Physical activity and post-stroke depression

Moždani udar je treći najčešći uzrok smrtnosti u razvijenim zemljama svijeta, a najčešći uzrok trajnog invaliditeta. Depresija nakon moždanog udara jedna je od najčešćih komplikacija moždanog udara. Većina simptoma depresije nakon moždanog udara, javlja se u prva 2 mjeseca, dok se u manjem broju bolesnika prvi simptomi mogu javiti i nakon godinu dana od moždanog udara. Najčešći klinički oblici depresije nakon moždanog udara su mala i velika depresivna epizoda. U liječenju depresije nakon možanog udara, od velike važnosti je multidisciplinarni pristup, njime će se postaviti rana dijagnoza moždanog udara i započeti neurorehabilitacija. U procjeni depresije nakon moždanog udara, kao i funkcionalnog deficita i razine tjelesne aktivnosti, potrebno je koristiti međunarodne, standardizirane upitnike. Promocija zdravog načina života postala je jedna od glavnih odrednica zdravstvene strategije u većini razvijenih zemalja. Životni stil koji podržava tjelesnu aktivnost važan je u primarnoj preenciji moždanog udara, ali i u bolesnika koji su preboljeli moždani udar, a u svrhu sekundarne prevencije moždanog udara.Stroke is the third most frequent cause of death in developed countries worldwide and the most frequent cause of permanent disability. Post-stroke depression (PSD) is one of the most frequent complications of stroke. Most of the symptoms of PSD occur in in first two months, while minority of patients experiences their first symptoms 12 months after their stroke. Major depression and minor depression are the most frequently recognized expressions of PSD. In treatment of poststroke depression, multidisciplinary approach is of great importance leading to early diagnosis and treatment of stroke according to national recommendations, as well as early neurorehabilitation. In order to evaluate PSD, as well as functional deficit and level of physical activity, we should use international, standardized questionnaires. The promotion of physical activity as a part of healthy life style has become one of very important issue in health policy in many countries. A physically active lifestyle as we previously reported is important in primary stroke prevention, but also in stroke survivors in order to improve level of everyday activities and in secondary prevention of stroke

Physical activity and post-stroke depression

Moždani udar je treći najčešći uzrok smrtnosti u razvijenim zemljama svijeta, a najčešći uzrok trajnog invaliditeta. Depresija nakon moždanog udara jedna je od najčešćih komplikacija moždanog udara. Većina simptoma depresije nakon moždanog udara, javlja se u prva 2 mjeseca, dok se u manjem broju bolesnika prvi simptomi mogu javiti i nakon godinu dana od moždanog udara. Najčešći klinički oblici depresije nakon moždanog udara su mala i velika depresivna epizoda. U liječenju depresije nakon možanog udara, od velike važnosti je multidisciplinarni pristup, njime će se postaviti rana dijagnoza moždanog udara i započeti neurorehabilitacija. U procjeni depresije nakon moždanog udara, kao i funkcionalnog deficita i razine tjelesne aktivnosti, potrebno je koristiti međunarodne, standardizirane upitnike. Promocija zdravog načina života postala je jedna od glavnih odrednica zdravstvene strategije u većini razvijenih zemalja. Životni stil koji podržava tjelesnu aktivnost važan je u primarnoj preenciji moždanog udara, ali i u bolesnika koji su preboljeli moždani udar, a u svrhu sekundarne prevencije moždanog udara.Stroke is the third most frequent cause of death in developed countries worldwide and the most frequent cause of permanent disability. Post-stroke depression (PSD) is one of the most frequent complications of stroke. Most of the symptoms of PSD occur in in first two months, while minority of patients experiences their first symptoms 12 months after their stroke. Major depression and minor depression are the most frequently recognized expressions of PSD. In treatment of poststroke depression, multidisciplinary approach is of great importance leading to early diagnosis and treatment of stroke according to national recommendations, as well as early neurorehabilitation. In order to evaluate PSD, as well as functional deficit and level of physical activity, we should use international, standardized questionnaires. The promotion of physical activity as a part of healthy life style has become one of very important issue in health policy in many countries. A physically active lifestyle as we previously reported is important in primary stroke prevention, but also in stroke survivors in order to improve level of everyday activities and in secondary prevention of stroke

DIFFERENCES IN THE EFFECTIVENESS OF STANDARD PHYSICAL THERAPY COMPARED TO MANUAL YUMEIHO THERAPY AND EXERCISE IN PATIENTS WITH CHRONIC NONSPECIFIC LOW BACK PAIN

Cilj ovog istraživanja je usporediti učinkovitost terapijskog programa koji kombinira manualnu terapiju tehnikom yumeiho i vježbe, sa standardnim protokolom fizikalne terapije u rehabilitaciji osoba s kroničnom križoboljom. Metode: U istraživanju je sudjelovalo 46 ispitanika, koji su metodom slučajnog odabira podijeljeni u dvije istobrojne skupine. Ispitanici u skupini 1 (n=23) provodili su manualnu terapiju tehnikom yumeiho i vježbanje, dok su ispitanici skupine 2 (n=23) provodili standardni tretman fizikalne terapije. Istraživanje se sastojalo od inicijalnog i finalnog testiranja boli u lumbalnom dijelu kralježnice pri kretanju, kvalitete života, funkcionalnosti pokreta u svakodnevici, razini depresije, pokretljivosti kralježnice i statičkoj ravnoteži. Između inicijalnog i finalnog testiranja proveden je terapijski postupak u trajanju od tri tjedna (ukupno 15 tretmana). Rezultati: U rehabilitacijskom protokolu koji je uključivao manualnu terapiju tehnikom yumeiho i vježbe zabilježena su statistički značajna poboljšanja između inicijalnog i finalnog stanja u svim praćenim dimenzijama, dok je u rehabilitacijskom protokolu koji je uključivao fizikalnu terapiju zabilježeno statistički značajno poboljšanje u smanjenju boli, pokretljivosti kralježnice i funkcionalnosti pokreta u svakodnevici. 2 x 2 miješanim modelom ANOVE zabilježena je značajna razlika u učincima između dva rehabilitacijska programa u osjećaju boli, pokretljivosti kralježnice, kvaliteti života u domeni psihičkog i fizičkog zdravlju i funkcionalnosti pokreta u svakodnevici. Veličina učinka je izračunata preko parcijalno kvadrirane ete. U svim je praćenim dimenzijama osim ravnoteže pronađena statistički značajna povezanost između primijenjenih metoda rehabilitacije i učinaka rehabilitacijskog procesa s naglaskom na značajno veća poboljšanja u ispitanika koji su bili podvrgnuti terapiji yumeiho. Značajne interakcije prate umjerene i velike veličine učinka (jer su u svim varijablama zabilježene vrijednosti veće od 0,14 za parcijalno kvadriranu etu. Zaključak: Rehabilitacijski protokol koji je uključivao manualnu terapiju pokazao se učinkovitim u liječenju kronične križobolje. Potrebna su daljnja istraživanja ovog područja za dobivanje jasnije slike, a prijedlozi autora idu u smjeru uspoređivanja korištenog rehabilitacijskog modela s ostalim metodama, dužeg praćenja u postrehabilitacijskom razdoblju te studija na većem broju ispitanika.The aim of this study was to compare the effi ciency of a therapeutic program that combines manual therapy based on Yumeiho technique and exercise with standard physical therapy protocol in the rehabilitation of people with chronic back pain. Methods: The study included 46 subjects randomly divided into two groups with the same number of subjects. Group 1 subjects (n=23) were conducting manual therapy based on Yumeiho technique combined with exercise, whereas group 2 subjects (n=23) underwent physiotherapy treatment.The research consisted of initial and fi nal testing of pain in lumbar spine during movement, quality of life, functionality of movement in everyday life, level of depression, mobility of the spine and static balance. Between the initial and fi nal testing, a 3-week therapy program was conducted with a total of 15 treatments. Results: The rehabilitation protocol that included manual therapy based on Yumeiho technique and exercise showed signifi cant improvements between the initial and fi nal state of all dimensions monitored, whereas the rehabilitation protocol using physical therapy reported signifi cant improvement in reducing pain, spine mobility and functionality of movement in everyday life. The 2x2 mixed ANOVA model yielded signifi cant difference between the two rehabilitation programs in the sense of pain, spine mobility, quality of life in the domain of mental and physical health, depression and movement functionality in everyday life. The effect size was calculated by the partially squaring eta. In all monitored dimensions except for balance, statistically signifi cant interactions were found between the rehabilitation methods applied and the effects of rehabilitation process, with signifi cantly higher improvements in the group undergoing therapy with Yumeiho technique. Signifi cant interactions followed moderate and large effect size because all the variables recorded higher values than 0.14 for the partially squaring eta. Conclusion: Rehabilitation protocol that included manual therapy proved to be effective in the treatment of chronic back pain. Additional research is needed to get better insight into comparison of this rehabilitation model with other methods, longer monitoring in the post-rehabilitation period, and a greater number of subjects

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

EFFECTS OF ANTIEPILEPTIC DRUGS ON THE LEVEL OF PHYSICAL ACTIVITY IN PATIENTS WITH EPILEPSY

Cilj ovog istraživanja bio je ispitati utjecaj antiepileptične terapije na razinu tjelesne aktivnosti kod osoba s epilepsijom. Uzorak ispitanika činilo je 140 osoba oboljelih od epilepsije, 73 muškarac i 67 žena prosječne dobi od 24 do 45 godina (35,15 ± 10,01), a istraživanje je provedeno na Klinici za neurologiju KBC-a Sestre milosrdnice u Zagrebu. Testiranje se provodilo upitnikom International Physical Activity Questionnaire (IPAQ), koji je sadržavao 5 varijabli: posao, prijevoz, kućanski poslovi i briga za obitelj, sport i sportska rekreacija, vrijeme provedeno sjedeći. Korištene su i varijable o trajanju bolesti, učestalosti napada, vrsti epileptičnog napada te vrsti liječenja koje su dio općih podataka iz dokumentacije ispitanika. Dobiveni rezultati pokazuju kako je najčešća niska razina tjelesne aktivnosti (TA) kod osoba sa statusom nezaposlen, koji boluju više od 15 godina i imaju više od 15 napada tijekom godine. Kod osoba s generaliziranim napadima također je zabilježena niska razina TA, a visoka kod osoba sa žarišnim napadima. Muškarci za razliku od žena češće bilježe visoku razinu TA kao i zaposlene osobe. Bolesnici liječeni monoterapijom češće prakticiraju višu razinu TA za razliku od onih koji u svom liječenju koriste dva i/ili više antiepileptika (politerapija), gdje je zabilježena niska razina TA.The objective of this study was to examine the effects of antiepileptic drugs on the level of physical activity in people with epilepsy. We included 140 patients suffering from epilepsy, 73 men and 67 women, average age 24-45 years (35.15± 10.01). The study was conducted at Sestre milosrdnice University Hospital Centre, Department of Neurology in Zagreb. The patients were evaluated by the International Physical Activity Questionnaire (IPAQ) that comprises of 5 domains: work, transport, household chores, and care for the family, sporting activities and recreation, as well as sedentary time. The variable of disease duration was also used, as well as the variables of the seizure incidence, type of epileptic seizures, and type of treatment, which are included in general information provided in medical documentation. According to the findings, unemployed persons suffering from epilepsy for over 15 years with over 15 seizures throughout the year most frequently showed low levels of physical activity. Low levels of physical activity were also identified in persons with generalized seizures, whereas persons with focal seizures showed high levels of physical activity. Men and employed persons more frequently showed high levels of physical activity as opposed to women. Patients on monotherapy more frequently showed higher levels of physical activity as compared with those using more than two antiepileptic drugs, i.e. those on polytherapy, who showed low levels of physical activity

EFFECTS OF ANTIEPILEPTIC DRUGS ON THE LEVEL OF PHYSICAL ACTIVITY IN PATIENTS WITH EPILEPSY

Cilj ovog istraživanja bio je ispitati utjecaj antiepileptične terapije na razinu tjelesne aktivnosti kod osoba s epilepsijom. Uzorak ispitanika činilo je 140 osoba oboljelih od epilepsije, 73 muškarac i 67 žena prosječne dobi od 24 do 45 godina (35,15 ± 10,01), a istraživanje je provedeno na Klinici za neurologiju KBC-a Sestre milosrdnice u Zagrebu. Testiranje se provodilo upitnikom International Physical Activity Questionnaire (IPAQ), koji je sadržavao 5 varijabli: posao, prijevoz, kućanski poslovi i briga za obitelj, sport i sportska rekreacija, vrijeme provedeno sjedeći. Korištene su i varijable o trajanju bolesti, učestalosti napada, vrsti epileptičnog napada te vrsti liječenja koje su dio općih podataka iz dokumentacije ispitanika. Dobiveni rezultati pokazuju kako je najčešća niska razina tjelesne aktivnosti (TA) kod osoba sa statusom nezaposlen, koji boluju više od 15 godina i imaju više od 15 napada tijekom godine. Kod osoba s generaliziranim napadima također je zabilježena niska razina TA, a visoka kod osoba sa žarišnim napadima. Muškarci za razliku od žena češće bilježe visoku razinu TA kao i zaposlene osobe. Bolesnici liječeni monoterapijom češće prakticiraju višu razinu TA za razliku od onih koji u svom liječenju koriste dva i/ili više antiepileptika (politerapija), gdje je zabilježena niska razina TA.The objective of this study was to examine the effects of antiepileptic drugs on the level of physical activity in people with epilepsy. We included 140 patients suffering from epilepsy, 73 men and 67 women, average age 24-45 years (35.15± 10.01). The study was conducted at Sestre milosrdnice University Hospital Centre, Department of Neurology in Zagreb. The patients were evaluated by the International Physical Activity Questionnaire (IPAQ) that comprises of 5 domains: work, transport, household chores, and care for the family, sporting activities and recreation, as well as sedentary time. The variable of disease duration was also used, as well as the variables of the seizure incidence, type of epileptic seizures, and type of treatment, which are included in general information provided in medical documentation. According to the findings, unemployed persons suffering from epilepsy for over 15 years with over 15 seizures throughout the year most frequently showed low levels of physical activity. Low levels of physical activity were also identified in persons with generalized seizures, whereas persons with focal seizures showed high levels of physical activity. Men and employed persons more frequently showed high levels of physical activity as opposed to women. Patients on monotherapy more frequently showed higher levels of physical activity as compared with those using more than two antiepileptic drugs, i.e. those on polytherapy, who showed low levels of physical activity

Simple testing of upper extremity fine motor skills in patients with multiple sclerosis

Multipla skleroza najčešće je kronična bolest središnjeg živčanog sustava i pripada širokoj i važnoj skupini bolesti koje obilježuju razaranje mijelinskih ovojnica živčanih vlakana u mozgu, kralježničkoj moždini i vidnim putovima. Posljedica oštećenja ovojnice živca je uporenje ili blokada prijenosa živčanog impulsa između živčanih stanica, a samim time i poremećaj različitih funkcija u središnjem živčanom sustavu među kojima su vrlo očiti motorni poremećaji. Klinički napadaji i fizička onesposobljenost u MS-i predstavljaju temeljno obilježje tijeka bolesti. Napadajem se smatra javljanje novih simptoma, ponovno javljanje nekih starih simptoma te pojačanje prisutnih simptoma u vremenskom razdoblju duljem od 24 sata. Ne postoji mnogo testova za procjenu fine motorike gornjih ekstremiteta. Cilj provedenog istraživanja bio je dokazati da je ne toliko poznat 20 cents test vjerodostojan, precizan i pouzdan kao i 9 hole peg test koji se već koristi i poznat je svim zdravstvenim ustanovama u ispitivanju fine motorike gornjih ekstremiteta kod pacijenata s multiplom sklerozom te se postavlja pitanje postoji li dobra korelacija motorike desne i lijeve, odnosno dominantne i nedominantne ruke s obzirom na iznosi zbroja onesposobljenosti (EDSS) desne i lijeve ruke u bolesnika s multiplom sklerozom u oba testa. Nakon završetka obrade, analize i prikaza podataka rezultati su pokazali da je 20 cents test adekvatan i precizan u testiranju fine motorike gornjih ekstremiteta kao i 9 hole peg test, ali je dostupniji u primjeni i korištenju u odnosu na 9 hole peg spravu.Multiple sclerosis is chronic demyelinating disease of the central nervous system which affects brain, spinal cord and cranial nerves, mostly optic nerve. Consequence of the demielynation is slowing of the electrical impulse between the neurons and loss of different functions, especially upper and lower limb motoric functions. Relapses with different neurological deficits are clinical manifestation of the disease. Relaps is worsening, repetition or first presentation of central nervous dysfunctions longer then 24 hours. There is no enough tests for evaluating fine motor skills in multiple sclerosis patients. Nine hole peg test is one of the mostly used tests for evaluation of fine upper extremity motor functions in clinical settings. Twenty cents test is not so recognized in clinical settings and therefore the aim of the study was to compare these two tests and to show good correlation between them according to the level of disability (EDSS). At the end of our study and after the statistical data analysis we have shown that results of the 20 cents test are in good correlation with 9 hole peg test in evaluation of the upper extremity fine motor skills