Dependence of reaction time and movement speed on task complexity and age.

UNLABELLED: The aim of this study was to determine the differences in reaction time, reaction complexity, and movement speed depending on age. MATERIAL AND METHODS: The study included 40 healthy subjects (20 young and 20 older women and men). The study was conducted at the Human Motorics Laboratory, Lithuanian Sports University. An analyzer DPA-1 of dynamic upper and lower limb movements was used for the research purposes. RESULTS: The reaction time of the right arm of the young subjects was 0.26 s (SD, 0.01) and that of the left arm was 0.25 s (SD, 0.02), when an accuracy task was performed. The reaction time of the older subjects was 0.29 s (SD, 0.03) and 0.28 s (SD, 0.03) for the right and left arms, respectively. The reaction time of the right leg of the young subjects was 0.26 s (SD, 0.02) and that of the left leg was 0.27 s (SD, 0.03). The reaction time of the right and left legs of the older subjects was 0.33 s (SD, 0.02) and 0.35 s (SD, 0.04), respectively. The reaction of the young subjects was almost two times faster compared with the older persons after the accuracy task with each limb was accomplished. CONCLUSIONS: In case of movements with arms and legs, reaction time and movement speed directly depend on the complexity of a task. Reaction time and movement speed are slower for the older subjects in comparison with the young ones; the results worsen in proportion to the increasing complexity of a task.

Test-retest reliability of biodex system 4 pro for isometric ankle-eversion and -inversion measurement.

CONTEXT: The lack of knowledge about isometric ankle testing indicates the need for research in this area. OBJECTIVE: to assess test-retest reliability and to determine the optimal position for isometric ankle-eversion and -inversion testing. DESIGN: Test-retest reliability study. Isometric ankle eversion and inversion were assessed in 3 different dynamometer foot-plate positions: 0°, 7°, and 14° of inversion. Two maximal repetitions were performed at each angle. Both limbs were tested (40 ankles in total). The test was performed 2 times with a period of 7 d between the tests. SETTING: University hospital. PARTICIPANTS: The study was carried out on 20 healthy athletes with no history of ankle sprains. MAIN OUTCOME MEASURES: Reliability was assessed using intraclass correlation coefficient (ICC2,1); minimal detectable change (MDC) was calculated using a 95% confidence interval. Paired t test was used to measure statistically significant changes, and P <.05 was considered statistically significant. RESULTS: Eversion and inversion peak torques showed high ICCs in all 3 angles (ICC values .87-.96, MDC values 3.09-6.81 Nm). Eversion peak torque was the smallest when testing at the 0° angle and gradually increased, reaching maximum values at 14° angle. The increase of eversion peak torque was statistically significant at 7 ° and 14° of inversion. Inversion peak torque showed an opposite pattern-it was the smallest when measured at the 14° angle and increased at the other 2 angles; statistically significant changes were seen only between measures taken at 0° and 14°. CONCLUSIONS: Isometric eversion and inversion testing using the Biodex 4 Pro system is a reliable method. The authors suggest that the angle of 7° of inversion is the best for isometric eversion and inversion testing.

The influence of self-stretching based on postisometrical relaxation, static stretching combined with stabilizing exercises, and stabilizing exercises only on the flexibility of one-joint and two-joint hip flexors.

BACKGROUND AND OBJECTIVE. The limitations of muscle flexibility are a common dysfunction of the musculoskeletal system. Therefore, various therapeutic techniques are used in rehabilitation programs to increase their flexibility. The aim of this prospective, randomized, single-blind study was to evaluate the changes in the flexibility of hip flexors in children who participated in a 6-week therapeutic program consisting of one physiotherapy session per week with a physiotherapist and daily home exercises. MATERIAL AND METHODS. A total of 94 children aged 10-13 years were randomly assigned to 3 experimental groups: postisometrical relaxation group (PIR group), static stretching combined with stabilizing exercise group (SE/SS group), and stabilizing exercise group (SS group). To assess the flexibility of one- and two-joint hip flexors, the modified Thomas test was used. The examination was conducted by blinded observers. RESULTS. A significant improvement in the flexibility of one-joint hip flexors was documented in all 3 groups (P<0.01). The flexibility of two-joint hip flexors increased significantly only in the SS/SE group (P<0.05). After the program, the highest range of motion of the hip extension (test for one-joint hip flexors) was recorded in the SS/SE group (20.6° ± 4.5°), and it was significantly greater than in the SE group (16.6° ± 4.0°, P<0.05). There were no significant differences in the knee flexion (test for two-joint hip flexors) among all 3 groups (P>0.05). CONCLUSIONS. The 6-week therapeutic program regardless of the technique applied (postisometrical muscle relaxation, static stretching with stabilizing exercises, and stabilizing exercises only) resulted in the increased flexibility of one-joint hip flexors. Only static stretching combined with stabilizing exercises led to a significant increase in the flexibility of two-joint hip flexors.

Effectiveness of the second-stage rehabilitation in stroke patients with cognitive impairment.

UNLABELLED: The aim of this study was to evaluate the recovery of functional status and effectiveness of the second-stage rehabilitation depending on the degree of cognitive impairment in stroke patients. MATERIAL AND METHODS: The study sample comprised 226 stroke patients at the Virsuziglis Hospital of rehabilitation, Hospital of Lithuanian University of Health Sciences. Functional status was evaluated with the Functional Independence Measure, cognitive function with the Mini-Mental Status Examination scale, and severity of neurologic condition with the National Institutes of Health Stroke Scale. The patients were divided into 4 study groups based on cognitive impairment: severe, moderate, mild, or no impairment. RESULTS: More than half (53%) of all cases were found to have cognitive impairment, while patients with different degree of cognitive impairment were equally distributed: mild impairment (18%), moderate impairment (17%), and severe impairment (18%). Improvement of functional status was observed in all study groups (P<0.001). In the patients with moderate and severe cognitive impairment, cognitive recovery was significantly more expressed than in other study groups (P<0.001). Insufficient recovery of functional status was significantly associated with hemiplegia (OR, 11.15; P=0.015), urinary incontinence (OR, 14.91; P<0.001), joint diseases (OR, 5.52; P=0.022), heart diseases (OR, 4.10; P=0.041), and severe cognitive impairment (OR, 15.18; P<0.001), while moderate and mild cognitive impairment was not associated with the recovery of functional status. CONCLUSIONS: During the second-stage rehabilitation of stroke patients, functional status as well as cognitive and motor skills were improved both in patients with and without cognitive impairment; however, the patients who were diagnosed with severe or moderate cognitive impairment at the beginning of second-stage rehabilitation showed worse neurological and functional status during the whole second-stage rehabilitation than the patients with mild or no cognitive impairment.

[The International Classification of Functioning, Disability, and Health and experience of its implementation into practice]. / Tarptautine funkcionavimo, negalumo ir sveikatos klasifikacija bei jos diegimo i praktika patirtis.

The International Classification of Functioning, Disability, and Health (ICF) organizes and classifies health and other related conditions, their consequences, and factors. The aim of this article is to summarize the experience of implementation of the ICF and possibilities for its application based on the recent literature data. This article gives brief information about background and history of the ICF development; essential ICF regulations and aims are defined as well as data on designing the methods of evaluation of health and other conditions related to it according to the ICF and their practical use in various rehabilitation spheres are presented. Examples of other countries where the ICF is accepted and implemented in social security sphere are given. After summarizing the information on experience of the ICF implementation in other countries, the following aspects are emphasized: evaluation methods of functional state for patients and disabled are being developed and implemented according to the Comprehensive and Brief ICF Core Sets; the need for service in rehabilitation, geriatrics, and social security spheres is identified; the effectiveness of rehabilitation programs is evaluated based on the changes of personal functionality, described by the ICF categories. Development of a rehabilitation program is illustrated by the example of practical application of the ICF. According to the experience of other countries, guidelines of the ICF implementation into practice in Lithuania are given.

[Physical therapy for persons with traumatic brain injury]. / Traumini galvos smegenu suzalojima patyrusiu asmenu kineziterapija.

Traumatic brain injury is a major public health problem and may result in significant impairment of an individual's physical, cognitive, and psychosocial functioning. Therefore, special attention must be paid to physical therapy that plays an important role in early rehabilitation. Physical therapists have the opportunity to apply various scales and tests for assessment of the functional status of patients with traumatic brain injury and effectiveness of physical therapy: Functional Independence Measure, Disability Rating Scale, Barthel Index, Glasgow Coma Scale, Glasgow Outcome Scale, Rancho Los Amigos Scale, Mini-Mental State Examination, etc. This review presents the analysis of morbidity and mortality after traumatic brain injury, possibilities to assess patients' functional status, characteristics of physical therapy, and factors influencing the efficiency of physical therapy. Complications such as contractures, spasticity, sleep disturbances, impaired balance, as well as the attention and behavior disorders, lack of motivation, depression make difficulties in application of physical therapy and rehabilitation for the persons with traumatic brain injury.

[The factors influencing the functional state recovery in cerebral stroke patients during the second rehabilitation stage]. / Veiksniai, turintys itakos patyrusiuju galvos smegenu insulta funkcines bukles atsigavimui.

UNLABELLED: The aim of the study was to determine the functions influencing the recovery of the motor and cognitive functions and general functional state in cerebral stroke patients during the second rehabilitation stage, and their prognostic value. The contingent and methods. The studied contingent consisted of 226 cerebral stroke patients: 109 men and 117 women who had undergone the second stage rehabilitation in Virsuziglis Rehabilitation Hospital, a branch institution of Hospital of Kaunas University of Medicine. The mean age of the patients was 67.8+/-10.4 years. The greatest proportion of the patients (88.5%) was with cerebral infarction. The mean duration of rehabilitation was 38.8+/-8.9 days. The functional state of the patients was assessed by functional Independence Measure; the cognitive function, by the short mental function study method; the severity of the stroke, in accordance with the National Institutes of Health Stroke Scale. The prognostic value of the factors was evaluated by the logistic regression method. A study analyzed the influence of patient's gender, age, social factors, clinical symptoms and signs, risk factors for stroke, comorbidities, the character and localization of the stroke, and psychoemotional state on the recovery of capacities related to motor and cognitive functions, and restoration of general functional state. RESULTS: During the second stage of rehabilitation, the score of the functional state of the patients assessed by the Functional Independence Measures significantly improved from 65.9+/-20.3 to 93.5+/-20.9 (P<0.0001). At the end of rehabilitation, good efficacy of rehabilitation was determined in 64.2% of the rehabilitees; moderate, in 19.4%; insufficient, in 16.4%. In prognosing insufficient recovery of general functional state during the second stage of rehabilitation, the following factors had a significant influence: extremity hemiplegia, disturbed cognitive functions, urination impairment, joint and heart diseases. In cases of insufficient recovery of capacities linked with motor function in the second stage of rehabilitation, exerted extremity hemiplegia, neglect of the affected side of the body, urination impairments, joint and heart disorders had a significant influence, whereas localization of the stroke lesion in the left hemisphere of the brain, impairment of cognitive functions (disturbance of speech and perception), urination disturbances - on the insufficient recovery of capacities related to cognitive functions. CONCLUSION: Insufficient efficacy of rehabilitation of the rehabilitees with cerebral stroke in the second stage of rehabilitation was influenced by impairment of motor and cognitive functions, urination disturbances, and comorbidities. In forming individualized inpatient rehabilitation programs and prognosing the further health care of patients with cerebral stroke, it is important to pay attention to factors, influencing insufficient efficacy of rehabilitation.

[The evaluation of psychomotor development in preterm infants]. / Pirma laiko gimusiu kudikiu psichomotorines raidos ivertinimas.

UNLABELLED: The aim of this study was to assess psychomotor development of very-low-birth-weight infants. MATERIAL AND METHODS: A prospective study was carried out in the Clinic of Neonatology, Kaunas University of Medicine Hospital. Two groups of infants were selected: the study group consisted of 79 preterm infants treated in the Clinic of Neonatology; the control group consisted of 31 term infants. Psychomotor development of the infants was evaluated five times at the age of 1, 3, 6, 9, and 12 months by using the Bayley Scales of Infant Development. RESULTS: The results showed that at the age of 1 month, a significantly delayed psychomotor development was noted in 15.2% of preterm infants and in none of term infants; moderately delayed development - in 25.3% of preterm infants and in none of term infants; normal - in 54.4% and 90.3%, respectively; and accelerated development - 5.1% and 9.7%, respectively. At the age of 12 months, 21.8% of preterm infants and none of term infants showed a significantly delayed psychomotor development; 26.9% of study group patents and none in control group - moderately delayed development; 51.3% and 93.5%, respectively - normal development; and 6.5% and none, respectively - accelerated development. CONCLUSION: Psychomotor development of preterm infants is retarded during all first year of life.

Evaluation of activity and effectiveness of occupational therapy in stroke patients at the early stage of rehabilitation.

In Lithuania, the stroke is not only medical, but social issue as well, since only 20% of patients suffering from stroke remain active at work. Yearly stroke incidence in Lithuania is 7000-8000 cases. The most common outcome of stroke is unilateral paralysis (hemiplegia) followed by disorders of coordination, balance, and movements. Due to dysfunctions of movements, self-care, cognition, behavior, and communication, some part of stroke patients remains disabled. They need assistance and care provided by other people. Occupational therapy, which is part of rehabilitation of patients after stroke, is directed to independence training. There are scarce data related to effectiveness of occupational therapy depending on motor, cognitive, and psychosocial dysfunctions. Goals of study were to estimate effectiveness of occupational therapy at the early stage of rehabilitation depending on type of stroke, localization of brain injury, grade of lesion, age, and gender, to identify factors influencing effectiveness of occupational therapy, and to estimate their positive predictive value. The study included 106 patients at the early stage of rehabilitation, who were admitted to Department of Neurorehabilitation after stabilization of clinical condition from Departments of Neurology and Neurosurgery (mean duration of 14+/-2 days after stroke). The program of occupational therapy was not fulfilled by 6 patients: 2 patients were transferred to Nursing Hospital due to severe condition, and 4 patients were discharged prematurely and continued rehabilitation in outpatient setting. Hence, study population consisted of 100 subjects (47 men and 53 women) who were diagnosed with stroke (ischemic or hemorrhagic). Patient's functional status and disorders of activities were evaluated using Barthel Index and Functional Independence Measure. Complexes of occupational therapy were adjusted according to examination of patient's disorders of activities, age, grade of lesion, other diseases, and complications during rehabilitation process. Effectiveness of occupational therapy in patients after stroke at then early stage of rehabilitation was influenced by gender, age, degree of lesion, type of stroke. Better effectiveness of occupational therapy was observed in men (P<0.05), persons younger than 59 years (P<0.05), persons with hemiparesis (P<0.05) and hemorrhagic stroke (P<0.05). Low effectiveness in stroke patients at the early stage of rehabilitation was influenced by neglect (P<0.05), hemiplegia (P<0.001), and older age of patient (P<0.05). Application of individualized occupational therapy complexes for stroke patients at the early stage of rehabilitation with consideration of motoric and cognitive-psychosocial disorders, significantly improves recovery of impaired functions, though occupational therapy should be continued in later rehabilitation stages, since patients after early stage of rehabilitation still have limited independence in daily activities.

The evaluation of the rehabilitation effects on cognitive dysfunction and changes in psychomotor reactions in stroke patients.

Stroke patients often experience cognitive dysfunctions. One of the parameters assessing cognitive function is the reaction time as it reflects the speed of information processing. The aim of the study was to assess cognitive and psychomotor dysfunctions and the effectiveness of rehabilitation in stroke patients. The subjects of the study were 30 stroke patients who underwent rehabilitation at the Department of Neurorehabilitation. The mean age of patients was 65.33+/-13.2 years. During the study, the patients' cognitive functions, the handgrip strength, reaction time, and frequency of movements were assessed. There was a substantial improvement in patients' cognitive function after rehabilitation. Assessing the results obtained by Mini Mental State Examination, the change was 6.4+/-2.3 points, and assessing by Neurobehavioral Cognitive Status Examination (Cognistat), the change was 13.3+/-10 points (P<0.05). Before the early stage of rehabilitation, Cognistat results showed that the majority of the patients experienced memory loss, diminished constructive abilities, and disorientation. After occupational therapy, there was a statistically significant improvement in all cognitive function domains. At the end of the inpatient rehabilitation period, there was a significant change in patients' reaction time and movement frequency. At the end of early rehabilitation stage, the estimated reaction time in patients with stroke was compared with reaction time in healthy elderly people of the same age. There was no significant difference between these groups; consequently, we concluded that after rehabilitation, improvement of function was achieved. The results of this study showed that at the beginning of early rehabilitation period and after rehabilitation applied, there was a significant moderate correlation between mental state and reaction time in stroke patients.

[Factors influencing outcomes in patients with stroke]. / Veiksniai, turintys itakos galvos smegenu insulto baigtims.

Outcomes of stroke result in long-term disability in most of the patients. It has been confirmed by scientific studies that rehabilitation can improve functional status and quality of life of poststroke patients. The effectiveness of rehabilitation and the outcomes often differ among patients. For effective utilization of the rehabilitation resources, it is important to prognosticate the possible outcomes of the disorder. Recently, studies are performed with the aim to determine and evaluate factors possibly influencing functional recovery in poststroke patients and helping to distinguish patients with good outcome from those with poor outcome. Age, gender, initial severity of the stroke, functional status at admission to hospital, urinary incontinence, impairment in cognitive function, unilateral neglect syndrome are most often analyzed in scientific studies as factors determining the outcomes of the disorder.

[Evaluation of sensorimotor reactions during early rehabilitation for patients after cerebral stroke]. / Ligoniu, persirgusiu galvos smegenu insultu, sensomotoriniu reakciju vertinimas ankstyvosios reabilitacijos laikotarpiu.

Early inpatient rehabilitation is extremely important in functional improvement of patients suffering from cerebral stroke. From our point of view, in rehabilitation of patients after cerebral stroke, the estimation of sensorimotor reactions that enables the evaluation of sensorimotor functional changes is highly relevant. The article describes the comparison of sensorimotor reactions in two subgroups - stroke patients and healthy individuals - by applying Sensoneck system. The evaluation was performed before early stage of rehabilitation and thereafter (following early rehabilitation). In order to estimate the correlation between changes in functional independence and sensorimotor reactions, Functional Independence Measure was used. The study revealed that stroke patients had sensorimotor dysfunctions. During early rehabilitation, the quality of motion performance improved slightly, and sensorimotor reactions improved statistically significantly (P<0.05). The relationship between Functional Independence Measure and Sensoneck scores was not significant (P>0.05).

[Complications after spinal cord injuries and their influence on the effectiveness of rehabilitation]. / Komplikacijos po nugaros smegenu pazeidimo ankstyvuoju reabilitacijos laikotarpiu.

In this article, literature data on complications after spinal cord injuries and their influence on the efficiency of rehabilitation are analyzed. The spinal cord injury is associated with physical and psychological disorder that causes disability and requires intensive treatment. Authors in their articles indicate that many people after spinal cord injuries have complications. The most common complications are: skin breakdown, urinary tract infection, pulmonary complications, spasticity, pain, autonomic dysreflexia, cardiovascular disease, osteoporosis and fractures, heterotopic ossification, deep vein thrombosis. These complications make patients' rehabilitation more difficult and limit their self-care independence, and the treatment of such complications is very expensive.

The effectiveness of occupational therapy in restoring the functional state of hands in rheumatoid arthritis patients.

The aim of the study was to evaluate the effectiveness of occupational therapy in rheumatoid arthritis patients with impaired hand function. Standardized Functional Independence Measure was employed in order to evaluate the functional status of the patients and impaired activities. A dynamometer was used for the measurements of muscular strength of hands and a goniometer, for the range of motion of the wrist. Totally, we have examined 120 rheumatoid arthritis patients. They were divided into two groups: 60 patients in each. Occupational therapy was applied only to the patients of the first group. The mean age of Group 1 patients was 53.4+/-1.8 years, the mean age of Group 2 patients was 52.0+/-1.9 years. The mean duration of the disease was 11.5+/-2.6 years and 12.1+/-2.4 years, respectively. The effectiveness of therapy was considered ineffective if, after the completion of the course of occupational therapy, no increase in Functional Independence Measure score for patients with rheumatoid arthritis was observed. When the score increased from 1 to 3, we considered this as moderate effectiveness; when the score increased to 4-6, we evaluated the effectiveness of occupational therapy as good, and when the score of 7 was attained, effectiveness of occupational therapy was considered as very good. In Group 1, the moderate effectiveness of occupational therapy was determined in 31.7% of patients; good effectiveness, in 61.7%; and very good effectiveness, in 3.3% of rheumatoid arthritis patients. In Group 2, the moderate effectiveness of treatment was determined in 48.3% of patients and good effectiveness, in 5% of rheumatoid arthritis patients. CONCLUSIONS. Hand function (the strength of fingers and hands, the range of motion of the wrist) significantly improved in patients with rheumatoid arthritis after completion of a course of occupational therapy (p<0.05). The improvement of hand functions in patients with rheumatoid arthritis led to increased ability to take food and drink, to wash themselves, to put the clothes on the upper and lower parts of the body and take them off, to use the toilet, a bathtub or a shower, to walk, to manage a wheelchair, and to do personal hygiene (p<0.05).

[Evaluation of factors influencing effectiveness of kinesitherapy in patients after traumatic brain injury]. / Veiksniu, turinciu itakos ligoniu po galvos smegenu traumos kineziterapijos efektyvumui, ivertinimas.

OBJECTIVE OF THE STUDY: To establish the factors, which have an influence on recovery of motor and cognitive functions in patients after moderate or severe traumatic brain injury, when kinesitherapy is applied during the acute stage of injury and early stage of rehabilitation. MATERIAL AND METHODS: Subjects were 131 patients (99 men and 32 women) with a mean age of 39.5+/-15.9 years. Patients were divided into two subgroups according to degree of injury: severe injury (103 subjects) and moderate injury (28 subjects). During acute stage of injury, patients were treated at the Unit of Brain Injuries, Kaunas University of Medicine Hospital; thereafter, 80 patients continued rehabilitation at the Unit of Neurorehabilitation, while 51--in another rehabilitation centers. Recovery of motor and cognitive functions was evaluated using Functional Independence Measure: during acute stage of injury (beginning and end) and during early stage of rehabilitation (beginning, day 25, and end). RESULTS: In order to determine the effect of kinesitherapy, the influence of following factors was evaluated: meningitis, cranial nerves damage, musculoskeletal system dysfunctions, plegia of extremities, speech and cognitive dysfunctions, behavioral changes, sleep disorders, depression, pneumonia, edema, hydrocephalus, epilepsy. The motor score in patients after moderate traumatic brain injury at the beginning of acute stage was 32.4+/-12.7, while in patients after severe injury it was 21.3+/-7.7 (p<0.01). At the end of this stage, the difference between subgroups was insignificant: 61.8+/-24.0 and 60.9+/-22.5, respectively (p>0.05). At the beginning of acute stage of injury, cognitive function score differed significantly: in moderate injury subgroup, the score was 14.2+/-5.5, while in severe injury subgroup - 10.0+/-4.9 (p<0.01). At the end of early stage of rehabilitation, no significant difference in cognitive function scores was found between subgroups: 22.3+/-8.4 and 22.5+/-8.6 scores, respectively (p>0.05). CONCLUSIONS: Insufficient recovery of motor functions during period of kinesitherapy was influenced by depression, pneumonia, plegia of extremities, speech and cognitive dysfunctions, sleep disorders, dysfunctions of musculoskeletal system, behavioral changes, while the recovery of cognitive functions was influenced mainly by pneumonia, speech and cognitive dysfunctions, and sleep disorders (p<0.05).

Occupational therapy for patients with spinal cord injury in early rehabilitation.

OBJECTIVE: To determine factors influencing the effectiveness of occupational therapy of patients with spinal cord injury in early rehabilitation. MATERIAL AND METHODS: Data were obtained on 136 patients with spinal cord injury admitted to the Department of Rehabilitation, Kaunas University of Medicine Hospital in 1999-2005. The study population consisted of 97 (71.3%) males and 39 (28.7%) females. Complex rehabilitation was started after the stabilization of functional state in the Department of Neurosurgery and transfer to Department of Rehabilitation. The average duration of early rehabilitation in the Department of Rehabilitation was 68.3+/-22.5 days. According to the level of spinal cord injury patients were divided into two groups: patients with cervical lesions (C1-Th1 segments) and with thoracic-lumbar lesions (Th2-S1 segments). According to the level of spinal cord injury patients also were divided into two groups: complete (American Spinal Injury Association (ASIA-A)) and incomplete injury (ASIA-B, ASIA-C). The evaluation of the level of patients' independence was dependent on the level of injury: C4; C5; C6; C7-C8; Th1-Th9; Th10-L1; L2-S5 segments. Functional state and activity were evaluated by Functional Independence Measure (FIM). Effectiveness of occupational therapy was supposed to be good, if predicted independence level of final rehabilitation was achieved by a patient and it was supposed to be unsatisfactory if the same level of independence was not achieved. RESULTS: The examination of patients has shown that 21 (15.4%) patients had complete injury (ASIA-A) in cervical level and 41 (30.2%) patients had complete injury in thoracic-lumbar level. Thirty-five (25.7%) patients had incomplete injury in cervical area and 39 (28.7%) patients in thoracic-lumbar level. At the end of early rehabilitation period in the case of complete spinal cord injury in cervical level (C4-C8) the expected level was achieved by 33.3-100% of patients. In the case of incomplete injury the expected level was achieved by 87.5-100% of patients. No patient with spinal cord injury in thoracic-lumbar (Th1-S5) level achieved the expected level of independence of final rehabilitation in early rehabilitation period. CONCLUSIONS: Patients with spinal cord injury had disturbances of all activities according to FIM in early rehabilitation. The level of spinal cord injury had greater influence on the level of independence of patients with injury in cervical level rather than in thoracic-lumbar level. The level of independence in early rehabilitation period was achieved in 17.7% of complete spinal cord injury cases and in 45.9% of incomplete spinal cord injury cases.

[Influence of factors on independence of patients after stroke in early rehabilitation stage]. / Veiksniai, turintys itakos serganciuju galvos smegenu insultu savarankiskumui ankstyvuoju reabilitacijos laikotarpiu.

UNLABELLED: Brain stroke is the main cause of disability starting from age of 40 years. Due to this disability, a person loses his ability to work because of long-lasting disorders of biosocial functions. According to literature, occupational therapy for such patients, taking regard to their social, cultural and economic background, significantly increases their self-care and independence and helps to educate working skills. OBJECTIVE. To evaluate conditional disorders of patients with stroke under rehabilitation and to establish the influence of extent of brain damage, localization, age and gender on effectiveness of occupational therapy. MATERIAL AND METHODS: Study included 47 men and 53 women diagnosed with brain ischemia or hemorrhage (ischemic or hemorrhagic stroke). Out of them, 30 were of working age (18-59 years old) and 70 of non-working age (more than 60 years old). The mean age was 63.4+/-1.2 years. In order to assess the functional status of patients, they were tested using the Functional Independence Measure (FIM). RESULTS AND CONCLUSIONS: At the start of rehabilitation, the mean FIM score was 47.4+/-16.1 (48.9+/-15.6 for men and 46.3+/-16.6 for women, p>0.05). At the end of early rehabilitation, the mean FIM score reached up to 89.9+/-22.3 (94.7+/-18.9 for men and 85.7+/-24.3 for women, p<0.05). Evaluation of functional status showed that at the start of rehabilitation functional status was worse in women than men, nevertheless, women's functional status improved during rehabilitation, though the difference between men and women still remained. Occupational therapy was less effective for patients who suffered from hemiplegia than for patients with hemiparesis (p<0.01). Older patients (more than 60 years) had more expressed functional disorders, and worse functional recovery comparing with younger, working age patients (18-59 years old). Evaluation of occupational therapy effectiveness at the end of early rehabilitation showed that extent of brain damage influences independence of patients suffering from brain stroke (p<0.01).

[Influence of complications on independence of patients with spinal cord injury in early rehabilitation]. / Komplikaciju itaka pacientu, patyrusiu nugaros smegenu pazeidima, savarankiskumui ankstyvosios reabilitacijos laikotarpiu.

OBJECTIVE: To evaluate the influence of complications on independence of patients after spinal cord injury during rehabilitation. MATERIAL AND METHODS: Data were collected on 130 patients with spinal cord injury admitted to the Clinic of Rehabilitation, Kaunas University of Medicine Hospital in 1999-2004. The study population consisted of 94 (72.3%) males and 36 (27.7%) females. Their age ranged from 16 to 80 years. The functional improvement was determined in terms of progress in independence in twelve daily living skills using Functional Independence Measure scale. Neurological status was evaluated by Standard Neurological Classification of traumatic spinal cord injury. Also, during early rehabilitation period complications were evaluated. Patients were divided into two groups: patients with complications and patients without complications during rehabilitation. More passive occupational therapy procedures were applied to patients with complications in comparison with patients without complications. RESULTS AND CONCLUSIONS: The results of the study showed that 44 (33.8%) cases were without complications during rehabilitation and 86 (66.2%) patients had complications. The most frequent complications were chronic pain (55.8%), urinary infection (43%), spasticity (30.2%) and pressure ulcers (20.9%). No statistically significant dependence was found between the rate of complications and age, gender and level of injury (p>0.05). Statistically significant dependence has been observed only between the rate of complication and completeness of injury (p<0.05). The change of the increased independence of patients without complications during rehabilitation was statistically significantly greater in comparison with patients who had complications (p<0.05).

[Influence of factors on occupational therapy efficiency for patients after stroke]. / Veiksniai, turintys itakos serganciuju galvos smegenu insultu ergoterapijos efektyvumui.

About 80% of patients become disabled after stroke due to cognitive, motor dysfunctions leading to unsatisfactory daily activity and efficiency. The aims of the research were to evaluate the level of biosocial dysfunctions of patients with stroke by functional independence measure (FIM) and to assess the effectiveness of occupational therapy and factors influencing it. The contingent of the examined patients consisted of 100 patients with stroke and rehabilitated in the Department of Neurorehabilitation of Kaunas University of Medicine Hospital. The findings of the research have shown that occupational therapy is effective to all patients. However, there were significant differences in the averages of FIM points (p<0.05) between low, medium and high effectiveness groups. The conclusion has been made that the effectiveness of occupational therapy is influenced by the following factors: the level of injury, the localization of brain damage, dysuria, passage, memory dysfunctions, unilateral neglect (p<0.05).

[Health resorts and development of the health resort medicine in Lithuania]. / Kurortai ir kurortologijos pletra Lietuvoje.

Lithuanian health resorts are national resources of this country. Body hardening, health promotion, disease prevention and rehabilitation by means of applying natural factors are linked for centuries with the names of health resorts such as Druskininkai and Birstonas. The effect of natural factors is multiplex and depends on many parameters the study of which in concrete health resorts is indispensable in order to individualize the treatment at the health resorts and avoid undesirable side effects. As the contingent of the patients being referred to the sanatoria is changing--the number of severe patients after acute disorders and traumas is increasing constantly--the need of such studies becomes relevant. However, after renewal of independence of Lithuania in 1990, the policy of health resort development on the national scale has not been carried out yet. Besides, the number of localities that aim for becoming health resorts is increasing, however, such localities often do not meet the required criteria. The article reviews the status of health resorts and their localities together with their regulations in Lithuania, their development, specificity, the effects of the health resort natural factors (climatotherapy, balneotherapy, pelotherapy) on the healthy body and patients. The data are presented on the development of research studies concerning health resorts and main trends of health resort medicine: health promotion, prevention of disorders, early health resort rehabilitation, health resort tourism, treatment and health resort etiology. Possibilities of revival of studies concerning the effects of health resort factors on the rehabilities are discussed.