Balance evaluation techniques and physical therapy in post-stroke patients: A literature review

A stroke (cerebrovascular accident – CVA) is a significant social–economic issue. Approximately 15–30% of all patients develop life-long disability, 20% require over 3 months of specialized care in healthcare institutions, and the majority of the patients never recover the ability to maintain a proper vertical position. Such CVA sequelae as balance disturbances not only negatively affect patients’ daily physical activity, but also result in social isolation. A number of standardized clinical scales, tests, and instrumental examination techniques have been proposed for evaluating not only post-CVA balance function, but also any changes in this function following various interventions. Even though scientific literature lists numerous methods and instruments for the improvement of balance after a CVA, not all of them are equally effective, and there have been rather controversial evaluations of some techniques. Nevertheless, the application of the majority of the techniques as complementary or alternative measures to traditional physical therapy (PT) frequently yields better results

The impact of different physiotherapy techniques on trunk stabilizer muscles strength, pain and functional disability in persons diagnosed with intervertebral disc herniation

This pilot study presents data on the application of two different physiotherapy techniques and the comparison of their effectiveness in patients with radiologically confirmed intervertebral disc herniation. At baseline and the end of the application of the studied physiotherapy techniques, the subjects, after being distributed into two groups, underwent testing in order to determine their trunk stabilizer muscle strength, pain intensity at rest and on exertion, and the level of disability. The physiotherapy program consisted of individually selected exercises. Subjects of the first group additionally underwent sling exercise therapy, and subjects of the second group – physiotherapy with feedback exercises. Both combinations – physiotherapy with feedback exercises and physiotherapy with sling exercise therapy – statistically significantly reduced functional disability and lower back pain at rest and on exertion. The physiotherapy program with feedback exercises was more efficient than the physiotherapy program with sling exercise therapy when correcting imbalance in trunk stabilizer muscle strength. The impact of both physiotherapy programs on trunk stabilizer muscle strength was similar. Both combinations – physiotherapy with feedback exercises and physiotherapy with sling exercise therapy – had an equal impact on the decrease in pain and functional disabilit

Evaluation of activity and effectiveness of occupational therapy in stroke patients at the early stage of rehabilitation

In Lithuania, the stroke is not only medical, but social issue as well, since only 20% of patients suffering from stroke remain active at work. Yearly stroke incidence in Lithuania is 7000–8000 cases. The most common outcome of stroke is unilateral paralysis (hemiplegia) followed by disorders of coordination, balance, and movements. Due to dysfunctions of movements, self-care, cognition, behavior, and communication, some part of stroke patients remains disabled. They need assistance and care provided by other people. Occupational therapy, which is part of rehabilitation of patients after stroke, is directed to independence training. There are scarce data related to effectiveness of occupational therapy depending on motor, cognitive, and psychosocial dysfunctions. Goals of study were to estimate effectiveness of occupational therapy at the early stage of rehabilitation depending on type of stroke, localization of brain injury, grade of lesion, age, and gender, to identify factors influencing effectiveness of occupational therapy, and to estimate their positive predictive value. The study included 106 patients at the early stage of rehabilitation, who were admitted to Department of Neurorehabilitation after stabilization of clinical condition from Departments of Neurology and Neurosurgery (mean duration of 14±2 days after stroke). The program of occupational therapy was not fulfilled by 6 patients: 2 patients were transferred to Nursing Hospital due to severe condition, and 4 patients were discharged prematurely and continued rehabilitation in outpatient setting. Hence, study population consisted of 100 subjects (47 men and 53 women) who were diagnosed with stroke (ischemic or hemorrhagic). Patient’s functional status and disorders of activities were evaluated using Barthel Index and Functional Independence Measure. Complexes of occupational therapy were adjusted according to examination of patient’s disorders of activities, age, grade of lesion, other diseases, and complications during rehabilitation process. Effectiveness of occupational therapy in patients after stroke at then early stage of rehabilitation was influenced by gender, age, degree of lesion, type of stroke. Better effectiveness of occupational therapy was observed in men (P<0.05), persons younger than 59 years (P<0.05), persons with hemiparesis (P<0.05) and hemorrhagic stroke (P<0.05). Low effectiveness in stroke patients at the early stage of rehabilitation was influenced by neglect (P<0.05), hemiplegia (P<0.001), and older age of patient (P<0.05). Application of individualized occupational therapy complexes for stroke patients at the early stage of rehabilitation with consideration of motoric and cognitive-psychosocial disorders, significantly improves recovery of impaired functions, though occupational therapy should be continued in later rehabilitation stages, since patients after early stage of rehabilitation still have limited independence in daily activities

Efficiency of rehabilitation methods in treatment of arm lymphedema in patients after surgery for breast cancer

In this article we analyze influence of rehabilitation methods in treatment of arm lymphedema. In Kaunas oncological hospital were examined 60 women after surgery for breast cancer. The work objective was to evaluate efficiency of rehabilitation methods in treatment of arm lymphedema and in evaluate movement amplitude of shoulder joint. Two groups of women depending on rehabilitation start were evaluated. The same methods of rehabilitation were applied to both groups: physical therapy, electrostimulation, massage, lymphodrainage with apparate. Our study indicated that women, who were treated at early period of rehabilitation (3 months), showed statistically significantly (p0.05)

Evaluation of sensorimotor reactions during early rehabilitation for patients after cerebral stroke

Early inpatient rehabilitation is extremely important in functional improvement of patients suffering from cerebral stroke. From our point of view, in rehabilitation of patients after cerebral stroke, the estimation of sensorimotor reactions that enables the evaluation of sensorimotor functional changes is highly relevant. The article describes the comparison of sensorimotor reactions in two subgroups – stroke patients and healthy individuals – by applying Sensoneck system. The evaluation was performed before early stage of rehabilitation and thereafter (following early rehabilitation). In order to estimate the correlation between changes in functional independence and sensorimotor reactions, Functional Independence Measure was used. The study revealed that stroke patients had sensorimotor dysfunctions. During early rehabilitation, the quality of motion performance improved slightly, and sensorimotor reactions improved statistically significantly (P<0.05). The relationship between Functional Independence Measure and Sensoneck scores was not significant (P>0.05)

Change of cognitive functions after stroke with rehabilitation systems

The objective of this study is to assess and compare the effect of applying a computerised cognitive training programme and virtual environment rehabilitation system on cognitive functions in patients after a stroke. Methods. A controlled trial included 121 persons referred to second stage rehabilitation. The subjects were differentiated into three impact groups by a single blinded trial. Results. The trial revealed that cognitive functions improved in all patient groups (p<0.001). A paired comparison analysis of all groups demonstrated a tendency for cognitive functions, evaluated by the MoCA–LT test, to be more strongly improved in patients who practised a computerised cognitive training programme during their OT sessions than those who did not (p=0.054). Conclusions. The final outcome of the trial was that cognitive functions significantly improved in patients who practised computerised cognitive training programmes or virtual environment rehabilitation systems, compared to those participants who only had occupational therapy sessions

The relationship between pain catastrophizing, kinesiophobia and subjective knee function during rehabilitation following anterior cruciate ligament reconstruction and meniscectomy: A pilot study

Background and objective: Psychological responses to the initial injury and rehabilitation might be an important additional determinant of functional level outcomes after knee surgery. The objectives of this study were (1) to measure pain catastrophizing and kinesiophobia levels and (2) determine their association with self-reported subjective knee function during rehabilitation, following anterior cruciate ligament reconstruction (ACLR) and meniscectomy. Materials and methods: The study involved 41 participants. The levels of catastrophizing (Pain Catastrophizing Scale [PCS]), kinesiophobia (Tampa Scale of Kinesiophobia [TSK-11]), pain (Numeric Pain Rating Scale [NRS]), and subjective knee function (the Knee Injury and Osteoarthritis Outcome Score [KOOS]) were assessed before and after completion of 14-session rehabilitation program. Results: The mean level of catastrophizing changed from 5.8 (SD, 0.9) to 4.2 (SD, 0.5) during rehabilitation (P &lt; 0.05). The mean level of kinesiophobia changed from 22.7 (SD, 0.7) to 18.4 (SD, 0.6) (P &lt; 0.05). There was a moderate negative correlation between the PCS and the KOOS pain, function in daily living, knee-related quality of life subscales before and after rehabilitation (P &lt; 0.05). There was a moderate negative correlation between the TSK-11 score and the KOOS function in daily living subscale before and after rehabilitation (P &lt; 0.05). Conclusions: Pain catastrophizing and kinesiophobia decreased during rehabilitation. A higher pain catastrophizing level correlated with a greater level of knee pain during activities, more difficulties experienced during daily activities before and after rehabilitation. A high level of kinesiophobia correlated with more difficulties experienced in daily activities and poorer knee-related quality of life before and after rehabilitation

The Prevalence of Health Care-Associated Infections and Risk Factors in a University Hospital

The aim of the study was to evaluate the prevalence of health care-associated infections, risk factors, and antimicrobial use. Material and Methods. The study was carried out as a point-prevalence study in acute care wards, i.e., intensive care, surgical, and medical wards, at Vilnius University Hospital Santariškių Klinikos in April 2010. The study variables included the patient’s general data, indwelling devices, surgery, infection and its microbiological investigation, and antimicrobial use. All the variables that were logically related or had a P value of &lt;0.25 in the univariate analysis were included in the stepwise logistic regression in order to study the factors potentially associated with health careassociated infections. Results. A total of 731 patients were surveyed. The overall prevalence rate of health care-associated infections was 3.8%. The prevalence of health care-associated infections differed by hospital wards (range 0.0%–19.2%). The lower respiratory tract (32.2%), urinary tract (28.5%), and surgical site infections (32.1%) were the most common health care-associated infections. Moreover, 89.3% of the cases of health care-associated infections were microbiologically investigated. Staphylococcus aureus (28.6%) and Escherichia coli (19.1%) were the most frequently isolated microorganisms. The use of one or more invasive devices was recorded in 332 patients (45.4%). Of the surveyed patients, 20.2% received antimicrobial agents. The most commonly prescribed antimicrobial agents were fluoroquinolones (21.1%), broad-spectrum penicillins (19.1%), and first- or second-generation cephalosporins (18.6%). Conclusions. The prevalence of health care-associated infections was found to be similar to the reported overall prevalence rate of health care-associated infections in acute care hospitals in Lithuania