Ispitivanja urodinamskih disfunkcija kod bolesnika sa multiplom sklerozom

Background/Aim. Multiple sclerosis (MS) is a chronic autoimmune inflammatory disorder of the unknown origin leading to multifocal demyelization, axonal damage and the loss of the nervous tissue in various parts of the central nervous system. Most MS patients have decreased functionality of the bladder leading to various dysuria disorders during the course of the illness. However, in 2% of the cases dysuric problems are the first symptoms of the disease. Urodynamic testing could help to diagnose functional disorders of the lower urinary tract, which might not be otherwise possible by performing the standard invasive procedures or noninvasive scans, such us ultrasound, computed tomography or functional magnetic resonance imaging (fMRI). Methods. Urodynamic testing - cystometry with electromyographic (EMG) potentials from the external anal sphincter (EAS), was performed in 34 patients (25 female and 9 male patients). Those patients fulfilled Mc Donald's multiple sclerosis criteria. The urodynamic values were compared to neurological signs and the present disease symptoms. Results. The MS patients with (27) and without (7) miction problems were tested. Detrusor hyperreflexia is the most common finding, present in 58.8% of the cases. More than a half of the patients have detrusor sphincter dissynergia. Conclusions. Urodynamic testing helps us to determine neurological disorders characteristics and to prepare an appropriate treatment plan. During the course of the disease different urodynamic disfunctions may occur as well as changes in the urinating functionality. The rationale for urodynamic testing in patients suffering from MS before any other treatment procedure is to confirm the diagnosis of dysuric disorders and to secure appropriate treatment.Uvod/Cilj. Multipla skleroza (MS) je hronično zapaljensko autoimuno oboljenje nepoznate etiologije koje dovodi do multifokalne demijelinizacije, oštećenja aksona i gubitka nervnog tkiva u različitim delovima centralnog nervnog sistema. Većina bolesnika sa multiplom sklerozom ima i poremećenu funkciju mokraćne bešike koja dovodi do različitih dizuričnih smetnji tokom trajanja bolesti. Samo kod 2% bolesnika ove smetnje su prvi simptom bolesti. Urodinamsko ispitivanje omogućava nam da postavimo dijagnozu funkcionalnih poremećaja donjeg urinarnog trakta, što uobičajenim invazivnim procedurama ili neinvazivnim snimanjima (ultrazvuk, kompjuterizovana tomografija ili funkcionalna magnetna rezonanca) često nije moguće ustanoviti. Metode. Urodinamsko ispitivanje - cistometrija i registrovanje elektromiografskih (EMG) potencijala sa spoljašnjeg analnog sfinktera (SAS) urađeno je kod 34 bolesnika (25 žena i 9 muškaraca), koji ispunjavaju Mc Donaldove dijagnostičke kriterijume za multiplu sklerozu. Dobijene vrednosti su upoređivane sa neurološkom simptomatologijom i znacima bolesti. Rezultati. Ispitivani su bolesnici sa (n = 27) i bez (n = 7) mikcionih tegoba. Hiperrefleksija detrusor bila je najčešći nalaz, prisutan čak kod 58,8% bolesnika. Više od polovine ovih bolesnika imalo je detrusor-sfinkter disinergiju. Zaključak. Urodinamsko ispitivanje može pomoći da se utvrde postojeći neurourološki poremećaji i na osnovu njih planira sprovođenje odgovarajućeg terapijskog plana. Tokom trajanja bolesti mogu se ustanoviti različiti oblici urodinamskih nalaza disfunkcije, kao i promena funkcije mokrenja. Razlog za sprovođenje urodinamskog ispitivanja kod bolesnika sa MS pre svake terapije bio bi postavljanje jasne dijagnoze dizuričnih poremećaja koja bliže određuje pravilnu i adekvatnu terapiju

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

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 treatment of neurogenic dysfunction of bladder and bowel in patient with spinal cord injury

Neurogenic dysfunction of bladder and bowel, caused as a result of spinal nerve structures lesion, present a major problem for the patient, his environment and health care workers. Proper diagnosis of neurogenic dysfunction of bladder and bowel allows the application of an appropriate treatment plan that will allow adequate emptying and prevention of complications that may endanger the patient's life. Adequate treatment provides a uniform approach to this important issue in rehabilitation and training of patients

Demographic characteristics and functional outcomes in patients with traumatic and nontraumatic spinal cord injuries

Background/Aim. Spinal cord injuries (SCI) could be associated with a significant functional impairment in the areas of mobility, self-care, bowel and bladder emptying and sexuality. The aim of this study was to compare demographic characteristics and functional outcomes of nontraumatic and traumatic spinal cord injury patients. Methods. This study was designed as retrospective case series study. A detailed medical history including sex, age, mode of trauma, and clinical and radiological examination was taken for all patients. Hospital records were used to classify the patients according to the following: mechanism of injury, neurological level of injury, functional outcomes, associated injuries, method of treatment, secondary complications and length of stay. The following clinical scores were measured in the patients: American Spinal Injury Association standards (CASTA), Functional Independence Measure (FIM), and Modified Aschworth score (MAS). Results. Out of totally 441 patients with spinal cord injury, 279 were traumatic patients (TSCI) and 162 nontraumatic patients (NTSCI); 322 men and 119 women. The mean age of the patients was 46.1 ± 19.9 years. Traumatic and nontraumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower FIM score at admission and significantly better improvement in the FIM score at discharge. The two populations were discharged with similar functional outcome. Conclusions. The NTSCI patients in our study were younger, more frequently female, with less complications before rehabilitation and less frequently treated operatively than the TSCI patients. Hospital rehabilitation of the TSCI patients was longer than that of the NTSCI patients, but their functional gain from admission was also higher, so at discharge. Traumatic and nontraumatic spinal cord lesion patients achieved similar results in regard to neurological and functional status