{"id":23635,"date":"2015-12-25T13:12:40","date_gmt":"2015-12-25T12:12:40","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=23635"},"modified":"2015-12-25T13:25:43","modified_gmt":"2015-12-25T12:25:43","slug":"s-pumpou-na-ztuhle-svaly-ln","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=23635","title":{"rendered":"S pumpou na ztuhl\u00e9 svaly"},"content":{"rendered":"

Po\u010det pacient\u016f s d\u011btskou mozkovou obrnou se v posledn\u00edch letech nijak dramaticky nem\u011bn\u00ed. P\u0159ib\u00fdvaj\u00ed v\u0161ak nov\u00e9 metody, kter\u00e9 jim mohou usnadnit \u017eivot.<\/strong><\/p>\n

V\u011bt\u0161ina t\u011bchto d\u011bt\u00ed trp\u00ed spasticitou, neboli nadm\u011brn\u00fdm svalov\u00fdm nap\u011bt\u00edm. „U d\u011btsk\u00fdch pacient\u016f s obzvl\u00e1\u0161\u0165 z\u00e1va\u017en\u00fdm posti\u017een\u00edm jsme za\u010dali ned\u00e1vno pou\u017e\u00edvat tak\u00e9 baklofenov\u00e9 pumpy,“ \u0159\u00edk\u00e1 neurolog Jan H\u00e1lek z D\u011btsk\u00e9 kliniky Fakultn\u00ed nemocnice Olomouc. „S pomoc\u00ed t\u00e9to pumpy m\u016f\u017eeme pod\u00e1vat l\u00e9\u010divou l\u00e1tku baklofen, kter\u00e1 dok\u00e1\u017ee ovlivnit svalov\u00e9 nap\u011bt\u00ed, p\u0159\u00edmo do t\u00e9 \u010d\u00e1sti centr\u00e1ln\u00ed nervov\u00e9 soustavy, kam pot\u0159ebujeme.“ Z\u00e1kladem l\u00e9\u010dby t\u011bchto pacient\u016f v\u0161ak podle n\u011bj st\u00e1le z\u016fst\u00e1v\u00e1 rehabilitace. Pr\u00e1v\u011b d\u00edky n\u00ed je mo\u017en\u00e9 mnohdy dost podstatn\u011b zlep\u0161it kvalitu \u017eivota.<\/p>\n

Z\u00e1ludnosti d\u011btsk\u00e9 mozkov\u00e9 obrny<\/p>\n

Jen m\u00e1lokter\u00e1 nemoc m\u00e1 tak r\u016fznorod\u00e9 projevy jako d\u011btsk\u00e1 mozkov\u00e1 obrna. Zat\u00edmco jednomu zp\u016fsob\u00ed jen drobn\u00e9 probl\u00e9my s ch\u016fz\u00ed, u jin\u00e9ho m\u016f\u017ee v\u00e1\u017en\u011b ohrozit pohybov\u00fd i ment\u00e1ln\u00ed v\u00fdvoj. Spole\u010dn\u00e9 maj\u00ed tito pacienti pouze to, \u017ee u nich do\u0161lo v ran\u00e9m v\u011bku k po\u0161kozen\u00ed centr\u00e1ln\u00edho nervov\u00e9ho syst\u00e9mu.<\/p>\n

„Nemoc m\u016f\u017ee m\u00edt na sv\u011bdom\u00ed z\u00e1n\u011bt, krv\u00e1cen\u00ed \u010di trauma, k n\u011bmu\u017e dojde v t\u011bhotenstv\u00ed, v pr\u016fb\u011bhu porodu anebo kr\u00e1tce po n\u011bm,“ uv\u00e1d\u00ed Jan H\u00e1lek. N\u011bkdy lze riziko rozvoje t\u00e9to nemoci p\u0159edem p\u0159edv\u00eddat. Obzvl\u00e1\u0161\u0165 u d\u011bt\u00ed, u nich\u017e byla je\u0161t\u011b p\u0159ed narozen\u00edm diagnostikov\u00e1na vrozen\u00e1 vada mozku. V\u00edce ohro\u017een\u00e9 b\u00fdvaj\u00ed tak\u00e9 p\u0159ed\u010dasn\u011b narozen\u00e9 d\u011bti. Ty sleduje ji\u017e od narozen\u00ed d\u011btsk\u00fd neurolog, kter\u00fd dok\u00e1\u017ee dob\u0159e rozpoznat u\u017e prvn\u00ed p\u0159\u00edznaky nemoci.<\/p>\n

V n\u011bkter\u00fdch p\u0159\u00edpadech b\u00fdv\u00e1 ale velmi obt\u00ed\u017en\u00e9 stanovit spr\u00e1vnou diagn\u00f3zu v\u010das. U\u017e proto, \u017ee nemoc pot\u0159ebuje ur\u010ditou dobu k tomu, aby se rozvinula. Novorozenec s po\u0161kozen\u00fdm mozkem se tak zpo\u010d\u00e1tku nechov\u00e1 ve srovn\u00e1n\u00ed se sv\u00fdmi vrstevn\u00edky nijak n\u00e1padn\u011b. Projevy nemoci za\u010dnou b\u00fdt patrn\u00e9 a\u017e ve chv\u00edli, kdy jeho mozkov\u00e9 struktury dozraj\u00ed. Obvykle je odhal\u00ed pediatr p\u0159i n\u011bkter\u00e9 z pravideln\u00fdch preventivn\u00edch prohl\u00eddek a rodi\u010d\u016fm doporu\u010d\u00ed n\u00e1v\u0161t\u011bvu d\u011btsk\u00e9ho neurologa. Ten pak stanov\u00ed nejen diagn\u00f3zu, ale sna\u017e\u00ed se i odhalit p\u0159\u00ed\u010dinu onemocn\u011bn\u00ed.<\/p>\n

V\u011bt\u0161ina t\u011bchto d\u011bt\u00ed m\u00edv\u00e1 pohybov\u00e9 probl\u00e9my, velice \u010dast\u00e9 b\u00fdv\u00e1 ale i zv\u00fd\u0161en\u00e9 svalov\u00e9 nap\u011bt\u00ed. Nemoc v\u0161ak prov\u00e1z\u00ed i \u0159ada dal\u0161\u00edch komplikac\u00ed. Tyto d\u011bti leckdy trp\u00ed tak\u00e9 epilepsi\u00ed, m\u00edvaj\u00ed posti\u017eenou p\u00e1te\u0159, objevuj\u00ed se u nich i poruchy \u0159e\u010di nebo polyk\u00e1n\u00ed. Modern\u00ed medic\u00edna dok\u00e1\u017ee d\u011btskou mozkovou obrnu „pouze“ l\u00e9\u010dit, ale ne vyl\u00e9\u010dit. <\/p>\n

„S po\u0161kozen\u00edm mozku nic nenad\u011bl\u00e1me,“ \u0159\u00edk\u00e1 doktor H\u00e1lek, „m\u016f\u017eeme v\u0161ak minimalizovat jeho n\u00e1sledky tak, aby v\u00fdsledn\u00e1 pohybov\u00e1 funkce byla co nejlep\u0161\u00ed.“ A pr\u00e1v\u011b v tomto \u00fasil\u00ed podle jeho n\u00e1zoru nejv\u00edce pom\u00e1h\u00e1 c\u00edlen\u00e1 rehabilitace.<\/p>\n

Klob\u00e1sov\u00fd jed jako pomocn\u00edk<\/p>\n

Dlouholetou tradici m\u00e1 u n\u00e1s zejm\u00e9na metoda profesora V\u00e1clava Vojty, kter\u00fd u pacient\u016f s d\u011btskou mozkovou obrnou stimuloval ur\u010dit\u00e1m\u00edsta a sna\u017eil se tak u nich vyvolat reflexn\u00ed pohyb, kter\u00fd by vypadal \u00fapln\u011b stejn\u011b jako p\u0159irozen\u00fd. \u010casto u\u017e\u00edvan\u00e1 je tak\u00e9 metoda man\u017eel\u016f Bobathov\u00fdch, jej\u00edm\u017e c\u00edlem je dos\u00e1hnout relaxace svalov\u00e9ho nap\u011bt\u00ed pomoc\u00ed polohov\u00fdch a pohybov\u00fdch reflex\u016f.<\/p>\n

Uvol\u0148ovat ztuhl\u00e9 d\u011btsk\u00e9 svaly napom\u00e1haj\u00ed tak\u00e9 l\u00e9ky. „P\u0159i dlouhodob\u00e9m u\u017e\u00edv\u00e1n\u00ed si na n\u011b v\u0161ak pacient m\u016f\u017ee vyp\u011bstovat n\u00e1vyk,“ upozor\u0148uje docentka Ivana \u0160t\u011btk\u00e1\u0159ov\u00e1, p\u0159ednostka Neurologick\u00e9 kliniky 3. l\u00e9ka\u0159sk\u00e9 fakulty Univerzity Karlovy a Fakultn\u00ed nemocnice Kr\u00e1lovsk\u00e9 Vinohrady v Praze. „Z\u00e1rove\u0148 se mohou objevit i ne\u017e\u00e1douc\u00ed \u00fa\u010dinky jako je ospalost \u010di \u00fanava.“
\nNav\u00edc nep\u016fsob\u00ed pouze na c\u00edlov\u00e9 svalov\u00e9 skupiny, ale na cel\u00fd organismus. <\/p>\n

Proto se v posledn\u00edch desetilet\u00edch za\u010daly pou\u017e\u00edvat tak\u00e9 modern\u011bj\u0161\u00ed metody, jako je aplikace botulotoxinu neboli klob\u00e1sov\u00e9ho jedu p\u0159\u00edmo do posti\u017een\u00fdch sval\u016f. Tato metoda pom\u00e1h\u00e1 nejen d\u011btem s d\u011btskou mozkovou obrnou, ale i dosp\u011bl\u00fdm po c\u00e9vn\u00ed mozkov\u00e9 p\u0159\u00edhod\u011b nebo pacient\u016fm s roztrou\u0161enou skler\u00f3zou.
\nP\u016fsoben\u00edm botulotoxinu se naru\u0161\u00ed spoje mezi nervem a svalem, \u010d\u00edm\u017e se devastuje cel\u00e1 nervosvalov\u00e1 plot\u00e9nka. B\u011bhem t\u0159\u00ed m\u011bs\u00edc\u016f se v\u0161ak vytvo\u0159\u00ed plot\u00e9nka nov\u00e1, celkov\u011b zregenerovan\u00e1. D\u00edky tomu je d\u00edt\u011b mnohdy schopn\u00e9 l\u00e9pe j\u00edst, ps\u00e1t nebo chodit.<\/p>\n

„Efekt v\u0161ak nen\u00ed mo\u017en\u00e9 v\u017edy p\u0159edem spolehliv\u011b odhadnout,“ konstatuje doktor H\u00e1lek. „\u010c\u00e1st pacient\u016f je nav\u00edc nau\u010den\u00e1 se spastickou kon\u010detinou fungovat natolik, \u017ee jim zm\u011bna zp\u016fsob\u00ed sp\u00ed\u0161 probl\u00e9m.“ Ani tato metoda tedy rozhodn\u011b nen\u00ed pro ka\u017ed\u00e9ho.<\/p>\n

Dopravit l\u00e9k p\u0159\u00edmo na m\u00edsto<\/p>\n

V n\u011bkter\u00fdch p\u0159\u00edpadech pacient s t\u011b\u017ekou spasticitou nereaguje ani na tabletky ani na aplikaci botulotoxinu. „Nem\u016f\u017ee le\u017eet ani sed\u011bt ve voz\u00edku, pron\u00e1sleduj\u00ed ho svalov\u00e9 k\u0159e\u010de,“ p\u0159ibli\u017euje probl\u00e9my docentka \u0160t\u011btk\u00e1\u0159ov\u00e1. „V takov\u00e9m p\u0159\u00edpad\u011b je mo\u017en\u00e9 pod\u00e1vat pacientovi l\u00e9k na uvoln\u011bn\u00ed svalov\u00e9ho nap\u011bt\u00ed, baklofen, ve form\u011b roztoku.“
\nA to prost\u0159ednictv\u00edm baklofenov\u00e9 pumpy.<\/strong> Oproti tabletk\u00e1m m\u00e1 tento zp\u016fsob pod\u00e1v\u00e1n\u00ed velkou v\u00fdhodu v tom, \u017ee l\u00e9\u010div\u00e1 l\u00e1tka doputuje p\u0159\u00edmo tam, kde je j\u00ed zapot\u0159eb\u00ed, nevst\u0159eb\u00e1v\u00e1 se do ob\u011bhu a nezat\u011b\u017euje j\u00e1tra ani dal\u0161\u00ed org\u00e1ny. Men\u0161\u00ed d\u00e1vky l\u00e9ku tak p\u016fsob\u00ed nejen rychleji, ale i \u00fa\u010dinn\u011bji. Pacient v\u0161ak mus\u00ed v nark\u00f3ze podstoupit opera\u010dn\u00ed z\u00e1krok, p\u0159i n\u011bm\u017e mu neurochirurg zavede do p\u00e1te\u0159n\u00edho kan\u00e1lu mezi m\u00edchou a jej\u00edm obalem tenkou hadi\u010dku, kter\u00e1 je propojena s pumpou. Pot\u00e9 mu b\u011bhem cel\u00e9ho dne do t\u011bchto m\u00edst proud\u00ed p\u0159edem p\u0159esn\u011b naprogramovan\u00e9 d\u00e1vky baklofenu.<\/p>\n

„P\u016fl roku a\u017e rok hled\u00e1me spr\u00e1vnou d\u00e1vku,“ upozor\u0148uje docentka \u0160t\u011btk\u00e1\u0159ov\u00e1. „M\u011bla by co nejv\u00edce odpov\u00eddat re\u00e1ln\u00e9mu c\u00edli, jak\u00fd si p\u0159edem pacient stanov\u00ed.“ Co\u017e neb\u00fdv\u00e1 u dosp\u011bl\u00e9ho na rozd\u00edl od d\u00edt\u011bte p\u0159ece jenom tak velk\u00fd probl\u00e9m. Proto se tak\u00e9 nejsp\u00ed\u0161 tyto pumpy u dosp\u011bl\u00fdch pacient\u016f pou\u017e\u00edvaj\u00ed podstatn\u011b d\u00e9le ne\u017e u d\u011bt\u00ed. Na D\u011btsk\u00e9 klinice Fakultn\u00ed nemocnice Olomouc \u00fasp\u011b\u0161n\u011b pou\u017eili prvn\u00ed baklofenovou pumpu teprve loni.<\/p>\n

N\u011bkte\u0159\u00ed odborn\u00edci tak\u00e9 v\u011b\u0159\u00ed, \u017ee by d\u011btem s d\u011btskou mozkovou obrnou mohly do budoucna pom\u00e1hat i kmenov\u00e9 bu\u0148ky. Doktor H\u00e1lek je v\u0161ak skeptick\u00fd, proto\u017ee lidsk\u00fd mozek je velmi slo\u017eit\u00fd mechanismus. Zajistit, aby kmenov\u00e1 bu\u0148ka doputovala na spr\u00e1vn\u00e9m\u00edsto, nebude jednoduch\u00e9.<\/p>\n

Re\u00e1ln\u00fd pokrok mohou v\u0161ak podle n\u011bj o\u010dek\u00e1vat rodi\u010de d\u011bt\u00ed, kter\u00e9 vyr\u016fstaj\u00ed v l\u00e1skypln\u00e9m prost\u0159ed\u00ed, v\u00fdborn\u011b rehabilituj\u00ed a vyu\u017e\u00edvaj\u00ed v\u0161ech prost\u0159edk\u016f, kter\u00e9 modern\u00ed medic\u00edna nab\u00edz\u00ed.<\/p>\n

U n\u00e1s asi 1\u20133 d\u011bti z 1000 narozen\u00fdch maj\u00ed d\u011btskou mozkovou obrnu.<\/p>\n

Asi polovina pacient\u016f s d\u011btskou mozkovou obrnou se narodila p\u0159ed\u010dasn\u011b.<\/p>\n

Spastick\u00fdm typem onemocn\u011bn\u00ed (nadm\u011brn\u00fdm svalov\u00fdm nap\u011bt\u00edm) trp\u00ed asi 60\u201380 procent d\u011btsk\u00fdch pacient\u016f.<\/p>\n

S aplikac\u00ed baklofenov\u00fdch pump u d\u011bt\u00ed za\u010d\u00ednali u n\u00e1s jako prvn\u00ed l\u00e9ka\u0159i z Kliniky d\u011btsk\u00e9 neurologie pra\u017esk\u00e9 Fakultn\u00ed nemocnice Motol.<\/p>\n

P\u0159edej\u00edt v\u010das nemoci nen\u00ed v\u017edy mo\u017en\u00e9. N\u011bkter\u00fdm rizik\u016fm lze ale p\u0159esto zabr\u00e1nit d\u00edky pe\u010dliv\u00e9mu sledov\u00e1n\u00ed novorozenc\u016f.<\/p>\n

D\u011btsk\u00fdm pacient\u016fm pod\u00e1vaj\u00ed n\u011bkte\u0159\u00ed zahrani\u010dn\u00ed l\u00e9ka\u0159i botulotoxin u\u017e v kojeneck\u00e9m v\u011bku. U n\u00e1s se aplikuje a\u017e kolem 2. roku v\u011bku d\u00edt\u011bte.<\/p>\n

Od poloviny minul\u00e9ho stolet\u00ed se po\u010det nemocn\u00fdch d\u011bt\u00ed nijak dramaticky nem\u011bn\u00ed.<\/p>\n

Lidov\u00e9 noviny<\/p>\n","protected":false},"excerpt":{"rendered":"

Po\u010det pacient\u016f s d\u011btskou mozkovou obrnou se v posledn\u00edch letech nijak dramaticky nem\u011bn\u00ed. P\u0159ib\u00fdvaj\u00ed v\u0161ak nov\u00e9 metody, kter\u00e9 jim mohou usnadnit \u017eivot.<\/p>\n<\/div>","protected":false},"author":1,"featured_media":2052,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-23635","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/23635","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=23635"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/23635\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/2052"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=23635"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=23635"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=23635"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}