[The influence of physical training on metabolic indices in men with myocardial infarction and impaired glucose tolerance]. / Wplyw rehabilitacji fizycznej na insulinoopornosc i insulinemie u pacjentów po zawale miesnia sercowego z zaburzeniami tolerancji glukozy.

INTRODUCTION: Body mass reduction and regular physical training form part of a strategy to treat disorders of carbohydrate metabolism associated with obesity. Evidence shows that even a slight reduction in body mass may improve carbohydrate tolerance, lipid profile and insulin resistance, reduce insulin levels and finally delay or reduce risk of diabetes mellitus. Multiple studies, including prospective studies confirm the independent protective effects of physical training against future development of type 2 diabetes mellitus. Myocardial infarction is a severe complication of atherosclerosis. Patients with glucose intolerance have a 2-fold higher risk of dying. Impaired glucose tolerance is negatively associated with prognosis in patients after myocardial infarction. Glucose intolerance accompanies hyperinsulinemia, a major indicator of insulin resistance. AIM: The aim of the study was to analyze the effect of physical training on hyperinsulinemia/ insulin resistance in patients after myocardial infarction (MI) with impaired glucose tolerance (IGT). MATERIALS AND METHODS: 31 men aged 37-69 years (mean 51 +/- 7.4) with IGT 3.5 years after MI, in NYHA class I and II participated in the study. Group A (n=16 men) underwent supervised physical training and group B (n=15) received standard information on physical training. Tissue glucose disposal using normoglycemic glucose clamp technique, fasting insulinemia, glycemia during OGTT, lipid profile, BMI and body mass composition were obtained in all patients. RESULTS: The groups were matched for age. There were no differences in BMI, percent fat content, blood pressure, diet, smoking status and pharmacotherapy. Glycemia during baseline OGTT did not differentiate the groups, either. Analysis of insulinemia and glycemia during OGTT at baseline and at 12 weeks after regular physical training showed lower levels of insulinemia and glycemia compared with baseline levels in group A (fasting glycemia 6.41+/-0.46 vs. 4.8+/-0.32 mmol/l, p<0.001; fasting insulinemia 59.42+/-38.9 vs. 27.42+/-26.5 umol/l, p<0.001). A similar analysis in group B did not reveal any significant differences (fasting glycemia 6.17+/-0.49 vs. 6.18+/-0.46 mmol/ l; fasting insulinemia 61.86+/-48.5 vs. 68.86+/-78.5 umol/l). Mean tissue glucose disposal in the whole study population was 2.96+/-1.03 mg/kg bm/min. CONCLUSIONS: The present findings indicate the beneficial effects of regular physical training on the reduction of fasting insulinemia in patients after myocardial infarction with insulin resistance and improve lipid profile. In patients after myocardial infarction standard recommendations concerning physical activity are not well realized. It seems that better compliance, more strict control and motivation of patients can result in better metabolic control.

[Dislocations hip arthroplasty]. / Zwichniecia endoprotez stawów biodrowych.

The authors present analysis of dislocation following hip arthroplasty based on their own clinical material of 1985-2005 year. It contain 2712 cases of total hip arthroplasty, 2171 (80.1%) cases were cemented including 64 (2.4%) cases of revised arthroplasty, 541 (19.9%) cases were cement-free stabilized including 7 (0.2%) cases of revised arthroplasty. Obtained outcomes of analysis permit to make assertion that dislocation following hip arthroplasty occurred during first three month after surgery, more frequently in case of revised arthroplasty and following fractures of femoral neck. Requirement of success is appropriate steady of implant and right done supervision of rehabilitation with learned necessary motoric behaviors.

[Proximal humerus fractures analysis of treatment and rehabilitation outcomes]. / Analiza wyników leczenia i rehabilitacji zlaman konca blizego kosci ramiennej.

The authors make evaluation of functional outcomes proximal humerus fractures depending on applied method using Constant-Murley score in own modification. The clinical material of 1980-2004 years were 93 cases, 41 male (44.1%) and 52 female (55.9%) aged between 28-81 years. The operative treatment was employed in 52 cases (45.1%), nonoperativ in 18 cases (19.4%) and functional treatment using direct traction by olecranion in 33 cases (35.5%). Obtained outcomes based on Constant-Murley score in own modification notice limitation range of motion injured joint, reduction of muscle streught in shoulder rim and decrease of physical activity independently used method of treatment.

[Computer-based rehabilitation of cognitive impairments and motor arm function of patients with hemiparesis after stroke]. / Wspomagana komputerowo, skojarzona rehabilitacja zaburzen poznawczych i funkcji reki u osób z niedowladem polowiczym po udarze mózgu--doniesienie wstepne.

OBJECTIVE: To evaluate the usefulness of the computer program made for the patients after stroke to treat their cognitive impairments and hemiparesis. RESEARCH DESIGN AND METHODS: The experimental group involved 10 patients after stroke who were obliged to train on a computer every day during their three-week stay on the rehabilitation ward. The control group involved 10 patients after stroke who did not participate in any computer training during their rehabilitation process. The first part of the computer tasks trains the attention impairments and visual-motor co-ordination problems. We modified the joystick by adding special buttons to train movements of the wrist, thumb and forefinger of the impaired hand. Computer tasks are made in the way to stimulate both the cognitive functions and hand dexterity at the same time. RESULTS: This initial research shows a statistically significant improvement of the cognitive functions and hand dexterity among patients from the experimental group. According to these results we did not observe any significant improvement in the cognitive functions among patients who did not train on a computer (control group). CONCLUSIONS: The results of this research suggest the usefulness of this computer program in training cognitive impairments and visual-motor co-ordination as well as hand dexterity among the patients after stroke.

Physiotherapeutical management after osteoporotic fractures.

Osteoporosis, characterized by low bone mass and microarchitectural deterioration of bone tissue, can cause fractures after even a minor trauma, resulting in serious disability and even death. These fractures lower the quality of life, restrict the patient's ability to remain independent, and reduce self-esteem. Fractures caused by osteoporosis are an increasing problem, in both their medical and socio-economic aspects. The risk of osteoporotic fracture in the vertebrae, the proximal femur, and the distal radius increases with age. With proper physiotherapeutic management, promptly applied, many complications can be avoided and the quality of life can be improved. The aim of our article is to present a comprehensive physiotherapeutic approach after the most common fractures, taking into consideration safety factors in performing activities of daily living, in order to prevent subsequent fractures. Physiotherapeutic management after vertebral fracture includes 3 phases. Phase 1 aims at bone union and avoiding complications; phase 2 is directed to work on increasing physical fitness and learning proper and safe everyday activities; phase 3 encourages improvement and maintains the skills learned in the previous phases. The complete program of rehabilitation after a fracture of the proximal femur involves physiotherapy after surgery, prevention of further bone mass loss, and limiting the number of falls and subsequent fractures. The goal of management after a distal radius fracture is to restore normal hand functions and prevent complications resulting from limb immobilization. Physiotherapy, including kinesiotherapy, physicotherapy and ortotics support, should be an important element in the comprehensive therapy of osteoporotic fractures.

The Body Mass Index (BMI) and rehabilitation outcome in patients with degenerative changes of the knee joint.

Background. Given that obesity is the primary risk factor and pain the primary symptom of degenerative disease of the knee joint, we undertook to study the dependency between the Body Mass Index (BMI) and pain symptoms, and the impact of the BMI on the outcome of rehabilitation. Material and methods. Our research involved 38 patients with bilateral degeneration of the knee joint, according to the of the American College of Rheumatology (ACR). The patients were examined twice: at baseline before rehabilitation and immediately after a series of 10 procedures, as follow-up. Body build in terms of obesity was assessed on the basis of the BMI, according to WHO norms. The level of pain with and without loading on the limb was taken as the criterion for evaluating rehabilitation outcome. Pain level was evaluated using Likert's 11-point scale. Results. There was a statistically significant correlation (p<0.05 at baseline and p<0.01 at follow-up) between the BMI and the level of pain under load, but no significant correlation between BMI and pain when there was no load on the limb. The outcome was better in patients whose BMI was in the normal range or only somewhat above. Conclusions. Pain symptoms, especially when the limb is bearing weight, is significantly dependent on the BMI, which also has a major impact on rehabilitation outcome. Normalizing body weight should be a first-order priority in both the prevention and the rehabilitation of degenerative changes in the knee.