Pavel Kolář et al.

Clinical
Rehabilitation
 XXXI

FOREWORD

The main motivation for me to begin work on this In this book, I focused on the treatment component
textbook was an effort to refine knowledge of the of rehabilitation and devoted more space to it than the
qualified public about rehabilitation and provide educational, social and occupational areas. Given the
a framework regarding the true objectives of this fact that the diagnostic and treatment approaches of
field. Our profession is sometimes misconceived as rehabilitation are focused primarily on the movement
massage therapy, exercising after orthopedic proce- system, this field reaches into practically all clinical
dures, rehabilitation and sometimes it is reduced to fields (neurology, orthopedics, internal medicine,
only the use of therapeutic agents (modalities). I have oncology, immunology, psychiatry, etc.). Movement
also encountered the opinion that it is linked to or function plays an important role in all of these clinical
even directly considered some kind of an alternative fields. This is because physical activity and its repeated
treatment. Another important motivation for me was action manifest themselves by a change in function in
the lack of current study materials for physicians un- a number of systems (cardiorespiratory, immune, cen-
dergoing residencies, for graduate and post-graduate tral nervous system and metabolic changes), which
physical therapy students, as well as for physicians of allows for influencing these systems through modula-
other clinical specialties who want to be introduced to tion of its intensity, frequency and form. Another re-
the methods of treatment rehabilitation used in their ason why rehabilitation reaches into several medical
specialization. fields is the fact that the sensory afferent inputs from
In my view, I consider it essential that the foundati- the entire body are always processed not only within
on for rehabilitation treatment approaches be neither its own sensory modality (visual, acoustic, proprio-
a trend nor a school of thought (chiropractics, osteo- ceptive, integumentary, etc.), but also within an inte-
pathy, musculoskeletal medicine), but rather a wide, grated motor function. Our eyes, respiratory muscles,
general foundation in the fields of clinical physiology tongue, etc. serve not only the function they are do-
and neurophysiology. It also needs to be appreciated minantly selected for, but they also participate in pos-
that rehabilitation is not only limited to diagnostic tural and locomotive functions. This is well observed
and treatment methods, but it also attempts to limit in athletic performances in which maximal force or
the extent of psychological, behavioral and social a precisely accurate movement needs to be accomplis-
changes related to the consequences of an injury or hed. For example, to strike a ball with required force,
illness. Therefore, rehabilitation should not be perce- a tennis player makes a movement with their extre-
ived as strictly a medical field but a field that over- mity, which is linked to a face expression, movement
reaches these boundaries and extends into the social, of the tongue in the direction of the stroke, eye mo-
academic and work arenas. Comprehensive (integra- vement in the direction of the stroke, modification of
ted) rehabilitation applies to individuals whose health breathing by diaphragm activity (a grunt, Valsalva) to
was compromised to a varied extent as a result of an facilitate trunk stabilization, position of the contrala-
illness, injury or a congenital defect and who require teral extremity into the opposite (reciprocal) position
special assistance to achieve the highest possible level etc. It is an overall involuntary movement pattern that
of independence. A person with a disability perceives interlinks individual sensory modalities and, thus, it
limitations that they are unable to overcome while is related to the majority of medical fields. This princi-
performing certain activities but they feel able and ple of modality integration within postural locomotor
healthy in a number of other activities. Removing and functions is a component of CNS development and it
solving these limiting problems is one of the particu- was established based on this principle. The fact that
larly important tasks of rehabilitation. Therefore, the the described integration occurs at higher levels of
concept of rehabilitation must complement not only control than the spinal cord and the brain stem is sig-
the treatment process but also the subsequent rehabi- nificant. This can also provide hypotheses regarding
litation process. the effects of a number of alternative approaches who-
From this point of view, rehabilitation is a very se justification of spinal cord and brain reflexology is
broad field which cannot be covered in detail in one not sufficient and is therefore substituted in clinical
book. Similarly, it is not possible to cover this extensi- practice by alternative explanations. These central
ve subject by one specialist. Success is based on a co- programs are organized above the brain stem level
ordinated effort of various specialists. and can explain why functional pathologies become
XXXIIClinical Rehabilitation

chained in predetermined sequences; why needle ap- O. Stary played an important role. Stary and K. Lewit
plication in a single point has functional consequen- demonstrated the significance of painful functional
ces in a completely distant area of the body including deficits of the movement system. In this aspect, the
the visceral region; why an internal dysfunction does large contribution of Professor J. Jirout who was the
not only show reflexive response in the corresponding founder of functional radiology of the spine, needs
segment but in quite distant areas and in various af- to be remembered. Thanks to the work of Professor
ferent modalities (skin hyperalgic zones, changes in V. Janda, the basic significance of movement patterns
dermographism, muscle trigger points, joint restricti- was gradually underwood and the term “functional
ons, etc.); why respiratory function can be influenced pathology of the movement system” was established.
through eye movement (eye movement automatically This presentation was even further strengthened by
causes change in the breathing pattern); why breathing the influence of scientific studies and personal con-
pattern changes with a change in hand position, and tact with D.G. Simons and J.G. Travell to whom we are
a number of other phenomena. The control system grateful for providing detailed knowledge of muscle
of the postural locomotor functions then provides us trigger points that also cause a limitation in joint mo-
with a program that offers a completely new approach bility, so called joint restrictions. To understand the
in the understanding of rehabilitation approaches. function of the movement system, individual dys-
Clinical diagnosis focused on symptomatology or- functions, such as trigger points and joint restricti-
ganized within postural locomotor functions should ons, need to be understood in the context of the entire
not be considered an exclusive component of treat- movement system, i.e. the laws of chaining of functi-
ment rehabilitation but also a component of the rema- onal dysfunctions. The key to this understanding was
ining clinical specialties. a better knowledge of the control function of motor
I based the structuring of the General and Special skills. The new approach of treatment rehabilitation
Sections of the textbook on the function of the move- during movement re-education is based on utilization
ment system in relation to individual clinical special- of knowledge about human motor development. This
ties. Therefore, I did not base them on diagnoses but new trend enriches the current empirical and physical
rather on the functional manifestations of the disease. approaches by findings originating from the control
The General section of the textbook includes functio- processes of the CNS that mature during motor de-
nal symptomatology and syndromology in dysfuncti- velopment. Dr. Vaclav Vojta, whose work we are cur-
ons of the nervous, musculoskeletal and internal sys- rently trying to continue, has a significant role in this
tems and their clinical and laboratory examinations. approach. Professor Vojta also came from Henner’s
The majority of treatment approaches are also presen- department and his conceptualization is an inherent
ted in this context meaning that the treatment based component of contemporary clinical rehabilitation
on symptomatology and syndromology dominates. In practice. Unfortunately, the neurophysiological prin-
the Special Section of the textbook, treatment rehabi- ciple of the entire approach to developmental kinesio-
litation is presented in individual clinical specialties – logy is still not fully appreciated due to disagreements
neurology, orthopedics, internal medicine, oncology, about indication and the type of application of the
gynecology and psychiatry. Vojta method. However, not many critics understand
I purposely devoted less attention to occupational the true basis of the Vojta approach. What is essential
therapy, balneology and therapeutic agents (moda- and substantial is not only the way that rehabilitation
lities) than these treatment approaches deserve. The of movement dysfunction is utilized, but also the fact
reason is not to underestimate their value, but rather that the concept of developmental kinesiology is com-
them already being reasonably available and suffici- bined with the neurophysiological view relying on the
ently described elsewhere. findings of neurosciences associated with the current-
In clinical approaches of the General Section of ly predominant physical mechanical views.
the textbook, I have extensively drawn from and ex- In this book, I was also trying to respect and em-
panded on a trend known worldwide as the “Prague phasize more certain general principles that condition
School.” In rehabilitation, the roots of this school of the treatment effect, however, to convey the informa-
rehabilitation can be found in the Neurology Clinic tion in a written form is significantly limited for some
of Professor Henner whose concept of neurology of them. The respect for a comprehensive patient per-
was very broad and therefore included even vascu- spective is one such principle. The fact that human life
lar diseases and movement system diseases within occurs under specific biological, psychological, soci-
neurological symptomatology. Treatment rehabilita- al-psychological, materialistically economic and eco-
tion was promoted by K. Obrda who, together with logical conditions needs to be implanted within the
J. Karpisek, wrote the first rehabilitation textbook for diagnostic, treatment and preventative approaches.
neurological diseases and organized an international Diseases and injuries cannot be viewed in isolation
congress in 1965. On the theoretical level, F. Vele and but rather need to be integrated within the context
Foreword XXXIII

of such relationships because the treatment processes It is almost impossible to express in written form
and rehabilitation are significantly affected by them. some principles that significantly affect the results of
I also aspired to prevent this textbook from beco- a rehabilitation treatment. This, for example, includes
ming a proponent of only one method but rather sup- the mutual trust between the patient and the reha-
port a variety of rehabilitation approaches based on bilitation specialist, which cannot be substituted by
a person’s individual needs. The problem is that this a client-expert relationship or by a work performance
does not allow for providing a clear-cut treatment ap- contract. The importance of effective communicati-
proach for movement dysfunctions because these ap- on, charismatic approach, suggestive appeal and one’s
proaches need to also be modified to the patient’s, and own experience developed by sensory perceptions are
sometimes even the therapist’s, personality. In this additional examples.
context, protocols based on one uniform foundation Despite these limited options, I believe that this
outlining what and how much needs to be done can- book will assist in better orientation in the broad field
not be implemented. These approaches are a method that rehabilitation truly is and thus will help fulfill the
of choice, offering the option of finding individual so- purpose for which it was written.
lutions to how to effectively proceed and how to best
modify the approach for a specific individual. Pavel Kolar
 XI

Contents

I general SECTION

Introductory section Pain and Movement System Dysfunction............................21

Karel Lewit, Pavel Kolář
Pavel Kolář
REHABILITATION CONCEPT AND DEFINITION ............. 2
A. DIAGNOSTIC procedures
Jan Calta, Pavel Kolář
Current State of Providing Rehabilitation.............................. 2
TREATMENT (MEDICAL) REHABILITATION..................... 2 1 Assessment approaches focused
SOCIAL REHABILITATION....................................................... 5 On the FUNction of the movement
TOOLS OF School-based REHABILITATION................. 5 SYstem
TOOLS OF VOCATIONAL REHABILITATION..................... 5
Pavel Kolář, Karel Lewit, Olga Dyrhonová
PREVENTATIVE ROLE OF REHABILITATION.................... 5
FUNDAMENTAL PRINCIPLES FUNDAMENTALS OF A CLINICAL ASSESSMENT............25
OF REHABILITATION............................................................. 6 PATIENT PRELIMINARY CASE HISTORY
INDIVIDUAL TYPES OF REHABILITATION (ANAMNESIS).........................................................................25
SETTINGS................................................................................... 7 OBSERVATION (ASPECTION)................................................28
CLASSIFICATION OF FUNCTIONAL CAPABILITY, PALPATION..................................................................................29
DISABILITY AND HEALTH.................................................. 8 Karel Lewit
AUSCULTATION.........................................................................32
Petr Bitnar
TREATMENT REHABILITATION –
DIAGNOSTIC AND THERAPEUTIC
1.1 NEUROMUSCULAR FUNCTIONS
aPPROACHES
AND THEIR CLINICAL EXAMINATION............. 33
Pavel Kolář
Rehabilitative care Muscle in Reflexive Context as Part
of the Movement System....................................................34
Pavel Kolář Motor Patterns.........................................................................34
REPOSITIONING........................................................................13 Movement Stereotypes............................................................35
Indications for Repositioning................................................13 Clinical Manifestations and Examination
Principles of Repositioning....................................................13 of Neuromuscular Dysfunctions......................36
Goals of Repositioning ..........................................................14
Types of Repositioning...........................................................15
Pavel Kolář, Jiří Kříž I FUNCTIONAL AND NEUROLOGIC
VERTICALIZATION...................................................................17 SYMPTOMATOLOGY
PATIENT MOBILIZATION.......................................................17
Mobilization goals...................................................................17 1.1.1 Examination of Postural Functions............. 36
Prevention of Heterotopic Ossifications...............................18 Pavel Kolář
Types of Mobilization.............................................................19 POSTURE......................................................................................37
Active Movement....................................................................20 Postural Function – Normal..................................................37
Development of Posture.........................................................37
Treatment rehabilitation Reflex Model of Posture and Locomotion...........................39
focused on restoration Circumscription of the Term Posture...................................39
of a functional deficit Postural Stability......................................................................40
Postural Stabilization..............................................................40
Pavel Kolář Postural Reactibility................................................................40
Functional Emphasis of Methods in Treatment Postural Disturbances.............................................................42
Rehabilitation...........................................................................21 STANDING...................................................................................44
Karel Lewit, Pavel Kolář Examination of Individual Body Regions............................44
 XIIClinical Rehabilitation

Modified Examination of Standing.............................49 Kinesthesia...............................................................................73

Assessment of Standing in Neurologic Perception of Vibration..........................................................73
Disorders..............................................................................50 Two-point Discrimination.....................................................73
GAIT...............................................................................................50 Topognosis, Graphesthesia.....................................................74
Petra Valouchová, Pavel Kolář Stereognosis..............................................................................74
Phases of the Gait Cycle..........................................................50 Clinical Sensory Syndromes..................................................74
Types of gait according to V. Janda.......................................50 1.1.4 Assessment of Reflexes............................... 75
Examination of Gait in a Clinical Setting.............................51 Pavel Kolář
Laboratory Examination of Gait...........................................52 MYOTATIC REFLEXES..............................................................75
Typology of Gait Dysfunctions from Upper Extremities Myotatic Reflexes ..................................75
a Neurological Perspective.................................................52 Myotatic Reflexes of the Lower Extremities.........................75
Examination of Postural Stabilization EXTEROCEPTIVE REFLEXES..................................................76
and Postural Reactibility....................................................54 Idiomuscular Response..................................................76
Pavel Kolář PATHOLOGICAL REFLEXES...................................................76
1.1.2 Examination of Muscle Tone....................... 60 Pathological Reflexes Elicited
Pavel Kolář in the Upper Extremity.......................................................76
Reflex Regulation of Muscle Tone.........................................60 Pathological Reflexes Elicited
Connective Tissue Component in the Lower Extremity.......................................................77
of Muscle Tone.....................................................................60 Clonus.......................................................................................78
Deficits in Muscle Tone..................................................61 Mediopubic Reflex...................................................................78
Hypertonia and Spasm...........................................................61 1.1.5 Examination of Involuntary Movements....... 78
Contracture..............................................................................61 Pavel Kolář
Local Hypertonic Changes in Muscle Tissue.......................61 Tremor.......................................................................................79
Zdeněk Čech Spasms..........................................................................................79
Trigger Points – Clinical Characteristics..............................62 Myoclonus..............................................................................79
Histological Findings in the Area of a Trigger Point..........62 Fibrillar and Fascicular Twitches.......................79
Localization of Trigger Points................................................62 Choreic and Athetoid Hyperkineses....................79
Foundation of Trigger Point Formation Athetosis...................................................................................79
in Muscle Tissue..................................................................62 Chorea.......................................................................................79
Trigger Points versus Tender Points......................................63 Tics................................................................................................80
Local Muscle Twitch...............................................................63 1.1.6 Examination of Muscle Strength................. 80
Trigger Points as a Source of a Spontaneous Myofascial David Smékal, Magdaléna Lepšíková
Pain........................................................................................63 MUSCLE WEAKNESS................................................................80
Examination of Trigger Points with the Help MUSCLE STRENGTH.................................................................80
of Instrumentative Examination Methods ......................64 Assessment of Muscle Strength.............................................80
Spasticity...................................................................................65 Assessment of Muscle Strength.............................................81
Pavel Kolář
Rigidity......................................................................................68
Paratonia...................................................................................68 II NEUROLOGIC SYNDROMOLOGy
Hypotonia.................................................................................68
MUSCLE TONE DISTRUBANCES AND THEIR 1.1.7 Primary Myogenic Lesion........................... 83
POSTURAL LAYOUT.............................................................69 Petr Bitnar, Pavel Kolář
Pavel Kolář Weakness in Myopathies........................................................83
Upper Crossed Syndrome......................................................69 Pseudohypertrophy and Muscle Contractures
Lower Crossed Syndrome......................................................70 in Myopathies......................................................................84
Layer Syndrome.......................................................................70 1.1.8 Deficits at the Neuromuscular Junction........ 84
Assessment of Shortened Muscles.........................................70 Petr Bitnar
1.1.3 Examination of Sensory Functions.............. 70 Myasthenia Gravis...................................................................84
Alena Kobesová Lambert-Eaton Myasthenic Syndrome................................84
Sensory Testing....................................................................71 1.1.9 Peripheral Nerve Deficits........................... 84
Examination of Individual Sensory Modalities...................72 Petr Bitnar
Touch.........................................................................................72 Examination of Deficits in the Sensory Fibers
Temperature.............................................................................72 of the Peripheral Nerve.......................................................84
Pain............................................................................................72 Examination of Deficits in Motor Fibers
Joint Position Sense.................................................................73 of a Peripheral Nerve..........................................................85
Contents XIII

1.1.10 Spinal Cord Syndromology....................... 85 Deficits in Gnostic Functions................................................95

Jiří Kříž, Veronika Hyšperská Deficits in Practical Functions...............................................96
GRADUAL TRANSVERSE SPINAL CORD LESION............85 LIMBIC SYSTEM..........................................................................96
SUDDEN TRANSVERSE SPINAL CORD LESION...............85 Examination of Motor Functions from the Perspective
PSEUDOPARETIC SPINAL CORD LESION..........................85 of Cortical Plasticity............................................................97
SPASTIC SPINAL CORD LESION............................................85 Pavel Kolář, Magdaléna Lepšíková
MIXED SPINAL CORD LESION..............................................86 Examination of Selective Movement....................................98
CONUS MEDULLARIS SYNDROME.....................................86 Examples of Clinical Tests......................................................99
CAUDA EQUINA SYNDROME ...............................................86
POSTERIOR CORD SYNDROME............................................86
BROWN-SEQUARD SYNDROME...........................................86 III NEUROMOTOR DEVELOPMENT
INTraMEDULLARY SYNDROME.........................................86 AND ITS EXAMINATION
1.1.11 Cerebellar Syndromology......................... 86
Pavel Kolář CLINICAL EXAMINATION VIA MOTOR
FLACCIDITY................................................................................86 PROGRAMS...........................................................................100
HYPERMETRIA...........................................................................86 Pavel Kolář
ASYNERGY...................................................................................87 SCREENING OF NEUROMOTOR
DIADOCHOKINESIA.................................................................87 DEVELOPMENT.......................................................................101
OTHER CEREBELLAR SIGNS..................................................87 Central Coordination Disturbance (CCD)........................101
1.1.12 Extrapyramidal Syndrome........................ 87 Developmental Kinesiology as an Assessment
Pavel Kolář Method – the Examination of an Infant
1.1.13 Thalamic Syndrome.................................. 87 in the First Year of Life.....................................................101
Pavel Kolář Postural Activity....................................................................102
1.1.14 Brain Stem Syndromes.............................. 88 Postural Activity in Individual Phases of Development
Pavel Kolář (0–15 Months)...................................................................103
Medial syndromes..............................................................88 Postural Reactivity.................................................................112
Lateral syndromes............................................................88 Pavel Kolář, Marcela Šafářová
1.1.15 Syndromes of Meningeal Irritation, 1. Traction Test......................................................................113
Intracranial Hypotension, Hypertension 2. Landau Reaction................................................................113
and Ventricular Syndromes................................. 89 3. Axillary Suspension..........................................................114
Pavel Kolář 4. Vojta’s Tilt Reaction...........................................................115
SYNDROME OF MENINGEAL IRRITATION.......................89 5. Collis Horizontal Suspension..........................................116
INTRACRANIAL HYPOTENSION SYNDROME.................89 6. Peiper-Isbert Vertical Suspension...................................117
INCREASED CRANIAL PRESSURE SYNDROME ..............89 7. Collis Vertical Suspension................................................118
VENTRICULAR SYNDROMES................................................90 Primitive Reflexology............................................................118
1.1.16 Cortical Syndromes Pavel Kolář
and their Examination......................................... 90 Functional Relationship between Postural Activity,
Pavel Kolář, Rastislav Druga Postural Reactivity and Primitive Reflexology..............121
FRONTAL LOBE..........................................................................90 PSYCHOMOTOR DEVELOPMENT IN EARLY
Primary Motor Cortex (MI)..................................................91 CHILDHOOD........................................................................121
Premotor Cortex......................................................................91 Irena Zounková, Pavel Kolář
Frontal Eye Field......................................................................92 CENTRAL COORDINATION DISTURBANCE
Broca’s Speech Area.................................................................92 IN PRESCHOOL AND SCHOOL AGE.............................125
Prefrontal Cortex.....................................................................92 Irena Zounková, Pavel Kolář
Signs of an Injury to the Frontal Lobes Monitored Areas in a Neurodevelopmental
of the Motor Cortex............................................................93 Examination.......................................................................126
Axial phenomena....................................................................93 Physiotherapy in Central Coordination
Paraxial phenomena................................................................93 Disturbance........................................................................130
Other Disturbances with Lesions
to the Frontal Cortex..........................................................93 1.2 KINESIOLOGY AND CLINICAL
Assessment Tests for Frontal Lobes Deficits........................93 EXAMINATION OF THE JOINT SYSTEM...........133
TEMPORAL LOBE......................................................................94 Pavel Kolář
OCCIPITAL LOBE.......................................................................95 Joint Motions.........................................................................133
PARIETAL LOBE..........................................................................95 Joint Categories Based on the Number of Axes
Deficits in Phatic Functions...................................................95 and the Shape of Articular Surfaces................................134
 XIVClinical Rehabilitation

Classification of Joints according to the Number Anamnesis..............................................................................165

of Articulating Bones within the Joint...........................135 Aspection................................................................................165
Joint Innervation...................................................................135 Palpation.................................................................................165
Assessment of Joint Range of Motion.................................135 Passive Movements................................................................165
David Smékal Active Movements.................................................................166
1.2.1 Kinesiology of the Spine, Functional Tests.....................................................................166
Pelvis and the Thorax.........................................137 Instability Tests......................................................................166
Pavel Kolář Lateral Epicondylitis Tests....................................................166
SPINE........................................................................... 137 1.2.4 Kinesiology of the Wrist and the Hand....... 166
PELVIS..........................................................................140 Petr Bitnar
Thorax...................................................................... 141 WRIST..........................................................................166
ANATOMICAL PARAMETERS INFLUENCING MOVEMENTS OF THE CARPAL COMPLEX.....................167
SPINAL FUNCTION..................................................143 CARPOMETACARPAL JOINTS.......................................168
Regional Anatomical Parameters........................................143 HAND..........................................................................168
Global Anatomical Parameters............................................144 MAIN TYPES OF GRIp............................................................169
EXAMINATION OF THE SPINE, PELVIS ASSESSMENT OF THE WRIST AND THE HAND............169
AND THE THORAX...................................................145 Anamnesis..............................................................................169
Patient History (Anamnesis) and Physical Assessment...145 Aspection................................................................................170
Neurological Assessment......................................................145 Palpation.................................................................................170
Assessment of Motor Functions..........................................147 Passive Movements................................................................170
Functional Assessment.........................................................147 Active Movements.................................................................170
1.2.2 Kinesiology of the Shoulder Girdle Functional Tests.....................................................................170
(Plexus).............................................................154 1.2.5 Kinesiology of the Hip Joint.......................171
Petra Valouchová, Pavel Kolář Magdaléna Lepšíková, Pavel Kolář
BONES OF THE SHOULDER GIRDLE............................154 HIP JOINT ASSESSMENT..............................................173
JOINTS OF THE SHOULDER GIRDLE............................156 Anamnesis..............................................................................173
MOVEMENTS IN THE JOINTS OF THE Aspection................................................................................173
SHOULDER GIRDLE..................................................156 Palpation.................................................................................174
SHOULDER GIRDLE EXAMINATION............................ 157 Passive Movements................................................................174
Michaela Tomanová Active Movements.................................................................174
Anamnesis..............................................................................157 PEDIATRIC HIP JOINT ASSESSMENT ...............................174
Aspection................................................................................158 1.2.6 Kinesiology of the Knee Joint..................... 174
Palpation.................................................................................158 Pavel Kolář
Joint Play.................................................................................158 MOVEMENTS OF THE KNEE JOINT.............................. 174
Passive Movements................................................................159 KNEE JOINT ASSESSMENT........................................... 176
Active Movements.................................................................159 Anamnesis..............................................................................176
Adduction and Internal Rotation (Apley’s Scratch Test).... 159 Aspection................................................................................176
Abduction and External Rotation.......................................159 Palpation.................................................................................177
Special Tests for the Shoulder Girdle..................................159 Passive Movements................................................................177
Assessment of Movements against Resistance – Active Movements.................................................................177
Resistive Tests....................................................................159 Functional Assessment.........................................................177
Instability Tests......................................................................160 Examination of the Menisci.................................................177
Anterior Instability Testing..................................................160 Assessment of Knee Joint Stability......................................178
Posterior Instability Testing.................................................161 Patellofemoral Joint Examination.......................................180
Clunk Test...............................................................................161 Patellar Stability Test – Apprehension Test........................180
Inferior (Caudal) Instability.................................................161 Planer Sign.............................................................................180
Multidirectional Instability..................................................161 Zohlen Test.............................................................................180
Tests for Long Head of the Biceps Brachii Fairbank’s Test (Zohler’s Sign).............................................180
Tendon Pathology.............................................................161 1.2.7 Kinesiology of the Lower Leg
Rotator Cuff and Impingement Syndrome Tests...............162 and the Foot.......................................................180
Acromioclavicular Joint Tests..............................................163 Pavel Kolář, Ivan Vařeka
1.2.3 Kinesiology of the Elbow Joint..................163 ANKLE AND FOOT JOINTS..........................................180
Petr Bitnar MOVEMENTS IN THE ANKLE AND FOOT JOINTS.......182
ELBOW JOINT MOVEMENTS.......................................164 FUNCTIONAL RELATIONSHIPS BETWEEN
ASSESSMENT OF THE ELBOW JOINT...........................165 THE ANKLE AND THE FOOT JOINTS........................183
Contents XV

ASSESSMENT OF THE ANKLE AND THE FOOT.............183 3 PSYCHOLOGICAL FUNCTIONS

Anamnesis..............................................................................184 AND PAIN
Aspection................................................................................184
Petr Knotek
Palpation.................................................................................184
Passive Movements................................................................184
3.1 PSYCHOLOGICAL DIAGNOSTICS
Active Movements.................................................................185
IN REHABILITATION..................................... 207
Functional Assessment.........................................................185
Tests for Ankle Instability.....................................................185 3.2 ASSESSED PROCESSES AND METHODS
OF THEIR TESTING....................................... 207
1.3 SOFT TISSUES..........................................186 Reactivity to Painful Stimuli................................................207
Petr Bitnar Pain in the Pathological Process..........................................208
1.3.1 Skin............................................................187 Beginning Phase of Psychological Pain
1.3.2 Subcutaneous Tissues (Hypodermis).........191 Processing ..........................................................................209
1.3.3 Fasciae.......................................................191 Cognitive Processes...............................................................209
Affection.................................................................................210
Behavior..................................................................................210
2 Visceromotor RELATIONSHIPS Interpersonal Communication............................................210
AND THE AUTONOMIC
NERVOUS SYSTEM 4 Examinations by functional
Petr Bitnar, Hana Marčišová, Pavel Kolář laboratory methods
Milan Zedka, Pavel Kolář
2.1 VISCEROSOMATIC AND
SOMATOVISCERAL RELATIONSHIPS..............195 4.1 LABORATORY EXAMINATION
Petr Bitnar OF MOVEMENT..............................................213
2.1.1 Viscerosomatic (Visceromotor) Milan Zedka
Relationships......................................................195 4.1.1 Kinematic Analysis....................................213
Visceral Pattern......................................................................195 Milan Zedka
2.1.2 Somatovisceral Relationships....................196 4.1.2 Kinetic Analysis (Posturography)..............215
Movement System and Visceral Pain..................................196 Ondřej Čakrt
Movement System and Functional Deficits Physics Basis of the Examination........................................215
of the Internal Organs.......................................................197 Posturography in a Clinical Setting....................................215
Movement System as a Trigger Factor for Factors Influencing Postural Stability.................................216
a Latent Internal Illness....................................................198 4.1.3 Electromyographic Analysis
Movement System as a Tool for the Treatment in Biomechanics.................................................216
of Internal Illnesses...........................................................198 Milan Zedka, Petra Valouchová
2.1.3 Overview of Basic Visceral Patterns...........198 Examination of Muscle Coordination................................216
Examination of Force............................................................218
2.2 EXAMINATION OF THE AUTONOMIC Assessment of Muscle Fatigue.............................................218
NERVOUS SYSTEM........................................ 200
Hana Marčišová 4.2 SUPPLEMENTAL NEUROLOGICAL
2.2.1 Anatomy and Physiology of the ANS......... 201 EXAMINATIONS.............................................219
2.2.2 Function of the ANS within Milan Zedka
the Movement Apparatus.................................. 201 4.2.1 Electromyography.....................................219
Vasomotricity.........................................................................202 4.2.2 Electroencephalography........................... 222
Somatosensory System and the ANS..................................202 4.2.3 Evoked Potentials..................................... 224
ANS and Muscle Function...................................................203 Somatosensory Evoked Potentials.......................................224
2.2.3 Anatomical Vegetative Syndromes........... 204 Visual Evoked Potentials (VEPs).........................................225
Pavel Kolář Auditory Evoked Potentials.................................................226
CENTRAL AUTONOMIC SYNDROMES.............................204 Motor Evoked Potentials (MEPs)........................................227
PERIPHERAL AUTONOMIC SYNDROMES......................204
Claude-Bernard-Horner Syndrome....................................204 4.3 EXAMINATIONS BY IMAGING
Posterior Cervical Sympathetic Syndrome........................205 METHODS.................................................... 227
GROSS VEGETATIVE SYNDROMES....................................205 Pavel Kolář, Martin Kynčl
REFLEXIVE VEGETATIVE SYNDROMES..........................205 4.3.1 Radiologic Methods................................. 227
 XVIClinical Rehabilitation

X-RAY EXAMINATION...........................................................227 5.3.5 Frenchay Activities Index......................... 244

Pavel Kolář, Olga Dyrhonová 5.3.6 Factor Assessment according
Shoulder Joint........................................................................228 to Tardieu.......................................................... 244
Wrist........................................................................................228 5.3.7 Other Tests.............................................. 245
Hip Joint.................................................................................228
Knee Joint...............................................................................228
Ankle Joint..............................................................................228 B. TherapeuTIC methods
Spine........................................................................................228
COMPUTED TOMOGRAPHY (CT).....................................229
Pavel Kolář, Martin Kynčl 1 PHysIcal Therapy METhODs
MAGNETIC RESONANCE IMAGING.................................230 And cONCEPTs
Martin Kynčl, Pavel Kolář
Pavel Kolář
Functional Magnetic Resonance ........................................231
TRACTOGRAPHY....................................................................231
1.1 GENERAL PHYSICAL THERAPY
Martin Kynčl, Pavel Kolář
(MUSCULOSKELETAL) APPROACHES............ 248
SCINTIGRAPHIC EXAMINATION......................................231
Pavel Kolář, Martin Kynčl 1.1.1 Passive Movements.................................. 248
POSITRON EMISSION TOMOGRAPHY.............................231 Pavel Kolář
Pavel Kolář, Martin Kynčl 1.1.2 Active Assistive Exercise............................ 248
SINGLE PHOTON EMISSION COMPUTED Magdaléna Lepšíková
TOMOGRAPHY ...................................................................231 1.1.3 Muscle Strength Exercises........................ 248
Pavel Kolář, Martin Kynčl Zdeněk Čech
NEAR-INFRARED SPECTROSCOPY (NIRS).....................232 Kinesiologic Notes.................................................................248
Pavel Kolář, Martin Kynčl Input-Adaptation Relationship during
4.3.2 Examination by Ultrasound...................... 232 Strengthening Exercises....................................................249
Zdeněk Hříbal 1.1.4 Dynamic Neuromuscular Stabilization....... 252
Pavel Kolář, Marcela Šafářová
General Principles of Practice Techniques.........................253
5 ASSESSMENT OF THE SEVERITY Practice of Postural Stabilization of the Spine,
OF MOTOR INVOLVEMENT AND Chest and the Pelvis..........................................................254
LIMITATIONS IN THE ACTIVITIES Influence on Tightness and Improvement
OF DAILY LIVING of Chest Wall Dynamics...................................................255
Influence on Spinal Straightening.......................................256
Pavel Kolář
Training of the Postural Breathing Pattern and
the Stabilization Function of the Diaphragm................256
5.1 METHODS USED FOR MEASUREMENT
Postural Stabilization Training of the Spine
AND ASSESSMENT IN REHABILITATION....... 235
Using Reflex Locomotion.................................................258
Training of Deep Postural Stabilization of the Spine
5.2 ASSESSMENT OF THE EXTENT
in Modified Positions........................................................259
OF MOTOR INVOLVEMENT........................... 236
Exercising Postural Functions in Developmental Lines
5.2.1 Gross Motor Skills Assessment (Sequences)........................................................................259
by the Gross Motor Function Measure............... 236 Movement Assistance during Exercise...............................262
5.2.2 Developmental Kinesiology as an Facilitative Elements of Training Techniques....................262
Assessment Method of a Motor Deficit.............. 237 Exercise Examples.................................................................264
5.2.3 Additional Tests to Assess Motor 1.1.5 Soft Tissue Mobilization........................... 266
Deficits.............................................................. 239 Karel Lewit
Post-Isometric Relaxation....................................................266
5.3 TESTING AND ASSESSMENT Examples of Other Techniques............................................268
OF RESTRICTED ACTIVITIES 1.1.6 Dry Needling for Muscle
OF DAILY LIVING.......................................... 239 Trigger Points.................................................. 270
5.3.1 Functional Independence Measure ......... 242 Pavel Kolář
5.3.2 Barthel Index........................................... 242 1.1.7 Traction.................................................... 271
5.3.3 Katz Index of Activities of Daily Pavel Kolář
Living................................................................... 244 1.1.8 Relaxation Techniques............................. 271
5.3.4 Activity Index.......................................... 244 Pavel Kolář
Contents XVII

1.1.9 Exercises Aimed at the Restoration TheRAPEUTIC SYSTEM........................................................288

of Sensation (Somatesthesia)............................ 271 Activation of Reflex Locomotion........................................288
Pavel Kolář, Magdaléna Lepšíková Reflex Creeping......................................................................288
Activation System Positions 1–6.........................................290
1.2 METHODS AND APPORACHES Reflex Rolling.........................................................................291
USED IN REHABILItATION OF PATIENTS TREATMENT EFFECTS...........................................................294
WITH CHRONIC RESPIRATORY SYSTEM PRINCIPLES AND FUNDAMENTALS
INVOLVEMENT............................................. 271 OF THERAPY.........................................................................294
Pavel Kolář, Jan Šulc INDICATIONS AND CONTRAINDICATIONS.................295
1.2.1 Methods of Pulmonary Physical 1.3.2 Sensorimotor Stimulation........................ 295
Therapy............................................................. 272 Michaela Veverková, Marie Vávrová
Libuše Smolíková 1.3.3 Feldenkrais Method................................. 298
1.2.2 Corrective Physical Therapy Magdaléna Lepšíková
for the Postural System...................................... 273 1.3.4 Proprioceptive Neuromuscular
Libuše Smolíková Facilitation........................................................ 300
1.2.3 Respiratory Physical Therapy Irena Zounková, Pavel Kolář
Approaches Utilizing Postural Respiratory 1.3.5 Brunkow’s Method.................................. 301
Function of the Diaphragm............................... 275 Pavel Kolář
Pavel Kolář 1.3.6 Brügger’s Concept................................... 302
Role of the Diaphragm during the Physiological Dagmar Pavlů
Breathing Cycle..................................................................275 1.3.7 Sling Exercise Therapy............................. 304
Breathing Biomechanics in a Pathological State...............278 Alice Hamáčková, Dagmar Tomisová,
Posturally Locomotor Function Ctirad Tomis
of the Diaphragm..............................................................279 1.3.8 Exercise with a Therapy Ball..................... 305
Respiratory Physical Therapy Techniques Utilizing Pavel Kolář
Postural Locomotor Functions........................................280
Positional Influence on the Postural Respiratory
Function of the Diaphragm.............................................281 2 Modalities
1.2.4 Respiratory Physical Therapy –
Bronislav Schreier
Methods and Techniques for Respiratory
Pathway Hygiene.............................................. 281
2.1 CLASSIFICATION OF MODALITIES
Libuše Smolíková
BASED ON THE TYPE OF APPLIED
Active Cycle of Breathing Techniques................................282
ENERGY........................................................ 309
Autogenic Drainage..............................................................282
PEP System of Breathing......................................................282 2.1.1 Mechanotherapy...................................... 309
Oscillatory PEP System........................................................282 2.1.2 Thermotherapy and Hydrotherapy.......... 309
Respiratory Physical Therapy and Breathing 2.1.3 Electrotherapy......................................... 309
Muscle Training Devices..................................................284 2.1.4 Phototherapy............................................310
Intrapulmonary Percussive Ventilation..............................284 2.1.5 Combined Therapy and Combination
Inhalation Therapy – A Component of Respiratory of Modalities......................................................310
Physical Therapy................................................................284
Respiratory Physical Therapy for Patients 2.2 CLASSIFICATION OF MODALITIES
in Intensive Care Units.....................................................285 BASED ON THEIR PRIMARY EFFECT...............310
Control Mechanisms of Respiratory 2.2.1 Modalities with an Analgesic Effect..........310
Physical Therapy................................................................285 Modalities with Primary Analgesic Effect..........................310
1.2.5 Breathing Exercises Modalities with a Secondary Analgesic Effect...................311
(Breathing Gymnastics).................................... 285 2.2.2 Modalities with Dominantly
Libuše Smolíková a Myorelaxation Effect........................................312
1.2.6 Fitness Physical Therapy Ultrasound Therapy..............................................................313
and Pulmonary Illnesses.................................... 287 Combined Ultrasound and Electrotherapy ......................313
Pavel Kolář Electrotherapy........................................................................313
2.2.3 Modalities with Anti-Inflammatory
1.3 SELECTED PHYSICAL THERAPY and Trophic Effects.............................................313
CONCEPTS.................................................... 288 Vasopneumatic Therapy.......................................................313
1.3.1 Vojta’s Principle: Reflex Locomotion........ 288 Electrotherapy........................................................................314
Irena Zounková, Marcela Šafářová Ultrasound Therapy..............................................................314
 XVIIIClinical Rehabilitation

Phototherapy..........................................................................314 3.2.2 Use of Peloids.......................................... 321

Galvanotherapy......................................................................314 3.2.3 Use of Gas................................................ 322
Contrast Baths.......................................................................314
Cryotherapy...........................................................................315 3.3 SPAS IN THE CZECH REPUBLIC
2.2.4 Electrodiagnostic Testing and Electrical AND INDICATIONS FOR
Stimulation of Skeletal Muscles..........................315 A SPA TREATMENT....................................... 322
Electrodiagnostic Testing.....................................................315
Electrical Stimulation (Neuromuscular Electrical
Stimulation).......................................................................316 4 OCCUPATIONAL THERAPY
Electrical Stimulation (Electrogymnastics).......................316
Veronika Schönová, Pavel Kolář
2.3 GENERAL CONTRAINDICATIONS
4.1 AREAS OF FUNCTION
OF MODALITIES.............................................316
IN OCCUPATIONAL THERAPY ...................... 325

4.2 SPECIALIZATIONS................................. 326

3 Balneology
Jan Kálal, Ivan Vařeka 4.3 OCCUPATIONAL THERAPY
PROCESS...................................................... 326
3.1 CLASSIFICATION OF MEDICINAL
SOURCES.......................................................319 4.4 AREAS OF OCCUPATIONAL THERAPY
INTERVENTIONS........................................... 326
3.1.1 Waters.......................................................319
3.1.2 Peloids..................................................... 320 Motor Skills............................................................................326
3.1.3 Gases....................................................... 320 Sensory Skills.........................................................................327
3.1.4 Climate.................................................... 321 Cognitive, Communicative and Subsequent
Social Skills.........................................................................327
3.2 USE OF NATURAL HEALING Activities of Daily Living......................................................327
SOURCES IN BALNEOLOGY........................... 321 Assistive Devices....................................................................327
3.2.1 Use of Water............................................ 321 Pre-Return to Work Rehabilitation.....................................327

II Special section

1 TREATMENT REHABILITATION 1.2 OVERVIEW OF PHYSICAL

IN NEUROLOGY THERAPY METHODS..................................... 335
Pavel Kolář
Pavel Kolář, Ondřej Horáček
Sensory Training....................................................................335
Exercising with Conscious Awareness
General section as a Component of Sensorimotor Practice....................335
Sensory Stimulation Method Based on Affolter................335
1.1 NEUROPHYSIOLOGICAL Perfetti’s Method....................................................................335
FOUNDATION OF PHYSICAL THERAPY Rood’s Method.......................................................................335
APPROACHES............................................... 332 Movement Rehabilitation of Patients
Pavel Kolář with Hemiplegia Based on Brunnström.........................336
NEUROPLASTICITY......................................................332 Dagmar Pavlů, Pavel Kolář
Vladimír Komárek Sensory Integration Based on Ayres...................................337
Evolutionary Plasticity..........................................................332 Veronika Schönová
Repair Plasticity.....................................................................333 Neurodevelopmental Treatment Concept Based
Neuroplasticity and Sensorimotor Programs....................333 on Bobath...........................................................................338
SENSORY FUNCTIONS IN Irena Zounková
NEUROREHABILITATION..........................................334 Movement Therapy According to Petö...............................340
Pavel Kolář Irena Zounková, Pavel Kolář
Contents XIX

Vojta’s Method........................................................................341 OTHER FORMS OF MUSCULAR DYSTROPHY...............357

Pavel Kolář MYOTONIC DYSTROPHY.....................................................357
Sensorimotor Stimulation....................................................341 CONGENITAL, METABOLIC, INFLAMMATORY
Pavel Kolář AND TOXIC MYOPATHIES........................................358
Proprioceptive Neuromuscular Facilitation......................341 ION CHANNEL DYSFUNCTIONS.................................358
Pavel Kolář PERIODIC PARALYSES............................................................358
Hyperkalemic Periodic Paralysis.........................................359
1.3 NEUROPSYCHOLOGY..............................341 Hypokalemic Periodic Paralysis..........................................359
Kateřina Chamoutová, Pavel Kolář Paramyotonia Congenita......................................................359
1.3.1 Neuropsychological Approaches.............. 342 MYOTONIC SYNDROMES.....................................................359
Neurobehavioral Approach..................................................342 Myotonia Congenita.............................................................359
American Neuropsychological Approach..........................342 Atypical Myotonic Syndromes.............................................359
Neuropsychology in the Czech Republic...........................342
1.3.2 Neuropsychological Assessment.............. 343 1.8 PERIPHERAL PARALYSIS........................ 360
Most Commonly Used Neuropsychological Ondřej Horáček
Tests.....................................................................................344 1.8.1 Causes, Degrees and Diagnosis
1.3.3 Utilization of Neuropsychological of Peripheral Paralyses...................................... 360
Approaches in Rehabilitation............................ 345 1.8.2 Rehabilitation of Peripheral Paralyses........ 361
Physical Therapy....................................................................361
1.4 SPEECH THERAPY.................................. 346 Occupational Therapy...........................................................362
Pavel Kolář Modalities...............................................................................362
DEVELOPMENTAL DYSARTHRIA......................................346 1.8.3 An Overview of Peripheral Pareses
APHASIAS...................................................................................347 Based on Location............................................. 363
DYSARTHRIA............................................................................348 PERIPHERAL PARESES OF THE UPPER
Deficits in Swallowing and Management Options............349 EXTREMITIES............................................................363
Orofacial Therapy..................................................................350 BRACHIAL PLEXUS PALSY (C5-T1)....................................363
RADIAL NERVE PALSY (C5-C7)...........................................364
1.5 ORTHOTIC CARE IN NEUROLOGICAL MEDIAN NERVE PALSY (C5-T1)..........................................365
DISEASES..................................................... 350 ULNAR NERVE PALSY (C8-T1).............................................366
Petr Krawczyk LONG THORACIC NERVE PALSY (C5-C7).......................366
1.5.1 Orthotic Management for Patients SUPRASCAPULAR NERVE PALSY (C5-C6).......................367
with Cerebral Palsy........................................... 350 AXILLARY NERVE PALSY (C5-C6)......................................367
1.5.2 Orthotic Interventions for Patients MUSCULOCUTANEOUS NERVE PALSY
with Charcot-Marie-Tooth Disease.................... 352 (C5-C7)....................................................................................367
1.5.3 Orthotics for Patients Following PERIPHERAL PARESES OF THE LOWER
Poliomyelitis...................................................... 353 EXTREMITIES............................................................367
1.5.4 Orthotics for Patients Following CVA....... 353 LUMBOSACRAL PLEXUS PARESIS......................................367
FEMORAL NERVE PALSY (L2-L4)........................................367
1.6 OCCUPATIONAL THERAPY..................... 354 SCIATIC NERVE PALSY (L4-S3)............................................368
Veronika Schönová PERONEAL NERVE PALSY (L4-S1)......................................368
TIBIAL NERVE PALSY (L4-S3)...............................................368
FACIAL NERVE PALSY (C.N. VII)...................................369
SPECIAl section 1.8.4 Peripheral Pareses in Diseases
Involving Motor Neurons of the Anterior
1.7 DYSFUNCTIONS IN NEUROMUSCULAR Spinal Horns ..................................................... 369
TRANSMISSION AND MUSCLE DISEASES...... 354 1.8.5 Rehabilitation Following Peripheral
Petr Bitnar, Magdaléna Lepšíková Nerve Surgery................................................... 370
1.7.1 Dysfunction in Neuromuscular
Transmission – Myasthenia Gravis..................... 354 1.9 ENTRAPMENT SYNDROMES....................370
1.7.2 Muscle Diseases....................................... 355 Petr Bitnar, Ondřej Horáček
MUSCULAR DYSTROPHIES..........................................356 1.9.1 Etiology, Pathogenesis, Clinical
DUCHENNE AND BECKER MUSCULAR Manifestations and Diagnosis........................... 370
DYSTROPHY..........................................................................356 1.9.2 Overview of the Most Common
FACIOSCAPULOHUMERAL FORM Entrapment Syndromes......................................371
OF DYSTROPHY...................................................................356 ENTRAPMENT SYNDROMES OF THE UPPER
GIRDLE FORMS OF MUSCULAR DYSTROPHY..............357 THORACIC APERTURE..............................................371
 XXClinical Rehabilitation

SCALENUS SYNDROME.........................................................372 1.13 DEFICITS IN CEREBELLAR FUNCTIONS...389

COSTOCLAVICULAR AND HYPERABDUCTION Alena Kobesová
SYNDROME...........................................................................372 1.13.1 Functional Anatomy
ENTRAPMENT SYNDROMES OF THE UPPER of the Cerebellum............................................. 389
EXTREMITY AND THE SHOULDER GIRDLE..............372 1.13.2 Basic Clinical Manifestations
SUPRASCAPULAR NERVE.....................................................372 of a Cerebellar Lesion........................................ 390
MEDIAN NERVE.......................................................................372 ATAXIA.........................................................................390
ULNAR NERVE..........................................................................373 HYPERMETRIA.........................................................................390
RADIAL NERVE.........................................................................373 ADIADOCHOKINESIA............................................................391
ENTRAPMENT SYNDROMES OF THE LOWER ASYNERGY.................................................................................391
EXTREMITY AND THE PELVIC GIRDLE......................373 FLACCIDITY.................................................................392
FEMORAL NERVE....................................................................373 CEREBELLAR TREMOR.................................................392
SCIATIC NERVE........................................................................373 EYE MOVEMENT DISTURBANCES...............................392
PERONEAL NERVE..................................................................373 PALEOCEREBELLAR AND NEOCEREBELLAR
TIBIAL NERVE...........................................................................373 SYNDROME.............................................................392
1.9.3 Treatment Rehabilitation..........................374 PALEOCEREBELLAR SYNDROME......................................392
NEOCEREBELLAR SYNDROME...........................................392
1.10 POLYNEUROPATHIC SYNDROMES.........375 PSEUDOCEREBELLAR SYNDROME...................................392
Alena Kobesová 1.13.3 Rehabilitation in Cerebellar
1.10.1 Hereditary Motor and Sensory Dysfunctions..................................................... 393
Polyneuropathies.............................................. 375 1.13.4 Prognosis of Cerebellar
1.10.2 Diabetic Neuropathy.............................. 378 Dysfunctions..................................................... 394
DIABETIC FOOT SYNDROME..............................................378
1.10.3 Inflammatory Polyneuropathies............. 379 1.14 BALANCE DEFICITS.............................. 395
GUILLAIN-BARRE SYNDROME...........................................379 Ondřej Čakrt, Michal Truc
CHRONIC INFLAMMATORY DEMYELINATING 1.14.1 Balance Control...................................... 395
POLYNEUROPATHY...........................................................379 VERTIGO AND ITS MOST COMMON CAUSES...............395
1.14.2 Clinical Presentation of a Patient
1.11 POLIOMYELITIS AND with a Vestibular System Disturbance............... 396
POST-POLIOMYELITIC SYNDROME............... 381 EXAMINATION.........................................................................396
Ivana Wurstová 1.14.3 Theoretical Bases for Rehabilitation....... 397
1.11.1 Poliomyelitis........................................... 381 1.14.4 Rehabilitation of Individual Clinical
1.11.2 Post-Poliomyelitic Syndrome.................. 382 Presentations.................................................... 397
UNILATERAL VESTIBULAR LESION.................................397
1.12 SPINAL CORD INJURY.......................... 384 BENIGN PAROXYSMAL POSITIONAL VERTIGO...........398
Jiří Kříž BILATERAL VESTIBULAR DEFICIT....................................399
1.12.1 Etiology, Neurological Presentation....... 384 BALANCE DEFICITS ASSOCIATED
1.12.2 Systematic Approach to Treatment......... 385 WITH CHANGES IN THE CERVICAL SPINE ..............399
1.12.3 Medical Consequences of a Spinal CENTRAL BALANCE DEFICITS...........................................399
Cord Lesion and Possible Complications........... 385 VERTEBRAL ARTERY SYNDROME.....................................399
AUTONOMIC DYSREFLEXIA................................................385 PSYCHOGENIC VERTIGO.....................................................399
ORTHOSTATIC HYPOTENSION..........................................385 1.14.5 Biological Feedback in Rehabilitation
DEEP VEIN THROMBOSIS of Patients with Balance Deficits....................... 400
(THROMBOEMBOLISM)...................................................386 Ondřej Čakrt, Rudolf Černý, Jaroslav Jeřábek
URINARY DYSFUNCTION.....................................................386 Brain port...............................................................................400
BOWEL DYSFUNCTION.........................................................386
SEXUAL DYSFUNCTION........................................................386 1.15 EXTRAPYRAMIDAL DEFICITS............... 401
INTEGUMENTARY DYSFUNCTIONS.................................386 Alena Kobesová
SEPTIC CONDITIONS.............................................................386 1.15.1 Basic Characteristics, Classification......... 401
PAINFUL CONDITIONS.........................................................386 HYPOKINETIC DEFICITS......................................................401
SPASTICITY................................................................................386 HYPERKINETIC DEFICITS....................................................401
PARA-ARTICULAR OSSIFICATION....................................387 1.15.2 Parkinson’s Disease................................ 401
OSTEOPOROSIS........................................................................387 OBJECTIVE NEUROLOGICAL FINDINGS......................402
1.12.4 Rehabilitation for Patients HYPOKINESIA, BRADYKINESIA, AKINESIA...................402
with Spinal Cord Injury..................................... 387 RIGIDITY....................................................................................402
Contents XXI

TREMOR.....................................................................................402 1.21 CEREBRAL PALSY................................. 428

POSTURAL DEFICITS.............................................................402 Pavel Kolář
1.21.1 Screening for Risk of CP.......................... 429
1.16 NEURODEGENERATIVE DISEASES......... 407 1.21.2 Types of Cerebral Palsy and their
Barbora Danielová, Alena Zumrová Clinical Presentation......................................... 429
1.16.1 Basic Characteristics SPASTIC DIPLEGIA..................................................................429
of Neurodegenerative Illnesses......................... 407 SPASTIC HEMIPLEGIA...........................................................430
Ondřej Horáček CEREBELLAR FORM................................................................431
1.16.2 Amyotrophic Lateral Sclerosis................. 407 DYSKINETIC FORM OF CEREBRAL PALSY......................432
Barbora Danielová MIXED TETRAPLEGIA...........................................................433
1.16.3 Friedreich’s Ataxia...................................411 ATONIC DIPLEGIA..................................................................433
Alena Zumrová 1.21.3 Rehabilitation in Cerebral Palsy............. 433
1.16.4 Autosomal Dominant DESIRED OUTCOME AND COPING PROCESS.............433
Spinocerebellar Ataxia.......................................412 DESIRED OUTCOME...............................................................433
Alena Zumrová COPING PROCESS...................................................................434
Rehabilitation in Cerebral Palsy..........................................434
1.17 MULTIPLE SCLEROSIS............................412 Vojta’s Reflex Locomotion in Children
Ondřej Horáček with Cerebral Palsy...........................................................434
1.17.1 Diseases Characteristics...........................412 Neurodevelopmental Treatment Approach
1.17.2 Rehabilitation in Multiple Sclerosis..........414 in Children with CP..........................................................435
Petö Movement Therapy ......................................................436
1.18 DEFICITS IN CONSCIOUSNESS...............416 Exercises Aimed at the Development of Somesthesis......436
Pavel Kolář 1.21.4 Cerebral Palsy from the View
1.18.1 Causes.....................................................416 of an Orthopedic Physician............................... 436
LEVELS OF QUANTITATIVELLY LIMITED Alena Schejbalová
CONSCIOUSNESS.................................................... 417 INDICATIONS FOR SURGERY......................................436
SOMNOLENCE..........................................................................417 INDICATIONS FOR SURGICAL PROCEDURES
SOPOR..........................................................................................417 IN THE HIP JOINT AREA..................................................436
COMA..........................................................................................417 INDICATIONS FOR SURGICAL PROCEDURES
ASSESSMENT OF LEVELS OF CONSCIOUSNESS........... 417 IN THE KNEE JOINT AREA..............................................437
1.18.2 Neurorehabilitation Approaches INDICATION FOR SURGICAL INTERVENTIONS
for Unconscious Patients....................................417 IN THE ANKLE AND FOOT AREAS...............................438
INDICATIONS FOR SPINAL SURGICAL
1.19 CRANIOCEREBRAL (BRAIN) INJURIES.... 418 PROCEDURES ......................................................................438
Ondřej Horáček, Pavel Kolář INDICATIONS FOR UPPER EXTREMITY
1.19.1 Causes and Clinical Picture......................418 SURGICAL PROCEDURES ................................................439
APALLIC SYNDROME.............................................................419 1.21.5 Neurosurgical Treatment....................... 439
1.19.2 Rehabilitation for a Brain Injury .............419 Pavel Kolář
1.21.6 Botulotoxin in the Treatment of CP........ 440
1.20 VASCULAR DISEASES OF THE BRAIN.... 421 Pavel Kolář, Josef Kraus
Ondřej Horáček, Pavel Kolář
1.20.1 Ischemic Cerebrovascular Accidents......... 421
ISCHEMIA IN CAROTID CIRCULATION..........................421 2 TREATMENT REHABILITATION
ISCHEMIA IN VERTEBROBASILAR IN ORTHOPEDICS AND TRAUMATOLOGY
CIRCULATION..........................................................................422
Pavel Kolář, Jiří Kříž, Olga Dyrhonová
CLASSIFICATION BASED ON DISEASE
PROGRESSION......................................................................422
1.20.2 Hemorrhagic Cerebrovascular general section
Accidents.......................................................... 423
DIFFUSE HEMORRHAGES....................................................423 2.1 INFLUENCE OF FUNCTION
FOCAL SUBCORTICAL HEMORRHAGES.........................423 ON MORPHOLOGICAL TISSUE
CEREBELLAR HEMORRHAGE.............................................423 RESTRUCTURING.......................................... 445
BLEEDING INTO THE BRAIN STEM..................................423
SUBARACHNOID HEMORRHAGE......................................423 2.2 CLASSIFICATION ACCORDING
1.20.3 Rehabilitation for a CVA......................... 424 TO SYMPTOMATOLOGY................................ 447
 XXIIClinical Rehabilitation

2.2.1 Edema..................................................... 447 Camptodactyly.......................................................................454

Olga Dyrhonová, Jiří Kříž Clinodactyly...........................................................................454
2.2.2 Functional Changes in Soft Tissues.......... 447 Syndactyly..............................................................................454
Olga Dyrhonová, Jiří Kříž Thumb Hypoplasia................................................................454
2.2.3 Range of Motion Restrictions CONGENITAL DEVELOPMENTAL DEFECTS
in a Movement Segment................................... 448 OF THE LOWER EXTREMITES........................................454
David Smékal, Pavel Kolář Congenital Developmental Defects
2.2.4 Hypermobility......................................... 449 of the Hip Joint..................................................................454
David Smékal, Pavel Kolář Congenital Developmental Defectsof the Knee Joint.......454
CAUSES....................................................................... 449 Congenital Knee Dislocation...............................................454
COMPENSATORY HYPERMOBILITY.................................449 Congenital Patellar Subluxation..........................................454
HYPERMOBILITY IN NEUROLOGICAL DISEASES........449 Patella Bipartita......................................................................455
STRUCTURAL HYPERMOBILITY........................................449 Congenital Developmental Defects
LOCALIZED PATHOLOGICAL (POSTRAUMATIC) of the Lower Leg and Foot...............................................455
HYPERMOBILITY................................................................449 Club Foot (Talipes Equinovarus, Pes Equinovarus
TREATMENT REHABILITATION STRATEGIES................ 449 Congenitus)........................................................................455
2.2.5 Deficit in the Nervous System Pes Metatarsus Adductus (Pes Calcaneovalgus)...............456
Regulatory Mechanisms ................................... 450 Congenital Flatfoot (Vertical Talus, Pes Planovalgus
Pavel Kolář Congenitus)........................................................................456
CHANGE IN AFFERENTATION FROM Metatarsus Varus (Pes Adductus).......................................457
THE RECEPTORS.................................................................450 Congenital Deformities of the Toes....................................457
MOTOR LEARNING DEFICIT AT THE LEVEL Congenital Hallux Varus......................................................457
OF THE CENTRAL REGULATORY Digitus Quintus Supraductus...............................................457
MECHANISMS .....................................................................451 Syndactyly..............................................................................457
TREATMENT REHABILITATION STRATEGY....................451 Polydactyly.............................................................................457
Macrodactyly.........................................................................457
2.3 CLASIFFICATION ACCORDING CONGENITAL DEVELOPMENTAL DEFECTS
TO ETIOLOGY AND PATHOGENESIS.............. 451 OF THE THORAX.................................................................457
Pavel Kolář Pectus Excavatum (Infundibuliform).................................457
2.3.1 Congenital Developmental Defects......... 452 Pectus Carinatum..................................................................458
Pavel Kolář, Martin Švehlík Rehabilitation in Congenital Developmental
ETIOLOGY....................................................................452 Defects of the Thorax........................................................458
REHABILITATION TREATMENT PRINCIPLES IN CONGENITAL DEVELOPMENTAL DEFECTS
CONGENITAL DEVELOPMENTAL DEFECTS..............452 OF THE SPINE.......................................................................458
POST-SURGICAL REHABILITATION..................................452 Diastematomyelia..................................................................458
CLASSIFICATION OF CONGENITAL Meningomyelocele ...............................................................459
DEVELOPMENTAL DEFECTS.....................................452 Klippel-Feil Syndrome..........................................................459
CONGENITAL DEVELOPMENTAL DEFECTS Spina Bifida............................................................................459
OF THE UPPER EXTREMITIES........................................453 2.3.2 SOFT TISSUE INJURIES CAUSED
Congenital Developmental Defects BY OVERLOADING............................................. 459
of the Shoulder Girdle......................................................453 Pavel Kolář, Jiří Kříž, Olga Dyrhonová
Sprengel’s Deformity.............................................................453 ENDON INJURIES........................................................459
Cleidocranial Dysostosis .....................................................453 ETIOLOGY AND PATHOGENESIS......................................459
Congenital Clavicle Nonunion............................................453 DIAGNOSTICS...........................................................................459
Os Acromiale.........................................................................453 Clinical Picture......................................................................459
Congenital Developmental Defects Tendinosis...............................................................................460
of the Elbow Joint..............................................................453 Enthesopathy..........................................................................460
Congenital Dislocation of the Elbow, Paratenonitis, Peritendinitis, Tenosynovitis.......................460
Congenital Dislocation of the Radial Head...................453 Imaging Methods..................................................................460
Congenital Radioulnar Synostosis......................................453 Differential Diagnosis...........................................................460
Congenital Shortening of the Radius..................................453 LOCALIZATION.......................................................................460
Congenital Developmental Defects of the Wrist...............453 Upper Extremity....................................................................460
Manus Vara Congenita.........................................................453 Lower Extremity....................................................................460
Madelung’s Deformity..........................................................454 Therapy....................................................................................460
Congenital Developmental Defects of the Fingers...........454 REHABILITATION....................................................................461
Contents XXIII

2.3.3 Degenerative Joint Diseases.................... 462 Special section

Pavel Kolář
OSTEOARTHRITIS........................................................462 2.4 CLASSIFICATION ACCORDING
ETIOLOGY AND PATHOGENESIS......................................462 TO LOCATION................................................476
Primary (Idiopathic) OA......................................................462 2.4.1 Spine........................................................476
Secondary OA........................................................................462 CONGENITAL DEVELOPMENTAL DEFECTS..................477
DIAGNOSIS................................................................................463 DEFORMITY.................................................................477
LOCATION.................................................................................463 Pavel Kolář, Marcela Šafářová
Coxarthrosis...........................................................................463 SCOLIOSIS..................................................................................477
Gonarthrosis..........................................................................463 Classification According to Etiology
TREATMENT.............................................................................463 and Pathogenesis.................................................................. 477
Pharmacotherapy..................................................................463 Non-structural (Functional) Scoliosis................................477
Surgical Procedures...............................................................464 Structural Scoliosis................................................................477
Rehabilitation.........................................................................464 Idiopathic Scoliosis...............................................................477
Olga Dyrhonová, Pavel Kolář Congenital Scoliosis..............................................................481
Arthroplasty...........................................................................464 Neuromuscular Scoliosis......................................................481
Martina Votavová Scoliosis in Neurofibromatosis............................................481
Rehabilitation Following Arthroplasty...............................465 Other Types of Scoliosis.......................................................481
Martina Votavová, Věra Cikánková Rehabilitation.........................................................................481
Hip Joint Arthroplasty..........................................................466 Klapp’s Crawling Method.....................................................482
Knee Joint Arthroplasty........................................................466 Schroth Method.....................................................................483
Ankle Arthroplasty...............................................................467 Vojta’s Method........................................................................483
Shoulder Joint Arthroplasty.................................................467 Modifications of Physical Activity ......................................484
Elbow Joint Arthroplasty......................................................468 Orthotic Treatment...............................................................484
2.3.4 Inflammatory Diseases............................ 468 Surgical Treatment................................................................484
Pavel Kolář, Olga Dyrhonová, Jiří Kříž HYPERKYPHOSIS.....................................................................484
ETIOLOGY AND PATHOGENESIS.................................468 Pavel Kolář
STERILE INFLAMMATION....................................................468 Juvenile Kyphosis (Scheuermann’s Disease)......................484
INFECTIOUS INFLAMMATION...........................................468 LUMBAR HYPERLORDOSIS..................................................485
Classification Based on Etiology.........................................468 TORTICOLLIS............................................................................485
Classification Based on Location.........................................469 Congenital Muscular Torticollis..........................................485
Pyogenic Arthritis.................................................................469 Muscular Torticollis in Adults.............................................486
Osteomyelitis..........................................................................469 Acquired Muscular Torticollis.............................................486
Spondylodiscitis.....................................................................470 Post-Traumatic Torticollis....................................................486
PRINCIPLES OF REHABILITATION..................................47 Spastic Torticollis...................................................................487
2.3.5 Traumatology of the Movement System....471 Acute Torticollis.....................................................................487
Olga Dyrhonová, Pavel Kolář VERTEBROGENIC PAIN SYNDROME............................487
HEALING PHASES....................................................................471 Pavel Kolář
WOUNDS....................................................................472 ETIOLOGY AND PATHOGENESIS......................................487
CONTUSION................................................................472 CLASSIFICATION ACCORDING
TENDON INJURIES......................................................472 TO ETIOLOGY AND PATHOGENESIS...........................488
MUSCLE INJURIES.......................................................472 STRUCTURAL CAUSES...........................................................488
DIAGNOSIS................................................................................472 FUNCTIONAL CAUSES...........................................................488
CLASSIFICATION.....................................................................472 Intervertebral Disc Involvement.........................................488
Muscle Cramp........................................................................472 Intervertebral Joint Degeneration.......................................489
Muscle Soreness.....................................................................472 Spinal Stenosis.......................................................................489
Muscle Strain..........................................................................473 Abnormality of the Spinal Canal.........................................490
Muscle Tear............................................................................473 Spondylolisthesis...................................................................490
JOINT INJURIES........................................................... 474 Osteoporosis...........................................................................491
BONE INJURIES – FRACTURES..................................... 474 Ankylosing Spondylitis.........................................................491
FRACTURE CLASSIFICATION..............................................474 Infections................................................................................491
BONE HEALING.......................................................................474 Tumors....................................................................................491
FRACTURE HEALING TIMES...............................................475 Deficit in the CNS Control Function..................................492
TREATMENT.............................................................................475 Deficit in Processing Nociception.......................................493
REHABILITATION....................................................................476 Psychological Disturbance...................................................494
 XXIVClinical Rehabilitation

CONSEQUENCES OF STRUCTURAL CONGENITAL DEVELOPMENTAL DEFECTS..................520

AND FUNCTIONAL DEFICITS........................................494 OVERUSE SOFT TISSUE INJURIES ................................520
Discogenic Pain.....................................................................494 ENTHESOPATHY......................................................................520
Radicular Syndrome..............................................................494 Lateral Epicondylitis (Epicondylitis Radialis Humeri).....520
Pseudoradicular Syndrome..................................................495 Medial Epicondylitis (Epicondylitis Ulnaris Humeri)......520
SPECIFIC TREATMENT..........................................................495 Triceps Brachii Enthesopathy..............................................520
Rehabilitation.........................................................................495 Olecranon Bursitis.................................................................521
Pavel Kolář, Karel Lewit, Jiří Čumpelík, DEGENERATIVE DISEASES
Veronika Kubů OF THE ELBOW JOINT.............................................521
Pharmaceutical Treatment...................................................505 ELBOW JOINT ARTHRITIS...................................................521
Pavel Kolář TRAUMATIC LESIONS..................................................522
Invasive Procedures...............................................................505 DISLOCATIONS........................................................................522
Jan Štulík FRACTURES IN THE ELBOW JOINT REGION................522
Intervention Methods Guided REHABILITATION IN TRAUMATIC LESIONS.................522
by Computerized Tomography........................................505 POST-TRAUMATIC COMPLICATIONS..........................523
Surgical Treatment................................................................505 ELBOW FLEXION CONTRACTURE ...................................523
Simple Resection...................................................................505 AXIAL DEFORMITIES OF THE ELBOW ............................523
Osteosynthesis.......................................................................506 Cubitus Varus.........................................................................523
Bony Fusion (Arthrodesis) of the Surrounding Cubitus Valgus.......................................................................523
Segments.............................................................................506 VOLKMANN’S CONTRACTURE..........................................524
Mobile Spinal Stabilization...................................................507 2.4.4 Wrist and Hand....................................... 524
2.4.2 Shoulder Girdle....................................... 508 Petr Bitnar, Pavel Kolář
Petra Valouchová, Olga Dyrhonová, CONGENITAL DEVELOPMENTAL DEFECTS..................524
Jiří Kříž, Pavel Kolář, Michaela Tomanová OVERUSE SOFT TISSUE INJURIES.................................524
CONGENITAL DEVELOPMENTAL DEFECTS TENOSYNOVITIS.....................................................................524
OF THE SHOULDER GIRDLE.....................................508 Trigger Thumb, Finger (Digitus Saltans)............................524
SOFT TISSUE INJURIES.................................................508 De Quervain’s Disease...........................................................525
IMPINGEMENT SYNDROME................................................508 DUPUYTREN’S CONTRACTURE.........................................525
CALCIFIC TENDINITIS..........................................................510 DEGENERATIVE JOINT INJURIES..................................526
SUBACROMIAL BURSITIS.....................................................511 RHIZARTHROSIS.....................................................................526
ROTATOR CUFF TEARS.........................................................511 ARTHRITIS OF THE INTERPHALANGEAL
SYNDROME OF THE LONG HEAD JOINTS OF THE HAND......................................................526
OF THE BICEPS TENDON.................................................512 TRAUMATIC LESIONS..................................................526
Tendinosis of the Long Head of the Biceps........................512 SOFT TISSUE INJURIES..........................................................526
Subluxation of the Long Head of the Biceps Tendon.......512 DISLOCATIONS........................................................................527
Biceps Tendon Rupture.........................................................512 FRACTURES...............................................................................527
FROZEN SHOULDER SYNDROME......................................513 Distal Forearm Fractures......................................................527
DEGENERATIVE DISEASES........................................... 514 Navicular Fracture.................................................................527
GLENOHUMERAL ARTHRITIS............................................514 POST-TRAUMATIC CONDITIONS................................528
ACROMIOCLAVICULAR ARTHRITIS ...............................514 WRIST INSTABILITY...............................................................528
TRAUMATIC LESIONS.................................................. 514 NAVICULAR NON-UNION ..................................................528
GLENOHUMERAL DISLOCATION.....................................514 GENERAL REHABILITATION PRINCIPLES
ACROMIOCLAVICULAR DISLOCATION.........................515 FOR WRIST AND HAND INJURIES............................528
STERNOCLAVICULAR DISLOCATION.............................515 2.4.5 Hip Joint.................................................. 529
PROXIMAL HUMERAL FRACTURES.................................516 Magdaléna Lepšíková, Pavel Kolář,
INSTABILITY................................................................. 517 Olga Dyrhonová
GLENOHUMERAL INSTABILITY........................................517 PEDIATRIC DISEASES...................................................529
Post-traumatic Instability (Recurring Dislocations)........517 Congenital hip dysplasia............................................529
Multidirectional Non-traumatic Instability Clinical Assessment of Newborns and Infants..................529
(Habitual Dislocation)......................................................518 Examination by Imaging Methods......................................530
DIFFERENTIAL DIAGNOSIS OF SHOULDER Classification according to Radiological Findings............531
GIRDLE PAIN............................................................518 Treatment...............................................................................531
GENERAL PRINCIPLES OF REHABILITATION SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)..........533
OF SHOUDLER GIRDLE DYSFUNCTIONS................. 519 LEGG-CALVE-PERTHES DISEASE.......................................534
2.4.3 Elbow Joint...............................................519 TRANSIENT SYNOVITIS OF THE HIP...............................536
Pavel Kolář, Petr Bitnar, Olga Dyrhonová ADULTHOOD DISEASES..............................................537
Contents XXV

OVERUSE SOFT TISSUE INJURIES......................................537 TOE DEFORMITIES.................................................................553

Hip Adductor Enthesopathy................................................537 Hammer Toe (Digitus Hamatus).........................................553
Rectus Femoris Enthesopathy..............................................537 Club Toe (Digitus Malleus)..................................................553
Hamstring Enthesopathy......................................................537 OVERUSE SOFT TISSUE INJURIES.................................553
DEGENERATIVE DISEASES...................................................537 PERITENDINITIS (TENOSYNOVITIS), ACHILLES
Osteoarthritis of the Hip (Coxarthrosis)............................537 TENDON TENDINOSIS......................................................553
TRAUMATIC LESIONS............................................................538 TENOSYNOVITIS, POSTERIOR TIBIALIS
Groin Injuries.............................................................. 538 TENDINOSIS.........................................................................553
Hip Joint Dislocation................................................. 538 ENTHESOPATHY OF THE SHORT MUSCLES
Proximal Femoral Fractures.................................................538 OF THE SOLE OF THE FOOT, CALCANEAL
REFERRED PAIN TO THE HIP JOINT SPUR (CALCAR CALCANEI)............................................554
FROM OTHER SITES...........................................................539 TIBIALIS ANTERIOR SYNDROME......................................554
2.4.6 Knee Joint................................................ 539 TRAUMATIC LESIONS..................................................555
Pavel Kolář, Jiří Kříž ACHILLES TENDON RUPTURE...........................................555
CONGENITAL DEVELOPMENTAL DEFECTS INJURY TO THE ANKLE LIGAMENTOUS
OF THE KNEE JOINT.................................................540 APPARATUS ..........................................................................555
OVERUSE SOFT TISSUE INJURIES.................................540 Acute Ankle Instability.........................................................555
TENDINOPATHIES..................................................................540 Chronic Lateral Ankle Instability........................................555
Patellar Tendonitis (Jumper’s Knee)...................................540 Rehabilitation Treatment Following Injuries
Rectus Femoris Enthesopathy..............................................540 and Surgeries of the Ligamentous Apparatus
Hip Adductor Enthesopathy................................................540 of the Ankle and Foot.......................................................556
Enthesopathy of the Biceps Femoris Tendon....................540
ASEPTIC NECROSIS OF THE KNEE....................................540 2.5 ORTHOTICS........................................... 557
Osgood-Schlatter Disease (Aseptic Necrosis Petr Krawczyk
of the Tibial Tuberosity)...................................................540 2.5.1 Classification and Technical
Sinding-Larsen-Johansson Syndrome Overview of Orthoses........................................ 558
(Osteochondrosis of the Patellar Apex)..........................541 OVER-THE-COUNTER ORTHOSES................................558
Osteochondritis Dissecans...................................................541 CUSTOM-MADE ORTHOTICS......................................558
DEGENERATIVE DISEASES...........................................542 2.5.2 Functional Indications for Orthoses......... 558
PATELLOFEMORAL JOINT DISORDERS...........................542 FUNCTIONAL DEMANDS OF ORTHOSES....................559
GONARTHROSIS......................................................................543 ACTION PRINCIPLES OF ORTHOSES ..........................559
TRAUMATIC LESIONS..................................................543 2.5.3 Contraindications.................................... 559
Miroslav Dobeš 2.5.4 Upper Extremity Orthoses....................... 559
SOFT TISSUE INJURIES OF THE KNEE.............................543 SCS CLASSIFICATION..................................................560
Physiology of Healing of the Knee Structures...................543 DESCRITPION OF ORTHOSIS FUNCTION
Physiology of Soft Tissue Healing.......................................543 ACCORDING TO SCS CLASSIFICATION...................560
Physiology of Ligamentous Healing...................................543 BASIC OVERVIEW OF UPPER EXTREMITY
Physiology of Autogenous Graft Healing...........................543 ORTHOSES...............................................................560
Rehabilitation Following Meniscal Injuries Hand Orthosis – HO..........................................................560
and Repairs.........................................................................544 Wrist Orthosis, Wrist Hand Orthosis –
Rehabilitation following Medial Collateral WO, WHO...............................................................................560
Ligament (MCL) Injury....................................................546 Elbow Orthosis, Elbow Wrist Hand
Rehabilitation following Anterior Cruciate Orthosis – EO, EWHO.........................................................561
Ligament Injury and Reconstruction.............................547 Shoulder Orthosis, Shoulder Elbow
Actual Rehabilitation Program............................................547 Orthosis, Shoulder Elbow Wrist Hand
2.4.7 Ankle and Foot........................................ 550 Orthosis – SO, SEO, SEWHO.........................................561
Miroslav Dobeš, Pavel Kolář, Olga Dyrhonová 2.5.5 Lower Extremity Orthoses....................... 562
CONGENTIAL DEVELOPMENTAL DEFECTS.................550 BASIC CLASSIFICATION OF LOWER EXTREMITY
TREATMENT OF CONGENITAL ORTHOSES...............................................................562
DEVELOPMENTAL DEFECTS IN GENERAL................550 Foot Orthosis – FO............................................................562
ALIGNMENT DEFORMITIES.........................................550 Ankle-Foot Orthosis – AFO.........................................562
FLAT FOOT................................................................................550 Knee Orthosis – KO............................................................563
Classification of flat foot.......................................................550 Knee-Ankle-Foot Orthosis – KAFO.........................563
HALLUX VALGUS.....................................................................551 Hip-Knee-Ankle-Foot Orthosis – HKAFO............565
HALLUX RIGIDUS....................................................................552 2.5.6 Trunk Orthoses........................................ 565
METATARSALGIA....................................................................552 BASIC CLASSIFICATION OF TRUNK ORTHOSES..........565
 XXVIClinical Rehabilitation

Cervicothoracic Orthoses – CTO..........................566 2.6.2 Prosthetics................................................574

Thoracic Orthoses – TO................................................566 Structure of a Prosthesis.......................................................575
Thoracolumbar Orthoses – TLO.............................566 Gait with a Prosthesis............................................................575
Thoracolumbosacral Orthosis – TLSO.............566 Indication Criteria.................................................................575
Cervicothoracolumbosacral Residual Limb Care...............................................................575
Orthoses – CTLSO...........................................................566 Gait Training..........................................................................576
2.5.7 Most Commonly Applied Orthoses Prosthesis Prescription.........................................................576
in Pediatric Orthopedics................................... 566 Categories of Amputees According to Insurance
Congenital Pes Equinovarus (Club Foot)..........................566 Companies Regulations....................................................576
Metatarsus Adductus............................................................567 2.6.3 Complications in Amputations.................576
Pes Calcaneovalgus...............................................................567
Foot Deformities in Arthrogryposis...................................567 2.7 REHABILITATION TOOLS....................... 577
Flat Foot..................................................................................567 Jan Kálal
Osgood-Schlatter Disease (Patellar Ligament
Tendinopathy)...................................................................567
Patellar Dislocation...............................................................567 3 TREATMENT REHABILITATION
Genu Varum, Genu Valgum, Genu Recurvatum..............567 FOR SELECTED INTERNAL
Congenital Developmental Hip Dysplasia.........................567 AND OTHER DISEASES
Legg-Calve-Perthes Disease.................................................568
Miloš Máček, Jiří Radvanský,
Limb Reduction Defects ......................................................568
Libuše Smolíková, Pavel Kolář
Scoliosis..................................................................................568
2.5.8 Most Commonly Applied Orthoses
in Orthopedics for Adult Patients...................... 569 GENERAL SECTION
ORTHOTIC OPTIONS IN COMPLICATIONS
DURING APPLICATION OF TOTAL 3.1 PHYSIOLOGICAL MECHANISMS
ENDOPROSTHESIS OF THE KNEE UTILIZED IN REHABILITATION
AND HIP JOINTS..................................................................569 INCLUDING ADAPTATION
ORTHOSES APPLICATION IN RHEUMATOID TO PHYSICAL ACTIVITY................................ 585
ARTHRITIS.............................................................................569 Miloš Máček, Jiří Radvanský
LEG LENGTH DISCREPANCY..............................................569 3.1.1 Cardiac System Adaptation...................... 585
ORTHOTIC CARE FOR THE TREATMENT Jiří Radvanský
OF FOOT DEFECTS.............................................................570 3.1.2 Pulmonary System Adaptation................. 586
NOTES TO APPLICATION OF TRUNK Miloš Máček
ORTHOSES IN LOW BACK PAIN.....................................570 3.1.3 Metabolic Adaptation.............................. 588
ORTHOTIC DEVICES FOR FOOT DEFORMITIES Jiří Radvanský
IN ADULTHOOD..................................................................571 3.1.4 Immunity Adaptation.............................. 589
ORTHOTIC OPTIONS FOR ACUTE AND Ondřej Suchánek, Pavel Kolář
CHRONIC JOINT INSTABILITIES
OF THE LOWER AND UPPER EXTREMITES...............571 3.2 FUNCTIONAL STRESS TEST
ORTHOSES IN SPINAL TRAUMA........................................572 IN PATIENTS WITH CARDIOPULMONARY
ORTHOTIC OPTIONS IN TENDON INJURIES DYSFUNCTION.............................................. 591
OF THE HAND......................................................................572 Jiří Radvanský
FUNCTIONAL TREATMENT OF TENDON 3.2.1 Laboratory Stress Test.............................. 592
INJURIES IN THE LOWER EXTREMITY.......................572 3.2.2 Basic Terminology of a Functional
FUNCTIONAL TREATMENT OF LOWER Stress Test.......................................................... 592
EXTREMITY FRACTURES.................................................573 3.2.3 Fitness Testing in Less Fit Individuals....... 593
ORTHOTIC CARE IN PATIENTS AFTER 3.2.4 Fitness Assessment Based
CRANIALTRAUMA..............................................................573 on Submaximal Stress Tests............................... 595
ORTHOTIC MANAGEMENT FOR PATIENTS 3.2.5 Assessment of Stress Test......................... 596
FOLLOWING BURN INJURIES.........................................574 3.2.6 Assessment of Activity Including
Assessment of the Functional Ability
2.6 REHABILITATION OF PATIENTS of an Elderly Patient.......................................... 598
AFTER EXTREMITY AMPUTATION..................574 3.2.7 Specific Stress Test Adaptations
Jan Kálal for Patients with Ischemic
2.6.1 Reasons for Amputations..........................574 Heart Disease (IHD).......................................... 598
Contents XXVII

3.3 FUNCTIONAL LUNG ASSESSMENT.......... 599 3.5.2 Rehabilitation following

Jan Šulc Cardiac Surgery..................................................618
3.3.1 Causes of the Onset of Pulmonary Pre-Operative Fitness Improvement and Correction
Dysfunctions in Patients with Deficits of Musculoskeletal System Dysfunctions.......................618
in the Movement System and in Certain Post-Operative Rehabilitation Approaches........................618
Organ Systems.................................................. 599 Exercise therapy.....................................................619
3.3.2 Diagnostic Approaches............................ 599 Post-Operative Complications.............................................621
Methods in Pulmonary Function Testing..........................601
Description of Pulmonary Function Parameters..............603 3.6 ISCHEMIC HEART DISEASE (IHD).......... 621
3.3.3 Interpretation and Implementation Jiří Radvanský
of Conclusions from a Pulmonary KEY COMPONENTS OF A COMPLEX
Function Test..................................................... 604 REHABILITATION PLAN...................................................622
Restrictive Lung Dysfunction..............................................604
Lung Hyperinflation..............................................................604 3.7 METABOLIC DISTURBANCES.................. 624
Obstructive Deficits..............................................................605 Jiří Radvanský
Changes in Lung Elastic Properties ...................................605 3.7.1 Diabetes Mellitus – Type 2....................... 624
IMPLEMENTATION INTO CLINICAL PRACTICE..........605 3.7.2 Diabetes Mellitus – Type 1....................... 627

3.8 RHEUMATIC DISEASES.......................... 627

SPECIAL SECTION Irena Koudelková, Pavel Kolář
3.8.1 Rheumatoid Arthritis............................... 628
3.4 RESPIRATORY DISEASES........................ 606 3.8.2 Juvenile Rheumatoid Arthritis
Miloš Máček, Jiří Radvanský, (Juvenile Idiopathic Arthritis)............................631
Libuše Smolíková, Pavel Kolář 3.8.3 Ankylosing Spondylitis............................ 632
3.4.1 Rehabilitation for Bronchial Asthma ....... 606 3.8.4 Osteoporosis........................................... 635
Miloš Máček 3.8.5 Fibromyalgia Syndrome........................... 636
EXERCISE-INDUCED BRONCHOSPASM..........................607 Petr Knotek, Pavel Kolář
3.4.2 Rehabilitation in Chronic Obstructive CLINICAL MANIFESTATIONS AND DIAGNOSIS...........638
Pulmonary Disease (COPD).............................. 609 Differential Diagnosis...........................................................638
Miloš Máček Biological Aspects of FMS....................................................639
PERIPHERAL MUSCLE DYSFUNCTION............................609 Psychological Aspects of FMS.............................................640
Rehabilitation of Patients with COPD................................610 TREATMENT.............................................................................641
Program for Patients with Mild and Moderate COPD.....611
Assistive Methods with Exercise Therapy in COPD.........611 3.9 OTHER DYSFUNCTIONS AND DISEASES...644
3.4.3 Implementation of Rehabilitation Pavel Kolář
in Other Respiratory Dysfunctions.....................614 3.9.1 Lymphedema and Treatment................... 644
Miloš Máček Martin Wald, Hana Váchová
Respiratory Insufficiency in Neuromuscular ANATOMY OF THE LYMPHATIC SYSTEM.......................645
Disturbances and Thoracic Deformities.........................614 MECHANISM OF LYMPHATIC FLUID
Rehabilitation of Patients Following Spinal FORMATION.........................................................................645
Cord Injury: Effect on Lung Function............................614 DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS...............645
Jan Šulc TREATMENT.............................................................................645
Rehabilitation of Patients on Breathing Support...............616 Manual Lymphatic Drainage...............................................646
Libuše Smolíková Pharmacotherapy..................................................................646
3.4.4 Methods and Approaches Used Treatment Frequency............................................................646
in the Rehabilitation of Patients with EDEMA PREVENTION............................................................646
Chronic Pulmonary System Dysfunction.............617 PROGNOSIS...............................................................................647
Libuše Smolíková, Pavel Kolář 3.9.2 Treatment Rehabilitation of Bowel
Incontinence..................................................... 647
3.5 SURGICAL PROCEDURES Pavel Kolář
IN THE THORACIC REGION............................617
Lenka Babková 3.10 GERIATRICS......................................... 648
3.5.1 Rehabilitation following Zdeněk Kalvach
Pulmonary Surgery............................................617 3.10.1 Aging Phenotype and Involution
Breathing Preparation...........................................................618 Deterioration.................................................... 649
 XXVIIIClinical Rehabilitation

3.10.2 Geriatric Frailty and Geriatric ONCOLOGICAL DISEASES OF THE SPINE......................663

Syndromes........................................................ 649 ONCOLOGICAL DISEASES AND SURGICAL
GERIATRIC SYNDROMES OF HYPOMOBILITY, APPROACHES FOR THE EXTREMITIES.......................664
DECONDITIONING AND MUSCLE WEAKNESS.......650 4.5.2 Metastatic Involvement of the Brain
HYPOMOBILITY.......................................................................650 and the Spinal Cord.......................................... 666
DECONDITIONING.................................................................650
SARCOPENIA.............................................................................650 4.6 PARANEOPLASTIC SYNDROMES............ 666
GERIATRIC MODIFICATIONS AND CONTINUITY
OF REHABILITATION ACTIVITIES..............................650 4.7 SIDE EFFECTS OF ONCOLOGIC
3.10.3 Principles of Movement Activity TREATMENT................................................. 667
Selection in the Aging Population..................... 651 NEUROLOGICAL SYMPTOMS.............................................667
Miloš Matouš, Pavel Kolář 4.7.1 Cerebellar Syndrome................................ 667
Assessment Prior to Exercise Program Initiation.............652 4.7.2 Peripheral Polyneuropathy...................... 667
Exercise Programs.................................................................652 4.7.3 Hormone Therapy.................................... 669
Reconditioning Stays............................................................653 4.7.4 Immunotherapy....................................... 669

4.8 SOFT TISSUES AND MUSCLE TISSUE....... 669

4 TREATMENT REHABILITATION
IN ONCOLOGY 4.9 RADIATION THERAPY............................ 669
Vítězslav Hradil
4.10 LYMPHEDEMA......................................671
REHABILITATION SPECIFICS FOR PATIENTS
WITH ONCOLOGIC CONDITIONS................................657
BASIC GOALS AND ASSESSMENT
5 TREATMENT REHABILITATION
OF REHABILITATION TREATMENT..............................657
IN GYNECOLOGY AND OBSTETRICS
REHABILITATION TREATMENT
COMPLICATIONS................................................................658 Martina Ježková, Pavel Kolář

5.1 OVERVIEW OF GYNECOLOGICAL
GENERAL SECTION SYNDROMES WITH CONTRIBUTION
OF FUNCTIONAL DEFICITS............................ 673
4.1 PAIN PATTERNS IN PATIENTS WITH Martina Ježková, Pavel Kolář
ONCOLOGICAL DISEASES............................. 658
4.1.1 Pain Pattern and Its Treatment................. 658 DYSFUNCTIONS OF THE MENSTRUAL CYCLE
4.1.2 Classification of Oncologic Pain............... 658 AND FUNCTIONAL STERILITY.................................. 674
AMENORRHEA.........................................................................674
4.2 PARAMETERS FOR THE DYSMENORRHEA....................................................................674
INTERRUPTION OR MODIFICATION STERILITY..................................................................................675
OF A REHABILITATION PROGRAM................ 659
4.2.1 Laboratory Values.................................... 659 5.2 PREMENSTRUAL SYNDROME
4.2.2 Long Bone Metastases............................. 659 AND MENOPAUSE........................................ 678
4.2.3 Other Parameters Modifying PREMENSTRUAL SYNDROME......................................678
Rehabilitation Treatment................................... 660 MENOPAUSE................................................................678
MENOPAUSE, PREMENOPAUSE,
4.3 REHABILITATION APPROACHES............ 660 POSTMENOPAUSE...............................................................678
4.3.1 Modalities................................................ 660 Menopausal Syndrome..................................................679
4.3.2 Physical Therapy Techniques................... 661 SYNDROMES THAT CAN BE AFFECTED
4.3.3 Contraindications.................................... 661 BY REHABILITATION.................................................679

4.4 SPECIFIC FACTORS INFLUENCING 5.3 PELVIC INFLAMMATORY DISEASE.......... 679

REHABILITATION TREATMENT..................... 662
5.4 ANATOMICAL DEFICITS
IN GYNECOLOGY.......................................... 680
SPECIAL SECTION
5.5 GYNECOLOGICAL SURGICAL
4.5 METASTATIC INVOLVEMENT.................. 662 PROCEDURES............................................... 680
4.5.1 Metastatic Involvement of the Skeleton..... 662 Post-Operative Complications (Post-Surgical Incisions)... 683
Contents XXIX

5.6 URINARY INCONTINENCE...................... 683 7.2 TREATMENT............................................711

Martina Hoskovcová 7.2.1 Biological, Psychological
and Social Context: Non-Specific
5.7 PREGNANCY, BIRTH AND THE Rehabilitation Factors ........................................711
POSTPARTUM (POSTNATAL) PERIOD.......... 686 7.2.2 Treatment Rehabilitation..........................713
Martina Ježková, Pavel Kolář Barbora Danielová, Petr Knotek, Pavel Kolář
PREGNANCY................................................................686 7.2.3 Psychotherapy..........................................714
BIRTH...........................................................................686 7.2.4 Psychopharmacotherapy..........................714
POSTPARTUM..............................................................687

8 REHABILITATION IN PSYCHIATRY
6 TREATMENT REHABILITATION
IN PAIN MANAGEMENT 8.1 REHABILITATION IN THE AREAS
OF SOCIAL AND VOCATIONAL
Jiří Kozák, Pavel Kolář
FUNCTIONS...................................................717
Ondřej Pěč, Lenka Vachková, Jan Mužík
6.1 CLASSIFICATION OF PAIN...................... 691
8.1.1 General Aspects of Psychiatric
Acute Pain..............................................................................691 Rehabilitation....................................................718
Chronic pain..........................................................................691 Current Schools of Psychiatric Rehabilitation...................718
Target Group of Psychiatric Rehabilitation........................718
6.2 FOUNDATIONS OF Principles of Psychiatric Rehabilitation..............................718
NEUROPHYSIOLOGIC PAIN.......................... 691 Recovery.................................................................................719
8.1.2 Process of Psychiatric Rehabilitation
6.3 PAIN MANAGEMENT.............................. 692 and Possible Approaches................................... 720
Process of Psychiatric Rehabilitation According
6.4 COMPLEX REGIONAL PAIN to the Boston School.........................................................720
SYNDROME (CRPS)...................................... 695 Process of Psychosocial Rehabilitation
According to the Netherlands’ School STORM............721
8.1.3 Specific Levels of Psychiatric
7 TREATMENT REHABILITATION Rehabilitation................................................... 721
IN PSYCHOSOMATIC DISEASES Vocational rehabilitation......................................................721
Assisted Education................................................................723
Petr Knotek, Pavel Kolář
Rehabilitation and Housing.................................................723
Rehabilitation in the Areas of Social Interaction
7.1 MODERN PSYCHOSOMATICS................. 701
and Leisure Time...............................................................724
7.1.1 Psychosomatics and Current Science........ 702 8.1.4 Psychiatric Rehabilitation Assessment...... 725
7.1.2 Psychosomatics and Irrationality.............. 702
7.1.3 Biological, Psychological 8.2 PSYCHOMOTOR THERAPY..................... 725
and Social Approach......................................... 703 Běla Hátlová, Milena Adámková
Psychosomatic Integrity.......................................................704 8.2.1 General Aspects of Psychomotor
Normality...............................................................................705 Therapy............................................................. 726
Psychobiology and Sociocultural Norms...........................705 Research in Kinesiotherapy..................................................726
Cognitive Processes and Adaptation..................................705 Physical Self-Concept...........................................................726
Failure as a Pathological Adaptation...................................706 Role of Movement Activity in Stress Coping ....................726
7.1.4 Placebo and Nocebo................................ 706 Somatic State and Movement Abilities of Patients
7.1.5 Charisma.................................................. 708 with Mental Illness............................................................726
7.1.6 Physical Manifestations as Signs Why Movement Therapy?....................................................727
and Symptoms.................................................. 708 8.2.2 Kinesiotherapy........................................ 727
7.1.7 Deficits and Signs......................................710 Circumscription of the term Kinesiotherapy....................727
Acute Psychological Reaction to Stress..............................710 Actions of Kinesiotherapy....................................................727
Neurotic Disturbances..........................................................710 Types of Kinesiotherapy in the Treatment
Psychosomatic Disturbance.................................................710 of Psychiatric Patients.......................................................728
Psychosomatic Diseases of Organs Integrated and Focused Kinesiotherapy.............................728
and Organ Systems............................................................710 Kinesiotherapeutic Activation Programs...........................728
Systemic Diseases..................................................................711 Kinesiotherapeutic Active Relaxation Programs...............728
Somatopsychological Disturbance......................................711 Perceptive (Attention) Focused Kinesiotherapy................728
XXXClinical Rehabilitation

Kinesiotherapeutic Programs Increasing Kinesiotherapy for the Treatment of Neuroses..................730

Self-Confidence and Confidence in Others...................729 Kinesiotherapy for the Treatment
Kinesiotherapeutic Communication Programs................729 of Personality and Behavioral Disorders........................731
Therapeutic Utilization of Athletic Exercises....................729 Principles of Kinesiotherapy Administration
Suggested Forms of Kinesiotherapy in the Mentally Ill..............................................................731
for the Treatment of Psychological Illnesses..................729
Kinesiotherapy for the Treatment of Dementia................729 biographies of influential figures...... 733
Kinesiotherapy for the Treatment
of an Addiction Syndrome...............................................729 Abbreviations...........................................747
Kinesiotherapy for the Treatment of Schizophrenia.........730
Kinesiotherapy for the Treatment of Manic Illnesses.......730 Index...........................................................749