[An assessment of the functional status in the neurorehabilitation of patients after ischemic stroke].

OBJECTIVE: Introduction: In this article, the authors focused on the symptoms of ischemic stroke and the effect of neurorehabilitation methods on the functional status of patients after ischemic stroke. The aim of the study was to evaluate and compare the functional status of patients after ischemic stroke with improved classic kinesiotherapy, classic kinesiotherapy and NDT-Bobath and classic kinesiotherapy and PNF. PATIENTS AND METHODS: Materials and methods: The study involved 120 patients after ischemic stroke. Patients were treated in the Department of Rehabilitation and Physical Medicine USK of Medical University in Lodz. Patients were divided into 3 groups of 40 people. Group 1 was rehabilitated by classical kinesiotherapy. Group 2 was rehabilitated by classic kinesiotherapy and NTD-Bobath. Group 3 was rehabilitated by classical kinesiotherapy and PNF. In all patient groups, magnetostimulation was performed using the Viofor JPS System. The study was conducted twice: before treatment and immediately after 5 weeks after the therapy. The effects of applied neurorehabilitation methods were assessed on the basis of the Rivermead Motor Assessment (RMA). RESULTS: Results: In all three patient groups, functional improvement was achieved. However, a significantly higher improvement was observed in patients in the second group, enhanced with classical kinesitherapy and NDT-Bobath. CONCLUSION: Conclusions: The use of classical kinesiotherapy combined with the NDT-Bobath method is noticeably more effective in improving functional status than the use only classical kinesiotherapy or combination of classical kinesiotherapy and PNF patients after ischemic stroke.

Location of the ischemic focus in rehabilitated stroke patients with impairment of executive functions.

BACKGROUND: Executive dysfunctions are part of the clinical symptoms of a stroke and can inhibit the process of rehabilitation. Patients with impaired executive functions may manifest aggression, impulsiveness, impaired thinking and planning. OBJECTIVES: The aim of this study was to assess the effect of the ischemic focus location on the effectiveness of physiotherapy in improving the executive functions in patients after stroke. MATERIAL AND METHODS: Ninety patients after unilateral ischemic cerebral stroke were studied. We studied 45 patients treated at the Department of Rehabilitation and Physical Medicine of the WAM University Hospital of Lodz for 5 weeks. The rehabilitation program included: kinesitherapy, physiotherapy, speech therapy, psychological consultations and psychotherapy. The control group consisted of patients who were waiting for admission to the Department of Rehabilitation. The patients in both groups were divided into three subgroups with different locations of stroke: front, back and subcortical. Executive functions were measured by the Wisconsin Card Sorting Test (WCST), the trail making test (TMT - A, TMT - B), the verbal fluency test (VFT). RESULTS: Patients rehabilitated in the hospital with the front and subcortical lesion location reported improvement in executive functions in terms of a greater number of the analyzed indicators of the Wisconsin Card Sorting Test (WCST) than those with the back lesion location. Patients rehabilitated at home with the subcortical lesion location did not experience a significant improvement in executive functions in any of the analyzed indicators of the Wisconsin Card Sorting Test (WCST). Most of the indicators, with the exception of the total errors of Wisconsin Card Sorting Test (WCST) and TMT B, have not been modified by the location of stroke. CONCLUSIONS: Executive dysfunction occurs not only in patients with an anterior location of the stroke, but also in the posterior and subcortical locations. Patients with a subcortical location of the stroke require more treatment to mitigate the dysfunction.

[The education influence on effects of rehabilitation in patients after stroke]. / Wplyw edukacji zdrowotnej na wyniki rehabilitacji u pacjentów po udarze mózgu.

Patients after stroke face a new situation where some educational and pedagogical actions should be reinitiated. Stroke often causes a break away from the previous lifestyle. It the acute phase it excludes the possibility of employment or performance of household duties that were carried out before or indulging in previously preferred ways of spending free time. Patients often abandon the habits that they developed before stroke, inclusive of hygienic habits. Therefore, it is an important objective of rehabilitation to reinstate in stroke patients behaviours characteristic of their peers, which would mark the beginning of their own care for health. The pedagogic and educational activities should lead to a transformation in the patient. This could be one of the factors in facilitating the patient's return to previous forms of activity. AIM: The aim of this study was to analyze progress in patient's rehabilitation and satisfaction, to assess impact of health education on higher satisfaction and better knowledge in stroke patients as well as on their recovery. Another aim was to assess the factors that maximize the patients' chances of returning to the labor market. MATERIALS AND METHODS: The study involved 30 patients after stroke, 8 women and 22 men, over 40 years of age, who underwent either early or late rehabilitation, the type of which affected the time of treatment. The minimal duration of the patient's stay was 21 days, in which time an individually tailored way of education, rehabilitation, treatment and care was implemented. The study used a questionnaire and the Bartel and the Rankin scales. The subject of the analysis consisted of 22 questions that were based on hypotheses. They assessed the facts, the sources of information, knowledge and subjective feelings of the patients concerning the education carried out by the rehabilitation team and its impact on the patients' rehabilitation. RESULTS: A highly significant (p<0,01) improvement to patients' health and an increase in their knowledge were observed in the rehabilitation. CONCLUSIONS: During the rehabilitation patients gained a significant improvement to their health, which resulted in more independence in daily living. The implemented health education has an effect on the scope of the patients' knowledge during and after rehabilitation, which translates into a higher satisfaction from the patient's education. The acquired knowledge and skills increase the chances of the patient to return to activities and participation in social life at a satisfactory level. The members of the rehabilitation team, especially the physicians, play an important role in health education of patients.

[Assessment of the pain patients with the multiple sclerosis after applying the physiotherapy treatment]. / Ocena delegliwosci bólowych u chorych na stwardnienie rozsiane po zastosowaniu zabiegów fizjoterapeutycznych.

UNLABELLED: Multiple sclerosis is one of the most common demyelinating disease of the CNS connected with the autoimmune action. The effect of the disease is progressive disability, and one of the symptoms is pain. In relieving pain in the course of MS physical procedures and exercises of physiotherapy are used. AIM: The aim of the study was assessment of the pain in patients with the multiple sclerosis after applying laser radiation, magnetostimulation and kinesiotherapy. MATERIALS AND METHODS: The studied material was consisted of 120 patients with multiple sclerosis of both sexes (82 women and 38 men) aged 21-81 years. Patients were randomly divided into 4 treatment groups and the assesment was performed three times. In the first group laser therapy, in the group II laser and magnetostimulation, in the third group kinesiotherapy, in the fourth group magnetostimulation was used. The same program of physiotherapy in all groups was used. All patients were performed the following tests to assess of the pain: The Laitinen Modified Questionnaire Indicators of Pain of and the Visual- Analogue Scale (VAS). RESULTS: In all treatment groups was observed tends to decrease a result of a point in The Laitinen Modified Questionnaire Indicators of Pain and the Visual-Analogue Scale (VAS). Correlation between groups demonstrated statistically significant result on the level p<0.05 in the group where the laser treatment was applied towards group II assessed with parameter of the Questionnaire of Pain according to Laitinen, as well as towards group II and III assessed with parameter - of the Visual Analogue Scale (VAS). The good result, i.e. the reduction of the spot value, after the III examination towards the preliminary examination were got in the group II. CONCLUSIONS: Laser radiation is an effective method which has an analgesisc action. The combination of laser radiation and magnetostimulation reduces pain in patients with multiple sclerosis, and also allows to maintain a therapeutic effect even after the cessation of the application of these procedures, which indicates the possibility to elicitation the biological phenomenon of hysteresis in these methods.

[Assessment of degree of functional efficiency patients with the gonarthrosis after applying physiotherapy]. / Ocena stopnia sprawnosci funkcjonalnej pacjentów z choroba zwyrodnieniowa stawów kolanowych po zastosowanej fizjoterapii.

UNLABELLED: Gonarthrosis is the most important problem of contemporary medicine. Social and economic aspect of this phenomenon caused the World Health Organization gave it the status of "disease of civilization". AIM: The aim of the study was assessment of the impact chosen models of physiotherapy proceedings on the functional efficiency of patients with the gonarthrosis. MATERIALS AND METHODS: In the study took part in 120 patients of both sexes divided into 4 groups. Group I - 30 patients with the gonarthrosis who have been applied electrostimulation of Kot'z and static exercises with biofeedback of extensors and flexors of the knee joint. Group II - 30 patients with the gonarthrosis who have been applied electrostimulation of Kot'z and dynamic exercises of muscles working on the knee joint. Group III - 30 patients with the gonarthrosis who have been applied static exercises with biofeedback of extensors and flexors of the knee joint, without electrostimulation. Group IV - 30 patients with the gonarthrosis who have been applied dynamic exercises of muscles working on the knee joint, without electrostimulation. Participants in the project were examined twice (before the starting and after finishing rehabilitation) and the level of the functional efficiency of patients was assessed based on results of the Functional Lequesne Index for knee joints. RESULTS: Results collected at this work are confirming the dominant role of the model of therapy from the group I (Kot'z electriostimulation and static exercises with biofeedback) in the forming of the functional efficiency of patients with the gonarthrosis. Results of this group, in the statistically significant way differ from of the patients from the group III (only static exercises) and IV (only dynamic exercises). No significant diferences between groups I and II confirm the tkey role in the forming of the result of Kot'z electrostimulation. CONCLUSIONS: Combination of kinesio exercises and Kot'z electrostimulation influences significally on increasing of the functional efficiency patients with gonarthosis. Out of all analysed models of therapy it turned out that the most effective is combination of "Russian stimulation" and static exercises with biofeedback.

[The overall assessment of the quality of the physical health of patients with multiple sclerosis after the application of physical therapy. Part 1]. / Calosciowa ocena jakosci zdrowia fizycznego pacjentów ze stwardniniem rozsianym po zastosowaniu zabiegów fizjoterapeutycznych. Czesc 1.

INTRODUCTION: Multiple sclerosis is one of the demyelinating diseases of the central nervous system. The biggest problem of patients affected by this disease are physical limitations which force many times to changes in employment and dependent on their families.The progressive disability significantly reduces the quality of life of patients with MS. MATERIAL AND METHODS: The study involved 120 patients with multiple sclerosis at the age of 21 - 81 years. Patients were divided into four groups, and the test was performed three times. In the first group was used laser therapy, group II laser and magnetostimulation, in the third group kinesiotherapy in the fourth group magnetostimulation. In all patients MSQOL (Quality of Life Questionnaire-54) was carried out, this survey analyzed overall assessment of physical health. RESULTS: In all test groups was observed tends to decrease as a result of a point in Quality of Life Questionnaire MSQOL-54 and continuation in this relationship even after cessation of use of these therapies. The correlation between the two groups showed a statistically significant result at the level of p <0.001 in the group I and II in relation to group III and IV. CONCLUSIONS: Synergic action of laser radiation and magnetic stimulation, causing a plurality of changes at the cellular and tissue level, has a beneficial effect on improving functional status, and thereby improves the quality of life of patients with multiple sclerosis. Thanks to physical therapy, it is possible to achieve long-term effects of therapy, which proves the biological hysteresis phenomenon. Such results can not be achieved with using monotherapy only - by kinesiotherapy.

Application of laser radiation and magnetostimulation in therapy of patients with multiple sclerosis.

BACKGROUND: Multiple sclerosis is one of the most common neurological disorders. It is a chronic inflammatory demyelinating disease of the CNS, whose etiology is not fully understood. Application of new rehabilitation methods are essential to improve functional status. OBJECTIVE: The material studied consisted of 120 patients of both sexes (82 women and 38 men) aged 21-81 years. The study involved patients with a diagnosis of multiple sclerosis. The aim of the study was to evaluate the effect of laser radiation and other therapies on the functional status of patients with multiple sclerosis. METHODS: Patients were randomly divided into four treatment groups. The evaluation was performed three times - before the start of rehabilitation, immediately after rehabilitation (21 days of treatment) and subsequent control - 30 days after the patients leave the clinic. The following tests were performed for all patients to assess functional status: Expanded Disability Status Scale (EDSS) of Kurtzke and Barthel Index. RESULTS: Results of all testing procedures show that the treatment methods are improving the functional status of patients with multiple sclerosis, with the significant advantage of the synergistic action of laser and magneto stimulation. The combination of laser and magneto stimulation significantly confirmed beneficial effect on quality of life. The results of these studies present new scientific value and are improved compared to program of rehabilitation of patients with multiple sclerosis by laser radiation which was previously used. CONCLUSIONS: This study showed that synergic action of laser radiation and magneto stimulation has a beneficial effect on improving functional status, and thus improves the quality of life of patients with multiple sclerosis. The effects of all methods of rehabilitation are persisted after cessation of treatment applications, with a particular advantage of the synergistic action of laser radiation and magneto stimulation, which indicates the possibility to elicitation in these methods the phenomenon of the biological hysteresis.

[Physiotherapeutic proceeding in symptomatic calcaneal spur treatment].

Calcaneal spur is one of the most common disorders associated with foot pain. According to appearance of pain in each step during the day, it is important to find the most effective method of treatment. This article is a review of medical reports about non-operative treatment method. It shows that ultrasound therapy was the most common physical intervetion used so far, and mostly occurs to be effective. However one of the comparative studies improves higher efficiency of phonopheresis. Another comparative study, shows higher efficiency of combined ultrasound and laser therapy, than exclusive laser therapy. There haven't been found any articles that would evaluate efficacy of electrotherapy and short wave diathermy (electric field) in the treatment of mentioned disorder. Studies that describe the effect of ESWT treatment were also analyzed in this article, and all of them confirm its effectiveness in heel spur therapy, showing no side-effects. Cryotherapy also causes positive effect in treatment of this disorder. However Cryoultrasound therapy that uses the energy of two interconnected terapeutic techniques which is cryotherapy and ultrasounds, proved to be more effective.

[The influence of high-tone power therapy on the functional status of patients with multiple sclerosis]. / Wplyw terapii energotonowej na stan funkcjonalny chorych na stwardnienie rozsiane.

UNLABELLED: Multiple sclerosis is a chronic, inflammatory, demyelinating disease of the central nervous system, which is characterized by diverse symptomatology. Most often affects people at a young age gradually leading to their disability. Looking for new therapies to alleviate neurological deficits caused by the disease. One of the alternative methods of therapy is high - tone power therapy. The article is a comparison of high-tone power therapy and kinesis in improving patients with multiple sclerosis. The aim of this study was to evaluate the effectiveness of high-tone power therapy and exercises in kinesis on the functional status of patients with multiple sclerosis. MATERIAL AND METHODS: The study involved 20 patients with multiple sclerosis, both sexes, treated at the Department of Rehabilitation and Physical Medicine in Lodz. Patients were randomly divided into two groups studied. In group high-tone power therapy applied for 60 minutes, while in group II were used exercises for kinesis. Treatment time for both groups of patients was 15 days. To assess the functional status scale was used: Expanded Disability Status Scale of Kurtzke (EDSS), as well as by Barthel ADL Index. Assessment of quality of life were made using MSQOL Questionnaire-54. For the evaluation of gait and balance using Tinetti scale, and pain VAS rated, and Laitinen. Changes in muscle tone was assessed on the basis of the Ashworth scale. RESULTS: Both group I and II improved on scales conducted before and after therapy. In group I, in which the applied high-tone power therapy, reported statistically significant results in 9 out of 10 tested parameters, while in group II, which was used in the exercises in kinesis an improvement in 6 out of 10 tested parameters. Correlating the results of both the test groups in relation to each other did not show statistically significant differences. CONCLUSIONS: High-Tone Power Therapy beneficial effect on the functional status of patients with multiple sclerosis. Obtaining results in terms of number of tested parameters allows for the use of this therapy in the comprehensive improvement of patients with multiple sclerosis. Exercises from the scheme kinesis favorable impact on the functional status of patients with MS and are essential in the rehabilitation of these patients. In any group, no adverse effects were observed.

[The effect of neurorehabilitation on the functional state and muscle tone of upper limb in patients after ischaemic stroke]. / Wplyw neurorehabilitacji na stan funkcjonalny i napiecie miesniowe konczyny górnej u chorych po udarze niedokrwiennym mózgu.

UNLABELLED: Rehabilitation of upper limb in patients after ischemic stroke is a major challenge for modern neurorehabilitation. Function of upper limb of patients after ischemic stroke returns on the end of the rehabilitation comparing with another parts of the body. Below presents two groups of patients after ischemic stroke who were rehabilitated with use of the following methods: kinesiotherapy combined with NDT- Bobath method and kinesiotherapy only. The aim of this study was to assess the impact of kinesiotherapy only and NDT- Bobath method combined with kinesiotherapy on the functional state and muscle tone of upper limb in patients after ischemic stroke. MATERIAL AND METHODS: The study involved a group of 40 patients after ischemic stroke with motor control and muscle tone problems of upper limb. Patients were divided into two groups, each of them included 20 people. Upper limb in group I was rehabilitated with the use of kinesiotherapy exercise however group II with the use of kinesiotherapy exercise combined with NDT- Bobath method (Neurodevelopmental Treatment Bobath). To evaluate the patients before and after rehabilitation muscle tone Asworth scale was used and to assess functional status Rivermead Motor Assessment (RMAIII) scale was used. RESULTS: After 5 weeks of rehabilitation in group II in majority patients were observed decrease of muscle tone and improvement in upper limb functional status. In group I the muscle tone were also decreased and functional status were better but in smaller impact than in II group. CONCLUSIONS: Classical kinesiotherapy combined with the NDT-Bobath method gives better results in neurorehabilitation of upper limb than the use of kinesiotherapy exercises only in patients after ischemic stroke.

[Comparison of the effects of rehabilitation in stroke patients rehabilitated in stationary conditions and the home]. / Porównanie efektów rehabilitacji u chorych po Udarze mózgu usprawnianych w warunkach stacjonarnych i warunkach domowych.

UNLABELLED: Rehabilitation after stroke is to help the patient recover optimal physical condition, psychosocial and vocational. Standard of care is to ensure comprehensiveness and continuity of the rehabilitation process. THE AIM OF THE STUDY: Was to compare the effects of rehabilitation in stroke patients rehabilitated in the hospital and at home. MATERIAL AND METHODS: The 90 patients after ischemic stroke were examined. The first examined group (45 people) consisted ofpatients rehabilitated at the Department of Rehabilitation and Physical Medicine of the WAM University Hospital in Lodz. The second examined group number (45 people) consisted of patients waiting for admission to the Department of Rehabilitation, who were rehabilitated in environmental conditions. The patients were examined twice: first before the rehabilitation (study I) and then at the end of rehabilitation program (study II). Functional status was examined with the Barthel ADL Index and the Brunnstrom scale. RESULTS: Both individuals after stroke rehabilitated in hospital and those rehabilitated in environmental conditions achieved a significant improvement in functional of paretic limbs and improving independence in activities of daily living. However, the improvement observed in the hospital group was significantly higher. Better positive effects in patients included hospital rehabilitation is achieved through the implementation of comprehensive treatment of the involvement in the therapeutic process the entire interdisciplinary team. CONCLUSIONS: The comprehensive stationary rehabilitation significantly affected on improving the functional ability of stroke compared to those rehabilitated in environmental conditions. Rehabilitation at home, even though it is associated with certain restrictions is an important element in the overall process of rehabilitation.

[The use of transdermal therapeutic systems in physical therapy]. / Zastosowanie terapeutycznych systemów transdermalnych w terapii fizykalnej.

Methods of the transdermal administration of drugs have long been sought in the medical field in order to ensure the noninvasive and painless transmission of the medicine. Such methods include the TTS (transdermal therapeutic system). It is a method, or rather a set of methods that allows the introduction of the drug to the sites of pathologically changed areas without the pharmacological burdening of the whole body. An important aspect of this treatment is that the substance can be introduced passively (even to unconscious or sanity-limited patients) or actively, i.e. exactly at the point of the pathological changes, thus avoiding contraindications for applications in the general purpose and discomfort of the patient. The transdermal therapeutic system can be found in various areas of medicine. It is also increasingly beginning to act as an alternative to a number of other areas such as pharmacotherapy, physical therapy, and cosmetology; as a precognitive application, hormonal substitution, nutritious, analgesic, anti-inflammatory, or anti-swelling application; an application for the treatment of scars, delayed fracture healing, the neuromuscular stimulation, trophy of tissues; or a bacteriostatic application. Further research in this area seems to have a great practical significance.

[The effect of standard kinesiotherapy combined with proprioceptive neuromuscular facilitation method and standard kinesiotherapy only on the functional state and muscle tone in patients after ischaemic stroke]. / Wplyw metod kinezyterapii klasycznej oraz proprioceptywnego nerwowo-miesniowego torowania ruchu i kinezyterapii klasycznej na stan funkcjonalny i napiecie miesni u pacjentów po przebytym udarze niedokrwiennym mózgu.

UNLABELLED: The ischemic stroke is a disease of the central nervous system. Up until today there have been very few scientific findings concerning the most effective methods of patients rehabilitation. The authors of this article present two groups of patients after ischemic stroke who were rehabilitated with use of the following methods: kinesiotherapy combined with PNF (proprioceptive neuromuscular facilitation) method and kinesiotherapy only. The aim of this study was to assess the impact of kinesiotherapy only and PNF method combined with kinesiotherapy on the functional state and muscle tone in patients after ischaemic stroke. MATERIAL AND METHODS: The study involved a group of 30 patients after ischaemic stroke. Patients were divided into two groups, each of them comprising 15 people. Group I was rehabilitated with the use of kinesiotherapy exercise and group II with the use of kinesiotherapy exercise combined with PNF method. To evaluate the patient before and after rehabilitation muscle tone Asworth scale was used and to assess functional status Rivermed Motor Assessment (RMA) scale was used. RESULTS: Both in group I and II an improvement in muscle tone and functional status were noted. Better results were observed in group II in which patients were rehabilitated with the use of kinesiotherapy exercise combined with PNF method. All results in group I and II displayed a statistically significant improvement in functional status and muscle tone. CONCLUSIONS: The use of the classical kinesiotherapy only had a noticeably smaller impact on improvement of functional status and muscle tone in patients from group I than the use of both: classical kinesiotherapy and PNF method which were employed in group II.

[Application of laser therapy in the physiotherapy of patients with multiple sclerosis]. / Zastosowanie promieniowania laserowego w fizjoterapii chorych na stwardnienie rozsiane.

Multiple sclerosis is a chronic disease of the nervous system, which main manifestations are disseminated demyelinated the changes in the central nervous system. The pathogenesis of this disease is still not known, the curative treatment is not possible. In connection with the alleged autoimmune genesis of MS patients are administered immunomodulatory drugs. Patients with multiple sclerosis suffer from a number of symptoms associated with this disease. The aim of this article is to present the main clinical symptoms characteristic of MS and to present biological effects of low-energy lasers used in the treatment of multiple sclerosis.

[NDT-Bobath method used in the rehabilitation of patients with a history of ischemic stroke]. / Metoda NDT-Bobath stosowana w rehabilitacji pacjentów po przebytych udarach niedokrwiennych mózgu.

Ischemic stroke is the third leading cause of death and disability in human. The vitally important problem after ischemic stroke is hemiparesis of the body. The most common methods used in improving the mobility of patients after ischemic stroke is a Bobath-NDT (Neuro-Developmental Treatment - Bobath), which initiated the Berta and Karel Bobath for children with cerebral palsy. It is a method designed to neurophysiological recovery of these vital functions that the patient was lost due to illness, and wants it back.