The role of rehabilitation and anabolic treatment in severe os-teoporosis associated with significant vitamin D deficiency – case report

It is well known that vitamin D deficiency increases the risk of osteoporosis and that vertebral compressions fractures are a manifestation of osteoporosis. This paper presents the case of a patient with severe osteoporosis associated with vitamin D deficiency who developed over the course of two years multiple vertebral compression fractures. Method: We present the case of a 76-year-old caucasian female diagnosed with osteoporosis and significant vitamin D deficiency who was investigated for mechanical pain and functional deficit at the level of the spine and walking disorders. The patient was hospitalized in our Rehabilitation department twice. At the first hospitalization two years ago, the deficiency of vitamin D was found and the treatment was initiated. During the sec-ond hospitalization, biochemical and radiological investigations were per-formed to establish the diagnosis. Numerous vertebral compression fractures were dis-covered which were not re-vealed in the imaging investigations performed two years earli-er. She underwent symptomatic and appropriate medical rehabilitation treatment. Results and discussion: The evolution was fa-vorable after the hospitalization period, with a decrease in pain and functional deficit, as well as walking improvement. After endocrinological consultation it was decided to initiate therapy with Teriparatide which can decrease the risk of future fractures and reduce the back pain. Con-clusions: Adequate and prompt treatment of vitamin D deficiency and osteoporosis is very im-portant to avoid vertebral compression fractures or other complications of this disease. Physical and rehabilitation medicine also plays an important role in management of these patients

Medical management and rehabilitation in a patient with avas-cular necrosis of the femoral head in the context of vitamin D deficiency and secondary hyperparathyroidism – case report

Vitamin D is essential in determining bone and muscle health. Vitamin D deficiency (VDD) produces secondary hyperparathyroidism, loss of bone quality and mass, mineral-ization effects and fractures, myopathy, and falls. The avascular necrosis (AVN) of the femoral head pathophysiology is still unclear and can be considered a vascular bone dis-ease. Our paper aimed to evaluate the etiology of AVN in a young male with bilateral fem-oral neck damage who required bilateral arthroplasty. Method: We present the case of a 46-year-old male patient with VDD and bilateral total hip arthroplasty for osteoarthritis secondary to AVN of the femoral head. After complete hormonal, biological, and imaging evaluations, the diagnosis of primary hyperparathyroidism was not supported; the im-provement of vitamin D deficiency after eight months of treatment clarified the diagnosis: hyperparathyroidism secondary to vitamin D deficiency. Results: Supplementation with 4000 IU of vitamin D improved the patient’s response to specific rehabilitation methods. Conclusions: Severe vitamin D deficiency can secondarily affect the structure of the femo-ral head through secondary hyperparathyroidism, producing AVN, but only osteopenia was obtained on DXA evaluation. VDD can be an important etiological factor in the occur-rence of AVN, and its correction can improve the evolution of the disease, improving the rehabilitation of these patients

Is LASER therapy a viable option for increasing implant stability in bone tissue?

Fractures can occur at any age, but in modern times as the worldwide population grows older, the risk increases. Many of the fractures need metallic implants for a more efficient healing process and a reduced risk of complications. An implant can be used in orthopedic surgery if it can safely interact with the bone and the surrounding tissue. The most used materials in fracture management are metal alloys (Steel, Titanium, Cobalt-Chrome) that need to be compatible with tissue, however, they do not stimulate the healing process. Physiotherapy could improve the bone/implant interaction by stimulating the local metabolism and cell proliferation while also reducing local symptoms such as pain. The advantages of using LASER therapy are: a reduced number of contraindications, the availability of the equipment in rehabilitation facilities, and the compliance of patients as there is no discomfort during the procedure. The main drawback of using LASERs in bone stimulation is that there is no consensus in protocol usage between researchers because of the multitude of parameters. Through this article, we aim to shed some light on the use of LASER therapy in implant osseointegration and bone healing

Eating habits and nutritional status of women with musculo-skeletal diseases

Different theories link chronic musculoskeletal pain with lifestyle components, including diet. However, nutritional assesment and optimization is not routinely included into the medical management of patients with muskuloskeletal diseases (MSKD). In this study we aimed to evaluate the diet and nutritional status of a group of women with MSKD and to assess the extent to which they comply with the general recommendations for a healthy diet. The results showed that 97% of the subjects included were overweight or obese, and the compliance to different general nutritional recommandations ranged between 3% to 57%. Furthermore, the quality of life of this patients measured through SF-36 question-naire was severly affected and the reported pain intensity on numeric pain scale had a mean of 8 (±1.3) in our study group. Although there are currently no specific guidelines for the nutrition of patients with chronic pain, an important first step would be to guide these patients towards an increase in diet quality and a healthy lifestyle by adhering to general nutritional recommendations regarding healthy eating

The analyse of the antioxidant effect of natural peloidotherapy in aging process

Medical research has developed remarkably in recent years, including the involvement of the glutathione peroxidase (GPx) family of enzymes in the course of human aging, with numerous clinical studies published in the literature reporting this particular fact. Thus, mud therapy and its effect on biological aging have been represented in papers that have been published to date. Papers published in the literature analyzing GPx vari-ation during sapropelic mud therapy suggest the beneficial effect of this family of en-zymes in diseases with an important inflammatory component, mainly monitored in patients with osteoarthritis. This study investigated the effects of sapropelic mud treat-ment on GPx values in patients receiving treatment with sapropelic mud at the Balneal and Rehabilitation Sanatorium of Techirghiol, Romania. We included 52 patients, split into two groups, who received treatment with cold mud baths and warm mud baths. Values close to statistical significance were found in patients who received treatment with cold mud baths in terms of mean GPx values at the four-time points studied. Fur-ther studies evaluating GPx in patients receiving sapropelic mud treatment are needed

Effects of High-Intensity Electromagnetic Stimulation on Reducing Upper Limb Spasticity in Post-Stroke Patients

Super Inductive System (SIS) stimulation of spastic limbs by tissue-induced electromagnetic field may have the effect of reducing spasticity and improving functionality in patients with post-stroke spasticity. The aim of the study was to evaluate two different protocols for the application of SIS on upper limb spasticity after stroke. We included 60 patients with post-stroke upper limb spasticity, who were randomized into two groups: the study group, with a 9 min application protocol (1 min for agonist muscles, 8 min for antagonistic muscles); and the control group, with an 8 min protocol applied only to the antagonistic muscles. The duration of therapy was 10 days, and the results were assessed using the Modified Ashworth Scale (MAS) and the Barthel Index. Both the MAS and the Barthel Index improved significantly after 10 days of treatment (p < 0.001), but 30 days after the completion of therapy, there was an attenuation of the effects in both study groups. The study group had a significantly higher percentage of patients with improved MAS after 10 days (p = 0.004) and within 30 days (p < 0.001) than the control group. An SIS protocol applied on both agonist and antagonist muscles has a more pronounced and longer lasting spasticity-reducing and improved functionality effect than its application on only antagonistic muscles

Telerehabilitation—A Viable Option for the Recovery of Post-Stroke Patients

As the number of stroke survivors is continuously growing, with an important number suffering from consequent functional deficits, the rehabilitation field is facing more complex demands. Technological progress gives us the opportunity to remotely assist patients while they exercise at home through telerehabilitation (TR), addressing the problems of limited medical resources and staff, difficult transportation, or living a long distance from rehabilitation centers. In addition, TR is a way to provide continuity in long-term post-stroke recovery during the COVID-19 pandemic, which limits traveling and human interaction. While the implementation of TR is increasing, the biggest challenges are to raise patients’ acceptability of the new method and their motivation and engagement during the program. In this review, we aimed to find methods to address these challenges by identifying the patients who benefit the most from this therapy and efficiently organizing the space and technology used for telerehabilitation. User-friendly technologies and devices along with therapists’ constant support and feedback are some of the most important aspects that make TR an efficient intervention and an alternative to conventional therapy

Effects of High-Intensity Electromagnetic Stimulation on Reducing Upper Limb Spasticity in Post-Stroke Patients

Super Inductive System (SIS) stimulation of spastic limbs by tissue-induced electromagnetic field may have the effect of reducing spasticity and improving functionality in patients with post-stroke spasticity. The aim of the study was to evaluate two different protocols for the application of SIS on upper limb spasticity after stroke. We included 60 patients with post-stroke upper limb spasticity, who were randomized into two groups: the study group, with a 9 min application protocol (1 min for agonist muscles, 8 min for antagonistic muscles); and the control group, with an 8 min protocol applied only to the antagonistic muscles. The duration of therapy was 10 days, and the results were assessed using the Modified Ashworth Scale (MAS) and the Barthel Index. Both the MAS and the Barthel Index improved significantly after 10 days of treatment (p p = 0.004) and within 30 days (p < 0.001) than the control group. An SIS protocol applied on both agonist and antagonist muscles has a more pronounced and longer lasting spasticity-reducing and improved functionality effect than its application on only antagonistic muscles

The Importance of Rehabilitation Programs Using Balneary Treatments in Patients with Spinal Cord Injury

The rehabilitation tools that are designed to improve the function of patients with spinal cord injury (SCI) have various effects. The goals of rehabilitation are to prevent secondary complications, maximize physical functioning, and integrate them into the community. The objective of this study is to evaluate the functional and neurological outcomes of patients with SCI after in-patient rehabilitation in a balneary unit. Methods: one hundred forty-two patients, admitted for primary rehabilitation in a two-year period (2020&ndash;2021), aged &ge;18 years with SCI, divided into traumatic SCI (T-SCI) and nontraumatic SCI (NT-SCI). The following demographic information was collected: gender, age, studies, occupation, and environment. All patients underwent an initial clinical examination which included diagnosis, causes of SCI, medication, Carmeli score, fall risk, Visual Analogue Scale (VAS) for pain, Functional Independence Measure Motor (FIMm), Functional Independence Measure Cognitive (FIMc), and Functional Independence Measure Total (FIMt). At discharge, the fall risk, VAS, FIMm, FIMc, and FIMt were analyzed. We compared the results between the two groups. Results: T-SCI group was 65 (45.77%) and the NT-SCI group was 77 (54.23%). The study analyzed the effects of rehabilitation on the functional presentation of patients with SCI. It also compared the effects of rehabilitation on T-SCI versus NT-SCI on different outcomes such as age, gender, and clinical&ndash;functional impairment. Conclusions: Physical medicine and rehabilitation increase the autonomy of patients. Neurological improvement begins in the first 10 days of complex rehabilitation treatment and is not significantly different between the two groups. The cause of the injury in SCI does not affect the results of the rehabilitation

Safety of Electrotherapy Treatment in Patients with Knee Osteoarthritis and Cardiac Diseases

OBJECTIVE: To assess the safety of electrotherapy applied in the knee area in patients with known atrial arrhythmias or ischemic heart disease, as it is not known whether this treatment induces or aggravates arrhythmias during or immediately after therapy. MATERIAL AND METHODS: The analytical and transversal study involved 46 patients with degenerative knee osteoarthritis (OA), with or without cardiac diseases, from the Clinical Rehabilitation Hospital inpatient center, Cluj-Napoca, Romania. All patients underwent a 10-day physical therapy program for knee OA (electrotherapy, massage and kinesiotherapy). Heart rate and the total number of ventricular and supraventricular extrasystoles were evaluated before and after treatment, by 24 h Holter ECG monitoring. RESULTS: There was no significant increase in heart rate or in the number of ventricular or supraventricular extrasystoles before or after electrotherapy treatment, regardless of the positive or negative history of arrhythmia or ischemic heart disease (all p > 0.05). Mean values during day 1 were: 35.15 (95% CI [9.60–60.75]) for ventricular ones extrasystoles and 91.7 (95% CI [51.69–131.7]) for supraventricular ones, which during day 2 were 38.09 (95% CI [3.68–72.50]), 110.48 (95% CI [48.59–172.36]), respectively. CONCLUSION: One of the most important things to consider when dealing with an OA patient is that they are most likely older than 65 years, which increases the chance of having a cardiac disease. This raises the need for viable interventions regarding the management of this disease in patients that probably have multiple comorbidities, and where pharmacological and surgical management are not possible, limited or have multiple side effects. Electrotherapy used for treating knee OA did not cause a significant increase in heart rate or number of ventricular and supraventricular extrasystoles in this category of patients