u010dinnost LokoHelpu oproti tradi\u010dn\u00edmu tr\u00e9ninku na b\u011b\u017eeck\u00e9m p\u00e1se a tak\u00e9 n\u00e1cvik ch\u016fze s ohledem na schopnost ch\u016fze a postur\u00e1ln\u00ed schopnost pacienta. D\u016fle\u017eit\u00e1 byla rovn\u011b\u017e n\u00e1maha terapeut\u016f. V\u00fdsledky studie ukazuj\u00ed v\u00fdznamn\u00fd pozitivn\u00ed trend ve prosp\u011bch LokoHelpu. I publikovan\u00e9 studie ukazuj\u00ed, \u017ee intenzivn\u00ed lokomo\u010dn\u00ed tr\u00e9nink, kter\u00fd je podporov\u00e1n p\u0159\u00edstroji v kombinaci s fyzioterapi\u00ed m\u00e1 v\u00fdrazn\u011bj\u0161\u00ed p\u0159evahu nad stejn\u011b dlouho trvaj\u00edc\u00edm tradi\u010dn\u00edm fyzioterapeutick\u00fdm o\u0161et\u0159en\u00edm s ohledem na doc\u00edlen\u00ed schopnosti ch\u016fze a jin\u00fdch funk\u010dn\u00edch parametr\u016f u pacient\u016f po mozkov\u00fdch p\u0159\u00edhod\u00e1ch10,11. P\u0159\u00edzniv\u00e9 je, \u017ee pozitivn\u00ed v\u00fdsledky lokomo\u010dn\u00ed terapie podporovan\u00e9 p\u0159\u00edstroji vedou k vy\u0161\u0161\u00ed intenzit\u011b cvi\u010den\u00ed.<\/p>\n
1.) Dietz V, Harkema SJ. 2.) Duysens J, Van de Crommert HW. <\/p>\n 3.) Nielsen JB. 4.) Dietz V, Colombo G, Jensen L, Baumgartner L. 5.) Dietz V, Wirz M, Colombo G, Curt A. 6.) Dietz V 7.) Kuhn RA 8.) Arshavsky YI. 9.) Dietz V, Muller R, Colombo G. 10.) Van de Crommert HW, Mulder T, Duysens J. 11.) Butt SJ, Lebret JM, Kiehn O. <\/p>\n <\/p>\n 12.) Freivogel S, Mehrholz J, Husak-Sotomayor T, Schmalohr D. <\/p>\n","protected":false},"excerpt":{"rendered":" Fyzik\u00e1ln\u00ed mechanismus Princip lokomo\u010dn\u00ed terapie (a terapie na b\u011b\u017eeck\u00e9m p\u00e1su) je zalo\u017een na plasticit\u011b centr\u00e1ln\u00edho nervov\u00e9ho syst\u00e9mu (CNS) a na fyzik\u00e1ln\u00edm mechanismu neurologick\u00e9 kontroly ch\u016fze. Kortik\u00e1ln\u00ed plasticita je schopnost motor cortexu zm\u011bnit neuronov\u00e9 okruhy \u00fapravou reprezenta\u010dn\u00ed mapy, zm\u011bnou synoptick\u00e9 morfologie nebo mimo jin\u00e9 axon\u00e1ln\u00edch trajektori\u00ed1. T\u011bchto zm\u011bn m\u016f\u017ee b\u00fdt dosa\u017eeno c\u00edlenou terapi\u00ed nebo zku\u0161enostmi. Neur\u00e1ln\u00ed […]<\/p>\n","protected":false},"author":1,"featured_media":666,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_links_to":"","_links_to_target":""},"categories":[5],"tags":[8],"_links":{"self":[{"href":"https:\/\/www.fysiomed.cz\/woodway\/wp-json\/wp\/v2\/posts\/180"}],"collection":[{"href":"https:\/\/www.fysiomed.cz\/woodway\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.fysiomed.cz\/woodway\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.fysiomed.cz\/woodway\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.fysiomed.cz\/woodway\/wp-json\/wp\/v2\/comments?post=180"}],"version-history":[{"count":5,"href":"https:\/\/www.fysiomed.cz\/woodway\/wp-json\/wp\/v2\/posts\/180\/revisions"}],"predecessor-version":[{"id":691,"href":"https:\/\/www.fysiomed.cz\/woodway\/wp-json\/wp\/v2\/posts\/180\/revisions\/691"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.fysiomed.cz\/woodway\/wp-json\/wp\/v2\/media\/666"}],"wp:attachment":[{"href":"https:\/\/www.fysiomed.cz\/woodway\/wp-json\/wp\/v2\/media?parent=180"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.fysiomed.cz\/woodway\/wp-json\/wp\/v2\/categories?post=180"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.fysiomed.cz\/woodway\/wp-json\/wp\/v2\/tags?post=180"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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\nGait training with the newly developed, LokoHelp-system is feasible for non-ambulatory patients after stroke, spinal cord and brain injury.
\nBrain Injury, July 2008; 22(7-8):625-632 Abstract<\/em><\/p>\n