Trunk and Hip Analysis During Gait in Post-Discectomy, Active Lumbar Stabilization.

This paper presents a post-discectomy rehabilitation program through active lumbar stabilization with focus on trunk and hip movement analysis during gait. Material and methods: Analysis consisted of a kinematic gait study, with kinematic point tracking and software data processing in MATLAB. The analysis was performed on a patient with L5-S1 discectomy. The purpose was to track progress and change in trunk and hip during the rehabilitation program and to establish a relationship between trunk and hip movement during gait, in regards to the patient's rehabilitation program. Results: Trunk and hip analysis during gait showed significant differences in patient hip and trunk rotational movement between the three analyzed readings of the patients. Changes were found in both left and right hip flexion-extension coupling and flexion in terminal swing. The rotational movement of the trunk is reduced in a more physiological margin from -13.4 to -1.0 anterior-posterior movement which correlates with unimproved in transversal rotation. The analysis made for hip and trunk synchronization revealed an increased synchronization after the end of the functional reeducation program. Conclusions: This method allowed to evaluate changes in trunk and hip motion during gait. Tracking and visualizing the motion between trunk and hip during gait gives a better understanding of the importance of each movement and the strong link between gait phase coordination and motion angle amplitude. It gives a new perspective on the rehabilitation process that targets lumbar stabilization.

PSYCHOTIC DISORDERS GENERATED BY AUTOIMMUNE ENCEPHALITIS (CLINICAL CASE).

Encephalitis is a brain inflammation, which could involve also the meninges. The etiology of encephalitis could be: viral, bacterial, fungal or autoimmune. Anti-NMDAR encephalitis is an immune disorder, easy to diagnose and is a treatable condition. Most patients with anti-NMDAR encephalitis develop a multistage illness that progresses from psychosis, memory deficits, seizures, to catatonic state and breathing instability. We present a case report of a 20-year old woman, who presented: amnesia, visual hallucination, illusions, seizures after that occurred following autoimmune encephalitis. The exact incidence of anti-NMDAR encephalitis is unknown, but it seems to be more frequent than any other known paraneoplastic encephalitis. The present case is important considering that autoimmune encephalitis is a rare frequency disorder in Romania, with patients presenting resounding psychiatric and neurological manifestations.

Neuro-proprioceptive facilitation in the re-education of functional problems in facial paralysis. A practical approach.

UNLABELLED: Facial paralysis, in the form of Bell's syndrome, is an acute paralysis of idiopathic origin. Disability in patients with this medical condition is the result of impairment or loss of complex and multidimensional functions of the face like emotion expression through facial mimics, facial identity and communication. AIM: This study aimed to present new and improved practical manual techniques in the area of facial neuromuscular facilitations and to review the literature for disability indexes and facial nerve grading. MATERIAL AND METHODS: We present the practical modality of using neuro-proprioceptive facilitation techniques, such as rhythmic initiation, repeated stretch (repeated contractions), combination of isotonics and percussion, and also report the effects of these techniques in three Bell's syndrome patients which were previously evaluated. CONCLUSIONS: Recovery from facial paralysis can be a difficult and long lasting process and the utilization of a grading system may help the physical therapist. The effects of this type of therapy may help_benefit the patient if the therapist is well trained and familiar with the neurophysiological background.

[Discarthrosis with hyperalgic lumbar multileveled radicular syndrome]. / Spondilo-discartroza cu sindrom lombar radicular etajat hiperalgic.

UNLABELLED: The problems at the level of intervertebral discs are producing dysfunctions and important functional regression at the level of lumbar column, at a stage at which the patient could remain blocked in an anterior or lateral flexion position or producing an antalgic position of scoliosis that could incapacitate the patient to perform activities of daily living. The medical rehabilitation, in such cases, must seek not only the relief of local pain through different methods of obtaining it, but also the functional reeducation of the intervertebral articulations through specific analytical mobilization in order to achieve the biomechanical harmonization of the rachis. MATERIAL AND METHODS: We report the case study of a 66 year-old patient who presented to our clinic for medical consult and physical therapy when he was diagnosed with discharthrosis, hyperalgic lumbar multileveled radiculopathy at L4-L5 and L5-S1. The lumbar x-ray showed osteophytes, disc narrowing at the level of L5-S1 and inter-apophysis arthrosis. The clinical examination revealed difficulty walking with pain in the right sacroiliac articulations and right sciatic emergence with plantar paraesthesia. The patient developed pain induced scoliosis on the right side that restricted the lumbar range of motion and prevented the right flexion blocking him into an left flexion, any attempt of straightening inducing pain. The condition was treated using specific analytical lumbar mobilization for the realignment of the vertebrae complex. CONCLUSIONS: In this case study, we found that functional reeducation in cases of pain induced deviations of the rachis of the column should be centered on the harmonization of inadequate pressure and position of the complex intervertebral articulations.

[Acute nontumoral brain edema--the pathogenic mechanisms and therapeutic principles]. / Edemele cerebrale acute netumorale--mecanisme patogenice, principii terapeutice.

Non-tumoral acute cerebral edemas represent a major problem of emergency medicine. The pathogenic mechanisms involved in the occurrence of non-tumoral acute cerebral edemas may be grouped into two categories--by pressure gradients: acute increase of hydrostatic intravascular and intraventricular pressure; acute decrease of intravascular osmotic pressure;--by tissue lesion involving: the cerebral capillaries (vasogenic edema) or the parenchymal cells (cytotoxic edema). From the acute edenogenous brain lesion, "second aggression factors" are released. In the various etiologic circumstances, this mechanisms appear associated and intricate in particular ways. The etiopathogenetic features of edema formation and their physiopathology effects have therapeutic significance.

[The transient ischemic attack, between diagnosis and treatment]. / Atacul ischemic tranzitoriu, între diagnostic si tratament.

The transient ischemic attack (TIA) in cerebral circulation in 161 patients is studied. The causes and favouring factors are analysed, arterial hypertension and dyslipidemias representing 70% of the factors that might be incriminated in the physiopathology of TIAs. The paraclinical and therapeutic results demonstrate that in over 30% of the cases the etiology could be explained by "the multiple defect theory", the importance of transcranial Doppler in the diagnosis and prognosis of TIA, especially in the young patients, being underlined.

Drug test value by transcranial Doppler in the diagnosis of neurologic vascular diseases.

The response to various drugs was studied in relation to intracranial vascularization under ultrasound control. The investigation was made in 461 patients (258 females and 203 males) aged between 18 and 87 years. Vasoactive substances interacting with the synaptic neurotransmitters metabolism directly or via CNS were used: papaverine, vincamine, sadamin, nicergoline, carbocromen, clonidine, captopril, magnesium sulphate, nifedipine, piracetam, nicotine, caffeine, dipyridamole, histamine, fentanyl. The normal arterial response was compared with the response of the involved atherosclerotic artery or with congenital malformation. The tests value in the diagnosis of neurologic vascular diseases is discussed.

[Transcranial Doppler exploration of the brain stem vascularization in neurological pathology]. / L'exploration de la vascularisation du tronc cérébral par transcranial Doppler dans la pathologie neurologique.

The hemodynamic alterations in the vertebrobasilar system arteries of 1051 patients are discussed. The aspects revealed by transcranial Doppler are classified as obstructions, stenoses and atherosclerotic type lesions. Their prevalence compared with the clinical diagnosis or through other investigation methods is commented upon, an etiological classification of such alterations in hemodynamics in the basilar and vertebral arteries being attempted. Multiple defect theory seems to be, in such cases as well, the clinical expression accounting for the pathogenic phenomena and response to drug tests.

Assessment of hemodynamic disturbances in aphasic patients by transcranial Doppler ultrasonography.

The author presents a study of Doppler cerebrovascular ultrasonography carried out in 38 aphasie patients (forms ranging from transient speech disturbances to severe, persistent disturbances of motor, sensory or mixed aphasia) after ischemic or hemorrhagic stroke. In these cases, the clinical symptoms were dominated by speech impairment and neurological deficits (mainly pyramidal), of low intensity or transient. The angiographic study revealed stenotic or occlusive disturbances at various levels of the cerebral arterial trunks. The prevalence of some clinical aspects of aphasia correlated with Doppler velocimetric images is discussed and the use of transcranial Doppler method in idiopathic aphasia, possible consequence of a transient ischemic attack, is suggested.

[Neurosonography reveals various etiologies of migraine]. / La neurosonologie--révélatrice de différentes étiologies dans la migraine.

125 patients with migraine were studied by determining the intracerebral blood flow by means of Doppler cranial neurosonography. The findings confirm the presence of certain nonsystematic vascular defects involved in the pathologic response of the synaptic factors of the cerebral blood flow, thus demonstrating the validity of the multiple pathologic arterial segments and the possibility of response to various therapies. The study classifies migraines based on Doppler cerebrovascular neurosonography.

[Intracerebral hemodynamic changes in lesions of the internal carotid arteries]. / Modificari intracerebrale de hemodinamica în leziunile arterei carotide interne.

The Doppler transcranial sonography is useful in making a correct, functional diagnosis of cerebral hemodynamics in the case of internal carotid artery lesions. Being a noninvasive method, it can be employed in following up the evolution of a stenosis, for assessing the collateral blood supply in the territory of the obstructed artery branches and thus for determining the prognosis of a cerebral infarction. For an adequate prophylactic and curative treatment the method is recommended, alone, in estimating the extra and intracranial circulation.

[Changes in the pulsatility index (Gosling) under drug action]. / La modification de l'indice de pulsatilité (Gosling) sous l'action des médicaments.

The alterations in cerebral hemodynamics induced by drugs (papaverine, Cavinton, magnesium sulphate, piracetam, histamine) in a series of 152 patients compared with a control series were analysed. The response of each basal cerebral artery to these drugs is assessed through the pulsatility index value.