Impact of musculoskeletal disorders in patients using orthopedic equipment on sternotomy wound healing after cardiac surgery - preliminary report.

BACKGROUND: The presence of locomotive disorders may negatively impact the outcome of cardiac surgeries. This retrospective study aimed to assess the effect of preoperative diagnosis of locomotive disorders requiring the continuous use of orthopedic devices on postoperative rehabilitation and stable sternum adhesion. MATERIAL AND METHODS: The study included 122 patients who underwent cardiac surgery, with 68 patients in the study group having a musculoskeletal disorder and 54 patients in the control group without such disorders. Preoperative demographic, clinical, and laboratory data as well as postoperative rehabilitation and sternum adhesion were evaluated. RESULTS: The results showed that patients in the study group had lower levels of calcium (p < 0.001), vitamin D (p < 0.001), and creatine kinase (p = 0.022) prior to the surgery. In the early postoperative period, 8 patients from the study group and 4 from the control group required reoperation due to sternal instability (p = ns). In the late postoperative period, sternal instability was present in 2 patients from the study group and 3 from the control group (p = ns). The survey study revealed a significantly better (p = 0.029) evaluation of postoperative rehabilitation among the study group patients. CONCLUSIONS: Overall, the results indicated that a preoperative locomotive disorder has no significant impact on sternal instability in the early or late postoperative periods. However, patients with such disorders have a better understanding of the importance, purpose, and course of rehabilitation after cardiac surgery and exhibit lower levels of calcium, vitamin D, and creatinine.

Can We Target Close Therapeutic Goals in the Gait Re-Education Algorithm for Stroke Patients at the Beginning of the Rehabilitation Process?

(1) Background: The study aimed to determine the most important activities of the knee joints related to gait re-education in patients in the subacute period after a stroke. We focused on the tests that a physiotherapist could perform in daily clinical practice. (2) Methods: Twenty-nine stroke patients (SG) and 29 healthy volunteers (CG) were included in the study. The patients underwent the 5-meter walk test (5mWT) and the Timed Up and Go test (TUG). Tests such as step up, step down, squat, step forward, and joint position sense test (JPS) were also performed, and the subjects were assessed using wireless motion sensors. (3) Results: We observed significant differences in the time needed to complete the 5mWT and TUG tests between groups. The results obtained in the JPS show a significant difference between the paretic and the non-paretic limbs compared to the CG group. A significantly smaller range of knee joint flexion (ROM) was observed in the paretic limb compared to the non-paretic and control limbs in the step down test and between the paretic and non-paretic limbs in the step forward test. (4) Conclusions: The described functional tests are useful in assessing a stroke patient's motor skills and can be performed in daily clinical practice.

Evaluating the Accuracy of Upper Limb Movement in the Sagittal Plane among Computer Users during the COVID-19 Pandemic.

(1) Background: The most common musculoskeletal pathology among healthcare professionals is neck and/or shoulder pain. The aim of this study was to determine the dominant upper limb functionality concerning the ability to replicate a given movement pattern among employees reporting neck or upper limb pain while using a computer during the COVID-19 pandemic. (2) Methods: The study was conducted from March to April 2021 on a group of 45 medical employees who used a computer workstation for 4 to 6 h of their working time. In the design of this study, three study groups were created: a group of patients with pain syndrome of segment C5/C7 of the spine, a group of patients with shoulder pain syndrome, and a control group of healthy volunteers. (3) Results: The examined groups significantly differed in the correctness of performing the given movement (p = 0.001) and the minimum value of inclination during the exercise session (p = 0.026), as well as the maximum lowering (p = 0.03) in relation to the control group. (4) Conclusions: The VECTIS device can be used to assess the accuracy of reflecting the prescribed movement of the upper limb in rehabilitation programs for patients with cervical spine pain syndrome and shoulder pain syndrome.

Perspectives of Motor Functional Upper Extremity Recovery with the Use of Immersive Virtual Reality in Stroke Patients.

Stroke is one of the leading causes of disability, including loss of hand manipulative skills. It constitutes a major limitation in independence and the ability to perform everyday tasks. Among the numerous accessible physiotherapeutic methods, it is becoming more common to apply Virtual Reality "VR". The aim of this study was to establish whether immersive VR was worth considering as a form of physical therapy and the advisability of applying it in restoring post-stroke hand function impairment. A proprietary application Virtual Mirror Hand 1.0 was used in the research and its effectiveness in therapy was compared to classical mirror therapy. A total of 20 survivors after ischaemic stroke with comparable functional status were divided into a study group (n = 10) and control group (n = 10). Diagnostic tools included 36-Item Short Form Survey "SF-36" and the Fugl-Meyer Assessment Upper Extremity "FMA-UE". Collected metrics showed a normal distribution and the differences in mean values were tested by the student's t-test. In both, the study and control groups' changes were recorded. A statistically significant outcome for FMA-UE and SF-36 measured by the student's t-test for dependent or independent samples (p > 0.05) were obtained in both groups. Importantly, proven by conducted studies, an advantage of VR proprietary application was subjective sensations amelioration in pain and sensory impressions. Applying Virtual Mirror Hand 1.0 treatment to patients after a stroke appears to be a good solution and definitely provides the opportunity to consider VR applications as an integral part of the neurorehabilitation process. These results give a basis to plan further larger-scale observation attempts. Moreover, the development of the Virtual Mirror Hand 1.0 as an innovative application in physiotherapy may become equivalent to classical mirror therapy in improving the quality and effectiveness of the treatment used for post-stroke patients.

Effect of Treadmill Training with Visual Biofeedback on Selected Gait Parameters in Subacute Hemiparetic Stroke Patients.

BACKGROUND: Functional limitations after a stroke are unique to each person and often include impaired independent mobility. A reduction in existing gait deficits after a stroke is often one of the main goals of rehabilitation. Gait re-education after stroke is a complex process, which consists of the effects of many therapeutic interventions. OBJECTIVE: The study aimed to analyze the effects of using a treadmill with visual feedback in gait re-education in the sub-acute stroke period and assess the impact of biofeedback treadmill training on selected gait parameters, improving static balance and reducing the need for orthopedic aids. METHODS: The study included 92 patients (F: 45, M: 47) aged 63 ± 12 years, with post-ischemic sub-acute (within six months onset) stroke hemiparesis, treated at a neurological rehabilitation ward. All patients participated in a specific rehabilitation program, and in addition, patients in the study group (n = 62) have a further 10 min of treadmill training with visual feedback. Patients in the control group (n = 30) participated in additional conventional gait training under the direct supervision of a physiotherapist. The evaluation of static balance was assessed with the Romberg Test. A Biodex Gait Trainer 3 treadmill with biofeedback function was used to evaluate selected gait parameters (walking speed, step length, % limb loading, and traveled distance). The use of an orthopedic aid (walker or a crutch) was noted. RESULTS: After four weeks of rehabilitation, step length, walking speed, traveled distance, and static balance were significantly improved for the study and control group (p < 0.05). Treadmill gait training yielded significantly better results than a conventional rehabilitation program. Only the study group observed a corrected walking base (p < 0.001). All participants showed a reduction in the use of walking aids (p = 0.006). There was no asymmetry in the % of limb loading for either group prior to or following rehabilitation. CONCLUSIONS: The treadmill with visual biofeedback as conventional gait training has resulted in a significant improvement in parameters such as step length, walking speed, static balance, and a reduction in the use of locomotion aids. However, the achieved improvement in gait parameters is still not in line with the physiological norm.

The Use of the ICF Classification Sheet to Assess Cognitive-Behavioral Disorders and Verbal Communication in Patients after Ischemic and Hemorrhagic Stroke during Rehabilitation.

Background: In patients after experiencing stroke, the cognitive-behavioral deficits and disorders of verbal communication limit the effectiveness of rehabilitation. The key is to diagnose them at an early stage of rehabilitation and to implement appropriate psychological and speech therapy. Objective: Identify differences in the frequency and effectiveness of cognitive-behavioral disorder therapy depending on the clinical type of stroke, assessed before and after rehabilitation treatment, and their presentation using the ICF (International Classification of Functioning, Disability, and Health) classification. Materials and Methods: The study was prospective and included the analysis of cognitive-behavioral and verbal communication disorders. The study consisted of 47 patients after intracerebral hemorrhage (ICH) and 47 patients after an ischemic stroke (IS) before the implementation of rehabilitation and after completing a 4-week rehabilitation. Results: In the group after ICH, psychological therapy significantly reduced the disturbances of consciousness and orientation (p < 0.001) and improved the speed of performing tasks in tests (p < 0.001). In patients after IS and ICH, memory and attention function improved significantly (p < 0.001). Moreover, in patients after ICH, language function deficits decreased significantly (p = 0.018). Mood disturbances were maintained in 17% of patients after ICH and 40% of patients after IS (p = 0.007). Speech therapy reduced speech articulation disorders and aphasia in 85% of patients after ICH (p = 0.001) and in 68% of patients after IS (p = 0.033). Conclusions: The frequency and type of cognitive-behavioral and verbal communication disorders vary depending on the history of ICH or IS. The ICF classification may be useful in assessing and analyzing cognitive-behavioral and verbal communication disorders, which may lead to the implementation of appropriate psychological and speech therapy at an early stage of rehabilitation and increase the effectiveness of the therapy.

Assessment of CVD Risk Factors in Secondary Prevention after Ischemic Stroke Using the ICF.

Background: Patients after undergoing ischemic stroke have a high risk of further cardiovascular disease (CVD) incidents. Monitoring risk factors is critical to prevent the recurrence of CVD. Objective: The aim of the study was to determine differences in the incidence of risk factors for CVD in a post-ischemic stroke patient group (SG) compared to the control group, which had not undergone ischemic stroke (CG), and to characterize them using the ICF (International Classification of Functioning, Disability and Health) classification system. Materials and Methods: The incidence of risk factors for recurrent CVD events were retrospectively analyzed in 55 patients in SG and 55 patients in CG. The results were translated into categories from the ICF classification system. Results: Atrial fibrillation (p = 0.013), carotid artery stenosis > 50% (p < 0.001), LDL > 71 mg/dL (p < 0.001), heart rate > 80/min (p = 0.007), taking NOAC (p = 0.008) and NSAIDs (p < 0.001) as well as nicotinism (p = 0.001) were significantly more common in SG compared to CG. The value of the distribution of the total incidence of CVD risk factors were observed to be higher for SG than for CG. In SG, both for males (p < 0.001) and females (p < 0.001) more risk factors for recurrent CVD incidents were observed compared to CG. Conclusions: Patients in SG differ in the occurrence of risk factors for CVD event compared to CG. The use of a single tool, such as the ICF assessment sheet, can be useful in assessing and analyzing risk factors for recurrent CVD events. This may help to reduce the risk of subsequent CVD events in secondary prevention.

Consequences of prolonged sedentary work during the COVID-19 pandemic.

PURPOSE: The COVID-19 pandemic has reduced physical activity and increased the time spent sitting. Combined with the lack of ergonomics at home workplaces, the risk of discomfort has increased, especially around the cervical spine and upper limbs. Evaluation of the mentioned problem is the subject of the study. METHODS: The study used an original questionnaire based on the Nordic Musculoskeletal Questionnaire. The analysis used responses from people who reported discomfort in the form of tingling or numbness in the cervical spine, shoulder, elbow and wrist during the pandemic. Statistical analysis of the results was carried out to formulate conclusions. In addition, individual data were presented as percentages. RESULTS: Considering the working time exceeding 8 hours a day, discomfort in the wrist joint area was most often reported among people working remotely (15.1%). Shoulder complex discomfort was the most common symptom (22%) reported by people working more than 8 hours a day, under the age of 31. In young people, the risk of discomfort in the shoulder, hand and cervical spine area increased. CONCLUSIONS: Extended working time is conducive to the appearance of symptoms within the hands. In future studies, it will be necessary to analyze the ergonomic factors responsible for this phenomenon.

Risk Factors for the Recurrence of CVD Incidents in Post-Stroke Patients over a 5-Year Follow-Up Period Based on the ICF Classification.

Background and Objectives: Stroke is a strong risk factor for recurrent cardiovascular disease (CVD) incidents. The risk of post-stroke CVD incidents can be reduced by eliminating the most relevant risk factors. The aim of the study was to compare the incidence of recurrent CVD events and to determine the quantitative and qualitative differences in CVD risk factors over the 5-year follow-up period in patients with ischemic stroke (IS) and haemorrhagic stroke (ICH) with the use of ICF classification categories to present these differences. Materials and Methods: The study was retrospective. The study groups included 55 post-IS patients and 47 post-ICH patients. The results were translated into the categories from the International Classification of Functioning, Disability and Health (ICF) classification. Results: As compared to post-ICH patients, post-IS patients were significantly more frequently observed to have recurrent CVD incidents (p < 0.001), including fatal CVD incidents (p = 0.003). More risk factors in total were identified in both post-IS patients (p = 0.031) and post-ICH patients (p = 0.002) who had a recurrent CVD incident. Post-IS patients were more often found to have arterial blood pressure higher than 140/90 mmHg (p = 0.045). On the other hand, post-ICH patients were more frequently observed to have carotid artery stenosis in the range of 50-69% (p = 0.028) and an eGFR of <15 mL/min/1.73 m2 (p = 0.001). Conclusions: The type of primary stroke determines the type and incidence of risk factors as well as the recurrence rate of CVD incidents over a 5-year follow-up period. Patients after IS have a higher risk of recurrence of CVD events, including fatal ones in the 5-year follow-up compared to patients after ICH. In addition, post-IS patients who have a recurrent CVD event over a 5-year follow-up have more risk factors for a CVD event than ICH. The ICF classification can be useful for assessing and analysing risk factors for recurrent CVD incidents, which can help to improve the effectiveness of secondary prevention.

The Use of Samsung Health and ECG M-Trace Base II Applications for the Assessment of Exercise Tolerance in the Secondary Prevention in Patients after Ischemic Stroke.

Background and objectives: The aim of the study was to use the mobile application Samsung Health for the assessment of parameters of exercise tolerance and the ECG (electrocardiogram) M-Trace Base II for the assessment of cardiological parameters. Materials and Methods: The measurements were conducted during rest and after performing SMWT (Six Minute Walk Test) and SCT (Stair Climb Test) in 26 patients after ischemic stroke (IS) and 26 healthy individuals. Results: In the SMWT, the post-stroke group (SG) walked a shorter distance (p < 0.001), achieving lower mean gait velocity (p < 0.001) and lower maximum gait velocity (p = 0.002). In the SCT, SG achieved a lower mean gait velocity (p < 0.001) and lower maximum gait velocity (p < 0.001) when compared to the control group (CG). In SG, myocardial ischemia in ECG was noted in four patients after SMWT and in three patients following SCT. Both in SG and in CG the increase in SBP (systolic blood pressure) value measured after SMWT and SCT compared to at rest (p < 0.001) was observed. In SG, in the compared ratios rest to SMWT and SCT as well as SMWT to SCT, there was an increase in HR (heart rate) (p < 0.001). Conclusions: ECG M-Trace Base II and Samsung Health are mobile applications that can assess cardiological parameters and exercise tolerance parameters in patients after IS, so they can be used to plan the intensity of exercise in rehabilitation programs.

Does Regular Dancing Improve Static Balance?

The aim of the study was to compare the static balance of dancers and non-dancers in a bipedal and unipedal stance. Twenty-three female dancers (mean age: 21.3 ± 1.7) and 24 age and sex-matched subjects (mean age 22.3 ± 1.0) participated in this study. A force platform was used to assess balance. The tests on the balance platform were performed in several positions with different foot placement, such as normal standing (NS) eyes open and eyes closed positions, semi-tandem position (ST), tandem position (TP), and one-leg standing (1L) eyes open and eyes closed position. Significant differences in balance between the dancers and the control group, especially in the tandem position and one-leg standing position with eyes closed were found. We observed higher results for the velocity of the COP in the frontal plane in the TP with a dominant limb in front (p = 0.04) and higher results for the velocity of the COP in the frontal plane (p = 0.01) and in the sagittal plane (p < 0.01) in the TP with a dominant limb in front in the control group. We also observed significant differences between groups in the mean velocity of COP sway in the sagittal plane in the 1 L position with eyes closed (p = 0.04). We concluded that dancing regularly for several years improves static balance.

The ICF Classification as a Simple Tool to Aid in the Assessment of Healthcare Services in a Non-COVID-19 Hospital during the COVID-19 Pandemic.

The COVID-19 pandemic has had a significant impact on the operation of medical facilities. In this period, they have seen increased absence of medical staff from work, a decrease in the number of hospitalizations and in the value of healthcare services provided. We assess the impact of this pandemic on the operation of a non-COVID-19 orthopedic and rehabilitation hospital using International Classification of Functioning, Disability and Health (ICF) categories. The authors analyzed these parameters in relation to the operation of a non-COVID-19 orthopedic, rehabilitation and rheumatological hospital in Q1 2020 compared to Q1 2019. For the analysis, the categories and qualifiers of the ICF were used, allowing for a simple and easily readable data analysis. In March 2020, in comparison to March 2019, the average working time of medical workers (p < 0.001) and the number of hospitalizations (p < 0.034) decreased significantly. In April 2020, compared to April 2019, the average working time of medical workers (<0.001) and the number of hospitalizations (0.002) also decreased significantly. In addition, in April 2020, the percentage value of the contracted services provided decreased significantly (p = 0.017), which was not observed in March of that year. The COVID-19 pandemic has affected the operation of a non-COVID-19 hospital, causing an increase in staff absences from work, a decrease in the number of hospitalizations and a decrease in the value of the revenue generated from health services provided. The ICF is a useful tool for the evaluation of a hospital's healthcare services.

The ICF Classification System to Assess Risk Factors for CVD in Secondary Prevention after Ischemic Stroke and Intracerebral Hemorrhage.

Background and objectives: Patients with a history of prior stroke have a high risk for subsequent cardiovascular events (CVD). Therefore, the implementation of an effective strategy to reduce risk factors and thereby improve secondary prevention outcomes is crucial in this patient population. The aim of this study was to determine differences in the incidence of risk factors for recurrent CVD events based on clinical type of prior stroke and to characterize them using the ICF (International Classification of Functioning, Disability and Health) classification system. Materials and Methods: The incidence of risk factors for recurrent CVD events were retrospectively analyzed in 109 patients with a history of ischemic stroke (IS) and 80 patients with a history of intracerebral hemorrhage (ICH) within 14 days poststroke. Results: Atrial fibrillation/flutter (p = 0.031), >70% carotid artery stenosis (p = 0.004), blood pressure >140/90 mmHg (p = 0.025), blood HbA1c levels >7% (p = 0.002), smoking (p = 0.026) and NSAID (nonsteroidal anti-inflammatory drug) use (p < 0.001) were significantly more common in patients with a history of ischemic stroke. However, liver function test abnormalities were observed more commonly in patients with a history of hemorrhagic stroke (p = 0.025). Conclusions: The incidence and type of risk factors for recurrent CVD events vary according to the clinical type of prior stroke. The ICF classification system is a useful tool for evaluating these risk factors. This may help reduce the risk of subsequent CVD events.

Wireless Motion Sensors-Useful in Assessing the Effectiveness of Physiotherapeutic Methods Used in Patients with Knee Osteoarthritis-Preliminary Report.

Osteoarthritis of the knee (OAK) is characterized by pain, limitation of joint mobility, and significant deterioration of proprioception resulting in functional decline. This study assessed proprioception in OAK patients following two ten-day rehabilitation programs using the Orthyo® system. Fifty-four study participants with clinical symptoms and radiological signs of OAK were randomly divided into an exercise group (n = 27) or a manual therapy group (n = 27). The control group consisted of 27 volunteers with radiological signs of OAK, but with no clinical symptoms or prior history of rehabilitation. The following parameters were assessed: knee proprioception using inertial sensors and a mobile application, patients' function using Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and pain intensity using the visual analog scale (VAS). Following rehabilitation, knee proprioception tests did not improve in either study group. Both study groups showed significant improvement of the WOMAC-assessed function (exercise group: p < 0.01, manual therapy group: p = 0.01) and a significant decrease (p < 0.01) of VAS-assessed pain following rehabilitation, but the post-therapy results did not differ significantly between the aforementioned groups. The Orthyo® system provided a quick and accurate assessment of the knee joint position sense. There was no direct relationship between functionality, pain, and proprioception threshold in the knee joint.

Muscle Activity Detectors-Surface Electromyography in the Evaluation of Abductor Hallucis Muscle.

Despite the high availability of surface electromyography (sEMG), it is not widely used for testing the effectiveness of exercises that activate intrinsic muscles of foot in people with hallux valgus. The aim of this study was to assess the effect of the toe-spread-out (TSO) exercise on the outcomes of sEMG recorded from the abductor hallucis muscle (AbdH). An additional objective was the assessment of nerve conduction in electroneurography. The study involved 21 patients with a diagnosed hallux valgus (research group A) and 20 people without the deformation (research group B) who performed a TSO exercise and were examined twice: before and after therapy. The statistical analysis showed significant differences in the third, most important phase of TSO. After the exercises, the frequency of motor units recruitment increased in both groups. There were no significant differences in electroneurography outcomes between the two examinations in both research groups. The TSO exercise helps in the better activation of the AbdH muscle and contributes to the recruitment of a larger number of motor units of this muscle. The TSO exercises did not cause changes in nerve conduction. The sEMG and ENG are good methods for assessing this exercise but a comprehensive assessment should include other tests as well.

Body balance a few years after total hip replacement.

PURPOSE: These aim of the study was to conduct a long-term evaluation of whether total hip replacement permanently affects the dynamic body balance. METHODS: Twenty-five patients after the unilateral total hip replacement (mean age: 69.9 ± 6.2) and 25 subjects without the total hip replacement (mean age: 68.4 ± 4.8) who matched the age and overall health participated in this study. The force platform and functional tests such as Timed Up and Go, 3m walk test, Functional Reach Test, 30s Chair Stand Test, Step Test and Berg Balance Scale were used to assess dynamic balance. The results obtained in individual trials were compared using the Student's t-test for independent variables, the Welch test or the non-parametric Mann-Whitney U-test. RESULTS: Subjects from the THR group exhibited significantly increased time and distance in the tests performed on the force platform, compared to the control group. We also observed worse balance and functional test scores in the THR group: Timed Up and Go test ( p < 0.001), 3 m walk test ( p < 0.001), Functional Reach Test ( p < 0.001), 30 s Chair Stand Test ( p = 0.001) and Step Test (operated leg: p < 0.001, non-operated leg: p < 0.001). The results obtained in the Berg Balance Scale tests were not significantly different between the groups ( p = 0.218). CONCLUSIONS: We observed significant differences in postural stability and dynamic balance between patients after THR and subjects in the same age without endoprosthesis. Our research shows that total hip replacement permanently impairs patients' dynamic balance and their functionality in certain lower-extremity activities.

Mobile Applications in Evaluations of Knee Joint Kinematics: A Pilot Study.

Because medical professionals lack the means to monitor exercises performed by patients in their home environment directly, there is a strong case for introducing technological solutions into this domain. They include methods that use wireless inertial sensors, which emit signals recorded and processed by special applications that work with mobile devices. This paper's aim is (a) to evaluate whether such sensors are suitable for qualitative and quantitative motion analysis, and (b) to determine the repeatability of results over a few recordings. Knee joint activity was analysed using a system of inertial sensors connected through a Wi-Fi network to mobile devices. The tested individuals did eight different activities, all of which engaged the knee joint. Each excercise was repeated three times. Study results did not reveal any statistically significant differences between the three measurements for most of the studied parameters. Furthermore, in almost every case, there were no statistically significant differences between the results of the right and left lower limb (p > 0.05). This study shows that easy use and repeatability of results combined with the feature of quantitative and qualitative analysis make the examined method useful for functional evaluations of the knee joint.

Early results of supervised versus unsupervised rehabilitation of patients with cervical pain.

PURPOSE: Comparison of early effects of supervised (led by physiotherapist) and unsupervised rehabilitation protocols in patients with myofascial pain syndrome, disk-root conflict and degenerative spine disease at cervical level. METHODS: Three groups of patients (n = 60 each) with clinically and neurophysiologically confirmed myofascial pain syndrome, disk-root conflict and degenerative spine disease were randomly subdivided to supervised and unsupervised treatment subgroups (n = 30 each). Thirty healthy subjects with similar demographic and anthropometric properties as patients were enrolled to control group. Patients were examined before and after rehabilitation with visual analog scale of pain, Spurling's test, painful passive elongation and active trigger points detection in trapezius muscle, sensory perception studies and surface electromyography (at rest, during maximal contraction) and electroneurography. RESULTS: Supervised treatment resulted in decrease of pain intensity (P = .001) and Spurling's symptoms incidence (P = .008) in patients from disk-root conflict group. Painful elongation and incidence of trigger points in trapezius muscle were the least observed at P = .009 after supervised therapy of myofascial pain syndrome. Supervised therapy resulted in decrease of resting electromyography amplitude and increase of maximal contraction electromyography amplitude from trapezius muscle (P = .02) in myofascial pain syndrome patients and from biceps and abductor pollicis brevis muscles of patients from other groups (P from .05 to .001). Median nerve electroneurography and sensory perception results improved at P = .05 after supervised treatment in disk-root conflict group. CONCLUSIONS: Twenty-day supervised rehabilitation provides better therapeutic effects than unsupervised one in treatment of muscle dysfunctions in patients with myofascial pain syndrome, degenerative changes and disk-root conflict at cervical spine.

Does total hip replacement impact on postural stability?

BACKGROUND: Total hip replacement (THR) is a procedure which can improve the quality of life in patients with osteoarthritis. However, deficits in static stability and impairment of lower limb efficiency can be observed even several months after the procedure. The aim of this study was to investigate the static balance of the standing position in patients treated by THR. METHODS: The study included 30 THR patients and 30 healthy subjects. The subjects were examined once. A Metitur balance platform and a one-leg standing (OLS) test were used to assess the static balance. The tests on the balance platform were performed in several positions with different foot placement, such as normal standing, eyes open (NS EO) and eyes closed (NS EC) positions, tandem position (TP), the second form of tandem position (2TP) and one-leg standing position (1 L). RESULTS: Significant imbalance in the sagittal plane during normal standing EO and EC positions were found in the THR group. No significant differences in the measured parameters were found during tests in tandem, the second form of tandem and one-leg standing positions in the groups. The mean time of standing on the operated limb in the THR group during the OLS test was significantly shorter than that in the control group. CONCLUSIONS: Deficits in static balance may occur in THR patients even a long time after the procedure. The test performed in the NS position is sufficient to assess the balance. The rehabilitation protocols currently used after THR should include postural stability exercises. TRIAL REGISTRATION NUMBER: Trial registry: NCT03218267 . 12 July 2017 (retrospectively registered).

The usefulness of isometric protocol for foot flexors and extensors in assessing the effects of 16-week rehabilitation regiment in poststroke patients.

BACKGROUND: Ankle joint function in a paretic limb has a fundamental impact on mobility. Return of joint function is a measure of early poststroke physical rehabilitation. This study aims to assess the suitability of using the isometric protocol for objective evaluation of flexor and extensor muscle strength in the paretic limb of poststroke patients. METHODS: 34 patients (F: 9, M: 25) aged 51-79 years with hemiparesis following an acute ischemic stroke and 34 healthy controls were examined using the isometric protocol measured on the Biodex System®. The following parameters were analyzed: peak torque [PT], average torque [AVGT], average torque/body weight [AVGT/BW] for flexors and extensors, and AVGT flexor/AVGT extensor [agonist/antagonist ratio] of the paretic foot, the nonparetic foot and foot of healthy controls using three foot-shank positions (15°, 0°, and - 15°) prior to rehabilitation commencement and at its completion 16 weeks later. RESULTS: Prior to rehabilitation commencement, nonparetic foot differed significantly (p < 0.05) from healthy foot controls in all parameters and all positions for flexors and in all positions for foot-shank positions of 0° and - 15° for extensors. At rehabilitation program completion the following parameters increased significantly for the paretic foot: PT, AVGT, and AVGT/BW for foot extensors in all tested positions, and PT for foot flexors in foot-shank position of - 15°. The nonparetic foot however, showed no significant difference following rehabilitation regardless parameter or foot position tested for flexors and extensors alike. Prior to rehabilitation agonist/antagonist ratio in the paretic foot differed significantly from corresponding parameter in the control group for the foot-shank positions of 15° and 0°, whereas at rehabilitation completion, the two groups showed significant difference only in foot-shank position of 0°. CONCLUSIONS: In the early period following stroke, there is a significant strengthening of the paretic limb, but no improvement in the strength of nonparetic limb.