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Multipla skleroza spada u kronične demijelinizacijske bolesti središnjeg živčanog sustava. Progresivna je bolest koja razara mijelinsku ovojnicu aksona neurona, te se za uzrok javljaju fizički i mentalni poremećaji. Javlja se u dobi od petnaeste do četrdesetipete, češća je u žena nego u muškaraca, a simptomi multiple skleroze su različiti kod svakog pojedinca. Kako i dalje nije pronađen lijek za ovo medicinsko stanje isto se liječi simptomatski. Dugotrajna fizioterapija pomaže olakšavanju simptoma koje se javljaju u multipli sklerozi, od fizičkih simptoma poput slabost i/ili spastičnost u mišićima, gubitak balansa, nepravilna postura do psihičkih simptoma kao što su depresija i anksioznost. Hipoterapija je terapijski pristup koji koristi konje za pomoć ljudima s različitim zdravstvenim problemima. Konji se koriste u terapiji jer svojim prirodnim hodom, ritmom i temperaturom tijela mogu pozitivno djelovati na ljude. Osoba s multiplom sklerozom ima aktivnu ulogu pri kontroli smjera i ritma konja prilikom terapije. Ovakav pristup zahtjeva tim koji gradi vodič, pacijent, fizioterapeut i još mnogi drugi zdravstvenih stručnjaci. Svrha hipoterapije je sprječavanje daljnjeg pogoršanja stanja bolesti te omogućiti bolesniku neovisnost u svakodnevnim aktivnostima. Multiple sclerosis belongs to the chronic demyelinating diseases of the central nervous system. It is a progressive disease that destroys the myelin sheath of neuron axons and causes physical and mental disorders. It occurs between the ages of fifteen and forty-five, is more common in women than in men, and the symptoms of multiple sclerosis are different for everyone. Since no cure has been found for this medical condition, it is treated symptomatically. Long-term physiotherapy helps to alleviate the symptoms that occur in multiple sclerosis, from physical symptoms such as weakness and/or spasticity in muscles, loss of balance, improper posture to psychological symptoms such as depression and anxiety. Hippotherapy is a therapeutic approach that uses horses to help people with various health problems. Horses are used in therapy because they can have a positive effect on people with their natural gait, rhythm, and body temperature. A person with multiple sclerosis plays an active role in controlling the direction and rhythm of the horse during therapy. This approach requires a team that consists of a guide, a patient, a physiotherapist, and many other health professionals. The purpose of hippotherapy is to prevent further deterioration of the condition of the disease and to enable the patient to be independent in daily activities.

Osteoporoza je bolest koju karakterizira niska koštana masa i mikroarhitektonsko propadanje koštanog tkiva. Ovo stanje dovodi posljedično do povećane lomljivosti kostiju i posljedičnog povećanja rizika od prijeloma. Za osteoporozu je karakteristično da mineralna gustoća kostiju iznosi najmanje 2,5 standardne devijacije (SD) manje od vrijednosti koje su prosječne za mladu, zdravu ženu. Gubitak koštane gustoće javlja se postepeno prateći proces starenja. Rana osteoporoza najčešće biva neprepoznata, tj. ona je asimptomatska te se njezina prisutnost zamjećuje tek nakon prijeloma. Najčešći prijelomi uzrokovani osteoporozom su prijelom kuka, kralježaka te podlaktice. Osteoporoza se dijeli na lokalizirani i generalizirani oblik. Najčešći tip osteoporoze vezan je uz razdoblje menopauze u žena, s toga se i naziva postmenopauzna osteoporoza. Etiologija osteoporoze uvelike ovisi o procesu pregradnje kosti. Na gubitak koštane mase mogu utjecati hormonalni i okolišni čimbenici te genetika i druge bolesti. Patogenetski mehanizmi osteoporoze mogu se sažeti u tri veće cjeline, a to su: a) nastanak osteoporoze zbog neadekvatnog stjecanja koštane mase tijekom rasta i razvoja kostura, b) nastanak zbog pretjerane razgradnje kostiju te c) nastanak zbog nedovoljnog stvaranja kosti u procesu pregradnje. Ključni simptom osteoporoze je bol u leđima, lokalizirana duž cijele kralješnice te je difuznog karaktera. Osim bolova mijenja se centar gravitacije, smanjuje se visina, držanje postaje pognuto, itd. Kod postavljanja dijagnoze najznačajniju ulogu imaju anamneza, povijest bolesti te detaljni fizikalni pregled uz test koštane gustoće ili denzitometrija. Ciljevi medikamentoznog liječenja su uspostava ravnoteže između aktivnosti osteoblasta i osteoklasta te povećanje mineralne koštane gustoće uz posljedično smanjenje rizika od prijeloma. Prevenciju osteoporoze potrebno je započeti u djetinjstvu. Preporuča se redovita tjelesna aktivnost te pravilna prehrana. U rehabilitaciji je važno održati funkcionalni ili puni opseg pokreta u zglobovima, adekvatnu snagu mišića, toleranciju bolova te osigurati podnošljivost opterećenja. Fizioterapijska procjena uključuje uzimanje anamneze, opservaciju, palpaciju te postupke mjerenja i testiranja kojima se potvrđuju oštećenja i ograničenja same funkcije pojedinca. Najčešće korištene fizioterapijske intervencije su fizikalni čimbenici (krioterapija, terapija laserom, magnetoterapija, hidroterapija), terapijsko vježbanje, terapija vibracije cijeloga tijela (engl. Whole-body vibration – WBV) te edukacija pacijenta. Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue. This condition leads to increased bone fragility and a consequent increase in the risk of fractures. Osteoporosis is characterized by a bone mineral density of at least 2,5 standard deviations (SD) less than the average fo a young, healthy woman. Loss of bone density occurs gradually following the aging process. Early osteoporosis is most often unrecognized, i.e. it is asymptomatic and it is presence is noticed only after a fracture. The most common fractures caused by osteoporosis are fractures of the hip, vertebrae and forearm. Osteoporosis is divided into localized and generalized forms. The most common type of osteoporosis is related to the menopause period in women, hence the name postmenopausal osteoporosis. The etiology of osteoporosis largely depends on the bone remodeling process. Bone loss can be influenced by hormonal and enviromental factors, as well as genetics and other diseases. Pathogenetic mechanisms of osteoporosis can be summed up in three major units, namely: a) occurrence of osteoporosis due to inadequate acquisition of bone mass during skeletal growth and development, b) occurrence due to excessive bone breakdown and c) occurrence due to insufficient bone formation in the remodeling process. The key symptom of osteoporosis is back pain, localized along the entire spine and of a diffuse character. In addition to pain, the center gravity changes, the height decreases, the posture becomes stooped, etc. When establishing a diagnosis, anamnesis, medical history and a detailed physical examination with a bone density test or densitometry play the most important role. The goals of the medical treatment are the establishmnet of a balance between the activity of osteoblasts and osteoclasts and an increase in bone mineral density with a consequent reduction in the risk of fractures. Prevention of osteoporosis should start in childhood. Regular physical activity and proper nutrition are recommended. In rehabilitation, it is important to maintain a functional or full range of motion in the joints, adequate muscle strength, pain tolerance and ensure load tolerance. Physiotherapy evaluation includes taking an anamnesis, observation, palpation and measurement and testing procedures that confrim impairmnets and limitations of the individuals function. The most commonly used physiotherapy interventions are physical factors (cryotherapy, laser therapy, magnetotherapy, hydrotherapy), therapeutic exercise, whole-body vibration therapy (WBV) and patient education.

Dijagnoza raka dojke utječe na fizičko i psihičko ponašanje svake bolesnice. Potrebno je imati na umu pacijentov strah, tjeskobu i depresiju u odnosu na operaciju. Psihička ponašanja mogu utjecati na fizičke nuspojave pacijentica, te nuspojave nadalje najčešće rezultiraju duljim oporavkom. Komplikacije uzrokovane operacijom uključuju bol, serom, hematom, infekciju, umor, ograničen opseg pokreta ramena i limfedem. Fizioterapeut provodi procjenu prema SOAP modelu, ispunjava sve potrebne sastavnice i mjerenja te zajedno s pacijenticom izrađuje plan i program fizioterapijskih postupaka. Pacijentice bi trebale biti potaknute na aktivnu suradnju u svojem oporavku, a fizioterapijski postupci mogu pomoći u smanjenju negativnih učinaka svih komplikacija. Fizioterapijski postupci započinju neposredno poslije operativnog zahvata kako bi se spriječile bilo kakve daljnje komplikacije te kako bi se omogućio povratak u aktivnosti svakodnevnog života. The diagnosis of breast cancer affects the physical and psychological behavior of each patient. It is necessary to keep in mind the patient's fear, anxiety and depression in relation to the operation. Furthermore, psychological behaviors can affect the physical side effects of patients, and these side effects usually result in a longer recovery. Complications from surgery include pain, seroma, hematoma, infection, fatigue, limited shoulder range of motion, and lymphedema. The physiotherapist conducts an assessment according to the SOAP model, fills in all the necessary components and measurements and, together with the patient, creates a plan and program of physiotherapy procedures. Patients should be encouraged to actively cooperate in their recovery, and physiotherapy procedures can help reduce the negative effects of all complications. Physiotherapy procedures begin immediately after the operation in order to prevent any further complications and enable the return to activities of daily life.

Zglob koljena je vrlo kompleksan zglob sa puno mišića i ligamenata te tetiva, a samim time i zglob u kojem su moguće razne ozljede. Sportaši su više skloniji ozljedama koljena ukoliko se radi o dinamičnijim sportovima gdje ima puno udaraca poput nogometa ili rukometa no ozljede se mogu dogoditi i kod osoba koje ne sudjeluju u sportu, djece i starijih. U sportu ima više kretnji, više udaraca i velik je pritisak na zglobove kao što su koljeno ili gležanj. Snažna muskulatura mora biti prisutna kod svake osobe kako bi se mogla normalno kretati i raditi. Osim mišića natkoljenice koji imaju velik utjecaj na koljeno m. popliteus je također bitan mišić pri kretanju i održavanju stabilnosti. Važan je pri ciklusu hoda, poznat je i pod nazivom ključ za koljeno i njegovo ozljeđivanje ima itekako utjecaj na samo kretanje i obavljanje aktivnosti kod svih osoba, a posebno sportaša te zahtijeva rehabilitaciju. Ozljede ovog mišića nisu česte i oporavak je uglavnom kratak u odnosu na ozljede drugih mišića. Ovisno o stanju koje se može dogoditi, tendinopatija m. popliteusa naprezanje mišića ili prisustvo pojedinih izraslina, potrebna je primjena fizikalne terapije. Od fizikalnih procedura ovisno o vrsti ozljede primjenjuje se krioterapija, elektroterapija i kineziterapija koja ima veliku ulogu i fokus mora upravo biti na njoj. Konzervativno liječenje uglavnom ima pozitivne rezultate u smislu smanjenja simptoma i olakšanja pri kretanju a moguće je i operativno liječenje kod težih oblika ukoliko nema pozitivnih rezultata kod konzervativnog načina liječenja. The knee joint is a very complex joint with many muscles and ligaments and tendons, and therefore a joint in which various injuries are possibe. Athletes are more prone to knee injuries if they are involved in more dynamic sports where thre are a lo of kick such as footbal or handball, but injuries can also occur in people who do not participate in spots, children and the elderly. In sports there are more movements, more blows and there is a lot of pressure on joints such as the knee or ankle. Strong musculature must be present in every person in order to be able to move and work normally. In addition to the muscles of the upper leg, which have a great influence on the knee, the popliteus muscle for movement and maintaining stability. It is important durin gait cycle, it is also known as the knee wrench and its injury has a great impact on the movement and performance of activities for all people, especially athletes and requires rehabilitation. Injuries of this mucle are not comon and recovery is ussually short compared to injuries of other muscles. Depending on the condition that may occur, tendinopathy of the popliteus muscle, muscle strain or the presence of certain growths, the appliacition of physical therapy is necessary. Of the physical procedures, depending on the type of injury, cryotheapy, electrotherapy and kinesitherapy are applied, which play a major role and the focus must be on it. Conservative treathment mostly has positive results in terms of symptom reduction and ease of movement, and operative treatment is also possible in more severe forms if there are no positive results with conservative treatment.

Trudnoća, ili popularno nazvano, drugo stanje, period je u životu žene fertilnih godina u kojem dolazi do razvijanja ploda unutar maternice. Maternica je organ smješten u zdjelici koji kroz trudnoću raste kako plod raste i razvija se. Vremenski je period fiziološke trudnoće definiran između 37.- og i 42.-og tjedna, s time da može doći i do ranijeg poroda koji se tada naziva prijevremenim porodom. Kako plod raste zajedno s maternicom, dolazi i do promjena na ostalim organskim sustavima žene. Dolazi do promjene tjelesne mase, odnosno njenog rasta, kardiovaskularnih, respiratornih, posturalnih prilagodbi, mišićnih promjena, promjena obrasca hoda, hormonalnih promjena te neurovaskularnih promjena. Posturalne se prilagodbe događaju kroz cijelu trudnoću, a počinju biti izraženije u drugom i trećem tromjesečju. U cervikalnom dijelu kralježnice dolazi do povećana cervikalne lordoze, u području torakalne kralježnice dolazi do povećanja torakalne kifoze zbog slabljenja mišića te skraćenja pektoralnih mišića što posljedično dovodi do unutarnje rotacije ramenog obruča. Također, dolazi i do povećanja lumbalne lordoze uz smanjenje gibljivosti lumbalnog dijela kralježnice zbog rasta maternice te širenja trudničinog trbuha. Osim na abdomen i na posturu trudnice, rast uterusa, također, utječe na mišiće zdjeličnog dna i na organe smještene unutar zdjelice. Posljedično s povećanjem uterusa dolazi do smanjenja kapaciteta zaprimanja mokraće mokraćnog mjehura te do slabljenja mišića zdjeličnog dna. Urinarna inkontinencija stanje je kod koje dolazi do nemogućnosti zadržavanja mokraće. Postoji nekoliko vrsta urinarne inkontinencije pa se tako dijeli na stresnu ili statičku, urgentnu, prelijevajuću, miješanu, funkcionalnu, neurogeni mjehur i hiperfleksiju mjehura. U trudnoći se najčešće javlja stresna ili statička vrsta inkontinencije prilikom povećanja intraabdominalnog tlaka kod kašlja, kihanja, smijanja, podizanja nekog tereta i slično. Fizioterapija ima veliku ulogu u prevenciji i liječenju urinarne inkontinencije. Primjenjuju se vježbe za jačanje mišića zdjeličnog dna i Knack metoda. Vježbama za mišiće zdjeličnog dna mišićima se povećava snaga i izdržljivost te se ponovno uspostavlja, poboljšava i održava njihova funkcija. Knack metoda označuje pravodobnu kontrakciju mišića zdjeličnog dna prije, odnosno, prilikom povećanja intraabdominalnog tlaka kod kašlja ili kihanja. U radu je navedeno i istraživanje koje je provedeno među trudnicama s ciljem ispitivanja koliko se od trudnica koje su sudjelovale u ispitivanju susreće s urinarnom inkontinencijom te kako ona utječe na njihov svakodnevni život Pregnancy, or as it is popularly called, the second condition, is a period in the life of a woman of fertile years in which the fetus develops inside the uterus. The uterus is an organ located in the pelvis that grows throughout pregnancy as the fetus grows and develops. The time period of physiological pregnancy is defined between the 37th and 42nd weeks, with the fact that earlier birth can occur, which is then called premature birth. As the fetus grows together with the uterus, changes occur in the other organ systems of the woman. There is a change in body weight, i.e. its growth, cardiovascular, respiratory, postural adjustments, muscle changes, changes in walking patterns, hormonal changes, and neurovascular changes. Postural adjustments occur throughout pregnancy, and they begin to be more pronounced in the second and third trimesters. In the cervical part of the spine, there is increased cervical lordosis, in the area of the thoracic spine there is an increase in thoracic kyphosis due to weakening of the muscles and shortening of the pectoral muscles, which consequently leads to internal rotation of the shoulder girdle. Also, there is an increase in lumbar lordosis with a decrease in the mobility of the lumbar part of the spine due to the growth of the uterus and the expansion of the pregnant woman's belly. In addition to the abdomen and the pregnant woman's posture, the growth of the uterus also affects the muscles of the pelvic floor and the organs located inside the pelvis. Consequently, with the increase of the uterus, there is a decrease in the capacity of the urinary bladder to receive urine and a weakening of the muscles of the pelvic floor. Urinary incontinence is a condition in which there is an inability to hold urine. There are several types of urinary incontinence, so it is divided into stress or static, urgent, overflow, mixed, functional, neurogenic bladde,r and bladder hyperflexion. In pregnancy, stress or static incontinence occurs most often when the intra-abdominal pressure increases during coughing, sneezing, laughing, lifting a load, etc. Physiotherapy plays a major role in the prevention and treatment of urinary incontinence. Exercises to strengthen the pelvic floor muscles and the Knack method are used. Pelvic floor muscle exercises increase muscle strength and endurance and restore, improve and maintain their function. The Knack method refers to the timely contraction of the pelvic floor muscles before, or during the increase in intra-abdominal pressure during coughing or sneezing. The paper also mentions the research that was conducted among pregnant women to examine how many of the pregnant women who participated in the study experience urinary incontinence and how it affects their daily life.

Reumatoidni artritis je kronična sistemska upalna bolest vezivnog tkiva. Promjene se najčešće događaju na perifernim zglobovima ekstremiteta. Pojavljuju se češće kod žena u odnosu na mušku populaciju u svim etničkim skupinama između 20. i 45. godine života. Uzrok bolesti je nepoznat, ali postoje razni čimbenici koji mogu prethoditi razvoju reumatoidnog artritisa. Karakteristično obilježje reumatoidnog artritisa je sinovitis na perifernim zglobovima. Prvi prepoznatljivi simptom je jutarnja zakočenost zglobova u trajanju od nekoliko sati. Nakon toga slijedi prvi objektivni znak, oteklina zglobova koja je obično simetrična. Za dijagnosticiranje bolesti koriste se rendgenske snimke koje služe za prikaz stupnja oštećenja koje je nastalo kod pacijenta. Kao „ zlatni standard“ u ranom dijagnosticiranju reumatoidnog artritisa pokazala se magnetska rezonanca. Uloga fizioterapeuta je da pomaže pacijentu u rješavanju ograničenja u aktivnostima svakodnevnog života. Fizioterapijski proces sastoji se od predstavljanja, upućivanja, uzimanja fizioterapijske anamneze, znakove upozorenja na koje fizioterapeut treba obratiti pažnju, pregled pacijenta, analiza, izrada plana terapije te na kraju završetak tretmana. Od testova i metoda koriste se HAQ upitnik za procjenu ishoda bolesti, VAS skala boli i manualni mišićni test za procjenu funkcije mišića. Liječenje se sastoji od konzervativne metode i operativnih zahvata. Od konzervativnih metoda najvažnija je fizikalna terapija. U fizikalnoj terapiji primjenjuju se različite metode liječenja. Najučinkovitijom metodom pokazalo se terapijsko liječenje koja sadrži različite vrste vježbi. Rheumatoid arhritis is a chronic systemic inflammtory disease of the connective tissue. Changes most often occur on the peripheral joints of the extremities. It appears more often in female compared to male population in all ethnic groups between 20. and 45. years of age. The cause of the disease is unkown, but there are various that may precede the development of rheumatoid arthritis. A characteristic feature of rheumatoid arthritis is synovitis on the peripheral joints. First a recognizable symptom is the stiffness of the joint sin the morning lasting several hours. After that the first objective sing follows, joint swelling which is usually symmetrical. To diagnose the disease, X- rays are used to show the degree of damage that has occured in the patient. It has been proven as the „ gold standard „ in the early diagnosis of rheumatoid arthritis magnetic resonance. The role of physiotherapist is to help the patient treat the limitations in the activity of daily life. The physiotherapy process consists of presenting, referring, taking physiotheraphy amnesis, warning signs that a physiotherapist needs to pay attention to, examining the patient, analysing, creating a therapy plan and finally completing the treatment. Among the tests and methods used are HAQ questionnaire to assess the outcome of the disease, the VAS pain scale and a manual muscle test to assess muscle function. The treatment consists of a conserative method and surgical procedures. The most important of the conserative treatment methods is physical therapy. Diffrent treatment methods are applied to physical therapy. It has been proven that the most of effective method is a therapeutic treatment that contains diffrent types of exercises.

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.

Koljenski zglob najsloženiji je i najveći zglob u ljudskom tijelu, a sastoji se od tibiofemoralnog i patelofemoralnog zglobnog kompleksa. Zbog svoje složenosti, ali i biomehanike, pri nekim fazama hoda opterećen je i s nekoliko tjelesnih težina, a čini ga kombinacija kutnog i obrtnog zgloba što znači da su moguće kretnje ekstenzije, fleksije, unutarnje i vanjske rotacije. Tijekom rasta i razvoja femura, tibije i patele potreban je specifičan odnos biomehaničkih sila kako bi se u konačnici formirala normalna zglobna funkcija u dječjoj i odrasloj dobi. Za stabilnost patele i urednu biomehaniku koljena važan je i položaj patele s obzirom na njenu visinu, odnosno udaljenost od zglobne pukotine. Hondromalacija patele je razmekšanje hrskavice različitog stupnja pri čemu još nema promjena na subhondralnoj kosti. U samom početku je reverzibilna, a kasnije postaje ireverzibilna uz visoki rizik razvoja sekundarne artroze. Hondromalacija patele može se dijagnosticirati pomoću artroskopije, a nekada se pronalazi kao usputni nalaz artrotomije s meniscektomijom koljena. Fizikalna terapija ima važnu ulogu u liječenju i rehabilitaciji te u prevenciji ozljeda i oštećenja struktura koljenskog zgloba. Proces rehabilitacije počinje neposredno nakon ozljeđivanja, mora biti prilagođen svakoj osobi, a traje sve do povratka izgubljenih sposobnosti. Liječenje može biti preventivno, konzervativno i kirurško. Najčešće je konzervativno, ali postoje slučajevi kada je jedini izlaz u kirurškom liječenju. Bitno je da se s konzervativnim liječenjem počne što ranije, točnije pri pojavi prvih simptoma. Od velike je važnosti unutar 24 do 72 sata primijeniti terapijsku metodu RICE (R – rest; pošteda, I – ice; hlađenje, C – compression; kompresija, E – elevation; elevacija). U metode procjene uključuju se inspekcija, palpacija, mjerenje opsega pokreta zgloba te se procjenjuje snaga mišića. Primjenjuju se razne procedure fizikalne terapije. Nakon akutnog liječenja oštećenja, cilj nam je ublažiti bol i potaknuti cijeljenje oštećenog dijela. Simptomi se najčešće tretiraju elektroterapijom, krioterapijom, ultrazvukom, transkutanom električnom stimulacijom (TENS), laserom i magnetoterapijom. Kineziterapija se koristi pokretom u svrhu liječenja, rehabilitacije i prevencije bolesti te se kombinira s drugim oblicima fizikalne terapije. Iznimno je važna u rehabilitaciji hondromalacije patele zbog aktivnog sudjelovanja bolesnika u procesu osposobljavanja. Osnovni ciljevi kineziterapije su uspostaviti, održati i povećati opseg pokreta koljenskog zgloba, održati i povećati mišićnu snagu, izdržljivost i brzinu pokreta te poboljšati ravnotežu i neuromišićne koordinacije pokreta. Stoga je od iznimne važnosti na vrijeme prepoznati oštećenje zglobne hrskavice te pravovremeno započeti s konzervativnim liječenjem kako bi se izbjegli rizici kirurškog liječenje te razvoj sekundarne artroze koljenskog zgloba. The knee joint is the most complex and largest joint in the human body and consists of the tibiofemoral and patellofemoral joint complex. Due to its complexity and biomechanics, it is subjected to multiple body weights during some phases of gait and is a combined angular and rotational joint, meaning that extension, flexion, internal and external rotation are possible. During the growth and development of the femur, tibia and patella, a certain relationship of biomechanical forces is required to eventually form normal joint function in children and adults. The position of the patella with its height, i.e. the distance to the joint space, is also important for the stability of the patella and the orderly biomechanics of the knee. Chondromalacia of the patella is a softening of the cartilage of varying degrees, although the subchondral bone is not yet altered. It is initially reversible and later becomes irreversible with a high risk of developing secondary osteoarthritis. Patellar chondromalacia can be diagnosed by arthroscopy and is sometimes discovered as an incidental finding during arthrotomy with knee meniscectomy. Physiotherapy plays an important role in the treatment and rehabilitation as well as prevention of injury and damage to the structures of the knee joint. The rehabilitation process begins immediately after the injury and must be tailored to the individual, and continues until the lost abilities are restored. Treatment can be preventive, conservative or surgical. It is usually conservative, but there are cases where the only way out is surgical treatment. It is important to start conservative treatment as early as possible, more precisely when the first symptoms appear. It is very important to use the therapeutic method RICE (R - rest, I - ice, C - compression, E - elevation) within 24 to 72 hours. Assessment methods include inspection, palpation, measuring the range of motion of the joint, and assessing muscle strength. Various methods of physical therapy are used. After acute treatment of the injury, our goal is to relieve pain and promote healing of the damaged part. Symptoms are most commonly treated with electrotherapy, cryotherapy, ultrasound, transcutaneous electrical stimulation (TENS), laser and magnetic therapy. Kinesiotherapy uses movement to treat, rehabilitate, and prevent disease and is combined with other forms of physical therapy. It is of great importance in the rehabilitation of patellar chondromalacia as patients are actively involved in the exercise process. The main goals of exercise therapy are to establish, maintain and increase the range of motion of the knee joint, maintain and increase muscle strength, endurance and speed of movement, and improve balance and neuromuscular coordination of movements. Therefore, it is extremely important to detect the damage to the articular cartilage and initiate conservative treatment in time to avoid the risks of surgical treatment and the development of secondary osteoarthritis of the knee joint.

Neuromišićne bolesti su nasljedne progresivne bolesti koje su uzrokovane problemima na motoneuronima. Očituju se u različitim razdobljima života gdje neke bolesti započinju već po rođenju, neke u ranom djetinjstvu, a neke tek u adolescentskoj ili odrasloj dobi. U neuromišićne bolesti se ubrajaju mnogobrojne bolesti i sindromi, od kojih svaka ima specifične simptome i terapije. U ovom radu su istaknute Duchenneova mišićna distrofija i Charcot-Marie-Toothova bolest. Duchenneovu mišićnu distrofiju karakterizira proksimalna mišićna slabost i pseudohipertrofija potkoljenica, te pozitivan Gowersov znak, izražena lordoza i gegajući hod. Simptomi ove bolesti u konačnici vode do nepokretnosti. Charcot-Marie-Toothova bolest je opisana kao sindrom koji zahvaća distalne mišiće uz razvoj mišićne slabosti i atrofije, te se dijeli na više vrsta s različitim načinom nasljeđivanja i simptomima. U radu su također prikazana i istraživanja o načinima fizikalne terapije za ove dvije bolesti koja su pokazala učinkovitost treninga respiratornih mišića kod Duchenneove mišićne distrofije, te trening s kontinuiranim povećanjem otpora kod Charcot-Marie-Toothove bolesti. Unatoč prikazanim istraživanjima, od iznimne bitnosti su buduća istraživanja o ovim bolestima. Neuromuscular diseases are inherited progressive diseases caused by problems on motoneurons. They manifest at different periods of life where some diseases begin as early as birth, some in early childhood, and some only in adolescence or adulthood. Neuromuscular diseases include numerous diseases and syndromes, each of which has specific symptoms and therapies. Duchenne muscular dystrophy and Charcot-Marie-Tooth disease are highlighted in this paper. Duchenne muscular dystrophy is characterized by proximal muscle weakness and pseudohypertrophy of the lower legs, as well as a positive Gowers sign, pronounced lordosis and limping gait. The symptoms of this disease ultimately lead to immobility. Charcot-Marie-Tooth disease has been described as a syndrome that affects the distal muscles with the development of muscle weakness and atrophy, and is divided into several types with different mode of inheritance and characteristics. The paper also presents research on physical therapy methods for these two diseases, which showed the effectiveness of respiratory muscle training in Duchenne muscular dystrophy, and training with a continuous increase in resistance in Charcot-Marie-Tooth disease. Despite the research presented, future research on these diseases is extremely important.

Cilj: Protetička rehabilitacija nakon amputacije donjeg uda uključuje sve kompleksne postupke i interakcije rehabilitacijskog tima i pacijenta koje su usmjerene cilju uspostavljanja sigurnog i stabilnog hoda s protezom. Nakon otpuštanja iz rehabilitacijskog centra pacijent koristi protezu, sukladno dobi, stilu života i okolini u kojoj živi. Cilj: Cilj rada je procijeniti uspješnost protetičke rehabilitacije osoba s amputacijom donjeg uda koristeći indekse predviđene mobilnosti pacijenta (engl. Amputee Mobility Predictor; AMP) i brzinu hoda. Ispitanici i metode: U radu su korišteni podaci pacijenata iz baze podataka Zavoda za fizikalnu i rehabilitacijsku medicinu Kliničkog bolničkog centra u Rijeci, a pri tome su u skladu s Helsinškom deklaracijom ostali anonimni: dob, spol, vrsta i strana amputacije, AMP, brzina hoda i vrijeme provedeno u protezi. Od sto pacijenata s amputacijom 62 su bila transtibijalna (TT) i 38 transfemoralna (TF). U ispitivanju je sudjelovalo 27 žena i 73 muškarca. Svim pacijentima je utvrđen AMP indeks prije rehabilitacijskog postupka (AMPnoPRO) te nakon završenog rehabilitacijskog postupka (AMPPRO). Rezultati: Nakon provedene protetičke rehabilitacije utvrđena je statistički značajna razlika u konačnoj mobilnosti (AMP: p < 0,001) i brzini hoda (p = 0,002) između TT i TF grupa, odnosno bolji rezultat su postigli pacijenti s nižom razinom amputacije (TT). Također je utvrđena statistički značajna povezanost između vremena provedenog u protezi i brzini hoda te AMP indeksa (p < 0,001). Zaključak: Razina amputacije je važna stavka koja pridonosi konačnom ishodu rehabilitacijskog postupka, odnosno viša razina amputacije kod pacijenata (TF) predstavlja jedan oblik ograničenja za bolji uspjeh u odnosu na pacijente s nižom razinom amputacije (TT)., Aim: Prothetic rehabilitation after lower limb amputation includes all complex procedures and interactions between the rehabilitation team and the patient aimed for establishing a safe and stable walk with the prosthesis. After being released from the rehabilitation center, the patient uses the prosthesis, according to age, lifestyle and the environment in which he lives. Aim: The aim of the paper is to evaluate the success of the prosthetic rehabilitation after lower limb amputation patients using Amputee Mobility Predictor (AMP) and walking speed measures. Patients and methods: The following patients’ data ware taken from the database at the Department of Physical and Rehabilitation Medicine of the Clinical Hospital Center Rijeka, used in purpose of this work only, and stayed anonymous according to the Helsinki Declaration: age, sex, type and side of amputation, AMP, walking speed and the time spent in the prosthesis. From the 100 patients with amputation, 62 of them was transtibial (TT) and 38 transfemoral (TF). The AMP index was established for all patients prior to the rehabilitation procedure (AMPnoPRO) and after the completed rehabilitation procedure (AMPPRO). Results: After the prosthetic rehabilitation, a statistically significant difference in ultimate mobility (AMP: p < 0,001) and walking speed (p = 0.002) between the TT and the TF group was established, respectively, in a patients with a lower level of amputation (TT). A statistically significant correlation between the time spent in the prosthesis and walking speed and AMP index (p < 0.001) was also established. Conclusion: The level of amputation is an important factor contributing to the ultimate outcome of the rehabilitation process, and a higher level of amputation in patients (TF) is one form of limitation for better success compared to patients with lower amputation levels (TT).

Vrat je jedan od najčešćih izvora muskuloskeletne boli. Iako je bol u vratu najčešće akutna i samolimitirajuća, u 30% slučajeva prelazi u kroničnu bol s umjerenim ili težim simptomima. Bol u vratu može biti povezana s degenerativnim promjenama te fizikalnim i psihosocijalnim čimbenicima, a važnu ulogu ima sjedilački način života te smanjena fizička aktivnost i stres. Ovisno o simptomatologiji razlikuju se cervikalni sindrom, cervikobrahijalni i cervikocefalni sindrom. Iako su simptomi u početku lokalizirani u području vratne kralježnice, s napredovanjem degenerativnih promjena dolazi do širenja boli u okolna područja. Dijagnoza kroničnog bolnog sindroma vrata temelji se na detaljno uzetoj anamnezi i kliničkom pregledu. Uz klinički pregled, često se u dijagnosticiranju boli koriste slikovna dijagnostika i elektrodijagnostika. Liječenje kroničnog bolnog sindroma vrata pretežno je neoperacijsko ili konzervativno te većina pacijenata dobro reagira na ovakav oblik liječenja. Cilj liječenja je smanjiti bol i omogućiti pacijentu obavljanje svakodnevnih životnih aktivnosti. U liječenju kroničnog bolnog sindroma vrata primjenjuju se lijekovi, metode fizikalne terapije, invazivno liječenje, alternativne i komplementarne metode te kognitivno-bihevioralna terapija. Fizikalna terapija je temelj liječenja i prevencije kronične boli u vratu. Najčešće korištene metode fizikalne terapije su kineziterapija, masaža, spinalna manipulacija, trakcija, krioterapija, termoterapija, ultrazvuk, elektroterapija i laser. The neck is one of the most common sources of musculoskeletal pain. Although neck pain is in most cases acute and self-limiting, in 30% of cases it can progress toward chronic pain with moderate to severe symptoms. The cause of neck pain may be associated with degenerative changes as well as physical and psychosocial factors. A sedentary lifestyle, reduced physical activity, and stress also play an important role. Depending on the symptomatology, it is possible to differentiate between the cervical, the cervicobrachial, and the cervicocephalic syndrome. Although symptoms are localized in the cervical spine in the beginning, the pain starts to spread to the surrounding areas as degenerative changes progress. The chronic cervical pain syndrome is diagnosed based on extensive history taking and a clinical examination. Apart from the clinical examination, diagnostic imaging and electrodiagnostics are often used to diagnose the pain. Treatment of the chronic neck pain syndrome is predominantly nonoperative or conservative, and most patients respond well to this type of treatment. The goal of treatment is to reduce pain and to enable the patient to perform everyday activities. Methods applied in the treatment of the chronic neck pain syndrome are medicines, methods of physical therapy, invasive treatment, alternative and complementary methods, and cognitive-behavioral therapy. Physical therapy is the basis of treatment and prevention of chronic neck pain. The most common methods of physical therapy are kinesitherapy, massage, spinal manipulation, traction, cryotherapy, thermotherapy, ultrasound, electrotherapy, and laser.

Sindrom bolnih križa predstavlja socioekonomski i javnozdravstveni problem u razvijenom svijetu. Sjedilački način života najviše doprinosi bolnim križima. Javlja se uglavnom u starijoj populaciji, no raste incidencija u mlađoj dobi. Križobolja s obzirom na etiologiju može biti diskogena i nediskogena. Diskogenoj križobolji uzrok su degenerativne promjene diska. Nediskogena može biti posljedica upalnih stanja, promjena fasetnih zglobova, mišićno koštanog sindroma, zadebljanja žutih ligamenta, bolesti iz različitih sustava u blizini lumbalne kralježnice. Za pravilnu dijagnozu potrebna je temeljito uzeta anamneza i klinički pregled, te slikovne dijagnostičke pretrage. Terapija uključuje nefarmakološke i farmakološke metode. Nefarmakaloške metode su medicinske vježbe, elektroterapija, terapija ultrazvukom, terapija laserom, toplinska terapija. Studije su kontradiktorne u efikasnosti nefarmakoloških metoda, stoga bi se za učinkovito liječenje trebalo indivudulano prilagoditi pojedincu. Farmakološke metode ubrajaju neopiodne analgetike i opiode. Prema stupnju i intenzitetu boli postoje smjernice Svjetske zdravstvene organizacije za upotrebu analgetika. Low back pain syndrome poses a socio-economic and public health issue in the modern world. The most common contributing factor to the development of low back pain is sedentary lifestyle. This syndrome mostly affects elderly population, but it is becoming increasingly prevalent at a younger age. Considering its etiology, low back pain can be discogenic and non-discogenic. Discogenic low back pain is caused by degenerative changes of the intervertebral disc. On the other hand, non-discogenic low back pain can be caused by inflammatory conditions, facet joint disorders, musculoskeletal syndromes, degenerative changes of the sacroiliac joint, flava ligamentum hypertrophy, various conditions in the lumbar spine region. A correct diagnosis requires a thorough anamnesis and a clinical examination and, if necessary, the use of diagnostic imaging techniques. Treatment of the aforementioned syndrome includes pharmacological and non-pharmacological methods. Non-pharmacological methods include medical exercise, electrotherapy, therapeutic ultrasound, laser therapy, shortwave diathermy. The studies of efficiency of the non-pharmacological methods are contradictory, and thus such methods should be individually adjusted to patients in order to achieve effective treatment. Pharmacological methods include non-opioid analgesics and opiods. World Health Organization issues guidelines for analgesics usage, taking into consideration level and intensity of pain. It is crucial to adjust the dosage to each patient individually.

Cerebralna paraliza je klinički entitet kojeg karakterizira poremećaj pokreta i položaja uzrokovan neprogresivnim oštećenjem nezrelog mozga. Mnogo je etioloških faktora zbog kojih dolazi do oštećenja mozga koja može uzrokovati cerebralnu paralizu. Posljedice oštećenja utječu na motoričku funkciju te mišićno-koštani i kognitivni razvoj, a javlja se i niz drugih pridruženih zdravstvenih poteškoća. Također, kada se govori o cerebralnoj paralizi, uvijek treba naglasiti da cerebralna paraliza predstavlja, ne samo medicinski problem, nego i psihološki i socijalni problem. Dijagnoza se postavlja kod djece kod koje je uočen usporeni razvoj motorike, a koji se potvrđuje nalazima magnetske rezonancije. Terapija djeteta s cerebralnom paralizom je usmjerena na ostvarivanje zadanog cilja. Dva glavna cilja su smanjiti komplikacije uzrokovane cerebralnom paralizom i poboljšati sposobnost usvajanja novih vještina. Dodatni ciljevi su edukacija roditelja, smanjenje tjelesnih deformacija i poboljšanje pokretljivosti. Cerebralna paraliza zahtjeva interdisciplinarni pristup te ima veliki utjecaj i na dijete i na čitavu obitelj i njihov život. Svaki terapijski pristup se bazira na individualnom pristupu. Vrlo je bitno terapiju započeti što ranije jer ranija terapija olakšava razvoj djeteta i pridonosi boljem ishodu terapije i kvaliteti života. Terapija cerebralne paralize ne treba biti usmjerena samo na motoričke tretmane, već i na tretmane i drugih poremećaja od kojih dijete pati. Postoji niz terapijskih sistema koji se primjenjuju u radu s djecom s cerebralnom paralizom. Rijetko se kad terapija oslanja na samo jedan sistem, najčešće se primjenjuje kombinacija terapijskih postupaka. Takav pristup omogućava fleksibilnost i individualizaciju kako bi se ostvarili ciljevi postavljeni za dijete i obitelj., Cerebral palsy is a clinical entity characterized by disorder of movement and posture caused by a non-progressive injury to the immature brain. There are many etiological factors that may cause brain injury that result in cerebral palsy. The consequences of brain injury may have an effect on motor function, musculoskeletal and cognitive development as well as on a range of other associated health issues. Also, when it comes to cerebral palsy, it should always be noted that it is not merely about a medical problem, but also the psychological and social components have to be taken into account. Diagnosis is made in children with slow motor development and is comfimed with findings from magnetic resonance imaging. In children with cerebral palsy, the treatment is aimed at achieving two main goals: reduce complications of cerebral palsy and improve the ability to acquire new skills. Additional goals are represented by parent education, reduction of body deformations and mobility improvement. Cerebral palsy has a major impact on the child, the whole family and their life, thus an interdisciplinary approach is required. It is important to begin the therapy as early as possible in order to facilitatee the patient's development and contribute to a better treatment outcome in terms of quality of life. Cerebral palsy treatment should not be focused only on improvement of motor skills; attention should be pointed at every kind of impairment from which the child suffers. In this view, a wide range of therapeutic approaches is available and a combination of therapeutic procedures is usually employed. This multimodal approach allows flexibility and treatment individualization toward achievement of specific goals set for the child and family.

We aimed to verify by Rasch analysis whether the Mini-BESTest, a balance measure, confirms its main psychometric properties in patients with subacute stroke undergoing rehabilitation in three different countries (Slovenia, Croatia, and Italy), and to examine the stability of item hierarchy and difficulty across the three national versions through a differential item functioning analysis. We investigated 159 patients with subacute stroke consecutively admitted to three rehabilitation facilities after screening for an intensive, tailored rehabilitation program. Balance function was tested within 36 h from admission and after ∼25 days. As no differential item functioning was found between admission and discharge data or among countries, all data were pooled. Rasch criteria for the functioning of rating scale categories were fulfilled. In terms of internal construct validity, all items except item #14 (Cognitive Get UpGo; infit value=1.42) showed an acceptable fit to the Rasch model. The patient ability-item difficulty matching was very good. Reliability indices were high. The Principal Component Analysis of standardized residuals confirmed the unidimensionality of the test. On the basis of the item calibration, raw scores of the Mini-BESTest were transformed into linear estimates of dynamic balance and six statistically detectable levels of balance ability were defined. Good psychometric features of the Mini-BESTest were confirmed. The three different national versions showed stability in item hierarchy, indicating equivalence of their cross-cultural adaptations. Problems with item #14 in these patients warrant further study.

Fizikalna terapija se različito razvijala u zapadnim i istočnim zemljama svijeta. Vježbe koje su se provodile u programu po formi i načinu izvođenja pripadaju zemljama Dalekog istoka, a mogu biti pronađene i u istočnim vještinama (npr. Tai-Chi i Chi-Kung). Pacijenti koji su sudjelovali u programu su osobe starije životne dobi (65 godina i više) koje nisu zdravi pojedinci, već pacijenti od kojih većina ima komorbiditete. Cjelokupni program trajao je dva tjedna. Cilj programa bio je ispitati utjecaj u radu navedenih 9 vježbi na ispitanike. Uz to, ispitati praktičnost i pamtljivost pacijentima dotad neviđenih vježbi. Prije početka programa, svakom ispitaniku učinjen je šestominutni test hoda, pri čemu je mjeren prijeđeni put, tlak, puls i EKG te Borgova skala. Uz to im je napravljena kompletna krvna slika. Isto je ponovljeno po završetku programa. Za vrijeme izvođenja programa, svakodnevno je, prije i poslije izvođenja vježbi, svakom pacijentu mjeren tlak i puls. Na temelju tih podataka izrađene su slike – grafovi za svakog pacijenta na kojima se može pratiti kretanje pulsa i srednjeg arterijskog tlaka (koji je naknadno izračunat). Iz rezultata je zaključeno da su vježbe pozitivno doprinijele stanju pacijenata – u šestominutnom testu hoda čak 75% pacijenata povećalo je prijeđeni put, a isti postotak pacijenata osjeća jednak ili manji napor pri izvođenju testa. Tlak i puls dolaze u jako različitim oscilacijama. One nisu velike, a krajnje vrijednosti su unutar granica normalnog nalaza. Tijekom vježbanja, svi su pacijenti izrazili želju da s ovakvim vježbama nastave i nakon završetka programa, što bi i trebao biti smisao fizikalne terapije. Physical Therapy has been developing differently in western and eastern countries. Excercises that have been demonstrated in this program by form resemble ones from Far East countries. They can also be found in martial art skills like Tai-Chi and Chi-Kung. The patients that have been participating in this program are elderly people (65 or more years of age). Those are not healthy individuals – most of the patients have developed comorbidities. The program itself went on for two whole weeks. The main goal of the program was to examine how do 9 exercises affect the examinees. Besides that, goal was to examine whether the new excercises were practical and memorable to patients. Before the program started, each examinee went through six-minute walking test. Pressure, puls, ECG, Borg scale and distance travelled were measured. Besides that, they got blood test done. Same was repeated after the program ended. Each day during program execution, before and after exercising, each patient got his pulse and pressure measured. Based on these data pictures were made – graphs to represent each of the patients’ pulse and pressure (afterwards calculated mean arterial pressure) movement. Conclusion that can be brought from the results is that excercises contributed to patients’ wellbeing - 75% of the examinees travelled longer distance and felt same or lower effort while performing the test. Pressure and pulse oscilate, but don’t exceed boundaries for normal values. During excercising, patients said they want to continue with this practice after finishing the program, which is also the purpose of the physical therapy

Klasifikacija reumatskih bolesti poznata pod nazivom „reumatizam“ obuhvaća više različitih bolesti. Reumatoidni artritis (RA ) je oblik artritisa koji uzrokuje bol, oteklinu, ukočenost i gubitak funkcije u zglobovima. To je kronična, sustavna upalna bolest koju karakterizira uništavanje sinovijalne membrane što rezultira destrukcijom, ankilozom i deformitetom. Reumatoidni artritis obično se ponavlja u epizodama koje traju po nekoliko tjedana ili mjeseci što se izmjenjuje s razdobljima u kojima uglavnom nema simptoma. Odlikuje se fazama spontanih remisija i egzarcebacijama. Bolest se javlja kao simetrični poliartritis, koji obično počinje periferno te se širi proksimalno, npr. na ruci zahvaća prvo proksimalne zglobove prstiju šake, zatim zahvaća ručni zglob, lakat, a tek u poodmaklom stadiju zglob ramena. Klinička slika je u početku bolesti obično nekarakteristična i vrlo varijabilna. Tada vodeći simptomi mogu biti gubitak apetita, bol u mišićima, anemija i ubrzana sedimentacija eritrocita. Nakon početne nespecifične faze pojavljuju se prvi karakteristični znakovi bolesti, kao što je jutarnja ukočenost zglobova, a najprije zglobova prstiju i šake. Postupci u bolesnika s aktivnim reumatoidnim artritisom obično počinju temeljitom procjenom svih tegoba bolesnika, fizikalnim pregledom i labaratorijskim testovima. Rutinska rentgenološka pretraga ključna je za dijagnozu i liječenje reumatskih bolesnika. Rendgenske snimke prikazuju oštećenja kosti i deformacije, te mogu pokazati koliko je bolest uznapredovala. Rehabilitacija bolesnika s upalnim reumatizmom, uz liječenje lijekovima, ima za cilj očuvanje punog ili funkcionalnog opsega pokreta svih zglobova, dostatne mišićne snage, uz toleranciju dnevnih opterećenja bez ili s podnošljivim bolom. Glavne sastavnice specijaliziranog rehabilitacijskog programa bolesnika s upalnim reumatizmom su procedure fizikalne terapije (medicinske vježbe, prilagođena fizička aktivnost, procedure termoterapije i elektroterapije, balneoterapija i masaža); promoviranje zaštite zglobova; korištenje pomagala i ortoza; edukacija i samopomoć bolesnika; redukcija tjelesne težine i vokacijska rehabilitacija. Jedna od najbitnijih stavki u skrbi o bolesniku oboljelom od reumatske bolesti svakako je edukacija. Potrebna je ne samo oboljelom, nego i članovima obitelji i svrha joj je pomoć u razumijevanju bolesti, važnosti svih mjera liječenja i njihovu svakodnevnom provođenju. Classification of rheumatic diseases known by the term „rheumatism “includes various diseases. Rheumatoid arthritis (RA) is a type of arthritis that causes pain, swelling, angularity and loss of articulation function. That is a chronicle, systematic disease that is characterised by destruction of synovial membranes, which results in destruction, anchylosis and deformation. Rheumatoid arthritis is usually repeated in episodes that can last from a few weeks up to a few months and is intertwined with periods in which, usually, there are no symptoms. It is characterised with phases of spontaneous remissions and exacerbations. This disease occurs as symmetrical polyarthritis, which usually begins peripherally and it spreads proximally, for example on arms it firstly affects proximal interphalangeal joints of the hand, and then it affects the wrist itself, elbow and in further stage it affects shoulder joints. In the beginning, clinical picture is usually uncharacteristic and very variable. Then the leading symptoms might be the loss of appetite, muscle pain, anaemia and accelerated erythrocyte sedimentation rate. Afterwards the first nonspecific phase, the first characteristic signs of disease, such as morning angularity of joints, finger joints and wrists, start to occur. Methods of treatment for patients with RA start with thorough assessment of all difficulties the patient is having, physical examination and laboratory tests. Routine of x-ray examination is crucial for setting the diagnose and hospital treatment of RA. The X-rays show bone damage and deformation, and can also show the extent of the disease. Rehabilitation of patients with inflammatory rheumatism, besides medication, has a goal of keeping full or functional extent of all joint movements, sufficiently muscle strength, with tolerance of daily ballast with or without tolerable pain. Principal components of specialised rehabilitation programme of patients with inflammatory rheumatism are procedures of physical therapy (medical exercises, adjusted physical activity, procedures of thermotherapy and electrotherapy, balneotherapy and massage); promoting joints protection; using orthopaedic aids and orthosis; education and self-help, reduction of body weight and vocational rehabilitation. One of the most important components in taking care of the patient with RA surely is education. It is necessary not only for the patient, but for the whole family. The aim of education is to help to understand the disease, to learn about the importance of all treatment procedures and about the importance of practicing new learned procedures as a daily routine.

Prednja ukrižena sveza jedan je od najsnažnijih pasivnih stabilizatora koljena, a ozljeda same sveze zahtjeva zahtjevan i često dug proces rehabilitacije. Profesionalni sportaši najčešće stradavaju od ozljeda prednje ukrižene sveze, ali one se znaju dogoditi i osobama koji se povremeno bave sportskim aktivnostima, tj. rekreativcima. Mehanizam ozljede zasnovan je na traumi koja nastaje nakon što vanjske sile nadvladaju maksimalnu sposobnost istezanja ligamenta, nakon koje dolazi do parcijalne ili potpune rupture sveze. Prvi simptomi rupture LCA su bol i oteklina, nakon koje osoba osjeća nestabilnost u samom zglobu te smanjen opseg pokreta. Nakon što se dijagnostički potvrdi ruptura prednje ukrižene sveze, pristupa se kirurškom zahvatu rekonstrukcije LCA, u kojoj se kao implatant najčešće koriste tetive mišića stražnje lože, i to tetive m. semitendinosusa i/ili m. gracilisa (ST/STG-graft). Rehabilitacija je kako smo već naveli dugotrajna i zahtjevna, a u njoj se koristi veliki broj modaliteta fizikalne terapije, kao što su elektroprocedure, krioterapija, hidroterapija, kineziterapija i drugi. U ovom radu usporedili smo odnos snage i gibljivosti zgloba koljena godinu dana nakon operacije, te usporedili rezultate prošlogodišnjih mjerenja sa kontrolnim rezultatima. Dobivenim rezultatima potvrdili smo uspješnost operacijskih tehnika metodom ST i STG grafta, te rehabilitacijskog procesa koji je uslijedio. Zbog ograničenosti po pitanju broja ispitanika, tj. premalog broja samih, dobiveni rezultati nisu statistički značajni. Anterior cruciate ligament is one of the most strongest passive knee stabilizer, whose injuries often demand long and complicated rehabilitation. Professional athletes are often victims of the anterior cruciate ligament injuries, but they also can happen to people who are occasionally engaged in sporting activities, ie. recreationists. The mechanism of injury is based on the trauma that occurs after an external forces overcome the maximum stretching capability of ligaments, after which there is a partial or complete ligament rupture. The first symptoms of LCA rupture are pain and swelling, after which the person feel instability in the joint and reduced range of motion. After confirmation of the diagnosis, surgeons do the ACL reconstruction. The implatant they use is muscle tendon of m. semitendinosus and/or m. gracilis. Rehabilitation proces is long and challenging, in which we use a number of physical therapy modalities, such as electroprocedures, cryotherapy, hydrotherapy, kinesiotherapy, and others. In this study we compared the relationship of power and flexibility of the knee joint one year after surgery, and we also compared the results from last year with control results. The results have confirmed the success of both surgical techniques and following rehabilitation proces. Because of the small number of subjects, the obtained results have no statistical significance.

Sindrom smrznutog ramena kao klinički entitet sastavni je dio izvanzglobnih oboljenja ramenog zgloba poznatiji kao periartritishumeroskapularis ili sindrom bolnog ramena. Patoanatomski gledano, dolazi do skvrčavanja fibrozne zglobne čahure ramena, koja postaje manja i neelastična. Stvaraju se brojne priraslice zglobne čahure ramena, zbog čega pokreti u ramenu postaju progresivno ograničeni i bolni. Općenito, cilj fizikalne terapije je smanjivanje boli, povećanje funkcije i edukacija bolesnika u cilju sprječavanja budućih bolnih epizoda. Ozbiljni slučajevi, koji ni nakon tri mjeseca intenzivne fizikalne terapije ne pokazuju poboljšanje, mogu se liječiti operativnim putem. Iako do danas nije razjašnjen uzrok koji pokreće proces u kojem nastaje sindrom smrznutog ramena, poznajemo vrlo jasnu kliničku sliku i primjereno liječenje. Stoga je cilj ovoga rada definirati, objasniti i prikazati načine liječenja sindroma smrznutog ramena kroz primjer pacijenta. U ovom radu je, kroz konkretni primjer ispitanika prikazan utjecaj konzervativnog i operativnog modaliteta na povrat izgubljene funkcije ramenog zgloba. Nakon 10 dana intenzivne mobilizacije i primjene odgovarajućih metoda fizikalne terapije, nije došlo do povećanja opsega pokreta. Kod pojedinih pokreta zabilježeno je smanjenje opsega pokreta, stoga je operativni zahvat bilo vrlo važno obaviti. Nakon operativnog zahvata (artroskopska prednja, stražnja i donja kapsulotomija oba ramena) dolazi do povećanja opsega pokreta, što je olakšalo daljnju rehabilitaciju. Istraživanja su pokazala da nema efekta primjena samo jednog modaliteta rehabilitacije. Najbolji način liječenja sindroma smrznutog ramena je „timski rad“ procedura fizikalne terapije, prije svega kineziterapije i mobilizacijskih tehnika, u suradnji sa farmakološkim lijekovima (intraartikularnim injekcijama kortikosteroida, NSAR...) koji smanjuju izrazito bolne senzacije u pojedinim fazama bolesti. Frozen shoulder syndrome as a clinical entity is an integral part extra-articular shoulder joint disease known as periartritis humeroskapularis (PHS) or painful shoulder syndrome. Pathoanatomically, there is a contraction of the fibrous joint of shoulder capsule, which becomes less and inelastic. Created numerous adhesions shoulder joint capsule, causing movements in the shoulder become progressively restricted and painful. In general, the goal of physical therapy is to decrease pain, increase the functionality and prevent future pain episodes. Serious cases, that even after three months of intensive physical therapy did not show improvement, can be treated surgically. Although it has not clarified the cause that initiates the process that creates the frozen shoulder syndrome, we know clear clinical picture and the appropriate treatment. Therefore, the aim of this thesis is to define, explain and present methods of treatment of frozen shoulder through the example of a patient. In this thesis, through a concrete example of the respondents to show the influence of conservative and operative modalities on recovering the lost function of the shoulder joint. After 10 days of intense mobilization and application of appropriate methods of physical therapy, there was no increase range of motion. In some movements showed a decrease in range of motion, so the surgery was very important to do. After surgery (arthroscopic front, rear and bottom capsulotomy both shoulders) to an increase range of motion, which facilitated further rehabilitation. Studies have shown that there is no effect of using only one modality of rehabilitation. The best treatment of frozen shoulder is "teamwork" of physical therapy procedures, primarily physical training and mobilization techniques, in collaboration with pharmacological therapy (intra-articular injections of corticosteroids, NSAID, ect.) that reduce extremely painful sensations in different stages of the disease.

U reumatske bolesti ubraja se više od 100 različitih entiteta koji zahvaćaju mišićno--koštani sustav. Cilj rehabilitacije bolesnika s reumatskim bolestima je maksimalno očuvanje ili oporavak fizičke, psihičke i društvene funkcije bolesnika. To je kontinuirani i sustavni proces koji provodi multidisciplinarni tim s dugoročnim i kratkoročnim ciljevima, sukladno statusu bolesnika. Međunarodna klasifikacija funkcioniranja, onesposobljenosti i zdravlja predstavlja okvir za klasifikaciju posljedica bolesti, bolesnikovo funkcioniranje i razinu zdravlja. Specijalizirani rehabilitacijski program reumatskih bolesnika kreira se individualno prema potrebama pojedinca, a obično se sastoji od aktivnih metoda (kineziterapija, radna terapija) i pasivnih metoda (termoterapija, elektroterapija, ortopedska pomagala). Kod planiranja postupaka prvo se respektiraju lokalni simptomi, a potom djeluje sustavno na opće zdravlje. Iznimno je važno provođenje edukacije o bolesti, medikamentnoj terapiji, važnosti načina života i samopomoći. Vokacijska rehabilitacija najučinkovitija je kada se provodi dok još nije nastala trajna radna onesposobljenost., The rheumatic diseases are more than 100 diverse disorders affecting the musculoskeletal system. The goal of rehabilitation of patients with rheumatic diseases, is maximal preservation or the recovery of the patients’ physical, psychological and social functions. It is a continuous and systematic process which is performed by a multidisciplinary team, with long-term and short-term goals, depending on the status of the patient. The International classification of functioning, disability and health provides the framework for the classification of the consequences of diseases, patient’s functioning and the level of health. Specialised rehabilitation programmes for rheumatic patients are created on individual basis, and usually consist of active methods (kinesitherapy, work therapy) and passive methods (thermoterapy, electrotherapy, orthosis, walking aids and assistive devices). When planning the proceedings, local symptoms are taken into consideration first and then general health condition is targeted systematically. It is therefore, extremely important to educate patients concerning the nature of the disease, medication therapy, their way of life and self-management interventions. Vocational rehabilitation appears to be most successful when permanent work disability has not yet occured.