Rehabilitacja poudarowa metodą PNF, z zastosowaniem i bez zastosowania toksyny botulinowej : opisy przypadków

One of the most common diseases of the nervous system is stroke. Its most frequently occuring kinetic symptoms are paresis or paralysis accompanied by an increase in muscular tension called spasticity. For patients and their carers these disturbances become a problem in many aspects of their everyday life, especially in locomotion. New ways need to be looked for to create therapies that could decrease or remove spasticity and restore the function which was disrupted. Therapy by botulinum toxin has been used as a method of decreasing spasticity to treat children with cerebral palsy having equines-varus foot, and it proves to be a breakthrough in the treatment of diseases with increased muscular tension. Owing to it, a range of mobility increases, for example in an ankle and knee joints, which facilitates locomotion. This improvement is caused by both pharmacological action, and assisted kinesitherapy. Proproceptive Neuromuscular Facilitation (PNF) is considered to be especially effective rehabilitation method based on neuro-physiological mechanisms. This method in the therapy of adults, along with the application of botulinum toxin, seems to facilitate physical activity of the patient after stroke, which may be very important for secondary stroke prevention. The aim of the research was to assess the influence of the therapy by PNF method associated with a botulinum toxin application on the patients after stroke with spasticity in lower limbs. During gait the patients had the flexion of ankle and knee joints measured by means of VICON system with the special focus on the amplitude of angular values. All patients presented in this description of cases showed an improvement in most of the measured parameters, in both a four-week and a three-month period after the therapy. The results show a necessity to carry out further randomized control studies of larger groups.Jedną z częściej spotykanych chorób układu nerwowego jest udar mózgu. Do najczęstszych objawów ruchowych należą niedowłady bądź porażenia kończyn, z towarzyszącym wzrostem napięcia mięśniowego, zwanym spastycznością. Dla pacjentów oraz ich opiekunów zaburzenia te stają się problemem w wielu aspektach życia codziennego, między innymi w lokomocji. Wymaga to poszukiwania nowych dróg w tworzeniu terapii mogących zmniejszyć bądź znieść spastyczność i przywrócić zaburzoną funkcję. Terapia toksyną botulinową jako metoda obniżająca spastyczność, jest stosowana do tej pory w terapii dzieci z mózgowym porażeniem dziecięcym ze stopą końsko-szpotawą i przynosi przełom w leczeniu schorzeń przebiegających z nadmiernym napięciem mięśniowym. Uzyskuje się poprawę zakresu ruchomości, miedzy innymi w stawie skokowym, a poprzez to ułatwia lokomocję. Poprawa ta uzyskiwana jest zarówno poprzez oddziaływanie farmakologiczne, jak i prowadzoną równolegle kinezyterapię. Szczególnie skuteczne wydają się metody rehabilitacyjne oparte na mechanizmach neurofizjologicznych. Jedną z takich metod jest PNF. Zastosowanie terapii metodą PNF połączone z zastosowaniem toksyny botulinowej u dorosłych wydaje się ułatwiać aktywność ruchową pacjenta po udarze mózgu, co może być bardzo ważne w profilaktyce wtórnej udaru mózgu. Celem pracy było przedstawienie możliwości połączenia i wpływu terapii metodą PNF skojarzoną z podaniem toksyny botulinowej u pacjentów po udarze mózgu ze spastyczną kończyna dolną. Dokonano w trakcie chodu pomiaru kąta ugięcia w stawie skokowym i kolanowym biorąc pod uwagę amplitudę ruchu, wykorzystując system VICON. U wszystkich przebadanych w niniejszym doniesieniu pacjentów odnotowano poprawę większości analizowanych parametrów, zarówno w okresie czterotygodniowym, jak i czteromiesięcznym. Przeprowadzone pomiary wskazują na konieczność wykonania randomizowanych, kontrolowanych badań na dużych grupach

The effects of physiotherapy with PNF concept on gait and balance of patients with Huntington's disease : pilot study

Background and purpose Huntington's disease (HD) is a neurodegenerative, progressive disorder of the central nervous system which causes significant gait and balance disturbances. This is a pilot study which aims to determine the effects of a physiotherapy programme with use of Proprioceptive Neuromuscular Facilitation (PNF) on gait and balance in HD patients. Material and methods 30 HD patients aged 21-60 with genetically confirmed diagnosis participated in the study. Participants followed a 3-week-long PNF-based physiotherapy programme. Gait and balance were evaluated twice in each participant: first at baseline and then after the course of physiotherapy. The following methods were used for gait disturbances: Tinetti Gait Assessment Tool, Up and Go Test, Timed Walking Tests for 10m and 20m (TWT10m, TWT20m). Balance was assessed with use of Berg Balance Scale, Pastor Test and Functional Reach Test. Results There was a significant improvement in all measures of balance and gait. Conclusion PNF-based physiotherapy is effective and safe in HD patients

The effects of physiotherapy with PNF concept on gait and balance of patients with Huntington's disease – pilot study

Background and purpose Huntington's disease (HD) is a neurodegenerative, progressive disorder of the central nervous system which causes significant gait and balance disturbances. This is a pilot study which aims to determine the effects of a physiotherapy programme with use of Proprioceptive Neuromuscular Facilitation (PNF) on gait and balance in HD patients. Material and methods 30 HD patients aged 21–60 with genetically confirmed diagnosis participated in the study. Participants followed a 3-week-long PNF-based physiotherapy programme. Gait and balance were evaluated twice in each participant: first at baseline and then after the course of physiotherapy. The following methods were used for gait disturbances: Tinetti Gait Assessment Tool, Up and Go Test, Timed Walking Tests for 10m and 20m (TWT10m, TWT20m). Balance was assessed with use of Berg Balance Scale, Pastor Test and Functional Reach Test. Results There was a significant improvement in all measures of balance and gait. Conclusion PNF-based physiotherapy is effective and safe in HD patients

The influence of motor ability rehabilitation on temporal-spatial parameters of gait in Huntington's disease patients on the basis of a three-dimensional motion analysis system: An experimental trial

Objective There is no existing standard, evidence-based, scientific model for motor ability improvement in Huntington's Disease (HD) patients aimed at maintaining independent gait for as long as possible, or performing activities of daily living, the effectiveness of which would be supported by the results of studies using objective research tools. Under these circumstances, the aim of this study was to analyze the influence of motor ability rehabilitation on the spatial-temporal parameters of gait in HD patients. Design It was an experimental trial. The studied group consisted of 30 patients (17 women and 13 men) with HD. In hospital conditions, the patients participated in the 3-week motor ability l rehabilitation programme tailored to individual needs. The study group was tested using the Vicon 250 three-dimensional gait analysis system before and after the physical exercise programme. Results Walking speed after therapy increased for the left lower limb from 1.06 (SD 0.24) [m/s] to 1.21 (SD 0.23) [m/s], and for the right lower limb from 1.07 (SD 0.25) [m/s] to 1.20 (SD 0.25) [m/s]. The cycle length increased after the applied therapy for the left lower limb from 1.17 (SD 0.20) [m] to 1.23 (SD 0.19) [m]. Conclusion The three-week motor ability rehabilitation programme positively influences spatial-temporal gait parameters in HD patients

Physical activity, psychological and functional outcomes in non-ambulatory stroke patients during Rehabilitation : a pilot study

Despite the extensive literature on stroke rehabilitation, there are few studies that comprehensively show non-ambulatory stroke patients. The aim of the study was to explore the dynamics of the change in physical activity (PA), psychological and functional outcomes, and the correlation between them in non-ambulatory patients during early in-patient post-stroke rehabilitation. Measurements were taken on 21 participants at the beginning of and 6 weeks post-conventional rehabilitation with the Barthel Index (BI), Berg Balance Scale (BBS), Trunk Control Test (TCT), Stroke Impact Scale (SIS), General Self-Efficacy Scale, Stroke Self-Efficacy Questionnaire (SSEQ), the original scale of belief in own impact on recovery (BiOIoR), Hospital Anxiety and Depression Scale, Acceptance of Illness Scale and when the patient could walk—Time Up & Go and 6 Minute Walk Test. Daily PA was assessed over 6 weeks using a Caltrac accelerometer. Only outcomes for BI, BBS, TCT, SIS, and SSEQ significantly improved 6 weeks post-rehabilitation. PA energy expenditure per day significantly increased over time (p < 0.001; effect size = 0.494), but PA only increased significantly up to the third week. PA change was correlated with BiOIoR post-treatment. Self-efficacy in self-management mediated improvement in SIS. The BiOIoR and confidence in self-management could be important factors in the rehabilitation process

Can selected physiotherapeutic techniques really help in treating back pain and improving the quality of life of advanced cancer patients: a randomised controlled study

Background: The available literature lacks studies using the KinesioTaping (KT) method and the hold-relax (HR) technique in working with advanced cancer patients. Patients and methods: The study involved 72 patients (38 women and 34 men), diagnosed with advanced cancer. Patients were randomly assigned either to KT group (exercise programme and KT), HR group (exercise programme and the HR technique of the proprioceptive neuromuscular facilitation — PNF method) or C group (a control group, exercise programme). To assess selected parameters the Numerical Rating Scale (NRS) scale and Edmonton Symptom Assessment System — revised (ESAS-r) were used. The physiotherapeutic programme lasted three weeks and took place 5 days a week for 30 minutes within each group. Additionally, in the KT group, kinesio tapes were applied on the paraspinal muscles of the lumbar spine. In the HR group the therapy with the Hold–Relax technique was applied. Results: There was a statistically significant decrease in pain in all groups and improvement in the quality of life in patients from both experimental groups. Those changes were significantly greater in the KT group than in both the C group and the HR group. Conclusions: Both KT and HR techniques of the PNF method are effective in reducing pain and improving the quality of life in the examined advanced cancer patients, however KT has a stronger impact

Zespoły bólowe kręgosłupa – analiza czynników ryzyka i częstości występowania dolegliwości

The aim of the study was to analyze the risk factors of back pain in M.A. students. The study involved 150 physical therapy students from the University School of Physical Education (AWF) in Krakow and 100 applied information technology (IT) students from the Cracow University of Technology. The study group was determined on the basis of dean’s lists and quota sampling. The study was conducted using a proprietary questionnaire. The results showed that the level of knowledge on prevention of back pain in physical therapy students is greater than in science students. Physiotherapy students experience back pain more often than IT students. The physical activity level of physical therapy students is higher than the IT students. The type of activity may signifi cantly affect the occurrence of back pain in students. The presented results may be indicative of the significant effect of stress on the occurrence of pain among students. Cite this article as: Pasiut S., Osińska A. Back pain – analysis of risk factors and the frequency of ailment occurrences. Med Rehabil 2016; 20(1): 12-21.Celem badań była analiza czynników ryzyka bólów kręgosłupa u studentów studiów magisterskich. W badaniu wzięło udział 150 studentów fizjoterapii AWF w Krakowie i 100 studentów informatyki stosowanej Politechniki Krakowskiej. Badaną grupę określono na podstawie list dziekańskich i doboru kwotowego. Badanie przeprowadzono za pomocą autorskiego kwestionariusza ankietowego. Wyniki wykazały, iż poziom wiedzy profilaktyki bólów kręgosłupa u studentów fizjoterapii jest większy niż u studentów informatyki. Studenci fizjoterapii częściej doznają bólów kręgosłupa niż studenci informatyki. Aktywność fizyczna studentów fizjoterapii jest większa niż studentów informatyki. Charakter zajęć, może w istotny sposób wpływać na występowanie dolegliwości bólowych kręgosłupa u studentów. Przedstawione wyniki mogą wskazywać, iż stres może w istotny sposób wpływać na występowanie dolegliwości bólowych wśród studentów

Możliwosci wykorzystania komórek szpiku kostnego w przyszłej terapii chorób mózgu

Medical problems associated with the increasing number of patients suffering from brain diseases have resulted in a constant search for effective therapeutics. Considering the complicated pathological processes occurring in diseases of the central nervous system and the limited capability of the neural tissue to regenerate, therapy of neurological diseases is extremely difficult. The lack of efficient medical treatment results in complex problems associated with rehabilitation and thus in functional disturbances, which prevent patients from restoring their independence and returning to complete, also professional, activity, Cell therapy has recently been considered as a possible approach in the treatment of brain diseases. Its aim is to supply pathologically changed brain tissue with factors promoting regeneration and with cells that may replace the damaged ones. Bone marrow cells have become a potential source of cells in this type of therapy. Bone marrow contains at least two major kinds of stem cells: haematopoietic stem cells, which give rise to the blood cells and mesenchymal stem cells, which can differentiate into cells of mesenchymal lineage and produce an array of growth factors essential for repair. The review presents the achievements of studies on use of bone marrow cells in the therapy of various brain diseases of traumatic or neurodegenerative aetiology

Mechanizm rocker – mechanizm przetaczania stopy

The main idea of this article is the understanding of the anatomical work of foot rocker mechanisms during gait phases together with the muscle work of the hip, knee, ankle and foot being collectively responsible for the proper positioning of the joints in the lower limb. There are three rockers in a human’s foot: the heel rocker, the ankle and forefoot rocker. The names given to each of them are in accordance with their location in the foot. The term rocker is used to describe the process of the rolling of one element in a foot over another. The existing evidence suggests that analyzing foot work and its disorders in gait phases is crucial in planning the treatment of patients with walking problems, as it is an element of the cyclic opening and closing of the biomechanical chain. This analysis should go together with the awareness of the fact that proper gait is the result of combined work of the hip, knee and foot and demands a knowledge of the correlation between the tibia, calcaneus, metatarsum and forefoot. The information given helps one to evaluate trials of the ankle and foot and to assess the methodological quality of treatment in close chains in opposition to those in open chains, which brings fewer effects - hence stressing the need to widen the terminology of therapists working on gait problems. A knowledge of the ‘rocker mechanism’ can be an indicator in treatment progress, rehabilitation documentation as well as in the choice of exercises and the introduction of abilities acquired during therapy to daily functioning

Analiza dostępności wczesnej rehabilitacji poudarowej na terenie Miasta Krakowa

Introduction and aim: The aim of the study was to determine the availability and use of early stroke rehabilitation in Krakow.Material and methods: The research material was a group of 90 people (39 women and 51 men) who had suffered the neurological incident of a stroke. The study was conducted among people residing in the city of Krakow who had suffered a stroke. Results and conclusions: The research tool was a questionnaire, consisting of closed questions. The questions in the survey concerned the history of the stroke, the availability characteristics of the process of rehabilitation after discharge from the Department of Neurology, and respondents’ knowledge about funding opportunities for rehabilitation. Analysing the collected data indicated the need to develop and improve the availability of early stroke rehabilitation provided to the city of Krakow.Wprowadzenie i cel: Celem pracy było określenie dostępności i możliwości korzystania z wczesnej rehabilitacji poudarowej na terenie Miasta Krakowa. Materiał i metody: Materiał badawczy stanowiła grupa 90 osób (39 kobiet i 51 mężczyzn), u których wystąpił incydent neurologiczny w postaci udaru mózgu. Badania zostały przeprowadzone wśród osób po udarze mózgu przebywających na terenie Miasta Krakowa. Narzędziem badawczym był kwestionariusz ankiety, który składał się z pytań o charakterze zamkniętym. Pytania w ankiecie dotyczyły informacji na temat przebytego udaru mózgu, charakterystyki oraz dostępności przebiegu procesu rehabilitacyjnego po wypisaniu z oddziału neurologii oraz wiedzy badanych na temat możliwości finansowania rehabilitacji. Wyniki i wnioski: Analizując zebrane dane wskazano na potrzebę rozwoju i poprawy dostępności wczesnej rehabilitacji poudarowej świadczonej na terenie Miasta Krakowa