Τόμος 31 (2013) – Τεύχος 3 – Άρθρο 5 – Επιθεώρηση Κλινικής Φαρμακολογίας και Φαρμακοκινητικής-Ελληνική Έκδοση – Volume 31 (2013) – Issue 3 – Article 5 – Epitheorese Klinikes Farmakologias και Farmakokinetikes-Greek Edition

 

Τίτλος – Title

Θεραπευτική Άσκηση στη Νοητική Υστέρηση

Therapeutic Exercise for Persons with Mental Retardation

Συγγραφέας – Author

Γεωργία Α. Λιουδάκη

ΕΠΑΣ Ρεθύµνου, Ε. ∆ασκαλάκη 3, ΤΚ 74100 Ρέθυµνο, Κρήτη, Ελλάς

Georgia Lioudaki

Vocational School of Rethymno, 3 E. Daskalaki Str, Rethymno GR-74100, Ηellas

Παραπομπή – Citation

Λιουδάκη,Γ.Α. : Θεραπευτική Άσκηση στη Νοητική Υστέρηση, Επιθεώρηση Κλιν. Φαρμακολ. Φαρμακοκινητ. 31: 182-196 (2013)

Lioudaki,G. : Therapeutic Exercise for Persons with Mental Retardation, Epitheorese Klin. Farmakol. Farmakokinet. 31: 182-196 (2013)

Ημερομηνία Δημοσιευσης – Publication Date
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Γλώσσα Πλήρους Κειμένου –
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Ελληνικά – Greek

Παραγγελία – Αγορά –
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Λέξεις κλειδιά – Keywords
Νοητική υστέρηση, νοητική ανικανότητα, άσκηση
Mental retardation, intellectual disability, exercise
Λοιποί Όροι – Other Terms

Άρθρο

Article

Περίληψη – Summary

Η νοητική υστέρηση (ΝΥ) είναι η διαταραχή που οδηγεί σε σηµαντική δυσλειτουργία του  ατόµου σχετικά µε την αυτοφροντίδα, την αυτοεξυπηρέτηση, την επικοινωνία, µε την αυτόνοµη  διαβίωσή  του, τις σχολικές και επαγγελµατικές του ικανότητες. Αυτή εκδηλώνεται πριν την ολοκλήρωση της ανάπτυξης, δηλαδή πριν τα 18 χρόνια. Αν και απέχει πολύ από το ιδανικό, η νοητική ικανότητα αντιπροσωπεύεται ακόµα από το ∆είκτη Νοηµοσύνης (∆Ν). Η ταξινόµηση της ΝΥ γίνεται σε τέσσερις βαθµίδες: Ήπια ΝΥ (∆Ν ανάµεσα στο 50-55 και 70), Μέτρια ΝΥ (∆Ν στο 35-40 και 50-55), Σοβαρή ΝΥ (∆Ν 20-25 έως 35-40) και Βαριά ΝΥ (∆Ν<20-25). Μια άλλη σηµαντική οµάδα είναι αυτή της οριακής νοηµοσύνης (∆Ν 70-85). Παλαιότερα κατατασσόταν στη ΝΥ, αλλά πλέον, λόγω της προσαρµοστικής τους ικανότητας, δεν θεωρούνται άτοµα µε αναπηρία.   Ο ∆Ν έχει µικρή χρησιµότητα για ηλικίες κάτω των 3. Στα αίτια της ΝΥ περιλαµβάνονται χρωµοσωµικές ή συγγενείς ανωµαλίες, µεταβολικές διαταραχές, δηλητηριάσεις του εµβρύου, προγεννητικές και περιγεννητικές επιπλοκές, λοιµώξεις, περιβαλλοντικοί και κοινωνικοπολιτισµικοί παράγοντες. Συχνά συνυπάρχουν άλλες διαταραχές όπως επιληψία (15-30%), εγκεφαλική παράλυση (20- 30%), αισθητηριακές βλάβες, ψυχιατρικές και αναπτυξιακές διαταραχές. Τα άτοµα µε ΝΥ έχουν υψηλότερα ποσοστά διαβήτη, υπέρτασης, καρδιαγγειακών παθήσεων και παχυσαρκίας σε σχέση µε το γενικό πληθυσµό. Υπάρχουν στοιχεία ότι τα επίπεδα άσκησης και φυσικής δραστηριότητας στα άτοµα µε ΝΥ είναι χαµηλά και θεωρούνται πληθυσµιακή οµάδα υψηλού κινδύνου για καθιστικό τρόπο ζωής µε τα συνοδά προβλήµατα υγείας. Είναι σαφές ότι τα άτοµα µε ΝΥ προσαρµόζονται στα αυξηµένα επίπεδα φυσικής δραστηριότητας περίπου µε τον ίδιο τρόπο, όπως τα άτοµα χωρίς ανικανότητα. Γι αυτό, είναι σηµαντικό να αναπτυχθούν και να δοκιµαστούν   παρεµβάσεις   που   θα   ενθαρρύνουν   αυτόν  τον πληθυσµό να ξεκινήσει και να διατηρήσει ένα    πρόγραµµα άσκησης. Πριν το σχεδιασµό ενός προγράµµατος θεραπευτικής άσκησης θα πρέπει να λαµβάνεται εκτενές ιατρικό ιστορικό. Η φαρµακευτική θεραπεία, που  χρησιµοποιείται, κυρίως για τις συνοσηρότητες, µπορεί να επηρεάσει την εκτέλεση. Υπάρχουν πολλές δοκιµασίες που έχουν σταθµιστεί για τα άτοµα µε  ΝΥ και  µπορούν να χρησιµοποιηθούν στην αξιολόγηση του προγράµµατος, όπως Cooper-test, EEI, Modified Bass Test, Bal- ance Beam Speed Test 1 & 2 κ.α., αλλά έχουν χρησιµοποιηθεί και απλοί αισθητήρες κίνησης, µέτρηση καρδιακής συχνότητας, αύξηση διάρκειας και ταχύτητας βαδί- σµατος κ.α. Η θεραπευτική άσκηση προτείνεται να είναι πολυδιάστατη, να αποβλέπει στη βελτίωση της αντοχής, της δύναµης, της ισορροπίας, να είναι διασκεδαστική και να  χρησιµοποιεί  κίνητρα  και  επιβράβευση.  Λόγω    της µειωµένης γνωστικής λειτουργίας, η συνεχής επίβλεψη είναι απαραίτητη. Χρειάζονται περισσότερες έρευνες για να καθορίσουν συγκεκριµένα πρωτόκολλα αξιολόγησης και άσκησης σε κάθε ηλικία και βαρύτητα ΝΥ.

Mental Retardation (MR) is a disorder defined by the presence of incomplete or arrested mental development, principally characterized by the deterioration of concrete functions at each stage of devel- opment, such as cognitive, language, motor and socialization functions. Adaptation to the environment is always affected. The disorder presents itself before the age of 18. Though far from ideal, the cognitive ability is still represented by the intelligence quotient (IQ). The classification of MR gets into four degrees of severity: Mild MR (IQ between 50-55 and 70), Moderate MR (IQ is 35-40 and 50-55), Severe MR (IQ 20-25 to 35-40) and Profound MR (IQ<20-25). Causal factors related with MR are multiples and can be classified as follows: Genetic, acquired (congenital and developmental), environmental and sociocultural. MR is also associated with a number of disorders. Up to15 – 30% of cases of MR are associated with epilepsy and 20-30% with cerebral palsy. Sensory impairments, psychiatric disorders and language deficits are also common among individuals with MR. People with MR have higher rates of diabetes, hypertension, cardiovascular disease and obesity in relation to the general population. There is evidence that levels of exercise and physical activity in individuals with MR are low and are considered a high- risk group population for sedentary lifestyle with the accompanying health problems. It is clear that individuals with MR adapt to the increased levels of physical activity about the same way as persons without a disability. Therefore, it is important to develop interventions that will encourage this population to start and maintain an exercise program. Before designing a therapeutic exercise program a comprehensive medical history should be obtained. Drug therapy can affect the  execution of the program. There are suitable instruments to measure exercise outcomes such as Cooper-test, EEI, Modified Bass Test, Balance Beam Speed Test 1, 2,  but also have been used simple motion sensors, measuring heart rate, duration and walking speed. Therapeutic exercise is suggested to be multi-dimensional, aiming to improve endurance, strength, balance, fun to participate in and to incorporate motivational techniques (i.e. token reward system). Due to reduced cognitive function, augmented, constant supervision is neces- sary. More research is needed to determine specific evaluation and exercise protocols in each age and gravity MR.

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