The necessity of application of control measurement in therapy of persons with brain injury

Uvod: Kontrolno merenje je uobičajeno u eksperimentalnim situacijama, dok se u praksi često ne realizuje ili se obavi razgovor sa pacijentom. Očigledno je da moramo da postavimo pitanja poput: da li je uopšte potrebno vršiti kontrolno merenje, kada se ono vrši, kojim instrumentima i koliko kontrolnih merenja je potrebno izvršiti? Ova pitanja duboko zadiru u doktrinu bilo koje nauke i prakse. Cilj: U ovom radu razmatra se eventualna neophodnost primene kontrolnih merenja sa teorijskog i praktičnog aspekta. Metode: U radu smo se bavili terapijom kognitivnih i motoričkih funkcija kod osoba sa povredom mozga, odnosno fenomenima pamćenja, pažnje, orijentacije i praksičkim funkcijama. Uzorak je činilo 15 muških i ženskih ispitanika starosti od 15 do 20 godina. Kognitivne i praksičke funkcije ispitivali smo subtestovima The Mental Status in Neurology (Stub, Block, 1983) i Cognitive Asseasment Abillity (Adamovich, Henderson, Auerbach, 1985). Izbor subtestova je u ovom slučaju bio orijentisan ka stečenim znanjima, iskustvima, poluapstraktnom i apstraktnom mišljenju. Nakon eksperimentalnog tretmana koji je trajao četiri nedelje, izvršili smo kontrolno merenje. Rezultati: Dobijeni rezultati pokazuju opravdanost primene kontrolnog merenja kod testiranih ispitanika. Oni ukazuju na značaj kontrolnog merenja, koji se ogleda u mogućnost evidentiranja napretka tretiranih pacijenta u ispitivanim domenima. Kontrolnim merenjem, dakle, možemo utvrditi napredak ili zastoj u oporavku pojedinih delova ispitivanih i tretiranih funkcija. Rezultati istraživanja nedvosmisleno ukazuju na statistički značajnu razliku (od p<0,5 do p<0,1) između prvog i drugog merenja u ispitivanim funkcijama. Zaključak: Na osnovu dobijenih rezultata možemo zaključiti da je kontrolno merenje neophodan pristup u potvrdi značaja primene aktuelnih terapijskih postupaka, njihovoj modifikaciji i doziranju.Introduction: Control measurement is common in experimental situations, while in practice, it is often overlooked or just reduced to a conversation with the patient. It is obvious that we have to ask questions such as: is it necessary to perform a control measurement at all, when is it performed, with which instruments and how many control measurements should be performed? These questions go deep into the doctrine of any science and practice. Aim: In this paper, the eventual necessity of performing control measurements is considered from the theoretical and practical aspects. Methods: In this work, we dealt with the therapy of cognitive and motor functions, that is, the phenomena of memory, attention, orientation, and practical functions. The sample consisted of 15 male and female respondents aged 15 to 20 years. We examined their cognitive and practical functioning using subtests from The Mental Status in Neurology (Stub, Block, 1983) and Cognitive Assessment Ability (Adamovich, Henderson, Auerbach, 1985). The choice of subtests was oriented towards acquired knowledge, experiences, semi-abstract and abstract thinking from the patient’s immediate environment. Upon application of the experimental model, which lasted four weeks, we performed a control measurement. Results: The obtained results show the justification of the application of the control measurement in the tested subjects. The results indicate the importance of control measurement, which is reflected in the possibility of recording the progress of treated patients in the examined domains. By control measurement, therefore, we can determine progress or stagnation in the recovery of certain parts of the tested and treated functions. The research results unequivocally indicate a statistically significant difference (p<0.5 to p<0.1) between the first and second measurements in the examined functions. Conclusion: Based on the obtained results, we can conclude that control measurement is a necessary approach in confirming the correctness of using current therapeutic procedures, their modification, and dosage

The Necessity of Application of Control Measurement in Therapy of Persons with Brain Injury

Introduction. Control measurement is common in experimental situations, while in practice it is often overlooked or just reduced to a conversation with the patient. It is obvious that we have to ask questions such as: is it necessary to perform a control measurement at all, when is it performed, with which instruments and how many control measurements should be performed? These questions go deep into the doctrine of any science and practice. Aim. In this paper, the eventual necessity of performing control measurements is considered from the theoretical and practical aspects. Methods. In this work, we dealt with the therapy of cognitive and motor functions, that is, the phenomena of memory, attention, orientation and practical functions. The sample consisted of 15 male and female respondents aged 15 to 20 years. We examined their cognitive and practical functioning using subtests from The Mental Status in Neurology (Strub, R., Black, W. 1983) and Cognitive Assessment Ability (Adamovich, B., Henderson, J., Auerbach, S., 1985). The choice of subtests was oriented towards acquired knowledge, experiences, semi-abstract and abstract thinking from the patient's immediate environment. Upon application of the experimental model, which lasted four weeks, we performed a control measurement. Results. The obtained results show the justification of the application of the control measurement in the tested subjects. The results indicate the importance of control measurement, which is reflected in the possibility of recording the progress of treated patients in the examined domains. By control measurement, therefore, we can determine progress or stagnation in the recovery of certain parts of the tested and treated functions. The research results unequivocally indicate a statistically significant difference (p<0.5 to p<0.1) between the first and second measurements in the examined functions. Conclusion. Based on the obtained results, we can conclude that control measurement is a necessary approach in confirming the correctness of using current therapeutic procedures, their modification and dosage

The Necessity of Application of Control Measurement in Therapy of Persons with Brain Injury

Introduction. Control measurement is common in experimental situations, while in practice it is often overlooked or just reduced to a conversation with the patient. It is obvious that we have to ask questions such as: is it necessary to perform a control measurement at all, when is it performed, with which instruments and how many control measurements should be performed? These questions go deep into the doctrine of any science and practice. Aim. In this paper, the eventual necessity of performing control measurements is considered from the theoretical and practical aspects. Methods. In this work, we dealt with the therapy of cognitive and motor functions, that is, the phenomena of memory, attention, orientation and practical functions. The sample consisted of 15 male and female respondents aged 15 to 20 years. We examined their cognitive and practical functioning using subtests from The Mental Status in Neurology (Strub, R., Black, W. 1983) and Cognitive Assessment Ability (Adamovich, B., Henderson, J., Auerbach, S., 1985). The choice of subtests was oriented towards acquired knowledge, experiences, semi-abstract and abstract thinking from the patient's immediate environment. Upon application of the experimental model, which lasted four weeks, we performed a control measurement. Results. The obtained results show the justification of the application of the control measurement in the tested subjects. The results indicate the importance of control measurement, which is reflected in the possibility of recording the progress of treated patients in the examined domains. By control measurement, therefore, we can determine progress or stagnation in the recovery of certain parts of the tested and treated functions. The research results unequivocally indicate a statistically significant difference (p<0.5 to p<0.1) between the first and second measurements in the examined functions. Conclusion. Based on the obtained results, we can conclude that control measurement is a necessary approach in confirming the correctness of using current therapeutic procedures, their modification and dosage

Transient ischemic attack (TIA) is an emergency

Transient ischemic attack (TIA) is a warning sign of stroke, and stroke is one of the leading causes of morbidity and mortality in the world. The assessment and management of TIAs can be difficult even for an experienced neurologist. The purpose of this article is to increase the awareness and establish a diagnostic and therapeutic approach to patientswith TIA. In terms of therapy, patients with TIA share the same recommendations as those with acute ischemic stroke. Based on the etiology, therapeutic measures for secondary prevention after a TIA include antithrombotic, antihypertensive, statins therapy, aswell as carotid intervention as appropriate. Itwas shown that early evaluation following appropriate treatment after TIA reduces the risk of the first and early recurrent stroke by about 80%, therefore TIA should be considered as an emergency and should be treated as such

Puncture site bleeding complications in patients with Clopidogrel hyper-response: Three case reports

Dual antiplatelet therapy (clopidogrel and acetylsalicylic acid) is a standard for the embolization of planned intracranial aneurysms with CNS stent due to the possibility of stent thrombus formation. All anti-aggregation drugs, including those listed, have bleeding as a side effect. Three patients with aneurysm had an elevated response to antiplatelet therapy with clopidogrel, which was confirmed by a multiplate test on the "VerifyNow" system. After reducing the dose of clopidogrel or after interrupting it, with the introduction of low molecular weight heparin for the duration of five days, aneurysms were successfully resolved by intracranial implantation of the stent. Perioperative angiograms and postoperative CT angiograms have verified hematomas at the place of punction of the femoral artery. Bleeding was resolved by the femoral artery suture by a vascular surgeon. All patients were discharged home without further complications and with dual antiplatelet therapy. By measuring the platelet function in vitro, the degree of inhibition of platelet activity achieved by the action of the drug can be assessed. A specific test can identify those patients who are highly responsive to the drug with increased platelet reactivity and the possibility of increased risk of bleeding. Our suggestion is to reduce the dosage of clopidogrel or to leave it out for 24 hours with preventive doses of low molecular weight heparin or to change the strategy of treatment of intracranial aneurysm, i.e. avoiding implantation of CNS stent

Familial cerebral cavernous malformation syndrome in Serbian family

Cavernomas are benign vascular malformations, and about 50% of all cases are multiple. The hereditary form of brain cavernomas is uncommon, and it is certainly under diagnosed. Another entity is familial cerebral cavernous malformation syndrome. It is defined as the occurrence of multiple cavernomas or the occurrence of cavernomas in at least two members of a family or the presence of a mutation in one of the three genes causing familial cerebral cavernous malformation syndrome. We present a Serbian family in which three consecutive members of family had brain cavernoma. According to our knowledge, this is second case of hereditary cavernoma described in Serbian population

Neurorehabilitation in patients with traumatic brain injury

Patients with traumatic brain injury (TBI) may have significant cognitive deficit and rehabilitation is based on the improvement of remaining abilities aiming to bring the person closer to premorbid profile. The aim of this study was to compare attention, memory and constructive-praxis state between healthy individuals and TBI patients before and after 4-weeks of special neurorehabilitation therapy. The experimental group (E) consisted of 15 patients with brain injury, while the control group (C) consisted of 15 healthy subjects. The assessment instruments were the subtests of "Attention" and "Memory" tests, and performed before and after the 4-weeks-therapy (focus, attention transfer, memory, and constructive practice therapy). Descriptive statistical methods and two-factor-analysis of variance was used as analytical statistical methods, where one factor represented group affiliation and the other was measurement (before and after therapy). The difference significance was determined at the level of error probability of type Ia = 0.05 (statistically significant difference p < 0.05, highly statistically significant difference p < 0.01). Results showed that all groups had 15 respondent (10 men, 5 women), ages between 15 and 18 years. In all tests high statistically significant difference between E and C group was found on the first measurement. Statistically significant difference between subjects of both groups on the second measurement was also found. High statistically significant difference of the E group on the first and second measurement was found. It can be said that applied therapies were effective. However, patients demonstrated lower score on tests after therapy than their healthy matches, indicating that four-week-therapy is not sufficient and should be continued.Approaches and Models in Special Education and Rehabilitatio

Brain plasticity: developmental and clinical aspects of importance for early intervention

Brain plasticity is not only accommodation of young brain tissue that can change own characteristics, but process that occurs during whole life period, even during old age. Mechanisms of plasticity incorporate: formation of new axon terminals and new synapses, change in neuronal membrane excitability, change in the balance of excitation and inhibition, a long-term potentiation (LTP) or long-term depression (LTD). Molecular mechanisms of brain plasticity encompass neurotrophins, NMDA receptors, the role of calcium ions and calcium channels, free radicals and lipid peroxides. Neuroplasticity also may lead to destabilization of neuronal connections therefore without control of this process plasticity becomes excessive and as a result pathological destabilization and disease may occur. Compensation, which is reorganisation of behavior aimed at minimizing or circumventing a particular disability, is also possible due to process of neuroplasticity. Although, without any doubt, younger and growing brain has greater potential for compensation of damage and higher ability for correction of dysfunctions. Here we discussed biological potential of brain plasticity and importance of this process for early intervention is special education and rehabilitation. Early intervention will have full effect only if it is applied well-timed, otherwise the effects will be reduced. Accurate early intervention should consider: definition of optimal time period for beginning of early intervention; composition of proper protocols for methods of stimulation and systemic exercise; and application of these measures in connection with prospective biological potentials

Post-stroke dementia - a comprehensive review

Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI) may affect up to one third of stroke survivors. Various definitions of PSCI and PSD have been described. We propose PSD as a label for any dementia following stroke in temporal relation. Various tools are available to screen and assess cognition, with few PSD-specific instruments. Choice will depend on purpose of assessment, with differing instruments needed for brief screening (e.g., Montreal Cognitive Assessment) or diagnostic formulation (e.g., NINDS VCI battery). A comprehensive evaluation should include assessment of pre-stroke cognition (e.g., using Informant Questionnaire for Cognitive Decline in the Elderly), mood (e.g., using Hospital Anxiety and Depression Scale), and functional consequences of cognitive impairments (e.g., using modified Rankin Scale). A large number of biomarkers for PSD, including indicators for genetic polymorphisms, biomarkers in the cerebrospinal fluid and in the serum, inflammatory mediators, and peripheral microRNA profiles have been proposed. Currently, no specific biomarkers have been proven to robustly discriminate vulnerable patients (‘at risk brains’) from those with better prognosis or to discriminate Alzheimer’s disease dementia from PSD. Further, neuroimaging is an important diagnostic tool in PSD. The role of computerized tomography is limited to demonstrating type and location of the underlying primary lesion and indicating atrophy and severe white matter changes. Magnetic resonance imaging is the key neuroimaging modality and has high sensitivity and specificity for detecting pathological changes, including small vessel disease. Advanced multi-modal imaging includes diffusion tensor imaging for fiber tracking, by which changes in networks can be detected. Quantitative imaging of cerebral blood flow and metabolism by positron emission tomography can differentiate between vascular dementia and degenerative dementia and show the interaction between vascular and metabolic changes. Additionally, inflammatory changes after ischemia in the brain can be detected, which may play a role together with amyloid deposition in the development of PSD. Prevention of PSD can be achieved by prevention of stroke. As treatment strategies to inhibit the development and mitigate the course of PSD, lowering of blood pressure, statins, neuroprotective drugs, and anti-inflammatory agents have all been studied without convincing evidence of efficacy. Lifestyle interventions, physical activity, and cognitive training have been recently tested, but large controlled trials are still missing

Comparative analysis of ligamentum flavum in patients with lumbar disc herniation and patients with lumbar spinal stenosis

Uvod: Veliki broj studija ispitivao je histološku građu ligamentum flavuma (LF) kod osoba sa lumbalnom spinalnom stenozom (LSS) i neretko je kontrolna grupa obuhvatala pacijente sa lumbalnom diskus hernijom (LDH). Međutim, nijedna studija nije prvo pokazala jasnu kliničku, morfološko-radiološku razliku između ove dve bolesti. Ciljevi studije: Prvi cilj istraživanja bio je da se pokaže klinička i morfološko-radiološka razlika između pacijenata sa LDH i pacijenata sa LSS, kako bi se napravila jasna distinkcija između ova dva entiteta i time omogućilo poređenje analize LF između ove dve grupe pacijenata. Drugi cilj bio je da se pokažu histološke i ultrastrukturene promene LF kod obe grupe pacijenata. Treći cilj je bio da se pokaže povezanost i uticaj različitih kliničkih, morfološko-radioloških i histoloških parametara na kvalitet života kod pacijenata sa LDH i pacijenata sa LSS pre operativnog lečenja i 6 meseci nakon operacije. Četvrti cilj bio je da se na osnovu dobijenih rezultata razmotri definisanje teorije o nastanku spinalnih neurogenih klaudikacija kod pacijenata sa LSS uzrokovanom hipetrofijom LF. Materijal i metode: Sprovedena je studija preseka pri odeljenju neurohirurgije Kliničko-bolničkog centra Zemun u Beogradu i obuhvata pacijente operisane u periodu od januara 2020. godine do decembra 2021. godine. Studija obuhvata 60 pacijenata podeljenih u dve grupe. Prvu grupu čine pacijenti operisani zbog LDH, dok drugu grupu čine pacijenti operisani zbog LSS. Kod obe grupe pacijenata je tokom operacije uzorkovan LF. Prikupljeni su demografski i klinički podaci o pacijentima, kao i morfološko-radiološki nalazi obe grupe pacijenata. Urađena je histološka analiza LF, a potom i statistička analiza primenom metoda deskriptivne i analitičke statistike radi poređenja dobijenih rezultata između dve ispitivane grupe. Rezultati: Gotovo dve trećine pacijenata u obe grupe bili su muškarci (63,3%). Prosečna starost u grupi LDH bila je 45,7±14,7 godina, a u grupi LSS 63,1±8,0 godina. Pacijenti iz grupe LDH i grupe LSS značajno su se razlikovali po učestalosti glavnih tegoba i kliničkih nalaza, ostalih tegoba, trajanju simptoma i pri fizičkom pregledu. Takođe, dve grupe su se značajno razlikovale u brojnim morfološkim/radiološkim parametrima. Histopatološka analiza LF je pokazala da su se grupe značajno razlikovale po količini kolagenih i elastičnih vlakana, kao i po histološkom izgledu, odnosno arhitektonici elastičnih vlakana. Elektronskomikroskopski nalaz je ukazalo na razliku u prisustvu nervnih vlakana između dve ispitivane grupe. Zaključak: LDH i LSS dva klinički i morfološko-radiološki različita spinalna entiteta. LF kod pacijenata sa LSS pokazuje znake fibroze i ožiljavanja što govori u prilog inflamatornoj teoriji u nastanku spinalnih neurogenih klaudikacija kod pacijenata sa LSS.Introduction: A large number of studies examined the histological structure of the ligamentum flavum (LF) in people with lumbar spinal stenosis (LSS) and often the control group included patients with lumbar disc herniation (LDH). However, no study has first demonstrated a clear clinical, morphological-radiological distinction between these two entities. Aims of the study: The first aim of the study was to demonstrate the clinical, morphological-radiological difference between patients with LDH and patients with LSS, in order to make a clear distinction between these two entities and thereby allow comparison of LF analysis between these two groups of patients. The second aim was to demonstrate the histological and ultrastructural changes of the LF in both groups of patients. The third aim was to demonstrate the association and influence of different clinical, morphological-radiological and histological parameters on the quality of life in patients with LDH and patients with LSS, preoperatively as well as 6 months after surgery. Based on the obtained results the fourth goal was to consider the theory definition of the spinal neurogenic claudication origin in patients with LSS caused by LF hypertrophy. Material and methods: A cross-sectional study was conducted at the Neurosurgery department of the Clinical Hospital Center Zemun in Belgrade and includes patients operated on between January 2020 and December 2021. The study includes 60 patients divided into two groups. The first group consists of patients operated on for LDH, while the second group consists of patients operated on for LSS. In both groups the LF was harvested during the operation. Demographic and clinical data, as well as morphological/radiological findings of both groups of patients were collected. A histological analysis of LF was performed, followed by a statistical analysis using the methods of descriptive and analytical statistics in order to compare the obtained results between the two investigated groups. Results: Almost two-thirds of patients in both groups were men (63.3%). The average age in the LDH group was 45,7±14,7 years, and in the LSS group 63,1±8,0 years. Patients from the LDH group and the LSS group differed significantly in terms of frequency of main complaints and clinical findings, other complaints, duration of symptoms and physical examination findings. Also, the two groups differed significantly in numerous morphological/radiological parameters. Histopathological analysis of LF showed that the groups differed significantly in the amount of collagen and elastic fibers, as well as in the histological appearance, that is, the architecture of elastic fibers. Electron microscopic findings indicated a difference in the presence of nerve fibers between the two examined groups. Conclusion: LDH and LSS are two clinically and morphologically/radiologically different spinal entities. LF in patients with LSS shows signs of fibrosis and scarring, which supports the inflammatory theory in the origin of spinal neurogenic claudication in patients with LSS