Author/Editor     Pihlar, Zdenka; Pražnikar, Aleš
Title     Prilagoditve vozičkov za uporabnikwe z znižanim mišičnim tonusom
Translated title     Wheelchair adaptations for users with low muscle tone
Type     članek
Source     Rehabilitacija
Vol. and No.     Letnik 6, št. Suppl 1
Publication year     2007
Volume     str. 19-26
Language     slo
Abstract     Neural control and muscle activity are essential for good posture. Low muscle tone or hypotonia is most frequently a manifestation of motor unit disorders or diseases, such as neuromuscular diseases. Prevailing and common clinical symptoms of this otherwise heterogeneous group of diseases are paralysis, low muscle tone and increased fatigability. When the condition progresses, secondary manifestation of the primary disease may show, especially posture disorders, such as scoliosis and contractures. Primary areas of deviation where posture problems are first manifested are: pelvis hip joint; middle part of the thoracic spine, cervical spine and feet. A wheelchair enables persons with low muscle tone sit and move with assured posture correction (body functions and body structures level), execution of activities of daily living (activity) and involvement into life situations participation). A wheelchair is aimed at supporting body posture in a sitting position, preventing pelvis inclination, preventing compensatory postures, slowing down the development of deformations, providing an even pressure distribution over the seating area, supporting the function of upper limbs and head as well as ensuring safety and comfort. Technical solutions need to follow those aims and support the possibility of upgrading with additional technical solutions for increased activity (ventilator for assisted ventilation, smart/technical systems for environment control,..). The selection and prescription of an appropriate wheelchair is a demanding process which requires from the rehabilitation team to adjust the wishes of the users and their needs in the closer and wider environment to the available technical solutions within the range of disposable funds.
Summary     Nevralni nadzor in delovanje mišic sta bistvenega pomena za ustrezno držo. Mišična ohlapnost oziroma hipotonija je največkrat posledica okvare ali bolezni motorične enote, na primer živčnomišičnih bolezni. Prevladujoči in skupni klinični znaki te sicer raznotere skupine bolezni so ohlapna ohromelost, usahlost mišic in povečana utrudljivost. Z napredovanjem bolezni se pogosto razvijejo sekundarne posledice osnovne bolezni, zlasti motnje drže, kot so skolioza in kontrakture. Primarna področja deviacije, kjer se problemi drže pokažejo najprej, so: medenica - kolčni sklep, predel sredine prsnega dela hrbtenice, vratna hrbtenica in stopala. Invalidski voziček omogoča osebi z zmanjšanim mišičnim tonusom sposobnost sedenja in gibanja ob zagotavljanju ustrezne korekcije drže (nivo telesnih funkcij, telesne zgradbe), izvajanja vsakodnevnih aktivnosti (dejavnost) in vključevanja v življenjske aktivnosti (sodelovanje). Z vozičkom želimo podpreti držo trupa v sedenju, preprečiti nagib telesa v medenici, preprečiti kompenzatorne položaje, upočasniti razvoj deformacij, doseči enakomerno razporeditev pritiska na sedni površini, podpreti funkcijo zgornjih ekstremitet in glave ter zagotoviti udobje in varnost. Tehnične rešitve morajo slediti tem ciljem ter podpirati možnosti nadgradnje dodatnih tehničnih rešitev za povečanje dejavnosti (ventilator za umetno predihavanje, sistemi za upravljanje okolice..). Izbor in predpis ustreznega invalidskega vozička je zahteven proces, v katerem mora rehabilitacijski tim uskladiti želje uporabnika in njegove potrebe v ožjem in širšem okolju z dosegljivimi tehničnimi možnostmi znotraj razpoložljive vsote denarja.