Diagnostics of Balance and Gait Disorders in Patients with Parkinson’s Disease

Maria Kłoda, Grażyna Brzuszkiewicz-Kuźmicka, Edyta Smolis-Bąk, Izabela Korabiewska, Monika Lewandowska, Dariusz Białoszewski

M. Kłoda, G. Brzuszkiewicz-Kuźmicka, E. Smolis-Bąk, I. Korabiewska, M. Lewandowska, D. Białoszewski – Diagnostics of Balance and Gait Disorders in Patients with Parkinson’s Disease. FP 2017; 17(2); 122-131


Parkinson’s disease is a chronic, progressing affliction of the human central nervous system. It is one of degenerative diseases and affects mainly the extrapyramidal system, and in particular the substantia nigra of the midbrain.  Along with the axial symptoms of Parkinson’s disease, the other most important ones would include abnormalities of posture and gait. The improper posture has an impact on future problems with locomotion and self-service functions.
Prior to introducing any physiotherapy, there should be carried out a number of tests, which will allow both, quantitative and qualitative assessment the patient’s gait and his or her posture. These tests include among others: gait analysis performed on a treadmill of the ”Zebris” FDM-TDM type, which uses the WinFDM-T data base system, Vicon 460 system for the three-dimensional assessment of gait, Timed Up & Go, 10 MWT or Tinetti tests.
Demographic data indicate the increasing incidence of the Parkinson’s disease, which seems to be due to the gradual lengthening of a human life span. This makes it very important to properly rehabilitate and care for the patients.
As the disease progresses, patients begin to experience discomfort during their daily activities, and in locomotion, and thus their quality of life is being reduced. Here comes the great importance of implemented physiotherapy treatments, which are supposed to maintain, for as long as possible, the patients’ mobility at the level sufficient to enable their independent functioning. Introduced early enough physiotherapy procedures significantly improve gait parameters in patients with the Parkinson’s disease, thus delaying progression of the disease.

Key words:
diagnostics, Parkinson’s disease, balance disorders, gait disorders

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Dynamika powrotu utraconych funkcji u pacjentów poddanych fizjoterapii po operacyjnym leczeniu pourazowych krwiaków przymózgowych / The dynamics of the return of lost functions in patients undergoing physiotherapy following surgical treatment of post-traumatic paracerebral hematomas

Grażyna Brzuszkiewicz-Kuźmicka, Stanisław Kuźmicki,
Zbigniew Śliwiński, Maria Kłoda, Michał Sobstyl, Agata Kuźmicka

FP 2014; 14(3); 66-75

Celem pracy jest określenie wpływu wczesnej fizjoterapii na dynamikę powrotu zdolności wykonywania czynności dnia codziennego, poprawę stanu funkcjonalnego i zmniejszenie ubytków neurologicznych oraz zmianę stanu świadomości u chorych po operacyjnym leczeniu pourazowych krwiaków przymózgowych.
Materiał badań stanowiła grupa 86 chorych leczonych operacyjnie z powodu pourazowego krwiaka przymózgowego. Wszystkich pacjentów podzielono na dwie grupy, gdzie podstawowym kryterium różnicującym badanych był rodzaj zastosowanej kinezyterapii.
Do oceny stopnia neurologicznego deficytu i niepełnosprawności wykorzystano Międzynarodową Skalę Niedowładów Mięśni, Zmodyfikowaną Skalę Barthel i Skalę Rankina, natomiast ocenę stanu świadomości dokonano w oparciu o skalę Glasgow Coma Scale.
Powrót utraconych funkcji u chorych usprawnianych wg wybranych wzorców koncepcji PNF i elementów Metody Bobath, w porównaniu do pacjentów poddanych kinezyterapii tradycyjnej, posiadał większą dynamikę, szczególnie w pierwszych dniach i następował w istotnie szybszym tempie. Jednak takiej zależności nie odnotowano w przypadku powrotu stanu świadomości. Największe możliwości uzyskana powrotu utraconych funkcji występują we wczesnym okresie pooperacyjnym (1-5 doba).

Słowa kluczowe:
wczesność, pourazowe krwiaki przymózgowe, kinezyterapia


The objective of this study is to determine the impact of early physiotherapy on the dynamics of the recovery of the ability to perform daily activities, improvement in functional status, reduction in neurological deficits and change in the consciousness status in patients following surgical treatment of post-traumatic paracerebral hematomas.
The study material consisted of 86 patients undergoing surgical treatment of post-traumatic paracerebral hematomas. All patients were divided into two groups with the type of kinesitherapy performed as the main differentiating factor.
The grade of neurological deficit was assessed by the International Scale of Muscle Weakness, modified Barthel Index, and Rankin Scale, while consciousness was assessed on the basis of the Glasgow Coma Scale.
The return of lost function in patients undergoing rehabilitation according to selected PNF patterns and elements of Bobath therapy as compared to patients subjected to conventional kinesitherapy was characterized by better dynamics, particularly within the initial days, and progressed at a significantly higher rate. However, no relationship of this kind was observed for the recovery of consciousness. Patients have the highest potential for the return of lost functions in the early postoperative period (days 1-5).

Key words:
early physiotherapy, post-traumatic paracerebral hematomas, kinesitherapy

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The assessment of the attitude towards physical activity among the Physiotherapy students of Warsaw Medical University (WMU) and the students of Physical Education Academy (PEA)

Edyta Smolis-Bąk, Agnieszka Szymańczuk, Hanna Rymuza,
Ilona Kowalik, Maria Kłoda, Grażyna Brzuszkiewicz-Kuźmicka

E. Smolis-Bąk, A. Szymańczuk, H. Rymuza, I. Kowalik, M. Kłoda, G. Brzuszkiewicz-Kuźmicka – The assessment of the attitude towards physical activity among the Physiotherapy students of Warsaw Medical University (WMU) and the students of Physical Education Academy (PEA). FP 2016;16(4);30-39


Physical activity is a key integrating element of a healthy lifestyle. Physical Fitness determines the resourcefulness in various life situations, its high level may facilitate work, broaden the capabilities and contribute to a healthy lifestyle. Studies show that physical therapists are particularly predisposed to promote a healthy lifestyle among the medical patients. On the other hand, due to the nature of their work, they are at risk of muscular and skeletal injuries.
The objective was to assess the Warsaw Medical University (WMU) and the Academy of Physical Education (APE) Physiotherapy Students’ attitude toward physical activity and physical fitness.
Methodology. Examined was a group of 90 students (37 females, 9 males from WMU and 22 females, 22 males from PEA) of the age 22.7 on average ±2.0 years. Prepared questionnaire designed to assess attitudes toward physical activity was used. The level of physical fitness of the investigated students was examined with International Physical Fitness Test.
Results. The number of physical activity hours is significantly lower at the Medical University (1.6 ±1.5) than PE Academy (3.6 ±1.7), p<0,001. Very high (80%) interest in physical activity during leisure time has been demonstrated, with higher tendency among Physiotherapy PEA students than the WMU students (p = 0.07). A significantly lower level of physical fitness among WMU students, as compared to PEA students, was also found. Conclusions. 1. Very high interest in physical activity during leisure time, in both groups, should be taken advantage of and developed in educational process. 2. Medical University students presented a much lower fitness level than PEA students, which may have resulted from fewer hours of physical activities at the Medical University of Warsaw (WMU). 3. Due to higher expectations in case of physiotherapists, it seems that physical fitness should be one of the recruitment process criteria at Medical University of Warsaw. Keywords: physical activity, assessment of physical fitness, physiotherapy students

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The Pathogenesis of Parkinson’s Disease Related Balance Disorders. The Balance Disorders Evaluation Methods. Review Article

Maria Kłoda, Renata Kowalska-Taczanowska, Grażyna Brzuszkiewicz-Kuźmicka, Andrzej Friedman

M. Kłoda, R. Kowalska-Taczanowska, G. Brzuszkiewicz-Kuźmicka, A. Friedman – The Pathogenesis of Parkinson’s Disease Related Balance Disorders. The Balance Disorders Evaluation Methods. Review Article. FP 2016;16(1);82-87

Basis of the Parkinson’s disease are the chronic neurodegenerative changes, manifesting themselves in the asymmetric bradykinesia, the muscular rigidity and the resting tremor (the so-called triad of symptoms). Along with the advancement of the disease, there occur symptoms within the autonomic nervous system, speech and swallowing disorders, dementia, cognitive function disorders. The neurodegenerative process caused by the dopamine deficiency in the brain, leads to the gradual loss of movements coordination, which is worsening along with the development of the disease. Slowness of movements, characteristic for the patients with Parkinson’s disease, is in turn the leading cause of the locomotion disability. This symptom, together with the coexisting postural instability, are qualified as the main causes of the balance disorders accompanying the disease in question.  The implementation of the proper procedures for diagnosis of the balance disorders, in this group of patients, actually helps to reduce the number of falls.Currently the most popular tool for evaluating the posture stability disorders are the clinical tests of balance. Very popular for the evaluation of the balance disorders are the simple motor ability tests, allowing to assess a given motor skill in the quantitative and the half-quantitative manner. The actual usefulness of the balance assessment on the stabilometric platforms has been proved in the numerous clinical studies. The efficacy of the described method has been demonstrated in the research of the probability of falls due to Parkinson’s disease. Meaningful are also the reports of the superiority of the posturography over the other methods for the balance assessment. Unfortunately, the application of the posturography tests in balance analyses, in patients with Parkinson’s disease, is still being limited to the selected centers. This is mainly due to the relatively high cost of the purchase of the posturography platform.

Key words:
Parkinson’s disease, posturography tests, balance assessment

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Prevalence of feet defects in preschool-aged children

Maria Kłoda, Grażyna Brzuszkiewicz-Kuźmicka, Maria Drajczyk, Piotr Drajczyk, Janina Grzegorzewska, Edyta Smolis-Bąk

M. Kłoda, G. Brzuszkiewicz-Kuźmicka, M. Drajczyk, P. Drajczyk, J. Grzegorzewska, E. Smolis-Bąk – Prevalence of feet defects in preschool-aged children. FP 2016;16(1);36-46

Introduction and study aim. Childhood is known to be a very important period of life when the foot is gradually determining in order to become a strong support of the human body. The aim of the study is to assess the frequency of appearance of foot defects in preschool children.
Material and methods. The study group consisted of 143 preschool children, in which the following parts of examination were evaluated: orthopedic measurements, antropometric measurements, plantoconturographical examination and podoscopic examination. Parents were asked to fill out the questionnaire regarding to the development of their child’s feet, defects as well as their child’s habits and sports in which they participate.
Results. The analysis of Clarke’s angular indicator revealed that flat foot was the most frequent defect in the study group (146/286 feet, circa 50%), and diminished foot was the second frequent problem in the examined group of children (102/286). The normal foot was established to be present in 37 cases. There was also 1 elevated foot due to Clarke’s assessment. No statistical significance was observed between body sides and foot defects. Gender of patient was not statistically correlated to the examined children’s defects besides flat foot, which was observed to be more frequently present in males: 42 males (36%) vs 19 females (11%), p<0,05. Conclusions. The flat foot was observed to be the most frequently present defect of foot in preschool children. On the other hand, cored foot has been demonstrated to be the most rarely present defect in the study group. Percentage of children who participate in sport activities and wear comfortable shoes in order to prevent foot defects, is unsatisfactory. Motor activity should be more efficiently promoted among parents and caregivers of preschool children. Key words: foot defect, angular indicator, plantoconturography

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