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Uvod: Nadzor in uravnavanje ravnotežja je zelo pomemben dejavnik za normalno gibanje in dejavnosti vsakodnevnega življenja. Vibracija je občutek, ki ga povzroči sinusoidno nihanje predmetov na koži. Ločimo med lokalno vibracijo in vibracijo celega telesa. Lokalna vibracija predstavlja inovativno tehniko za izboljšanje ravnotežja, zlasti pri osebah z različnimi nevrološkimi stanji, njeni učinki pa so na zdravi populaciji še dokaj neraziskani. Namen: Namen diplomskega dela je bil na vzorcu mladih odraslih proučiti vpliv lokalne vibracije podplatov na statično ravnotežje. Metode dela: V raziskavo je bilo vključenih 30 študentov fizioterapije v starosti med 20 in 27 let. Testirali smo mirno stojo s stopali skupaj na pritiskovni plošči z odprtimi in zaprtimi očmi in klinični test stoje na eni nogi na mehki podlagi z zaprtimi očmi. Nato smo opravili lokalno vibracijsko terapijo podplatov z napravo Hypervolt (frekvenca 30 Hz, amplituda 12 mm). Vibracije smo zaporedno na vsak podplat dovajali v sedečem položaju po pet minut. Po vibracijski terapiji smo zopet opravili meritve statičnega ravnotežja in rezultate obeh meritev primerjali med sabo. Analizirali smo štiri parametre gibanja središčnega pritiska: hitrost gibanja središčnega pritiska, pot, ki jo opravi središče v mediolateralni in anteroposteriorni smeri ter ploščino, izračunano z metodo lastnih vrednosti kovariančne matrike. Za primerjavo rezultatov gibanja središčnega pritiska in kliničnega testa stoje na eni nogi pred in po vibracijski terapiji smo uporabili parni T-test. Rezultati: Ena spremenljivka (pot v anteroposteriorni smeri) je bila pomembno manjša po vibraciji pri odprtih in zaprtih očeh in stopalih skupaj. Pri meritvah z zaprtimi očmi in stopali skupaj je bila pomembna razlika tudi pri ploščini, le ta se je po vibracijski terapiji povečala. Ostale spremenljivke niso pokazale pomembnih razlik med meritvami pred in po vibracijski terapiji. Tudi meritve testa stoje na eni nogi na mehki podlagi z zaprtimi očmi niso pokazale razlike pred in po vibraciji. Razprava in zaključek: Glede na dobljene rezultate lahko zaključimo, da se po lokalni vibraciji podplatov pri mladih odraslih nakazuje zelo blag učinek na statično ravnotežje, vendar ni pomembnega izboljšanja ravnotežja. Introduction: Balance and postural control are very important factors for normal movement and daily activities. Vibration is a feeling caused by sinusoidal oscillation of objects on the skin. We distunguish between two types of vibration: focal vibration and whole-body vibration. Focal vibration is an innovative technique for balance improvement, especially in various neurological patients. Its effects on a healthy population are still relatively unexplored. Purpose: The purpose of this thesis was to research effects of focal plantar vibration on static balance in a sample of young adults. Methods: A group of 30 physiotherapy students, aged between 20 and 27, participated in the research. Their static balance was tested by standing still on a pressure plate with feet close together and by clinical one-leg standing test on a soft surface with the eyes closed. We then performed local vibration therapy on the plantar side of the foot with Hypervolt device (frequency 30 Hz, amplitude 12 mm). Vibrations were applied sequentially to each sole of the foot in a sitting position for five minutes. After vibration therapy, static balance measurements were performed again and the results of both measurements were compared with each other. We analyzed four parameters of the central pressure movement: the velocity od the central pressure movement, the path, taken by the center in the mediolateral and anteroposterior direction, and the area, calculated by the method of the last values of the covariance matrix. Paired T-test was used to compare the results of central pressure movement and the clinical one-leg standing test before and after vibration therapy. Results: One variable (path in anteroposterior direction) was significantly lower after vibration with open as well as closed eyes and feet together. In the measurements with eyes closed and feet together, there was also a significant difference in the ares, which increased after vibration therapy. Other variables didn't show significant differences between measurements before and after vibration therapy. Measurements of the one-leg test on the soft surface with eyes closed also showed no difference before and after vibration. Discussion and conclusion: Based on obtained results, we can conclude, that after focal plantar vibration in young adults, a very mild effect on static balance is indicated, but there is no significant improvement in balance.

Uvod: Modificiran klinični test senzorične interakcije in ravnotežja (ang. modified clinical test of sensory interaction and balance – mCTSIB) je bil razvit za sistematično ocenjevanje sistemov pri uravnavanju ravnotežja. Izvaja se lahko v treh stoječih položajih, v vsakem v štirih pogojih z določenim vrstnim redom. Stabilometrija je veljaven postopek objektivnega merjenja statičnega ravnotežja. Spremenljivke opišejo premike središča pritiska med stojo na pritiskovni plošči. Namen: Ugotoviti zanesljivost posameznega preiskovalca pri izvedbi mCTSIB na pritiskovni plošči v treh položajih stoje, primerjati izvedljivost testiranja v vseh položajih in testnih pogojih ter izide med starostnimi skupinami. Metode dela: V raziskavo je bilo vključenih 60 zdravih preiskovancev v štirih starostnih skupinah (po 15 preiskovancev). Preiskovanci prvih dveh starostnih skupin so se udeležili dveh testiranj v razmiku enega tedna, preiskovanci tretje in četrte starostne skupine pa enkrat. Protokol mCTSIB je bil prilagojen stabilometriji. Izračunani so bili intraklasni korelacijski koeficienti (ICC3, k) ter ANOVA in naknadni t-testi za neodvisne vzorce z Bonferronijevim popravkom. Rezultati: Zanesljivost posameznega preiskovalca za mCTSIB v položaju stoje s stopali skupaj je bila visoka do odlična (ICC = 0,79-0,95) pri vseh testnih pogojih. V položaju tandemske stoje je bila zanesljivost pri TPOO visoka (ICC = 0,82-0,87), pri TPZO zmerna do visoka (ICC = 0,68-0,79) ter pri MPOO in MPZO nizka do zmerna (ICC = 0,50-0,73). V položaju stoje na eni nogi je bila zanesljivost pri pogoju TPOO visoka do odlična (ICC = 0,78-0,97), pri pogojih TPZO in MPOO zmerna do visoka (ICC = 0,55-0,83) in pri MPZO nizka do visoka (ICC = 0,39-0,82). Z višjo starostjo in oteževanjem pogojev se je krajšal čas stoje v določenem položaju. Pri spremenljivkah hitrost CoP ter mediolateralni in anteroposteriorni premik CoP so se s staranjem pokazale največje razlike. Zaključek: Stabilometrija po postopku mCTSIB je zanesljiva pri zdravih preiskovancih, starih od 20 do 49 let. Z oteževanjem pogojev in položajev se zanesljivost niža. MCTSIB je v položaju stoje s stopali skupaj nezahteven za mlade. Položaj tandemske stoje je primeren za vse starostne skupine (20–79 let). Položaj stoje na eni nogi, je pri starih 50–79 let smiseln le v pogoju TPOO . Potrebne so dodatne raziskave z izvedbo celotnega protokola mCTSIB na večjem vzorcu preiskovancev. Smiselno bi bilo preveriti ali za zanesljivost zadostuje krajši čas testiranja ter katera dolžina najkrajšega časa še zadostuje za zanesljive izide. Background: Modified clinical test of sensory interaction and balance (mCTSIB) was developed for systematic evaluation of balance systems. It may be performed in three standing positions, in each in the four conditions with a specific order. Stabilometry is a valid objective measure of static balance. Its parameters describe movements of the centre of pressure (CoP) while standing on a force plate. Purpose: To determine intratester reliability of the mCTSIB performed on a force plate in three standing positions, to compare feasibility of all the positions and test conditions and the outcomes between the age groups. Methods: 60 healthy participants of four adult age groups (15 subjects in each) were included in the study. Participants of the first two age groups were assessed twice with a one-week interval, and participants of the third and fourth age groups were assessed once. The mCTSIB protocol was adapted for stabilometry. Intraclass correlation coefficient (ICC3, k), ANOVA and post hoc independent t-tests with Bonferroni correction were calculated. Results: Intratester reliability for the mCTSIB in 2-leg stance under all conditions was good to excellent (ICC 0.79-0.95). For tandem stance, the reliability was good in firm surface with eyes open (FSEO) condition (ICC 0.82-0.87), moderate to good when eyes were closed (FSEC) (ICC 0.68-0.79), and poor to moderate in both compliant surface conditions (CSEO, CSEC) (ICC 0.50-0.73). For 1-leg stance, the reliability was good to excellent in FSEO (ICC 0.78-0.97), moderate to good in FCEC and CSEO (ICC 0.55-0.83) and poor to good in CSEC condition (ICC 0.39-0.82). In each test position, the stance time decreased with increased age and aggravation of test conditions. CoP velocity, and ML and AP CoP movement changed the most with aging. Conclusion: Stabilometry according to the mCTSIB protocol is reliable in healthy participants, aged from 20 to 49 years. Reliability decreases with aggravation of the test conditions and positions. MCTSIB in 2-leg stance is undemanding for young people. Tandem stance position is feasible for all age groups (20-79 years), but in 1-leg stance only FCEO condition is feasible for 50–79 years old. Additional studies with entire mCTSIB protocol with larger sample size are needed. It would be reasonable to establish whether a shorter test time influence reliability and which is the shortest data collection time sufficient for reliable results.

Uvod: Ravnotežje je sposobnost vzdrževanja stabilne drže med mirno stojo, stanjem z motnjami ali zavestnim gibanjem. Za vzdrževanje ravnotežja mora osrednje živčevje usklajevati informacije iz različnih senzoričnih sistemov. Obogaten priliv iz somatosenzoričnega sistema lahko olajša uravnavanje drže in ravnotežja. Ena od možnosti dodajanja senzoričnega priliva je tudi transkutana električna živčna stimulacija. Namen: Ugotoviti, ali transkutana električna živčna stimulacija (TENS) vpliva na zmanjšanje gibanja središčnega pritiska med mirno stojo v štirih senzoričnih pogojih. Metode dela: V raziskavi je sodelovalo 20 preiskovancev, starih od 60 do 83 let. Testirali smo stojo na pritiskovni plošči, ob čemer je imel preiskovanec stopala skupaj. Na oba spodnja uda smo namestili tudi samolepilne elektrode, in sicer na baze metatarzal in zadnjo stran goleni, pod podkolensko jamico. Testiranje smo opravili v štirih različnih pogojih senzoričnega priliva: odprte oči brez električne stimulacije, odprte oči z električno stimulacijo, zaprte oči brez električne stimulacije, zaprte oči z električno stimulacijo. Analizirali smo naslednje spremenljivke: hitrost gibanja središčnega pritiska, pot, ki jo opravi središče v mediolateralni in anteroposteriorni smeri, ploščino, izračunano z metodo Fourierjeve analize obrisa, in ploščino, izračunano z metodo lastnih vrednosti kovariančne matrike. Rezultati: Med meritvami z odprtimi in zaprtimi očmi so bile statistično pomembne razlike pri vseh opazovanih spremenljivkah. Pri primerjavi gibanja središča pritiska pri odprtih očeh je bila ena spremenljivka (površina PCA) pomembno manjša pri meritvah s transkutano električno živčno stimulacijo, ena spremenljivka pa je dosegla mejno vrednost statistično pomembnega zmanjšanja hitrosti gibanja središča pritiska. Ostale štiri spremenljivke niso pokazale razlike med meritvami brez ali s transkutano električno živčno stimulacijo. Pri meritvah z zaprtimi očmi ni bilo pomembnih razlik med rezultati brez in s transkutano električno živčno stimulacijo za vse opazovane spremenljivke. Razprava in zaključek: Na podlagi dobljenih rezultatov lahko zaključimo, da transkutana električna živčna stimulacija ne prispeva pomembno pri nadzoru drže starejših odraslih. Introduction: Balance is an ability of maintaining stable posture at standstill at disturbed standing or at conscious movement. The central nervous system must synchronise information from various sensory systems in order to keep the balance. A rich somatosensory input can contribute to maintaining posture and balance. Transcutaneous electrical nerve stimulation belongs to one of these options of adding sensory inputs. Purpose: To examine if the transcutaneous electrical nerve stimulation (TENS) affects the movement reduction of the centre of pressure at standstill in four sensory conditions. Methods: A group of 20 older adults, aged 60 to 83, participated in the research. Tested was their stance on a foam pad with feet together. Self-adhesive electrodes were placed on both lower limbs, on the metatarsal base and the back side of the shank, under the knee. Tests were performed in four different conditions of sensory input: with eyes open and without electrical stimulation with eyes open and with electrical stimulation with eyes closed and without electrical stimulation with eyes closed and with electrical stimulation. The following variables were analysed: movement speed of the centre of pressure centre’s path in mediolateral and anteroposterior direction area, calculated through Human Silhouette Recognition with Fourier Descriptors and the area, calculated through the method of auto-covariance matrix. Results: Statistically significant differences were obtained in all observed variables of measurements with both, eyes closed and eyes open. One variable (PCA area) was significantly lower in measurements with transcutaneous electrical nerve stimulation when comparing movement speed of the centre of pressure in eyes open, and one variable was borderline significant in speed reduction of the centre of pressure. There were no statistically significant differences in other four variables comparing measurements with or without transcutaneous electrical nerve stimulation . No significant differences were found in measurements with and without transcutaneous electrical nerve stimulation having eyes closed. Discussion and conclusion: Based on the gained results, it can be concluded that transcutaneous electrical nerve stimulation does not significantly contribute to the posture control of older adults.

Uvod: Stopalo je zelo pomemben del telesa, saj se preko njega prenaša celotna teža. Za normalno držo telesa pa je potrebna tudi stabilnost. K stabilnosti in normalni obliki stopala pripomorejo ortopedski vložki. Le ti so pripomočki, ki pomagajo pri k boljši podpori stopala. Izdelani so iz različnih materialov in na različne načine. Lahko se jih izdela po meri za posameznika ali pa so izdelani serijsko. Pomembno je, da se vložki čim bolj prilegajo stopalu in mu tako nudijo potrebno oporo. Namen: Namen diplomskega dela je pregled literature s področja kako ortopedski vložki vplivajo na stabilnost osebe. Pregledali bomo različne članke na to temo, ter kako se le ti razlikujejo po uporabljeni metodah in testih. Metode dela: Za pisanje diplomskega dela smo uporabili opisno metodo. Članke smo iskali po spletnih podatkovnih bazah s pomočjo ključnih besed. Knjige uporabljene v diplomskem delu so iz knjižnice Zdravstvene fakultete v Ljubljani in knjižnice URI Soča. Iskali smo literaturo v različnih jezikih, to so slovenski, angleški in hrvaški jezik. Iskanje literature je potekalo od marca do maja 2018. Rezultati: Za ugotavljanje ali vložki vplivajo na stabilnost oseb se najpogosteje uporablja stabilometrija. Pri tej se uporablja pritiskovna plošča, ki pripomore k tem, da se lahko izračunajo različni podatki, kot so center mase in velikost podporne plošče. Avtorji so primerjali stabilnost pri uporabi različnih vrst vložkov v primerjavi z neuporabo vložkov. Izvajali so statične in dinamične meritve. Ter primerjali rezultate mlajših in starejših odraslih. Razprava in zaključek: Na podlagi pregledanih člankov lahko sklepamo, da vložki vplivajo na stabilnost določenih oseb. Največ prebranega gradiva je vključevalo starejšo populacijo. Dokazano je, da vložki pripomorejo h stabilnosti oseb pri starejših odraslih, ter da zmanjšajo možnost padca. Menimo pa, da je to področje še zelo neraziskano in bi bile potrebne še nadaljnje študije. Introduction: Foot transmits the whole body weight to the ground, therefore is a very important part of the body. To access normal posture we need good stability. We can increase stability and normal form of the foot with orthopedic insoles. Shoe insoles are the most common orthopedic devices that help relieve problems and correct irregularities of the foot. They are made of different materials and in different ways, either individually produced or serial. In order to provide the necessary support to the foot, it is important that shoe insoles fit as close as possible to the foot. Purpose: The purpose of this final thesis was to review the literature on the impact of insoles on the stability of different subjects. Various articles were reviewed and differences in the methods and tests used were described. Methods: To write this final thesis descriptive method was used. A literature review was performed using various online databases and keywords such as: orthopedic insoles, orthopedic footwear, stability, materials, manufacture, stabilometry. The books used are from library of the Faculty of Health Sciences in Ljubljana and the URI Soča library. We searched for literature in Slovenian, English and Croatian language from March to May 2018. Results: Stabilometry is the most commonly used method to determine the effects of insoles on stability of the body. To do so force platforms are used, which help us to describe the center of pressure movements. Studies compared stability with or without insoles by performing static and dynamic measurements also comparing the results of young and elderly. Discussion and conclusion: Based on the literature review, we can conclude that the insoles have some influence on the stability of the body. The most studies included in the literature review observed elderly. They proved that insoles contribute to the stability of the body in older adults and consequently reduce the frequency of falls. Nevertheless, improvements in this field of research are still possible, and further studies are needed.

Uvod: Ravnotežje je potrebno za vzdrževanje stabilnega položaja med gibanjem, pri prehodih v različne položaje in med izvajanjem vsakodnevnih dejavnosti. Med teste za ocenjevanje sistemov ravnotežja spada modificiran test senzorične interakcije. S postopkom stabilometrije se s pomočjo pritiskovne plošče zabeleži gibanje središča pritiska. Za uporabno meritev je potrebno, da preiskovanec vzdržuje položaj vsaj 30 sekund. Namen: Z meritvami časa in gibanja središča pritiska pri testu stoje na eni nogi smo želeli ugotoviti izvedljivost modificiranega testa senzorične interakcije na eni nogi pri dejavnih starejših. Metode dela: V raziskavi je sodelovalo 21 preiskovancev, starih od 60 do 82 let. Testirali smo stojo na njihovi stojni nogi na pritiskovni plošči v treh različnih pogojih: na trdi podlagi z odprtimi očmi, na trdi podlagi z zaprtimi očmi in na mehki podlagi z odprtimi očmi. Za analizo podatkov smo opazovali najdaljši čas stoje na eni nogi in naslednje spremenljivke gibanja središča pritiska: hitrost, pot v mediolateralni in anteroposteriorni smeri, ploščino, izračunano z metodo Fourierjeve analize obrisa, in ploščino, izračunano z metodo lastnih vrednosti kovariančne matrike. Rezultati: Pri stoji na eni nogi na trdi podlagi z zaprtimi očmi so preiskovanci dosegli povprečen čas 38,7 sekund, na trdi podlagi z zaprtimi očmi povprečen čas 9, 8 sekund in na mehki podlagi z odprtimi očmi 19,9 sekund. Preiskovanci, ki so pri stoji na eni nogi na trdi podlagi z zaprtimi očmi dosegli čas, daljši od 30 sekund, so povprečno opravili 351,6 cm celotne poti, v eni sekundi so povprečno opravili 6,2 cm/s, v mediolateralni smeri so povprečno opravili 235,6 cm, v anteroposteriorni smeri pa 212,9 cm. Ploščina, izračunana z metodo Fourierjeve analize obrisa, je znašala 749,9 cm2 in ploščina, izračunana z metodo lastnih vrednosti kovariančne matrike, 19,0 cm2. Razprava in sklep: Modificiran test senzorične interakcije na eni nogi na pritiskovni plošči za dejavne starejše ni primeren v celoti, zaradi prekratkega časa zadrževanja položaja in s tem premalo podatkov za zanesljivost rezultatov spremenljivk gibanja središča pritiska. Standardna klinična izvedba modificiranega testa stoje na eni nogi, pri kateri se meri čas zadrževanja položaja s štoparico, je pri tej populaciji preiskovancev izvedljiva. Introduction: Balance is required to maintain a stable position during movement, during the transition into a different position, and during everyday activities. A modified sensory interaction test is one of the tests for the assessment of balance systems. In stabilometry, center of pressure movement can be measured using a force platform. For an useful measurement the subject has to sustain the position for at least 30 seconds. Purpose: By measuring time and center of pressure movement during the single-leg stance test on active older adults, we wanted to determine the viability of the modified single-leg sensory interaction test. Methods: 21 subjects participated in the study, aged between 60 and 82. We tested their single-leg stance on their supporting leg using a force platform under three conditions: on a hard surface with the subjects’ eyes open on a hard surface with the subjects’ eyes closed on a soft surface with the subjects’ eyes open. To analyze the data, we observed the longest single-leg stance duration and the following center of pressure movement variables: speed, distance in the mediolateral and anteroposterior directions, surface area calculated with the perimeter-based Fourier analysis, and surface area calculated using the eigenvalues of the covariance matrix. Results: The average duration of the subjects’ single-leg stance on a hard surface with their eyes open was 38.7 seconds, on a hard surface with their eyes closed 9.8 seconds, and on a soft surface with their eyes open 19.9 seconds. Subjects who maintained the single-leg stance for over 30 seconds, in total traveled 351,6 cm on average and at 6.2 m/s on average. They traveled 235.6 cm in the mediolateral direction and 212.9 cm in the anteroposterior direction. The area calculated with the perimeter-based Fourier analysis was 749.9 cm2 and the area calculated using the eigenvalues of the covariance matrix 19.0 cm2. Discussion and conclusion: The modified sensory interaction test using a force platform is unsuitable for active older adults, because the time spent maintaining the stance is too short, leading to a shortage of data to ensure reliable center of pressure movement variable results. Standard clinical performance single-leg stance test at which time for standing at one leg is measured, is suitable for this type of subjects.

Kopsavilkums Palielinoties cilvēka vecumam, palielinās kritienu un traumatisma riski. Tā kā Latvijā, kā arī Eiropā kopumā, palielinās populācijas novecošanās, kritienu un traumatisma riski pieaug, un to samazināšanai ir nepieciešami efektīvi profilaktiski pasākumi, kas uzlabotu īpaši gados veco cilvēku mobilitāti un novērstu kritienus. Pašreiz nav vienotu vadlīniju stājas stabilitātes pārbaužu metodikā un uzlabošanā, tādēļ ir nozīmīgi izprast faktorus, kas var ietekmēt posturālo kontroli. Tādejādi darbā tika izvirzīts mērķis noskaidrot kognitīvo procesu ietekmi uz stājas stabilitāti, kā arī izvērtēt antropometrisko parametru ietekmi uz līdzsvara saglabāšanu. Pētījumā piedalījās 60 izmeklējamās personas, kas vecum- un dzimumdiferencēti tika iedalītas 4 pētījuma grupās pa 15 cilvēkiem katrā grupā. Izmeklējamām personām tika noteikti antropometriskie parametri, un, izmantojot stabilometrijas platformu “Alfa”, reģistrēti ķermeņa atbalsta spiediena centra svārtību parametri līdzsvara testa (Romberga testa) laikā, izmeklējamai personai atrodoties vertikālā stājā ar atvērtām un aizvērtām acīm, kā arī stabilometrijas testa laikā, veicot trīs atšķirīgas grūtības pakāpes kognitīvos uzdevumus. Iegūtie rezultāti liecina, ka antropometriskie parametri nav noteicoši stājas stabilitātes spēju saglabāšanā, bet to būtiski ietekmē indivīda vecums. Pētījuma rezultāti ļauj secināt, ka kognitīvie procesi ietekmē stājas stabilitāti gados vecākiem cilvēkiem, to pasliktinot, savukārt, gados jauniem cilvēkiem kognitīvās slodzes ietekme uz stājas stabilitāti nav izteikta, vai pat tā tiek uzlabota., With the increase of person’s age, increases risks of falls and traumatism. In Latvia, as well as in the whole Europe increases the ageing of the population, effective prophylactic measures are necessary for the decrease of risks of falls and traumatism, which would improve mobility of older people and would prevent falls. Presently, there are no common guidelines in the methodology tests of postural stability and in improvement; therefore, it is important to understand the factors that may influence postural control. Thereby, the objective of this research work is to estimate influence of cognitive processes on posturalstability, as well as to evaluate the relationship between anthropometric characteristics and body-balancing movements. In research participated 60 subjects, who were divided, differentiating age and sex, in 4 research groups, with 15 person in each group. Anthropometric parameters were determined for the investigated person and using stabilometric force platform “Alfa” were registered movement’s parameters of the center of pressure of body during balance test (Romberg’s test), while subject were in vertical posture with eyes open and closed and during three cognitive tasks of different degree of difficulty. Results show that anthropometric parameters are not determinant in preservation of stabilometric abilities, but individual’s age significantly influences that. Results of the study allows to conclude that cognitive processes influence postural stability in older people, while for younger people influence of cognitive activity is not explicit or even it is improved.

Pētījums attiecas uz aktuālu klīniskās fizioloģijas un neirozinātnes problēmu, kura ir saistīta ar dažādu eksogēnu stimulu spēju ietekmēt gan cilvēka smadzeņu darbību, gan stājas stabilitāti. Pētījums veikts ar mērķi noskaidrot binaurālo pukstu (BP) stimulācijas ietekmi uz pieaugušu jaunu cilvēku nomoda elektroencefalogrammu (EEG) un stājas stabilitātes parametriem, kā arī savstarpēji salīdzinoši novērtēt vairākus objektīvus un subjektīvus BP sensitivitātes kritērijus. Binaurālo pukstu tūlītējās, daudzbusīgās ietekmes kopaina ir īpatnēja katram indivīdam, līdz ar to – indivīda binaurālo pukstu jutības (sensitivitātes) vērtējumā ir jāizmanto vairāku fizioloģisko reakciju spilgtumu raksturojošas un savā starpā vāji korelējošas pazīmes. Pētījuma rezultāti liecina, ka stājas stabilitātes uzlabošanās ir viens no BP stimulācijas izraisītās tūlītējās ietekmes komponentiem. Pētījuma ietvaros tika izstrādāta metode binaurālo pukstu tipa skaņu stimulu (vienlaicīgi aplicēto skaņu frekvenču starpība 10 Hz) izraisītā efekta uz EEG un stājas stabilitātes parametriem novērtēšanai. Tika veikta deviņu novadījumu EEG reģistrācija un stabilometrijas tests 12 izmeklējamām personām randomizēti trīs variantos (kontroles ieraksts klusumā, BP stimulācija un skaņa, kas neizraisa BP). Pierādījās hipotēze, saskaņā ar kuru binaurālo pukstu stimulācijas izraisītās EEG α-viļņu parametru maiņas visizteiktākās ir parietālās daivas garozā. Kopumā pētījuma rezultāti uzskatāmi par objektīvu apliecinājumu BP stimulācijas efektam uz stājas stabilitātes parametriem un nomoda EEG., This study covers a topical problem of clinical physiology and neuroscience, which is related with capability of various exogenous stimuli to effect human brain functions and stance stability. The aim of the study is to find out the effect of binaural beat (BP) stimulation on young adult awake state electroencephalogram (EEG), stance stability parameters and also to determine and compare numerous objective and subjective criteria of BP sensitivity. Overview of the immediate and extensive effects of binaural beats is specific to every individual, therefore to evaluate ones binaural beat sensitivity, it`s necessary to use strength of multiple physiological characteristics with weak corelations between them. The results of the study shows that one of the immediate effects of binaural beat stimulation is improvement of stance stability. Within the frameworks of the study a method to evaluate effects of BP (simultaneously applied sound frequency difference was 10 Hz) on EEG and stance stability was made. Randomized acquisiton of nine channel EEG and stabilometry test for 12 persons was made in three variants (control recording in silence, BP stimulation and sound which does not elicit BP effect). A hypothesis that the changes of EEG α-wave parameters caused by binaural beat stimulation were the most significant in the cortex of parietal lobe. Overall results of this study serves as an objective proof that the BP stimulation has a significant effect on stance stability parameters and awake state EEG.

Stājas noturības fizioloģisko mehānismu izpēte ir aktuāla sakarā ar nepieciešamību izstrādāt un zinātniski pamatot noturības uzlabošanas paņēmienus veciem cilvēkiem, slimniekiem ar redzes, līdzsvara maņas un balsta struktūru defektiem. Darba mērķis bija noteikt, kāda tipa (valodas vai matemātiskie) un grūtības līmeņa prātošanas uzdevumi palīdz vai traucē stājas noturībai. Pētījumā izmantotā metode bija stabilometrija, izmantojot līdzsvara platformu "Sigma Balance Platform". Pārbaudāmajām personām vajadzēja saglabāt stabilu stāju, vienlaikus mutiski atbildot uz valodas un matemātiskiem uzdevumiem. Prātošanas uzdevumi bija dažādās grūtības pakāpēs. Rezultātu analīzei tika izmantota COP (atbalsta spiediena centra)novirze pa x un y asi. Izmeklējamo personu grupa sastāvēja no 20 abu dzimumu cilvēkiem, kas bija 16 – 27 gadus veci. Viņi bija ar līdzvērtīgu fizisko attīstību un izglītību. No darbā iegūtajiem rezultātiem var secināt, ka stabilometrijas parametru vērtības būtiski atšķiras starp indivīdiem vienas kompaktas jauniešu grupas ietvaros. Katram indivīdam stabilometrijas parametru vērtības atšķiras stājā uz kreisās un labās kājas. Dzimumam nav viennozīmīga ietekme uz stabilometrijas parametru vērtībām. Prātošana samazina stājas stabilitāti neatkarīgi no uzdevuma veida un sarežģītības., Postural stability’s physiological study is topical in order to work out and scientifically prove resilience skills for older people, for patients with visual and balance defects as well as defects in support structure. The aim of the research work was to determine what kind (language or mathematical) and how difficult cognitive tasks help or trouble postural stability. Method used in the research was stabilometry, a special balance platform Sigma Balance Platform was used. Inspected persons should have maintained stable posture at the same time answering to the language and mathematical tasks orally. The cognitive tasks were in different degrees of difficulty. The results were analysed using COP (centre of pressure) deflection in X and Y axis. The group of the inspected persons consisted of 20 male and female at the age of 16-27. They all were with equivalent physical development and education.

Održavanje ravnoteže kompleksna je funkcija u koju je uključeno vestibularno osjetilo, propriocepcija, dodir, vid i sluh. Ispitivanje ravnoteže na stabilometrijskoj platformi u SUVAG-u uključuje i određivanje slušnog i vidnog nadzora koji pokazuju kolika je uloga sluha i vida u održavanju ravnoteže. Za to su osmišljeni posebni testovi. Ovi nadzori su propisani prilikom normiranja statokinezigrama, tj. određivanja normalnih vrijednosti stabilometrijskog nalaza u zdravih osoba, podijeljenih prema dobnim skupinama. To nam omogućuje uspoređivanje važnosti nadzora u djece oštećena sluha ili govora u odnosu prema zdravoj djeci. Djeci koja su u SUVAG-ovom edukacijskom programu redovito se radi stabilometrijsko ispitivanje, pa su uočljive razlike u nadzorima prema osnovnoj dijagnozi.

Glavni cilj ovog istraživanja bio je odrediti mjesta oštećenja i oštećena svojstva u slušnom putu te promjene do kojih dolazi porastom životne dobi, zatim naći odgovor kako funkcionalno audiološki dijagnosticirati prezbiakuziju i pratiti rehabilitaciju, a s krajnjim ciljem odgode i usporenja starenja slušnog osjetila. Ispitano je 100 osoba u dobi od 60 do 99 godina podijeljenih u dobne skupine od 5 i 10 godina, a kontrolnu skupinu sačinjavalo je 20 osoba u dobi od 20 do 60 godina, od toga 10 osoba uredna sluha i 10 osoba s gubitkom sluha u tonskom audiogramu sličnim onome u starijih nagluhih osoba. Ispitivanje je obuhvatilo audiološku anamnezu, otoskopski i ostali otorinolaringološki pregled, tonsku audiometriju, ispitivanje stapesnog refleksa, ispitivanje razlikovnog praga glasnoće, visine tona, trajanja i lokalizacije zvuka u prostoru, koristilo je verbotonalnu audiometriju, uobičajenu, usporenu i otežanu govornu audiometriju, ispitivanje razumljivosti rečenica uobičajene brzine, ubrzanih rečenica i izmjenično upućenih desno-lijevo, zatim filtriranu govornu audiometriju, ispitivanje optimalnoga slušnog polja, logopedsko, psihološko, psihijatrijsko, vestibulometrijsko i stabilometrijsko ispitivanje. Može se zaključiti da prezbiakuzija predstavlja prirodni proces starenja slušnog puta na svim razinama. Periferna i centralna funkcija pravilno, geometrijski slabe s porastom životne dobi. Svi dijelovi ne stare istom jačinom, veća udaljenost od periferije u pravilu određuje i jače oštećenje funkcije. Stoga su promjene najizraženije na najvišoj, kortikalnoj razini, a pojačavaju ih unutarnji i vanjski čimbenici koji neposredno ili posredno djeluju na slušno osjetilo i centralne integrativne činitelje. Oštećenje periferne funkcije u slušnom putu pojačava stupanj centralnog oštećenja slušne funkcije. Značajku prezbiakuzije predstavlja sužavanje centralnih funkcija koje se najslikovitije očituje u sažimanju najbolje razumljivosti u filtriranom govornom audiogramu na samo jedno frekvencijsko područje od oktave i pol. Usporedba slušne i vestibularne funkcije pokazuje značajnu povezanost centralnih mjera oba sustava u određivanju stupnja oštećenja funkcija uzrokovanih starenjem. Govorna funkcija prati u centralnom sastojku oštećenje centralne slušne funkcije. Više kognitivne sposobnosti također prate centralno oštećenje u prezbiakuziji. Za dijagnostiku početnih promjena u prezbiakuziji nužne su tri pretrage: tonska audiometrija, otežana govorna audiometrija i audiometrija ubrzanim rečenicama. Za punu funkcionalnu audiološku dijagnozu i praćenje prezbiakuzije uz ove pretrage potrebno je uključiti i ispitivanje stapesnog refleksa, ispitivanje razlikovnih pragova, verbotonalnu audiometriju, ispitivanje razumljivosti rečenica uobičajene brzine i izmjenično upućenih desno-lijevo, zatim filtriranu govornu audiometriju, ispitivanje optimalnoga slušnog polja, vestibulometrijsko i stabilometrijsko ispitivanje. Rezultati logopedskog, psihološkog i psihijatrijskog ispitivanja mogu koristiti u oblikovanju i usmjeravanju rehabilitacijskog programa. Dokazane međusobne sveze slušanja, govora i vestibularnog osjetila te utjecaj kognitivnih funkcija na slušnu i govornu funkciju pokazale su nužnost cjelovitog, spaciocepcijskog pristupa rehabilitaciji prezbiakuziji. Tako oblikovan rehabilitacijski program dovodi do poboljšanja svih pokazatelja ispitivanih centralnih funkcija, koje je izraženije što je oštećenje funkcije veće.

U literaturi se ili ne spominje slušna funkcija u održavanju ravnoteže, ili joj se pridaje nevažna uloga, pa je zbog toga stabilometrijski programi za rad ne sadrže. Ovaj se rad nastavlja na dva prethodna stabilometrijska projekta Poliklinike SUVAG koji su otkrili uvjete uključenja sluha u održavanju ravnoteže. U prvom su ispitivane osobe s perifernim i centralnim vestibularnim smetnjama, a u drugom zdravi klizači u otežanim položajima tijela, a u ovom istraživanju upoznaju se vrijednosti slušnovidnog nadzora u ovisnosti o životnoj dobi. Samo se nakon tako dobivenih parametara može uvesti u funkcionalnu dijagnostiku za kliničku praksu spaciocepcijska integracija. Slijedeći korak je razvijanje dodatnih usmjerenih i nadziranih rehabilitacijskih postupaka.

Naknadno

Uloga vestibularnog osjetila u razvoju mišljenja i govora od 1970. godine sve se više ispituje u svijetu, a u Poliklinici "SUVAG" već od 1960. godine. Potvrđeno je da je kod gluhih sa sačuvanom vestibularnom funkcijom, rehabilitacija slušanja i govora uspješnija u prosjeku tri puta. Sve se više rabe vestibularne vježbe, sve su raznovrsnije, a indikacije su im šire od početnih iz četrdesetih godina za kompenzaciju jednostavnog vestibularnog oštećenja sve do najnovijih za disgrafiju, disleksiju i nerazvijen govor. Našim se istraživanjem uspoređivao stabilometrijski nalaz (na platformi Cosmogamma R 50 100) sa stanjem slušanja i stanjem govora, gluhih i nagluhih rehabilitanata Poliklinike "SUVAG" u Zagrebu. Za statističku obradbu uzeti su još nalazi sluha, vestibularnog osjetila u elektronistagmogramima i nalazi fizijatrijskog pregleda. Dobiveni rezultati potvrđuju hipotezu s kojom se krenulo u istraživanje. Stabilometrijski bolji ispitanici bolji su u slušanju, govoru i gramatičnosti govora. Vestibularni se utjecaj zbiva na tri razine: perifernoj receptornoj, subkortikalnoj integracijskoj i kortikalno gramatičkoj. To nas obvezuje da se vestibularne vježbe dopune i prilagode najslabijim elementima slušanja i govora, posebno gramatike, da im se poveća satnica i da se djelomice uključe u druge rehabilitacijske postupke.