Vliv multidisciplinárního rehabilitačního programu během hospitalizace na posturální stabilitu a stabilitu chůze u Huntingtonovy nemoci – pilotní studie

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Autoři: L. Brabcová ^1,2; J. Roth ¹; O. Ulmanová ¹; J. Rusz ^1,3; J. Klempíř ¹; O. Horáček ²; M. Kolářová ²; P. Košková ²; P. Rolková ²; H. Božková ²; L. Sabó ²; M. Inemanová ²; K. Lísalová ²; F. Jančok ²; E. Růžička ¹; H. Brožová ¹
Působiště autorů: Department of Neurology and Centre of Clinical Neuroscience, Charles University, 1st Faculty of Medicine and General Teaching Hospital, Czech Republic ¹; Rehabilitation Centre, Beroun Rehabilitation Hospital, Czech Republic ²; Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic ³
Vyšlo v časopise: Cesk Slov Neurol N 2019; 82(3): 301-308
Kategorie: Původní práce
doi: https://doi.org/10.14735/amcsnn2019301

Souhrn

Cíl: Posturální instabilita a instabilita chůze patří mezi významné motorické symptomy Huntingtonovy nemoci (HN), které zvyšují riziko pádů. Rehabilitace je podstatnou součástí terapie instability. Cílem studie bylo zhodnotit, krátkodobý a dlouhodobý efekt multidisciplinárního rehabilitačního programu na posturální instabilitu i instabilitu chůze u HN a posoudit možnost provedení programu za hospitalizace.

Metodika: 13 pacientů s HN bez těžšího kognitivního deficitu a deprese absolvovalo třítýdenní multidisciplinární rehabilitační program během hospitalizace, který byl specificky zaměřený na posturální stabilitu a stabilitu chůze. Vyšetření proběhla na začátku programu, po dokončení rehabilitace, po 1 a 3 měsících od dokončení. Testování zahrnovalo vyšetření stability chůze (Dynamic Gait Index; DGI), posturální stability pomocí posturografu na stabilní (PSS) and nestabilní 20% (PSU) plošině a motorické skóre pomocí Unified Huntington’s Disease Rating Scale (UHDRS).

Výsledky: PSS prokázalo statisticky významné zlepšení přetrvávající po dobu 3 měsíců a signifikantní zlepšení v DGI ihned po rehabilitaci. V motorickém skóre UHDRS a PSU statisticky významné zlepšení nalezeno nebylo.

Závěr: Specifický rehabilitační program je bezpečný a dobře využitelný při terapii poruch stability u HN. Posturální stabilita dle PSS byla zlepšena po sledovanou dobu 3 měsíců. Zlepšení stability chůze dle DGI odeznělo do 1 měsíce. V PSU signifikantní zlepšení nebylo prokázáno. Tato studie nabízí návrh specifického rehabilitačního protokolu pro trénink stability u HN.

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Klíčová slova:

Huntington’s disease – rehabilitation – gait – instability

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