Decannulation factors in patients after serious brain injuries

Background. Patients with a long term tracheotomy (longer than 4 weeks) are quite frequent patients in the Neurorehabilitation Wards. These are especially patients after serious traumatic brain injuries, ischemic or hemorrhagic strokes, ischemic brain injuries and others. A correct multidisciplinary treatment requires a very close cooperation of: physiotherapists, neurologists, laryngologists and speech therapists. The aim of our study was to analyze factors that may influence positive decanulation in patients with tracheotomy performed because of the traumatic brain injury, stroke or cardiac arrest. Methods. Our material includes 127 patients hospitalized in our Department of Rehabilitation between 2002 and 2005. All of them had tracheotomy performed after the brain injury. We analyzed factors like: age, sex, cause of tracheotomy, GCS scale, duration of tracheotomy, concomitant diseases, microbiology examination of the bronchial secretion and the influence of these factors on decanulation. Results. We confirmed that young age (less than 40), traumatic brain injury and short time of tracheotomy are the positive decannulation factors.Background. Patients with a long term tracheotomy (longer than 4 weeks) are quite frequent patients in the Neurorehabilitation Wards. These are especially patients after serious traumatic brain injuries, ischemic or hemorrhagic strokes, ischemic brain injuries and others. A correct multidisciplinary treatment requires a very close cooperation of: physiotherapists, neurologists, laryngologists and speech therapists. The aim of our study was to analyze factors that may influence positive decanulation in patients with tracheotomy performed because of the traumatic brain injury, stroke or cardiac arrest. Methods. Our material includes 127 patients hospitalized in our Department of Rehabilitation between 2002 and 2005. All of them had tracheotomy performed after the brain injury. We analyzed factors like: age, sex, cause of tracheotomy, GCS scale, duration of tracheotomy, concomitant diseases, microbiology examination of the bronchial secretion and the influence of these factors on decanulation. Results. We confirmed that young age (less than 40), traumatic brain injury and short time of tracheotomy are the positive decannulation factors

Investigation of wayfinding and lost perceptions in the theme hotels regarded as non-places: Examples of Kundu-Antalya hotels

Yaşamakta olduğumuz yüzyılda sosyal ve kültürel değerlerin küresel bir değer sistemi içerisinde değişiyor olması kişiliklerimizin gelişimini etkilemektedir. Dünya yeni algılarla dönüşürken yeni algılar da dünyayı yeniden tanımlamaktadır. İçinde bulunduğumuz çağı tanımlayan farklılık, geçicilik, hız, değişim ve dönüşüm gibi olgular algı ve davranışlarımızı etkilediği gibi yaşadığımız fiziksel ortamın da değişmesine sebep olmaktadır. Yok-mekan olarak değerlendirilen tüketim ve eğlence yapıları insanların yeni beklentilerine ve ihtiyaçlarına cevap oluşturan mekansal oluşumlardır. Yeni algılar yeni beklentileri beraberinde getirirken insanları artık zamanın içinde var olmak değil, hayatın güzellikleri içerisinde kaybolmak tatmin etmektedir. Tüketim ve eğlence amaçlı tasarlanmış yok-mekanlarda insanların beklentilerinin farklılaşması sonucu yön bulma davranışının amaçsızlaşması ve kaybolma sürecine dönüşmesi çalışmanın temel konusudur. Farklılık ve yenilik arayışı merak duygusunu sürekli canlı tutmak ile mümkün olmakta, yön bulma davranışı merak ve keşfetme duygusuyla ile buluştuğunda ise keyifli bir gezinti sürecine dönüşmektedir. Bu süreç daha fazla mekan deneyimleme isteği ile birlikte döngüsel bir kaybolma halinin yaşanmasına sebep olmaktadır. Yön bulma davranışı bağlamında gözlemlenen bu değişimler tez kapsamında Temalı Otellerdeki turistler üzerinde yürütülen bir alan çalışması ile sorgulanmıştır._x000B_Antalya, Kundu bölgesindeki dört farklı temalı otelde konaklayan turistlerle gerçekleştirilen alan çalışması sonucunda çağın yeni tanımlamaları olan yenilik, değişim, dönüşüm, geçicilik ve farklılık gibi olguların turistlerin tatil beklentilerine yeni yerler görme, farklı deneyimler yaşama isteği şeklinde yansıdığı belirlenmiştir. Turistlerin tatilleri süresince kendilerini farklı bir dünyada hissettiren, mimarisi ile büyüleyerek kendilerinde merak ve keşfetme duygusu uyandıran otellerde tatil yapmak istedikleri gözlemlenmiştir. Temalı otellerdeki yön bulma davranışının tatil amacı taşıyan turistler için anlamını yitirerek kaybolmayı deneyimleme isteğine dönüştüğü bulunmuştur. Kaybolmayı deneyimleme isteğinin yeniçağın farklılaşan insan beklentilerinin bir örneğini oluşturduğu tespit edilmiştir. Temalı oteller turistlerin beklentilerinin farkında olarak turistlere içinde bulundukları tasarım kurgusu içerisinde kaybolacakları bir tatil yaratmayı amaçlamıştır. Karmaşık görsel ve mekansal öğeler ile tasarlanmış mimari kurgulara sahip temalı otellerin modasal bir üslup haline gelmesi çağın bireylerine ilişkin algı-davranış çözümlemesinin başarılı bir sonucu olarak değerlendirilmiştir. In the century that we live, changes on social and cultural values within the global dynamics affect developments and changes of our lives and personalities. As the world transforms by the existing perceptions, the new perceptions continue to transform the world itself. The new phenomenons that define the current era such as difference, impermanence, speed, change and transformation also lead to a change in the physical environment. Consumption and entertainment buildings which are considered as non-places are the new spatial forms that respond to people?s new expectations and needs. New perceptions have brought new expectations and people do not want to exist in time, but rather to get lost in the beauties of life to be more satisfied. The main subject of the study is the transformation of way finding behavior into a lost process as the result of differentiation of people?s expectations in the non-places of consumption and entertainment. Seeking for difference and innovation is possible to constantly keep alive the sense of curiosity and when the wayfinding behavior meets with the sense of wonder and novelty, transforms into a pleasant trip process. This process, together with the request of experiencing more spaces have caused a cyclical state of being lost. The changes observed in the context of wayfinding behavior have been questioned within the field work carried out on the tourists in the theme hotels._x000B_At the field work which carried out by tourists in four themed hotel, it?s determined that the new phenomenon?s of the era such as innovation, change, transformation and transience reflects to the tourist?s holiday expectations in the form of request to see new places and live different experiences. It?s observed that tourists want to have a holiday that make them feel in a different world and evoke their sense of curiosity and discovery by the charming architecture of the hotel. Finally, It?s determined that the wayfinding behavior in the theme hotels has lost the meaning for leisure-oriented tourists and turn into a desire to experience a lost process. The desire to experience the state of being lost is an important example of new human expectations. Theme hotels, together with the aware of tourist?s expectations, aim to create a holiday that tourists will get lost in the design concept. The use of architectural concepts set by adapting congested visual and spatial elements in the theme hotels have become a trendy style which is regarded as a successful result of the analysis of today?s human perception-behavior link

POWIKŁANIA PO STABILIZACJI TRANSPEDIKULARNEJ ODCINKA PIERSIOWEGO KRĘGOSŁUPA U PACJENTÓW PO URAZIE RDZENIA KRĘGOWEGO – OPIS TRZECH PRZYPADKÓW I PRZEGLĄD LITERATURY

A case report of three cases of complications after transpedicular stabilization in thoracic part of the spine.Objectives. The aim of the study was to report the complications after surgical stabilization in thoracic level of the spine that could be very dangerous and cause many symptoms. All patients were treated in The Department of Rehabilitation, University Hospital in Bydgoszcz, Collegium Medicum of Nicolaus Copernicus University in Bydgoszcz, PolandCase report 1. The case of 24 year old patient after spinal fracture within T9 as well as T12 level was introduced. The patient was subjected to transpedicular stabilization within the levels of T8-T10 and T11-L2. In ASIA classification A, the lack of any sensation in sacral segments, no anal sphincter motor activity was noticed. Complications manifested by dislocation of screws as well as postoperative wound infection occurred, what caused the necessity for the stabilizer removal. These complications exerted harmful effect on early rehabilitation process. The patient underwent three surgical procedures resulted from dislocation of screws.Case report 2. 31 year old male patient after SCI in T6 region of the spine. He was treated with transpedicular stabilization within the levels of T5-T6. The complication was screw translocation in vertebral body T5 and connecting aortic aneurysm. He was successfully operated by thoracic surgeons.Case report 3. 26 year old male patient after fracture of T5 and T6 vertebra column. He was operated with transpedicular stabilization. He had fever and respiratory tract infection symptoms; after radiological examination the diagnosis of pleuritis was stated and a dislocation of screw in T3 and T4 vertebral body. He was treated conventionally without operation.Conclusions Complications prolong as well as disturb rehabilitation treatment. The control radiographic examinations need to be performed directly after operative treatment to evaluate the stabilization system during walking and assuming the erect position. Increased pain ailments within spinal cord segment that was subjected to surgical procedure may signify the possible dislocation of screws. Such dislocation, noticed within thoracic region, can be life-threatening, because of the nearness of the significant anatomical structures.Opisano trzy przypadki pacjentów, u których wystąpiły powikłania po stabilizacji transpedikularnej odcinka piersiowego kręgosłupa.Celem pracy było opisanie powikłań po stabilizacji odcinka piersiowego kręgosłupa, które mogą być niebezpieczne dla zdrowia i życia chorych oraz są przyczyną wystąpienia wielu dolegliwości.1 opis przypadku. 24-letnia chora po złamaniu kręgosłupa z uszkodzeniem rdzenia kręgowego na poziomie T9 i T12. Została zakwalifikowana do wykonania stabilizacji transpedikularnej na wysokości od T8 do T10 oraz od T11 do T12. W klasyfikacji ASIA A, bez czucia oddawania moczu i stolca oraz czynności zwieraczy odbytu i cewki moczowej. Powikłaniem po stabilizacji było nieprawidłowe umieszczenie śruby transpedikularnej oraz zakażenie rany pooperacyjnej. Wskutek tych powikłań konieczne było usunięcie całej stabilizacji transpedikularnej. Zdarzenia te znacznie spowolniły i ograniczyły cały proces rehabilitacji. Pacjentka łącznie została poddana trzem operacjom neurochirurgicznym wskutek nieprawidłowego umieszczenia śrub transpedikularnych.2 opis przypadku. 31-letni mężczyzna po urazie rdzenia kręgowego na wysokości T6. Wykonano stabilizacje transpedikularną na poziomach od T5-T6. Powikłaniem było nieprawidłowe umieszczenie w trzonie kręgu T5 śruby transpedikularnej, co spowodowało powstanie tętniaka aorty. Ostatecznie chory ponownie był operowany przez zespół neurochirurgów i chirurgów naczyniowych z dobrym rezultatem.3 opis przypadku. 26-letni mężczyzna po złamaniu kręgosłupa i uszkodzeniu rdzenia kręgowego na wysokości T5 i T6. Po wykonaniu stabilizacji transpedikularnej wzrosły parametry stanu zapalnego tj. gorączka oraz cechy zapalenia dróg oddechowych. Wykonano zdjęcie radiologiczne płuc, które wykazało zapalenie opłucnej oraz nieprawidłowe położenie śrub transpedikularnych w trzonach T3 i T4. Chorego leczono zachowawczo.Wnioski. Powikłania opóźniają oraz zaburzają cały proces rehabilitacji pacjenta. Kontrola radiologiczna po wykonaniu stabilizacji transpedikularnej powinna być wykonywana również po zabiegu operacyjnym, aby zapewnić choremu bezpieczną pionizację oraz naukę chodu. Wystąpienie dolegliwości bólowych wzdłuż dermatomów odpowiadających poziomom wykonanej stabilizacji transpedikularnej może wskazywać na nieprawidłowe położenie śrub transpedikularnych. W odcinku piersiowym takie powikłanie może być groźne dla życia chorych, z powodu bliskiego położenia ważnych struktur anatomicznych

Rehabilitation and nursing in children after hypoxic-ischemic brain injury — cases reports

Children after hypoxic-ischemic brain injury are getting enlarge group of patients hospitalized in the department of Rehabilitation and Physiotherapy in Bydgoszcz. This kind of brain injury is one of the worst because it involves all neurons. The prognosis and physiotherapy progress without healthy neurons reservoir is unknown (opposite in mechanical brain injury). The after-effects of brain injury can be acute (early) and chronic (late). Medical care is often palliative procedure in this group of patients. Authors presents clinical, nursing and rehabilitation subject in children after hypoxic-ischemic brain injury. Multidirectional rehabilitation is necessary to start as soon as it is possible. The main aim of physiotherapy in this group of patients is to protect them from complications. The survival rate in children after severe brain damages depends on nursing care and proper rehabilitation. Adv. Pall. Med. 2011; 10, 1: 35–40Children after hypoxic-ischemic brain injury are getting enlarge group of patients hospitalized in the department of Rehabilitation and Physiotherapy in Bydgoszcz. This kind of brain injury is one of the worst because it involves all neurons. The prognosis and physiotherapy progress without healthy neurons reservoir is unknown (opposite in mechanical brain injury). The after-effects of brain injury can be acute (early) and chronic (late). Medical care is often palliative procedure in this group of patients. Authors presents clinical, nursing and rehabilitation subject in children after hypoxic-ischemic brain injury. Multidirectional rehabilitation is necessary to start as soon as it is possible. The main aim of physiotherapy in this group of patients is to protect them from complications. The survival rate in children after severe brain damages depends on nursing care and proper rehabilitation. Adv. Pall. Med. 2011; 10, 1: 35–4

Rehabilitacja i pielęgnacja dzieci po urazie niedokrwienno-niedotlenieniowym ośrodkowego układu nerwowego — opisy przypadków

Wśród pacjentów hospitalizowanych w Klinice Rehabilitacji Szpitala Uniwersyteckiego CM UMK w Bydgoszczy coraz większą liczbę chorych stanowią dzieci po niedokrwienno-niedotlenieniowym urazie ośrodkowego układu nerwowego (OUN). Następstwa uszkodzenia mózgu mogą mieć charakter ostry (wczesne) lub późny (przewlekłe). Leczenie i rehabilitacja przeważnie nie przynoszą oczekiwanych rezultatów. Często opieka nad takim pacjentem sprowadza się jedynie do działań paliatywnych. W pracy autorzy przedstawili najistotniejsze problemy kliniczne, pielęgnacyjne i rehabilitacyjne, z jakimi spotykają się w tej grupie chorych. Szczególną uwagę zwrócono na wcześnie rozpoczętą wielokierunkową rehabilitację. Usprawnianie w tej grupie pacjentów najczęściej sprowadza się jedynie do zminimalizowania liczby i ciężkości powikłań. Przeżywalność osób dotkniętych tak znacznym uszkodzeniem zależy w dużym stopniu od opieki pielęgnacyjnej i właściwie prowadzonej rehabilitacji. Medycyna Paliatywna w Praktyce 2011; 5, 2: 59–6

Pomyślna terapia i rehabilitacja udaru u ciężarnej ze wszczepioną sztuczną zastawką aortalną

This report describes a case of a 40 year-old woman with implanted aortic prosthetic valve, who experienced thrombo-embolic complication in a form of ischaemic stroke in 15 week of pregnancy. At the beginning of the event, the patient suffered from mixed aphasia, right-side paresis and depressive syndrome. Thanks to cooperation of many specialists, especially rehabilitation team, she restored overall physical efficiency, speaking ability, delivered a healthy child, and returned to normal family and social activity. Problems of anti-thrombotic therapy during pregnancy in patients with prosthetic valves are discussed. Kardiol Pol 2011; 69, 6: 593–59