KINESIOLOGIC ELECTROMYOGRAPHY OF THE ABDOMINAL AND THE DORSAL MUSCLES

Elektromiografija (EMG) standardna je elektrodijagnostička metoda za analizu mišićne aktivnosti, a kao kineziološka metoda primjenjuje se za praćenje mišićne aktivnosti pri pokretu ili pri održavanju položaja tijela (1, 2, 3). EMG uzorak čine oscilacije akcijskih potencijala oko izoelektrične linije, a gustoća oscilacija raste s porastom broja motornih jedinica koje se istodobno kontrahiraju (prostorna sumacija) i s porastom frekvencije sukcesivnih izbijanja pojedinih motornih jedinica (vremenska sumacija). Prosječna amplituda integriranog površinskog EMG uzorka u linearnoj je korelaciji sa snagom izometričke kontrakcije (14). Mioelektrična aktivnost mišića u različitim fazama pokreta pojačava se ili smanjuje, a u nekim položajima i posve prestaje. Mišići trupa, trbušni i leđni, aktiviraju se trima tipovima kontrakcije: izametrički, izotonički i miješano izometričko-izotonički. Za promatranje kineziološke aktivnosti površinskih miSrća trupa najprikladnije su disk elektrode od srebrnog klorida, koje se učvršćuju na prethodno dobro očišćenu kožu. Primjenjuje se bipolarna tehnika snimanja, a elektrode se postave na udaljenosti od 3 do 4 cm poviše mišićnog trbuha. Kožni otpor i zmeđu elektroda treba iznositi manje od 5000 oma. Za praćenje aktivnosti mišića u dubljim slojevima upotrebljavaju se vrlo tanke žičane elektrode. Istodobno se prati aktivnost više mišića (~ do 8), sinergista i antagonista na simetričnim dijelovima tijela, ovisno o tehničkim mogućnostima snimanja. Radi jasnijeg uočavanja uzroka aktivacije i relaksacije promatranih mišića, uz EMG snimanje neophodno je potrebno registrirati i pokret ili trajanje statičke radnje. Pokret se registrira s pomoću elektroda učvršćenih na površini segmenata koje signaliziraju promjenu položaja. Na osciloskopu rezultiraju oscilacije električnog traga, a daljnja obrada omoguću j e grafičko prikazivanje krivulje kutova segmenata u pokretu. Elektronsko snimanje kutova između segmenata pri gibanju naziva se elektrogoniometrija, a jedna od metoda snimanja jest POLGON (»pollarized light goniometry«) (5). U tehnici POLGON elektrode za snimanje pokreta jesu fotosenzori, osjetljivi na polarizacijsko svjetlo. Pokreti se snimaju obasjavanjem fotosenzora, tj. detekcijskih elektroda na segmentima u gibanju s polarizacijskim svjetlom (slika 1). EMG i POLGON snimanje omogućuju grafički prikaz više mišića i pokreta zglobova, te rezultiraju polimiografima i dijagramima kutova.Electromyography (EMG) with surface electrodes and POLGON (polarized light goniometry) are electrodia gnostical methods making it possible to record electrokinesiologic activity of the muscles. Kinesiologic EMG gives an objective picture of myoelectric activity during a lovement or while maintaining a position of the body. The abdomin al and dorsal muscles have shown different va.riations of myoelect r ic activity in healthy test subjects. The activity of the smooth abdomina,l muScle is very low in the activities of everyday life, while the oblique abdominal muscles are more often activated and so are the extensor muscles of the b ~~ e:k . The activity of the m. sacrospinaiis in healty test subjects when bending or stooping and strai·ghtening - returning to the erect posture - show a typical bifurcate pattern with lower amplitudes of myoelectric activity on bending and higher activities on straightening up, while in the maximally bent (stooped) position the muscle is completely relaxed. In patients with low back pain inhibition of the normal function of the muscle has been observer and antalgic activity registered. Thus low back pain becomes accessible to objective kinesiologic study. Antalgic activity becomes manifest in the EMG pattern by continuous myoelectric activity with higher amplitudes on bending (stooping) and reduced amplitudes on straightening, while in the maximally bent position no relaxation is achieved. Kinesiologic EMG gives an insight into activation and rela•xation of individual muscles during exercises and at rest. · Kinesiologic EMG has found its application in the programming and following of kinesitherapeutic procedures and in the evaluat ion of functional damage or injury to the locomotor system

Economic evaluations of health technologies: insights into the measurement and valuation of benefits

Economic evaluations have been applied in the field of healthcare for several decades with the principle aim of improving the economic efficiency of resource allocation, i.e., help maximizing benefits from available (and constrained) resources. Broadly speaking, “economic evaluation is the comparative analysis of alternative courses of action in terms of both their costs and consequences” (Drummond et al., 1997). Economic evaluations became reasonably well-accepted in the decision-making process within the systems of different countries because they offer a promise of a systematic and transparent framework for deciding which intervention - among alternative interventions - to fund from a restricted budget. That is, once efficacy and effectiveness have been established, decision-makers can decide between competing interventions based on their relative cost-effectiveness and thus maximize the aggregate (value of) health benefits attained

Electrokinesiologic Diagnosis and Osteoporosis

Elektrokineziološka metoda omogućuje objektivnu dijagnostiku funkcioniranja kralješnice. Temelji se na kineziološkim podaciam pokreta kralješnice u sagitalnoj ravnini i kvantitativnim podacima površinske elektromiografske aktivnostiparavertebralnih mišića u odječcima pokreta, sagibanja, uspravljanjai u maksimalnom otklonu prema naprijed. U bolesnika s osteoporozom ne nalaze se specifična odstupanja. Odstupanja koja se mogu naći ukazuju na smanjenu fleksibilnost, smanjenu kontraktivnu snagu mišića, produljeno trajanje pokreta i izostanak mišićne relaksacije u trenutku maksimalnog otklona prema naprijed.Elektrokinesiologic method enables objective diagnosis of spinal function. Kinematica data and quantitative surface electromyography of erector spine muscles in different phase of body movement in saggital plane, are the basis for diagnosis. There are not specific changes in the patients with osteoporosis. The changes may be decreased flexibility, decreased contracile muscle forse, duration of movement increased, and lack of muscle relaxation in maximal forward bending position

The impact of the design of payment scales on the willingness to pay for health gains

The questionnaire format applied in a CV study represents the way in which the WTP estimates are obtained. Payment scales are often used in CV studies as the questionnaire format of choice. The study summarized here analyzes the impact of the design of two payment scales (PS) on the monetary value of QALY gains. The scales differed in terms of their end-points, mid points, and coarseness. We judged the performance of the two PS against several indicators: the average WTP per QALY estimates, post-estimation uncertainty levels, the existence of mid-point concentration, and the dependency on end-points. Our results show that PS design influences respondents’ WTP values. The results also suggest that a more detailed scale with a more realistic range may help respondents to elicit values closer to their “true” WTP values, hence produce higher-quality outcomes. Further research and pretesting strategies are suggested to explore and minimize the effects of PS design on WTP estimates, which may ultimately increase the quality of WTP estimates

Community Based Rehabilitation Program for People with Musculoskeletal Conditions

Community based rehabilitation program in people with musculoskeletal conditions was evaluated using Dartmouth COOP Functional Health Assessment Charts/WONCA (COOP/WONCA charts). The program consisted of educative and training protocol in a primary healthcare setting. It had two parts, both with six visits, in the first part three times a week and in the second part once a week. Clients with musculoskeletal conditions (N=204) were included if they agreed to take active part in the rehabilitation process. The first part of the program was completed by 77 clients, and complete program by 52 subjects. Positive changes on the COOP/ WONCA charts were achieved by more than 50% of the subjects that completed the program, in all categories but Social Activities. The program proved effective in terms of short-term evaluation with COOP/WONCA charts in those that complete the program. The high dropout rate and long-term efficiency have yet to be investigated

Community Based Rehabilitation Program for People with Musculoskeletal Conditions

Community based rehabilitation program in people with musculoskeletal conditions was evaluated using Dartmouth COOP Functional Health Assessment Charts/WONCA (COOP/WONCA charts). The program consisted of educative and training protocol in a primary healthcare setting. It had two parts, both with six visits, in the first part three times a week and in the second part once a week. Clients with musculoskeletal conditions (N=204) were included if they agreed to take active part in the rehabilitation process. The first part of the program was completed by 77 clients, and complete program by 52 subjects. Positive changes on the COOP/ WONCA charts were achieved by more than 50% of the subjects that completed the program, in all categories but Social Activities. The program proved effective in terms of short-term evaluation with COOP/WONCA charts in those that complete the program. The high dropout rate and long-term efficiency have yet to be investigated

Health literacy in Croatia

Istraživanja pokazuju da niska razina zdravstvene pismenosti ima negativne posljedice za zdravlje pojedinca i zajednice. Cilj istraživanja je utvrditi prosječnu razinu zdravstvene pismenosti u Republici Hrvatskoj na nacionalno reprezentativnom uzorku te identificirati obilježja koja se mogu dovesti u vezu s posebno niskom razinom pismenosti. Rezultati pokazuju da se razina zdravstvene pismenosti u Hrvatskoj, u prosjeku, nalazi na samoj granici između problematične i adekvatne. Unutar populacije, međutim, postoje značajne razlike u razini zdravstvene pismenosti povezane s klasnim, ekonomskim i socijalnim obilježjima pojedinaca. Niža zdravstvena pismenost odražava se u nevoljkosti pojedinca da se odazove na preventivne preglede, da zadrži težinu ispod razine pretilosti ili da redovito vježba. Naši rezultati sugeriraju da se podizanje razine zdravstvene pismenosti u Hrvatskoj ne bi smjelo oslanjati primarno na medijske kampanje jer je informacije o zdravlju iz medija građanima teško razumjeti i upotrijebiti u svrhu zaštitite od bolesti.Research shows that low levels of health literacy have negative consequences for the health of the individual and the community. The aim of the research is to establish the average level of health literacy in Croatia on a nationally representative sample and to identify characteristics that can be linked to particularly low levels of health literacy. The results show that the level of health literacy in Croatia, on average, is at the very border between problematic and adequate. Within the population, however, there are significant differences in the level of health literacy associated with the class, economic and social characteristics of individuals. Lower health literacy reflects in an individual\u27s reluctance to respond to preventive screenings, keep weight below obesity levels, or exercise regularly. Our results suggest that raising the level of health literacy in Croatia should not rely primarily on media campaigns, because health information from the media is difficult for citizens to understand and use for the purpose of protection against diseases

QUANTITATIVE ANALYSIS OF KINEZIOLOGIC ELECTROMYOGRAPHIC ACTIVITIES OF SACROSPINAL MUSCLE DURING LATEROFLEXION MOVEMENTS IN HEALTHY AND PATIENTS WITH CHRONIC LOW BACK PAIN

Kvantitativna analiza kineziološke elektromiografske aktivnosti (EK-a) sakrospinalnih mišića tijekom pokreta laterofleks ije primijenjena je na 21 zdravom ispitaniku i 74 bolesnika s kroničnom križoboljom, s ciljem da se analiziraju kinematički parametri i mišićna aktivnost. Svi ispitivani kinematički pokazatelji (trajanje, brzina i amplituda pokreta) su kod bolesnika s križoboljom značaj no lošijih vrijednosti u odnosu na zdrave ispitanike. Bolesnici s križoboljom imaju pri pokretu laterofleksije u desno značajno manju brzinu i duže trajanje pokreta, dok amplituda pokreta nije značajno promijenjena. Pri pokretu laterofleksije u lijevo imaju značajno manju brzinu i amplitudu pokreta, a trajanje pokreta nije promijenjeno. Iz toga proizlazi da je brzina pokreta u desno snižena uz održanu amplitudu (dakle produženo je trajanje pokreta), a u lijevo zbog smanjene amplitude pokreta, a trajanje pokreta je isto kao i kod zdravih ispitanika. EMG aktivnost sakrospinalnih mišića je u svim fazama pokreta veća kod bolesnika s križoboljom nego kod zdravih ispitanika. Aktivnost lijevog mišića u svim fazama pokreta veća je od aktivnosti desnog mišića, osim pri pokretu iz maksimalnog lateralnog otklona u lijevo u vertikalni položaj. Najviša aktivnost, i kod zdravih ispitčlnika i kod bolesnika s križoboljom, registrirana je za agonistički sakrospinalni mišić kod gibanja iz maksimalnog otklona u vertikalan položaj. Tijekom pokreta laterofleksije u desno EMG aktivnost je značajno niža obostrano nego pri pokretu laterofleksije u lijevo i kod zdravih i kod bolesnika. Prikazana metoda kineziološke analize pokreta laterofleksije može imati praktički značaj u funkcionalnoj dijagnostici kralježnice .i praćenju učinka terapije.Quantitative analysis of kinesiologic electromyiographic activities (EK) of sacrospinal muscles during lateroflexion movements was applied in 21 healthy subjects and 74 patients with chronic low back pain, to analyzing kinematic parameters and muscular activity. All the examined kinematic indicators (duration, speed and movements amplitude) were ·in patients with low back pain of •signifi cantly worse values than in healthy ones. The low back patients have during •lateroflexion movement to the right significantly lower speed and longer duration of movement, while amplitude remains unchanged. During lateroflexion to the left speed and amplitude are significantly lower, and duration remains unchanged. So, speed of movement to the right was decreased with maintained amplitude (duration of movement was prolonged), and to the left was lowered because of decreased amplitude with m~:intained duration. ,EMG activity of sacrospinal muscles was higher in all the phases of movements in patients with low back pain, than in healthy ones. The activity of left muscle, \u27in all the phases of the movements, was higher than the activity of the right one, except the movement from maximally lateral decline to the left in vertical posture. The greatest activity, both in healthy subjects and in patients with low back pain too, was registered for agonistic sacrospjnal muscle at movement from maximaf decline into vertical posture. During lateroflexion movement to the right, EMG activity was significantly lower bi!aterally, than at lateroflexion movement to the left, both in healthy subjects and in patients. The very method of kinesiologic analysis of lateroflexion movements, can be very practical for functional diagnostics of spine and for the follow-up of therapy effect