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Cilj rada je ustvrditi na koje načine bolest utječe na pojedinca, njegove vrijednosti, djelovanja te značenja pripisivana tijelu, a zatim i ima li potencijal promjene društvenih. Pritom se na bolest gleda kao na utjelovljeno iskustvo, a na tijelo kao na mjesto društvene koreografije. Ovaj pristup u fokus stavlja prostor intersubjektivnosti, odnosno propituje tenziju između individualnog subjekta i društveno konstruiranog objekta. Pritom u prvi plan dolaze pojmovi poput srama, epistemičke nepravde, aspektnog zatočeništva, ali i društveno-povijesni procesi koji utječu na poimanje i doživljavanje bolesti, poput kršćanstva, kartezijanskog naslijeđa te biomedicinskog diskursa. Metodologija kojom se koristim je etnografska, a obuhvaća kvalitativne intervjue, analizu autobiografskog narativa te stručne literature iz područja fenomenologije bolesti, medicinske antropologije i antropologije tijela. The purpose of this thesis is to determine the ways in which illness affects the individual, his values, actions and meanings attributed to the body, and subsequently whether it has the potential for social change. In doing so, illness is seen as an embodied experience, while the body is perceived as a place of social choreography. This approach focuses on the space of intersubjectivity, that is, questions the tension between the individual subject and the socially constructed object. Concepts such as shame, epistemic injustice, aspectival captivity come to the fore, but also socio-historical processes that influence our understanding and experiencing of illness, such as Christianity, the Cartesian legacy and the biomedical discourse. The methodology I use is ethnographic. It includes qualitative interviews, analysis of autobiographical narrative and of scientific literature from the fields of illness phenomenology, medical anthropology and anthropology of the body.

Uvod: Najpogostejša strukturna deformacija hrbtenice je skolioza. Pri nekaterih pacientih je mogoče določiti osnovni vzrok skolioze, vendar pa vzrok pri večini skolioz ni znan. Izraz idiopatska skolioza se nanaša na paciente, pri katerih ne najdemo jasnega vzroka bolezni. Adolescentna idiopatska skolioza je najpogostejša idiopatska skolioza, ki jo diagnosticiramo kadar je Cobbov kot na rentgenskem posnetku večji od 10°. Dejavniki ki napovedujejo povečanje patološke krivine hrbtenice so: zrelost (kronološka starost, menarha, skeletna zrelost, Risserjev znak), velikost, tip in lokacija krivine. Cilj konservativnega kot tudi operativnega zdravljenja skolioze je preprečiti napredovanje ukrivljenosti hrbtenice. Kot pomemben del konservativnega zdravljenja so se izkazale tudi stabilizacijske vaje, ki se pogosto uporabljajo pri zdravljenju adolescentne idiopatske skolioze. Namen: Namen diplomskega dela je, na podlagi pregleda strokovne in znanstvene literature, ugotoviti učinkovitost stabilizacijskih vaj pri pacientih z adolescentno idiopatsko skoliozo. Metode dela: Raziskave so bile izbrane v elektronski podatkovni zbirki PubMed s ključnimi besedami »adolescent scoliosis AND stabilization exercise«. Izbrane so bile raziskave, ki so ustrezale sledečim vključitvenim merilom: članki s prosto dostopnim celotnim besedilom, raziskave, ki so bile objavljene po letu 2012, randomizirane kontrolirane raziskave, raziskave, v katerih so ocenjevali učinkovitost stabilizacijskih vaj pri pacientih z adolescentno idiopatsko skoliozo. Rezultati: V pregled literature je bilo vključenih pet raziskav. V štirih raziskavah je bila učinkovitost stabilizacijske vadbe primerjana z drugo obliko vadbe (za skoliozo specifične fizioterapevtske vaje, vaje za osnovno zavedanje telesa, Schroth pristop), v eni raziskavi pa sta bili primerjani nadzorovana, vodena stabilizacijska vadba s strani strokovnjaka in nenadzorovana stabilizacijska vadba, izvajana samostojno v domačem okolju. V večini izbranih raziskav so ugotovili statistično značilno izboljšanje rezultatov meritev rotacije trupa s skolimetrom, Cobbovega kota, intenzitete bolečine, kakovosti življenja, vizualnega in haptičnega zaznavanja, zaznavanja položaja telesa, subjektivne zaznave deformacije trupa in izboljšanje periferne mišične moči. Večinoma so bile v teh raziskavah ugotovljene statistično značilne izboljšave znotraj posameznih intervencijskih skupin. Vse raziskave pa niso pokazale statistično značilnih razlik med različnimi vadbenimi pristopi, zato je potrebno nadaljnje raziskovanje. Razprava in zaključek: Rezultati pregledanih raziskav kažejo, da ima stabilizacijska vadba pozitivne učinke pri zmanjševanju intenzitete bolečine, povezane s skoliozo, preprečuje napredovanja skolioze, zmanjša asimetrijo in deformacijo hrbtenice ter vpliva na kakovost življenja posameznika s skoliozo. V prihodnjih raziskavah bi bilo potrebno upoštevati naslednja priporočila: vključiti večje število preiskovancev, daljše vadbene programe, uporabiti enotna merilna orodja za vrednotenje rezultatov in spremljati dolgoročne vplive vadbe. Introduction: Scoliosis is the most common structural deformity of the spine. In some patients, the underlying cause of scoliosis can be determined, but the cause of most scoliosis is unknown. Idiopathic scoliosis refers to patients in whom no clear cause of the disease is found. Adolescent idiopathic scoliosis is the most common idiopathic scoliosis and is diagnosed when the Cobb angle on the radiograph is greater than 10⁰. Factors predictive of increase in the pathological curvature of the spine are: maturity (chronological age, menarche, skeletal maturity, Risser sign), size, type and location of curvature. The aim of conservative as well as operative treatment of scoliosis is to prevent the progression of spinal curvature. Stabilisation exercises, which are commonly used in the treatment of adolescent idiopathic scoliosis, have proven to be an important part of conservative treatment. Purpose: The aim of this diploma work is to determine the effectiveness of stabilisation exercises in patients with adolescent idiopathic scoliosis based on a review of the literature. Methods: Studies were selected if they met the following inclusion criteria: articles with freely available full text, studies published after 2012, randomised controlled trials, studies evaluating the effectiveness of stabilisation exercises in patients with adolescent idiopathic scoliosis. Results: Five studies were included in the literature review. Four studies compared the effectiveness of stabilisation exercise with another form of exercise (Scientific Exercises Approach to Scoliosis, basic body awareness therapy, Schroth exercises) and one study compared supervised, guided stabilisation exercise with unsupervised stabilisation exercise performed independently in the home environment. Most studies found statistically significant results within-group differences for measures of trunk rotation with a scoliometer, Cobb angle, pain intensity, quality of life, visual and haptic perception, body position perception, subjective perception of trunk deformity, peripheral muscle strength. However, not all studies showed the same statistically significant differences between the different exercise approaches, so further investigation is needed. Discussion and conclusion: The results of reviewed research suggest that stabilisation exercise has positive effects in reducing the intensity of pain associated with scoliosis, preventing scoliosis progression, reducing asymmetry and spinal deformity, and affects on the quality of life of individuals with scoliosis. Future research should consider the following recommendations: include a larger number of subjects, longer exercise programmes, use uniform measurement tools to evaluate the results and monitor the long-term effects of exercise.

Skolioza je medicinsko stanje koje je, u širem smislu, opisano kao lateralna zakrivljenost kralježnice, odnosno zakrivljenost u frontalnoj ravnini. Međutim, skolioza nije iskrivljenje kralježnice samo u jednoj (frontalnoj) ravnini nego u sve tri ravnine (i sagitalnoj i horizontalnoj). Dakle, radi se o trodimenzionalnoj deformaciji kralježnice. Kralježnica je u frontalnoj ravnini savijena prema lateralno (postranično), u sagitalnoj je ravnini smanjena fiziološka torakalna kifoza (ili fiziološka lumbalna lordoza), a u horizontalnoj ravnini nastaje torzija kralježaka (zavrtanje jednog dijela trupa prema drugom dijelu trupa) uz rotaciju cijele kralježnice (oko uzdužne osovine), zajedno s rebrima. Tako nastaje deformitet prsnog koša sa stražnjom rebrenom grbom na strani konveksiteta zakrivljenosti te prednjom rebrenom grbom na strani konkaviteta zakrivljenosti. U lumbalnom dijelu gdje nema rebara, izbočenje (grba) je znatno manje,a izbočenje se odnosi na vrh zdjelice i na meka tkiva. Kroz povijest su se prije svega koristile konzervativne metode,tj. ne operacijske kojima se pokušala zaustaviti progresija ili pak potpuno izlječenje osobe sa skoliozom. Danas su glavne metode konzervativnog liječenja fizikalna terapija i terapija ortozama. Razlikujemo više oblika i metoda tjelovježbe od kojih su se neke formirale od početka 20.stoljeća. Danas ih prilagođavamo potrebama svakog pacijenta, također razlikujemo brojne oblike ortoza u liječenju skolioza s naglaskom od koliko dijelova su rađene, od kakvog su materijala, na koji segment kralježnice djeluju itd. Scoliosis is a medical condition that, in a broader sense is described as a lateral curvature of the spine, ie a curvature in the frontal plane. However, scoliosis is not a curvature of the spine in only one (frontal) plain but in all three plaines (sagittal and horizontal). Thus, it is a three-dimensional deformity of spine. The spine is bent laterally in the frontal plain, physiological thoracic kyphosis (or physiological lumbar lordosis) is reduced in the sagittal plain, and torsion of the spine occurs in the horizontal plain (rotation of one part of the torso towards the other part of the torso) with rotation of the whole spine (around the longitudinal axis), together with the ribs. This creates a deformity of the chest with the posterior rib crest on the side od the convexity of curvature and the front rib crest on the side of the concavity of curvature. In the lumbar region where there are no ribs, the protrusion (hump) is much smaller, and the protrusion refers to the top of the pelvis and to the soft tissues. Throughout history, conservative methods have been used, ie non – surgical methods that tried to stop the progression or complete cure of each patient, we also distinguish many forms of orthosis in treatment of scoliosis with emphasis on how many parts they are made of, what material they are, what segment of the spine they act on,etc.

Patients with severe adolescent idiopathic scoliosis (AIS) require instrumented spinal fusion surgery. The range of instrumented vertebra is still questioned, especially the selection of the lowest instrumented vertebra (LIV). This single institution retrospective consecutive study is to provide real-world data on outcomes. The study aims to assess whether bending films can determine the LIV. The method of determination of the lower tilted vertebra (LTV) is presented. The selection of the LTV was identified on standing PA (LTVs) and on bending X-rays (LTVb). Group A is a reference group, with less flexible curves. Groups B and C contained patients with more flexible curves. Group B covered patients with instrumentation ending at the LTVs and group C with shorter instrumentation ending at LTVb. The disc angle below the LIV was monitored for postoperative decompensation. Sixty-eight subjects with AIS Lenke 1A and 1B types underwent selective fusion. The decompensation criteria of the unfused disc below the fusion were determined as a wedging disk of >5 degrees of the Cobb angle. The patients were monitored during the postoperative period with 5.8 years average followup (minimum of 2 years). The rate of decompensation was comparable in groups A and B (31% and 33%, respectively). In contrast, the rate of decompensation was doubled in group C (60%). Caudal fusion shortening in more flexible curves according to bending films is associated with the first free disc asymmetry, which leads to decompensation below the fusion. This method should be considered in addition to other LIV selection criteria. Pacienti s těžkou adolescentní idiopatickou skoliózou (AIS) vyžadují operační léčbu instrumentovanou spinální fúzí. Rozsah instrumentované fúze je stále zpochybňován, zejména výběr nejnižšího instrumentovaného obratle (LIV). Tato retrospektivní konsekutivní studie poskytuje real-world data evidence. Cílem studie je posoudit, zda úklonové snímky páteře mohou ovlivnit selekci LIV. Je uvedena metoda stanovení dolního tiltovaného obratle (LTV). Výběr LTV byl identifikován na stojících PA (LTV) a na úklonových rentgenových snímcích (LTVb). Skupina A je referenční skupina s méně flexibilními křivkami. Skupiny B a C obashují pacienty s flexibilnějšími křivkami. Skupina B zahrnuje pacienty s instrumentací končící na LTV a skupina C s kratší instrumentací končící na LTVb. Úhel disku pod LIV byl sledován pro pooperační dekompenzaci. Šedesát osm subjektů s typy AIS Lenke 1A a 1B podstoupilo selektivní fúzi. Kritéria dekompenzace prvního volného disku pod fúzí byla stanovena jako úhel disku s >5° Cobbova úhlu. Pacienti byli sledováni v pooperačním období s průměrnou dobou sledování 5,8 roku (minimálně 2 roky). Míra dekompenzace byla srovnatelná ve skupinách A a B (31 %, resp. 33 %). Naopak míra dekompenzace byla ve skupině C dvojnásobná (60 %). Zkracování kaudální fúze v pružnějších křivkách podle úklonových snímků je spojeno s asymetrickým rozevřením disku, které vede k dekompenzaci pod fúzí. Tato metoda by měla být brána v potaz jako doplněk k dalším kritériím výběru LIV.

Sažetak: Glavni cilj ovog istraživanja bio je na osnovu pregleda najnovijih smjernica za skoliozu sistematizirati te prikazati najnovije smjernice za fizioterapijsku procjenu kod pojedinih tipova skolioze. Pri tomu je naglasak bio na standardnoj fizioterapijskoj procjeni. Za prikupljanje podataka korištene su sljedeće baze podataka: PubMed, Pedro i Google Scholar, zaključno sa 12. veljače 2022. godine. Radovi su navedeni prema referencama, a uključivali su one koji su imali za cilj prikazati pristup u liječenju raznih tipova skolioze te smjernice za terapiju istih. Nakon sustavnog pregleda literature, odnosno metoda pristupa tretiranju skolioze, može se reći da je kod navedenih smjernica za provođenje fizioterapijske procjene utvrđena klinička vjerodostojnost. Obzirom na multifaktorsku etiologiju skolioze, pristup fizioterapijskoj procjeni također treba sagledati u tom kontekstu. Stoga je jedan od glavnih ciljeva međunarodnog Znanstvenog društva za ortopedsko i rehabilitacijsko (konzervativno) liječenje skolioze uskladiti glavne smjernice za standardnu procjenu skolioze. Upravo su fizioterapeuti važna karika za uspješno djelovanje u prevenciji daljnjeg razvoja i terapiji skolioze. Summary: The main objective of this review was to systematize and present the latest guidelines for physiotherapy assessment in certain types of scoliosis based on a review of the latest guidelines for scoliosis. The emphasis was on standard physiotherapy assessment. For data collection, PubMed, Pedro and Google Scholar were used, as of February 12, 2022. The papers were listed according to the references. They included those that aimed to present an approach in the treatment of various types of scoliosis and guidelines for their treatment. After a systematic review of the literature, ie the method of approach to the treatment of scoliosis, it can be said that the clinical guidelines have been established in the above guidelines for conducting physiotherapy assessment. Given the multifactorial etiology of scoliosis, the approach to physiotherapy assessment should also be considered in this context. Therefore, one of the main goals of the International Scientific Society for Orthopedic and Rehabilitation (Conservative) Treatment of Scoliosis is to harmonize the main guidelines for standard assessment of scoliosis. Physiotherapists are an important link for successful action in the prevention of further development and treatment of scoliosis.

Uvod: Hrbtenica omogoča telesu gibljivost trupa in glave, prav tako pa mu daje oporo, ravnotežje in pokončno držo. Pri človeku ima v sagitalni ravnini obliko črke S, v frontalni ravnini pri vzravnanem telesu pa je ravna. V prsnem in križničnem delu je izbočena nazaj, v ledvenem in vratnem delu pa naprej. Raznovrstne deformacije in bolezenski procesi pa lahko privedejo do stranske ukrivljenosti hrbtenice ali skolioze. Danes jo opredeljujemo kot tridimenzionalno torzijsko deformacijo hrbtenice in trupa, ki povzroči lateralni odklon v frontalni ravnini, aksialno rotacijo v horizontalni ravnini in spremembo sagitalnega profila. Idiopatskih skolioz je 80 %, ostalih 20 % pa sekundarnih. Zdravljenje skolioze lahko poteka operativno oziroma konzervativno. Namen: Namen diplomskega dela je raziskati vplive konzervativnega in operativnega zdravljenja za paciente v odrasli dobi. Metode dela: V diplomskem delu je bila uporabljena deskriptivna metoda s pregledom domače in tuje literature pri primerjavi med ortotičnim in operativnim zdravljenjem pri pacientih z AIS. Analizirali smo tri vprašalnike ter na podlagi pregledanega sestavili anketo, s katero smo anonimno anketirali odrasle paciente z adolescentno idiopatsko skoliozo. Rezultati: Anketni vprašalnik je sestavljen iz osnovnih podatkov, ki zajemajo starost in spol preiskovancev ter šestnajst vprašanj o velikosti krivine hrbtenice pred in po zdravljenju AIS, bolečini, težavah z dihanjem ter vrstah zdravljenja. V raziskavi je sodelovalo 71 oseb, od tega je bilo 63 žensk in 8 moških. Povprečna starost preiskovancev je bila 39,1 let. Razprava in sklep: Med pregledom rezultatov ankete smo ugotovili, da je bila večina preiskovancev zdravljenih konzervativno, nekaj pa tudi operativno. Preiskovanci so navajali močne bolečine in težave z dihanjem predvsem ob večjem fizičnem naporu. Prišli smo do spoznanja, da se zdravstveno stanje pacientov s starostjo slabša, prav tako pa smo opazili, da delež pacientov z AIS ne pozna velikosti ukrivljenosti svoje hrbtenice. Introduction: The spine enables the movement of the torso and head, as well providing it with support, balance and an upright posture. The sagittal plane of the human spine is the shape of an 'S', whereas the frontal plane of an upright corpus is straight. It is extruded backwards at the height of the chest and sacrum, intruded at the kidneys and neck. Various deformations and illnesses can also lead to a lateral deformation of the spine or scoliosis. Today this condition is classified as a three-dimensional torsional deformation of the spine, caused by a lateral deviation of the frontal plane, axial rotation of the horizontal plane, implicitly, the change of the sagittal profile. The total of 80 % of all cases are recognized as idiopathic scoliosis, with the other 20 % being secondary. Treatment of this condition can be surgical or conservative. Purpose: The intent of the diploma thesis is to research the impacts of both conservative and surgical treatment methods on adult patients. Methods: The literature review of domestic and foreign literature was conducted. Comparisons of orthotic and operative treatments on patients with AIS were of primary focus in the source material. We analyzed three questionnaires and based on the review we compiled a survey with which we will anonymously survey adult patients with adolescent idiopathic scoliosis. Results: The survey questionnaire consists of basic data, which are gender and age and sixteen questions, which were all related to the curvature of spine before and after treatment of AIS, pain, breathing problems and form of treatment. In total, 71 people participated in the survey, 63 of which were women and 8 participants were men. The average age of participants was 39.1 years. Discussion and conclusion: Upon analysis it was determined that most subjects were treated conservatively, only a few were treated operatively. Subjects reported of severe pain and difficult breathing, especially with increased physical exertion. It can be observed that the health status of patients deteriorates with age. The data also show that a number of patients with AIS are not aware of the extent of their spinal curvature.

Koncept kvalitete života se često koristi u medicini kao ishodišna mjera određenog liječenja ili rehabilitacije. Zbog toga danas postoje brojni upitnici kojima se mjeri kvaliteta života kod raznih patoloških stanja te mjerni instrumenti za procjenu kvalitete života kod osoba s deformacijama kraljeţnice. S obzirom na to da je idiopatska skolioza na prvom mjestu deformiteta po prevalenciji i po kompleksnosti, uzorak u istraživanju čine adolescenti s dijagnozom idiopatske skolioze tretirani specijaliziranim vježbama po Schroth metodi. SRS-22r upitnik, koji se koristi kod procjene kvalitete života osoba sa skoliozom neovisno o načinu liječenja, do sada nije bio validiran u Republici Hrvatskoj. Osnovni cilj ovog rada je stoga validacija i multikulturalna adaptacija spomenutog mjernog instrumenta. Prvi korak istraživanja bio je proces prijevoda upitnika u duhu hrvatskog jezika. Nakon toga uslijedio je proces validacije. Upitnik sadrži 22 čestice odnosno 22 pitanja koja čine pojedine subskale unutar samog upitnika. Statističkim rječnikom rečeno učinjena je faktorska analiza čestica u upitniku te je mjerena unutarnja konzistencija tih čestica u hrvatskoj verziji prijevoda. Na taj način su dobivene sljedeće subskale: mentalno zdravlje, bol, slika o sebi, funkcionalnost, aktivnost i (ne)zadovoljstvo terapijom. Iako testiranje ne daje identičnu strukturu izvorne verzije upitnika, njime je potvrđeno da je upitnik primjenjiv u zadanom uzorku istraživanja na hrvatskom jeziku. Na osnovu demografskih čimbenika iz upitnika o osobnim podatcima, kao sporedna stvar istraživanja bilo je ispitivanje sporednih hipoteza od kojih su dvije pokazale statistički značajnu razliku. Ispitanici koji nisu imali indikaciju za nošenje ortoze imali su značajno viši rezultat na subskali slika o sebi. To nam govori kako osobe koje ne nose ortozu sebe vide bolje. Ispitanici muškog roda imaju značajno viši rezultat na subskali mentalno zdravlje što govori kako dječaci sa skoliozom imaju manje emocionalnih problema u usporedbi s djevojčicama. Klinički značaj istraživanja leži u tome da je upitnik primjenjiv u budućnosti kao dio slžţbene medicinske dokumentacije u procjeni stanja kod deformacija kralježnice. The concept of quality of life is often used in medicine as a finishing point for a particular treatment or rehabilitation. For this reason, today we have a number of questionnaires that measure the QoL in various pathological conditions. There are also measuring instruments for assessing the quality of life in people with spinal deformities. Since idiopathic scoliosis is the number one deformity in terms of prevalence and also in terms of complexity, the sample in the study consisted of adolescents diagnosed with idiopathic scoliosis treated with specialized exercises according to the Schroth method. The SRS-22r questionnaire used to assess the QoL of people with scoliosis, regardless of the method of treatment, has not yet been validated in Croatia. Therefore, the main goal of this study was the validation and multicultural adaptation of the mentioned measuring instrument. The first step was to translate the questionnaire authentically in the spirit of the Croatian language. After that the validation process could begin. Factor analysis of individual particles in the questionnaire was performed and the internal consistency of the Croatian version was measured. Testing did not give an identical version of the original, but confirmed that the questionnaire was applicable in a selected sample. A side issue of the research was to examine secondary hypotheses compiled within individual subscales of the questionnaire based on demographic factors from the personal data questionnaire. Two statistically significant differences were found; subject who have no indication for wearing an orthosis have a significantly higher score on the self-image subscale which tells us how people who do not wear orthoses see themselves better. Male respondents have had a significantly higher score on the mental health subscale suggesting that boys with scoliosis have fewer emotional problems compared to girls. The clinical significance of the research lies in the fact that the questionnaire is applicable in the future as part of the official medical documentation in the assessment of the condition of spinal deformities.

Skolioza je trodimenzionalna deformacija kralježnice u sve tri ravnine, a danas se javlja sve češće zbog sjedilačkog načina života. Osoba koja ima skoliozu najčešće svoje držanje i posturu drži u pasivnom obliku zbog hipotonije ili hipertonije muskulature. Prema etiologiji dijele se na dvije velike skupine: funkcionalne i strukturalne. Funkcionalne se dijele na posturalne i kompenzatorne, dok se strukturalne dijele na kongenitalne i stečene (idiopatske) skolioze. Čimbenici koji utječu na pojavu skolioza najčešće su nagli rast u pubertetu, genetske predispozicije, neurološki deficiti, promjene u mišićnim i vezivnim strukturama, no najčešće je problem u načinu života, odnosno premalo tjelesne aktivnosti. Češće su u djevojčica, nego u dječaka te stvaraju velike zdravstvene, ali i estetske probleme. Dijagnostičke metode uz pomoć kojih se ustanovljuje skolioza ili skoliotično držanje su klinički pregled koji obuhvaća specifične testove, mogućnost rendgenskih snimaka, CT, magnetska rezonanca. Skolioze se liječe konzervativno uz pomoć tjelesne aktivnosti, korektivne gimnastike i primjenom ortoza. Visoku učinkovitost u korekciji skolioza pokazuju primjena kinesio tape-a, plivanje i hipoterapija. Skoliozu je potrebno otkriti što ranije i započeti liječenje na vrijeme kako bi se spriječile moguće komplikacije. Prije operativnog liječenja, ukoliko je neophodno, važno je provesti sve konzervativne metode liječenja kojih je danas sve više. U rehabilitaciji skolioza neophodna je suradnja svih članova tima, uključujući pacijenta i njegovu obitelj. Nastanak skolioze i skoliotičnog držanja mogu se spriječiti edukacijom populacije o korisnosti kretanja i tjelesne aktivnosti te pravilnih navika sjedenja, stajanja, hodanja i nošenja tereta. Scoliosis is a three-dimensional deformity of the spine in all three planes, and today it occurs more and more often due to a sedentary lifestyle. A person who has scoliosis usually keeps his posture in a passive form due to hypotonia or hypertension of the musculature. According to the etiology, we can divide them into two large groups: functional and structural. Functional are divided into postural and compensatory, and structural into congenital and acquired (idiopathic) scoliosis. Factors influencing the occurrence of scoliosis are most often sudden growth at puberty, genetic predispositions, neurological deficits, changes in muscles and connective structures, but most often the problem is lifestyle, or too little physical activity. They are more common in girls than in boys and create major health and aesthetic problems. Diagnostic methods used to establish scoliosis or scoliotic posture are a clinical examination that includes specific tests, the possibility of X-rays, CT, magnetic resonance imaging. Scoliosis is treated conservatively with the help of physical activity, corrective gymnastics and the use of orthoses. The use of kinesio tape, swimming and hippotherapy show high efficiency in the correction of scoliosis. Scoliosis needs to be detected as early as possible and treatment started on time to prevent possible complications. Before surgical treatment, if necessary, it is important to implement all conservative methods of treatment, which are more and more common today. In the rehabilitation of scoliosis, the cooperation of all team members is necessary, including the patient and his family. The development of scoliosis and scoliotic posture can be prevented by educating the population about the usefulness of movement and physical activity and proper habits of sitting, standing, walking and carrying loads.

Cilj ovog istraživanja je ispitati kvalitetu života povezanu sa zdravljem [KŽPZ] u odraslih osoba s adolescentnom idiopatskom skoliozom [AIS]. Cilj istraživanja operacionaliziran je kroz dva istraživačka problema: ispitati razinu kvalitete života povezane sa zdravljem odraslih osoba s adolescentnom idiopatskom skoliozom te ispitati doprinos percepcije bolesti, socijalne podrške, prihvaćanja bolesti i trenutne psihološke uznemirenosti u objašnjenju kvalitete života povezane sa zdravljem. Istraživanje je provedeno putem online upitnika na ukupno 127 sudionika u dobi od 17-50 godina (M=25.9, SD=6.58). U istraživanju je sudjelovalo 112 žena i 15 muškaraca. Sudionici su pružili sociodemografske i zdravstvene informacije te ispunili sljedeće upitnike: skraćena verzija Upitnika o percepciji bolesti, SRS-22r upitnik o kvaliteti života povezanoj sa zdravljem za osobe sa skoliozom, Upitnik prihvaćanja bolesti, Višedimenzionalna ljestvica percipirane socijalne podrške te Upitnik za ispitivanje općih psihopatoloških teškoća CORE-OM. Rezultati pokazuju kako većina sudionika doživljava barem blagu bol radi kralježnice, a slika o sebi prosječno je blago narušena, kao i njihovo psihičko zdravlje. Najveće prosječno nezadovoljstvo sudionika tiče se njihovog tretmana, pri čemu većina sudionika ne iskazuje zadovoljstvo tretmanom leđa te nije sigurna da bi ili sigurno ne bi ponovno izabrala isti tretman. Ukupan rezultat ukazuje na prosječno blago sniženu KŽPZ sudionika. Značajnim prediktorima KŽPZ pokazali su se: prihvaćanje bolesti, percepcija bolesti i psihološka uznemirenost. Dobiveni rezultati ukazuju na potrebu holističkog pristupa pacijentima s AIS te eventualnu dobrobit psihoedukacije ili slične psihološke intervencije. The aim of the study was to investigate health-related quality of life [HRQL] in adults with adolescent idiopathic scoliosis [AIS]. Two research problems included examining the level of health-related quality of life in adults with adolescent idiopathic scoliosis and examining the contribution of perception of illness, social support, illness acceptance and current psychological distress in explaining health-related quality of life. The research was conducted through an online questionnaire on 127 participants aged between 17-50 years old (M=25.9, SD=6.58). There were 112 women and 15 men. Participants provided sociodemographic and health data and completed the following questionnaires: Brief Illness Perception Questionnaire, SRS-22r HRQL Questionnaire, Acceptance of Illness Scale, Multidimensional Scale of Perceived Social Support, and The Young Person's Clinical Outcomes in Routine Evaluation. Results show that most participants experience at least minor pain due to their spine issues, and their self-image, as well as mental health, is mildly impaired. Participants are most unhappy with their treatment, where most participants don’t state they are satisfied with their back treatment and aren’t sure if they would, or they certainly wouldn’t pick the same treatment again. The total score shows a mildly disturbed HRQL. Illness acceptance, illness perception and current psychological distress are significant predictors of HRQL. These results indicate the need for holistic approach in treating AIS patients and potential benefits of psychoeducational or a similar type of intervention for these patients.

Idiopatska skolioza je razvojni poremećaj kralježnice s postraničnom krivinom u frontalnoj ravnini uz kut prema Cobbu veći od 10 st. Izražena u manjem stupnju je estetski poremećaj, ali kod većeg može doći do oštećenja funkcije srca i pluća. Zbog nepoznavanja etio- logije liječenje je simptomsko, usmjereno na ranije prepoznavanje i pravodobno liječenje radi sprječavanja progresije. Cilj istraživanja je identificiranje prediktora za razvoj idiopatske skolioze analizom perinatalnih čimbenika, ranog razvoja i prirođenih malformacija sustava za kretanje, kako bi se anamnezom i kliničkim pregledom prepoznala rizična djeca. Analizirali smo 100 ispitanika s idiopat- skom skoliozom (79 djevojčica i 21 dječak) u dobi od 6-18 godina s kutom prema Cobbu od 15 i više stupnjeva, te kontrolnu skupinu od 100 ispitanika bez idiopatske skolioze. Podatci su unešeni u upitnik, a statistička analiza rađena je Mann-Whitneyjevim, Leveneo- vim testom, hi-kvadrat, Fisherovim egzaktnim i t-testom. U ispitivanim skupinama našli smo značajnu razliku u parametrima: miro- vanje majki u trudnoći, faza puzanja, menarhe i mutacija glasa, pojavnost ravnih stopala, dorzalgija, skraćenje noge i deformacija koštano-zglobnog sustava. Kod devetero djece kasno je dijagnosticirana skolioza u dobi od 15-18 godina, a prema tipu skolioze bilo je: 4C 55, 3C 20, E 18 i n3n4 7 ispitanika. Postoji značajna razlika u skupini djece s idiopatskom skoliozom i bez nje u razvoju, simptomi- ma i deformacijama koštanog sustava koje se identificiraju anamnezom i pregledom prije kliničkih znakova, a upućuju na povećani rizik razvoja u kasnijoj životnoj dobi. Sastavili smo upitnik ispunjavanjem kojeg kod mlađe klinički neupadne djece identificiramo onu s povećanim rizikom, te ih možemo češće kontrolirati, ranije dijagnosticirati idiopatsku skoliozu i započeti optimalno liječenje., Idiopathic scoliosis is a developmental disorder of the spine with lateral curvature in the frontal plane and Cobb angle of more than 10 degrees. Idiopathic scoliosis with minor Cobb angle is an aesthetic disorder, but a significant Cobb angle can cause damage to the heart and lung function. Because its aetiology is unknown, treatment is symptomatic, focused on early recognition and timely treatment to prevent progression. The objective of the study was to identify predictors for the development of idiopathic scoliosis by analysis of perinatal factors, early development and congenital malformations of the locomotor system in order to identify children at risk by history and clinical examination. We analysed 100 subjects with idiopathic scoliosis, 79 girls and 21 boys aged 6-18 years with a Cobb angle of 15 degrees or more, and a control group of 100 subjects without idiopathic scoliosis. Data were entered into the questionnaire, and statistical analysis was done by Mann-Whitney test, Levene test, χ2-test, Fisher exact test and t-test. In the idio- pathic scoliosis group, significant differences were recorded in the following parameters: complications/rest during pregnancy, crawling stage, menarche, and mutation/voice change in boys, expression of flat feet, dorsalgia, leg shortening and deformities of the musculoskeletal system. Idiopathic scoliosis was diagnosed late in nine children aged 15-18 years; according to the type of sco- liosis, 4C type was recorded in 55, 3C in 20, E in 18 and n3n4 in seven subjects. In conclusion, there was a significant between-group difference in development, symptoms and deformities of the skeletal system, identified by history and examination before the onset of clinical signs of idiopathic scoliosis, indicating an increased risk of scoliosis development later in life. We have designed a question- naire to be filled out for younger clinically inconspicuous children in order to identify those at an increased risk, so we can follow-up them more often, diagnose idiopathic scoliosis earlier and start optimal treatment on time.

Skolioza predstavlja učestalu deformaciju kralješnice koju karakterizira patološka lateralna zakrivljenost kralješnice povezana s različitim stupnjem hiperlordoze i poremećajem rotacije s Cobb-ovim kutom zakrivljenosti većim od 10 stupnjeva. Patogeneza i etiologija skolioze je multifaktorijalna te uključuje brojne dokazane okolišne (konzumiranje alkohola, nedostatak vitamina kod KS) i genetske (jednonukleotidni polimorfizam) faktore, no unatoč tome točni molekularni i stanični mehanizmi razvoja bolesti i dalje su nepoznati.

Uvod: Korekcijska spinalna ortoza je pomembna in jo priporočajo pri zdravljenju skeletno nezrelih najstnikov z AIS ter pri tistih, ki imajo krivino 25°- 40° po Cobbu. Lyon ortoza ali nastavljiva modularna-večdelna ortoza se uporablja že več kot 60 let. Razvile so se tri nivojske različice teh ortoz te so torakalna, torakolumbalna in lumbalna Lyon ortoza. Ta ortoza omogoča zdravljenje vseh krivin, odstopajočih od normale, razen primarne visoke torakalne krivine, za katero priporočimo Milwaukee ortozo. ART ortoza je nova asimetrična, iz trdnega polikarbonata, torzijska ortoza, izdelana z dvema asimetričnima lateralnima polikarbonatnima deloma, ki sta na sredini povezana z navpično tračnico iz kovine. Cilj ART ortoze ni le dobiti ravno hrbtenico, temveč poravnati obliko trupa, nastalo zaradi skolioze. Ta korekcija je mogoča le, če vretenca niso deformirana, v nasprotnem primeru želimo poudariti popravek asimetrije pritiska na telesa vretenc. Namen: Namen diplomskega dela je predstaviti Lyon in ART korekcijski spinalni ortozi s pomočjo pregleda strokovne literature. Predstaviti želimo zgodovinski razvoj ortoz, njihovo funkcijo, indikacije in kontraindikacije, učinkovitost delovanja na uporabnika in primerjavo rezultatov. Metode dela: V diplomskem delu je bila uporabljena deskriptivna metoda dela s pregledom domače in tuje literature s področja spinalne ortotike, bolj natančno Lyon in ART korekcijskih ortoz. Literaturo smo iskali na spletnih portalih COBISS in DiKUL ter v bibliografskih podatkovnih bazah Google Učenjak, MEDLINE, CINAHL in PubMed. Rezultati: Nekatere študije kažejo dobre rezultate ART ortoze za takojšnje zmanjšanje skolioze, nato pa se trend ohranja še 6 mesecev in eno leto po začetnem nošenju. Torej novi koncepti in prvi rezultati ART ortoze, ki so definirani kot spremenjena ali "nova" Lyon ortoza, potrjujejo, da lahko ta ortoza popolnoma zamenja antigravitacijski korekcijski mavec in staro Lyon ortozo. Zmanjšanje Cobbovega kota po enem letu zagotovo tudi ni končni rezultat zdravljenja (2 leti po odstavitvi ortoze), čeprav nekateri avtorji v tem trenutku kot napovedno mero uporabljajo njegovo zmanjšanje. Razprava in zaključek: Uporaba ortoze pri konzervativnem zdravljenju AIS ima pomembno vlogo, katere cilj je preprečitev nastanka deformacije pri kostno nezrelih mladostnikih in posledično težav v odraslem obdobju. Pri kakovosti posameznih ortoz se mnenja avtorjev razlikujejo, zato je narejenih več raziskav o učinkovitosti le teh. Pri uporabi Lyon ortoz je konzervativno zdravljenje dokazano kot zelo učinkovito. Ambulantno izvajanje korekcije skolioz z antigravitacijskim mavcem in Lyon ortozami je bilo finančno ugodno in otroku omogočalo nemoten pouk. Za nov način izdelave ortoze se strokovnjaki odločajo zaradi izboljšanja kakovosti, predvsem pa zaradi zadovoljstva pacientov, saj s tem pripomorejo k njihovemu boljšemu počutju med izdelavo kot tudi nošenjem ortoze in čim hitrejšemu okrevanju. Učinkovito ortotično zdravljenje ima velik pomen pri pacientovem poteku bolezni. Potrebno je izbrati pravilno vrsto ortoze, saj jo pacient uporablja večji del dneva in močno vpliva na kvaliteto njegovega življenja. Introduction: The correctional spinal orthosis is a very important and recommended tool for treating adolescents with under developed bone structures. It is mostly used for treating younger people with AIS and for people with a 25° to 40° scoliosis according to Cobb. The Lyon orthosis or the modular-multi-part adjustable orthosis has been used for over 60 years. It has developed into 3 subcategories: the thoracic, thoracolumbal and lumbal Lyon orthoses. The Lyon orthosis can be used for treating all kinds of scoliosis (deviating from the normal values). The ART orthosis is a new asymmetric orthosis made from hard polycarbonate. It is a torsional orthosis made from two asymmetric polycarbonate lateral parts that are connected to each other through the middle with a vertical metal track. The goal of the ART orthosis is not only to straighten the spine but also to correct the shape of the body caused by the scoliosis called the scoliosis correction. The purpose: The purpose of the thesis is to present the Lyon and ART correctional spinal orthosis based on professional literature. The orthoses will be described according to their development, function, indications, contraindications and efficiency with the comparison of the results. Methods: Work method is based on the literature review. The review of domestic and foreign literature on spinal orthotics, with special emphasis on the Lyon and ART orthoses was conducted. The literature was searched in COBISS and DiKUL platforms and bibliographic databases such as Google Scholar, MEDLINE, CINAHL and PubMed. Results: Some studies point to the results of ART orthosis for the immediate reduction of scoliosis, and then the trend is maintained for another 6 months within one year of wearing. Therefore the new concepts and the first results of ART orthosis, defined as altered or "new" Lyon orthosis, confirm that the antigravitation plaster cast and the old Lyon orthosis can be replaced. Angular reduction in the first year is also certainly not the final result of the treatment (2 years after the removal of orthosis), therefore further studies are needed. Conclusion: The use of the orthosis in conservative AIS treatment has a significant role. The goal is to prevent a deformity in adolescents with bone structures not yet fully developed, thereby preventing further problems in adulthood. The opinions of authors differ regarding the quality of different kinds of orthosis. Therefore, various researches about the efficiency of different kinds of orthosis were conducted. It has been proven that conservative treatment is very successful when using the Lyon orthosis. Clinical scoliosis correction with a antigravitation plaster cast and a Lyon orthosis is an inexpensive way of treating scoliosis and it allows children to continue their education. The improved orthosis was decided upon due to higher quality, the added comfort during the manufacture and wearing and faster rehabilitation. Efficient orthotic treatment has an important role in the development of the medical condition. The correct orthosis should be selected since it is worn up to 23h a day and it effects the quality of patient’s life.

Introduction. Surgical treatment of structural adolescent scoliosis, either through anterior or posterior spinal fusion, results in severe pain. Aim. In comparison with the anterior approach, the posterior approach is considered advantageous in that several spine curvatures can be corrected in a single operative act. The aim was to compare the effectiveness of a morphine-based multimodal protocol over the first 48 postoperative hours in anterior and posterior surgeries. Methods. This retrospective chart review included consecutive adolescents (10-21 years of age) treated using either the anterior (n=28) or the posterior (n=30) approach at a single hospital centre over 3 years (2015-2017). Intravenous morphine (48 mg/24 hours) was administered at hourly intervals; pain was assessed using an 11 point (higher score=worse pain) visual analogue scale on 12 occasions during the first 24 hours and on 3 occasions during the second 24 hours. Additional analgesia (non-opioid or weak opioid) was delivered on demand and/or according to medical assessment. Results. With adjustments for age and number of affected spinal segments, VAS pain scores were lower in the anterior approach, overall (48 hours) (difference = -18%, 95% CI -30 to -5), and particularly over hours 0-3 (-23%, 95% CI -36 to -7%) and hours 4-6 (-26%, 95% CI -40 to -10%) after the surgery. The rate of additional analgesic administrations was comparable throughout the observed period (rate ratios around 1.0). Conclusion. The evaluated intravenous morphinebased multimodal analgesic protocol appeared less effective in surgeries using the posterior approach, suggesting that the two approaches might require different protocols for the same level of analgesia., Uvod. Kirurško liječenje strukturalnih adolescentnih skolioza prednjim ili stražnjim kirurškim pristupom za posljedicu ima jaku poslijeoperacijsku bol. Cilj. U usporedbi s prednjim pristupom, smatra se da stražnji pristup ima prednosti u mogućnosti liječenja više skoliotičnih zavoja kralježnice u jednom operativnom aktu. Željeli smo usporediti uspješnost multimodalnog protokola za bol temeljenog na morfiju u prvih 48 sati poslijeoperacijskog tijeka kod pacijenata operiranih prednjim i stražnjim pristupom. Metode. Ovaj retrospektivni pregled obuhvatio je uzastopne adolescentne pacijente (u dobi od 10 do 21 godine) liječene prednjim (n = 28) i stražnjim (n = 30) pristupom u jednom bolničkom centru kroz tri godine (2015. – 2017.). Intravenska aplikacija morfija (48 mg / 24 h) provedena je u intervalima od jednog sata, bol je evaluirana primjenom vizualne analogne skale (VAS za bol) u 11 točaka (veći broj = intenzivnija bol) u 12 navrata tijekom prva 24 sata te tri navrata tijekom druga 24 sata. Dodatni analgetici (neopioidni ili slabi opioidni) aplicirani su prema subjektivnim potrebama pacijenata ili procjeni medicinskog osoblja. Rezultati. Uz korekcije za dob i broj spinalnih segmenata zahvaćenih operacijskim liječenjem, VAS za bol bila je niža kod prednjeg pristupa, ukupno (48 sati) (razlika = –18 %, 95 % CI –30 do –5 %) i posebno u periodu od 0 do 3 sata (–23 %, 95 % CI –36 do –7 %) i periodu od 4 do 6 sati (–26%, 95 % CI –40 do -10 %) nakon operacijskog zahvata. Stopa dodatno administriranih analgetika bila je usporediva tijekom čitavoga promatranog perioda (omjer stopa 1,0). Zaključak. Promatrani intravenski multimodalni protokol baziran na morfiju pokazao se manje uspješnim u pacijenata operiranih stražnjim pristupom, sugerirajući da dva promatrana kirurška pristupa zahtijevaju različite protokole za isti stupanj analgezije.

Wprowadzenie: Jedną z najczęstszych wad postawy, która występuje zarówno u dzieci, jak i u dorosłych jest skolioza. Jako trójpłaszczyznowe skrzywienie kręgosłupa, wiąże się ona ze zmianami innych części ciała: miednicy, klatki piersiowej oraz wielu narządów wewnętrznych. Celem pracy jest analiza postawy ciała osób ze skoliozą z uwzględnieniem oceny pochylenia tułowia w płaszczyźnie strzałkowej oraz położenia wybranych segmentów narządu ruchu. Materiał i metody: Grupa badana składała się z 26 osób ze skoliozą dwułukową (średnia wieku 37 lat). Grupę kontrolną również stanowiło 26 osób, u których nie stwierdzono trójpłaszczyznowego skrzywienia kręgosłupa (średni wiek 34 lata). Wielkość skoliozy, określana wartością kąta Cobba, mieściła się w przedziale 12–17°. Metodą, która została wykorzystana do oceny przestrzennego położenia wybranych segmentów ciała, była fotogrametria. Wyniki: Grupa kontrolna uzyskała istotnie wyższe średnie wyniki niż grupa badana w zakresie zmiennej określającej położenie tułowia w płaszczyźnie strzałkowej. Ponadto grupa badana uzyskała wyższe niż grupa kontrolna wyniki średnie w zakresie zmiennej odpowiadającej rotacji tułowia. W grupie badanej kierunek wygięcia w odcinku piersiowym nie wykazuje związku z ustawieniem głowy i barków w płaszczyźnie czołowej; w tej samej grupie kierunek wygięcia kręgosłupa w odcinku lędźwiowym nie ma związku z położeniem miednicy w płaszczyźnie czołowej. Wnioski: Zmiany postawy ciała są jedną z głównych konsekwencji skoliozy idiopatycznej, a fotogrametria jest metodą umożliwiającą ocenę postawy całego ciała osób z tym rodzajem skoliozy. Po przeprowadzonych badaniach stwierdzono, że u osób ze skoliozą występuje większe pochylenie tułowia do przodu niż u osób zdrowych. U pacjentów ze skoliozą wykazano także występowanie rotacji obręczy barkowej i miednicznej. Introduction: One of the most common postural defects occurring both in children and adults is scoliosis. Scoliosis, a three dimensional curvature of the spine, is also associated with changes in other parts of the body, for example the pelvis, the chest and many internal organs. The aim of this study was to analyze the posture of people with scoliosis, including an evaluation of the tilt of the trunk in the sagittal plane and the position of selected segments of the musculoskeletal system. Material and Methods: The study included 52 people who were divided into two groups. The control group consisted of 26 people who did not have scoliosis. The average age of the group was 34 years. The study group also consisted of 26 people. The average age in this group was 37 years, and it is to this group that the people with scoliosis were assigned The degree of scoliosis, determined measuring the Cobb angle, was between 12° and 17°. The method used to assess the spatial position of the body segments was the photogrammetric method. Results: The control group achieved signifi cantly higher scores than the study group when the position of the trunk in the sagittal plane was determined. Conversely, when the rotation of the torso was measured the average score of the research group was higher than that of the control group. The direction of bending of the thorax in the study group showed no connection to the setting of the head and shoulders in the frontal plane. In the same group the direction of bending of the spine in the lumbar section was not related to the position of the pelvis in the frontal plane. Conclusion: Changes in body posture are one of the main consequences of idiopathic scoliosis. Photogrammetry is a method that enables the whole body posture of people with idiopathic scoliosis to be assessed. After the research it was found that people with scoliosis have a higher inclination to the front trunk than people without the condition. Additionally, rotation of the shoulder and pelvic girdle was also detected in patients with scoliosis.

Uvod: Skolioza je tridimenzionalna deformacija hrbtenice, ki se izrazi kot rotacija in odklon v frontalni ter sagitalni ravnini (Košak, 2009). Cilj rehabilitacije pacienta s skoliozo je preprečiti napredovanje krivine in zmanjšati spremembe, ki so nastale na hrbtenici in trupu. Dolgoročni cilj je tudi preprečiti poslabšanje kakovosti življenja, ki je povezano z zdravstvenim stanjem pacienta (Naglič et al., 2014). Izbira, kakšno ortozo predpisati pacientu, je odvisna od začetne krivine, hitrosti progresije krivine ter mnenja zdravstvenega tima. Pri odpravljanju skolioze se uporablja več različnih ortoz. S pričetkom terapije se pri pacientu ustvari stres, saj ne ve, kakšen bo izid zdravljenja. Z nošenjem ortoze se mladostniku spremeni način življenja, ki povzroči določeno breme (Reichel, Schanz, 2003). Za odkrivanje kakovosti življenja je bilo sestavljenih mnogo vprašalnikov, ki nam pomagajo določati, ali se pacient dobro počuti ali občuti stres med zdravljenjem ter ali zdravljenje na pacientu pušča negativne psihološke posledice. Namen: Namen diplomskega dela je odkriti, ali nošenje ortoze pri pacientih z AIS povzroča emocionalni stres ter slabšo samopodobo. Metode dela: V diplomskem delu je bila uporabljena deskriptivna metoda s sistematičnim pregledom literature, ki se je predvsem nanašala na različne metode odkrivanja počutja pri pacientih z AIS. Raziskali bomo štiri vprašalnike, s pomočjo katerih bomo kasneje sestavili lasten vprašalnik, na podlagi katerega bomo izvajali intervju z nekdanjimi pacientkami. Rezultati: Vprašalnik je sestavljen iz 9. glavnih vprašanj, ki so predvsem namenjena odkrivanju pacientovega počutja med nošenjem ortoze ter socialnega življenja med postopkom rehabilitacije. V raziskavi je sodelovalo 6 oseb ženskega spola, ki so že zaključile postopek rehabilitacije. Izbirali smo samo osebe ženskega spola, saj se AIS pogosteje pojavi pri deklicah kot pri dečkih. Povprečna starost udeleženk v raziskavi je bila 23,5 let. Med postopkom rehabilitacije so uporabljale Milwaukee-ortozo ali pa Rigo-Chêneau-ortozo. Razprava in sklep: Med pregledom rezultatov intervjujev smo odkrili, da je ortoza na vsako posameznico vplivala drugače, a hkrati so vse udeleženke občutile stisko tekom zdravljenja. Zaskrbljenost nad lastnim izgledom je pri nekaterih pacientkah povzročila, da se v javnosti z ortozo niso pojavljale, česar glavna posledica je bila, da ortoze niso nosile zadostno količino časa. Odkrili smo, da osebam z AIS veliko pomeni, če jim družina pomaga, jih vzpodbuja ter z njimi sodeluje med postopkom rehabilitacije. Introduction: Scoliosis is a three-dimensional deformation of the spine, which is expressed as a rotation and a deviation in the frontal and sagittal plane (Košak, 2009). The goal of rehabilitation of a patient with scoliosis is to prevent the progression of the curve and to reduce the changes that have occurred on the spine and trunk. The long-term goal is also to prevent a deterioration in the quality of life associated with the patient's health (Naglič et al, 2014). The choice of what kind of orthosis to prescribe to the patient depends on the initial curve, the speed of progression of the curve, and the opinion of the medical team. There are several different orthoses used to correct scoliosis. With the onset of therapy, the patient becomes stressed, as the patient does not know where this therapy is taking him. By wearing orthosis, he changes his way of liveing, which causes a certain burden on the adolescent (Reichel, Schanz, 2003). In order to discover the quality of life, many questionnaires have been compiled to help us determine whether the patient feels good or feels stress during treatment, and whether treatment on the patient leaves negative psychological consequences. Purpose: The purpose of the final thesis is to find out whether orthotic wear in patients with AIS causes emotional stress and poor self-esteem. Methods: In the final thesis, the descriptive method was used with a systematic review of literature, which mainly related to various methods of detecting well-being in patients with AIS. We will be looking at four questionnaires, which will help us to develop our own questionnaire later, on the basis of which we will conduct an interview with former patients. Results: The questionnaire consists of 9 main questions, which are primarily aimed at discovering the patient's feelings while wearing orthosis and social life during the rehabilitation process. The study involved 6 female participants who had already completed the rehabilitation process. Only women were selected, as AIS is more common with girls than in boys. The average age of participants in the study was 23.5 years. During the rehabilitation process, they used Milwaukee orthosis or Rigo - Chêneau ortozo. Discussion and conclusion: During the review of the results of the interviews, we discovered that the orthosis affected each other differently, but at the same time all the participants felt distress during rehabilitation. Concerns about their own appearance have caused some patients not to appear in the public with orthosis, the main consequence of which was that the orthosis was not worn by a sufficient amount of time. We have discovered that to females with AIS means a lot if the family helps them, encourages them and cooperates with them during the rehabilitation process.

Uvod: Ena najpogostejših deformacij hrbtenice, s katero se srečujemo, je skolioza. Najlažje jo opišemo, če govorimo o dimenzionalni ukrivljenosti hrbtenice v vseh treh ravninah. Deformacijo glede na določene parametre lahko zdravimo operativno ali konzervativno z uporabo različnih spinalnih ortoz. Ravno elastična TriaC ortoza je tista, ki je v nekaterih primerih najbolj primerna oblika za konzervativno zdravljenje le-te. Njen prvoten cilj je zmanjšanje progresije deformacije in krivine poravnavati v normalen anatomski položaj. Namen: Namen diplomskega dela je predstaviti konstrukcijo elastične korekcijske spinalne ortoze TriaC, njeno učinkovitost pri zdravljenju skolioz skozi čas na podlagi predhodno opravljenih raziskav. Metode dela: Za izdelavo diplomskega dela smo uporabili opisno oziroma deskriptivno metodo zbiranja literature s pomočjo domačih in tujih virov. Izbrano literaturo smo pridobili preko mednarodnih baz podatkov z uporabo ključnih besed. Izbirali smo jo glede na časovni okvir 2008–2018, ker pa je ortoza TriaC bila nekoč bolj uporabljana in raziskovana, smo uporabili tudi starejše klinično pomembne študije. Rezultati: Na temo TriaC ortoze smo našli štiri uporabne članke, katere smo medsebojno primerjali in predstavili. Za boljšo primerjavo smo uporabili drugo različico elastičnih spinalnih ortoz – SpineCor ortozo. Razprava in sklep: TriaC ortoza je ena izmed fleksibilnih dinamičnih ortoz, ki je bila razvita z namenom udobja, kozmetike in možnostjo nadzora med samo uporabo. Njena prepoznavna lastnost je ustvarjanje neprekinjenih korekcijskih sil na hrbtenico v vseh položajih in s tem doseganje korekcije, ki ni le posledica delovanja zunanjih sil, ampak tudi notranjih sil, ki jih ustvarijo mišice. Je edina ortoza, ki se začne graditi od glavne zgornje krivine navzdol. Ortoza je najbolj primerna za korekcijo lumbalnih krivin, manj za torakalne in dvojne krivine. Večji pozitivni učinek kaže na področju kozmetike, prilagodljivosti in udobja v primerjavi z ostalimi rigidnimi ortozami. Introduction: One of the most common spinal deformations we encounter is scoliosis. It is easiest to describe it if we speak on the dimensional curvature of the spine in all three planes. We can treat deformation with regards to certain parameters operatively or conservatively with the use of various spinal orthoses. Especially TriaC brace is the one which is the most appropriate form in some cases to treat the spine conservatively. Its primary goal is to reduce the progression of deformation and to align the curvatures into a normal anatomic position. Purpose: The purpose of the bachelor’s thesis is to present the construction of the elastic correctional spinal orthosis TriaC, its efficiency in the treatment of scolioses through time on the basis of the previously performed research. Methods: In order to produce the bachelor’s thesis, we used the descriptive method of collecting literature by means of domestic and foreign sources. The selected literature was collected through the international databases by the use of keywords. We selected it with regards to the timeframe 2008-2018. Because the TriaC brace was more used and researched in past, however, we also used older clinically relevant studies. Results: We found four useful articles on the topic of the TriaC brace. We compared them and presented them. For a better comparison, we used the second version of the elastic spinal orthoses – the SpineCor orthosis. Discussion and conclusion: TriaC brace is one of the flexible dynamic orthoses which was developed with the purpose of the comfort, cosmetics, and the option of control between the uses. Its recognizable characteristic is creating continuous correctional forces on the spine in all the positions and thus achieving the correction which is not only a consequence of outer forces but also internal forces which are created by muscles. It is the sole orthosis which begins building from the main upper curvature downwards. The orthosis is the most appropriate for the correction of lumbar curvatures. It is less appropriate for thoracic and double curvatures. The larger positive effect is shown in the field of cosmetics, adjustability, and comfort in comparison to other rigid orthoses.

Suvremeni način života donosi mnoge pozitivne promjene, ali i povećanje brojnih negativnih čimbenika koji se reflektiraju na zdravlje cjelokupne populacije. Ono što se najviše može primijetiti jest utjecaj na rast i razvoj djeteta. Razne mogućnosti koje donosi tehnologija u vidu igrica, odmaknulo je djecu od vanjskih aktivnosti. Zbog “novog“ načina igranja, djeca su ponajviše u sjedećem položaju što naposljetku rezultira raznim promjenama u posturi tijela. Najčešće dolazi do promjena u kralježnici kao što su skolioza, kifoza i lordoza, no može zahvatiti i donje ekstremitete (“X“ i “O“ noge). Radi prevencije tih stanja potrebno je poznavanje rasta i razvoja djeteta po određenim razdobljima. Prevencija se naročito mora odvijati unutar tri krizna razdoblja djetetovog života, odnosno u prvoj godini života, u dobi od 6 do 7 godina te u doba puberteta. Ukoliko ipak dođe do deformiteta, potrebno je potražiti pomoć educiranih stručnjaka koji će usmjeriti dijete ka pravilnom izvođenju korekcijskih vježbi. The modern way of life brings many positive changes but also the increase in the number of negative factors that are reflected in the health of the entire population. What is most noted is the impact on growth and development of the child. Because of various opportunities of technology in the form of games, the children are not interested for outdoor activity. The “new“ form of playing, children are mostly in a sitting position which ultimately results in various changes in posture. The most common changes occur in the spine, such as scoliosis, kyphosis and lordosis. Also, can affect the lower limbs ("X" and "O" leg). To prevent these conditions it is necessary to understanding the growth and development of the child at certain periods of life. In particular, prevention is necessary within three crises in a child's life, or in the first year of life, at the age of 6-7 years and during puberty. If there is a deformity, it is necessary to seek help from educated professionals who will direct the child to the proper performance of corrective exercises.

Uvod: Slikanje skolioze spada med visokodozne preiskave, ker zajema kar nekaj radiosenzitivnih organov in v večini primerov zajema mlajšo populacijo. Namen: Namen diplomske naloge je bil ugotoviti, ali obstajajo razlike v dozni obremenitvi pacienta glede na položaj slikanja (anteroposteriorna ali posteroanteriorna projekcija). Metode dela: Raziskavo smo izvedli na fantomu. Naredili smo 20 rentgenogramov, pri čemer smo fantom slikali 5-krat v AP projekciji in 5-krat v PA projekciji za področje vratne in prsne hrbtenice do 10. prsnega vretenca, nato pa smo postopek 10-krat ponovili še za področje ledvene hrbtenice. Vsako meritev smo ponovili petkrat, pri čemer smo pred vsako meritvijo fantom in dozimeter na novo postavili zato, da smo v meritev vključili napako zaradi postavitve aparata, fantoma in dozimetra. Rezultati: Iz pridobljenih rezultatov lahko razberemo, da sta DAP in VKD višji pri PA projekciji. V vratnem in prsnem predelu slikanja znaša razlika pri VKD 24,8 % v prid AP projekciji, enako je tudi pri slikanju ledvenega predela, kjer je v PA projekciji VKD večja za 17,8 %. Efektivna in absorbirana doza na organe pa sta v PA projekciji nižji, kar pa je najpomembneje. Efektivna doza prikazuje statistično značilne razlike med AP in PA projekcijo slikanja. Pri uporabi PA projekcije je v vratnem in prsnem predelu ta razlika znašala 75 %, v ledvenem predelu pa je razlika povprečnih efektivnih doz za 25 % manjša. Absorbirana doza se je v PA projekciji zmanjšala približno za polovico. Razprava in sklep: Rezultati raziskave so pokazali, da je izbira PA projekcije za slikanje celotne hrbtenice skolioze metoda izbora. Pri PA projekciji ležijo radioobčutljivi organi bližje slikovnemu sprejemniku in tako prejmejo nižjo dozo, v AP projekciji pa so le-ti bolj izpostavljeni sevanju. Ugotovili smo, da je efektivna doza v PA projekciji nižja kot v AP projekciji, kljub temu da je VKD v PA projekciji večja kot v AP projekciji. Razlog za to je položaj hrbtenice, ki je v PA projekciji bližje izvoru rentgenskih žarkov, radiosenzitivni organi pa ležijo bližje stativu in na ta način prejmejo nižjo dozo, ker se veliko žarkov absorbira že v hrbtenici. Introduction: The X-ray of scoliosis is a high-dose research because it involves quite a few radiosensitive organs. At the PA projection, the radiosensitive bodies lie closer to the image receiver, thus receiving a lower dose. In the AP projection, they are more exposed to radiation. Aim: The purpose of the thesis is to determine whether there are differences in the dosage load relative to the position of imaging (the AP or the PA projection) and what the dose for the selected radio sensing organs in both of these projections is. Method: We conducted the survey on the phantom. We made 20 X-ray diagrams where we photographed the phantom 5 times in the AP projection and 5 times in the PA projection for the area of the neck and chest spine to the 10 thoracic vertebrae. We then repeated the procedure for the lumbar spine. Each measurement was repeated five times. Before each measurement, the phantom, and the dosimeter were repositioned beforehand in order to include the error in the measurement due to the installation of the apparatus, the phantoms and the dosimeter. Results: We can see from the results that the input skin dose and DAP are higher in the PA projection. In the neck and chest area of the imaging, the difference in input skin dose is 24.8 % in favor of the AP projection and the same as in the lumbar region where the PA projection of VKD is 17.8 % higher. The effective dose and absorbed dose are lower in the PA projection and that is the most important. The effective dose shows the statistically significant difference between the AP and the PA projection. When using PA projections, this difference was 75 % in the neck and chest area, and in the lumbar region, the difference in mean effective doses was 25 % lower. The absorbed dose in the PA projection decreased by about half. Discussion and conclusion: The results have shown that the choice of the PA projection for imaging the entire scoliosis is the selection method. We found that the effective dose in the PA projection is lower than in the AP projection. However, the VKD in the PA projection is bigger than in the AP projection. The reason for this is the position of the spine which is closer to the source of x-rays in the PA projection. In addition, the radiosensitive organs lie closer to the tripod. Thus they receive a lower dose because many rays are already absorbed in the spine.

Rast djeteta je pravilno programiran, reguliran je i usmjeren prema svom genetskom potencijalu. No, postoje faktori koji usporavaju tempo razvoja. Neki od tih faktora su bolesti, emocionalni stresovi, naprezanja i slično. Glavnu ulogu kod držanja tijela imaju glava, ramena, kralješnica, zdjelica, noge i stopala. Zbog čestog nemarnog držanja tijela dolazi do kifotičnog, lordotičnog i skoliotičnog držanja tijela, ali i do same kifoze, lordoze i skolioze. Kifotično loše držanje jest zakrivljenost prsne fiziološke kifoze, a kifoza je deformacija kralješnice u sagitalnoj ravnini. Lordotično loše držanje očituje se u vratnom i slabinskom dijelu kralješnice, a lordoza je deformacija kralješnice u lumbalnom predjelu i bočnoj ravnini. Skoliotično loše držanje jest iskrivljenje kralješnice u lijevu ili desnu stranu u čeonoj ravnini, a skolioza je deformacija kralješnice u frontalnoj ravnini s rotacijom i torzijom kralješaka. Nepravilna tjelesna držanja i deformacije kralješnice mogu se ispraviti prilagođenim tjelesnim vježbama.

Uvod: Spinalne deformacije spremljajo človeka že od nekdaj. Ena izmed deformacij je skolioza, za katero je značilna nagnjenost hrbtenice vstran in rotacija vretenc. Deformacije lahko zmanjšamo ali ustavimo njihovo napredovanje z ortozami. Korekcijska spinalna ortoza Milwaukee, ki se uporablja za zdravljenje skolioze, se je od svoje prve konstrukcije z leti spreminjala. Vedno novejša spoznanja in veliko raziskav je vplivalo na spremembo ortoze. Namen: Namen diplomskega dela je predstaviti konstrukcijski razvoj Milwaukee ortoze od njenega nastanka pa vse do danes. Cilj je prikazati učinkovitost ortoze v primerjavi s preostalimi konzervativnimi metodami zdravljenja ter v primerjavi z operativnim zdravljenjem. Metode dela: V diplomskem delu smo uporabili deskriptivno metodo s sistematičnim pregledom literature. Pri iskanju smo uporabili časovni okvir, in sicer od leta 2006 do 2016, razen knjige Milwaukee brace, ki je iz leta 1976. Literaturo smo iskali v angleškem in slovenskem jeziku. V rezultate smo zaradi opuščanja uporabe Milwaukee ortoze, ter pomanjkanja mlajših raziskav od 10 let, vključili članke od 1980 do 2003. Rezultati: Analizirali smo 12 raziskav. Rezultati so razvrščeni v štiri sklope in v treh tabelah prikazujejo ugotovitve raziskav in učinkovitost Milwaukee ortoze v primerjavi s preostalimi konzervativnimi metodami zdravljenja, v primerjavi z ortozami ter v primerjavi z operativnim zdravljenjem. Tabele prikazujejo število vključenih v raziskave, začetni in končni Cobbov kot, starost ob začetku in koncu zdravljenja in čas trajanja zdravljenja. Razprava in sklep: Po pregledu literature smo ugotovili, da Milwaukee ortoza v primerjavi s preostalimi konzervativnimi metodami zdravljenja prikazuje učinkovite rezultate, vendar med posameznimi metodami ni bistvenih razlik. V primerjavi s preostalimi ortozami za zdravljenje skolioze, je Milwaukee ortoza učinkovita, vendar so se nekatere TLSO ortoze in Boston ortoza izkazale za bolj učinkovite. Iz raziskav je razvidno, da operativno zdravljeni pacienti, v primerjavi s pacienti zdravljenimi z Milwaukee ortozo, dosegajo boljše rezultate glede same korekcije in velikosti krivine. Introduction: Spinal deformities are present for a very long time. One of the spinal deformity is scoliosis, which is characterised by the lateral tendency of the spine and the rotation of the vertebrae. Impact of spinal deformities can be reduced or at least their progress can be stopped with braces. Correction spinal ortosis Milwaukee, which is use for treatment of scoliosis, has changed during its first application. Orthosis modification was improved due to new research findings. Purpose: The purpose of my diploma paper is to present constructional development of the Milwaukee orthosis since first application until today. Goal is to demonstrate effectiveness of Milwaukee brace compared to other conservative treatments and to surgical treatment. Methods: In the diploma paper, descriptive method with systematic overview of already existing literature is used. Included is a time frame from 2006 to 2016, except the book Milwaukee brace, which is from 1976. Literature in English and Slovene was searched. Included are also articles from 1980 to 2003 due to lack of research in the last 10 years and due to little application of the Milwaukee brace. Results: 12 articles were analysed. The results are divided into four sections and they are showed in three tables of research findings on Milwaukee brace effectiveness compared to other conservative treatments and surgical treatments. The results in tables show numbers of patients participating in each research. Also shown are average age, time of treatment and the Cobb angle before and after treatment. Discussion and conclusion: After the examination of the literature it was discovered that the Milwaukee brace compared to other conservative treatment shows effective results, but between each method there are actually no differences. Compared with other braces for the treatment of scoliosis, Milwaukee brace is effective, but some TLSO and Boston orthosis proved to be more effective. The studies show that the surgically treated patients compared to patients treated with Milwaukee brace, can achieve better correction and the size of the curve.

Posturom nazivamo stav ili držanje tijela. Ne postoji univerzalni model dobre posture ali najbolja definicija jest da je to ona postura pri kojoj tijelo najmanje napreže da bi održalo stabilnu ravnotežu. Također razlikujemo četiri osnovna tipa držanja ali najčešće u praksi susrećemo preklapanja tih držanja. Bitno je razlikovati loše držanje tj. funkcionalno oštećenje i strukturalno oštečenje. Od iznimne važnosti je pravovremeno djelovati na pojavu loše posture i lošeg držanja da ne bi funkcionalni poremećaj prešao u strukturalni. U strukturalne poremećaje kralježnice spadaju kifoza i lordoza kao poremećaji u sagitalnoj ravnini te skolioza kao iskrivljenje kralježnice u sve tri ravnine sagitalna, frontalna i transverzalna. Proces fizioterapije započinje izradom plana na temelju fizioteraputske dijagnoze. Fizioterapeutska intervencija treba ciljano biti usmjerena pacijentu, njegovim glavnim problemima i istovremeno ga tretirati kao cjelokupnu osobu. Cilj fizioterapije kod deformacije kralješnice treba prilagoditi: očekivanjima pacijenta (adolescent), očekivanjima roditelja (skrbnika) i očekivanjima fizioterapeuta. Svaki kinezioterapijski program trebalo bi započeti vježbama disanja. Kinezioterapija kod kifoze za cilj ima smanjenje kifoze, jačanje abdominalne muskulature te vježbe disanja u svim položajima zbog umanjivanja respiratorne insuficijencije koja može biti kod kifoze ugrožena. Kinezioterapija kod lordoze obuhvaća aktivne vježbe trbušne muskulature u stojećem, ležećem i sjedećem položaju. Toniziranje m. Iliopsoasa, samo ako je predhodno pasivno korigirana lumarna lordoza, vježbe za smanjivanje inklinacije kuta zdjelice te vježbe istezanja mišića m. quadratus lumboruma. Kinezioterapijski program za korekciju skolioze obuhvaća nekoliko vježbi od kojih bitno je provoditi vježbe jačanja trbušne muskulatrure i leđnih ekstenzora, istezat m. quadratus lumborum te mišiće stražnje lože natkoljenice. Također kod svih deformiteta poželjno je provoditi vježbe stava i posture ispred ogledala te vježbe pojačane mobilnosti kralježnice tj pasivno i aktivno istezanje kralježnice. There is no universal model of good posture, but it is the one in which body is least stretched to maintain a stable balance. We also distinguish four basic types of posture but most commonly in practice we encounter overlapping these postures. It is important to distinguish functional damage and structural damage. Also, it's importante to act in a timely manner on the appearance of bad posture so that the functional disorder does not become structural. Structural disorders of the spine include obesity and lordosis as disorders in the sagittal plane and scoliosis as a spinal curvature in all three planes, sagittal, frontal and transversal. The physiotherapy process begins with the development of a plan based on a physiotherapeutic diagnosis. Physiotherapeutic intervention should be targeted to the patient, his main problems, and treated as a whole person at the same time. The goal of physiotherapy in spine deformation needs to be adjusted to: adolescent expectations, parent expectations and physiotherapist expectations. Every kinesiotherapy program should start with breathing exercises. Kinesiotherapy at the kyphosis aims to reduce kyphosis, strengthen the abdominal musculature and breathing exercises in all positions due to the reduction of respiratory insufficiency that may be at risk of fading. Kinesitherapy in lordosis involves active exercises of the abdominal muscles in standing, lying and sitting positions. Tonifying m. Iliopsoasis, only if passive corrected lumborous lordosis, pelvic inclination reduction exercises, and quadratus lumborum muscle relaxation. The kinesitherapeutic program for correcting scoliosis includes several exercises from which it is essential to perform strengthening of the abdominal musculature and back extensors, stretching the quadratus lumborum and the back muscles of the thorax. Also, in all deformities, it is desirable to carry out posture in front of the mirror and exercise of increased spinal mobility, passively and actively stretching the spine.

U današnjem svijetu se može vidjeti pojava hipokinezije, kako kod odraslih, tako i kod djece. Usvojili smo životnu naviku neaktivnosti, smanjenog hodanja i smanjene pokretljivosti cijelog lokomotornog sustava. Sjedilački stil života dovodi do neravnomjernog razvoja mišićnih grupa, što uz neke druge okolinske faktore može rezultirati pojavom nepravilnog tjelesnog držanja. Cilj ovog završnog rada je prikazati problematiku nepravilnog tjelesnog držanja kod djece te prikazati kako je ono povezano sa sjedilačkim načinom života, odnosno upotrebom računala. Istraživanja pokazuju kako većina djece još od vrtićke dobi koristi računalo te da ga često upotrebljavaju dulje nego što je to preporučeno. Sjedenje je opterećenje za kralježnicu, a pogotovo nepravilno sjedenje, koje može dovesti i do drugih negativnih posljedica. U radu se opisuju tri najraširenija oblika nepravilnog držanja: kifotično, lordotično i skoliotično nepravilno držanje. Važno je provoditi pravovremena mjerenja kako bi se na vrijeme otkrile eventualne devijacije. S ergonomijski dizajniranim računalima primjerenima djeci i s odgovarajućim kineziološkim vježbama može se na vrijeme prevenirati ili pak korigirati nepravilno držanje. U tome veliku ulogu imaju prvenstveno roditelji i stručnjaci. In today's world, we can see the emergence of hypokinesia in adult population, but also in children’s. We have adopted a habit of inactivity, reduced walking and reduced mobility of the entire musculoskeletal system. Sedentary lifestyle leads to the unbalanced development of muscle groups and, with other environmental factors, may result in improper body posture. The aim of this final work is to present the problems of improper body posture in children and to show how it is associated with a sedentary lifestyle, with computer use. Research shows that most children already from kindergarten have used the computer, and it is often used longer than what it’s recommended. Experts say that sitting is burden for the spine, and especially improper seating, which can lead to other negative consequences. This paper describes the three most widespread types of posture: kyphotic, lordotic I scoliotic incorrect posture. It is important to provide measurements of body posture on regular basis, so the possible deviation could be detected. With ergonomically designed furniture for children and with appropriate kinesiological exercises we can prevent or correct bad posture. Parents and experts have mayor role in that.

Uvod: Skolioza je strukturna deformacija hrbtenice, pri kateri so značilne tri spremembe: ukrivljenost dela hrbtenice ali cele hrbtenice vstran, torzija ali vrtenje posameznih vretenc in rotacija hrbtenice okoli vzdolžne osi. Rentgensko slikanje skolioze naj vključuje področje od baze lobanje do vrha črevnic, v postero-anteriorni (PA) projekciji, da lahko preprečimo preveliko radiacijo senzitivnih organov. Namen: Namen projektne naloge je primerjava protokolov med radiološkimi oddelki v Sloveniji pri slikanju skolioze. Metode dela: Za pridobitev rezultatov smo uporabili deskriptivno metodo: anketo in pregled literature. Literaturo smo nato primerjali z rezultati ankete in glede na priporočila skušali sestaviti najbolj optimalen protokol za slikanje skolioze. Rezultati: Med rezultati so predstavljeni rezultati ankete, ki smo jo poslali na vse radiološke oddelke slovenskih bolnišnic, kjer slikajo celotno hrbtenico po programu za skoliozo. Rezultati tako prikazujejo različne parametre, s katerimi radiološki inženirji na teh oddelkih slikajo celotno hrbtenico po programu za skoliozo. Razprava: Slikanje celotne hrbtenice se po radioloških oddelkih slovenskih bolnišnic glede na pregledano literaturo najbolj razlikuje pri uporabi projekcij, saj vsi anketirani slikajo preiskovance v antero-posteriorno (AP) projekciji, vendar je glede na literaturo in priporočila slikanje v projekciji PA boljše, saj s tem ščitimo radiosenzibilna tkiva. Anketiranci uporabljajo različne razdalje gorišče‒slikovni sprejemnik, vendar je razdalja odvisna od detektorskega sistema, ki je v uporabi, fokusa rešetke ter velikosti prostora, kje se izvaja diagnostika. Zaključek: Rezultati tokratne raziskave bodo omogočili optimizacijo radiološkega posega – rentgenskega slikanja hrbtenice po programu za slikanje skolioze, s čimer bodo preiskovanci v bodoče pri tej preiskavi prejeli nižjo dozo sevanja. Introduction: Scoliosis is a structural deformation of the spine, characterized by three changes: the curvature of a part of the spine or the entire spine sideways, the torsion or rotation of the individual vertebrae and the rotation of the spine along the longitudinal axis. X-ray imaging of scoliosis should include the area from the base of the skull to the tip of the ilia, in the posterior-anterior (PA) projection, in order to prevent excessive radiation of sensitive organs. Purpose: The purpose of this project is to compare protocols for imaging scoliosis between radiological departments in Slovenia. Methods: The descriptive method, a survey and literature review, was used to obtain the results. We then compared the literature with the results of our survey and according to recommendations we tried to draw up the most optimal protocol for imaging scoliosis. Results: In our results section we show the findings of our survey, which was sent to all the radiological departments in Slovenia, where the whole spine is imaged for scoliosis. The results thus illustrate the various parameters by which the departmental radiology engineers image the spine for scoliosis. Discussion: With regards to our literature review, imaging of the entire spine within radiological departments of Slovenian hospitals differs the most in the use of projections. Their responses indicated that most scoliosis imaging is in the anterior-posterior (AP) projection, whereas the literature and recommendations suggest the PA projection to be a better choice, since the radiosensitive tissues are protected. The respondents use different focal point-to-pixel distances, but the distance depends on the detector system in use, the focus of the grid and the size of the space where the diagnostics are performed. Conclusion: The results of this research will enable the optimization of radiological interventions – X-ray imaging of the spine for scoliosis diagnosis, which will allow the subject to receive a lower dose of radiation in the future.

Uvod: Skolioza je lateralna deviacija, odmik hrbtenice od navidezne črte mediane, ki jo pogosto spremlja še rotacija posameznih vretenc, idiopatska skolioza pa je krivina hrbtenice, večja od 10° po Cobb-ovem kotu, s pridruženo rotacijo teles vretenc in je neznanega izvora. Je najpogostejša strukturna deformacija hrbtenice pri otrocih in mladostnikih. Določimo jo glede na parametre, ki jih zabeležimo s pomočjo meritev, opazovanja in ocene drže. Pomembno določilo skolioze je rentgenska slika hrbtenice, s katere razberemo Cobb-ov kot. Večina idiopatskih skolioz nastane v mladostniških letih (med 10-18 letom) in prizadene 2-3% populacije te starostne skupine. Idiopatsko skoliozo se zdravi s konzervativno terapijo, ki vključuje opazovanje,fizioterapijo in aplikacijo ortoz ter operacijsko. Na hojo ima skolioza velik vpliv, saj povzroči razvoj patološkega vzorca hoje. Zdravljenje skolioze z ortozo oziroma steznikom je najpogostejše ne-operativno zdravljenje skolioze in ima tako pozitivne, kot tudi negativne učinke. Namen: Namen diplomskega dela je ugotoviti vpliv ortotične obravnave idiopatske skolioze na hojo. Metode dela: Uporabljena je bila deskriptivna metoda, saj so bili pregledani in med sabo primerjani znanstveni članki na področju ortotične obravnave skolioze Rezultati: V diplomskem delu so vključeni rezultati 9 raziskav, katere raziskujejo vpliv ortotične obravnave idiopatske skolioze na hojo. Tabele prikazujejo značilnosti pacientov, vrsto ortotične obravnave in vpliv ortotične obravnave na hojo. Razprava in sklep: Ortotična obravnava idiopatske skolioze ima največji vpliv na zmanjšanje krivine skolioze, s tem pa je boljša tudi hoja. Ortoza pozitivno vpliva na stojo, saj izboljša ravnotežje, stabilnost in propriocepcijo. Na parametre stoje in hoje najbolj vpliva rigidnost steznika. Z odstranitvijo rigidnega steznika, se nekateri parametri bistveno poslabšajo. Obravnava idiopatske skolioze s steznikom pozitivno vpliva na dolžino koraka, dolžino faze opore in kadenco. Steznik nima pomembnega vpliva na povišano porabo energije in na povišane vrednosti električne mišične aktivnosti merjenih mišic pri hoji. Potrebne so nadaljnje raziskave o vplivu steznika na parametre stoje in hoje tudi po odstranitvi le tega. Introduction: Scoliosis is a lateral deviation, an offset of the spine from the apparent median line. Scoliosis is often accompanied with rotation of the vertebra. Idiopathic scoliosis is a spinal curvature, that has Cobb's angle greater than 10° and rotation of the vertebra. Its origin is unknown. It is the most common structural deformation of the spine among children and youngsters. Scoliosis is determined regarding to the parameters, which are obtained with measurements, observation and posture assessment. Cobb's angle of the scoliosis is determined from X-ray images. Idiopathic scoliosis is most common in adolescent years (between 10-18 years of age) and affects 2-3% of adolescents. It can be treated with conservative therapy, which includes observing, physiotherapy, orthotic treatment with a brace and with operation. Scoliosis has a major effect on gait, because it develops phatological gait patern. Orthotic treatment of scoliosis is the most common non-operative treatment of scoliosis and has both positive and negative effects. Purpose: The purpose of the diploma thesis is to determine the influence of orhotic treatment with a brace on gait. Methods: A descriptive method was used in the study to review and compare scientific papers related to orthotic treatment of scoliosis. Results: Diploma includes results of 9 studies, which researched the influence of orhotic treatment of idiopathic scoliosis on gait. The tables present the data about patients features, type of the orthotic treatment and influence of orthotic treatment on gait. Discussion and conclusion: Orthotic treatment of idiopathic scoliosis has its greatest impact on reducing the curvatures of the scoliosis and beceause of that, the gait is better too. Orthosis has a positive effect on stance because it improves balance, stability and proprioception. Rigidity of the brace has the biggest impact on the stance and gait parameters. With the removal of the rigid brace some of those parameters get significantly worse. Treatment of idiopathic scoliosis with a brace has a positive effect on step length, length of stance phase and cadence. The brace has no significant effect on high energy consumption and on high values of electrical activity od measured muscles during gait. Further research of the brace impact on stance and gait are needed, including when the brace is removed

Streszczenie Wstęp: Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) jest międzynarodową organizacją wyznaczającą standardy leczenia osób ze skoliozami i prowadzenia badań naukowych w tej dziedzinie. Standardy leczenia uwzględniają konieczność stosowania fizjoterapii. Wytyczne SOSORT określają jakie warunki powinny spełniać metody fizjoterapii stosowane w procesie leczenia. Jedną z koncepcji stosowanych na świecie w procesie leczenia zachowawczego osób ze skoliozą jest metoda Proprioceptive Neuromuscular Facilitation (PNF). International PNF Association (IPNFA) tworzy standardy nauczania, stosowania metody PNF i prowadzenia badań naukowych związanych z koncepcją. Cel: Celem pracy jest proba wykazania zgodności założeń metody PNF z wytycznymi SOSORT dotyczącymi leczenia zachowawczego skolioz. Materiał i metody: Do analizy wykorzystano rekomendacje SOSORT stworzone w latach 2005 - 2012 oraz informacje i wiedzę zgodną z aktualnymi ustaleniami International PNF Association (IPNFA). Wyniki: W pracy wykazano zgodność założeń metody PNF z wytycznymi SOSORT odnoszącymi się do fizjoterapii takimi jak: indywidualne planowanie leczenia, ukierunkowanie na główne cele leczenia (zatrzymanie progresji skrzywienia, poprawa funkcji układu oddechowego, zmniejszenie dolegliwości bólowych, względy estetyczne) oraz możliwość specjalistycznego oddziaływania na deformacje kręgosłupa (autokorekcja kręgosłupa i miednicy w trzech płaszczyznach, stabilizacja postawy, trening czynności codziennych, edukacja zdrowotna). Wstępne badania wykazują pozytywny wpływ wybranych wzorców metody PNF na parametry posturalne osób ze skoliozą. Wnioski: Szczegółowo opisana struktura metody PNF może być wykorzystana przy planowaniu badań naukowych. Konieczne jest prowadzenie badań mających na celu wykazanie skuteczności metody PNF w procesie leczenia osób ze skoliozą.

UVOD: Skolioza je trodimenzionalna deformacija kralježnice. Skolioza dovodi do promjena i deformacije cijelog prsnoga koša, kao i intratorakalnih organa. Smanjuje se volumen pluća, smanjuje se mobilnost rebara i dolazi do poremećaja frekvencije disanja kako u mirovanju tako i pri bilo kojoj aktivnosti. Respiratornom fi zioterapijom poboljšava se vitalni kapacitet i pomaže pri odstranjivanju sekreta iz dišnih puteva. Fizioterapijom se djeluje na mobilnost prsnog koša, jačanju dišnih mišića i opskrbu plućnog tkiva kisikom. Cilj istraživanja je utvrditi opravdanost respiratorne fi zioterapije kod AIS. MATERIJALI I METODE: Istraživanje je izvršeno retrospektivno, koristeći bazu podataka pacijenata koji su operirani u KB Dubrava , na odjelu Ortopedije. Na uzorku od 30 pacijenata promatrane su dvije varijable, forsirani vitalni kapacitet (FVC) i forsirani ekspiracijski volumen u prvoj sekundi forsiranog izdisaja (FEV1). Statistička obrada napravljena je programskim paketom MedCalc gdje je korišten Studentov t-test za zavisne uzorke. REZULTATI: Na osnovu statističke obrade se dobiju rezultati da postoji statistički značajna razlika u povećanju FVC nakon provedene fi zioterapije (p=0.006) kao i da postoji statistički značajna razlika između početnog FEV1 i nakon provedene fi zioterapije (p=0.021). ZAKLJUČAK: Ispitanici dobro reagiraju na fi zioterapiju, te je njihov spirometrijski nalaz (FVC i FEV1) nakon odrađene fi zioterapije statistički značajno bolji od spirometrijskog nalaza iste skupine prije fi zioterapije. Ovim istraživanjem potkrepljuje se važnost provođenja fi zioterapije za bolesnike sa slabijom plućnom funkcijom. Time se otvara put znanstveno-utemeljenom (evidence-based) propisivanju fi zioterapije za bolesnike koji imaju slabiju plućnu funkciju kod AIS.

Skolioza je trodimenzionalna deformacija kralježnice u frontalnoj, sagitalnoj i transverzalnoj ravnini. Prema etiologiji, može biti primarna (idiopatska) i sekundarna (najčešće neuromuskularna), a češće se javlja kod djevojčica u adolescenciji. Osim estetskog poremećaja skolioza može uzrokovati dorzalgiju, a progresivne skolioze s Cobbovim kutom većim od 50° izazivaju ireverzibilno oštećenje respiratorne funkcije i indikacija su za operativno liječenje. Ostale skolioze liječe se konzervativno specifičnim vježbama za skoliozu, a kod Cobbova kuta većeg od 20° u kombinaciji s ortozom. Unatrag dvadeset godina brojni su radovi dokazali da je konzervativno liječenje skolioze specifičnim vježbama i ortozom uspješno te da može zaustaviti progresiju i korigirati kut skolioze. Liječenje provodi tim posebno educiranih članova koji čine liječnik (ortoped ili fizijatar), ortotičar i fizioterapeut. U liječenju posebnu pažnju treba posvetiti suradnji oboljeloga i osigurati potporu obitelji i okoline., Scoliosis is a three-dimensional deformity of the spine in the frontal, sagittal and transverse plane. According to the etiology, it may be primary (idiopathic) or secondary (mainly neuromuscular). It is more common in girls and mostly develops during adolescence. In addition to aesthetic problems, scoliosis may cause back pain. Progressive scoliosis with a Cobb angle of above 50° causes irreversible damage to the respiratory function and is an indication for surgical treatment. Scoliosis specific exercises (SSE) are used alone or in combination with braces for conservative treatment at a Cobb angle of more than 20°. During the last twenty years many published papers have proven that conservative treatment of scoliosis is successful, is able to stop the progression and is able to correct the angle of scoliosis. The treatment is carried out by a specially trained team consisting of physicians, orthotists and physiotherapists. It is necessary to ensure that the patient cooperates and receives support from family and friends.