Physiotherapy treatment in generalised dystonia with patient after implementation of electrodes to two-side stimulation of the internal globus pallidus (GPi-DBS)
Keywords:
dystonia, internal globus pallidus stimulation, in home physiotherapy, info therapy, quality of lifeAbstract
This work is based on studies of patient case, patient M.Z age 21, born in the 28th week of pregnancy, new born with severe problems with breading and blood circulation (5/7 points in Apgar scale). Sustention of life functions by incubation and oxygen therapy. In the 11th month of life patient is diagnosed with ICP (Infantile Cerebral Palsy). Till that point patient has not reached crawling function or even independent reaching sitting position in motorise growth. Has not attempted standing up position or walking. Rehabilitated in ambulatory environment and in integrational kindergarten. In result of which till age of 12 has gained ability to independently gain sitting position and sustain balance. Problems have arisen at the moment of entering growing up age. Uncontrolled dystonic, twisted and opposite movements have emerged of agonist and antagonistic muscle. This has resulted in change of diagnosis in the direction of primal dystonia – inherited dystonia. After genetic test this diagnosis has been excluded and diagnosis of repeated dystonia – Sagawa Syndrome has been made. Dopamin treatment has been included in therapy that had no result. Finger deformation, spine with the chest rotation and neck deformation symptoms have increased. Spastic symptoms have increased to extreme stiffness, which transferred to worse functionality of internal organs (heart, lungs, stomach). That was a reason of diagnosis change in January 2008 to finally be generalising dystonia. In May 2009 patient received internal globus pallidus stimulator implant on the left side. With the second surgery – September 2009 patient was implanted with electrodes of deep brain stimulation on the right side. This has resulted in decrease of involuntary twisting movement and strong muscle tension. In home physiotherapy has been started which intend was to increasing quality of life by rationalization of breathing and manual functions, re-establishing upper body muscle stability. PIR and PNF exercises as well as stretching positions and exercises has been used with the use of big ball and electro stimulation. This resulted in increase of patients optimistic humour as for his future in that degree and started to make life plans. Noted has to be that patient in spite of his functional limitations is showing big intellectual functionality. Which shows in the knowledge of 3 languages which allows him with the use of internet (info therapy) have wide contact with world.
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