{"id":9475,"date":"2019-10-28T09:50:49","date_gmt":"2019-10-28T09:50:49","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=9475"},"modified":"2019-10-28T10:49:24","modified_gmt":"2019-10-28T10:49:24","slug":"principii-si-metode-de-reabilitare-spondilita-anchilozanta-si-alte-spondilartropatii-seronegative","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/principii-si-metode-de-reabilitare-spondilita-anchilozanta-si-alte-spondilartropatii-seronegative\/","title":{"rendered":"Principii \u0219i metode de reabilitare \u00een spondilita anchilozant\u0103 \u0219i alte spondilartropatii seronegative"},"content":{"rendered":"

\"\"<\/a><\/strong><\/p>\n

 <\/p>\n

 <\/p>\n

Autor:<\/strong><\/em><\/p>\n

Prof. univ. dr. Mioara Banciu<\/strong><\/em><\/p>\n

Medic primar reumatologie, balneofizioterapie \u0219i recuperare medical\u0103<\/em><\/p>\n

Universitatea de Medicin\u0103 \u0219i Farmacie \u201cVictor Babe\u0219\u201d, Timi\u0219oara<\/em><\/p>\n

 <\/p>\n

 <\/p>\n

Se constat\u0103 o continu\u0103 cre\u0219tere a morbidit\u0103\u021bii afect\u0103rii articula\u021biei sacro-iliace cu:
\nAnamneza familiar\u0103 prezent\u0103 15-20%;
\nInciden\u021b\u0103 de 0,5-1,9% \u00een SA;
\nPrevalen\u021ba bolii de 1,29% \u0219i
\nPrevalen\u021ba mai mult de 1,1% \u00een SASN<\/p>\n

Fiziokinetoterapia \u0219i balneoterapia constituie o parte vital\u0103 a programului de tratament \u00een SA pentru men<\/u>\u021b<\/u>inerea unui poten<\/u>\u021b<\/u>ial maxim de mi<\/u>\u0219<\/u>care <\/u>\u0219<\/u>i prevenirea deform<\/u>\u0103<\/u>rilor posturale<\/u>.<\/p>\n

Principii \u0219i obiective<\/u><\/strong><\/p>\n

Strategia de reabilitare vizeaz\u0103:<\/p>\n

    \n
  1. Func\u021bia coloanei: prin determinarea indicelui BASFI (Bath Ankylosing Spondylitis Functional Index); indicele Dougados (DFI);<\/li>\n
  2. Durerea: prin scala vizual\u0103 analog\u0103 VAS sau BASDAI (Bath Disease Activity Index);<\/li>\n
  3. Mobilitatea coloanei: bilan\u021b articular al coloanei CDL, articula\u021biilor afectate (\u0219old, genunchi, articula\u021bii periferice) \u0219i expansiunea toracic\u0103;<\/li>\n
  4. Aprecierea global\u0103 de c\u0103tre pacient (VAS la o s\u0103pt\u0103m\u00e2n\u0103);<\/li>\n
  5. Durata redorii articulare (la o s\u0103pt\u0103m\u00e2n\u0103);<\/li>\n
  6. Indicele entezitic modificat de Haywood \u0219i pentru articula\u021bii periferice: num\u0103r articula\u021bii dureroase, tumefiate;<\/li>\n
  7. Reactan\u021bii de faz\u0103 acut\u0103 (VSH, PCR);<\/li>\n
  8. Examen radiologic: Rx bazin (SI, CF) \u0219i Rx coloana lombar\u0103, cervical\u0103 (AP, lateral).<\/li>\n<\/ol>\n

     <\/p>\n

    Material \u0219i metod\u0103<\/u><\/strong>
    \nS-au studiat 155 pacien\u021bi cu SA, interna\u021bi \u00een clinic\u0103 \u00eentre 2000-2004, dintre care 16 cu SASN (artrit\u0103 psoriazic\u0103, sindrom Reiter, artrit\u0103 reactiv\u0103 cu stafilococ, Chlamidia), a dominat sexul masculin (134B\/21F), raportul mediu urban\/rural 85\/70; 57,2% au avut v\u00e2rst\u0103 \u00eentre 20-39 ani.
    \nDiagnosticul precoce este necesar pentru instituirea unui tratament adecvat \u0219i s-a efectuat conform criteriilor New York modificate:<\/p>\n

      \n
    1. Criterii clinice:<\/li>\n
    2. Durerea lombar\u0103 cu durat\u0103 > 3 luni ameliorat\u0103 de exerci\u021biu fizic, agravat\u0103 de repaus;<\/li>\n
    3. Limitarea mi\u0219c\u0103rilor coloanei \u00een plan sagital \u0219i frontal;<\/li>\n
    4. Limitarea expansiunii toracice (v\u00e2rst\u0103, sex).<\/li>\n
    5. Criterii radiologice:<\/li>\n<\/ol>\n

      Sacroileit\u0103 > gradul II bilateral<\/p>\n

      Sacroileit\u0103 grad III-IV unilateral<\/p>\n

      SA definit<\/u>\u0103<\/u>: c\u00e2nd exista Rx + 1 criteriu clinic<\/p>\n

      SA probabil<\/u>\u0103<\/u>: c\u00e2nd exist\u0103 3 criterii clinice + 1 criteriu radiologic<\/p>\n

       <\/p>\n

      Metode de evaluare:<\/u><\/strong>
      \nIndicele de activitate a bolii BASDAI (Bath Ankylosing Spodylitis Activity):<\/p>\n

        \n
      1. Fatigabilitate; 2. <\/strong>Durere vertebral\u0103; 3.<\/strong> Durere \u0219i inflama\u021bie articular\u0103; 4. <\/strong>Sensibilitatea entezelor; 5.<\/strong> Redoare matinal\u0103 (calitativ 0-10 sau cantitativ max 120 min); 6. <\/strong>Laborator: VSH, fibrinogen, PCR, lichid sinovial \u2013 formul\u0103 inflamatorie.<\/li>\n<\/ol>\n

        Indicele entezitic modificat de Haywood (\u00een drepta \u0219i st\u00e2nga)<\/p>\n

          \n
        • Tendonul lui Achile; \u2022 Inser\u021bia fascei plantare; \u2022 Marele trohanter; \u2022 Originea adductor \u0219old; \u2022 Creasta iliac\u0103 (marg sup, inf); \u2022\u00a0Sterno costal; \u2022 Sterno clavicular; \u2022 C7\/T1.<\/li>\n<\/ul>\n

          Scor total<\/p>\n

          0=f\u0103r\u0103 durere;<\/p>\n

          1=discomfort;<\/p>\n

          2=durere definite;<\/p>\n

          3= durere, retrac\u021bie.<\/p>\n

          M<\/u>\u0103<\/u>surarea mobilit<\/u>\u0103\u021b<\/u>ii coloanei vertebrale<\/u><\/p>\n

          BASMI \u2013 indice metrologic al SA<\/u><\/p>\n

          – Distan\u021ba tragus-perete (cm) \u2013 Jekinson 1994;<\/p>\n

          – Expansiunea toracic\u0103 (diferen\u021ba expir-inspir <2,5 cm \u0103n decubit dorsal);<\/p>\n

          – Distan\u021ba indice-sol (cm) – Fitzgerald 1983;<\/p>\n

          – Flexia lombar\u0103 lateral\u0103 (cm) – Pile 1991;<\/p>\n

          – Flexia coloanei modificat\u0103 \u2013 Schober (sub 4-6 cm retrac\u021bie);<\/p>\n

          – Rota\u021bia coloanei cervicale dreapta, st\u00e2nga;<\/p>\n

          – Distan\u021ba intermaleolar\u0103 (cm) cu abduc\u021bia picioarelor.<\/p>\n

          Indice func\u021bional BASFI <\/u><\/p>\n

          VAS 10 cm, 0=u\u0219or, 10=imposibil<\/p>\n

            \n
          1. \u00cembrac\u0103 ciorapii sau pantalonii f\u0103r\u0103 ajutor;<\/li>\n
          2. Se apleac\u0103 \u00eenainte pentru a ridica un stilou de pe podea f\u0103r\u0103 ajutor;<\/li>\n
          3. Se ridic\u0103 de pe scaunul de la mas\u0103 f\u0103r\u0103 a se ajuta de m\u00e2ini;<\/li>\n
          4. Se ridic\u0103 f\u0103r\u0103 ajutor de pe podea din pozi\u021bia culcat;<\/li>\n
          5. St\u0103 10 minute nesprijinit \u0219i f\u0103r\u0103 a avea disconfort;<\/li>\n
          6. Urc\u0103 12-15 trepte f\u0103r\u0103 sprijin de balustrad\u0103 sau f\u0103r\u0103 baston;<\/li>\n
          7. Se uit\u0103 peste um\u0103r f\u0103r\u0103 a r\u0103suci corpul;<\/li>\n
          8. Execut\u0103 complet activit\u0103\u021bi zilnice acas\u0103 sau la serviciu;<\/li>\n
          9. Efectueaz\u0103 exerci\u021bii medicale;<\/li>\n
          10. Efectueaz\u0103 sport sau gr\u0103din\u0103rit;<\/li>\n<\/ol>\n

            Scor general 0-100 puncte reconvertit scor final 0-10.
            \nSeveritatea bolii depinde de:<\/p>\n

              \n
            1. Leziuni func\u021bionale: anchiloz\u0103 \u00eentins\u0103, osificare intervertebral\u0103 (articula\u021biile interapofizare posterioare, enteze, ligamente), articula\u021biei \u0219oldului;<\/li>\n
            2. Leziuni structurale: 8 vertebre afectate \u00eenseamn\u0103 gradul III, 20 de vertebre gradul V.<\/li>\n<\/ol>\n

               <\/p>\n

              Rezultate<\/u><\/strong><\/p>\n

                \n
              • Tratamentul medicamentos la to\u021bi pacien\u021bii s-a completat cu cel fizical (electroterapie: curen\u021bi de joas\u0103 frecven\u021b\u0103, medie, \u00eenalt\u0103 frecven\u021b\u0103, ultrasonoforez\u0103) pentru combaterea durerii, inflama\u021biei \u0219i contracturii musculare;<\/li>\n
              • <\/u>Gimnastica medical<\/u>\u0103<\/u> trebuie efectuat\u0103 \u00een terapie de grup sau individual, precoce <\/u>\u0219<\/u>i continuu<\/u>, concomitent cu educa<\/u>\u021b<\/u>ia<\/u>, instruirea pacien\u021bilor asupra naturii bolii \u0219i terapiei;<\/li>\n
              • Kinetoterapia se efectueaz\u0103 pentru:<\/li>\n<\/ul>\n
                  \n
                1. Men<\/u>\u021b<\/u>inerea <\/u>\u0219<\/u>i corectarea posturilor<\/u> (flexie, \u00eenclinare cervical\u0103, cifoz\u0103, delordozare, flexia \u0219oldului)<\/li>\n
                2. a) Adaptarea de posturi corectoare cu con\u0219tientizarea pozi\u021biei, profilactice, de conten\u021bie, repaus nocturn sau orteze din materiale termoplastice folosite \u00een acela\u0219i scop;<\/li>\n
                3. b) Exerci\u021bii posturale Forestier (din decubit dorsal, ventral, pozi\u021bie \u0219ez\u00e2nd\u0103 \u0219i ortostatism).<\/li>\n
                4. Exercitii de mobilizare a coloanei<\/u> \u2013 suple\u021be articular\u0103<\/li>\n
                5. a) Cre<\/u>\u0219<\/u>terea amplitudinii unghiului articular<\/u>: exerci\u021bii active ROM \u00een ax fiziologic zilnice, exerci\u021bii ROM asistate de kinetoterapeut se continu\u0103 pasiv mi\u0219carea, exerci\u021bii pasive ROM (influenteaz\u0103 structurile periarticulare), exerci\u021bii rezistive cu greut\u0103\u021bi;<\/li>\n
                6. b) Tehnici de joc articular<\/u>: alunecarea suprafe\u021belor articulare sau mi\u0219c\u0103ri accesorii care nu sunt sub control voluntar:<\/li>\n<\/ol>\n

                  – Trac\u021biune mecanic\u0103 sau manual\u0103 \u00een caz de disfunc\u021bie articular\u0103;<\/p>\n

                  – Manipul\u0103ri \u00een caz de restric\u021bie reversibil\u0103 cauzat\u0103 de durere, incongruen\u021b\u0103 articular\u0103 sau disfunc\u021bie muscular\u0103.<\/p>\n

                    \n
                  1. c) Cre<\/u>\u0219<\/u>terea for<\/u>\u021b<\/u>ei musculare<\/u> \u2013 vizeaz\u0103 mu\u0219chii erectori ai trunchiului, mu\u0219chii abdominali, psoas iliac (lordozant), muschii fesieri:<\/li>\n<\/ol>\n

                    – Restaurarea balan\u021bei musculare \u00eentre mu\u0219chi pelvini, adductori, tendonul cvadriceps, mu\u0219chi posturali;<\/p>\n

                    – Exerci\u021bii de \u00eentindere pasiv\u0103, activ\u0103;<\/p>\n

                    – Exerci\u021bii izometrice, izotonice concentrice, excentrice, izokinetice:<\/p>\n

                      \n
                    1. d) Men<\/u>\u021b<\/u>inerea balan<\/u>\u021b<\/u>ei echilibrului propriocep<\/u>\u021b<\/u>iei<\/u> (joc cu mingea);<\/li>\n
                    2. e) Mi<\/u>\u0219<\/u>c<\/u>\u0103<\/u>ri <\/u>\u00ee<\/u>n lant kinetic deschis<\/u> (circumduc\u021bia piciorului bra\u021bului);<\/li>\n
                    3. f) Mi<\/u>\u0219<\/u>c<\/u>\u0103<\/u>ri <\/u>\u00ee<\/u>n lan<\/u>\u021b<\/u> kinetic <\/u>\u00ee<\/u>nchis<\/u> (presiune, ap\u0103rare);<\/li>\n
                    4. g) Ameliorarea capacit<\/u>\u0103\u021b<\/u>ii respiratorii<\/u> \u2013 exerci\u021bii de respira\u021bie, inspir cu relaxare, cu repeti\u021bii, tonifierea diagfragmului (decubit dorsal cu greut\u0103\u021bi pe abdomen), tonifierea mu\u0219chilor intercostali, inspir profund contra rezisten\u021b\u0103 manual\u0103 aplicat\u0103 pe torace, \u00eentinderea mu\u0219chilor pectorali, cre\u0219terea for\u021bei stabilizatorilor omoplatului;<\/li>\n
                    5. h) Men<\/u>\u021b<\/u>inerea capacit<\/u>\u0103\u021b<\/u>ii cardiovasculare;<\/u><\/li>\n
                    6. i) Cre<\/u>\u0219<\/u>terea anduran<\/u>\u021b<\/u>ei<\/u> \u2013 prin jocuri sportive: baschet, volei;<\/li>\n
                    7. j) Activit<\/u>\u0103\u021b<\/u>i aerobice<\/u> (s\u0103rituri) pentru echilibru, coordonare, propriocep\u021b<\/li>\n<\/ol>\n

                      TERMOTERAPIA<\/strong><\/p>\n

                        \n
                      • Caldura influen\u021beaz\u0103:<\/li>\n<\/ul>\n

                        -relaxarea muscular\u0103;<\/p>\n

                        -reducerea redorii;<\/p>\n

                        -amelioreaz\u0103 circula\u021bia local\u0103:<\/p>\n

                          \n
                        1. a) Prin radia\u021bie \u2013 infraro\u0219ii;<\/li>\n
                        2. b) Conduc\u021bie \u2013 \u00eempachet\u0103ri cu parafin\u0103, n\u0103mol;<\/li>\n
                        3. c) Conversie \u2013 diatermie, unde scurte, microunde.<\/li>\n<\/ol>\n

                          HIDROTERAPIA<\/strong><\/p>\n

                            \n
                          • Stimuleaz\u0103 circula\u021bia general\u0103 \u0219i local\u0103;<\/li>\n
                          • Cre\u0219te amplitudinea articular\u0103, mobilitatea;<\/li>\n
                          • Amelioreaz\u0103 for\u021ba \u0219i troficitatea muscular\u0103;<\/li>\n
                          • Dus subacval;<\/li>\n
                          • B\u0103i kinetice.<\/li>\n<\/ul>\n

                            Clasificarea ICDFDH define\u0219te dimensiunile sub forma a 5 categorii de \u00eencadrare a bolnavilor:<\/p>\n

                              \n
                            1. Infirmitate<\/u> = devia\u021bii sau pierderi \u00een func\u021biile sau structurile organismului;<\/li>\n
                            2. Activitatea<\/u> = performarea unei sarcini sau ac\u021biuni;<\/li>\n
                            3. Limitarea de activitate<\/u> (disabilitatea) = dificult\u0103\u021bi \u00een \u00eent\u00e2mpinarea unor activit\u0103\u021bi;<\/li>\n
                            4. Participarea, implicarea individului <\/u>\u00ee<\/u>n diferite situa<\/u>\u021b<\/u>ii vitale<\/u> legate de starea de s\u0103n\u0103tate, structur\u0103, func\u021biile organismului, factorii de mediu;<\/li>\n
                            5. Restric<\/u>\u021b<\/u>ia de participare (handicap)<\/u>= dificultatea individului \u00een ceea ce prive\u0219te felul, posibilit\u0103\u021bile sale de implicare \u00een diverse situa\u021bii de via\u021b\u0103.<\/li>\n<\/ol>\n

                              CONCLUZII<\/u><\/strong><\/p>\n

                                \n
                              • Diagnosticul precoce \u00een SA \u0219i SASN cu stabilirea unei scheme adecvate \u0219i individualizate de tratament, c\u00e2t \u0219i o complian\u021ba \u00eentre medic \u0219i pacient, are succese terapeutice de durat\u0103, tergivers\u00e2nd evolu\u021bia nefavorabil\u0103 a bolii spre anchiloz\u0103.<\/li>\n
                              • Ameliorarea st\u0103rii de s\u0103n\u0103tate a acestor suferinzi prin modificarea stilului de via\u021b\u0103, a condi\u021biilor familiale, aplicarea posturilor nocturne, dinamice, ocupa\u021bionale, efectuarea unor activit\u0103\u021bi sportive, recrea\u021bionale are drept consecin\u021b\u0103 \u00eembun\u0103t\u0103\u021birea calit\u0103\u021bii vie\u021bii.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

                                    Autor: Prof. univ. dr. Mioara Banciu Medic primar reumatologie, balneofizioterapie \u0219i recuperare medical\u0103 Universitatea de Medicin\u0103 \u0219i Farmacie \u201cVictor Babe\u0219\u201d, Timi\u0219oara     Se constat\u0103 o continu\u0103 cre\u0219tere […]<\/p>\n","protected":false},"author":9,"featured_media":9476,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[276,363],"tags":[],"class_list":["post-9475","post","type-post","status-publish","format-standard","has-post-thumbnail","category-interviu","category-reabilitare-medicala"],"yoast_head":"\nPrincipii \u0219i metode de reabilitare \u00een spondilita anchilozant\u0103 \u0219i alte spondilartropatii seronegative<\/title>\n<meta name=\"description\" content=\"Principii \u0219i metode de reabilitare \u00een spondilita anchilozant\u0103 \u0219i alte spondilartropatii seronegativeAutor: Prof. univ. dr. 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