Peripheral Application of Repetitive Pulse Magnetic Stimulation on Joint Contracture for Mobility Restoration:Controlled Randomized Study

Background: Joint contracture is a limitation in the passive or active range of motion (ROM) of a joint, where in addition to the mobility limiting factor the pain is also present. Repetitive pulsed Magnetic Stimulation (rPMS) appears to be an effective, non-invasive and safety solution for treating this condition. Therefore aim of this study was to evaluate the effect of rPMS in treating joint contracture. Methods: 30 subjects with joint contracture in the knee were enrolled in this study and divided respectively into Treatment and Control group. The treatment group were delivered with rPMS therapy. The control group was delivered with conventional physiotherapy method (ultrasound). The primary outcome measurements were: 1. Mobility evaluation by goniometry (ROM in degrees while performing flexion) and Patient Functional Assessment Questionnaire (PFAQ) for ability to perform Activities of Daily Living (ADL) and 2. Pain evaluation by 10-point Visual Analog Scale (VAS) for pain perception. Absence of adverse events was set as a secondary measure. Results: The results of the study show statistical difference (p<0.05) between the levels of improvement of all studied parameters while comparing between both groups. The results suggest greater immobility restoration and pain relieving effect of the rPMS in comparison to conventional physiotherapy method. Conclusion: rPMS an effective and safe non-invasive method for mobility restoration and pain relief in case of joint contractures. This study suggests the method as beneficial and quality of life ameliorating among patients suffering from immobilized joints accompanied by pain

PERIPHERAL APPLICATION OF REPETITIVE PULSE MAGNETIC STIMULATION ON JOINT CONTRACTURE FOR MOBILITY RESTORATION: CONTROLLED RANDOMIZED STUDY

Background: Joint contracture is a limitation in the passive or active range of motion (ROM) of a joint, where in addition to the mobility limiting factor the pain is also present. Repetitive pulsed Magnetic Stimulation (rPMS) appears to be an effective, non-invasive and safety solution for treating this condition. Therefore aim of this study was to evaluate the effect of rPMS in treating joint contracture. Methods: 30 subjects with joint contracture in the knee were enrolled in this study and divided respectively into Treatment and Control group. The treatment group were delivered with rPMS therapy. The control group was delivered with conventional physiotherapy method (ultrasound). The primary outcome measurements were: 1. Mobility evaluation by goniometry (ROM in degrees while performing flexion) and Patient Functional Assessment Questionnaire (PFAQ) for ability to perform Activities of Daily Living (ADL) and 2. Pain evaluation by 10-point Visual Analog Scale (VAS) for pain perception. Absence of adverse events was set as a secondary measure. Results: The results of the study show statistical difference (p<0.05) between the levels of improvement of all studied parameters while comparing between both groups. The results suggest greater immobility restoration and pain relieving effect of the rPMS in comparison to conventional physiotherapy method. Conclusion: rPMS an effective and safe non-invasive method for mobility restoration and pain relief in case of joint contractures. This study suggests the method as beneficial and quality of life ameliorating among patients suffering from immobilized joints accompanied by pain

A prospective evaluation of the prognostic indicators in severe traumatic brain injury survivors

The authors performed a prospective study on patients who suffered from severe TBI. The aim of the study was to investigate the prognostic value of time alteration of the GCS parameters and the rest prognostic indicators 2 weeks post injury in severe TBI survivors. Seventy patients were initially enrolled. Data where retrieved from the emergency department records, the Intensive Care Unit (ICU), neurosurgical and rehabilitation unit records, units where all patients were hospitalized. All patients underwent a follow-up at 3, 6 and 12-month post injury. The prognostic indicators, like GCS parameters and GCS total score, coma duration, post traumatic amnesia, cerebral pons reflexes, computerized tomography findings, concomitant injuries and age were evaluated on the day of injury. Their alteration in time, 2 weeks post injury, was recorded and was related to the 12 months functional outcome. Functional outcome was estimated using the Glasgow Outcome Scale (GOS) and the Functional Independence Measure-Motor scale (FIM-M) 3, 6 and 12 months post injury. Fifty one patients survived and were followed up to 12 months. Logistic regression models and ROC analysis were applied. Regarding functional outcome at 12 months, increase in GCS on day 15 emerged as prognostic factor, with all its subscales time alteration being related to the 12 month outcome, while a greater GCS score on day 15 was also related to survival. A higher Motor and Verbal response on day 15 post injury was strongly associated with patient's independence. GCS motor score 2 weeks post injury showed a statistically significant correlation with the 12 months functional outcome in TBI survivors. Motor’s response alteration in time seems to be the best predictor among the GCS parameters and the rest prognostic indicators for the long-term functional outcome of patients with severe TBI.Η βαρύτητα της ΚΕΚ καθορίζεται από προγνωστικούς παράγοντες των οποίων η πολυπλοκότητα καθιστά επισφαλή την πρόγνωση της λειτουργικής έκβασης αυτών των ασθενών. Σκοπός αυτής της μελέτης ήταν να εκτιμηθεί κατά πόσο η χρονική μεταβολή των τριών παραμέτρων της Κλίμακας Κώματος Γλασκώβης, καθώς και των λοιπών προγνωστικών δεικτών, μπορούν να αξιοποιηθούν ως προγνωστικοί παράγοντες της μακροπρόθεσμης (12μηνης) λειτουργικής έκβασης επιζώντων ασθενών με σοβαρή ΚΕΚ. Πραγματοποιήθηκε προοπτική μελέτη ασθενών με σοβαρή ΚΕΚ. Εβδομήντα ασθενείς εντάχθηκαν αρχικά στη μελέτη. Τα δεδομένα προήλθαν από τα αρχεία του τμήματος επειγόντων, των Μονάδων Εντατικής Θεραπείας (ΜΕΘ), των νευροχειρουργικών κλινικών και των κέντρων αποκατάστασης όπου νοσηλεύτηκαν οι ασθενείς. Όλοι οι ασθενείς παρακολουθήθηκαν για διάστημα 3,6 και 12 μηνών μετά την κάκωση. Η κλίμακα Γλασκώβης και οι λοιποί προγνωστικοί παράγοντες προσδιορίστηκαν την ημέρα εισαγωγής και 15 ημέρες μετατραυματικά. Η λειτουργική έκβαση αξιολογήθηκε 12 μήνες μετά την κάκωση με την Κλίμακα Έκβασης Γλασκώβης (Glasgow Outcome Scale -GOS) και το κινητικό μέρος της Κλίμακας Λειτουργικής Ανεξαρτησίας (Functional Independence Measure-Motor scale - FIM-M). Πενήντα ένας ασθενείς επέζησαν και παρακολουθήθηκαν επί 12 μήνες. Εφαρμόστηκε μοντέλο λογαριθμιστικής παλινδρόμησης και ανάλυση καμπύλης ROC. Αύξηση της τιμής της GCS 15 μέρες μετατραυματικά συσχετίζεται σημαντικά με την επιβίωση. Αναφορικά με τη λειτουργική έκβαση στους 12 μήνες, η αύξηση στην τιμή της κλίμακας GCS 15 ημέρες μετατραυματικά, όπως και σε όλες τις παραμέτρους της, βρέθηκε να συσχετίζεται στατιστικά σημαντικά με την έκβαση. Υψηλότερη βαθμολογία στην κινητική και λεκτική απάντηση συσχετίστηκε ισχυρά με τη λειτουργική ανεξαρτησία, ενώ η κινητική απάντηση στις 15 ημέρες αποδείχθηκε ο ισχυρότερος προγνωστικός παράγοντας της λειτουργικής ανεξαρτησίας του ασθενούς. Φαίνεται ότι η χρονική μεταβολή μετατραυματικά στην κινητική απάντηση της Κλίμακα Κώματος Γλασκώβης αποτελεί τον καλύτερο προγνωστικό δείκτη για τη μακροπρόθεσμη έκβαση των ασθενών με σοβαρή ΚΕΚ

HIGH-INTENSITY ELECTROMAGNETIC STIMULATION CAN REDUCE SPASTICITY IN POST-STROKE PATIENTS

Background: Level of spasticity in post-stroke patients allows for the predictability of the patient’s level of recovery. The study aimed to assess the anti-spastic effect of high-intensity electromagnetic field stimulation in post-stroke condition. Methods: 30 post-stroke patients, randomized into two groups participated. The treatment group (TG) was delivered ten therapies to spastic muscles with high-intensity electromagnetic stimulation. The control group (CG) was delivered ten electrotherapy sessions in the spastic muscle area combined with kinesiotherapy. Modified Ashworth Scale (MAS) was used as a primary outcome measure to evaluate the level of spasticity. Secondary outcome measure, Barthel Index of Activities of Daily Living (ADL) was used to evaluate the patient’s quality of life. Results were obtained pre-treatment, post-treatment and after 1-month follow-up was completed. Results: During the 1-month follow-up, TG improved results up to 66% decreasing spasticity from 2.33±0.90 in the beginning to 0.87±0.64 points on the MAS. The CG, during the 1-month follow-up, improved up to 31% decreasing spasticity from 2.13±0.74 in the beginning to 1.47±0.74 points on the MAS. According to Barthel Index, 81% level of improvement was observed in TG during 1-month follow-up vs. 72% level of improvement observed for the CG in a 1-month follow-up. Conclusion: The evaluation showed greater spasticity reduction in TG - 66% vs. 31% in the CG after the 1-month follow-up visit. Results suggest that high-intensity electromagnetic stimulation is an effective extracorporeal physical modality for spasticity management in post-stroke patients

Prognostic value of time-related Glasgow Coma Scale components in severe traumatic brain injury: a prospective evaluation with respect to 1-year survival and functional outcome

The severity of traumatic brain injury (TBI) is determined by many variables, the complexity of which has made prediction of functional outcome an elusive target. To evaluate whether the three components of the Glasgow Coma Scale (GCS) and their alterations over time can serve as predictors of functional outcome after a severe TBI at 12 months after the TBI insult, we carried out a prospective study of patients with severe TBI. Seventy patients were initially enrolled. Data were retrieved from the emergency department records and the patients’ intensive care unit, neurosurgical, and rehabilitation unit records. All patients underwent follow-up at 3, 6, and 12 months after injury. GCS components were evaluated on the day of injury and 2 weeks after injury. Functional outcome was estimated using the Glasgow Outcome Scale and the Functional Independence Measure motor scale. It was evaluated during rehabilitation and at 12 months after injury. Fifty-one patients were alive and followed up until 12 months. Logistic regression and receiver-operator characteristic curve analyses were carried out. In terms of functional outcome at 12 months, only GCS on day 15 was found to be a prognostic factor, with all its subscales being related to outcome 12 months later, whereas a higher GCS score on day 15 was also related to survival. A higher motor and verbal response on day 15 was strongly associated with a patient’s functional independence, whereby the motor response was a better predictor. The GCS motor score 2 weeks after injury was statistically significantly associated with the 12-month functional outcome in TBI survivors. Motor response was the most useful predictor among the GCS components with respect to the long-term functional outcome in patients with severe TBI. (c) 2013 Wolters Kluwer Health vertical bar Lippincott Williams &amp; Wilkins