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A common approach to managing lower-limb motor impairments resulting from a stroke is to use an orthotic device, mainly an ankle orthosis (AO) or an ankle-foot orthosis (AFO), to provide direct control of the ankle and foot and facilitate the swing phase of gait. AOs and AFOs have a favourable impact on walking speed, walking impairment (step/stride length), and balance (weight distribution in standing) in stroke patients. The contemporary stroke rehabilitation guidelines therefore recommend that AFOs should be used for ankle instability or dorsiflexor weakness and to improve walking ability and safety. The manuscript presents AOs and AFOs that are available on the Slovenian market, and some of our findings regarding the effects of the use of AOs and AFOs in stroke patients. V rehabilitaciji bolnikov po možganski kapi za zmanjšanje motoričnih disfunkcij spodnjega uda pogosto uporabljamo ortoze, najpogosteje ortoze za gleženj (OG) in ortoze za gleženj in stopalo (OGS), ki omogočajo večjo stabilnost gležnja in stopala med prenosom teže na okvarjeni spodnji ud in olajšajo fazo zamaha. Dokazano je, da imajo OG/OGS pri bolnikih po možganski kapi ugoden učinek na funkcijo hoje (hitrost), nepravilnosti hoje (dolžina koraka) in ravnotežje (porazdelitev teže v stoječem položaju). Veljavne smernice za rehabilitacijo bolnikov po možganski kapi zato priporočajo, da bolnikom nameščamo OGS za stabilizacijo skočnega sklepa in stopala, pomoč pri učinkovitosti, nadzoru in varnosti hoje. V prispevku so predstavljene OG in OGS, ki so na voljo na slovenskem trgu. Navedenih je tudi nekaj naših ugotovitev v zvezi z učinki nameščanja OG/OGS.

Rehabilitation goals are hierarchical in time and conceptual level, where goals might concern patient%s impairments, activities, social participation, or well-being. International classification of functioning, disability and health (ICF) in its conceptual framework covers this interaction and provides the description of the complete range of health-related situations in terms of human functioning and its limitations. The ICF framework provides a sound theoretical basis for rehabilitation. The information obtained in developing a patient's health profile according to ICF has the potential to enhance the assessment and goal-setting process, rehabilitation planning, improve the selection of appropriate interventions and outcome measurements. The ICF classification system was employed as an organizational tool, a descriptive tool in goal-setting process, a facilitative tool in the Talking Mats approach to goal-setting, or a tool for the formation of a novel approach to goal-setting. Hierarhično so rehabilitacijski cilji razporejeni po času in po konceptualni ravni, na kateri se nanašajo na bolnikove telesne funkcije oz. okvare le-teh, dejavnosti, sodelovanje v življenjskih okoliščinah in blagostanje. Mednarodna klasifickacija funkcioniranja in zmanjšane zmožnosti v svojem pojmovnem okviru zajema ta interaktivni proces in opise situacij glede na človeško funkcioniranje in njegove omejitve. Predstavlja dobro teoretično podlago za rehabilitacijo. Informacije, pridobljene pri določanju profila funkcioniranja posameznika s pomočjo MKF, olajšajo proces določanja rehabilitacijskih ciljev, načrtovanja in izbiranja rehabilitacijskih postopkov ter merjenja izidov zdravljenja. Pri določanju rehabilitacijskih ciljev so doslej MKF uporabili predvsem kot okvir za organizacijo podatkov o rehabilitacijskih ciljih, opisovanje profila funkcioniranja bolnika, pripomoček za določanje rehabilitacijskih ciljev s postopkom Talking Mats ali kot orodje za razvoj novega pristopa pri določanju rehabilitacijskih ciljev.

Background: Rehabilitation of persons after stroke is using virtual reality (VR) in therapeutic practice more than ever. The objective of our study was to determine whether the balance training exercise within virtual environment can be as effective as the conventional balance training for persons after stroke. We used three specific "exergames" from the REWIRE system designed for balance training that were functionally very close to the conventional balance training for patients after stroke. Methods: Between June 2016 and May 2017, 20 patients of the Department for Rehabilitation of Patients After Stroke of the University Rehabilitation Institute in Ljubljana participated in the study. The participants were randomised into two groups: the experimental group training with additional VR "exergames" and the control group receiving additional conventional balance training. The additional balance exercises were limited to 5 days for both groups. Before and after the exercises, a set of clinical tests (the 10m walking test, the Timed up & go test, the Four Square Step Test and modified sensory integration tests) were conducted. Results: The Timed Up & Go test and the Four Square Step Test showed statistically significant improvements in the test group. The control group showed statistically significant improvement in 10m walk test and also the Timed Up & Go test. However, there were no statistically significant differences between the groups after the exercises. Conclusions: Balance training with REWIRE exergames was relatively simple to use and comparable with conventional balance training in terms of effectiveness. We believe that the additional therapeutic procedure may be useful in rehabilitation of persons after a stroke. Izhodišče: V rehabilitaciji po možganski kapi se v terapevtski praksi vedno pogosteje uporablja vadba v navidezni resničnosti (VR). Namen naše raziskave je bil ugotoviti, ali je vadba ravnotežja s pomočjo navideznega okolja pri bolnikih po možganski kapi enako učinkovita kot konvencionalna vadba ravnotežja. V ta namen smo uporabili tri specifične video igre za vadbo ravnotežja iz sistema REWIRE, ki jih je bilo možno funkcionalno posnemati s konvencionalno vadbo ravnotežja pri bolnikih po možganski kapi. Metode: V raziskavo, ki je potekala od junija 2016 do maja 2017 na Oddelku za rehabilitacijo bolnikov po možganski kapi na Univerzitetnem rehabilitacijskem inštitutu - Soča (URI - Soča), je bilo vključenih 20 bolnikov, ki so bili naključno razdeljeni v testno (vadba ravnotežja s pomočjo navideznega okolja) in kontrolno skupino (konvencionalna vadba ravnotežja). Dodatna vadba ravnotežja je v obeh skupinah trajala pet dni. Dan pred začetkom vadbe in dan po koncu vadbe smo pri vseh bolnikih izvedli test hitrosti hoje na 10 metrov, časovno merjeni test vstani in pojdi, test korakanja v štirih kvadratih ter Modificirane klinične teste senzorične integracije. Rezultati: Po vadbi so bili rezultati testa hoje na 10 metrov in testa korakanja v štirih kvadratih pri testni skupini statistično značilno boljši, pri kontrolni skupini so se statistično značilno izboljšali izidi časovno merjenega testa vstani in pojdi in testa hitrosti hoje na 10 metrov. Med skupinama statistično pomembnih razlik po vadbi ni bilo. Zaključek: Vadba ravnotežja v navideznem okolju s sistemom video iger REWIRE je bila razmeroma preprosta in primerljivo učinkovita kot konvencionalna vadba ravnotežja. Ocenjujemo, da je lahko koristen dodaten terapevtski postopek pri rehabilitaciji bolnikov po možganski kapi.

Introduction: There have been remarkable advances in acute stroke treatment in the last 15 years. The purpose of our study was to determine whether this has changed the referral of patients to the triage outpatient clinic for patients after stroke at the University Rehabilitation Institute (URI) in Ljubljana. Methods: In this retrospective study, we included patients after stroke who were first examined in our triage outpatient clinic in the period from January 1 to December 31, 2007, and from January 1, 2015, to October 31, 2015. From the available medical documentation, we collected socio-demographic data, data on the type, duration and method of treatment of the disease, the institution from which the patients were referred, the specialties of the referral physicians, and the measures set out during examination in the triage outpatient clinic. Results: Statistically significant differences in patients examined in 2015 as compared to those examined in 2007 were: longer period of time from the occurrence of stroke up to time of examination in the triage outpatient clinic (p

Introduction: We present the effects of individually prescribed aerobic training using exercise bike on aerobic capacity, functional status and walking performance of patients in the subacute stage after stroke. Methods: Forty stroke patients admitted to comprehensive inpatient stroke rehabilitation program were randomised into control and treatment group. In addition to standard neurorehabilitation program in both groups, the patients in the treatment group had individually prescribed aerobic training on exercise bike. With weekly progression of intensity and duration of exercise, the patients reached 30 minutes of aerobic training per day, five times a week at the intensity of 80% of peak work capacity achieved on stress-testing performed at admission. In all patients, the number of training units of dynamic exercises were recorded and oxygen consumption (VO2peak), 6-minute walking test (6 MWT), Stand up and Go test and Functional Independence Measure (FIM) assessment were performed before and after four weeks of exercise. Results: Thirty-eight patients were included in the statistical analysis (19 in each group). The groups were balanced regarding age, gender, time to admission, mean oxygen consumption, walking distance during 6MWT, the time to perform the Stand up and Go test and the Functional Independence Measure score. After four weeks of training all the measured parameters improved in both groups, the improvement being larger in the treatment group, though not statistically significantly. Only the number of training units of dynamic exercises in was statistically significantly higher in the test group. Conclusion: The individually prescribed aerobic training improves cardiovascular performance, walking ability and functional performance in patients in the subacute stage after stoke. The four-week period of aerobic training was probably too short for demonstrating chronic cardiovascular and metabolic adaptation on regularly aerobic activity. The most important goal of the training is that the patients gain knowledge and feeling of how to continue the program after discharge from inpatient rehabilitation. Uvod: V članku prikazujemo učinke individualno načrtovane in stopnjevane aerobne vadbe na sobnem kolesu na povečanje telesne zmogljivosti, hojo ter funkcijsko stanje v subakutnem obdobju po možganski kapi. Metode: V raziskavo smo vključili 40 bolnikov v subakutnem obdobju po možganski kapi in jih naključno razdelili v testno in kontrolno skupino. Testna skupina je poleg ustaljenega programa rehabilitacije izvajala individualno načrtovan aerobni trening na sobnem kolesu. S postopnim večanjem intenzivnosti in daljšanjem trajanja treninga so bolniki ob koncu treninga vadili pol ure dnevno, pet dni v tednu, z intenzivnostjo 80 % maksimalne obremenitve, dosežene pri obremenitvenem testu na kolesu ob sprejemu. Pri vseh bolnikih smo beležili število vadbenih enot dinamične vadbe, pred pričetkom in po štirih tednih vadbe pa izmerili največjo porabo kisika (VO2peak), v šestih minutah prehojeno razdaljo, izvedli časovni test vstani in pojdi in ocenili funkcijsko stanje bolnikov z Lestvico funkcijske neodvisnosti (FIM). Rezultati: V statistično analizo je bilo vključenih 38 bolnikov, po 19 v vsaki skupini. Skupini sta bili izenačeni po spolu, starosti, času od nastopa možganske kapi do pričetka rehabilitacije, začetni povprečni vrednosti VO2peak, po prehojeni razdalji v šestih minutah, času izvedbe testa vstani in pojdi in oceni FIM. Po štiritedenski vadbi smo pri bolnikih obeh skupin beležili izboljšanje vseh merjenih parametrov, večje v testni skupini, vendar razlike med skupinama niso bile statistično značilne. Statistično značilno večje je bilo le število vadbenih enot dinamične vadbe v testni skupini. Zaključek: Individualno predpisana aerobna vadba ima ugoden učinek na telesno zmogljivost, hojo in funkcijsko stanje bolnikov tudi v subakutnem obdobju po možganski kapi. Štiritedensko obdobje izvajanja aerobnega treninga pri naših bolnikih je bilo prekratko, da bi se pokazali učinki prilagoditve srca in ožilja ter presnove v mišicah zaradi redne aerobne telesne dejavnosti. Bolniki pa so pridobili znanje in občutek, na kakšen način lahko z aerobnimi aktivnostmi varno nadaljujejo po odpustu iz rehabilitacijske ustanove.

Ethical and moral decisions in the rehabilitation of patients after a stroke are present on daily basis. Due to a wide range of effects of the illness or limited possibilities for rehabilitation of these patients a conflict appears between fundamental ethical principles such as the right for autonomy, beneficence, nonmaleficience and justice. The purpose of our paper is to describe the most important areas where ethical issues can arise during inpatient rehabilitation treatment of stroke patients, and to describe the various possibilities to make the decision-making process easier. Etične in moralne odločitve so v rehabilitacijski obravnavi bolnikov po možganski kapi stalnica. Zaradi širokega spektra posledic bolezni ali omejenih možnosti rehabilitacije teh bolnikov se pojavljajo navzkrižja med osnovnimi etičnimi načeli, kot so pravica do samostojnega odločanja, dobronamernosti in neškodljivosti ter pravičnosti. Namen prispevka je opisati najpomembnejša področja, na katerih se lahko pojavijo etična vprašanja med rehabilitacijsko obravnavo bolnikov po možganski kapi na Univerzitetnem rehabilitacijskem inštitutu Republike Slovenije - Soča in opisati različne možnosti, na podlagi katerih bi se lahko olajšal proces sprejemanja odločitev.

Questionnaires used in the study. (DOCX 18Â kb)

Background: Stroke survivors' low cardiovascular fitness decreases their walking ability, activities of daily living, independence and quality of life. The purpose of our literature review was to establish the effectiveness of aerobic training, or combined programs (including aerobic training) in stroke patients. Methods: Based on the inclusion criteria, a literature review was conducted using the PubMed and PEDro databases. The search was limited to publications in English until the end of 2014. Results: Twenty-one randomised controlled trials involving patients in all phases after stroke were included. The effects of aerobic training were investigated in 12 studies and the effects of combined programs in 9. The most common ways of training were treadmill walking and training on a stationary bicycle. Aerobic training significantly improved peak oxygen consumption (14 studies), gait speed (8 studies), and gait endurance (11 studies). Conclusions: Cardiovascular capacity was more effectively improved by programs of aerobic training alone; though combined physiotherapy programs (including aerobic training) resulted in better rehabilitation outcomes. The largest improvements of gait speed and endurance, contributing to patients' greater independence, were attained in programs of aerobic gait training. Izhodišče: Slaba vzdržljivost srčno-žilnega sistema po možganski kapi zmanjšuje sposobnosti bolnikov za hojo in izvajanje dejavnosti vsakodnevnega življenja, povečuje njihovo odvisnost od drugih ter zmanjšuje kakovost življenja. Namen pregleda literature je bil ugotoviti učinkovitost aerobne in z aerobno vadbo kombinirane vadbe pri bolnikih po možganski kapi. Metode: Na podlagi meril za vključitev sta bili pregledani podatkovni zbirki PubMed in PEDro. Iskanje je bilo omejeno na angleščino in je zajelo vse objave do konca leta 2014. Rezultati: V pregled je bilo zajetih 21 randomiziranih kontroliranih poskusov, narejenih pri bolnikih v vseh obdobjih po možganski kapi. V 12 raziskavah so preučevali učinkovitost samostojne aerobne vadbe in v devetih kombinirane programe. Najpogostejša postopka aerobne vadbe sta bila vadba hoje na tekočem traku in vadba na sobnem kolesu. Aerobna vadba je imela pomemben učinek na izboljšanje največje porabe kisika (14 raziskav), hitrosti hoje (8 raziskav) in vzdržljivosti pri hoji (11 raziskav). Zaključek: Programi samostojne aerobne vadbe so se izkazali za učinkovitejše pri izboljšanju vzdržljivosti srčno-žilnega sistema, kombinirani programi pa so imeli največje učinke na izid rehabilitacije. Programi z aerobno vadbo hoje so imeli največje učinke na zvečanje hitrosti hoje in na vzdržljivost pri hoji, ki je pripomogla k večji samostojnosti bolnikov.

Background: Most patients are motivated to resume driving after suffering stroke or after undergoing brain tumor surgery. However, a variety of cognitive deficits can hamper the successful return to efficient and safe driving. Methods: In this pilot study, we assessed the cognitive abilities of patients that are important in driving. Five post-stroke patients and two patients after brain tumor surgery performed a real-life driving test. Both groups of patients showed no relevant motor deficits. Results: Systematic evaluation of driving ability in patients after stroke or brain tumors can offer an important insight in ensuring a safe return to everyday driving. Conclusions: Systematic evaluation of driving ability in patients after stroke or brain tumors can offer an important insight in ensuring a safe return to everyday driving. Izhodišča: Bolniki po možganski kapi in operaciji tumorja se pogosto želijo vrniti k vožnji osebnega avtomobila, vendar jih pri uspešnem vračanju k vožnji lahko ovirajo primanjkljaji, prisotni na kognitivnem področju. Metode: V pilotni raziskavi smo ocenjevali kognitivne sposobnosti, pomembne pri vožnji, in izvedli praktični preizkus vožnje pri petih bolnikih po možganski kapi in dveh bolnikih po operaciji možganskega tumorja, pri katerih ni bilo pomembnih motoričnih primanjkljajev. Rezultati: V rezultatih je prikazan opis posledic bolezni na področju pozornosti in izvršilnih sposobnostih ter pregled izidov na praktičnem preizkusu sposobnosti vožnje. Zaključki: Sistematično ocenjevanje vozniških sposobnosti pri bolnikih po možganski kapi in možganskih tumorjih nudi pomemben vidik pri zagotavljanju varnega vračanja k vožnji.

Background: In a pilot study of telerehabilitation at home for patients after stroke, we wanted to develop a rehabilitation service that would enable the patients after discharge from inpatient rehabilitation to work out at home over a longer period under the supervision of a therapist. Methods: We developed a model of telerehabilitation service, established the technological infrastructure for its implementation via Internet and prepared 19 multimedia contents (videos) - 14 to show correct postures and transfers and 5 comprising a variety of exercises for stretching. Five stroke patients who completed the inpatient rehabilitation program at the University Rehabilitation Institute in Ljubljana were included in the study. An occupational therapist and a physiotherapist supervised the telerehabilitation for 3 months after patient%s discharge. They selected multimedia contents for each patient and weekly adapted them to his needs during videoconferencing. Results: During the telerehabilitation service, 14 different videos were selected for two patients, 13 for another patient, and 10 for two others. The therapists held 13 videoconferences with three patients and 12 with two. With all patients, there were some problems with the Internet connection. Especially in the beginning of telerehabilitation, all patients needed a support of their relatives or other persons. The most viewed videos were those with the exercises for stretching. Conclusions: Responses of patients and their assistants to telerehabilitation service were positive. Further development should particularly address the identification of appropriate contents of telerehabilitation, adapted to the heterogeneous needs of patients after stroke. Izhodišča: S pilotsko raziskavo storitev telerehabilitacije na domu za bolnike po možganski kapi smo želeli razviti storitev rehabilitacije na daljavo, s katero bi omogočili bolnikom po odpustu iz rehabilitacijske ustanove vadbo doma skozi daljši čas ob strokovnem nadzoru terapevta. Metode: Izdelali smo model telerehabilitacijske storitve, vzpostavili tehnološko infrastrukturo za izvajanje telerehabilitacije s pomočjo svetovnega spleta in pripravili 19 multimedijskih vsebin (filmov). Od teh filmov jih je 14 prikazovalo vadbo pravilnih telesnih položajev in pravilno premeščanje, pet pa jih je prikazovalo različne vaje za razgibavanje. V raziskavi je sodelovalo pet bolnikov, ki so preboleli možgansko kap in so bili vključeni v rehabilitacijske programe na Univerzitetnem rehabilitacijskem inštitutu - Soča. Storitve sta izvajala delovni terapevt in fizioterapevt tri mesece po odpustu iz rehabilitacijske ustanove. Za vsakega bolnika sta pripravila individualni izbor multimedijskih vsebin in ga tedensko prilagajala bolnikovim zmožnostim s pomočjo videokonferenc. Rezultati: V času telerehabilitacijske storitve smo dvema bolnikoma predpisali uporabo 14 različnih filmov, enemu 13 različnih filmov in dvema 10 različnih filmov. Terapevta sta imela s tremi bolniki videokonferenco 13-krat in z dvema 12-krat. Pri vseh bolnikih so se nekajkrat pojavile težave s povezavo preko svetovnega spleta. Predvsem v začetku vadbe so vsi bolniki potrebovali pomoč svojca ali druge osebe. Več ogledov filmov smo zabeležili za vsebine, ki so prikazovale vaje za razgibavanje. Zaključek: Odzivi bolnikov in njihovih pomočnikov na telerehabilitacijsko storitev so pozitivni. V nadaljnjem razvoju bo storitev potrebno predvsem vsebinsko izpopolniti in bolje prilagoditi raznovrstnostim potrebam bolnikov po možganski kapi.

Background: Improvement of upper limb function in stroke patients is largely determined by changes in hand function. Optimal hand function requires precise control and coordination of movement and forces produced by fingers. The specific grip patterns can be evaluated by the Southampton Hand Assessment Procedure (SHAP). The aim of our study was to evaluate the use of SHAP for impairment assessment and monitoring change or improvement in stroke patients. Methods: A retrospective study was performed that involved sixty stroke patients admitted to inpatient rehabilitation and assessed by SHAP ad admission and discharge. Results: The indices of function of the impaired hand after brain lesion either in the left or in the right hemisphere were statistically significantly lower than those of the unimpaired hand (p

Due to lack of professionals and rehabilitation teams many patients in Slovenia do not receive adequate rehabilitation. One possibility to improve access to and quality of rehabilitation on the primary, secondary and tertiary level is telerehabiltiation. It enables rehabilitation through modern information and communication technologies at the patient's home. The article provides a review of the literature on telerehabilitation and presents the potentials for its use in Slovenia. Zaradi pomanjkanja strokovnjakov in rehabilitacijskih timov na vseh ravneh številne osebe v Sloveniji ne prejmejo ustrezne rehabilitacije. Ena od možnosti za povečanje dostopnosti in kakovosti rehabilitacije na primarni in sekundarni ter zato tudi terciarni ravni je morda telerehabilitacija. Ta preko sodobnih informacijskih in komunikacijskih tehnologij omogoča bolniku rehabilitacijo na njegovem domu. Prispevek podaja pregled obstoječe literature o telerehabilitaciji, predstavljene pa so tudi možnosti njene uporabe v Sloveniji.