Virtualna stvarnost u rehabilitaciji i liječenju

This paper describes virtual reality and some of its potential applications in rehabilitation and therapy. Some aspects of this technology are discussed with respect to different problem areas (sensorimotor impairments, autism, learning difficulties), as well as previous research which investigated changes within some motor and motivation parameters in relation to rehabilitation of children with motor impairments. Emphasis is on the positive effects of virtual reality as a method in which rehabilitation and therapy can be offered and evaluated within a functional, purposeful and motivating context.U radu se prikazuje opis virtualne stvarnosti i neke mogućnosti njezine primjene u rehabilitaciji i terapiji. Navedeni su neki vidovi primjene ove tehnologije u različitim problemskim područjima (senzomotorički poremećaji, autizam, teškoće u učenju), kao i neka znanstvena istraživanja u kojima su se ispitivale promjene nekih parametara motorike i motivacije vezane uz rehabilitaciju djece s motoričkim poremećajima. Naglašeni su pozitivni učinci virtualne stvarnosti kao metode u kojoj se rehabilitacijski i terapijski postupci mogu provoditi i ocjenjivati unutar funkcionalnog, planiranog i motivirajućeg konteksta

The application of therapeutic ultrasound on the vertebral circulation in the cervical region in patients who presented with neck pain

Cilj ovog istraživanja bio je utvrditi učinkovitost terapijskog ultrazvuka na vertebralnu cirkulaciju u bolesnika s vratoboljom. Terapijski ultrazvuk će u kliničkoj ocjeni dovesti do smanjenja bolova u vratu, a može promijeniti i ekstrakranijsku hemodinamiku u vertebralnim arterijama, što može biti jedan od mehanizama smanjenja bolova i mišićnog spazma. Mehanizam smanjenja bolova poboljšanjem protoka temelji se na poznatoj činjenici da bolje otplavljivanje ostatnih produkata metabolizma dovodi do manjeg podražaja nociceptora. Ispitivanje je provedeno na 100 bolesnika s vratoboljom (prosječna dob 55 godina), 69 žena i 31 muškarac. Ispitanici su bili podijeljeni u ispitivanu i kontrolnu skupinu. Ispitivana skupina dobivala je terapijski ultrazvuk mobilnom tehnikom paravertebralno cervikalno (1 MHz, 0,5 W/cm2, 5 min.). Kontrolna skupina tijekom primjene terapijskog ultrazvuka imala je aparat isključen. Trajanje intervencije iznosilo je 15 tretmana (3 tjedna). Obje skupine ispitanika provodile su medicinsku gimnastiku i dobivale su transkutanu električnu nervnu stimulaciju paravertebralno cervikalno. Rezultati su pokazali da ne postoji statistički značajna razlika između ispitivane i kontrolne skupine u brzini protoka u vertebralnim arterijama kako nakon 15 tretmana tako i nakon mjesec dana od provedene fizikalne terapije. Brzina protoka u vertebralnim arterijama bila je najniža prije tretmana u obje skupine ispitanika.The aim of this study was to determine the efficacy of therapeutic ultrasound on vertebral circulation in patients with neck pain. Therapeutic ultrasound in clinical assessment will lead to reduction in pain in the neck, and can change hemodynamics in the extracranial vertebral arteries, which can be one of the mechanisms to reduce pain and muscle spasms. The mechanism of pain reduction by improving the blood flow is based on a known fact that the better elimination residual Products of metabolism leads to decreased stimulation of nociceptors. The study included 100 patients with neck pain (69 women and 31 men; mean age 55 years). Subjects were divided into test and control group. The test group received therapeutic ultrasound applied by mobile technology (1 MHz, 0.5 W/cm2, 5 min.) at the paravertebral cervical region. In control group, during the application of therapeutic ultrasound, device was turned off. Intervention was conducted 15 times within 3 weeks. Both groups of patients underwent a medical gymnastics program and received transcutaneous electrical nerve stimulation of paravertebra cervical region. The results showed that there was no statistically significant difference between the test and control groups in the rate of the blood flow in the vertebral arteries after 15 treatments, neither after a month of performed physical therapy. The lowest flow rates in the vertebral arteries, within both groups, were registered before treatment. It has been established that variation in blood flow in vertebral arteries does not diminish neck pain

A Coincidence of HLA-B27 Negative Spondyloarthritis and Paravertebral Non-Hodgkin’s Lymphoma – A Lesson to be Learned from the Past Experience

We reported a case of a 71-year-old woman with progressive low back pain and neurologic symptoms of lower extremities, who in the background had the coexistence of spondyloarthritis (SpA) and non Hodgkin’s lymphoma of the paravertebral location. This example describes a situation where SpA with minimal sacroiliac joints affection has nevertheless led to the overt axial SpA. This situation included undifferentiated or reactive SpA, as well as unusual disease context, presented with late-life disease onset, older age, female gender and no obvious hereditary predisposition. This combination of comorbid factors could allow environmental and disease-specifi c factors to accumulate over time and to, by modifying the primary, low-penetrant genetic background, lead to the development of lymphoma. By achieving better understanding of disease pathophysiology dynamic, we will be able to improve our capabilities to navigate biologic therapy in the future, in order to prevent the development of both, overt SpA and lymphoproliferative disease

Utjecaj gubitka sna na mozak

Each sleep phase is characterized by specific chemical, cellular and anatomic events of vital importance for normal neural functioning. Different forms of sleep deprivation may lead to a decline of cognitive functions in individuals. Studies in this field make a distinction between total sleep deprivation, chronic sleep restriction, and the situation of sleep disruption. Investigations covering the acute effects of sleep deprivation on the brain show that the discovered behavioral deficits in most cases regenerate after two nights of complete sleep. However, some studies done on mice emphasize the possible chronic effects of long-term sleep deprivation or chronic restriction on the occurrence of neurodegenerative diseases such as Alzheimer’s disease and dementia. In order to better understand the acute and chronic effects of sleep loss, the mechanisms of neural adaptation in the situations of insufficient sleep need to be further investigated. Future integrative research on the impact of sleep deprivation on neural functioning measured through the macro level of cognitive functions and the micro molecular and cell level could contribute to more accurate conclusions about the basic cellular mechanisms responsible for the detected behavioral deficits occurring due to sleep deprivation.Svaku fazu sna opisuju određeni kemijski, stanični i anatomski procesi koji su iznimno važni za održavanje fiziološke neuralne funkcije. Različiti oblici gubitka sna mogu kod čovjeka uzrokovati pad kognitivnih funkcija. Istraživanja u ovom znanstvenom području razlikuju situaciju potpunog gubitka sna, kronične restrikcije (ograničavanja) sna te stanje isprekidanog sna. Proučavanje akutnih učinaka neispavanosti na moždanu funkciju ukazuje na činjenicu da se otkriveni deficiti kognitivnih funkcija u većini slučajeva regeneriraju nakon dvije noći potpunog sna. Ipak, studije na miševima naglašavaju mogućnost utjecaja dugotrajne neispavanosti na nastanak nekih neurodegenerativnih bolesti kao što su Alzheimerova bolest i demencija. Kako bismo bolje razumjeli akutne i kronične učinke gubitka sna potrebno je dodatno istražiti mehanizme neurološke adaptacije na situacije neispavanosti. Buduća bi istraživanja o utjecaju gubitka sna na neurološke funkcije trebala pratiti makro razinu fenomena mjerenjem kognitivnih funkcija, ali i mikro razinu kroz molekularne i stanične procese. Takav bi pristup mogao doprinijeti točnijim zaključcima o osnovnim staničnim mehanizmima odgovornima za otkriveni kognitivni deficit uslijed nedostatka sna

Najčešća odstupanja u razvoju motorike šake od rođenja do prve godine života

The early child development, from birth until the age of one year is, amongst other changes, characterized by intense motor learning. During that period, the voluntary learning patterns evolve from reflexive patterns to coordinated voluntary patterns. All of the child’s voluntary movements present active forms in which the child communicates with the environment. In this communication, the hand plays an important role. Its brain representation covers one-third of the entire motor region, situated in the close proximity to the speech region. For this reason, some authors refer to hand as a “speech organ”. According to numerous studies, each separate finger also has a relatively large representation in the cerebral cortex, which points to the importance of the fine motor skills development, or precise, highly differentiated movements of hand muscles following the principles of differentiation and hierarchical integration. Development of the fine motor skills in the hand is important for the overall child development, and it also serves as a predictor pointing to immaturity of the central nervous system. The aim of this paper is to present the development of hand motoricity from birth until the age of one year, as well as the most frequent deviations observed in children hospitalized at Children’s Department of Rehabilitation, Clinical Department of Rheumatology, Physical Medicine and Rehabilitation, Sestre milosrdnice University Hospital Center.Rani razvoj djeteta, od rođenja do prve godine života, obilježen je između ostalog i intenzivnim motoričkim učenjem kojim se obrasci voljnih pokreta od refleksnih obrazaca razvijaju u koordinirane voljne pokrete. Svi voljni pokreti djeteta njegovi su aktivni oblici komunikacije s okolinom. U toj komunikaciji veliku važnost ima ruka. Njezina reprezentacija u mozgu zauzima trećinu cjelokupnog prostora motorne regije koja se nalazi u neposrednoj blizini regije za govor. Stoga neki autori ruku nazivaju “organom govora”. Kako su pokazale različite studije, svaki prst zasebno također ima relativno veliku zastupljenost u moždanoj kori, što upućuje na važnost razvoja fine motorike, odnosno preciznih visokodiferenciranih pokreta muskulature šake po načelima diferencijacije i hijerarhijske integracije. Razvoj fine motrike šake važan je za cjelokupni razvoj djeteta, a također je i prediktor koji ukazuje na nezrelost središnjega živčanog sustava. Cilj ovoga rada je prikazati razvoj motorike šake od rođenja do prve godine života, kao i najčešća odstupanja koja su zapažena kod djece koja su boravila na Odsjeku za rehabilitaciju djece Klinike za reumatologiju, fizikalnu medicinu i rehabilitaciju Kliničkog bolničkog centra „Sestre milosrdnice“

Child’s play in the humanization of child’s stay in hospital

Prilikom bolničkog liječenja (hospitalizacije) potrebno je voditi brigu o zadovoljenju djetetovih potreba. Odlazak u bolnicu velika je promjena za dijete, i često praćena neugodnim emocionalnim stanjima koja se mogu opisati kao sindrom hospitalizma. Većina djece prolazi sljedeće faze kojima se opisuje ovaj sindrom: faza prosvjeda, faza očajanja i faza prividne prilagodbe. Mnogo je teorija o prirodi i smislu igre, a ono u čemu se one generalno slažu jest da je dječja igra puno više od same zabave. Kroz igru djeca otkrivaju okolinu, vlastite vještine, uvježbavaju naučeno, kreiraju što bi još mogla učiniti. Igra je slobodna i spontana dječja aktivnost. Problematiku hospitalizma, kao i način suočavanja djeteta s liječenjem u bolničkim uvjetima, naglašavaju i pravni propisi koji reguliraju dječja prava i pridonose humanijem pristupu prema djetetu. U ovom radu prezentirane su vrste igara koje se mogu provoditi na dječjim odjelima. Uloga stručnjaka važna je u procesu hospitalizacije.During the hospital treatment (hospitalisation) it is necessary to take care of the fulfillment of the child’s needs. Moving into a hospital is a big change for a child, often accompanied by the unpleasant emotional states which can be described as the hospitalism syndrome. Most of the children go through the phases being described by this syndrome: protest phase, desperation phase, and superficial adjustment phase. There are a lot of theories about the nature and the point of play, but what they generally agree on is that child’s play is much more than just leisure time. Through play children discover the environment, their own skills, they practice what they’ve learned, create what they might do. Play is a free and spontaneous children’s activity. Hospitalism and other coping strategies associated with children’s fears instigated by hospitalization are also validated within the law regulations to prioritise the rights and needs of children. This paper presents different types of games that hospitalised children play at hospital wards. Professional help is essential in supporting children and their families to cope with hospitalization

MANAGEMENT OF CARDIOVASCULAR RISK FACTORS IN RHEUMATOID ARTHRITIS

Pacijenti s upalnim reumatskim bolestima, osobito s reumatoidnim artritisom (RA) imaju značajno povećani rizik za nastanak kardiovaskularnih (KV) bolesti u odnosu na opću populaciju. Ovo se osobito odnosi na povišeni rizik od infarkta miokarda i ishemijske bolesti srca. KV događaji i stope smrtnosti u RA veće su za 40-50 % u odnosu na opću populaciju, a rizik za ishemijsku bolest srca nešto je veći nego za moždani udar. Povećanje KV rizika u RA uzrokovano je kompleksnom sinergijom tradicionalnih i netradicionalnih faktora KV rizika, gdje upala izravnim ili neizravnim učincima na vaskularni sustav ima važnu ulogu i neovisni je čimbenik rizika. Pacijenti s jačom aktivnosti bolesti u RA imaju povećani rizik za razvoj srčanog zatajenja. Liječnici trebaju biti svjesni visokog KV rizika i osigurati dobar nadzor i liječenje KV bolesti u pacijenata s RA.Patients with infl ammatory rheumatic diseases, particularly rheumatoid arthritis (RA), have a signifi cantly increased risk of cardiovascular (CV) disease compared to the general population. This particularly refers to the increased risk of myocardial infarction and ischemic heart disease. CV events and mortality rate in RA are by 40%-50% higher as compared with general population and the risk of ischemic heart disease is slightly higher than that of stroke. The risk increase in RA is initiated by a complex interaction between traditional and non-traditional factors of CV risk, where infl ammation, through direct or indirect harmful effects on vascular system, plays an important role. The infl ammation in RA is crucial for the development of CV risk and is an independent risk factor for the increased incidence of CV diseases. Patients having stronger disease activity in RA have an increased risk of developing heart failure. Doctors of medicine should be aware of the high CV risk and provide good control and treatment of CV diseases in RA patients