Validation of the pendulum test in the assessment of muscle tone in persons with cerebral palsy

Introduction: Cerebral palsy (CP) is often accompanied by motor limitations, abnormal movements and spasticity. Precise and reproducible assessment of spasticity is essential for the selection and follow up of the therapeutic protocol. In clinics the spasticity is most often characterized with the estimate of resistance to a manual flexion and extension of a particular joint and use of a modified Ashworth scale (MAS). The MAS grading depends on the subjective assessment by the examiner. Aim: The possible alternative is to use the pendulum test (PT) determined parameters for the quantitative assessment of the spasticity. Material and Methods: We used a new instrument from the company 3F - Fit Fabricando Faber comprising inertial measurement units at the shank and thigh, and two EMG recording units to record electromyographic signals from the hamstrings and quadriceps muscles. The study included 48 subjects diagnosed with cerebral palsy. Results: The analysis of results showed that the new measure based on the PT recordings is highly corelated with the muscle tone in CP patients, and automatically distinguishes the type of spasticity (flexion or extension), relaxation rate and spasticity strength. Conclusion: The new measure showed sensitivity of the PT and indicates great potential of using the PT in the protocols for better control of spasticity in CP patients.The conference took place in the Anatomy Institute of Padova Universit

Functional Outcome Assessment of Lower Limb Amputees and Prosthetic Users with a 2-Minute Walk Test

The aim of this study was to assess the functional outcome of a population of lower limb amputees supplied with prosthesis. The research was conducted from June to September of 2010 at the Center for Physical and Rehabilitation Medicine, of the Clinical Hospital Center Rijeka, Croatia. The study included 50 adult subjects of both genders with a unilateral transtibial or transfemoral lower limb amputations. The 2-minute walk test (2MWT) was used to assess the functional outcome of these individuals. Data were statistically analyzed. Subjects were divided into groups according to age. The best results were obtained by subjects between the age of 45 and 59 years. The difference between groups was statistically significant (p<0.001). Taking into account the cause of amputation, there was a statistically significant difference in the results of the 2 MWT between subjects in whom the cause of amputation was circulatory and those where the cause of the amputation was not due to circulatory problems. The best results were obtained in subjects in whom the cause of amputation was not circulatory (p=0.009). Considering the level of amputation there was a statistically significant difference in the results of the 2MWT between subjects with transtibial and those with transfemoral amputations. Better results were obtained in transtibial amputees (p=0.039). Considering the first prosthetic supply, better results were obtained in subjects using prosthetic devices over 9 years (p=0.031). Our research confirmed that age, gender, level and cause of amputation, including the time from the first prosthetic supply have an effect on the 2MWT results

Online booking accommodation in rural tourism: An UTAUT perspective

The paper investigates the most important factors that cause tourists to intend or to already use a website for booking accommodation in rural areas of the Republic of Serbia. On a sample of 212 respondents who had previously used websites to book accommodation in rural tourism, using a modified model of acceptance and use of technology (UTAUT), the impact of four predictor variables (expected impact, expected effort, social impact and facilitation conditions) on the intention of tourists to use, and two independent variables (facilitating conditions and intentions of tourists) on the use of websites for booking accommodation in rural households in Serbia was examined. The SPSS software package was used for data analysis, using descriptive statistics and standard multiple regression. The conducted research indicates that the expected effect and facilitating conditions have a positive influence on the intention of tourists to use websites for booking accommodation, as well as that facilitating conditions and intentions of tourists have a positive impact on the use of websites when booking accommodation.Publishe

Habilitation of children with cerebral palsy

Cerebralna paraliza je klinički entitet kojeg karakterizira poremećaj pokreta i položaja uzrokovan neprogresivnim oštećenjem nezrelog mozga. Mnogo je etioloških faktora zbog kojih dolazi do oštećenja mozga koja može uzrokovati cerebralnu paralizu. Posljedice oštećenja utječu na motoričku funkciju te mišićno-koštani i kognitivni razvoj, a javlja se i niz drugih pridruženih zdravstvenih poteškoća. Također, kada se govori o cerebralnoj paralizi, uvijek treba naglasiti da cerebralna paraliza predstavlja, ne samo medicinski problem, nego i psihološki i socijalni problem. Dijagnoza se postavlja kod djece kod koje je uočen usporeni razvoj motorike, a koji se potvrđuje nalazima magnetske rezonancije. Terapija djeteta s cerebralnom paralizom je usmjerena na ostvarivanje zadanog cilja. Dva glavna cilja su smanjiti komplikacije uzrokovane cerebralnom paralizom i poboljšati sposobnost usvajanja novih vještina. Dodatni ciljevi su edukacija roditelja, smanjenje tjelesnih deformacija i poboljšanje pokretljivosti. Cerebralna paraliza zahtjeva interdisciplinarni pristup te ima veliki utjecaj i na dijete i na čitavu obitelj i njihov život. Svaki terapijski pristup se bazira na individualnom pristupu. Vrlo je bitno terapiju započeti što ranije jer ranija terapija olakšava razvoj djeteta i pridonosi boljem ishodu terapije i kvaliteti života. Terapija cerebralne paralize ne treba biti usmjerena samo na motoričke tretmane, već i na tretmane i drugih poremećaja od kojih dijete pati. Postoji niz terapijskih sistema koji se primjenjuju u radu s djecom s cerebralnom paralizom. Rijetko se kad terapija oslanja na samo jedan sistem, najčešće se primjenjuje kombinacija terapijskih postupaka. Takav pristup omogućava fleksibilnost i individualizaciju kako bi se ostvarili ciljevi postavljeni za dijete i obitelj.Cerebral palsy is a clinical entity characterized by disorder of movement and posture caused by a non-progressive injury to the immature brain. There are many etiological factors that may cause brain injury that result in cerebral palsy. The consequences of brain injury may have an effect on motor function, musculoskeletal and cognitive development as well as on a range of other associated health issues. Also, when it comes to cerebral palsy, it should always be noted that it is not merely about a medical problem, but also the psychological and social components have to be taken into account. Diagnosis is made in children with slow motor development and is comfimed with findings from magnetic resonance imaging. In children with cerebral palsy, the treatment is aimed at achieving two main goals: reduce complications of cerebral palsy and improve the ability to acquire new skills. Additional goals are represented by parent education, reduction of body deformations and mobility improvement. Cerebral palsy has a major impact on the child, the whole family and their life, thus an interdisciplinary approach is required. It is important to begin the therapy as early as possible in order to facilitatee the patient's development and contribute to a better treatment outcome in terms of quality of life. Cerebral palsy treatment should not be focused only on improvement of motor skills; attention should be pointed at every kind of impairment from which the child suffers. In this view, a wide range of therapeutic approaches is available and a combination of therapeutic procedures is usually employed. This multimodal approach allows flexibility and treatment individualization toward achievement of specific goals set for the child and family

Croatian Children’s Views towards Importance of Health Care Information

The aim of research was to investigate: the need for health care information of Croatian adolescents aged from 13 to 18 years; the difference in evaluation of the frequency of receiving information between hospitalized and healthy children; if the hospitalized children expectations about the frequency of receiving health care information differed significantly from information they have actually received; whose information was most comprehensible to the hospitalized children (doctors, parents, other health care givers). The children were either hospitalized in the pediatrics departments or were high schools pupils (healthy children). The hospitalized children »Completely agreed« (92.7%) with the statement »When I am sick, I should receive information about my health« in comparison to the healthy children (85.1%). In comparison to healthy children, the hospitalized children assessed that doctors, other health care givers and parents should give them information more frequently. The experience of hospitalized children indicate that they received less information then they have actually excepted. The information received from doctors was mostly in correlation with the understanding of this information. We concluded that the children want to be informed about their health, especially hospitalized children. Health care professionals should offer understandable health care information according to the children’s expectation

Nerorehabilitation in stroke survivals

Moždani udar je naglo nastali žarišni ili globalni neurološki deficit uzrokovan cerebrovaskularnim poremećajem. Simptomi ovise o veličini oštećenja i zahvaćenog područja te o vremenu proteklom od pojave simptoma do dijagnoze. Brzim prepoznavanjem simptoma i prijevozom pacijenta do jedinice akutnog liječenja povećava se udio pacijenata koji se mogu liječiti trombolitičkom terapijom te se na taj način smanjuje moralitet i invaliditet. Rani početak rehabilitacije u akutnoj fazi liječenja iznimno je važan. Ovisno o veličini oštećenja pacijenti se dalje zaprimaju na bolničko liječenje i specijalizirani program neurorehabilitacije, terapiju nastavljaju ambulantno ili se otpuštaju kući, na provođenje kućne rehabilitacije. Kriteriji za prijam su stabilan neurološki status, odsutnost značajnijeg komorbiditeta, prisutnost značajnijeg neuromotornog deficita u najmanje dvije od pet navedenih funkcija: pokretljivost, aktivnost samozbrinjavanja, komunikacija, kontrola stolice i mokrenja, kontrola žvakanja i gutanja. Rana rehabilitacija je ključna jer je oporavak neuroloških deficita najbolji u prva tri mjeseca nakon moždanog udara. Današnji principi neurorehabilitacije temelje se na teoriji neuroplastičnosti. Terapijski program se individualno prilagođava svakom pacijentu i uključuje medicinsku njegu, farmakološku terapiju, pacijenti prolaze specijalizirani program neurorehabilitacije, uz primjenu ortopedskih pomagala, provode se okupacijsko–radne aktivnosti, logopedske vježbe i kognitivni trening.Stroke is characterized by a sudden development of a focal or a global neurological deficit caused by a cerebrovaskular origin. Symptoms vary from the size of the damage and the affected area, and the time elapsed from the onset of the symptoms to their diagnosis. Early recognition of the symptoms and transportation to the hospital increases the proportion of patients who can be treated with thrombolytic therapy and that way reduce the morality and disability of the patients. Early initiation of rehabilitation in acute phase of treatment is of great importance. Depending on the severity of their deficits, patients are admitted into further inpatient neurorehabilitation or are released home to home therapy or they continue their therapy as an outpatient rehabilitation. Criteria for admission are stable neurological status, the absence of significant comorbidities, the presence of significant neurodevelopmental deficits in at least two of the five functions: reduc tion activities in mobility, self-care activities, communication, control of stool and urine, control chewing and swallowing. Early rehabilitation is crucial because the recovery of neurological deficits is most efficent in the first 3 months after the stroke. Today’s principles of neurorehabilitation are based on the theory of neuroplasticity. The therapeutic program is individually adapted to each patient and includes medical care, drug treatment, neurorehabilitation according to the protocol, with the application of orthopedic supplies, occupational activities, speech exercises and cognitive training

Croatian Children’s Views towards Importance of Health Care Information

The aim of research was to investigate: the need for health care information of Croatian adolescents aged from 13 to 18 years; the difference in evaluation of the frequency of receiving information between hospitalized and healthy children; if the hospitalized children expectations about the frequency of receiving health care information differed significantly from information they have actually received; whose information was most comprehensible to the hospitalized children (doctors, parents, other health care givers). The children were either hospitalized in the pediatrics departments or were high schools pupils (healthy children). The hospitalized children »Completely agreed« (92.7%) with the statement »When I am sick, I should receive information about my health« in comparison to the healthy children (85.1%). In comparison to healthy children, the hospitalized children assessed that doctors, other health care givers and parents should give them information more frequently. The experience of hospitalized children indicate that they received less information then they have actually excepted. The information received from doctors was mostly in correlation with the understanding of this information. We concluded that the children want to be informed about their health, especially hospitalized children. Health care professionals should offer understandable health care information according to the children’s expectation

Influence of applied CD34+ cell dose on the survival of Hodgkin's lymphoma and multiple myeloma patients following autologous stem cell transplants

Background/Aim. Autologous stem cell transplants (ASCTs) improve the rate of overall survival (OS) in patients with hematological malignancies such as multiple myeloma (MM) after induction chemotherapy, aggressive non-Hodgkin's lymphomas (NHL), and relapsed, chemotherapy-sensitive Hodgkin's lymphoma (HL). The study aim was to evaluate influence of applied CD34+ cell quantity on clinical outcome, as well as early post-transplant and overall survival (OS) of HL and MM patients following ASCT. Methods. This study included a total of 210 patients (90 HL/120 MM) who underwent ASCT. Stem cell (SC) mobilization was accomplished by granulocyte-colony stimulating factor (G-CSF) 10–16 μg/kg body mass (bm) following chemotherapy. For proven poor mobilizers, mobilization with G-CSF (16 μg/kgbm) and Plerixafor (24 or 48 mg) was performed. To our best knowledge, it was the first usage of the Plerixafor in our country in the ASCT-setting. Harvesting was initiated merely at "cut-off-value" of CD34+ cells ≥ 20 × 106/L in peripheral blood with "target-dose" of CD34+ cells ≥ 5 × 106/kgbm in harvest. The CD34+ cell count and viability was determined using flow cytometry. Results. The majority of HL patients (76.7%) were infused with > 5.0 × 106/kgbm CD34+ cells, while 68.3% of MM patients were treated by approximately 4.0–5.4 × 106/kgbm CD34+ dose, respectively. Beneficial response (complete/partial remission) was achieved in 83.3% (HL) and 94.2% (MM) patients. Among parameters that influenced survival of HL patients with positive response to the therapy, multivariate analysis (pre-ASCT performance status, CD34+ cell quantity applied, rapid hematopoietic, i.e. lymphocyte and platelet recovery) indicated that higher CD34+ cell dose used, along with pre-ASCT performance status correlated with superior event-free survival (EFS) and OS following ASCT. In MM patients, multivariate analysis (renal impairment, infused CD34+ cell quantity, early platelet recovery) indicated that the number of CD34+ cells infused was the most important parameter that influenced both EFS and OS after ASCT. Conclusion. Data obtained in this study undoubtedly confirmed that CD34+ cell dose applied is an independent factor that may contribute to superior clinical outcome and OS of HL and MM patients following ASCT

Aetiology and risk factors for cerebral palsy in children born at term

Cerebralna paraliza najčešći je uzrok trajnih i teških motoričkih oštećenja u djece. Smatra se posljedicom oštećenja nezrelog mozga ili mozga u razvoju. U terminske novorođenčadi etiologija je još i danas nedovoljno poznata i razlikuje se od etiologije CP-a u prijevremeno rođene djece. Prikazana je etiologija i rizični čimbenici za razvoj CP-a u terminske novorođenčadi rođene i/ili liječene u KBC-u Rijeka od 2002. do 2013. godine. Udio terminske novorođenčadi u skupini djece sa CP-om iznosio je 40%, uz najvišu zastupljenost postnatalne etiologije od 47%, za razliku od drugih autora koji navode prenatalnu etiologiju vodećom. Razlog tome može biti i primjena suvremene klasifikacije i podjele CP-a. Intrapartalna etiologija nađena je u 18%, a prenatalna u 35% slučajeva. U djece s nepoznatom etiologijom nađeni su rizični čimbenici tijekom porođaja koji mogu upućivati na intrapartalnu etiologiju, čime bi se povećao njen udio u ukupnoj etiologiji CP-a. Radi eventualne prevencije potrebna su daljnja ciljana istraživanja o etiologiji CP-a u terminske novorođenčadi, služeći se jasnom klasifikacijom i definicijom CP-a. Ključne riječi: cerebralna paraliza; postnatalno; prenatalno; rizični čimbeniciCerebral palsy is the most common cause of permanent and severe motor impairment in children. It is considered as a consequence of damage to immature or developing brain. The aetiology in infants born at term is still mostly unknown and differs from the aetiology in premature infants. We present aetiology and risk factors for CP in infants born at term and/or treated at Rijeka University Hospital Centre from 2002 to 2013. Infants born at term comprised about 40% of the children with CP, with the highest contribution of postnatal aetiology (47%), unlike other authors who cite prenatal aetiology as the leading one. The modern definition and classification of CP may be the reason for this observation. Intrapartum aetiology was found in 18% and prenatal in 35% of cases. In children with undetermined aetiology, most risk factors were found during birth, which may indicate intrapartum aetiology, and thus the increase in the percentage of intrapartum aetiology in the overall aetiology of CP. Aiming at possible prevention, additional research into CP aetiology in infants born at term is required using clear definition and classification of CP