Factors Affecting Balance Performance in Adolescents.

(1) Background: The influence of different factors on balance in adolescence is assessed by conducting functional balance tests that examine its different components. (2) Materials and methods: The study sample comprised 110 healthy adolescents of both sexes, aged 12-18 years. Single Leg Stance with Eyes Open (SLS-EO) and Eyes Closed (SLS-EC) tests were conducted to evaluate static balance, whereas the Functional Reach Test (FRT) and Lateral Reach Test (LRT) were performed to establish functional stability limits. The influence of sex, age, demographic factors, anthropometric characteristics, participation in sports activities, and trunk extensor muscle endurance (Biering-Sorensen test) on balance performance was determined through correlational and univariate linear regression analyses. (3) Results: Older age (Beta [ß] = 0.247; 95% CI [0.75, 5.20]; p < 0.01) and better trunk extensor muscle endurance (ß = 0.224; 95% CI [0.015, 0.13]; p < 0.05) were significant predictors of the SLS-EO results, while younger age (ß = -0.219; 95% CI [-1.32, -0.11]; p < 0.05) and higher muscle percentage (ß = 0.237; 95% CI [0.06, 0.48]; p < 0.05) emerged as significant predictors of LRT performance, and greater bone mass was a significant predictor of FRT results (ß = 0.444; 95% CI [3.62, 8.17]; p < 0.01). However, none of the independent variables was a statistically significant predictor of the SLS-EC results. (4) Conclusions: The current study found that age, trunk extensor muscle endurance, muscle percentage, and bone mass are significant predictors of different balance components, suggesting that balance is task-specific.

Outcome of early rehabilitation of patients with traumatic brain injury during COVID-19 pandemic in The Republic of Srpska, Bosnia and Herzegovina.

Introduction: The COVID-19 pandemic has placed a tremendous burden on the healthcare system. Patients with traumatic brain injury (TBI) have to get fast track treatment which is independent of environmental conditions. The aim of this study was to investigate epidemiological and clinical outcomes of early rehabilitation and compare it with the literature data during the non-COVID-19 period. Materials and methods: A retrospective study included 174 patients with TBI, average 57 ± 19.08 years. They all underwent treatment in the University Clinical Center, Republic of Srpska, Bosnia and Herzegovina during the period January-December 2021. We have analyzed the epidemiological data and clinical course in 174 patients as well as the outcome of early rehabilitation in 107 patients. In clinical evaluation were used: Glasgow Coma Score (GCS), Functional Independence Measure (FIM) and Barthel Index on admission and at discharge, as well as Glasgow Outcome Scale (GOS) at discharge. ANOVA, SPANOVA, Student t-test and Pearson correlation coefficient were used in statistical analysis. The value (p < 0.05) was used for statistical significance. Results: A total of 174 patients with TBI were included in this study. Most of the patients (n = 94) were older than 60, male (n = 125) and the most frequent cause of TBI was falling over (n = 88). About a half (n = 92) had a mild TBI, almost one third of the sample had moderate (n = 52), while only 30 patients had severe TBI. Total of 139 (80.3%) patients had the improved outcome, the worsening was registered in 2 (1.2%), while the fatal outcome was reported with 33 (18.5%) patients. When comparing the scores on admission and at discharge, the improvement of mean parameter values was reported for GCS (9.9 vs. 14.1), for Barthel Index (57.25 vs. 86.85), and for FIM (67.35 vs. 105.15), (p < 0.001). A complete recovery at discharge was found in 63.79%, a mild deficit in 8.62%, while serious deficit was found with 6.32%, and vegetative state with 2.29% patients. Conclusion: The COVID-19 pandemic had a significant effect on the epidemiological data but not on the clinical outcome of patients with TBI. Early rehabilitation proved to be effective and to contribute to positive treatment outcome.

Assessment of general movements and heart rate variability in prediction of neurodevelopmental outcome in preterm infants.

BACKGROUND: Adverse neurologic outcome in preterm infants could be associated with abnormal heart rate (HR) characteristics as well as with abnormal general movements (GMs) in the 1st month of life. AIMS: To demonstrate to what extent GMs assessment can predict neurological outcome in preterm infants in our clinical setting; and to assess the clinical usefulness of time-domain indices of heart rate variability (HRV) in improving predictive value of poor repertoire (PR) GMs in writhing period. STUDY DESIGN: Qualitative assessment of GMs at 1 and 3 months corrected age; 24h electrocardiography (ECG) recordings and analyzing HRV at 1 month corrected age. SUBJECTS: Seventy nine premature infants at risk of neurodevelopmental impairments were included prospectively. OUTCOME MEASURES: Neurodevelopmental outcome was assessed at the age of 2 years corrected. Children were classified as having normal neurodevelopmental status, minor neurologic dysfunction (MND), or cerebral palsy (CP). RESULTS: We found that GMs in writhing period (1 month corrected age) predicted CP at 2 years with sensitivity of 100%, and specificity of 72.1%. Our results demonstrated the excellent predictive value of cramped synchronized (CS) GMs, but not of PR pattern. Analyzing separately a group of infants with PR GMs we found significantly lower values of HRV parameters in infants who later developed CP or MND vs. infants with PR GMs who had normal outcome. CONCLUSIONS: The quality of GMs was predictive for neurodevelopmental outcome at 2 years. Prediction of PR GMs was significantly enhanced with analyzing HRV parameters.

Factors that predict walking ability with a prosthesis in lower limb amputees.

Introduction: Identification of predictive factors for walking ability with a prosthesis, after lower limb amputation, is very important in order to define patient's potentials and realistic rehabilitation goals, however challenging they are. Objective: The objective of this study was to investigate whether variables determined at the beginning of rehabilitation process are able to predict walking ability at the end of the treatment using support vector machines (SVMs). Methods: This research was designed as a retrospective clinical case series. The outcome was defined as three-leveled ambulation ability. SVMs were used for predicting model forming. Results: The study included 263 patients, average age 60.82 ± 9.27 years. In creating SVM models, eleven variables were included: age, gender, cause of amputation, amputation level, period from amputation to prosthetic rehabilitation, Functional Comorbidity Index (FCI), presence of diabetes, presence of a partner, restriction concerning hip or knee extension, residual limb hip extensor strength, and mobility at admission. Six SVM models were created with four, five, six, eight, 10, and 11 variables, respectively. Genetic algorithm was used as an optimization procedure in order to select the best variables for predicting the level of walking ability. The accuracy of these models ranged from 72.5% to 82.5%. Conclusion: By using SVM model with four variables (age, FCI, level of amputation, and mobility at admission) we are able to predict the level of ambulation with a prosthesis in lower limb amputees with high accuracy.

Cerebral palsy in preterm infants.

Background/Aim: Cerebral palsy (CP) is one of the leading causes of neurological impairment in childhood. Preterm birth is a significant risk factor in the occurrence of CP. Clinical outcomes may include impairment of gross motor function and intellectual abilities, visual impairment and epilepsy. The aim of this study was to examine the relationships among gestational age, type of CP, functional ability and associated conditions. Methods: The sample size was 206 children with CP. The data were obtained from medical records and included gestational age at birth, clinical characteristics of CP and associated conditions. Clinical CP type was determined according to Surveillance of Cerebral Palsy in Europe (SCPE) and topographically. Gross motor function abilities were evaluated according to the Gross Motor Function Classification System (GMFCS). Results: More than half of the children with CP were born prematurely (54.4%). Statistically significant difference was noted with respect to the distribution of various clinical types of CP in relation to gestational age (p < 0.001). In the group with spastic bilateral CP type, there is a greater proportion of children born preterm. Statistically significant difference was noted in the functional classification based on GMFCS in terms of gestational age (p = 0.049), children born at earlier gestational age are classified at a higher GMFCS level of functional limitation. The greatest percentage of children (70.0%) affected by two or more associated conditions was found in the group that had extremely preterm birth, and that number declined with increasing maturity at birth. Epilepsy was more prevalent in children born at greater gestational age, and this difference in distribution was statistically significant (p = 0.032). Conclusion: The application of antenatal and postnatal protection of preterm children should be a significant component of the CP prevention strategy.

FUNCTIONAL STATUS OF PATIENTS AFTER STROKE.

INTRODUCTION: Patients who have suffered from stroke become disabled and have specific problems due to the physical and mental disability that requires the implementation of rehabilitation and the creation of conditions for independent living, economic and social reintegration. The aim of this study was to evaluate the functional recovery of patients after ischemic stroke, during the subacute phase of medical rehabilitation. MATERIAL AND METHODS: The study was organized as a prospective study, which included 74 patients (44 men, 30 women) treated after stroke at the Department of Medical Rehabilitation, Clinical Center of Vojvodina during 2013. Motor recovery was assessed by Signe-Brunnstrom scale, and Barthel Index, Rivermead Mobility Index, and modified Rankin scale were applied to assess the function. RESULTS: The average age of patients after stroke was 66.59 ± 9.607 years. The mean hospital stay was 34.35 days. The majority of patients in this study had right-hand hemiparesis 47 (63.5%), and 27 (36.5%) had left-hand hemiparesis. By analyzing the average valueof motor recovery of the affected limb by S.Brunnstrom's scale during rehabilitation at the Department of Medical Rehabilitation, it was found that the value at the end of subacute rehabilitation phase was significantly increased (p<0.01). The results of this testing showed a statistically significant improvement (p<0.0l) in the average values of Barthel Index, Rivermead Mobility Index and modified Rankin scale during the rehabilitation treatment of stroke patients. CONCLUSION: The obtained results showed that the rehabilitation treatment resulted in better functional and motor recovery in the patients who had had ischemic stroke.

Scaphoid fractures in children.

INTRODUCTION: Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. OBJECTIVE: To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. METHODS: We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011).The outcome of the treatment of"acute"scaphoid fracture was evaluated using the Mayo Wrist Score. RESULTS: There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm--76% of patients. During the examined period 31 children with "acute" fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. CONCLUSION: Conservative therapy of "acute" scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

[Humeral lengthening: case report].

INTRODUCTION: Difference in length of upper extremities has mainly esthetic significance and is therefore not so often a subject of operative treatment, compared to lower extremities. CASE OUTLINE: We are presenting a case of a 16-year-old patient in whom a shortening of 9 cm of the right humerus was determined at the end of growth. This shortening was the result of surgical treatment of solitary bone cyst at the proximal end of the humerus done at the age of 10 years. In order to correct the length of the humerus we applied distraction osteogenesis with a compressive-distracting device according to Mitkovic (Traffix), and we achieved the lengthening of 7.5 cm. During the period of distraction we encountered the following complications: minimal suppuration at the site of the wedges that was successfully resolved with intensive local treatment, while pain and paresthesias along the N. radialis were resolved with a temporarily slowing of the distraction process. Fixation with a plate, i.e. bone grafting was not necessary, and final functional and esthetic result was excellent. CONCLUSION: Successful lengthening of the shortened humerus can be achieved with a unilateral compressive-distracting device according to Mitkovic as its application up to a complete bone reconstruction does not require additional plate fixation or bone grafting. The patient was capable of performing usual daily activities during application of the device.

Effect of simultaneous exposure to benzene and ethanol on urinary thioether excretion.

The toxicity of benzene is not an issue of the past, especially in developing countries. Bone marrow toxicity is demonstrated among workers. In this study, the effect of simultaneous exposure to benzene and ethanol on benzene metabolism in mice was investigated by measuring the excretion of thioethers in urine. Urinary thioether excretion significantly decreased in the mice receiving both benzene and ethanol compared with the animals receiving benzene only. The assay of determining thioethers in urine samples in this study is a simple and low-cost method, thus suitable for routine use, especially in developing countries, not only for benzene, but also for other alkilating agents, which can be found during occupational exposure. Our results suggest that further research is needed to elucidate the mechanisms of decreased urinary excretion of thioether after simultaneous exposure to benzene and ethanol.

[Robot--a member of (re)habilitation team].

INTRODUCTION: The rehabilitation process involves a whole team of experts who participate in it over a long period oftime. DEVELOPMENT OF ROBOTICS AND ITS APPLICATION IN MEDICINE: The Intensive development of science and technology has made it possible to design a number of robots which are used for therapeutic purposes and participate in the rehabilitation process. ROBOTICS IN MEDICAL REHABILITATION: During the long history of technological development of mankind, a number of conceptual and technological solutions for the construction of robots have been known. By using robots in medical rehabilitation it is possible to implement the rehabilitation of peripheral and central motor neurons by increasing the motivation of patients for further recovery and effectiveness of therapy. The paper presents some technological solutions for robot-assisted rehabilitation of patients of different age groups and some possibilities of its use in the treatment. CONCLUSION: Using robots in standard physiotherapy protocols that involve a number of repetitions, exact dosage, quality design and adaptability to each individual patient leads to the significant progress in the rehabilitation of patients.

Risk of the recurrent headache and migraine appearance within the family.

AIM: The aim of this research was to determine the risk for family appearance of the recurrent headache (non-migraine and migraine). METHODS: The research was conducted in Vojvodina, the Northern Province of Serbia. The population of Vojvodina is around 2 million people belonging to more than 20 different ethnic groups. During the 20-year period (1988-2008), 30,363 children aged 3 to 17 years were tested, independent of their place of birth. The presence of headaches similar to those tested was compared among all the members of the family within three generations. RESULTS: Positive family data of the recurrent headaches were detected among 98.6% children with migraine headaches, 64.7% children with non-migraine headaches, and 32.4% children without recurrent headaches. The relation among the members of the nuclear family (contingency quotient of 0.429) was significantly stronger than the relation to the members of wider family (contingency quotient of 0.338). CONCLUSIONS: The probability of a child having the migraine headache rather than the non-migraine one was very high for parents and high for father's mother, while it was not significant for mother's mother, mother's father and father's father, having similar recurrent headaches.

Probability of breech presentation and its significance.

Existing data related to the probability of breech presentation suggest that the breech presentation is a consequence of mere filling of the intrauterine space, with the same probability of breech and cephalic presentation. As a consequence, group of cephalic presenting fetuses is heterogeneous. Some fetuses randomly assume the cephalic presentation while others assume cephalic presentation 'intentionally' for a reason. Before comparing breech and cephalic presenting fetuses/newborns, bias should be eliminated by subtracting from the cephalic-presenting group the number of fetuses/newborns that is identical with the number of breech-presenting fetuses/newborns with identical characteristics. The subtracted group should be added to the breech-presenting group before comparison with the remaining cephalic-presenting fetuses/newborns. The comparison should be corrected for the gestational age and according to data that are not influenced by delivery. Data suggest that the physiological process that accounts for 92% of cephalic-presenting human fetuses at delivery should be sought from the 25th gestational week onwards.

[Botulinum toxin type A for the treatment of spasticity in children with cerebral palsy].

BACKGROUND/AIM: Cerebral palsy (CP) is the most common physical disability in childhood. Children have problems with motor functions as a result of limbs spasticity, which leads to severe contractures and limbs deformity. There is a growing interest in the therapeutic role of botulinum toxin type A (BTA) in CP. The aim of this study was to examine the effects of BTA on spasticity, active range of motion and functional motor outcomes in children with CP. METHODS: This study included 42 children of both sexes, aged 2-6 years, with spastic CP, divided into two groups: group I (21 child) treated with BTA and physical therapy, and group II (21 child) treated with physical therapy only. The following parameters were analyzed: spasticity; active range of motion of the hip, knee and ankle, and functional motor outcome. These parameters measurements were carried out four times in both groups: before the treatment, three, eight and 16 weeks after the beginning of the treatment. The obtained results were statistically processed and compared. RESULTS: There was no evidence of any significant difference between the groups before the treatment. After eight weeks there was a remarkable difference concerning spasticity reducing on behalf of the group I (group I -- 0.76 +/- 0.51 vs. II group -- 2.17 +/- 0.64; p < 0.0001). There was statistically significant difference concerning active range of motion increasing on behalf of the group I (hip abduction: group I --44.37 +/- 1.13(0) vs. group II -- 32.61 +/- 8.07(0),p < 0,01; knee extension: group I -- 0.77 +/- 1.82(0) vs. II group -- 14.99 +/- 7.61(0), p < 0.01; dorsiflexion of the foot: group I -- 11.50 +/- 6.08(0) vs. group II -- 8.98 +/- 7.85(0), p < 0.01). A statistically significant difference was found after 16 weeks in functional motor outcome as well, on behalf of the group I: functional motor abilities level in the group I was 1.86 vs. 2.71 in the group II, p < 0.05. CONCLUSION: Botulinum toxin type A application leads to an important spasticity decreasing, active range of motion increasing, as well as to functional abilities in children with CP.

[Osteosynthesis with Kirschner pin fixation in treatment of fractures with dislocation of the lateral condyle of the humerus in a pediatric population]. / Osteosinteza kirsnerovim iglama u lecenju preloma lateralnog kondila humerusa sa disokacijom ulomka u decjem uzrastu.

INTRODUCTION: Fractures of lateral condyle represent 17% of all pediatric fractures of the distal humerus, and in current pediatric orthopedics there is still no agreement regarding optimal treatment modalities. We presented a treatment protocol for pediatric dislocated fractures of the lateral condyle of the humerus used at the Pediatric Surgery Clinic in Novi Sad. MATERIAL AND METHODS: Over the study period (1991-2000) a total of 48 patients with dislocated fractures of the lateral condyle of the humerus were hospitalized at the Pediatric Surgery Clinic. Orthopedic reduction and percutaneous pin fixation under radiological supervision was done in 15 patients, while 33 patients needed surgical reduction and pin fixation. RESULTS: Satisfactory results were obtained in 42 patients (91.3%), out of which 29 patients (63.1%) presented with excellent results. Good results were obtained in 8 patients (17.4%), and fair results in 5 patients (10.8%). Unsatisfactory results were present in 4 patients (8.7%). Two patients were lost to follow-up. DISCUSSION: Dislocation fractures of the lateral condyle represent high risk for development of complications. Adequate diagnosis and treatment represent basic conditions for successful postinterventional result. Orthopedic reduction with percutaneous pin fixation is recommended for fractures that may be anatomically reduced. In cases of unsatisfactory results of reduction, as well as in cases with completely dislocated and rotated fragments, surgical reduction and pin fixation is necessary. CONCLUSIONS: Satisfactory results in 91.3% of cases, and long-term experience suggest that the recommended therapeutic option is adequate in treatment of dislocated fractures of the lateral condyle of the humerus in pediatric population.

[Osteosynthesis with Kirschner wires in the treatment of dislocated supracondylar humeral fractures in children]. / Osteosinteza Kirsnerovim iglama u lecenju dislociranih suprakondilarnih preloma humerusa kod dece.

INTRODUCTION: Elbow fractures account for 7-9% of all fractures in childhood, while the supracondylar type is the most common (up to 70%). 84% of all supracondylar elbow fractures occur under the age of 10 years (most often between the age of 5 and 8). The aim of this study was to present the technique and results of treatment of supracondylar fractures with grade III fragment dislocation in pediatric population. Treatment included orthopedic repositioning and percutaneous pin fixation. MATERIAL AND METHODS: Over the period 1991-2000, 255 patients were hospitalized due to supracondylar fracture of the humerus with grade III fragment dislocation at the Pediatric Surgery Clinic in Novi Sad. All patients were aged 3-15 years. Orthopedic repositioning and percutaneous pin fixation under X-ray control was performed in 243 patients (95.29%). RESULTS: This study included 167 (65.5%) patients with full documentation. Extensor type of fracture was verified in 151 patients (90.42%). Male patients predominated over female patients--119:48. The average follow-up period was 4, 5 months. On the basis of clinical examination, and after completed rehabilitation, satisfactory results were obtained in 158 patients (94.6%), while in 9 patients the final outcome was unsatisfactory. DISCUSSION: Literature analysis points to advantages of orthopedic repositioning and percutaneous pin fixation, with certain modifications in the treatment of supracondylar elbow fractures with grade III dislocation. CONCLUSIONS: Obtained results of treatment, advantages of this procedure, and our experience, suggest that orthopedic repositioning and percutaneous pin fixation is a procedure of choice in treatment of supracondylar elbow fractures with third III dislocation in children.