The use of surface electromyography in rehabilitating rheumatic patients after knee arthroplasty (pilot study).

OBJECTIVES: The aim of the conducted research was to assess muscle performance in rheumatic patients qualified for knee arthroplasty before and after surgical treatment. MATERIAL AND METHODS: Patients with the diagnosis of rheumatoid arthritis or a degenerative joint disease qualified for surgical treatment were examined. Three groups were analysed: 1) a control group, 2) a group of patients qualified for knee arthroplasty (G1), 3) a group of patients with one knee joint endoprosthesis qualified for the second surgery (G2). The study was carried out through a portable surface electromyography system from Noraxon U.S.A. INC., Clinical DTS and using surface electrodes. The surface electromyography (sEMG) examination was conducted twice: before and on the 10th day after the surgery. The study concerned the quadriceps femoris muscle, i.e. its straight and medial head in both lower limbs during isometric tension and active movement. RESULTS: The comparison of the examined muscles' activity in the control group revealed greatly increased activity during isometric tension than during active movement in both muscles. In the G1 group, the comparison of the average values of isometric tension of the examined muscles before the surgery showed slight differences between the healthy limb and the one qualified for the surgical treatment. After the surgery, significant asymmetry between the average values achieved by the healthy and the operated limb could be identified in both muscles. In the G2 group, muscle activity within the currently operated limb revealed only slight differences between the limbs before the surgery. After the surgery, there was an increase in muscle activity within the previously operated limb. CONCLUSIONS: Considerably higher average values of muscle activity during the isometric tension, when compared to the active movement in a sitting position, indicate the necessity of more widespread use of isometric tension in rehabilitating patients after knee arthroplasty.

Benefits of wrist splinting in patients with rheumatoid arthritis.

OBJECTIVES: The goal was to present the use of a functional wrist splint and its impact on hand function in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: The study group comprised 104 women aged 18-65 and diagnosed with RA, who were treated in the Rheumatology Clinic and Outpatient Department of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw. The control group consisted of 40 healthy women in the same age group. Assessment of the hand function was the research method. RESULTS: Our results revealed substantially deteriorated function of the rheumatoid hand in relation to the healthy hand. The use of a wrist stabiliser is justified in patients with RA due to its beneficial impact, such as improved hand strength and dexterity and reduced pain. Based on the results obtained, it may be assumed that it is mainly patients with moderate and high disease activity who require stabilisation. The small number of patients in remission and with low disease activity was a limitation of the study. Hands with RA require an individual approach, and the most effective methods slowing down development of deformation should be sought. The results presented in this article may provide a starting point for further research on the most favourable wrist stabilisation in order to improve hand function in RA. CONCLUSIONS: Our study showed that the hand function of women with RA is limited due to deteriorated grip quality and manual dexterity in comparison to healthy persons. Wrist stabilisation improves hand function in patients with RA.

Risk of falls in the rheumatic patient at geriatric age.

Evaluating the risk of falling of a geriatric rheumatic patient plays an essential role not only in planning and carrying out the physiotherapeutic process. The consequences of falls may be different and, although they do not always result in serious repercussions such as fractures or injuries, it is sufficient that they generate the fear of falling and cause a significant reduction in physical activity. Assessing functional capacity to define the risk of falling is of utmost importance in the case of patients after joint arthroplasty surgeries. The specificity of rheumatic patient's falls is determined by numerous factors. It is not always possible to avoid them. However, it becomes vital to include fall prevention in the rehabilitation process as well as to prepare the house for the needs of an elderly person so that they are safe and as self-dependent as possible.

Physical activity in the elderly who underwent joint replacement surgery in the course of rheumatic diseases.

According to the forecasts of the Central Statistical Office of Poland, in 2030 people at the age of 65 and older will account for 23.8%, i.e. their number will amount to approx. 8.5 m people. Geriatric rheumatic patients more often decide to undergo surgical joint replacement. According to the National Health Fund, the number of joint replacement services provided in 2014 increased by 93%, as compared to 2005. Improving the physical performance of this constantly expanding group of patients requires taking into account many factors to raise their functional status, reduce the risk of falling, teach rules of proper functioning with an artificial joint and encourage unassisted physical activity. Restoring fitness and independence is a difficult but necessary task due to an increasing number of seniors with replaced joint.

Total ankle replacement - surgical treatment and rehabilitation.

Functions of the ankle joint are closely connected with the gait and ability to maintain an upright position. Degenerative lesions of the joint directly contribute to postural disorders and greatly restrict propulsion of the foot, thus leading to abnormal gait. Development of total ankle replacement is connected with the use of the method as an efficient treatment of joint injuries and continuation of achievements in hip and knee surgery. The total ankle replacement technique was introduced as an alternative to arthrodesis, i.e. surgical fixation, which made it possible to preserve joint mobility and to improve gait. Total ankle replacement is indicated in post-traumatic degenerative joint disease and joint destruction secondary to rheumatoid arthritis. In this paper, total ankle replacement and various types of currently used endoprostheses are discussed. The authors also describe principles of early postoperative rehabilitation as well as rehabilitation in the outpatient setting.