Influence of structured treatment on gait parameters in rehabilitation patients with Parkinson's disease

Cilj: Glavni rehabilitacioni cilj u tretmanu bolesnika sa Parkinsonovom bolešću je da se unapredi, očuva i uspori propadanje funkcije hoda, održavanje bezbednog hoda za vreme različitih motornih i kognitivnih zadataka. Cilj ovog istraživanja je bio da ispita da li individualizovani strukturisani rehabilitacioni postupak, usmeren na različite patofiziološke mehanizme u osnovi poremećaja hoda obolelih od Parkinsonove bolesti, nezavisno poboljšava parametre hoda u poređenju sa optimalizovanom antiparkinsonom terapijom. Cilj je bio i da se utvrdi na koje specifične parametre hoda i na koji način deluje strukturisani rehabilitacioni tretman. Poseban cilj istraživanja je bio se ispita, da li repetitivna transkranijalna magnetna stimulacija suplementarne motorne areje moždane kore utiče na parametre hoda obolelih od Parkinsonove bolesti. Metodologija: Istraživanje, u formi otvorene prospektivne kliničke studije sprovedeno je na Klinici za neurologiju Kliničkog Centra Srbije u Beogradu. Istraživanjem su obuhvaćeni bolesnici sa Parkinsonovom bolešću (PB) koji su se ambulantno ili hospitalno lečili u periodu od 2010 do 2012 godine. U studiju su bila uključena 43 bolesnika sa PB, koji su bili randomizovani u dve studijske grupe metodom slučajnih brojeva: a) Grupa I, koja je bila podvrgnuta strukturisanom rehabilitacionom protokolu u trajanju od 21 dana, u režimu 6 terapijskih seansi nedeljno, ukupno 16 sati efektivnog vežbanja; b) Grupa II, koja je bila podvrgnuta tretmanu repetitivne transkranijalne magnetne stimulacije (rTMS) frekvencom od 10 Hz iznad suplementarne motorne areje (SMA) u trajanju od 10 dana ukupno 400 TMS pulseva tokom 20 minuta /dnevno. U našoj studiji sa dva protokola strukturisanim rehabilitacionim programom i rTMS, analiziranje efekata rTMS smo posmatrali odvojeno kako bismo dobili jasnije inicijalne rezultate. Dijagnoza PB postavljena na osnovu kriterijuma Britanske Banke mozgova i od strane neurologa specijalizovanog za bolesti nevoljnih pokreta. Na ispitanicima obe grupe su sprovedena identična testiranja. Sva testiranja kliničkih parametara bolesti, kao i testiranje hoda, sprovedena su tokom „ON“ perioda , u najvećem broju slučajeva 2 sata nakon uzimanja prve jutarnje doze L-dope...Aim: The main rehabilitation aim in rehabilitation of patients with Parkinson’s disease is advancing, keeping up and slowing down decline the gait function, keeping up walking safety during different motor and cognitive tasks. The aim of our study was to examine if individual structural rehabilitation treatment, directed to different patophisiology mechanisms in the base of gait disorder of patients with Parkinson’s disease (PD), indipendently making better the gait parameters in comparing to optimal antiparkinsonic therapy. The aim was to determine to which specific gait parameters and how structural rehabilitation treatment functioned. Specific aim og study was to examine, if repetitive transcranial magnetic stimulation (rTMS) of supplementary motor area of brain cortex influences to gait parameters to patients with Parkinson’s disease. Methodology: The examination in the form of open prospective clinical study was carried out at the Clinic for neurology at Clinical Center of Serbia in Belgrade. Researching were included the patients with Parkinson’s disease who were treated outpatiently or in hospital in the period from 2010-2012. Forty three participants with PD were included in two study groups with the method of randomly numbers: a) Group 1 was under the structural rehabilitation protocol lasting 21 days, under the regime of 6 seance therapies per week, all together 16 hours effective exercises; b) Group 2, was under rTMS treatment frequency of 10Hz above supplementary motor area (SMA) lasting 10 days, all together 400 TMS pulses during 20 minutes daily. In our study with two protocols given with structural rehabilitation programme and rTMS, analysing the effects of rTMS we watched separately in order to get better initial results.The diagnosis of PB was made on the base of UK Brain Bank Criteria for the diagnosis of Parkinson's disease and by the neurologist specialized for the movement disorders.The same testing was done to both groups of participants. All clinical tests, as well as gait testing, were done during “On“ period, mostly 2 hours after the first morning dose of L-Dopa. Patients from the group 1 were tested the first day before the beginning of given rehabilitation protocol, and after finishing rehabilitation protocol which lasted 21 days. Patients from the group 2 (rTMS) were tested 1. day, before biginning of protocol, after the finishing of protocol stimulation which lasted 10 and 21th day from the beginning of testing..

The quality of life of lumbar radiculopathy patients under conservative treatment

Background/Aim. The quality of life of lumbar radiculopathy patients conditioned by their health status is a result of both their subjective perception of the disease and their objective health status. The aim of this study was to evaluate the quality of life of lumbar radiculopathy patients under conservative treatment by means of generic and another lumbar syndrome specific questionnaires. Methods. A total of 50 patients (33 males, 17 females average age 46.1 years,) under conservative treatment in a hospital over four weeks were included in the study. They were interviewed using two questionnaires: the SF36 (Short form (36) Health Survey) generic questionnaire measuring eight domains of their quality of life summarized into two main ones (i.e. overall physical and overall mental health), and the lumbar syndrome specific North American Spine Society - Low Back Pain Outcome Instrument (NASS LBP), a questionnaire measuring four domains (functional limitations, motor and sensitive neurological symptoms, expectations from the treatment and satisfaction with it). Results. The values of physical health domain was low as 31.1 at the beginning of the treatment, were rising over the following six months and dropped insignificantly after four years (42.1/48.7 /47.0) The mental health values (47.2) did not alter as compared to that of the general population. A values of the quality of life stabilized within six months. The neurological symptoms domain did not correlate with other value scales and domains. Conclusion. The quality of life of lumbar radiculopathy patients was impaired only from its physical aspect, but after conservative treatment it improved over the following six months. After four years there is an insignificant drop of all quality of life values, indicating a need for a longer term monitoring of there patients

Influence of structured treatment on gait parameters in rehabilitation patients with Parkinson's disease

Cilj: Glavni rehabilitacioni cilj u tretmanu bolesnika sa Parkinsonovom bolešću je da se unapredi, očuva i uspori propadanje funkcije hoda, održavanje bezbednog hoda za vreme različitih motornih i kognitivnih zadataka. Cilj ovog istraživanja je bio da ispita da li individualizovani strukturisani rehabilitacioni postupak, usmeren na različite patofiziološke mehanizme u osnovi poremećaja hoda obolelih od Parkinsonove bolesti, nezavisno poboljšava parametre hoda u poređenju sa optimalizovanom antiparkinsonom terapijom. Cilj je bio i da se utvrdi na koje specifične parametre hoda i na koji način deluje strukturisani rehabilitacioni tretman. Poseban cilj istraživanja je bio se ispita, da li repetitivna transkranijalna magnetna stimulacija suplementarne motorne areje moždane kore utiče na parametre hoda obolelih od Parkinsonove bolesti. Metodologija: Istraživanje, u formi otvorene prospektivne kliničke studije sprovedeno je na Klinici za neurologiju Kliničkog Centra Srbije u Beogradu. Istraživanjem su obuhvaćeni bolesnici sa Parkinsonovom bolešću (PB) koji su se ambulantno ili hospitalno lečili u periodu od 2010 do 2012 godine. U studiju su bila uključena 43 bolesnika sa PB, koji su bili randomizovani u dve studijske grupe metodom slučajnih brojeva: a) Grupa I, koja je bila podvrgnuta strukturisanom rehabilitacionom protokolu u trajanju od 21 dana, u režimu 6 terapijskih seansi nedeljno, ukupno 16 sati efektivnog vežbanja; b) Grupa II, koja je bila podvrgnuta tretmanu repetitivne transkranijalne magnetne stimulacije (rTMS) frekvencom od 10 Hz iznad suplementarne motorne areje (SMA) u trajanju od 10 dana ukupno 400 TMS pulseva tokom 20 minuta /dnevno. U našoj studiji sa dva protokola strukturisanim rehabilitacionim programom i rTMS, analiziranje efekata rTMS smo posmatrali odvojeno kako bismo dobili jasnije inicijalne rezultate. Dijagnoza PB postavljena na osnovu kriterijuma Britanske Banke mozgova i od strane neurologa specijalizovanog za bolesti nevoljnih pokreta. Na ispitanicima obe grupe su sprovedena identična testiranja. Sva testiranja kliničkih parametara bolesti, kao i testiranje hoda, sprovedena su tokom „ON“ perioda , u najvećem broju slučajeva 2 sata nakon uzimanja prve jutarnje doze L-dope...Aim: The main rehabilitation aim in rehabilitation of patients with Parkinson’s disease is advancing, keeping up and slowing down decline the gait function, keeping up walking safety during different motor and cognitive tasks. The aim of our study was to examine if individual structural rehabilitation treatment, directed to different patophisiology mechanisms in the base of gait disorder of patients with Parkinson’s disease (PD), indipendently making better the gait parameters in comparing to optimal antiparkinsonic therapy. The aim was to determine to which specific gait parameters and how structural rehabilitation treatment functioned. Specific aim og study was to examine, if repetitive transcranial magnetic stimulation (rTMS) of supplementary motor area of brain cortex influences to gait parameters to patients with Parkinson’s disease. Methodology: The examination in the form of open prospective clinical study was carried out at the Clinic for neurology at Clinical Center of Serbia in Belgrade. Researching were included the patients with Parkinson’s disease who were treated outpatiently or in hospital in the period from 2010-2012. Forty three participants with PD were included in two study groups with the method of randomly numbers: a) Group 1 was under the structural rehabilitation protocol lasting 21 days, under the regime of 6 seance therapies per week, all together 16 hours effective exercises; b) Group 2, was under rTMS treatment frequency of 10Hz above supplementary motor area (SMA) lasting 10 days, all together 400 TMS pulses during 20 minutes daily. In our study with two protocols given with structural rehabilitation programme and rTMS, analysing the effects of rTMS we watched separately in order to get better initial results.The diagnosis of PB was made on the base of UK Brain Bank Criteria for the diagnosis of Parkinson's disease and by the neurologist specialized for the movement disorders.The same testing was done to both groups of participants. All clinical tests, as well as gait testing, were done during “On“ period, mostly 2 hours after the first morning dose of L-Dopa. Patients from the group 1 were tested the first day before the beginning of given rehabilitation protocol, and after finishing rehabilitation protocol which lasted 21 days. Patients from the group 2 (rTMS) were tested 1. day, before biginning of protocol, after the finishing of protocol stimulation which lasted 10 and 21th day from the beginning of testing..

Influence of structured treatment on gait parameters in rehabilitation patients with Parkinson's disease

Cilj: Glavni rehabilitacioni cilj u tretmanu bolesnika sa Parkinsonovom bolešću je da se unapredi, očuva i uspori propadanje funkcije hoda, održavanje bezbednog hoda za vreme različitih motornih i kognitivnih zadataka. Cilj ovog istraživanja je bio da ispita da li individualizovani strukturisani rehabilitacioni postupak, usmeren na različite patofiziološke mehanizme u osnovi poremećaja hoda obolelih od Parkinsonove bolesti, nezavisno poboljšava parametre hoda u poređenju sa optimalizovanom antiparkinsonom terapijom. Cilj je bio i da se utvrdi na koje specifične parametre hoda i na koji način deluje strukturisani rehabilitacioni tretman. Poseban cilj istraživanja je bio se ispita, da li repetitivna transkranijalna magnetna stimulacija suplementarne motorne areje moždane kore utiče na parametre hoda obolelih od Parkinsonove bolesti. Metodologija: Istraživanje, u formi otvorene prospektivne kliničke studije sprovedeno je na Klinici za neurologiju Kliničkog Centra Srbije u Beogradu. Istraživanjem su obuhvaćeni bolesnici sa Parkinsonovom bolešću (PB) koji su se ambulantno ili hospitalno lečili u periodu od 2010 do 2012 godine. U studiju su bila uključena 43 bolesnika sa PB, koji su bili randomizovani u dve studijske grupe metodom slučajnih brojeva: a) Grupa I, koja je bila podvrgnuta strukturisanom rehabilitacionom protokolu u trajanju od 21 dana, u režimu 6 terapijskih seansi nedeljno, ukupno 16 sati efektivnog vežbanja; b) Grupa II, koja je bila podvrgnuta tretmanu repetitivne transkranijalne magnetne stimulacije (rTMS) frekvencom od 10 Hz iznad suplementarne motorne areje (SMA) u trajanju od 10 dana ukupno 400 TMS pulseva tokom 20 minuta /dnevno. U našoj studiji sa dva protokola strukturisanim rehabilitacionim programom i rTMS, analiziranje efekata rTMS smo posmatrali odvojeno kako bismo dobili jasnije inicijalne rezultate. Dijagnoza PB postavljena na osnovu kriterijuma Britanske Banke mozgova i od strane neurologa specijalizovanog za bolesti nevoljnih pokreta. Na ispitanicima obe grupe su sprovedena identična testiranja. Sva testiranja kliničkih parametara bolesti, kao i testiranje hoda, sprovedena su tokom „ON“ perioda , u najvećem broju slučajeva 2 sata nakon uzimanja prve jutarnje doze L-dope...Aim: The main rehabilitation aim in rehabilitation of patients with Parkinson’s disease is advancing, keeping up and slowing down decline the gait function, keeping up walking safety during different motor and cognitive tasks. The aim of our study was to examine if individual structural rehabilitation treatment, directed to different patophisiology mechanisms in the base of gait disorder of patients with Parkinson’s disease (PD), indipendently making better the gait parameters in comparing to optimal antiparkinsonic therapy. The aim was to determine to which specific gait parameters and how structural rehabilitation treatment functioned. Specific aim og study was to examine, if repetitive transcranial magnetic stimulation (rTMS) of supplementary motor area of brain cortex influences to gait parameters to patients with Parkinson’s disease. Methodology: The examination in the form of open prospective clinical study was carried out at the Clinic for neurology at Clinical Center of Serbia in Belgrade. Researching were included the patients with Parkinson’s disease who were treated outpatiently or in hospital in the period from 2010-2012. Forty three participants with PD were included in two study groups with the method of randomly numbers: a) Group 1 was under the structural rehabilitation protocol lasting 21 days, under the regime of 6 seance therapies per week, all together 16 hours effective exercises; b) Group 2, was under rTMS treatment frequency of 10Hz above supplementary motor area (SMA) lasting 10 days, all together 400 TMS pulses during 20 minutes daily. In our study with two protocols given with structural rehabilitation programme and rTMS, analysing the effects of rTMS we watched separately in order to get better initial results.The diagnosis of PB was made on the base of UK Brain Bank Criteria for the diagnosis of Parkinson's disease and by the neurologist specialized for the movement disorders.The same testing was done to both groups of participants. All clinical tests, as well as gait testing, were done during “On“ period, mostly 2 hours after the first morning dose of L-Dopa. Patients from the group 1 were tested the first day before the beginning of given rehabilitation protocol, and after finishing rehabilitation protocol which lasted 21 days. Patients from the group 2 (rTMS) were tested 1. day, before biginning of protocol, after the finishing of protocol stimulation which lasted 10 and 21th day from the beginning of testing..

Vitamin D and parathyroid hormone in relation to bone mineral density in postmenopausal women

Background/Aim. Despite vitamin D insufficiency being widely reported, in Serbia the epidemiological data lack information regarding vitamin D status in the sera of postmenopausal women. The aim of this study was to establish the prevalence of inadequate serum 25-hydroxyvitamin D [25(OH)D] concentrations in postmenopausal Serbian women with seasonal variations of 25(OH)D, in relation to parathyroid hormone (PTH) and bone mineral density (BMD). Methods. A total of 95 postmenopausal women, mean age 65.1 ± 9.08 years, were examined. Measurements of 25(OH)D and PTH were performed both in the winter and the summer period, using electrochemiluminiscence immunoassays. BMD (g/cm2) was measured by the dualenergy x-Ray absortimetry (DXA) method on the spine and hip areas. Results. A decreased value of vitamin D (< 75 nmol/L) in 88.4% of postmenopausal women and an elevated level of PTH (> 65 pg/mL) in 25.3% of the cases were found. Elevated PTH varied individually, but was mostly increased if 25(OH)D was equal or lower than 37.6 nmol/L. 25(OH)D insufficiency was found in winter in 94.5% and in summer in 80% of the cases (p < 0.01). The mean of the PTH was higher (p < 0.05) in winter than in summer. A significant negative correlation between 25(OH)D and PTH (p < 0.001) was proved. Correlation between 25(OH)D and PTH with BMD at lumbar spine was established in the whole group, but at the femoral neck in women aged over 65 years (p < 0.05). Conclusion. Our results showed a high prevalence of vitamin D insufficiency (88.4%) among postmenopausal women. The levels of 25(OH)D and PTH changed significantly according to the season

Effects of diazepam and levodopa single doses on motor cortex plasticity modulation in healthy human subjects: A TMS study

Introduction. Administration of pharmacological agents with specific actions on neurotransmitter systems is a powerful driver of functional cortical reorganization. Plastic reorganization of the motor cortex in humans studies by the use of non-invasive stimulation protocols, which mimic the Hebbian model of associative plasticity. Objective. Aiming to explore pharmacological modulation on human motor cortex plasticity, we tested healthy subjects after each dosage of diazepam, levodopa i placebo administration, using paired associative stimulation protocol (PAS) that induce fenomena similar to a long-term potentiation and depression, as defined on the synaptic level. Methods. We analyzed effects of benzodiazepines (10 mg), levodopa (200 mg) and placebo on PAS protocol in 14 healthy volunteers, using a double-blind placebo-controlled study design. PAS consisted of electrical stimuli pairs at n.medianus and magnetic pulses over the scalp (transcranial magnetic stimulation) in precisely defined intervals (ISI was 10 and 25 ms) for a total of about 15 minutes (200 pairs). MEP amplitudes before and after (0, 10, 20 and 30 minutes later) interventional protocols were compared. Results. When protocols were applied with placebo depending on ISI (10 ms - inhibitory, 25 ms - facilitatory effects), MEP amplitudes decreased or increased, while values in the postinterventional period (0, 10, 20 and 30 min) were compared with initial values before the use of SAS. The use of benzodiazepines caused the occlusion of LTP-like effect, in contrast to amplification effects recorded after the administration of levodopa. With respect to the LTD-like protocol, the reverse was true (ANOVA for repeat measurements p<0.001). Conclusion. Administration of GABA-ergic agonist diazepam interferes with the induction of associative plasticity in the motor cortex of healthy individuals, as opposed to the use of levodopa, which stimulates these processes. The observed effects point at a potential role of pharmacological modulation of plasticity in humans

Hyperbaric oxygen therapy of angiopathic changes in patients with inherited gene imbalance

Introduction Phenotype match inherited by genes is in most cases present in monozygotic twins. Their phenotypic resemblance is unfortunately characterized by strong susceptibility for the development of chronic non-infectious diseases. One of the most common non-infectious chronic diseases that are phenotipically represented in twins is diabetes mellitus. Genetic imbalance is, in most cases, placed in 2, 3, 7, 8, 11, 12, 19 and 20 chromosomal pair of the human genome. CASE OUTLINE This study describes a pair of monozygotic twins, aged 54, who were diagnosed for diabetes type 2 ten years earlier. The first patient had trophic changes of muscles and skin tissues of the lower limb, and a necrotic wound on his right leg tibial region with the claudication distance of 50 m. After arteriography, he was referred by a vascular surgeon for hyperbaric oxygen therapy (HBO). HBO protocol implied 70 min. application of 100% oxygen at 2.5 absolute atmospheres. After the first series of HBO therapies consisting of 20 HBO treatments, claudication was eliminated and the necrotic wound healed. Next, surgical aortofemoral bypass was done. During the second HBO treatment, his monozygotic twin brother presented with angiopathic changes due to diabetes. In both patients, biochemical parameters corresponded to the expected level for diabetes type 2 imbalance, and the localization of the chromosomal defect (placed on 3, 11 and 19 chromosomal pair) was also in accordance with the respective disorder. After they were included into next 10 HBO treatments, Doppler imaging of the major arteries of limbs revealed normal findings. Conclusion Identical genetic impairment in monozygotic twins can lead to identical somatic changes with resultant consequences. HBO treatment of such patients associated with other therapeutic procedures (conducted by diabetologist, vascular surgeon and physiatrist) can postpone or prevent irreversible changes occurring due to blood vessel disorders

Gait in drug naive patients with de novo Parkinson's disease - altered but symmetric

Background: Motor symptoms in Parkinson's disease (PD) are typically asymmetrical. Early stage of PD is characterised with a predominantly unilateral appearance of tremor, rigidity and bradykinesia, with or without axial involvement. Also, studies have demonstrated gait asymmetry in de novo drug naive PD patients. Aim of this study was to investigate gait pattern, gait symmetry and gait variability in early phases of PD. Methods: The gait was measured in 40 de novo, drug naive PD patients and 43 healthy control subjects (HC) while performing a simple walking task. Calculated parameters were cycle time (CT), stride length (SL) and swing time (ST), and their coefficients of variation (CV). Results: Considering gait parameters, PD patients and HC differed in terms of all parameters, except for the CV of CT. Analysis of gait symmetry, comparison between the gait patterns of the left and the right leg in PD patients revealed no difference for any of the assessed parameters. The majority of the gait parameters did not differ between left and right legs of HC. Conclusions: It can be concluded that even gait was already altered in de novo drug naive PD patients, gait symmetry remained preserved. The SL was the most prominent parameter of altered gait in initial stages of PD patients, while the ST heralded postural asymmetry

Adhesive capsulitis: How to treat your patient?

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