Современи аспекти на неврорехабилитацијата и кинезитерапијата после мозочен удар

Во денешно време се забележува непроменлива тенденција на зголемување на бројот на заболени од цереброваскуларна болест и тие заземаат значајно место во морбидитетот и морталитетот на популацијата, што претставува сериозен медицинско­-епидемиолошки, социјален и економски проблем. Заедно со другите начини на лекување и профилакса во оваа група на пациенти е и физичката активност. Физички активните лица имаат помал ризик од мозочен удар и смрт во споредба со лицата кои се со ниско ниво на физичка активност. Оваа зависност се должи на позитивниот ефект со кој физичката активност влијае врз телесната тежина, артеријалниот притисок, холестеролот во крвта и гликозниот толеранс. Независно од тоа што реално целосно морфолошко возобновување по мозочен удар може никогаш да не се постигне, можноста за функционално моторно возобновување со стимулирање на мозочната пластичност благодарение на продолжителна, специфично ориентирана и интензивна неврорехабилитација, дава мал оптимизам во случаите на инвалидност. Резултатите од целосната функционална рековалесценција и лекувањето зависат од пациентот, правилната медикаментозна терапија и диетичниот режим

Kinesitherapy in patients with Parkinson's disease

Summary: Parkinson's disease is a progressive neurodegenerative disease that affects the extrapyramidal system. The disease is characterized by motor and non-motor symptoms that can significantly disrupt the patient's daily life and affect the quality of life. Incidence and prevalence increase proportionally with age. Motor symptoms occur as a result of the destruction of neurons in the striatonigral regions and consequent reduction of dopamine in the corpus striatium. As a result of these pathological processes, the characteristic symptoms of Parkinson's appear. From the point of view of neurorehabilitation, it aims to reduce the progression of the disease, prevent the occurrence of additional complications and, as far as possible, ease the patient's new condition. Purpose: To monitor the influence of kinesitherapeutic agents on motor abilities in patients with Parkinson's disease. Contingent and methods: The study included 12 patients with Parkinson's disease (7 men and 5 women, mean age 64.2±3.7), II-III according to Hoehn and Yahr during a period of 1 month. 15 individual one-hour kinesitherapeutic procedures were carried out, including spinal flexibility exercises from a relaxed initial position, dynamic exercises, games and sports elements. In the preparatory part, breathing exercises with prolonged exhalation, segmental massage, relaxing procedures, manual stretching with swaying are used. The main part of the procedure aims to reduce bradykinesia by mobilizing the spine and increasing the range of motion in the joints, improving balance and gait stability through cyclical exercises. The effect of the application of kinesitherapeutic agents on movement disorders is evaluated - subjective assessment of body posture, Waltenberg test, modified brain test. Results: The study shows that applied kinesitherapy during 1 month (15 individual procedures) has a positive effect (p<0.001), reduces the rigidity of cervical muscles, improves posture and coordination of patients with Parkinson's disease. Conclusion: The implementation of kinesitherapeutic agents for a long time shows a positive effect in patients with Parkinson's disease, which leads to an impact on their motor abilities. Key words: motor abilities, kinesitherapy, Parkinson's disease Area: Social Health and Medicin

Functional possibilities in patients with diabetic neuropathy

Summary: Diabetic neuropathy (DN) is the most common neurological complication, which occurs in patients with diabetes mellitus and is increasing in frequency. Most diabetics develop symmetric distal neuropathy and neuropathic pain, 25% of patients have carpal tunnel syndrome, 5% have autonomic neuropathy, and 1% have proximal asymmetric neuropathy. Kinesitherapy (КT) is one of the main therapeutic approaches for treating DN. There are indisputable data about its positive effect on the metabolic control of diabetics, which predetermines its possibilities to influence the basic pathogenetic factor for the development of DN. At the same time, there are very few studies analyzing the place and role of kinesitherapy in the treatment of DN. Guidelines are mainly given for the expediency of the application of certain exercises, based on the physiological mechanisms of their effects, without monitoring and evaluating their complex impact in patients with DN. The research goal is to follow through the effect of kinesitherapy methods on functional disorders with diabetic neuropathy. Material and Methods: 11 patients with diagnosed diabetic neuropathy have been examined (6 women and 5 men, average age 59.3 ± 6.6 years). Functional examination revealed limited ankle range of motion and muscle weakness. A complex of functionality tests is applied: pain sensitivity, discrimination sensation, vibration sensation, Romberg's test, manual muscle test (MMT), centimeter, ankle mobility test. The results were assessed on the 1st, 10th day and 1st month from the start of the treatment. Results: After applied kinesitherapy, the highest tendency towards improvement in functional recovery with significance level p<0.001 is at the 1st month. Conclusion: Therapeutic exercises significantly improve the functional capabilities of patients with diabetic neuropathy and the effectiveness of the application is shown in increasing the range of motion, endurance and muscle strength and reducing pain. Keywords: kinesitherapy, functional capabilities, diabetic neuropath

Kinesitherapeutic effect on the functionality in patients with ischemic cerebrovascular disease

Summary: Ischemic cerebrovascular disease is an acute disturbance of cerebral circulation as a result of insufficient flow of blood, oxygen and glucose in the brain, with subsequent disturbance of metabolic processes in the affected area. Disability among survivors is about 50%. Stereotypical synergistic movements are observed in post-stroke conditions, which represent a limitation or inability to adapt movements to different tasks or to changed conditions. The more selective the movement, the more difficult the control over it. The adequate therapeutic approach is determined by the severity of the damage and the duration of the disease. The objectives of the study are to determine the effect of therapeutic exercises on functionality in patients with ischemic cerebrovascular disease. Material and Methods: The study was conducted with 12 patients with ischemic cerebrovascular disease in the chronic period (ICDChP) (7 men and 5 women, mean age 61.3 ± 7.6 years old, weight 75.6±9.2 kg, height 167.2±6.3 cm and duration of illness - 1 year). The Brunnstrom test and the functional independence test - FIM are used to assess motor recovery and the level of functional independence. The stage of functional recovery and functional independence were assessed at the beginning of the study, at 10th day, 1 month and 2 months after the initiation of kinesitherapy. All patients were treated with therapeutic exercises for a period of 10 days, which the patients later continued as an adapted home exercise program for a period of 2 months. Results: After completing the therapeutic exercises, the highest tendency to improve motor recovery and functional independence is at 1 month, with a significance level of p<0.001 Conclusion: Therapeutic exercises significantly improved motor skills and functional independence in patients with functional disorders due to ICDChP. Keywords: kinesitherapy, functional disorders, motor recovery, functional independence, ischemic cerebrovascular disease Area: Social Health and Medicin

Effect of therapeutic exercises in plexitis of pl.brachialis

Purpose: To monitor the effect of a comprehensive kinesitherapy approach in patients with plexitis of pl.brachialis. Material and methods: The study was conducted with 16 patients (mean age 49.1 ± 6.8 years) with plexitis of pl.brachialis in the subacute stage and stable hemodynamics (blood pressure is below 140/90 mmHg). The early (10th day) and late (1st month) effect of the application of specialized kinesitherapy in unilateral manifestation of symptoms is evaluated, in which exercises are introduced for: reduction of pain and compensatory spasm; for gradual adaptation of the musculoskeletal system; to normalize muscle imbalance; to stimulate proprio- and exteroreceptors; for analytical effect on muscle strength; to improve normal postural mechanisms; for relaxation and body recovery after exercises, through breathing and relaxing exercises. Functional examinations are manual muscle test, centimetry and goniometry. Results: The present study shows that a comprehensive kinesitherapy approach permanently improves functional capabilities of motor recovery in patients with plexitis of pl.brachialis. The results are most pronounced at 1 month of treatment (p <0.001). Conclusion: The improvement is related to the long-term application of the methodology in relation to the modern principles of kinesitherapy and the application of specialized techniques for mobilization of the cervical part and shoulder complex. Key words: plexitis of pl.brachialis, kinesitherapy, subacute stag

Combined reflexology with acupressure and kinesitherapy methods after achilles tendon rupture

Achilles tendon rupture is one of the most common injuries of the locomotor system. It creates the formation of a motor deficit in the terminal part of the kinematic chain of the lower extremity and adversely affects the entire kinematics and kinetics of the musculoskeletal system in humans. Due to the lack of a synovial membrane, often the superficial fibers of the tendon tend to fuse with the skin tissue. Postoperative functional problems are associated with limited joint mobility and reduced trophic throughout the ankle complex and the overall reduction of the muscle activity of the affected lower limb. Material and methods: The study included 13 patients with Achilles tendon rupture. Patients are selected according to several criteria, so that there is homogeneity in the research: to be between the ages of 20 and 40; have no other inflammatory changes diagnosed (unilateral and / or bilateral). The subjects use a combination of reflexology with acupressure and kinesitherapy, based on modern principles of rehabilitation. The kinesitherapy method is based on the basic principles of modern postoperative rehabilitation: to be individual, intensive and specifically oriented. For the purposes of the research, a complex of functional tests was applied, the results of which were evaluated on the 1st day, the 10th day and the 1st month from the beginning of the treatment and displayed on a worksheet. Assessed: muscle weakness with manual-muscle test (MMT), muscle circumference with centimeter (cm), mobility in the ankle with agglometry (°). Results and discussion: The applied specialized kinesitherapy method permanently stabilizes the functional possibilities for motor recovery in patients with Achilles tendon rupture. The combination of soft tissue mobilization procedures - direct, joint and combined with massage and muscle-inhibitory techniques, supplemented with reflexology and acupressure is a condition for early and risk-free recovery of ankle arthrokinematics during postoperative treatment of rupture of the Achilles tendon. Conclusion: The presence of a positive change in all parameters is observed after the application of specialized kinesitherapy in all subjects. The complete and in-depth analysis of the obtained results gives us grounds to claim that combined reflexology with acupressure and kinesitherapy has both early and late therapeutic effect associated with the continuity of the application, the structure of implementation and the adequacy of the included therapeutic means. Keywords: Kinesitherapy, Achilles tendon rupture, muscle inhibitory techniques, acupressur

Neurorehabilitation in patients with dementia

Summary: Dementia is a widespread neurocirculatory disease that affects a large number of people worldwide, with significant consequences for individual functionality and quality of life. It is characterized by progressive loss of cognitive functions, such as memory, attention, language and ability to think. This affects the daily activities of patients and their general functionality. Hence, neurorehabilitation focuses on improving cognitive, physical and psychosocial functions in patients with dementia. This approach combines different techniques and interventions in order to maintain or improve existing functions and slow down the progress of the disease. Neurorehabilitation contributes to improving the quality of life of patients and their loved ones, and supports them in the special challenges they meet. In order to understand the meaning of neurorehabilitation in patients with dementia, it is important to emphasize the impact of this condition on individuals and their families. Dementia can have a significant emotional and financial burden, and therefore needs effective interventions that will help support patients and their loved ones. The aim of the study is to examine the influence of health therapeutic activities among the patients in preclinical stages of dementia. Material and Methods: For the study, 13 patients in preclinical dementia (7 women and 6 men, average age 77.6±5.3 years) with mild cognitive impairment compared to the Mini-Mental State Examination (MMSE) scale. Their Daily abilities and impairments were assessed with the Barthel index on a scale from 0 to 100 points to assess the 10 most common areas of daily activities and other human abilities and the results were assessed on the 1st day, 1st and 3rd month from the beginning of the therapy. The motor activity affects cerebral circulation and memory functions, normalization of vascular tone and blood pressure, decreasement of oxidative stress and systemic inflammation, improvement of sensitivity of arterial vessels and brain perfusion. It includes moderate intensity aerobic exercises, resistance and balance exercises and coordination exercises. Results: After the applied therapeutic exercises, the highest improvement in motor body was found at 1 month, with a significance level of p<0.001. Conclusion: Therapeutic exercises positively affect physical health by improving balance, speech and motor control and cognitive functions by enhancing attention, memory and visuospatial abilities in dementia.The final conclusion supports the importance of neurorehabilitation and the need for advanced research in this field. Keywords: motor neurorehabilitation, dementia, preclinical stage Area: Social Health and Medicin

Влијание на кинезитерапијата кај лумбална дискус хернија

Хернијацијата на лумбалниот диск е распространета медицинска состојба која погодува милиони луѓе ширум светот. Додека хируршките интервенции и фармаколошките третмани често служат како конвенционални патишта за управување со хернијација на лумбалниот диск, овие опции доаѓаат со нивни недостатоци. Кинезитерапијата може да биде особено корисна за време на субакутната фаза на хернијација на лумбалниот диск, каде што состојбата е стабилизирана до одреден степен, но функционалните оштетувања и болката продолжуваат. Токму во оваа фаза терапите засновани на движење можат значително да помогнат во промовирањето на заздравувањето на ткивото, намалувањето на мускулниот спазам и подобрувањето на постуралните навики, без ризици поврзани со хируршки или фармаколошки интервенции. Целта на истражувањето е да се следи ефектот на применетите кинезитерапевтски средства врз функционалните нарушувања кај пациенти со лумбална дискус хернија. Материјал и методи: Во студијата се шроследени 15 пациенти со лумбална дискус хернија во субакутна фаза кои се согласиле на домашен кинезитерапевтски третман во период од 1 месец. Се оценува ефектот на примената на кинезитерапевтски средства врз возобновување на болните функционални модели на движење, ублажување на болката во долниот дел на грбот, задниот дел, колковите и нозете, намалување на мускулниот спазам, враќање на функцијата на лумбалниот 'рбет и сакроилијачниот зглоб, подобрување на подвижноста на долниот дел на телото, оддржување на невролошката адаптација за намалување на чувството на болка, спречување на идни напади на болка и намалување на стравот поврзан со движењето. Приложени се: постизометриска релаксација на m. erector spinae, m.qudratus lumborum и m.iliopsoas, сегментарна масажа, позиционен третман, вежби за зајакнување на слаби мускули, релаксација, екстензиона терапија и активни вежби од различни почетни позиции. Резултати: Студијата покажува дека применетата кинезитерапија со продолжителност од 1 месец има позитивен ефект (p<0,001), со што ги намалува болката и мускулниот тонус, ја подобрува подвижноста на 'рбетот и спречува рецидиви, егзацербации и периферни невролошки симптоми. Заклучок: Кинезитерапевтските средства и нивното долгорочно спроведување имаат позитивен ефект кај пациенти со лумбална дискус хернија, што доведува до корекција на современиот стил на работа на пациентите. Клучни зборови: кинезитерапија, функционални нарушувања, лумбална дискус херниј

The role of physical therapy in amyotrophic lateral sclerosis

Purpose: To demonstrate the importance of physical therapy and rehabilitation in patients with Amyotrophic Lateral Sclerosis (ALS). Materials and methods: The research was done according to the PRISMA MODEL, with a selection of systematic reviews and a search through key terms from scientific and reliable literature. Results: According to the latest researches, it is recommended to implement stretching exercises, exercises with low to moderate burden, as well as aerobic activities (swimming, walking and stationary cycling) and massage. It has to be pointed out that aerobic and resistance exercises are appropriate for the initial and advanced stages of the disease and for slow-progressing cases. They should be started at the earliest opportunity. In addition, respiratory therapy can improve lung function and breathing. Moderate-intensity exercise increases synaptogenesis and dendritic branching in multiple brain regions, as well as neurotrophic factor production. Also, physical therapy promotes increased hypertrophy of skeletal muscle fibers, muscle protein synthesis and increased capillary density. The most recent data is reduction in the level of serum Myo-miRNA (biomarker for monitoring disease progression) after six weeks of rehabilitation, which is due to the stabilization of the skeletal muscles and the neuromuscular junction. All this leads to more optimal activation and synchronization of the motor units. Conclusion: Physical therapy has been shown to be essential in improving the quality of life of ALS patients and adapting to changes in daily functioning. The goals are: reducing pain, maintaining condition, flexibility, safe mobility and independence for as long as possible. Key words: ALS, kinesitherapy, initial stage, advanced stage

Influence of kinesitherapy on neuritis of sciatic nerve

Purpose: To monitor the effect of kinesitherapeutic agents on functional disorders in patients with neuritis of sciatic nerve. Contingent and methods: The study examined 11 patients with neuritis of sciatic nerve in the subacute stage, who agreed to kinesitherapy at home for a period of 1 month. The effect of the application of kinesitherapeutic agents on the restore pain-free functional movement patterns relieve lower back, buttock, thigh, and leg pain, reduce muscle spasm, restore function of the lumbar spine and the sacroiliac joint, improve mobility of the lower body, promote neurologic adaptations to reduce the perception of pain, prevent future pain flareups and reduce fear associated with movement. Applied: postisometric relaxation, segmental massage, posture treatment, exercises to strengthen weak muscles, relaxation, extension therapy and active exercises from different starting positions. Results: The study showed that the applied kinesitherapy for 1 month has a positive effect (p<0,001), reducing pain and muscle tone, improving the mobility of the spine, prevent recurrences, flareups and peripheral neurological symptoms. Conclusion: Prolonged use of kinesitherapeutic agents has a positive effect in patients with neuritis of sciatic nerve, which leads to a correction in the modern life and work style of patients. Key words: sciatic nerve, neuritis, kinesitherap