17 research outputs found
Strength of knee flexors of the paretic limb as an important determinant of functional status in post-stroke rehabilitation
Objective
The purpose of the study was to assess the effectiveness of the multi-modal exercise program (MMEP) in patients after stroke, and to identify muscles that are the best predictors of functional performance and changes in functional status in a 3-week rehabilitation program.
Methods
Thirty-one post-stroke patients (60.6±12.7 years) participating in a 3-week MMEP took part in the study. Measurements of extensor and flexor strength of the knee (Fext, Fflex) were done. Functional performance was measured using Timed Up & Go test (TUG), 6-Minute Walk Test (6-MWT) and Tinetti Test.
Results
The rehabilitation program improved all the results of functional tests, as well as the values of strength in the patients. Both baseline and post-rehabilitation functional status was associated with knee flexor and extensor muscle strength of paretic but not of non-paretic limbs. At baseline examination muscle strength difference between both Fflexkg−1 and Fextkg−1 had an influence on functional status. After rehabilitation the effect of muscle strength difference on functional status was not evident for Fextkg−1 and, interestingly, even more prominent for Fflexkg−1.
Conclusions
MMEP can effectively increase muscle strength and functional capacity in post-stroke patients. Knee flexor muscle strength of the paretic limb and the knee flexor difference between the limbs is the best predictor of functional performance in stroke survivors
The influence of NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke
In stroke patients, the NDT – (Bobath – Neurodevelopmental Treatment) and PNF (Proprioceptive Neuromuscular Facilitation) methods are used to achieve the main objective of rehabilitation, which aims at the restoration of maximum patient independence in the shortest possible period of time (especially the balance of the body).
The aim of the study is to evaluate the effect of the NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke.
The study included 72 patients aged from 20 to 69 years after ischemic stroke with Hemiparesis. The patients were divided into 4 groups by a simple randomization. The criteria for this division were: the body side (right or left) affected by paresis and the applied rehabilitation methods. All the patients were applied the recommended kinesitherapeutic method (randomized), 35 therapy sessions, every day for a period of six weeks. Before initiation of therapy and after 6 weeks was measured the total area of the support and path length (COP (Center Of Pressure) measure foot pressure) using stabilometer platform – alpha. The results were statistically analyzed.
After treatment studied traits decreased in all groups. The greatest improvement was obtained in groups with NDT-Bobath therapy. NDT-Bobath method for improving the balance of the body is a more effective method of treatment in comparison with of the PNF method. In stroke patients, the effectiveness of NDT-Bobath method does not depend on hand paresis
Biologiczne sprzężenie zwrotne w rehabilitacji chorych po udarze mózgu
Background and objectives. In patients after stroke there comes to body mass distribution disorders. It is an obstacle in reeducation of standing and walking as well as a limitation of the ability to perform everyday activities. The aim of the study was to assess the effect of balance platform training with the application of biofeedback on body mass distribution and the improvement of the efficiency of everyday activities performance in patients after stroke.Material and methods. The investigated group included 25 subjects, who participated in the programme of rehabilitation consisting of platform training and physiotherapy. The comparative group were 14 subjects rehabilitated according to the established set of exercises excluding those on the balance platform. The training with the use of visual and auditory biofeedback, consisting of 10 repetitions, was performed every day 6 days a week. Both groups were subjected to the same training programme. The measurement of the feet pressure force on the balance platform in a standing position, neurological and physiotherapeutic examination and functional estimation of everyday activities according to Barthel index, were performed in every patient before and 18 days after the training. For the training and the measurement of the pressure force ERBE balance platform was used with Windows Physio-Feedback System.Results and conclusions. In both groups statistically significant improvement of functional conditions and body mass distribution were observed. The training of hemiparetic patients on the force platform with the application of biofeedback affects the change in the value of pressure force of lower extremity to the values observed in healthy subjects. The increase in relative lower extremity pressure on the paretic side was 5 times higher in the group with biofeedback than in the group without it
Ocena stabilometryczna wpływu fizykalnych metod neurofizjologicznych na poprawę równowagi u chorych po udarze mózgu
Introduction: Postural instability and difficulty in maintaining an upright position in patients after a stroke are connected with an impaired schema of the body. As a result, patients are not able to cope with daily activities. NDT-Bobath and PNF methods are commonly used in physiotherapy nowadays. The study aimed at an evaluation of the usefulness of a stabilometric platform in measuring stability and body balance in a standing position as well as the assessment of the impact of the above methods on the improvement of balance in patients after a stroke.Material and methods: Sixty-two patients after an ischemic stroke were included in the study. The patients were randomized to two therapy groups: NDT-Bobath and PNF. To assess the stability of posture and body balance in static conditions (measuring the field of support and COP path length) an ALFA stabilometric platform was used. Results: Before the therapy was conducted a longer COP path and a larger field of support in patients with left-sided paresis were observed, which confirms the increased instability of the body and impaired balance. After the therapy the researchers observed a shorter COP path in patients with right-sided paresis (in both the groups) while there was no such trend in relation to the field of support. After the therapy patients for whom the NDT-Bobath method had been used demonstrated a significantly greater reduction of the COP path and reduction in the area of support.Conclusion: Increased postural instability and impairment of body balance occurred in stroke patients with left-sided paresis. In the physiotherapy of post-stroke patients NDT-Bobath and PNF methods have important therapeutic properties. A significantly greater reduction of the COP path and a large reduction in the area of support were observed in patients treated with the NDT-Bobath method.Wstęp: Niestabilność posturalna i trudności w utrzymaniu pionowej postawy u osób po udarze mózgu mogą być związane z zaburzeniem
schematu ciała (tzw. nieuwagą połowiczą). W konsekwencji chorzy nie mogą swobodnie funkcjonować w Ŝyciu codziennym.
Obecnie w fizjoterapii najczęściej stosowane są metody neurofizjologiczne jak: metoda NDT-Bobath i PNF. Celem pracy była ocena
przydatności platformy stabilometrycznej do pomiaru stabilności i równowagi ciała w pozycji stojącej oraz wpływu w/w metod na równowagę
u chorych po udarze mózgu.
Materiał i metody: Badania przeprowadzono u 62 chorych po udarze niedokrwiennym mózgu. Chorych losowo przydzielono do dwóch
grup terapii: NDT-Bobath i PNF. Do oceny stabilności postawy i równowagi ciała w warunkach statycznych (pomiar powierzchni pola
podparcia i długości drogi COP) wykorzystano platformę stabilometryczną ALFA.
Wyniki: Przed rozpoczęciem terapii obserwowano dłuższą drogę COP i większe pole podparcia u chorych z niedowładem lewostronnym,
co potwierdza większą niestabilność ciała i zaburzenia równowagi w tej grupie chorych. Po terapii większe wartości skrócenia drogi
przemieszczania się COP występowało u chorych z niedowładem prawostronnym (w obu grupach), a w przypadku wielkości pola
podparcia nie obserwowano takiej tendencji. Po terapii stwierdzono istotnie większe skrócenie drogi COP i zmniejszenie pola powierzchni
podparcia u chorych, u których stosowano metodę NDT-Bobath. Wnioski: U chorych po udarze mózgu większe zaburzenia stabilności postawy i równowagi ciała występują u osób z niedowładem lewostronnym.
W fizjoterapii chorych po udarze mózgu metody NDT-Bobath i PNF wykazują działania terapeutyczne. Istotnie większe
skrócenie drogi COP i większe zmniejszenie pola powierzchni podparcia obserwowano u chorych leczonych metodą NDT-Bobath
Evaluation effectiveness of exercises on the balance platform for using biofeedback to walking function in patients after stroke
Wstęp: W ostatnich dziesięcioleciach jako jedną z metod fizjoterapii
pacjentów po udarze mózgu stosuje się ćwiczenia na
platformach balansowych z wykorzystaniem biologicznego
sprzężenia zwrotnego (biofeedback).
Materiał i metody: Badania wykonano u 55 chorych obu płci
po udarze niedokrwiennym mózgu z objawami niedowładu
połowiczego. Chorych ze względu na czas, który upłynął od
udaru podzielono na 2 grupy: grupa I – do 6 miesięcy, i grupa
II – powyżej 6 miesięcy. W każdej z tych grup wyróżniono
podgrupy chorych: A, u których w fizjoterapii stosowano
ćwiczenia na platformie balansowej, w podgrupie B tych
ćwiczeń nie stosowano. Do oceny skuteczności rehabilitacji
wykorzystano prędkość pokonania dystansu 10 metrów oraz
Wskaźnik symetryczności obciążania kończyn dolnych (Ws).
Badania były wykonywane przed rozpoczęciem rehabilitacji
i po upływie 3 tygodni.
Wyniki: Stwierdzono bardzo wysoce istotną statystycznie różnicę
(p < 0,001) w wartościach Ws po 3 tygodniach rehabilitacji
pomiędzy pacjentami ćwiczącymi i niećwiczącymi na platformie
balansowej do pół roku od udaru mózgu oraz istotną statystycznie różnicę (p < 0,05) u pacjentów powyżej pół roku
od udaru mózgu. Zaobserwowano również wysoce istotną
statystycznie różnicę (p < 0,01) w prędkości chodu na dystansie
10 metrów po 3 tygodniach rehabilitacji pomiędzy pacjentami
ćwiczącymi i niećwiczącymi na platformie balansowej do
pół roku od udaru mózgu oraz istotną statystycznie różnicę
(p < 0,05) u pacjentów powyżej pół roku od udaru mózgu.
Wnioski: Wyniki badań potwierdzają przydatność ćwiczeń
na platformie balansowej z wykorzystaniem zastępczego
sprzężenia zwrotnego u chorych z niedowładem połowiczym
po udarze niedokrwiennym mózgu. Trening na platformie
balansowej wpływa na poprawę symetryczności obciążania
kończyn dolnych oraz na zwiększenie prędkości chodu na
dystansie 10 metrów.Introduction: In recent decades as one of the methods of
physiotherapy in patients after stroke are used to exercises
on balance platform with using biofeedback.
Material and methods: The study was performed in 55
patients of both sexes after ischemic stroke with hemiparesis.
Patients were divided on two groups by the time which has
elapsed since the stroke. Group I – up to 6 months. Group
II – more than 6 months. In each of these groups were
distinguished subgroups of patients. A subgroup in whom
physiotherapy was exercises on the balance platform. In a
subgroup B these exercises are not used. For the evaluation
of the effectiveness of rehabilitation used: gait speed on 10
meters distance and a loading Index of the Symmetry of
the lower limbs. Tests were conducted 1 day and after three
weeks of rehabilitation.
Results: There was observed a highly statistically significant
difference (p < 0.001) in the values of Ws after three weeks of
rehabilitation in patients between trainees and not trainess
on the balance platform to six months after the stroke, and
a statistically significant difference (p < 0.05) in patients over six months after stroke. There was also observed a highly
statistically significant difference (p < 0.01) in gait speed on
10 meters distance after three weeks of rehabilitation in
patients between trainees and not trainees on the balance
platform to six months after the stroke, and a statistically
significant difference (p < 0.05) in patients over six months
after the stroke.
Conclusion: The study was performed in patients with
hemiparesis after ischemic stroke confirmed the usefulness of
exercises on the balance platform with the use of substitute
feedback. Training on the balance platform improves the
symmetry of both loading of the lower limbs as well as to
increase the speed of walking
Ocena rozkładu sił nacisku na podłoże u chorych po udarze niedokrwiennym mózgu
Introduction: Hemiparesis, coexistence of disturbances of deep sensation and balance affect the patients’ performance after stroke. The aim of the study was to evaluate the usefulness of a force platform for measurig the distribution of lower extremities pressure force and the effect of hemiparesis on the change of the distribution of pressure force shifted by lower extremities on the base in a standing position in the patients after the first stroke.Material and methods: The study comprised 23 patients with and 16 patients without hemiparesis (a control group). ERBE force platform with a computer program for Windows Physio-Feedback-System was used for the measurement of the pressure.Results: Mean pressure force of lower extremities in the subjects without hemiparesis was found to distribute symmetrically and is 0.5 ±0.07 for each extremity. In the patients with hemiparesis no statistically significant difference was found between the relative pressure force on the base by the paretic extremity in the patients with left and right hemiparesis (p = 0.568); the pressure force of the extremity on the side of the paresis is from 0.11 to 0.30 of total pressure.Conclusions: Force platform allows for objective evaluation of the state of human body balance by measuring the pressure force on the base. It may be applied in tests of patients with hemiparesis. Relative pressure force shifted by an extremity on the side of the paresis doses not depend on the side of the paresis. The stroke victims with hemiparesis tend to load the lower limb on the paretic side to a lesser degree.Wstęp: Niedowład połowiczy, współwystępowanie zaburzeń czucia głębokiego i równowagi wpływają na funkcjonowanie chorych po
udarze mózgu. Celem pracy była ocena przydatności platformy balansowej do pomiaru rozkładu siły nacisku kończyn dolnych oraz
wpływu niedowładu połowiczego na zmianę rozkładu siły nacisku na podłoże przenoszonej przez kończyny dolne w pozycji stojącej
u chorych po pierwszym udarze mózgu.
Materiał i metody: Badaniami objęto 23 chorych z niedowładem połowiczym i 16 bez niedowładu połowiczego, którzy stanowili
grupę porównawczą. Do pomiaru siły nacisku zastosowano platformę balansową ERBE współpracującą z programem komputerowym
dla Windows Physio-Feedback-System.
Wyniki: Stwierdzono, że średnia siła nacisku kończyn dolnych u osób bez niedowładu połowiczego rozkłada się symetrycznie i wynosi
0,5 ±0,07 dla każdej kończyny. U osób z niedowładem stwierdzono brak znamiennie statystycznie różnicy pomiędzy względną siłą
nacisku na podłoże przez kończynę niedowładną u chorych z niedowładem lewostronnym i prawostronnym (p=0,568), siła nacisku
kończyny po stronie z niedowładem stanowi od 0,11 do 0,38 nacisku całkowitego.
Wnioski: Platforma balansowa pozwala na obiektywną ocenę stanu zrównoważenia ciała człowieka, poprzez pomiar siły nacisku na
podłoże. Może być zastosowana do badań u chorych z niedowładem połowiczym. Względna siła nacisku przenoszonego przez kończynę
po stronie z niedowładem nie zależy od strony niedowładu. Chorzy z niedowładem połowiczym po udarze mózgu w mniejszym stopniu
obciążają kończynę dolną po stronie z niedowładem
Stan funkcjonalny chorych trzy lata po udarze mózgu w zależności od powikłań neurologicznych i ogólnomedycznych
Introduction and purpose: There are several commonly
known complications occurring in the acute phase of stroke
which have influence on patients’ mortality and functional
status. There is, however, less information concerning the
state of the patients in long-term follow-up. The aim of
the study was to assess the functional status of stroke
patients depending on neurological and general medical
complications in three years follow-up.
Material and methods: The study has been carried out
amongst 101 patients treated at the Department of
Neurology with Stroke Unit of the Specialist Hospital in
Końskie, who were diagnosed with the first stroke in their
lives and registered with a questionnaire of the POLKARD
programme. Examination after three years consisted of
assessing the patients’ functional status using the Rankin’s
Scale and the Barthel’s Scale, examination by both the Mini
Mental State Examination and the Geriatric Depression Scale.
Their functional status was analysed before the stroke and
on discharging them from the hospital, as well as three years
after stroke depending on complications.
Results: The patients who are self-dependent in daily activities
(Rankin 0-1) constituted 47% of the researched, 42% require
some assistance (Rankin 2-3), and 11% require substantial
assistance or complex treatment (Rankin 4-5). The most
frequent recognised after-stroke complications are depressive
disorders (45.5%), falls (42.6%), dementia (33.7%), cardiological
complications (19.8%), pain and oedema in the paretic limbs
(15.8%). During three years from the stroke at least one complication occurred in case of 84% of the patients. Any
statistically essential dependence between complications and
gender, age as well as functional status was found.
Conclusions: The post-stroke complications occur statistically
independently from the patients’ functional status but their
incidence increases with progression of patients’ disability.
Systematic, long-term follow-up of the post-stroke patients
may prevent many complications and improve the patients’
quality of life.Wstęp i cel pracy: Powszechnie znany jest wpływ wczesnych
powikłań udaru mózgu na śmiertelność i stan funkcjonalny,
natomiast niewiele wiadomo o powikłaniach późnych
w opiece długoterminowej. Celem pracy była ocena stanu
funkcjonalnego pacjentów trzy lata po udarze niedokrwiennym
w zależności od rodzaju i częstości powikłań.
Materiał i metody: Analizą objęto 101 osób leczonych w Oddziale
Neurologii w Końskich z rozpoznaniem pierwszego
w życiu niedokrwiennego udaru mózgu i zarejestrowanych
w programie POLKARD. Po trzech latach od udaru chorych
oceniano za pomocą skali Rankina i Barthel, testem Mini
Mental i Geriatryczną Skalą Depresji. Analizowano stan
funkcjonalny przed udarem i przy wypisie ze szpitala oraz
trzy lata po udarze mózgu w zależności od powikłań.
Wyniki: Pacjenci samodzielni w zakresie codziennych
czynności (Rankin 0-1) stanowili 47% badanych, pewnej
pomocy wymagało 42% (Rankin 2-3), a 11% wymagało
znacznej pomocy lub kompleksowej pielęgnacji (Rankin
4-5). Najczęstszymi powikłaniami były zaburzenia depresyjne
(46,5%), upadki (42,6%), otępienie (33,7%) i powikłania kardiologiczne
(19,8%). W ciągu trzech lat od udaru przynajmniej
jedno powikłanie wystąpiło u 84% pacjentów. Nie znaleziono
statystycznie istotnej zależności między powikłaniami a płcią,
wiekiem i stanem funkcjonalnym.
Wnioski: Powikłania po udarze mózgu występują statystycznie
niezależnie od stanu funkcjonalnego, ale częstość ich
występowania narasta wraz z narastaniem niepełnosprawności.
Systematyczne, wieloletnie monitorowanie pacjentów po udarze mózgu może zapobiec wielu powikłaniom i poprawić
jakość życia chorych
The effect of solar ultraviolet radiation (UVR) on induction of skin cancers
Ultraviolet radiation is a physical mutagenic and cancerogenic factor. About 95% of ultraviolet A (UVA) (320–400 nm) and 5% of UVB (280–320 nm) reach the Earth’s surface. Melanin is a natural skin protective factor against UV radiation. Skin cancers associated with long-term exposure to UV radiation are: basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and cutaneous malignant melanoma (CMM). The high risk of BCC development is related to acute and repeated exposure to UV causing sunburn. Molecular studies of BBC demonstrated disorders in sonic hedgehog (SHH) cell signaling regulation pathway, associated with the suppressor protein patched homolog 1 gene (PTCH1) mutations. The risk of the BCC development is related to the polymorphism of melanokortin-1 receptor gene (MC1R). Tumor P53 gene mutations observed in BCC cells has been classified as secondary genetic changes. In SCC cells UV-induced mutations were mostly related to P53 gene. Increased expression of cyclooxigenase- 2 gene (COX-2) plays a significant role in the development of SCC. Other pathogenetic factors include intensification of the synthesis of pro-inflammatory cytokines (tumor necrosis factor α (TNF-α), interleukin-1 α (IL-1α), IL-1β and IL-6). Currently, the role of UVB has been recognized in the pathogenesis of CMM. In CMM cells the following gene mutations were noted: cyclindependent kinase inhibitor 2A INK4A (p16INK4A), cyclin-dependent kinase 4 (CDK4), Ras, phosphatase and tensin homolog deleted on chromosome 10 (PTEN) and proto-oncogene B-Raf (BRAF). The BRAF gene mutations were observed in ~50% of CMM cases. Mutations of P53 gene are not characteristic of CMM cells. Med Pr 2016;67(2):255–26
Wpływ depresji na jakość życia chorych ze stwardnieniem rozsianym
Background and purpose: Depression is a common complication of multiple sclerosis. It can essentially affect the natural course of the disease, treatment and rehabilitation results and can significantly decrease the quality of life. The aim of this study is to assess the effect of depression on multiple sclerosis patients’ quality of life using the Polish version of the Functional Assessment of Multiple Sclerosis questionnaire (FAMS).Material and methods: Ninety-four patients aged 18–51 years, treated as inpatients at a neurological department, were examined. Depression was diagnosed using the DSM-IV criteria. Depression was assessed by means of the Hamilton Depression Rating Scale (HDRS). The influence of depression on the quality of life assessed with Functional Assessment of Multiple Sclerosis questionnaire (FAMS) and its association with locomotor insufficiency were analyzed (EDSS-Kurtzky Scale). The Fischer exact test and the Mann-Whitney test were used for statistical analysis.Results: Fifty-eight patients (62%) suffered from depression. Among them, 48 patients (51%) suffered mild depression and 10 patients (11%) had moderate or severe depression. A significantly better quality of life was noted in patients without depression in comparison to patients with mild and, especially, to those with moderate or severe depression (p < 0.005). A clear association between the degree of locomotor insufficiency, depression severity, and quality of life of patients with multiple sclerosis was found.Conclusions: High incidence of depression and its severity are associated with locomotor insufficiency. Depression significantly affects multiple sclerosis patients’ quality of life. The Polish version of FAMS questionnaire is a reliable and sensitive tool assessing quality of life and should be widely used in clinical practice
The influence of the low-frequency magnetic fields of different parameters on the secretion of cortisol in men
Objectives: The aim of this paper is to test the infl uence of long-term application of the low-frequency magnetic fi elds in magnetotherapy and magnetostimulation on cortisol secretion in men. Materials and Methods: Patients were divided into three groups: 16 men underwent magnetotherapy and 20 men (divided into two groups) underwent magnetostimulation. Magnetotherapy – 2 mT induction, 40 Hz, bipolar square wave, was applied for 20 min to lumbar area. Magnetostimulation (Viofor Jaroszyk, Paluszak, Sieroń (JPS) system, M2P2 program) was applied to 10 patients for 12 min each day. The third group (10 patients) underwent magnetostimulation (Viofor JPS system, M3P3) for 12 min each day using a different machine. All groups had 15 rounds of applications at approximately 10:00 a.m. with intermissions on the weekends. Blood serum was taken four times in a 24-hour period, before applications, the day after applications and a month later. Chemiluminescence micromethod was used to indicate hormone concentrations. Data was statistically analyzed with the analysis of variance (ANOVA) method. Results: The statistically signifi cant gains in the circadian cortisol profi le at 4:00 p.m., before and after application, were observed as a decrease in concentration during magnetotherapy. In magnetostimulation, with the M2P2 program, a signifi cant increase in the cortisol concentration was observed in circadian profi le at 12:00 p.m. one month after the last application. After magnetostimulation with the M3P3 program, a signifi cant increase in concentration at 6:00 a.m. and a decrease in concentration at 12:00 p.m. were observed one month later. Statistically signifi cant difference was demonstrated in the participants after the application of magnetotherapy and magnetostimulation with M3P3 program compared to the men submitted to magnetostimulation, with M2P2 program, at 4:00 p.m. after 15 applications. Conclusions: Biological hysteresis one month after magnetostimulation suggests long-term infl uence on the hypothalamohypophysial axis. The circadian curves of cortisol secretion a day after magnetotherapy and magnetostimulation with M3P3 program compared to magnetostimulation with M2P2 progam differs nearly by 100%, which proves that they show varied infl uence on cortisol secretion in men. All changes in the hormone concentration did not exceed the physiological standards of cortisol secretion, which suggests a regulating infl uence of magnetic fi elds on cortisol concentration rather than a strong stressogenic impact of magnetostimulation