Zastosowanie robotyki w rehabilitacji zaburzeń chodu w schorzeniach neurologicznych

Neurolodzy, specjaliści rehabilitacji i fizjoterapeuci dysponują coraz nowszymi metodami rehabilitacji w schorzeniach układu nerwowego, wykorzystywanymi przede wszystkim w przypadkach uszkodzenia mózgu i rdzenia kręgowego. W ostatnim czasie powstało wiele nowych koncepcji dotyczących możliwości poprawy stanu neurologicznego, wśród których wymienić można koncepcję regeneracji neuronalnej, czy reorganizacji funkcjonalnej. Są one wykorzystywane do poszukiwania nowych metod rehabilitacji, których celem jest poprawa funkcji systemów neuronalnych. W artykule przedstawiono przegląd nowych metod rehabilitacji chodu z wykorzystaniem robotów, a także ich wpływ na obwody rdzeniowe oraz mózg. Opisano również podział i zastosowanie różnych układów robotycznych przeznaczonych do rehabilitacji chodu oraz praktyczne aspekty ich zastosowania

Choroba Wilsona

Choroba Wilsona należy do rzadkich, dziedziczących się autosomalnie recesywnie, schorzeń genetycznych. W wyniku mutacji w genie ATP7B dochodzi do zaburzeń wydalania miedzi z organizmu, co powoduje gromadzenie się jej w różnych narządach - głównie w wątrobie i w mózgu. Objawy pojawiają się najczęściej w 2.-3. dekadzie życia, pod postacią zaburzeń funkcji wątroby oraz objawów uszkodzenia układu pozapiramidowego i móżdżku. Ze względu na możliwość skutecznego leczenia choroby Wilsona bardzo ważne jest szybkie rozpoznanie i wdrożenie postępowania terapeutycznego. Polski Przeglą

Copper, Iron, and Manganese Toxicity in Neuropsychiatric Conditions

Copper, manganese, and iron are vital elements required for the appropriate development and the general preservation of good health. Additionally, these essential metals play key roles in ensuring proper brain development and function. They also play vital roles in the central nervous system as significant cofactors for several enzymes, including the antioxidant enzyme superoxide dismutase (SOD) and other enzymes that take part in the creation and breakdown of neurotransmitters in the brain. An imbalance in the levels of these metals weakens the structural, regulatory, and catalytic roles of different enzymes, proteins, receptors, and transporters and is known to provoke the development of various neurological conditions through different mechanisms, such as via induction of oxidative stress, increased α-synuclein aggregation and fibril formation, and stimulation of microglial cells, thus resulting in inflammation and reduced production of metalloproteins. In the present review, the authors focus on neurological disorders with psychiatric signs associated with copper, iron, and manganese excess and the diagnosis and potential treatment of such disorders. In our review, we described diseases related to these metals, such as aceruloplasminaemia, neuroferritinopathy, pantothenate kinase-associated neurodegeneration (PKAN) and other very rare classical NBIA forms, manganism, attention-deficit/hyperactivity disorder (ADHD), ephedrone encephalopathy, HMNDYT1-SLC30A10 deficiency (HMNDYT1), HMNDYT2-SLC39A14 deficiency, CDG2N-SLC39A8 deficiency, hepatic encephalopathy, prion disease and “prion-like disease”, amyotrophic lateral sclerosis, Huntington’s disease, Friedreich’s ataxia, and depression

Cardiac involvement in polymyositis and dermatomyositis: diagnostic approaches.

Polymyositis (PM) and dermatomyositis (DM) are rare idiopathic inflammatory myopathies (IIM). Myocardial involvement in patients with IIM is an unfavorable prognostic factor and one of the most common cause of mortality in this group of patients. The purpose of this review is the presentation of current knowledge on cardiovascular manifestations observed in IIM. Published in English data until December 2021 were selected. Clinical symptoms suggesting cardiac involvement are non-specific and require a differential diagnosis in accordance with cardiological guidelines. Troponin I is specific to cardiac injury and should be preferred to other markers to evaluate the myocardium in IIM. Abnormalities in electrocardiography are common in IIM , especially non-specific changes of ST-T segment. In standard echocardiography left ventricular diastolic dysfunction is reported frequently. New diagnostic technologies can reveal clinically silent myocardial abnormalities. However, prognostic value of subclinical impairment of myocardial function require further studies

Cognitive and Physical Intervention in Metals’ Dysfunction and Neurodegeneration

Metals—especially iron, copper and manganese—are important elements of brain functions and development. Metal-dysregulation homeostasis is associated with brain-structure damage to the motor, cognitive and emotional systems, and leads to neurodegenerative processes. There is more and more evidence that specialized cognitive and motor exercises can enhance brain function and attenuate neurodegeneration in mechanisms, such as improving neuroplasticity by altering the synaptic structure and function in many brain regions. Psychological and physical methods of rehabilitation are now becoming increasingly important, as pharmacological treatments for movement, cognitive and emotional symptoms are limited. The present study describes physical and cognitive rehabilitation methods of patients associated with metal-induced neurotoxicity such as Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, Huntington’s disease and Wilson’s disease. In our review, we describe physical (e.g., virtual-reality environments, robotic-assists training) and psychological (cognitive training, cognitive stimulation, neuropsychological rehabilitation and cognitive-behavioral and mindfulness-based therapies) methods, significantly improving the quality of life and independence of patients associated with storage diseases. Storage diseases are a diverse group of hereditary metabolic defects characterized by the abnormal cumulation of storage material in cells. This topic is being addressed due to the fact that rehabilitation plays a vital role in the treatment of neurodegenerative diseases. Unfortunately so far there are no specific guidelines concerning physiotherapy in neurodegenerative disorders, especially in regards to duration of exercise, type of exercise and intensity, as well as frequency of exercise. This is in part due to the variety of symptoms of these diseases and the various levels of disease progression. This further proves the need for more research to be carried out on the role of exercise in neurodegenerative disorder treatment

Lateralization Direction, Strength, and Consistency in Juvenile and Adolescent Idiopathic Scoliosis: A Case Control Pilot Study

The aim of this study was to assess the hypothesis that functional laterality features are associated with scoliosis incidence. The study included 59 patients with radiologically confirmed idiopathic scoliosis (mean age 13 years, 41 girls and 18 boys) and 55 controls (mean age 10.5 years, 38 girls and 17 boys). Side dominance was determined by the Lateral Preference Inventory. Direction, strength, and consistency of lateral dominance was obtained. Continuous data were compared by Student’s t-test or U Mann-Whitney test where appropriate. Categorical data were compared by chi-squared test and Fisher’s exact test. Groups were significantly different in terms of age (p < 0.001) and dependent variables: height (p < 0.001) and weight (p < 0.001). Lateralization analysis showed some trends, but the results obtained were not statistically significant. Statistical significance of lateralization direction are respectively: for hand (p = 0.364); leg (p = 0.277); eye (p = 0.804); ear (p = 0.938); number of right/left sided participants p = 0.492; p = 0.274; p = 0.387; p = 0.839, and right/mixed/left sided participants p = 0.930; p = 0.233; p = 0.691; p = 0.804. For laterality consistency depending on definition used, p = 0.105; p = 0.108; p = 0.380. The relationship between scoliosis and laterality is not a simple causal relationship and needs further investigation

Lateralization Direction, Strength, and Consistency in Juvenile and Adolescent Idiopathic Scoliosis: A Case Control Pilot Study

The aim of this study was to assess the hypothesis that functional laterality features are associated with scoliosis incidence. The study included 59 patients with radiologically confirmed idiopathic scoliosis (mean age 13 years, 41 girls and 18 boys) and 55 controls (mean age 10.5 years, 38 girls and 17 boys). Side dominance was determined by the Lateral Preference Inventory. Direction, strength, and consistency of lateral dominance was obtained. Continuous data were compared by Student’s t-test or U Mann-Whitney test where appropriate. Categorical data were compared by chi-squared test and Fisher’s exact test. Groups were significantly different in terms of age (p p p p = 0.364); leg (p = 0.277); eye (p = 0.804); ear (p = 0.938); number of right/left sided participants p = 0.492; p = 0.274; p = 0.387; p = 0.839, and right/mixed/left sided participants p = 0.930; p = 0.233; p = 0.691; p = 0.804. For laterality consistency depending on definition used, p = 0.105; p = 0.108; p = 0.380. The relationship between scoliosis and laterality is not a simple causal relationship and needs further investigation

Impact of Robotic-Assisted Gait Therapy on Depression and Anxiety Symptoms in Patients with Subacute Spinal Cord Injuries (SCIs)—A Prospective Clinical Study

Background: Mood disorders, especially depression, and emotional difficulties such as anxiety are very common problems among patients with spinal cord injuries (SCIs). The lack of physical training may deteriorate their mental state, which, in turn, has a significant impact on their improvement in functioning. The aim of the present study was to examine the influence of innovative rehabilitation approaches involving robotic-assisted gait therapy (RAGT) on the depression and anxiety symptoms in patients with SCI. Methods: A total of 110 participants with subacute SCIs were enrolled in this single-center, single-blinded, single-arm, prospective study; patients were divided into experimental (robotic-assisted gait therapy (RAGT)) and control (conventional gait therapy with dynamic parapodium (DPT)) groups. They received five training sessions per week over 7 weeks. At the beginning and end of therapy, the severity of depression was assessed via the Depression Assessment Questionnaire (KPD), and that of anxiety symptoms was assessed via the State–Trait Anxiety Inventory (STAI X-1). Results: SCI patients in both groups experienced significantly lower levels of anxiety- and depression-related symptoms after completing the seven-week rehabilitation program (KPD: Z = 6.35, p p < 0.001, r = 0.42). In the RAGT group, post-rehabilitation measurements also indicated an improvement in psychological functioning (i.e., decreases in depression and anxiety and an increase in self-regulation (SR)). Significant results were noted for each variable (STAI X-1: Z = −4.93; KPD: Z = −5.26; SR: Z = −3.21). In the control group, there were also decreases in the effects on depression and state anxiety and an increase in self-regulation ability (STAI X-1: Z = −4.01; KPD: Z = −3.65; SR: Z = −2.83). The rehabilitation modality did not appear to have a statistically significant relationship with the magnitude of improvement in the Depression Assessment Questionnaire (KPD) (including self-regulation) and State–Trait Anxiety Inventory (STAI) scores. However, there were some significant differences when comparing the groups by the extent and depth of the injury and type of paralysis. Moreover, the study did not find any significant relationships between improvements in physical aspects and changes in psychological factors. Conclusions: Subjects in the robotic-assisted gait therapy (RAGD) and dynamic parapodium training (DPT) groups experienced decreases in anxiety and depression after a 7-week rehabilitation program. However, the rehabilitation modality (DPT vs. RAGT) did not differentiate between the patients with spinal cord injuries in terms of the magnitude of this change. Our results suggest that individuals with severe neurological conditions and complete spinal cord injuries (AIS A, according to the Abbreviated Injury Scale classification) may experience greater benefits in terms of changes in the psychological parameters after rehabilitation with RAGT