Pavel Kolář et al.

CliniCal Rehabilitation

XXXI

The main motivation for me to begin work on this textbook was an effort to refine knowledge of the qualified public about rehabilitation and provide a  framework regarding the true objectives of this field. Our profession is sometimes misconceived as massage therapy, exercising after orthopedic proce-dures, rehabilitation and sometimes it is reduced to only the use of therapeutic agents (modalities). I have also encountered the opinion that it is linked to or even directly considered some kind of an alternative treatment. Another important motivation for me was the lack of current study materials for physicians un-dergoing residencies, for graduate and post-graduate physical therapy students, as well as for physicians of other clinical specialties who want to be introduced to the methods of treatment rehabilitation used in their specialization.

In my view, I consider it essential that the foundati-on for rehabilitation treatment approaches be neither a trend nor a school of thought (chiropractics, osteo-pathy, musculoskeletal medicine), but rather a wide, general foundation in the fields of clinical physiology and neurophysiology. It also needs to be appreciated that rehabilitation is not only limited to diagnostic and treatment methods, but it also attempts to limit the extent of psychological, behavioral and social changes related to the consequences of an injury or illness. Therefore, rehabilitation should not be perce-ived as strictly a  medical field but a  field that over-reaches these boundaries and extends into the social, academic and work arenas. Comprehensive (integra-ted) rehabilitation applies to individuals whose health was compromised to a varied extent as a result of an illness, injury or a congenital defect and who require special assistance to achieve the highest possible level of independence. A person with a disability perceives limitations that they are unable to overcome while performing certain activities but they feel able and healthy in a number of other activities. Removing and solving these limiting problems is one of the particu-larly important tasks of rehabilitation. Therefore, the concept of rehabilitation must complement not only the treatment process but also the subsequent rehabi-litation process.

From this point of view, rehabilitation is a  very broad field which cannot be covered in detail in one book. Similarly, it is not possible to cover this extensi-ve subject by one specialist. Success is based on a co-ordinated effort of various specialists.

In this book, I focused on the treatment component of rehabilitation and devoted more space to it than the educational, social and occupational areas. Given the fact that the diagnostic and treatment approaches of rehabilitation are focused primarily on the movement system, this field reaches into practically all clinical fields (neurology, orthopedics, internal medicine, oncology, immunology, psychiatry, etc.). Movement function plays an important role in all of these clinical fields. This is because physical activity and its repeated action manifest themselves by a change in function in a number of systems (cardiorespiratory, immune, cen-tral nervous system and metabolic changes), which allows for influencing these systems through modula-tion of its intensity, frequency and form. Another re-ason why rehabilitation reaches into several medical fields is the fact that the sensory afferent inputs from the entire body are always processed not only within its own sensory modality (visual, acoustic, proprio-ceptive, integumentary, etc.), but also within an inte-grated motor function. Our eyes, respiratory muscles, tongue, etc. serve not only the function they are do-minantly selected for, but they also participate in pos-tural and locomotive functions. This is well observed in athletic performances in which maximal force or a precisely accurate movement needs to be accomplis-hed. For example, to strike a ball with required force, a  tennis player makes a movement with their extre-mity, which is linked to a face expression, movement of the tongue in the direction of the stroke, eye mo-vement in the direction of the stroke, modification of breathing by diaphragm activity (a grunt, Valsalva) to facilitate trunk stabilization, position of the contrala-teral extremity into the opposite (reciprocal) position etc. It is an overall involuntary movement pattern that interlinks individual sensory modalities and, thus, it is related to the majority of medical fields. This princi-ple of modality integration within postural locomotor functions is a component of CNS development and it was established based on this principle. The fact that the described integration occurs at higher levels of control than the spinal cord and the brain stem is sig-nificant. This can also provide hypotheses regarding the effects of a number of alternative approaches who-se justification of spinal cord and brain reflexology is not sufficient and is therefore substituted in clinical practice by alternative explanations. These central programs are organized above the brain stem level and can explain why functional pathologies become

ForeWord

XXXII clinical rehabilitation

chained in predetermined sequences; why needle ap-plication in a single point has functional consequen-ces in a completely distant area of the body including the visceral region; why an internal dysfunction does not only show reflexive response in the corresponding segment but in quite distant areas and in various af-ferent modalities (skin hyperalgic zones, changes in dermographism, muscle trigger points, joint restricti-ons, etc.); why respiratory function can be influenced through eye movement (eye movement automatically causes change in the breathing pattern); why breathing pattern changes with a change in hand position, and a  number of other phenomena. The control system of the postural locomotor functions then provides us with a program that offers a completely new approach in the understanding of rehabilitation approaches.

Clinical diagnosis focused on symptomatology or-ganized within postural locomotor functions should not be considered an exclusive component of treat-ment rehabilitation but also a component of the rema-ining clinical specialties.

I based the structuring of the General and Special Sections of the textbook on the function of the move-ment system in relation to individual clinical special-ties. Therefore, I did not base them on diagnoses but rather on the functional manifestations of the disease. The General section of the textbook includes functio-nal symptomatology and syndromology in dysfuncti-ons of the nervous, musculoskeletal and internal sys-tems and their clinical and laboratory examinations. The majority of treatment approaches are also presen-ted in this context meaning that the treatment based on symptomatology and syndromology dominates. In the Special Section of the textbook, treatment rehabi-litation is presented in individual clinical specialties – neurology, orthopedics, internal medicine, oncology, gynecology and psychiatry.

I purposely devoted less attention to occupational therapy, balneology and therapeutic agents (moda-lities) than these treatment approaches deserve. The reason is not to underestimate their value, but rather them already being reasonably available and suffici-ently described elsewhere.

In clinical approaches of the General Section of the textbook, I have extensively drawn from and ex-panded on a trend known worldwide as the “Prague School.” In rehabilitation, the roots of this school of rehabilitation can be found in the Neurology Clinic of Professor Henner whose concept of neurology was very broad and therefore included even vascu-lar diseases and movement system diseases within neurological symptomatology. Treatment rehabilita-tion was promoted by K. Obrda who, together with J. Karpisek, wrote the first rehabilitation textbook for neurological diseases and organized an international congress in 1965. On the theoretical level, F. Vele and

O. Stary played an important role. Stary and K. Lewit demonstrated the significance of painful functional deficits of the movement system. In this aspect, the large contribution of Professor J. Jirout who was the founder of functional radiology of the spine, needs to be remembered. Thanks to the work of Professor V. Janda, the basic significance of movement patterns was gradually underwood and the term “functional pathology of the movement system” was established. This presentation was even further strengthened by the influence of scientific studies and personal con-tact with D.G. Simons and J.G. Travell to whom we are grateful for providing detailed knowledge of muscle trigger points that also cause a limitation in joint mo-bility, so called joint restrictions. To understand the function of the movement system, individual dys-functions, such as trigger points and joint restricti-ons, need to be understood in the context of the entire movement system, i.e. the laws of chaining of functi-onal dysfunctions. The key to this understanding was a better knowledge of the control function of motor skills. The new approach of treatment rehabilitation during movement re-education is based on utilization of knowledge about human motor development. This new trend enriches the current empirical and physical approaches by findings originating from the control processes of the CNS that mature during motor de-velopment. Dr. Vaclav Vojta, whose work we are cur-rently trying to continue, has a significant role in this approach. Professor Vojta also came from Henner’s department and his conceptualization is an inherent component of contemporary clinical rehabilitation practice. Unfortunately, the neurophysiological prin-ciple of the entire approach to developmental kinesio-logy is still not fully appreciated due to disagreements about indication and the type of application of the Vojta method. However, not many critics understand the true basis of the Vojta approach. what is essential and substantial is not only the way that rehabilitation of movement dysfunction is utilized, but also the fact that the concept of developmental kinesiology is com-bined with the neurophysiological view relying on the findings of neurosciences associated with the current-ly predominant physical mechanical views.

In this book, I was also trying to respect and em-phasize more certain general principles that condition the treatment effect, however, to convey the informa-tion in a written form is significantly limited for some of them. The respect for a comprehensive patient per-spective is one such principle. The fact that human life occurs under specific biological, psychological, soci-al-psychological, materialistically economic and eco-logical conditions needs to be implanted within the diagnostic, treatment and preventative approaches. Diseases and injuries cannot be viewed in isolation but rather need to be integrated within the context

Foreword XXXIII

of such relationships because the treatment processes and rehabilitation are significantly affected by them.

I also aspired to prevent this textbook from beco-ming a proponent of only one method but rather sup-port a  variety of rehabilitation approaches based on a person’s individual needs. The problem is that this does not allow for providing a clear-cut treatment ap-proach for movement dysfunctions because these ap-proaches need to also be modified to the patient’s, and sometimes even the therapist’s, personality. In this context, protocols based on one uniform foundation outlining what and how much needs to be done can-not be implemented. These approaches are a method of choice, offering the option of finding individual so-lutions to how to effectively proceed and how to best modify the approach for a specific individual.

It is almost impossible to express in written form some principles that significantly affect the results of a rehabilitation treatment. This, for example, includes the mutual trust between the patient and the reha-bilitation specialist, which cannot be substituted by a client-expert relationship or by a work performance contract. The importance of effective communicati-on, charismatic approach, suggestive appeal and one’s own experience developed by sensory perceptions are additional examples.

Despite these limited options, I  believe that this book will assist in better orientation in the broad field that rehabilitation truly is and thus will help fulfill the purpose for which it was written.

Pavel Kolar

XI

ConTenTS

InTrodUCTory SeCTIonPavel Kolář

REHABILITATION CONCEPT AND DEFINITION ............ 2Jan Calta, Pavel Kolář

Current State of Providing Rehabilitation ............................. 2TREATMENT (MEDICAL) REHABILITATION .................... 2SOCIAL REHABILITATION ...................................................... 5TOOLS OF SCHOOL-BASED REHABILITATION ................ 5TOOLS OF VOCATIONAL REHABILITATION .................... 5PREVENTATIVE ROLE OF REHABILITATION ................... 5FUNDAMENTAL PRINCIPLES

OF REHABILITATION ............................................................ 6INDIVIDUAL TYPES OF REHABILITATION

SETTINGS .................................................................................. 7CLASSIFICATION OF FUNCTIONAL CAPABILITY,

DISABILITY AND HEALTH ................................................. 8

TreATMenT reHABILITATIon – dIAGnoSTIC And THerAPeUTIC APProACHeS

reHABILITATIVe CAre

Pavel Kolář

REPOSITIONING .......................................................................13Indications for Repositioning ...............................................13Principles of Repositioning ...................................................13Goals of Repositioning .........................................................14Types of Repositioning ..........................................................15

Pavel Kolář, Jiří KřížVERTICALIZATION ..................................................................17PATIENT MOBILIZATION ......................................................17Mobilization goals ..................................................................17Prevention of Heterotopic Ossifications ..............................18Types of Mobilization ............................................................19Active Movement ...................................................................20

TreATMenT reHABILITATIon FoCUSed on reSTorATIon oF A FUnCTIonAL deFICIT

Pavel Kolář

Functional Emphasis of Methods in Treatment Rehabilitation ..........................................................................21

Karel Lewit, Pavel Kolář

Pain and Movement System Dysfunction ...........................21Karel Lewit, Pavel Kolář

A. dIAGnoSTIC ProCedUreS

1 ASSeSSMenT APProACHeS FoCUSed on THe FUnCTIon oF THe MoVeMenT SySTeM

Pavel Kolář, Karel Lewit, Olga Dyrhonová

FundaMEntals oF a clinical assEssMEnt ...........25PATIENT PRELIMINARY CASE HISTORY

(ANAMNESIS) ........................................................................25OBSERVATION (ASPECTION) ...............................................28PALPATION .................................................................................29

Karel LewitAUSCULTATION ........................................................................32

Petr Bitnar

1.1 neUroMUSCULAr FUnCTIonS And THeIr CLInICAL eXAMInATIon ............ 33

Pavel KolářMuscle in Reflexive Context as Part

of the Movement System ...................................................34Motor Patterns ........................................................................34Movement Stereotypes ...........................................................35CLINICAL MANIFESTATIONS AND ExAMINATION

OF NEUROMUSCULAR DYSFUNCTIONS .....................36

I FUnCTIonAL And neUroLoGIC SyMPToMAToLoGy

1.1.1 examination of Postural Functions ............ 36Pavel Kolář

POSTURE .....................................................................................37 Postural Function – Normal .................................................37Development of Posture ........................................................37Reflex Model of Posture and Locomotion...........................39Circumscription of the Term Posture ..................................39Postural Stability .....................................................................40Postural Stabilization .............................................................40Postural Reactibility ...............................................................40Postural Disturbances ............................................................42STANDING ..................................................................................44Examination of Individual Body Regions ...........................44

I GenerAL SeCTIon

XII clinical rehabilitation

Modified Examination of Standing ............................49ASSESSMENT OF STANDING IN NEUROLOGIC

DISORDERS .............................................................................50GAIT ..............................................................................................50

Petra Valouchová, Pavel KolářPhases of the Gait Cycle .........................................................50Types of gait according to V. Janda ......................................50Examination of Gait in a Clinical Setting ............................51Laboratory Examination of Gait...........................................52Typology of Gait Dysfunctions from

a Neurological Perspective ................................................52Examination of Postural Stabilization

and Postural Reactibility ...................................................54Pavel Kolář

1.1.2 examination of Muscle tone ...................... 60Pavel Kolář

Reflex Regulation of Muscle Tone ........................................60Connective Tissue Component

of Muscle Tone ....................................................................60DEFICITS IN MUSCLE TONE .................................................61Hypertonia and Spasm ..........................................................61Contracture .............................................................................61Local Hypertonic Changes in Muscle Tissue ......................61

Zdeněk ČechTrigger Points – Clinical Characteristics .............................62Histological Findings in the Area of a Trigger Point .........62Localization of Trigger Points ...............................................62Foundation of Trigger Point Formation

in Muscle Tissue .................................................................62Trigger Points versus Tender Points .....................................63Local Muscle Twitch ..............................................................63Trigger Points as a Source of a Spontaneous Myofascial

Pain .......................................................................................63Examination of Trigger Points with the Help

of Instrumentative Examination Methods .....................64Spasticity ..................................................................................65

Pavel KolářRigidity .....................................................................................68Paratonia ..................................................................................68Hypotonia ................................................................................68MUSCLE TONE DISTRUBANCES AND THEIR

POSTURAL LAYOUT ............................................................69Pavel Kolář

Upper Crossed Syndrome .....................................................69Lower Crossed Syndrome .....................................................70Layer Syndrome ......................................................................70Assessment of Shortened Muscles ........................................701.1.3 examination of Sensory Functions ............. 70

Alena KobesováSENSORY TESTING ...................................................................71Examination of Individual Sensory Modalities ..................72Touch ........................................................................................72Temperature ............................................................................72Pain ...........................................................................................72Joint Position Sense ................................................................73

Kinesthesia ..............................................................................73Perception of Vibration .........................................................73Two-point Discrimination ....................................................73Topognosis, Graphesthesia ....................................................74Stereognosis .............................................................................74Clinical Sensory Syndromes .................................................741.1.4 assessment of Reflexes .............................. 75

Pavel KolářMYOTATIC REFLExES .............................................................75Upper Extremities Myotatic Reflexes ..................................75Myotatic Reflexes of the Lower Extremities ........................75ExTEROCEPTIVE REFLExES .................................................76IDIOMUSCULAR RESPONSE .................................................76PATHOLOGICAL REFLExES ..................................................76Pathological Reflexes Elicited

in the Upper Extremity ......................................................76Pathological Reflexes Elicited

in the Lower Extremity ......................................................77Clonus ......................................................................................78Mediopubic Reflex ..................................................................781.1.5 examination of involuntary Movements ......78

Pavel KolářTREMOR.......................................................................................79SPASMS .........................................................................................79MYOCLONUS .............................................................................79FIBRILLAR AND FASCICULAR TwITCHES ......................79CHOREIC AND ATHETOID HYPERKINESES ...................79Athetosis ..................................................................................79Chorea ......................................................................................79TICS ...............................................................................................801.1.6 examination of Muscle Strength ................ 80

David Smékal, Magdaléna LepšíkováMUSCLE wEAKNESS ...............................................................80MUSCLE STRENGTH ................................................................80Assessment of Muscle Strength ............................................80Assessment of Muscle Strength ............................................81

II neUroLoGIC SyndroMoLoGy

1.1.7 Primary Myogenic lesion .......................... 83Petr Bitnar, Pavel Kolář

weakness in Myopathies .......................................................83Pseudohypertrophy and Muscle Contractures

in Myopathies .....................................................................841.1.8 Deficits at the neuromuscular Junction .......84

Petr BitnarMyasthenia Gravis ..................................................................84Lambert-Eaton Myasthenic Syndrome................................841.1.9 Peripheral nerve Deficits .......................... 84

Petr BitnarExamination of Deficits in the Sensory Fibers

of the Peripheral Nerve ......................................................84Examination of Deficits in Motor Fibers

of a Peripheral Nerve .........................................................85

contents XIII

1.1.10 Spinal Cord Syndromology ...................... 85Jiří Kříž, Veronika Hyšperská

GRADUAL TRANSVERSE SPINAL CORD LESION ...........85SUDDEN TRANSVERSE SPINAL CORD LESION ..............85PSEUDOPARETIC SPINAL CORD LESION .........................85SPASTIC SPINAL CORD LESION ...........................................85MIxED SPINAL CORD LESION .............................................86CONUS MEDULLARIS SYNDROME ....................................86CAUDA EQUINA SYNDROME ..............................................86POSTERIOR CORD SYNDROME ...........................................86BROwN-SEQUARD SYNDROME ..........................................86INTRAMEDULLARY SYNDROME ........................................861.1.11 Cerebellar Syndromology ........................ 86

Pavel KolářFLACCIDITY ...............................................................................86HYPERMETRIA ..........................................................................86ASYNERGY ..................................................................................87DIADOCHOKINESIA ................................................................87OTHER CEREBELLAR SIGNS .................................................871.1.12 extrapyramidal Syndrome ....................... 87

Pavel Kolář1.1.13 thalamic Syndrome ................................. 87

Pavel Kolář1.1.14 brain Stem Syndromes ............................. 88

Pavel KolářMEDIAL SYNDROMES .............................................................88LATERAL SYNDROMES ...........................................................881.1.15 Syndromes of Meningeal irritation, intracranial hypotension, hypertension and Ventricular Syndromes ................................ 89

Pavel KolářSYNDROME OF MENINGEAL IRRITATION ......................89INTRACRANIAL HYPOTENSION SYNDROME ................89INCREASED CRANIAL PRESSURE SYNDROME .............89VENTRICULAR SYNDROMES ...............................................901.1.16 Cortical Syndromes and their examination ........................................ 90

Pavel Kolář, Rastislav DrugaFRONTAL LOBE .........................................................................90Primary Motor Cortex (MI) .................................................91Premotor Cortex .....................................................................91Frontal Eye Field .....................................................................92Broca’s Speech Area ................................................................92Prefrontal Cortex ....................................................................92Signs of an Injury to the Frontal Lobes

of the Motor Cortex ...........................................................93Axial phenomena ...................................................................93Paraxial phenomena ...............................................................93Other Disturbances with Lesions

to the Frontal Cortex .........................................................93Assessment Tests for Frontal Lobes Deficits .......................93TEMPORAL LOBE .....................................................................94OCCIPITAL LOBE ......................................................................95PARIETAL LOBE .........................................................................95Deficits in Phatic Functions ..................................................95

Deficits in Gnostic Functions ...............................................95Deficits in Practical Functions ..............................................96LIMBIC SYSTEM .........................................................................96Examination of Motor Functions from the Perspective

of Cortical Plasticity ...........................................................97Pavel Kolář, Magdaléna Lepšíková

Examination of Selective Movement ...................................98Examples of Clinical Tests .....................................................99

III neUroMoTor deVeLoPMenT And ITS eXAMInATIon

CLINICAL ExAMINATION VIA MOTOR PROGRAMS ..........................................................................100Pavel Kolář

SCREENING OF NEUROMOTOR DEVELOPMENT ......................................................................101

Central Coordination Disturbance (CCD) .......................101Developmental Kinesiology as an Assessment

Method – the Examination of an Infant in the First Year of Life ....................................................101

Postural Activity ...................................................................102Postural Activity in Individual Phases of Development

(0–15 Months) ..................................................................103Postural Reactivity ................................................................112

Pavel Kolář, Marcela Šafářová1. Traction Test......................................................................1132. Landau Reaction ...............................................................1133. Axillary Suspension .........................................................1144. Vojta’s Tilt Reaction ..........................................................1155. Collis Horizontal Suspension .........................................1166. Peiper-Isbert Vertical Suspension ..................................1177. Collis Vertical Suspension ...............................................118Primitive Reflexology ...........................................................118

Pavel KolářFunctional Relationship between Postural Activity,

Postural Reactivity and Primitive Reflexology .............121PSYCHOMOTOR DEVELOPMENT IN EARLY

CHILDHOOD .......................................................................121Irena Zounková, Pavel Kolář

CENTRAL COORDINATION DISTURBANCE IN PRESCHOOL AND SCHOOL AGE ............................125Irena Zounková, Pavel Kolář

Monitored Areas in a Neurodevelopmental Examination ......................................................................126

Physiotherapy in Central Coordination Disturbance .......................................................................130

1.2 KIneSIoLoGy And CLInICAL eXAMInATIon oF THe JoInT SySTeM ..........133

Pavel KolářJoint Motions.........................................................................133Joint Categories Based on the Number of Axes

and the Shape of Articular Surfaces ...............................134

XIV clinical rehabilitation

Classification of Joints according to the Number of Articulating Bones within the Joint...........................135

Joint Innervation ..................................................................135Assessment of Joint Range of Motion ................................135

David Smékal1.2.1 Kinesiology of the Spine, Pelvis and the thorax ........................................137

Pavel KolářspinE .......................................................................... 137pElvis .........................................................................140thorax .....................................................................141anatoMical paraMEtErs inFluEncing

spinal Function .................................................143Regional Anatomical Parameters .......................................143Global Anatomical Parameters ...........................................144ExaMination oF thE spinE, pElvis

and thE thorax ..................................................145Patient History (Anamnesis) and Physical Assessment ..145Neurological Assessment .....................................................145Assessment of Motor Functions .........................................147Functional Assessment ........................................................1471.2.2 Kinesiology of the Shoulder Girdle (Plexus).............................................................154

Petra Valouchová, Pavel KolářbonEs oF thE shouldEr girdlE ...........................154Joints oF thE shouldEr girdlE ...........................156MovEMEnts in thE Joints oF thE

shouldEr girdlE .................................................156shouldEr girdlE ExaMination ...........................157

Michaela TomanováAnamnesis .............................................................................157Aspection ...............................................................................158Palpation ................................................................................158Joint Play ................................................................................158Passive Movements ...............................................................159Active Movements ................................................................159Adduction and Internal Rotation (Apley’s Scratch Test) ... 159Abduction and External Rotation ......................................159Special Tests for the Shoulder Girdle .................................159Assessment of Movements against Resistance –

Resistive Tests ...................................................................159Instability Tests .....................................................................160Anterior Instability Testing .................................................160Posterior Instability Testing ................................................161Clunk Test ..............................................................................161Inferior (Caudal) Instability ................................................161Multidirectional Instability .................................................161Tests for Long Head of the Biceps Brachii

Tendon Pathology ............................................................161Rotator Cuff and Impingement Syndrome Tests ..............162Acromioclavicular Joint Tests .............................................1631.2.3 Kinesiology of the elbow Joint .................163

Petr BitnarElbow Joint MovEMEnts ......................................164assEssMEnt oF thE Elbow Joint ..........................165

Anamnesis .............................................................................165Aspection ...............................................................................165Palpation ................................................................................165Passive Movements ...............................................................165Active Movements ................................................................166Functional Tests ....................................................................166Instability Tests .....................................................................166Lateral Epicondylitis Tests ...................................................1661.2.4 Kinesiology of the Wrist and the hand ...... 166

Petr Bitnarwrist .........................................................................166MOVEMENTS OF THE CARPAL COMPLEx ....................167carpoMEtacarpal Joints ......................................168hand .........................................................................168MAIN TYPES OF GRIP ...........................................................169assEssMEnt oF thE wrist and thE hand ...........169Anamnesis .............................................................................169Aspection ...............................................................................170Palpation ................................................................................170Passive Movements ...............................................................170Active Movements ................................................................170Functional Tests ....................................................................1701.2.5 Kinesiology of the hip Joint ......................171

Magdaléna Lepšíková, Pavel Kolářhip Joint assEssMEnt .............................................173Anamnesis .............................................................................173Aspection ...............................................................................173Palpation ................................................................................174Passive Movements ...............................................................174Active Movements ................................................................174PEDIATRIC HIP JOINT ASSESSMENT ..............................1741.2.6 Kinesiology of the Knee Joint ....................174

Pavel KolářMovEMEnts oF thE KnEE Joint ............................. 174KnEE Joint assEssMEnt .......................................... 176Anamnesis .............................................................................176Aspection ...............................................................................176Palpation ................................................................................177Passive Movements ...............................................................177Active Movements ................................................................177Functional Assessment ........................................................177Examination of the Menisci ................................................177Assessment of Knee Joint Stability .....................................178Patellofemoral Joint Examination ......................................180Patellar Stability Test – Apprehension Test .......................180Planer Sign.............................................................................180Zohlen Test ............................................................................180Fairbank’s Test (Zohler’s Sign) ............................................1801.2.7 Kinesiology of the lower leg and the Foot ......................................................180

Pavel Kolář, Ivan Vařeka anKlE and Foot Joints .........................................180MovEMEnts in thE anKlE and Foot Joints ......182Functional rElationships bEtwEEn

thE anKlE and thE Foot Joints .......................183

contents XV

assEssMEnt oF thE anKlE and thE Foot ............183Anamnesis .............................................................................184Aspection ...............................................................................184Palpation ................................................................................184Passive Movements ...............................................................184Active Movements ................................................................185Functional Assessment ........................................................185Tests for Ankle Instability ....................................................185

1.3 SoFT TISSUeS .........................................186Petr Bitnar

1.3.1 Skin ...........................................................1871.3.2 Subcutaneous tissues (hypodermis) ........1911.3.3 Fasciae ......................................................191

2 VISCeroMoTor reLATIonSHIPS And THe AUTonoMIC nerVoUS SySTeM

Petr Bitnar, Hana Marčišová, Pavel Kolář

2.1 VISCeroSoMATIC And SoMAToVISCerAL reLATIonSHIPS .............195

Petr Bitnar

2.1.1 Viscerosomatic (Visceromotor) Relationships .....................................................195Visceral Pattern .....................................................................1952.1.2 Somatovisceral Relationships ...................196Movement System and Visceral Pain .................................196Movement System and Functional Deficits

of the Internal Organs ......................................................197Movement System as a Trigger Factor for

a Latent Internal Illness ...................................................198Movement System as a Tool for the Treatment

of Internal Illnesses ..........................................................1982.1.3 overview of basic Visceral Patterns ..........198

2.2 eXAMInATIon oF THe AUTonoMIC nerVoUS SySTeM ....................................... 200

Hana Marčišová2.2.1 anatomy and Physiology of the anS ........ 2012.2.2 Function of the anS within the Movement apparatus ................................. 201Vasomotricity ........................................................................202Somatosensory System and the ANS .................................202ANS and Muscle Function ..................................................2032.2.3 anatomical Vegetative Syndromes .......... 204

Pavel KolářCENTRAL AUTONOMIC SYNDROMES ............................204PERIPHERAL AUTONOMIC SYNDROMES......................204Claude-Bernard-Horner Syndrome ...................................204Posterior Cervical Sympathetic Syndrome .......................205GROSS VEGETATIVE SYNDROMES ...................................205REFLExIVE VEGETATIVE SYNDROMES .........................205

3 PSyCHoLoGICAL FUnCTIonS And PAIn

Petr Knotek

3.1 PSyCHoLoGICAL dIAGnoSTICS In reHABILITATIon .................................... 207

3.2 ASSeSSed ProCeSSeS And MeTHodS oF THeIr TeSTInG ...................................... 207Reactivity to Painful Stimuli ...............................................207Pain in the Pathological Process .........................................208Beginning Phase of Psychological Pain

Processing .........................................................................209Cognitive Processes ..............................................................209Affection ................................................................................210Behavior .................................................................................210Interpersonal Communication ...........................................210

4 eXAMInATIonS By FUnCTIonAL LABorATory MeTHodS

Milan Zedka, Pavel Kolář

4.1 LABorATory eXAMInATIon oF MoVeMenT .............................................213

Milan Zedka

4.1.1 Kinematic analysis ...................................213Milan Zedka

4.1.2 Kinetic analysis (Posturography) .............215Ondřej Čakrt

Physics Basis of the Examination .......................................215Posturography in a Clinical Setting ...................................215Factors Influencing Postural Stability ................................2164.1.3 electromyographic analysis in biomechanics ................................................216

Milan Zedka, Petra ValouchováExamination of Muscle Coordination ...............................216Examination of Force ...........................................................218Assessment of Muscle Fatigue ............................................218

4.2 SUPPLeMenTAL neUroLoGICAL eXAMInATIonS ............................................219

Milan Zedka4.2.1 electromyography ....................................2194.2.2 electroencephalography .......................... 2224.2.3 evoked Potentials .................................... 224Somatosensory Evoked Potentials ......................................224Visual Evoked Potentials (VEPs) ........................................225Auditory Evoked Potentials.................................................226Motor Evoked Potentials (MEPs) .......................................227

4.3 eXAMInATIonS By IMAGInG MeTHodS ................................................... 227

Pavel Kolář, Martin Kynčl4.3.1 Radiologic Methods ................................ 227

XVI clinical rehabilitation

x-RAY ExAMINATION ..........................................................227Pavel Kolář, Olga Dyrhonová

Shoulder Joint .......................................................................228wrist .......................................................................................228Hip Joint ................................................................................228Knee Joint ..............................................................................228Ankle Joint .............................................................................228Spine .......................................................................................228COMPUTED TOMOGRAPHY (CT) ....................................229

Pavel Kolář, Martin KynčlMAGNETIC RESONANCE IMAGING ................................230

Martin Kynčl, Pavel KolářFunctional Magnetic Resonance .......................................231TRACTOGRAPHY ...................................................................231

Martin Kynčl, Pavel KolářSCINTIGRAPHIC ExAMINATION .....................................231

Pavel Kolář, Martin KynčlPOSITRON EMISSION TOMOGRAPHY ............................231

Pavel Kolář, Martin KynčlSINGLE PHOTON EMISSION COMPUTED

TOMOGRAPHY ..................................................................231Pavel Kolář, Martin Kynčl

NEAR-INFRARED SPECTROSCOPY (NIRS) ....................232Pavel Kolář, Martin Kynčl

4.3.2 examination by Ultrasound ..................... 232Zdeněk Hříbal

5 ASSeSSMenT oF THe SeVerITy oF MoTor InVoLVeMenT And LIMITATIonS In THe ACTIVITIeS oF dAILy LIVInG

Pavel Kolář

5.1 MeTHodS USed For MeASUreMenT And ASSeSSMenT In reHABILITATIon ...... 235

5.2 ASSeSSMenT oF THe eXTenT oF MoTor InVoLVeMenT .......................... 236

5.2.1 Gross Motor Skills assessment by the Gross Motor Function Measure .............. 2365.2.2 Developmental Kinesiology as an assessment Method of a Motor Deficit ............. 2375.2.3 additional tests to assess Motor Deficits ............................................................. 239

5.3 TeSTInG And ASSeSSMenT oF reSTrICTed ACTIVITIeS oF dAILy LIVInG ......................................... 2395.3.1 Functional independence Measure ........ 2425.3.2 barthel index .......................................... 2425.3.3 Katz index of activities of Daily living ..................................................................2445.3.4 activity index ......................................... 244

5.3.5 Frenchay activities index ........................ 2445.3.6 Factor assessment according to tardieu ......................................................... 2445.3.7 other tests ............................................. 245

B. THerAPeUTIC MeTHodS

1 PHySICAL THerAPy MeTHodS And ConCePTS

Pavel Kolář

1.1 GenerAL PHySICAL THerAPy (MUSCULoSKeLeTAL) APProACHeS ........... 248

1.1.1 Passive Movements ................................. 248Pavel Kolář

1.1.2 active assistive exercise ........................... 248Magdaléna Lepšíková

1.1.3 Muscle Strength exercises ....................... 248Zdeněk Čech

Kinesiologic Notes ................................................................248Input-Adaptation Relationship during

Strengthening Exercises ...................................................2491.1.4 Dynamic neuromuscular Stabilization ......252

Pavel Kolář, Marcela ŠafářováGeneral Principles of Practice Techniques ........................253Practice of Postural Stabilization of the Spine,

Chest and the Pelvis .........................................................254Influence on Tightness and Improvement

of Chest wall Dynamics ..................................................255Influence on Spinal Straightening ......................................256Training of the Postural Breathing Pattern and

the Stabilization Function of the Diaphragm ...............256Postural Stabilization Training of the Spine

Using Reflex Locomotion ................................................258Training of Deep Postural Stabilization of the Spine

in Modified Positions .......................................................259Exercising Postural Functions in Developmental Lines

(Sequences) .......................................................................259Movement Assistance during Exercise ..............................262Facilitative Elements of Training Techniques ...................262Exercise Examples ................................................................2641.1.5 Soft tissue Mobilization .......................... 266

Karel LewitPost-Isometric Relaxation ...................................................266Examples of Other Techniques ...........................................2681.1.6 Dry needling for Muscle trigger Points .................................................270

Pavel Kolář1.1.7 traction ................................................... 271

Pavel Kolář1.1.8 Relaxation techniques............................. 271

Pavel Kolář

contents XVII

1.1.9 exercises aimed at the Restoration of Sensation (Somatesthesia) ........................... 271

Pavel Kolář, Magdaléna Lepšíková

1.2 MeTHodS And APPorACHeS USed In reHABILITATIon oF PATIenTS WITH CHronIC reSPIrATory SySTeM InVoLVeMenT ............................................ 271

Pavel Kolář, Jan Šulc1.2.1 Methods of Pulmonary Physical therapy ............................................................ 272

Libuše Smolíková1.2.2 Corrective Physical therapy for the Postural System ..................................... 273

Libuše Smolíková1.2.3 Respiratory Physical therapy approaches Utilizing Postural Respiratory Function of the Diaphragm .............................. 275

Pavel KolářRole of the Diaphragm during the Physiological

Breathing Cycle .................................................................275Breathing Biomechanics in a Pathological State ..............278Posturally Locomotor Function

of the Diaphragm .............................................................279Respiratory Physical Therapy Techniques Utilizing

Postural Locomotor Functions .......................................280Positional Influence on the Postural Respiratory

Function of the Diaphragm ............................................2811.2.4 Respiratory Physical therapy – Methods and techniques for Respiratory Pathway hygiene ............................................. 281

Libuše SmolíkováActive Cycle of Breathing Techniques ...............................282Autogenic Drainage..............................................................282PEP System of Breathing .....................................................282Oscillatory PEP System .......................................................282Respiratory Physical Therapy and Breathing

Muscle Training Devices .................................................284Intrapulmonary Percussive Ventilation .............................284Inhalation Therapy – A Component of Respiratory

Physical Therapy ...............................................................284Respiratory Physical Therapy for Patients

in Intensive Care Units ....................................................285Control Mechanisms of Respiratory

Physical Therapy ...............................................................2851.2.5 breathing exercises (breathing Gymnastics) ................................... 285

Libuše Smolíková1.2.6 Fitness Physical therapy and Pulmonary illnesses ................................... 287

Pavel Kolář

1.3 SeLeCTed PHySICAL THerAPy ConCePTS ................................................... 2881.3.1 Vojta’s Principle: Reflex locomotion ....... 288

Irena Zounková, Marcela Šafářová

THERAPEUTIC SYSTEM .......................................................288Activation of Reflex Locomotion .......................................288Reflex Creeping .....................................................................288Activation System Positions 1–6 ........................................290Reflex Rolling ........................................................................291TREATMENT EFFECTS ..........................................................294PRINCIPLES AND FUNDAMENTALS

OF THERAPY ........................................................................294INDICATIONS AND CONTRAINDICATIONS ................2951.3.2 Sensorimotor Stimulation ....................... 295

Michaela Veverková, Marie Vávrová1.3.3 Feldenkrais Method ................................ 298

Magdaléna Lepšíková1.3.4 Proprioceptive neuromuscular Facilitation ....................................................... 300

Irena Zounková, Pavel Kolář1.3.5 brunkow’s Method ................................. 301

Pavel Kolář1.3.6 brügger’s Concept .................................. 302

Dagmar Pavlů1.3.7 Sling exercise therapy ............................ 304

Alice Hamáčková, Dagmar Tomisová, Ctirad Tomis

1.3.8 exercise with a therapy ball .................... 305Pavel Kolář

2 ModALITIeS

Bronislav Schreier

2.1 CLASSIFICATIon oF ModALITIeS BASed on THe TyPe oF APPLIed enerGy ....................................................... 309

2.1.1 Mechanotherapy ..................................... 3092.1.2 thermotherapy and hydrotherapy.......... 3092.1.3 electrotherapy ........................................ 3092.1.4 Phototherapy ...........................................3102.1.5 Combined therapy and Combination of Modalities .....................................................310

2.2 CLASSIFICATIon oF ModALITIeS BASed on THeIr PrIMAry eFFeCT ..............3102.2.1 Modalities with an analgesic effect .........310Modalities with Primary Analgesic Effect .........................310Modalities with a Secondary Analgesic Effect ..................3112.2.2 Modalities with Dominantly a Myorelaxation effect .......................................312Ultrasound Therapy .............................................................313Combined Ultrasound and Electrotherapy ......................313Electrotherapy .......................................................................3132.2.3 Modalities with anti-inflammatory and trophic effects ............................................313Vasopneumatic Therapy ......................................................313Electrotherapy .......................................................................314Ultrasound Therapy .............................................................314

XVIII clinical rehabilitation

3.2.2 Use of Peloids ......................................... 3213.2.3 Use of Gas ............................................... 322

3.3 SPAS In THe CZeCH rePUBLIC And IndICATIonS For A SPA TreATMenT ...................................... 322

4 oCCUPATIonAL THerAPy

Veronika Schönová, Pavel Kolář

4.1 AreAS oF FUnCTIon In oCCUPATIonAL THerAPy ..................... 325

4.2 SPeCIALIZATIonS ................................ 326

4.3 oCCUPATIonAL THerAPy ProCeSS ..................................................... 326

4.4 AreAS oF oCCUPATIonAL THerAPy InTerVenTIonS .......................................... 326

Motor Skills ...........................................................................326Sensory Skills ........................................................................327Cognitive, Communicative and Subsequent

Social Skills ........................................................................327Activities of Daily Living .....................................................327Assistive Devices ...................................................................327Pre-Return to work Rehabilitation ....................................327

II SPeCIAL SeCTIon

Phototherapy .........................................................................314Galvanotherapy .....................................................................314Contrast Baths.......................................................................314Cryotherapy ..........................................................................3152.2.4 electrodiagnostic testing and electrical Stimulation of Skeletal Muscles .........................315Electrodiagnostic Testing ....................................................315Electrical Stimulation (Neuromuscular Electrical

Stimulation) ......................................................................316Electrical Stimulation (Electrogymnastics) ......................316

2.3 GenerAL ConTrAIndICATIonS oF ModALITIeS ............................................316

3 BALneoLoGy

Jan Kálal, Ivan Vařeka

3.1 CLASSIFICATIon oF MedICInAL SoUrCeS ......................................................319

3.1.1 Waters ......................................................3193.1.2 Peloids .................................................... 3203.1.3 Gases ...................................................... 3203.1.4 Climate ................................................... 321

3.2 USe oF nATUrAL HeALInG SoUrCeS In BALneoLoGy .......................... 3213.2.1 Use of Water ........................................... 321

1 TreATMenT reHABILITATIon In neUroLoGy

Pavel Kolář, Ondřej Horáček

GenerAL SeCTIon

1.1 neUroPHySIoLoGICAL FoUndATIon oF PHySICAL THerAPy APProACHeS .............................................. 332

Pavel KolářnEuroplasticity .....................................................332

Vladimír KomárekEvolutionary Plasticity .........................................................332Repair Plasticity ....................................................................333Neuroplasticity and Sensorimotor Programs ...................333sEnsory Functions in

nEurorEhabilitation .........................................334Pavel Kolář

1.2 oVerVIeW oF PHySICAL THerAPy MeTHodS .................................... 335

Pavel KolářSensory Training ...................................................................335Exercising with Conscious Awareness

as a Component of Sensorimotor Practice ...................335Sensory Stimulation Method Based on Affolter ...............335Perfetti’s Method ...................................................................335Rood’s Method ......................................................................335Movement Rehabilitation of Patients

with Hemiplegia Based on Brunnström ........................336Dagmar Pavlů, Pavel Kolář

Sensory Integration Based on Ayres ..................................337Veronika Schönová

Neurodevelopmental Treatment Concept Based on Bobath ..........................................................................338Irena Zounková

Movement Therapy According to Petö ..............................340Irena Zounková, Pavel Kolář

contents XIX

Vojta’s Method .......................................................................341Pavel Kolář

Sensorimotor Stimulation ...................................................341Pavel Kolář

Proprioceptive Neuromuscular Facilitation .....................341Pavel Kolář

1.3 neUroPSyCHoLoGy .............................341Kateřina Chamoutová, Pavel Kolář

1.3.1 neuropsychological approaches ............. 342Neurobehavioral Approach .................................................342American Neuropsychological Approach .........................342Neuropsychology in the Czech Republic ..........................3421.3.2 neuropsychological assessment ............. 343Most Commonly Used Neuropsychological

Tests ....................................................................................3441.3.3 Utilization of neuropsychological approaches in Rehabilitation ........................... 345

1.4 SPeeCH THerAPy ................................. 346Pavel Kolář

DEVELOPMENTAL DYSARTHRIA .....................................346APHASIAS ..................................................................................347DYSARTHRIA............................................................................348Deficits in Swallowing and Management Options ...........349Orofacial Therapy .................................................................350

1.5 orTHoTIC CAre In neUroLoGICAL dISeASeS .................................................... 350

Petr Krawczyk1.5.1 orthotic Management for Patients with Cerebral Palsy .......................................... 3501.5.2 orthotic interventions for Patients with Charcot-Marie-tooth Disease ................... 3521.5.3 orthotics for Patients Following Poliomyelitis ..................................................... 3531.5.4 orthotics for Patients Following CVa ...... 353

1.6 oCCUPATIonAL THerAPy .................... 354Veronika Schönová

SPeCIAL SeCTIon

1.7 dySFUnCTIonS In neUroMUSCULAr TrAnSMISSIon And MUSCLe dISeASeS ..... 354

Petr Bitnar, Magdaléna Lepšíková1.7.1 Dysfunction in neuromuscular transmission – Myasthenia Gravis .................... 3541.7.2 Muscle Diseases ...................................... 355Muscular dystrophiEs .........................................356DUCHENNE AND BECKER MUSCULAR

DYSTROPHY .........................................................................356FACIOSCAPULOHUMERAL FORM

OF DYSTROPHY ..................................................................356GIRDLE FORMS OF MUSCULAR DYSTROPHY..............357

OTHER FORMS OF MUSCULAR DYSTROPHY ..............357MYOTONIC DYSTROPHY.....................................................357congEnital, MEtabolic, inFlaMMatory

and toxic MyopathiEs .......................................358ion channEl dysFunctions ................................358PERIODIC PARALYSES ...........................................................358Hyperkalemic Periodic Paralysis ........................................359Hypokalemic Periodic Paralysis .........................................359Paramyotonia Congenita .....................................................359MYOTONIC SYNDROMES ....................................................359Myotonia Congenita ............................................................359Atypical Myotonic Syndromes ............................................359

1.8 PerIPHerAL PArALySIS ....................... 360Ondřej Horáček

1.8.1 Causes, Degrees and Diagnosis of Peripheral Paralyses ..................................... 3601.8.2 Rehabilitation of Peripheral Paralyses ....... 361Physical Therapy ...................................................................361Occupational Therapy ..........................................................362Modalities ..............................................................................3621.8.3 an overview of Peripheral Pareses based on location ............................................ 363pEriphEral parEsEs oF thE uppEr

ExtrEMitiEs ...........................................................363BRACHIAL PLExUS PALSY (C5-T1) ...................................363RADIAL NERVE PALSY (C5-C7) ..........................................364MEDIAN NERVE PALSY (C5-T1) .........................................365ULNAR NERVE PALSY (C8-T1) ............................................366LONG THORACIC NERVE PALSY (C5-C7) ......................366SUPRASCAPULAR NERVE PALSY (C5-C6) ......................367AxILLARY NERVE PALSY (C5-C6) .....................................367MUSCULOCUTANEOUS NERVE PALSY

(C5-C7) ...................................................................................367pEriphEral parEsEs oF thE lowEr

ExtrEMitiEs ...........................................................367LUMBOSACRAL PLExUS PARESIS .....................................367FEMORAL NERVE PALSY (L2-L4) .......................................367SCIATIC NERVE PALSY (L4-S3) ...........................................368PERONEAL NERVE PALSY (L4-S1) .....................................368TIBIAL NERVE PALSY (L4-S3) ..............................................368Facial nErvE palsy (c.n. vii) ..................................3691.8.4 Peripheral Pareses in Diseases involving Motor neurons of the anterior Spinal horns .................................................... 3691.8.5 Rehabilitation Following Peripheral nerve Surgery .................................................. 370

1.9 enTrAPMenT SyndroMeS ...................370Petr Bitnar, Ondřej Horáček

1.9.1 etiology, Pathogenesis, Clinical Manifestations and Diagnosis .......................... 3701.9.2 overview of the Most Common entrapment Syndromes .....................................371EntrapMEnt syndroMEs oF thE uppEr

thoracic apErturE .............................................371

XX clinical rehabilitation

SCALENUS SYNDROME ........................................................372COSTOCLAVICULAR AND HYPERABDUCTION

SYNDROME ..........................................................................372EntrapMEnt syndroMEs oF thE uppEr

ExtrEMity and thE shouldEr girdlE .............372SUPRASCAPULAR NERVE ....................................................372MEDIAN NERVE ......................................................................372ULNAR NERVE .........................................................................373RADIAL NERVE ........................................................................373EntrapMEnt syndroMEs oF thE lowEr

ExtrEMity and thE pElvic girdlE .....................373FEMORAL NERVE ...................................................................373SCIATIC NERVE .......................................................................373PERONEAL NERVE .................................................................373TIBIAL NERVE ..........................................................................3731.9.3 treatment Rehabilitation .........................374

1.10 PoLyneUroPATHIC SyndroMeS ........375Alena Kobesová

1.10.1 hereditary Motor and Sensory Polyneuropathies ............................................. 3751.10.2 Diabetic neuropathy ............................. 378DIABETIC FOOT SYNDROME .............................................3781.10.3 inflammatory Polyneuropathies ............ 379GUILLAIN-BARRE SYNDROME ..........................................379CHRONIC INFLAMMATORY DEMYELINATING

POLYNEUROPATHY ..........................................................379

1.11 PoLIoMyeLITIS And PoST-PoLIoMyeLITIC SyndroMe .............. 381

Ivana Wurstová1.11.1 Poliomyelitis .......................................... 3811.11.2 Post-Poliomyelitic Syndrome ................. 382

1.12 SPInAL Cord InJUry ......................... 384Jiří Kříž

1.12.1 etiology, neurological Presentation ...... 3841.12.2 Systematic approach to treatment ........ 3851.12.3 Medical Consequences of a Spinal Cord lesion and Possible Complications .......... 385AUTONOMIC DYSREFLExIA ...............................................385ORTHOSTATIC HYPOTENSION .........................................385DEEP VEIN THROMBOSIS

(THROMBOEMBOLISM)...................................................386URINARY DYSFUNCTION ....................................................386BOwEL DYSFUNCTION ........................................................386SExUAL DYSFUNCTION .......................................................386INTEGUMENTARY DYSFUNCTIONS ................................386SEPTIC CONDITIONS ............................................................386PAINFUL CONDITIONS ........................................................386SPASTICITY ...............................................................................386PARA-ARTICULAR OSSIFICATION ...................................387OSTEOPOROSIS .......................................................................3871.12.4 Rehabilitation for Patients with Spinal Cord injury .................................... 387

1.13 deFICITS In CereBeLLAr FUnCTIonS ..389Alena Kobesová

1.13.1 Functional anatomy of the Cerebellum ............................................ 3891.13.2 basic Clinical Manifestations of a Cerebellar lesion ....................................... 390ataxia ........................................................................390HYPERMETRIA ........................................................................390ADIADOCHOKINESIA ...........................................................391ASYNERGY ................................................................................391Flaccidity ................................................................392cErEbEllar trEMor.................................................392EyE MovEMEnt disturbancEs...............................392palEocErEbEllar and nEocErEbEllar

syndroME ............................................................392PALEOCEREBELLAR SYNDROME......................................392NEOCEREBELLAR SYNDROME ..........................................392PSEUDOCEREBELLAR SYNDROME ..................................3921.13.3 Rehabilitation in Cerebellar Dysfunctions .................................................... 3931.13.4 Prognosis of Cerebellar Dysfunctions .................................................... 394

1.14 BALAnCe deFICITS ............................. 395Ondřej Čakrt, Michal Truc

1.14.1 balance Control ..................................... 395VERTIGO AND ITS MOST COMMON CAUSES ..............3951.14.2 Clinical Presentation of a Patient with a Vestibular System Disturbance .............. 396ExAMINATION ........................................................................3961.14.3 theoretical bases for Rehabilitation ...... 3971.14.4 Rehabilitation of individual Clinical Presentations ................................................... 397UNILATERAL VESTIBULAR LESION ................................397BENIGN PAROxYSMAL POSITIONAL VERTIGO ..........398BILATERAL VESTIBULAR DEFICIT ...................................399BALANCE DEFICITS ASSOCIATED

wITH CHANGES IN THE CERVICAL SPINE .............399CENTRAL BALANCE DEFICITS ..........................................399VERTEBRAL ARTERY SYNDROME ....................................399PSYCHOGENIC VERTIGO ....................................................3991.14.5 biological Feedback in Rehabilitation of Patients with balance Deficits ...................... 400

Ondřej Čakrt, Rudolf Černý, Jaroslav JeřábekBrain port ..............................................................................400

1.15 eXTrAPyrAMIdAL deFICITS............... 401Alena Kobesová

1.15.1 basic Characteristics, Classification ........ 401HYPOKINETIC DEFICITS .....................................................401HYPERKINETIC DEFICITS ...................................................4011.15.2 Parkinson’s Disease ............................... 401obJEctivE nEurological Findings .....................402HYPOKINESIA, BRADYKINESIA, AKINESIA ..................402RIGIDITY ...................................................................................402

contents XXI

TREMOR.....................................................................................402POSTURAL DEFICITS ............................................................402

1.16 neUrodeGenerATIVe dISeASeS ........ 407Barbora Danielová, Alena Zumrová

1.16.1 basic Characteristics of neurodegenerative illnesses ........................ 407

Ondřej Horáček1.16.2 amyotrophic lateral Sclerosis ................ 407

Barbora Danielová1.16.3 Friedreich’s ataxia ..................................411

Alena Zumrová1.16.4 autosomal Dominant Spinocerebellar ataxia.......................................412

Alena Zumrová

1.17 MULTIPLe SCLeroSIS ...........................412Ondřej Horáček

1.17.1 Diseases Characteristics ..........................4121.17.2 Rehabilitation in Multiple Sclerosis .........414

1.18 deFICITS In ConSCIoUSneSS ..............416Pavel Kolář

1.18.1 Causes ....................................................416lEvEls oF QuantitativElly liMitEd

consciousnEss ................................................... 417SOMNOLENCE .........................................................................417SOPOR .........................................................................................417COMA .........................................................................................417assEssMEnt oF lEvEls oF consciousnEss .......... 4171.18.2 neurorehabilitation approaches for Unconscious Patients ...................................417

1.19 CrAnIoCereBrAL (BrAIn) InJUrIeS ...418Ondřej Horáček, Pavel Kolář

1.19.1 Causes and Clinical Picture .....................418APALLIC SYNDROME ............................................................4191.19.2 Rehabilitation for a brain injury ............419

1.20 VASCULAr dISeASeS oF THe BrAIn ... 421Ondřej Horáček, Pavel Kolář

1.20.1 ischemic Cerebrovascular accidents ........ 421ISCHEMIA IN CAROTID CIRCULATION .........................421ISCHEMIA IN VERTEBROBASILAR

CIRCULATION .........................................................................422CLASSIFICATION BASED ON DISEASE

PROGRESSION .....................................................................4221.20.2 hemorrhagic Cerebrovascular accidents ......................................................... 423DIFFUSE HEMORRHAGES ...................................................423FOCAL SUBCORTICAL HEMORRHAGES ........................423CEREBELLAR HEMORRHAGE ............................................423BLEEDING INTO THE BRAIN STEM .................................423SUBARACHNOID HEMORRHAGE .....................................4231.20.3 Rehabilitation for a CVa ........................ 424

1.21 CereBrAL PALSy ................................ 428Pavel Kolář

1.21.1 Screening for Risk of CP ......................... 4291.21.2 types of Cerebral Palsy and their Clinical Presentation ........................................ 429SPASTIC DIPLEGIA .................................................................429SPASTIC HEMIPLEGIA...........................................................430CEREBELLAR FORM ...............................................................431DYSKINETIC FORM OF CEREBRAL PALSY .....................432MIxED TETRAPLEGIA ..........................................................433ATONIC DIPLEGIA .................................................................4331.21.3 Rehabilitation in Cerebral Palsy ............ 433dEsirEd outcoME and coping procEss ............433DESIRED OUTCOME ..............................................................433COPING PROCESS ..................................................................434Rehabilitation in Cerebral Palsy .........................................434Vojta’s Reflex Locomotion in Children

with Cerebral Palsy ..........................................................434Neurodevelopmental Treatment Approach

in Children with CP .........................................................435Petö Movement Therapy .....................................................436Exercises Aimed at the Development of Somesthesis .....4361.21.4 Cerebral Palsy from the View of an orthopedic Physician .............................. 436

Alena Schejbalováindications For surgEry .....................................436INDICATIONS FOR SURGICAL PROCEDURES

IN THE HIP JOINT AREA .................................................436INDICATIONS FOR SURGICAL PROCEDURES

IN THE KNEE JOINT AREA .............................................437INDICATION FOR SURGICAL INTERVENTIONS

IN THE ANKLE AND FOOT AREAS ..............................438INDICATIONS FOR SPINAL SURGICAL

PROCEDURES .....................................................................438INDICATIONS FOR UPPER ExTREMITY

SURGICAL PROCEDURES ...............................................4391.21.5 neurosurgical treatment ...................... 439

Pavel Kolář1.21.6 botulotoxin in the treatment of CP ....... 440

Pavel Kolář, Josef Kraus

2 TreATMenT reHABILITATIon In orTHoPedICS And TrAUMAToLoGy

Pavel Kolář, Jiří Kříž, Olga Dyrhonová

GenerAL SeCTIon

2.1 InFLUenCe oF FUnCTIon on MorPHoLoGICAL TISSUe reSTrUCTUrInG ......................................... 445

2.2 CLASSIFICATIon ACCordInG To SyMPToMAToLoGy ............................... 447

XXII clinical rehabilitation

2.2.1 edema .................................................... 447Olga Dyrhonová, Jiří Kříž

2.2.2 Functional Changes in Soft tissues ......... 447Olga Dyrhonová, Jiří Kříž

2.2.3 Range of Motion Restrictions in a Movement Segment .................................. 448

David Smékal, Pavel Kolář2.2.4 hypermobility ........................................ 449

David Smékal, Pavel KolářcausEs ...................................................................... 449COMPENSATORY HYPERMOBILITY ................................449HYPERMOBILITY IN NEUROLOGICAL DISEASES .......449STRUCTURAL HYPERMOBILITY .......................................449LOCALIZED PATHOLOGICAL (POSTRAUMATIC)

HYPERMOBILITY ...............................................................449trEatMEnt rEhabilitation stratEgiEs ............... 4492.2.5 Deficit in the nervous System Regulatory Mechanisms .................................. 450

Pavel KolářCHANGE IN AFFERENTATION FROM

THE RECEPTORS ................................................................450MOTOR LEARNING DEFICIT AT THE LEVEL

OF THE CENTRAL REGULATORY MECHANISMS ....................................................................451

trEatMEnt rEhabilitation stratEgy ...................451

2.3 CLASIFFICATIon ACCordInG To eTIoLoGy And PATHoGeneSIS ............. 451

Pavel Kolář2.3.1 Congenital Developmental Defects ........ 452

Pavel Kolář, Martin ŠvehlíkEtiology ...................................................................452rEhabilitation trEatMEnt principlEs in

congEnital dEvElopMEntal dEFEcts .............452POST-SURGICAL REHABILITATION .................................452classiFication oF congEnital

dEvElopMEntal dEFEcts ....................................452CONGENITAL DEVELOPMENTAL DEFECTS

OF THE UPPER ExTREMITIES .......................................453Congenital Developmental Defects

of the Shoulder Girdle .....................................................453Sprengel’s Deformity ............................................................453Cleidocranial Dysostosis ....................................................453Congenital Clavicle Nonunion ...........................................453Os Acromiale ........................................................................453Congenital Developmental Defects

of the Elbow Joint .............................................................453Congenital Dislocation of the Elbow,

Congenital Dislocation of the Radial Head ..................453Congenital Radioulnar Synostosis .....................................453Congenital Shortening of the Radius .................................453Congenital Developmental Defects of the wrist ..............453Manus Vara Congenita ........................................................453Madelung’s Deformity .........................................................454Congenital Developmental Defects of the Fingers ..........454

Camptodactyly ......................................................................454Clinodactyly ..........................................................................454Syndactyly..............................................................................454Thumb Hypoplasia ...............................................................454CONGENITAL DEVELOPMENTAL DEFECTS

OF THE LOwER ExTREMITES .......................................454Congenital Developmental Defects

of the Hip Joint .................................................................454Congenital Developmental Defectsof the Knee Joint ......454Congenital Knee Dislocation ..............................................454Congenital Patellar Subluxation .........................................454Patella Bipartita .....................................................................455Congenital Developmental Defects

of the Lower Leg and Foot ..............................................455Club Foot (Talipes Equinovarus, Pes Equinovarus

Congenitus) .......................................................................455Pes Metatarsus Adductus (Pes Calcaneovalgus)...............456Congenital Flatfoot (Vertical Talus, Pes Planovalgus

Congenitus) .......................................................................456Metatarsus Varus (Pes Adductus) ......................................457Congenital Deformities of the Toes ...................................457Congenital Hallux Varus .....................................................457Digitus Quintus Supraductus ..............................................457Syndactyly..............................................................................457Polydactyly ............................................................................457Macrodactyly ........................................................................457CONGENITAL DEVELOPMENTAL DEFECTS

OF THE THORAx ................................................................457Pectus Excavatum (Infundibuliform) ................................457Pectus Carinatum .................................................................458Rehabilitation in Congenital Developmental

Defects of the Thorax .......................................................458CONGENITAL DEVELOPMENTAL DEFECTS

OF THE SPINE ......................................................................458Diastematomyelia .................................................................458Meningomyelocele ..............................................................459Klippel-Feil Syndrome .........................................................459Spina Bifida ...........................................................................4592.3.2 SoFt tiSSUe inJURieS CaUSeD bY oVeRloaDinG ............................................ 459

Pavel Kolář, Jiří Kříž, Olga DyrhonováEndon inJuriEs .......................................................459ETIOLOGY AND PATHOGENESIS .....................................459DIAGNOSTICS ..........................................................................459Clinical Picture .....................................................................459Tendinosis ..............................................................................460Enthesopathy .........................................................................460Paratenonitis, Peritendinitis, Tenosynovitis ......................460Imaging Methods .................................................................460Differential Diagnosis ..........................................................460LOCALIZATION ......................................................................460Upper Extremity ...................................................................460Lower Extremity ...................................................................460THERAPY ...................................................................................460REHABILITATION ...................................................................461

contents XXIII

2.3.3 Degenerative Joint Diseases ................... 462Pavel Kolář

ostEoarthritis .......................................................462ETIOLOGY AND PATHOGENESIS .....................................462Primary (Idiopathic) OA .....................................................462Secondary OA .......................................................................462DIAGNOSIS ...............................................................................463LOCATION ................................................................................463Coxarthrosis ..........................................................................463Gonarthrosis .........................................................................463TREATMENT ............................................................................463Pharmacotherapy .................................................................463Surgical Procedures ..............................................................464Rehabilitation ........................................................................464

Olga Dyrhonová, Pavel KolářArthroplasty ..........................................................................464

Martina VotavováRehabilitation Following Arthroplasty ..............................465

Martina Votavová, Věra CikánkováHip Joint Arthroplasty .........................................................466Knee Joint Arthroplasty .......................................................466Ankle Arthroplasty...............................................................467Shoulder Joint Arthroplasty ................................................467Elbow Joint Arthroplasty .....................................................4682.3.4 inflammatory Diseases ........................... 468

Pavel Kolář, Olga Dyrhonová, Jiří KřížEtiology and pathogEnEsis ................................468STERILE INFLAMMATION ...................................................468INFECTIOUS INFLAMMATION ..........................................468Classification Based on Etiology ........................................468Classification Based on Location ........................................469Pyogenic Arthritis ................................................................469Osteomyelitis .........................................................................469Spondylodiscitis ....................................................................470principlEs oF rEhabilitation .................................472.3.5 traumatology of the Movement System ...471

Olga Dyrhonová, Pavel Kolář HEALING PHASES ...................................................................471wounds ...................................................................472contusion ...............................................................472tEndon inJuriEs .....................................................472MusclE inJuriEs.......................................................472DIAGNOSIS ...............................................................................472CLASSIFICATION ....................................................................472Muscle Cramp .......................................................................472Muscle Soreness ....................................................................472Muscle Strain .........................................................................473Muscle Tear ...........................................................................473Joint inJuriEs........................................................... 474bonE inJuriEs – FracturEs .................................... 474FRACTURE CLASSIFICATION .............................................474BONE HEALING ......................................................................474FRACTURE HEALING TIMES ..............................................475TREATMENT ............................................................................475REHABILITATION ...................................................................476

SPeCIAL SeCTIon

2.4 CLASSIFICATIon ACCordInG To LoCATIon ...............................................4762.4.1 Spine .......................................................476congEnital dEvElopMEntal dEFEcts .................477dEForMity ................................................................477

Pavel Kolář, Marcela ŠafářováSCOLIOSIS .................................................................................477Classification According to Etiology

and Pathogenesis ................................................................. 477Non-structural (Functional) Scoliosis ...............................477Structural Scoliosis ...............................................................477Idiopathic Scoliosis...............................................................477Congenital Scoliosis .............................................................481Neuromuscular Scoliosis .....................................................481Scoliosis in Neurofibromatosis ...........................................481Other Types of Scoliosis ......................................................481Rehabilitation ........................................................................481Klapp’s Crawling Method ....................................................482Schroth Method ....................................................................483Vojta’s Method .......................................................................483Modifications of Physical Activity .....................................484Orthotic Treatment ..............................................................484Surgical Treatment ...............................................................484HYPERKYPHOSIS ....................................................................484

Pavel KolářJuvenile Kyphosis (Scheuermann’s Disease) .....................484LUMBAR HYPERLORDOSIS .................................................485TORTICOLLIS ...........................................................................485Congenital Muscular Torticollis .........................................485Muscular Torticollis in Adults ............................................486Acquired Muscular Torticollis ............................................486Post-Traumatic Torticollis ...................................................486Spastic Torticollis ..................................................................487Acute Torticollis ....................................................................487vErtEbrogEnic pain syndroME ...........................487

Pavel KolářETIOLOGY AND PATHOGENESIS .....................................487CLASSIFICATION ACCORDING

TO ETIOLOGY AND PATHOGENESIS ..........................488STRUCTURAL CAUSES ..........................................................488FUNCTIONAL CAUSES ..........................................................488Intervertebral Disc Involvement.........................................488Intervertebral Joint Degeneration ......................................489Spinal Stenosis ......................................................................489Abnormality of the Spinal Canal ........................................490Spondylolisthesis ..................................................................490Osteoporosis ..........................................................................491Ankylosing Spondylitis ........................................................491Infections ...............................................................................491Tumors ...................................................................................491Deficit in the CNS Control Function .................................492Deficit in Processing Nociception ......................................493Psychological Disturbance ..................................................494

XXIV clinical rehabilitation

CONSEQUENCES OF STRUCTURAL AND FUNCTIONAL DEFICITS........................................494

Discogenic Pain ....................................................................494Radicular Syndrome .............................................................494Pseudoradicular Syndrome .................................................495SPECIFIC TREATMENT .........................................................495Rehabilitation ........................................................................495

Pavel Kolář, Karel Lewit, Jiří Čumpelík, Veronika Kubů

Pharmaceutical Treatment ..................................................505Pavel Kolář

Invasive Procedures ..............................................................505Jan Štulík

Intervention Methods Guided by Computerized Tomography .......................................505

Surgical Treatment ...............................................................505Simple Resection ..................................................................505Osteosynthesis ......................................................................506Bony Fusion (Arthrodesis) of the Surrounding

Segments ............................................................................506Mobile Spinal Stabilization ..................................................5072.4.2 Shoulder Girdle ...................................... 508

Petra Valouchová, Olga Dyrhonová, Jiří Kříž, Pavel Kolář, Michaela Tomanová

congEnital dEvElopMEntal dEFEcts oF thE shouldEr girdlE ....................................508

soFt tissuE inJuriEs ................................................508IMPINGEMENT SYNDROME ...............................................508CALCIFIC TENDINITIS .........................................................510SUBACROMIAL BURSITIS ....................................................511ROTATOR CUFF TEARS ........................................................511SYNDROME OF THE LONG HEAD

OF THE BICEPS TENDON ................................................512Tendinosis of the Long Head of the Biceps .......................512Subluxation of the Long Head of the Biceps Tendon ......512Biceps Tendon Rupture ........................................................512FROZEN SHOULDER SYNDROME .....................................513dEgEnErativE disEasEs...........................................514GLENOHUMERAL ARTHRITIS ...........................................514ACROMIOCLAVICULAR ARTHRITIS ..............................514trauMatic lEsions .................................................514GLENOHUMERAL DISLOCATION ....................................514ACROMIOCLAVICULAR DISLOCATION ........................515STERNOCLAVICULAR DISLOCATION ............................515PROxIMAL HUMERAL FRACTURES ................................516instability ................................................................ 517GLENOHUMERAL INSTABILITY .......................................517Post-traumatic Instability (Recurring Dislocations) .......517Multidirectional Non-traumatic Instability

(Habitual Dislocation) .....................................................518diFFErEntial diagnosis oF shouldEr

girdlE pain ...........................................................518gEnEral principlEs oF rEhabilitation

oF shoudlEr girdlE dysFunctions ................5192.4.3 elbow Joint ..............................................519

Pavel Kolář, Petr Bitnar, Olga Dyrhonová

congEnital dEvElopMEntal dEFEcts .................520ovErusE soFt tissuE inJuriEs ...............................520ENTHESOPATHY .....................................................................520Lateral Epicondylitis (Epicondylitis Radialis Humeri) ....520Medial Epicondylitis (Epicondylitis Ulnaris Humeri) .....520Triceps Brachii Enthesopathy .............................................520Olecranon Bursitis ................................................................521dEgEnErativE disEasEs

oF thE Elbow Joint ............................................521ELBOw JOINT ARTHRITIS ..................................................521trauMatic lEsions .................................................522DISLOCATIONS .......................................................................522FRACTURES IN THE ELBOw JOINT REGION ...............522REHABILITATION IN TRAUMATIC LESIONS ................522post-trauMatic coMplications .........................523ELBOw FLExION CONTRACTURE ..................................523AxIAL DEFORMITIES OF THE ELBOw ...........................523Cubitus Varus ........................................................................523Cubitus Valgus ......................................................................523VOLKMANN’S CONTRACTURE .........................................5242.4.4 Wrist and hand ...................................... 524

Petr Bitnar, Pavel KolářcongEnital dEvElopMEntal dEFEcts .................524ovErusE soFt tissuE inJuriEs ................................524TENOSYNOVITIS ....................................................................524Trigger Thumb, Finger (Digitus Saltans) ...........................524De Quervain’s Disease ..........................................................525DUPUYTREN’S CONTRACTURE ........................................525dEgEnErativE Joint inJuriEs .................................526RHIZARTHROSIS ....................................................................526ARTHRITIS OF THE INTERPHALANGEAL

JOINTS OF THE HAND .....................................................526trauMatic lEsions .................................................526SOFT TISSUE INJURIES .........................................................526DISLOCATIONS .......................................................................527FRACTURES ..............................................................................527Distal Forearm Fractures .....................................................527Navicular Fracture ................................................................527post-trauMatic conditions ...............................528wRIST INSTABILITY ..............................................................528NAVICULAR NON-UNION ..................................................528gEnEral rEhabilitation principlEs

For wrist and hand inJuriEs ...........................5282.4.5 hip Joint ................................................. 529

Magdaléna Lepšíková, Pavel Kolář, Olga Dyrhonová

pEdiatric disEasEs ..................................................529CONGENITAL HIP DYSPLASIA ...........................................529Clinical Assessment of Newborns and Infants .................529Examination by Imaging Methods .....................................530Classification according to Radiological Findings ...........531Treatment ..............................................................................531SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE) .........533LEGG-CALVE-PERTHES DISEASE ......................................534TRANSIENT SYNOVITIS OF THE HIP ..............................536adulthood disEasEs .............................................537

contents XXV

OVERUSE SOFT TISSUE INJURIES .....................................537Hip Adductor Enthesopathy ...............................................537Rectus Femoris Enthesopathy .............................................537Hamstring Enthesopathy .....................................................537DEGENERATIVE DISEASES ..................................................537Osteoarthritis of the Hip (Coxarthrosis) ...........................537TRAUMATIC LESIONS ...........................................................538Groin Injuries ............................................................. 538Hip Joint Dislocation ................................................ 538Proximal Femoral Fractures ................................................538REFERRED PAIN TO THE HIP JOINT

FROM OTHER SITES ..........................................................5392.4.6 Knee Joint ............................................... 539

Pavel Kolář, Jiří KřížcongEnital dEvElopMEntal dEFEcts

oF thE KnEE Joint ................................................540ovErusE soFt tissuE inJuriEs ................................540TENDINOPATHIES .................................................................540Patellar Tendonitis (Jumper’s Knee)...................................540Rectus Femoris Enthesopathy .............................................540Hip Adductor Enthesopathy ...............................................540Enthesopathy of the Biceps Femoris Tendon....................540ASEPTIC NECROSIS OF THE KNEE ...................................540Osgood-Schlatter Disease (Aseptic Necrosis

of the Tibial Tuberosity) ..................................................540Sinding-Larsen-Johansson Syndrome

(Osteochondrosis of the Patellar Apex) .........................541Osteochondritis Dissecans ..................................................541dEgEnErativE disEasEs...........................................542PATELLOFEMORAL JOINT DISORDERS ..........................542GONARTHROSIS .....................................................................543trauMatic lEsions .................................................543

Miroslav DobešSOFT TISSUE INJURIES OF THE KNEE.............................543Physiology of Healing of the Knee Structures ..................543Physiology of Soft Tissue Healing ......................................543Physiology of Ligamentous Healing ..................................543Physiology of Autogenous Graft Healing ..........................543Rehabilitation Following Meniscal Injuries

and Repairs ........................................................................544Rehabilitation following Medial Collateral

Ligament (MCL) Injury ...................................................546Rehabilitation following Anterior Cruciate

Ligament Injury and Reconstruction ............................547Actual Rehabilitation Program ...........................................5472.4.7 ankle and Foot ....................................... 550

Miroslav Dobeš, Pavel Kolář, Olga DyrhonovácongEntial dEvElopMEntal dEFEcts.................550TREATMENT OF CONGENITAL

DEVELOPMENTAL DEFECTS IN GENERAL ...............550alignMEnt dEForMitiEs ........................................550FLAT FOOT ...............................................................................550Classification of flat foot ......................................................550HALLUx VALGUS ....................................................................551HALLUx RIGIDUS ...................................................................552METATARSALGIA ...................................................................552

TOE DEFORMITIES ................................................................553Hammer Toe (Digitus Hamatus) ........................................553Club Toe (Digitus Malleus) .................................................553ovErusE soFt tissuE inJuriEs ................................553PERITENDINITIS (TENOSYNOVITIS), ACHILLES

TENDON TENDINOSIS .....................................................553TENOSYNOVITIS, POSTERIOR TIBIALIS

TENDINOSIS ........................................................................553ENTHESOPATHY OF THE SHORT MUSCLES

OF THE SOLE OF THE FOOT, CALCANEAL SPUR (CALCAR CALCANEI) ...........................................554

TIBIALIS ANTERIOR SYNDROME .....................................554trauMatic lEsions .................................................555ACHILLES TENDON RUPTURE ..........................................555INJURY TO THE ANKLE LIGAMENTOUS

APPARATUS .........................................................................555Acute Ankle Instability ........................................................555Chronic Lateral Ankle Instability .......................................555Rehabilitation Treatment Following Injuries

and Surgeries of the Ligamentous Apparatus of the Ankle and Foot ......................................................556

2.5 orTHoTICS .......................................... 557Petr Krawczyk

2.5.1 Classification and technical overview of orthoses ....................................... 558ovEr-thE-countEr orthosEs ...............................558custoM-MadE orthotics .....................................5582.5.2 Functional indications for orthoses ........ 558Functional dEMands oF orthosEs ...................559action principlEs oF orthosEs .........................5592.5.3 Contraindications ................................... 5592.5.4 Upper extremity orthoses ...................... 559scs classiFication .................................................560dEscritpion oF orthosis Function

according to scs classiFication ..................560basic ovErviEw oF uppEr ExtrEMity

orthosEs ..............................................................560HAND ORTHOSIS – HO .........................................................560wRIST ORTHOSIS, wRIST HAND ORTHOSIS –

wO, wHO ..............................................................................560ELBOw ORTHOSIS, ELBOw wRIST HAND ORTHOSIS – EO, EwHO ........................................................561SHOULDER ORTHOSIS, SHOULDER ELBOw

ORTHOSIS, SHOULDER ELBOw wRIST HAND ORTHOSIS – SO, SEO, SEwHO ........................................561

2.5.5 lower extremity orthoses ...................... 562basic classiFication oF lowEr ExtrEMity

orthosEs ..............................................................562FOOT ORTHOSIS – FO ...........................................................562ANKLE-FOOT ORTHOSIS – AFO ........................................562KNEE ORTHOSIS – KO ...........................................................563KNEE-ANKLE-FOOT ORTHOSIS – KAFO ........................563HIP-KNEE-ANKLE-FOOT ORTHOSIS – HKAFO............5652.5.6 trunk orthoses ....................................... 565basic classiFication oF trunK orthosEs .........565

XXVI clinical rehabilitation

CERVICOTHORACIC ORTHOSES – CTO .........................566THORACIC ORTHOSES – TO ...............................................566THORACOLUMBAR ORTHOSES – TLO ............................566THORACOLUMBOSACRAL ORTHOSIS – TLSO ............566CERVICOTHORACOLUMBOSACRAL

ORTHOSES – CTLSO ..........................................................5662.5.7 Most Commonly applied orthoses in Pediatric orthopedics................................... 566Congenital Pes Equinovarus (Club Foot)..........................566Metatarsus Adductus ...........................................................567Pes Calcaneovalgus...............................................................567Foot Deformities in Arthrogryposis ..................................567Flat Foot .................................................................................567Osgood-Schlatter Disease (Patellar Ligament

Tendinopathy)...................................................................567Patellar Dislocation ..............................................................567Genu Varum, Genu Valgum, Genu Recurvatum .............567Congenital Developmental Hip Dysplasia ........................567Legg-Calve-Perthes Disease ................................................568Limb Reduction Defects .....................................................568Scoliosis .................................................................................5682.5.8 Most Commonly applied orthoses in orthopedics for adult Patients ..................... 569ORTHOTIC OPTIONS IN COMPLICATIONS

DURING APPLICATION OF TOTAL ENDOPROSTHESIS OF THE KNEE AND HIP JOINTS .................................................................569

ORTHOSES APPLICATION IN RHEUMATOID ARTHRITIS ............................................................................569

LEG LENGTH DISCREPANCY .............................................569ORTHOTIC CARE FOR THE TREATMENT

OF FOOT DEFECTS ............................................................570NOTES TO APPLICATION OF TRUNK

ORTHOSES IN LOw BACK PAIN ....................................570ORTHOTIC DEVICES FOR FOOT DEFORMITIES

IN ADULTHOOD .................................................................571ORTHOTIC OPTIONS FOR ACUTE AND

CHRONIC JOINT INSTABILITIES OF THE LOwER AND UPPER ExTREMITES ..............571

ORTHOSES IN SPINAL TRAUMA .......................................572ORTHOTIC OPTIONS IN TENDON INJURIES

OF THE HAND .....................................................................572FUNCTIONAL TREATMENT OF TENDON

INJURIES IN THE LOwER ExTREMITY ......................572FUNCTIONAL TREATMENT OF LOwER

ExTREMITY FRACTURES ................................................573ORTHOTIC CARE IN PATIENTS AFTER

CRANIALTRAUMA .............................................................573ORTHOTIC MANAGEMENT FOR PATIENTS

FOLLOwING BURN INJURIES ........................................574

2.6 reHABILITATIon oF PATIenTS AFTer eXTreMITy AMPUTATIon .................574

Jan Kálal2.6.1 Reasons for amputations .........................574

2.6.2 Prosthetics ...............................................574Structure of a Prosthesis ......................................................575Gait with a Prosthesis ...........................................................575Indication Criteria ................................................................575Residual Limb Care ..............................................................575Gait Training .........................................................................576Prosthesis Prescription ........................................................576Categories of Amputees According to Insurance

Companies Regulations ...................................................5762.6.3 Complications in amputations ................576

2.7 reHABILITATIon TooLS ...................... 577Jan Kálal

3 TreATMenT reHABILITATIon For SeLeCTed InTernAL And oTHer dISeASeS

Miloš Máček, Jiří Radvanský, Libuše Smolíková, Pavel Kolář

GenerAL SeCTIon

3.1 PHySIoLoGICAL MeCHAnISMS UTILIZed In reHABILITATIon InCLUdInG AdAPTATIon To PHySICAL ACTIVITy ............................... 585

Miloš Máček, Jiří Radvanský3.1.1 Cardiac System adaptation ..................... 585

Jiří Radvanský3.1.2 Pulmonary System adaptation ................ 586

Miloš Máček3.1.3 Metabolic adaptation ............................. 588

Jiří Radvanský3.1.4 immunity adaptation ............................. 589

Ondřej Suchánek, Pavel Kolář

3.2 FUnCTIonAL STreSS TeST In PATIenTS WITH CArdIoPULMonAry dySFUnCTIon ............................................. 591

Jiří Radvanský3.2.1 laboratory Stress test ............................. 5923.2.2 basic terminology of a Functional Stress test ......................................................... 5923.2.3 Fitness testing in less Fit individuals ...... 5933.2.4 Fitness assessment based on Submaximal Stress tests .............................. 5953.2.5 assessment of Stress test ........................ 5963.2.6 assessment of activity including assessment of the Functional ability of an elderly Patient ......................................... 5983.2.7 Specific Stress test adaptations for Patients with ischemic heart Disease (ihD) ......................................... 598

contents XXVII

3.3 FUnCTIonAL LUnG ASSeSSMenT ......... 599Jan Šulc

3.3.1 Causes of the onset of Pulmonary Dysfunctions in Patients with Deficits in the Movement System and in Certain organ Systems ................................................. 5993.3.2 Diagnostic approaches ........................... 599Methods in Pulmonary Function Testing .........................601Description of Pulmonary Function Parameters .............6033.3.3 interpretation and implementation of Conclusions from a Pulmonary Function test .................................................... 604Restrictive Lung Dysfunction .............................................604Lung Hyperinflation .............................................................604Obstructive Deficits .............................................................605Changes in Lung Elastic Properties ..................................605IMPLEMENTATION INTO CLINICAL PRACTICE .........605

SPeCIAL SeCTIon

3.4 reSPIrATory dISeASeS ....................... 606Miloš Máček, Jiří Radvanský, Libuše Smolíková, Pavel Kolář

3.4.1 Rehabilitation for bronchial asthma ...... 606Miloš Máček

ExERCISE-INDUCED BRONCHOSPASM .........................6073.4.2 Rehabilitation in Chronic obstructive Pulmonary Disease (CoPD) ............................. 609

Miloš MáčekPERIPHERAL MUSCLE DYSFUNCTION ...........................609Rehabilitation of Patients with COPD ...............................610Program for Patients with Mild and Moderate COPD ....611Assistive Methods with Exercise Therapy in COPD ........6113.4.3 implementation of Rehabilitation in other Respiratory Dysfunctions.....................614

Miloš MáčekRespiratory Insufficiency in Neuromuscular

Disturbances and Thoracic Deformities ........................614Rehabilitation of Patients Following Spinal

Cord Injury: Effect on Lung Function ...........................614Jan Šulc

Rehabilitation of Patients on Breathing Support ..............616Libuše Smolíková

3.4.4 Methods and approaches Used in the Rehabilitation of Patients with Chronic Pulmonary System Dysfunction ............617

Libuše Smolíková, Pavel Kolář

3.5 SUrGICAL ProCedUreS In THe THorACIC reGIon ...........................617

Lenka Babková3.5.1 Rehabilitation following Pulmonary Surgery ...........................................617Breathing Preparation ..........................................................618

3.5.2 Rehabilitation following Cardiac Surgery .................................................618Pre-Operative Fitness Improvement and Correction

of Musculoskeletal System Dysfunctions ......................618Post-Operative Rehabilitation Approaches .......................618ExErcisE thErapy ....................................................619Post-Operative Complications ............................................621

3.6 ISCHeMIC HeArT dISeASe (IHd) ......... 621Jiří Radvanský

KEY COMPONENTS OF A COMPLEx REHABILITATION PLAN ..................................................622

3.7 MeTABoLIC dISTUrBAnCeS ................. 624Jiří Radvanský

3.7.1 Diabetes Mellitus – type 2 ...................... 6243.7.2 Diabetes Mellitus – type 1 ...................... 627

3.8 rHeUMATIC dISeASeS.......................... 627Irena Koudelková, Pavel Kolář

3.8.1 Rheumatoid arthritis .............................. 6283.8.2 Juvenile Rheumatoid arthritis (Juvenile idiopathic arthritis)............................6313.8.3 ankylosing Spondylitis ........................... 6323.8.4 osteoporosis .......................................... 6353.8.5 Fibromyalgia Syndrome .......................... 636

Petr Knotek, Pavel KolářCLINICAL MANIFESTATIONS AND DIAGNOSIS ..........638Differential Diagnosis ..........................................................638Biological Aspects of FMS ...................................................639Psychological Aspects of FMS ............................................640TREATMENT ............................................................................641

3.9 oTHer dySFUnCTIonS And dISeASeS ..644Pavel Kolář

3.9.1 lymphedema and treatment .................. 644Martin Wald, Hana Váchová

ANATOMY OF THE LYMPHATIC SYSTEM ......................645MECHANISM OF LYMPHATIC FLUID

FORMATION ........................................................................645DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS ..............645TREATMENT ............................................................................645Manual Lymphatic Drainage...............................................646Pharmacotherapy .................................................................646Treatment Frequency ...........................................................646EDEMA PREVENTION ...........................................................646PROGNOSIS ..............................................................................6473.9.2 treatment Rehabilitation of bowel incontinence .................................................... 647

Pavel Kolář

3.10 GerIATrICS ........................................ 648Zdeněk Kalvach

3.10.1 aging Phenotype and involution Deterioration ................................................... 649

XXVIII clinical rehabilitation

3.10.2 Geriatric Frailty and Geriatric Syndromes ....................................................... 649gEriatric syndroMEs oF hypoMobility,

dEconditioning and MusclE wEaKnEss ......650HYPOMOBILITY ......................................................................650DECONDITIONING ................................................................650SARCOPENIA ............................................................................650gEriatric ModiFications and continuity

oF rEhabilitation activitiEs .............................6503.10.3 Principles of Movement activity Selection in the aging Population .................... 651

Miloš Matouš, Pavel KolářAssessment Prior to Exercise Program Initiation ............652Exercise Programs ................................................................652Reconditioning Stays............................................................653

4 TreATMenT reHABILITATIon In onCoLoGy

Vítězslav HradilREHABILITATION SPECIFICS FOR PATIENTS

wITH ONCOLOGIC CONDITIONS ...............................657BASIC GOALS AND ASSESSMENT

OF REHABILITATION TREATMENT .............................657REHABILITATION TREATMENT

COMPLICATIONS ...............................................................658

GenerAL SeCTIon

4.1 PAIn PATTernS In PATIenTS WITH onCoLoGICAL dISeASeS ............................ 6584.1.1 Pain Pattern and its treatment ................ 6584.1.2 Classification of oncologic Pain .............. 658

4.2 PArAMeTerS For THe InTerrUPTIon or ModIFICATIon oF A reHABILITATIon ProGrAM ............... 6594.2.1 laboratory Values ................................... 6594.2.2 long bone Metastases ............................ 6594.2.3 other Parameters Modifying Rehabilitation treatment .................................. 660

4.3 reHABILITATIon APProACHeS ........... 6604.3.1 Modalities ............................................... 6604.3.2 Physical therapy techniques .................. 6614.3.3 Contraindications ................................... 661

4.4 SPeCIFIC FACTorS InFLUenCInG reHABILITATIon TreATMenT .................... 662

SPeCIAL SeCTIon

4.5 MeTASTATIC InVoLVeMenT ................. 6624.5.1 Metastatic involvement of the Skeleton ....662

ONCOLOGICAL DISEASES OF THE SPINE .....................663ONCOLOGICAL DISEASES AND SURGICAL

APPROACHES FOR THE ExTREMITIES ......................6644.5.2 Metastatic involvement of the brain and the Spinal Cord ......................................... 666

4.6 PArAneoPLASTIC SyndroMeS ........... 666

4.7 SIde eFFeCTS oF onCoLoGIC TreATMenT ................................................ 667NEUROLOGICAL SYMPTOMS ............................................6674.7.1 Cerebellar Syndrome ............................... 6674.7.2 Peripheral Polyneuropathy ..................... 6674.7.3 hormone therapy ................................... 6694.7.4 immunotherapy ...................................... 669

4.8 SoFT TISSUeS And MUSCLe TISSUe ...... 669

4.9 rAdIATIon THerAPy ........................... 669

4.10 LyMPHedeMA .....................................671

5 TreATMenT reHABILITATIon In GyneCoLoGy And oBSTeTrICS

Martina Ježková, Pavel Kolář

5.1 oVerVIeW oF GyneCoLoGICAL SyndroMeS WITH ConTrIBUTIon oF FUnCTIonAL deFICITS ........................... 673

Martina Ježková, Pavel Kolář

dysFunctions oF thE MEnstrual cyclE and Functional stErility .................................674

AMENORRHEA ........................................................................674DYSMENORRHEA ...................................................................674STERILITY .................................................................................675

5.2 PreMenSTrUAL SyndroMe And MenoPAUSe ....................................... 678prEMEnstrual syndroME .....................................678MEnopausE ...............................................................678MENOPAUSE, PREMENOPAUSE,

POSTMENOPAUSE ..............................................................678MENOPAUSAL SYNDROME .................................................679syndroMEs that can bE aFFEctEd

by rEhabilitation ................................................679

5.3 PeLVIC InFLAMMATory dISeASe ......... 679

5.4 AnAToMICAL deFICITS In GyneCoLoGy ......................................... 680

5.5 GyneCoLoGICAL SUrGICAL ProCedUreS .............................................. 680Post-Operative Complications (Post-Surgical Incisions) .. 683

contents XXIX

5.6 UrInAry InConTInenCe ..................... 683Martina Hoskovcová

5.7 PreGnAnCy, BIrTH And THe PoSTPArTUM (PoSTnATAL) PerIod ......... 686

Martina Ježková, Pavel KolářprEgnancy ...............................................................686birth ..........................................................................686postpartuM .............................................................687

6 TreATMenT reHABILITATIon In PAIn MAnAGeMenT

Jiří Kozák, Pavel Kolář

6.1 CLASSIFICATIon oF PAIn ..................... 691

Acute Pain .............................................................................691Chronic pain .........................................................................691

6.2 FoUndATIonS oF neUroPHySIoLoGIC PAIn ......................... 691

6.3 PAIn MAnAGeMenT ............................. 692

6.4 CoMPLeX reGIonAL PAIn SyndroMe (CrPS) ..................................... 695

7 TreATMenT reHABILITATIon In PSyCHoSoMATIC dISeASeS

Petr Knotek, Pavel Kolář

7.1 Modern PSyCHoSoMATICS ................ 701

7.1.1 Psychosomatics and Current Science ....... 7027.1.2 Psychosomatics and irrationality ............. 7027.1.3 biological, Psychological and Social approach ........................................ 703Psychosomatic Integrity ......................................................704Normality ..............................................................................705Psychobiology and Sociocultural Norms ..........................705Cognitive Processes and Adaptation .................................705Failure as a Pathological Adaptation ..................................7067.1.4 Placebo and nocebo ............................... 7067.1.5 Charisma ................................................. 7087.1.6 Physical Manifestations as Signs and Symptoms ................................................. 7087.1.7 Deficits and Signs .....................................710Acute Psychological Reaction to Stress .............................710Neurotic Disturbances .........................................................710Psychosomatic Disturbance ................................................710Psychosomatic Diseases of Organs

and Organ Systems ...........................................................710Systemic Diseases .................................................................711Somatopsychological Disturbance .....................................711

7.2 TreATMenT ...........................................7117.2.1 biological, Psychological and Social Context: non-Specific Rehabilitation Factors .......................................7117.2.2 treatment Rehabilitation .........................713

Barbora Danielová, Petr Knotek, Pavel Kolář7.2.3 Psychotherapy .........................................7147.2.4 Psychopharmacotherapy .........................714

8 reHABILITATIon In PSyCHIATry

8.1 reHABILITATIon In THe AreAS oF SoCIAL And VoCATIonAL FUnCTIonS ..................................................717

Ondřej Pěč, Lenka Vachková, Jan Mužík8.1.1 General aspects of Psychiatric Rehabilitation ...................................................718Current Schools of Psychiatric Rehabilitation ..................718Target Group of Psychiatric Rehabilitation .......................718Principles of Psychiatric Rehabilitation .............................718Recovery ................................................................................7198.1.2 Process of Psychiatric Rehabilitation and Possible approaches .................................. 720Process of Psychiatric Rehabilitation According

to the Boston School ........................................................720Process of Psychosocial Rehabilitation

According to the Netherlands’ School STORM ...........7218.1.3 Specific levels of Psychiatric Rehabilitation .................................................. 721Vocational rehabilitation .....................................................721Assisted Education ...............................................................723Rehabilitation and Housing ................................................723Rehabilitation in the Areas of Social Interaction

and Leisure Time ..............................................................7248.1.4 Psychiatric Rehabilitation assessment ..... 725

8.2 PSyCHoMoTor THerAPy .................... 725Běla Hátlová, Milena Adámková

8.2.1 General aspects of Psychomotor therapy ............................................................ 726Research in Kinesiotherapy .................................................726Physical Self-Concept ..........................................................726Role of Movement Activity in Stress Coping ...................726Somatic State and Movement Abilities of Patients

with Mental Illness ...........................................................726why Movement Therapy? ...................................................7278.2.2 Kinesiotherapy ....................................... 727Circumscription of the term Kinesiotherapy ...................727Actions of Kinesiotherapy ...................................................727Types of Kinesiotherapy in the Treatment

of Psychiatric Patients ......................................................728Integrated and Focused Kinesiotherapy ............................728Kinesiotherapeutic Activation Programs ..........................728Kinesiotherapeutic Active Relaxation Programs ..............728Perceptive (Attention) Focused Kinesiotherapy ...............728

XXX clinical rehabilitation

Kinesiotherapeutic Programs Increasing Self-Confidence and Confidence in Others ..................729

Kinesiotherapeutic Communication Programs ...............729Therapeutic Utilization of Athletic Exercises ...................729Suggested Forms of Kinesiotherapy

for the Treatment of Psychological Illnesses .................729Kinesiotherapy for the Treatment of Dementia ...............729Kinesiotherapy for the Treatment

of an Addiction Syndrome ..............................................729Kinesiotherapy for the Treatment of Schizophrenia ........730Kinesiotherapy for the Treatment of Manic Illnesses ......730

Kinesiotherapy for the Treatment of Neuroses .................730Kinesiotherapy for the Treatment

of Personality and Behavioral Disorders .......................731Principles of Kinesiotherapy Administration

in the Mentally Ill .............................................................731

BIoGrAPHIeS oF InFLUenTIAL FIGUreS ..... 733

ABBreVIATIonS ..........................................747

IndeX ..........................................................749