Tag: Rafał Gnat

An evaluation of the rehabilitation for patients recovering from knee joint trauma surgically treated by internal osteosynthesis

Paweł Ryngier, Edward Saulicz, Rafał Gnat, Tomasz Wolny

Paweł Ryngier, Edward Saulicz, Rafał Gnat, Tomasz Wolny – An evaluation of the rehabilitation for patients recovering from knee joint trauma surgically treated by internal osteosynthesis. Fizjoterapia Polska 2001; 1(4); 369-375

Abstract
Background. When the knee joint is immobilized, the sliding of joint surfaces is quickly reduced, primarily as a result of the periartricular contraction of the soft tissues (especially the articular capsule). This kind of mechanical imbalance between gliding and rolling is additionally strengthened by the disturbance of muscle equilibrium, both between different muscle groups (the femoral quadriceps and the ischio-crural muscles) and within the thigh muscle itself (between the vastus medialis and the rectus femoris). In the latter case, this status may also lead to the physiological route of knee-cap slide. In view of the complex arthromechanics of the knee joint and the proper distribution of muscle strength for its functioning, the purpose of our research was to study the impact of selected techniques of manual therapy and some of the motion patterns of the PNF method on improving the activity of the knee joint patients with injuries in the vicinity of this joint surgically treated by internal osteosynthesis. Material and methods. The study involved two groups of 17 people who were treated surgically for injuries to the vicinity of the knee joint. After a period of immobility the active mobility of this joint was assessed in all patients, along with the strength of the muscles functionally connected with the knee joint and subjective pain complaints. The studied patients from both groups underwent routine rehabilitation. Selected traction and mobilization techniques for the knee joint were additionally introduced for the patients from the main group, with exercises based on the notion of post-isometric relaxation and some motion patterns taken from PNF models. Results. The statistical analysis of the quantitative data we acquired pointed to a larger range of improvement in the mobility of the knee joint, associated with a somewhat larger simultaneous increase in the strength of the evaluated muscle groups among the patients from the main group.

Key words:
Immobilization, kinesitherapy, manual therapy

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Changes of values of selected spirometric parameters in course of complex rehabilitation treatment in patients with scolioses of I° and II°

Rafał Gnat, Edward Saulicz, Marek Zięba, Paweł Ryngier

Rafał Gnat, Edward Saulicz, Marek Zięba, Paweł Ryngier – Changes of values of selected spirometric parameters in course of complex rehabilitation treatment in patients with scolioses of I° and II°. Fizjoterapia Polska 2003; 3(1); 21-29

Abstract
Both the values of the spirometric parameters in people with low-degree scoliosis and their changes in course of the rehabilitation treatment aiming to correct the body posture are subjects rarely mentioned in literature. Just sparse articles give evidence for the presence of respiratory disturbances even in early stages of the development of scoliosis. The hypothesis claiming that normalisation of the values of selected spirometric parameters, decreased earlier, during attempts of correction of the body posture could be obtained was brought forward for needs of the presented report. 60 children with scolioses of Ist and IInd degree and without any coexisting health problems participated. The evaluation of the values of selected spirometric parameters was performed twice: at the beginning of the treatment (initial test) and after its termination (final test). The time of therapeutic influence averaged 28,77 days (SD = 9,47) and daily load with corrective exercises about 3 hours with supplementary procedures. During the period of time between initial and final tests most of the assessed spirometric parameters showed significant improvement increasing their values and bringing them closer to standards (FVC EX, FVC IN, FEV1, PEF, PIF, VC, IC). The ERV parameter didn’t show any important alterations. The volumes TV and MV as well as Tiffeneau coefficient maintained their previous rise tendencies.According to the stated hypothesis the corrective rehabilitation treatment improved values of selected spirometric parameters, which were decreased in course of low-degree scoliosis. Basing on the results some practical clues concerning corrective treatment of this postural fault may also be formulated.

Key words:
Scoliosis, rehabilitation treatment, Spirometry, spirometric parameters

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S-E-T: Possibilities for use in coxarthrosis deformans

Mirosław Kokosz, Rafał Gnat, Lech Wojdyła, Jacek Mańka

Mirosław Kokosz, Rafał Gnat, Lech Wojdyła, Jacek Mańka – S-E-T: Possibilities for use in coxarthrosis deformans. Fizjoterapia Polska 2004; 4(4); 411-418

Abstract

The purpose of this article is to describe the mechanisms that ensure the stability of the hip joint. In the first part, the passive and active control subsystems are explained, as well as the controlling function of the nervous system. This feed-forward mechanism protects the musculo-skeletal system from dangerous overuse in both static and dynamic conditions. The second part of the article gives the main rules for therapeutic intervention and some examples of stability exercises that can be used in cases of coxartrosis deformans.

Key words:
kinesitherapy, active control, passive control, controlling function of the nervous system
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The suitability of the „toe-touch” test for functional testing in physiotherapy

Michał Kuszewski, Henryk Knapik, Edward Saulicz, Rafał Gnat, Mirosław Kokosz

Michał Kuszewski, Henryk Knapik, Edward Saulicz, Rafał Gnat, Mirosław Kokosz – The suitability of the „toe-touch” test for functional testing in physiotherapy. Fizjoterapia Polska 2004; 4(4); 378-384

Abstract

Background. The objective of our study was to specify the relationship between selected flexibility parameters and the results of the „toe-touch” test. Material and methods. We examined 190 people from 18 to 51 years of age (ave. 23.8 ± 5.7). In each subject, global flexibility in the sagittal plane was tested with the „toe-touch” test, then the mobility of the upper and lower lumbar spine and both hip joints was examined, as was the range of plantar flexion of the ankle (an indirect indication of the length of the muscles of the dorsal aspect of the leg) and possible shortening of the hamstrings. A Saunders’ electronic goniometer was used to make measurements (in the lower lumbar spine Schober’s measurement was also utilized). The product-moment Pearson’s correlation test was used to estimate connections between parameters. Results. Significant correlations were registered between the results of the toe-touch test and the following parameters: mobility of the upper (r = 0.79) and lower lumbar spine (r = 0.70), shortening of the hamstrings (r = -0.67), mobility of both hip joints (r = 0.36 and r = 0.34), and the range of plantar flexion of both ankle joints (r = 0.33 and r = 0.25). There was no significant connection between the „toe-touch” test and the results of Schober’s measurement. Conclusion. The „toe-touch” test is a quick, simple and reliable way to evaluate the functional status of the lower spine and lower extremities.

Key words:
flexibility parameters, lumbar spinal mobility, crural muscles, plantar flexion of the ankle, shortening of the hamstrings hip mobility
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Biomechanical aspects of modern models of pelvis stability. Part II: symphysis pubis and anterior oblique muscle sling

Rafał Gnat, Edward Saulicz, Mirosław Kokosz, Michał Kuszewski

Rafał Gnat, Edward Saulicz, Mirosław Kokosz, Michał Kuszewski – Biomechanical aspects of modern models of pelvis stability. Part II: symphysis pubis and anterior oblique muscle sling. Fizjoterapia Polska 2006; 6(4); 328-333

Abstract
Biomechanical model of pelvis stability based on self-bracing mechanism contributed to certain discrimination of previous proposals mentioning the pelvic ring and ascribing important stabilizing role to pubic symphysis. However, the paper presents some arguments challenging thesis about complete lack of significance of the symphysis and anterior part of the pelvic stabilising system in process of maintaining stability. Both the symphysis itself as well as anterior oblique muscle sling seem to find their own, meaningful place there. Maybe this role could not be considered primary, but surely it is supplementary one. Observations of biomechanical, clinical and evolutional nature seem to support such a point of view. Spreading of the effective range of self-bracing due to compressive forces acting on the sacroiliac joint and increased friction between its surfaces divides the burden of maintaining stability on bigger number of muscles. The adductor longus that belongs to anterior oblique muscle sling seems to locate its attach-ment in the proper area. Moreover, a view of the pelvis, where the force closure mechanism is executed by posterior muscle slings exclusively brings about compelling impression of shearing forces arising within the sacroiliac joints. Activation of the anterior portion of the stabilizing system heads off the incoming threat immediately. Also assuming the upright body posture resulted in humans in more frequent, in comparison with other species, backward excursions of the centre of gravity. In such conditions the anterior part of the pelvic stabilizing system will always be activated in order to maintain stability.

Key words:
pelvis, symphysis pubis, anterior oblique muscle sling

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Biomechanical aspects of modern models of pelvis stability. Part I: sacroiliac joint and self-bracing mechanism

Rafał Gnat, Edward Saulicz, Michał Kuszewski, Mirosław Kokosz

Rafał Gnat, Edward Saulicz, Michał Kuszewski, Mirosław Kokosz – Biomechanical aspects of modern models of pelvis stability. Part I: sacroiliac joint and self-bracing mechanism. Fizjoterapia Polska 2006; 6(4); 280-288

Abstract
Last two decades of the XXth century brought about significant progress towards recognition of stabilizing mechanisms of kinematic links within human locomotory system. Panjabi formulated his concept concerning stabilizing system of the human kinetic link, scientist from Australia explained the mechanism of stabilization of the lumbar section of the spine, linked its dysfunctions to pain ailments rising in that region of the body and proved the effectiveness of the innovative training system in reduction of severity of such symptoms. Between numerous research in that direction, a biomechanical model of sacroiliac joint stability developed by Dutch scientists from Erasmus University, Rotterdam, is worthy paying attention. This model takes into consideration two coexisting mechanisms that make maintaining stability possible: the form closure and the force closure mechanism. As result of the cooperation between the two an effect of self-bracing of the sacroiliac joint comes into being. The leading idea hidden under the surface of the model is quite similar to the one that ancient architects had in minds while developing the structure of so called roman arch. Here, sacrum plays the role of the keystone and the two femora together with innominates are the columns. After application of quite a small, transversely oriented force, resulting from musculoligamentous system activity the construction remains stable. The objective of the paper is to familiarize reader with details of biological mechanisms that built up foundation for the Dutch model of sacroiliac joint stability.

Key words:
sacroiliac joint, form closure, force closure, self-bracing effect

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Efficacy of the PNF method in rehabilitation for activities of daily living in late post-stroke patients

Tomasz Wolny, Edward Saulicz, Rafał Gnat

Tomasz Wolny, Edward Saulicz, Rafał Gnat – Efficacy of the PNF method in rehabilitation for activities of daily living in late post-stroke patients. Fizjoterapia Polska 2009; 9(1); 51-60

Abstract
Background. Our increasing knowledge on the complexity of CNS injuries and mechanisms of neuronal plasticity indicates that the traditional approach to rehabilitation of stroke patients is no longer adequate. Appropriate stimulation of the central nerv-ous system to promote neuromuscular plasticity is crucial for the restoration of normal function. Rehabilitation based on PNF (Pro-prioceptive Neuromuscular Facilitation) significantly improves ADL functional performance of post-stroke patients. Materiał and methods. A total of 64 stroke patients were randomly divided into two groups. ActMties of daily living were eval-uated by means of the ‘Repty’ Functional lndex, which includes: self-service, sphincter control, mobility locomotion and communi-cation. Throughout the study period (their stay at the Neurological Rehabilitation Ward for a mean of 21 days), all patients received comprehensive rehabilitation, with Group A receiving conventional rehabilitation and Group B receMng also indMdual kinesiother-apy based on the PNF method. Results. Analysis of yariance showed significant differences in the following domains of the ‘Repty’ Functional lndex: self-service (p=0.0015), locomotion (p=0.0279), and total score (p=0.0032). No significant differences were found in the remaining domains (sphincter control, mobility and communication). Conclusions. PNF-based rehabilitation of late post-stroke patients significantly improved their ADL functional performance with respect to self-service and locomotion.
Key words:
PNF, physiotherapy, activities of daily-living
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Subjective assessment of the effects of different approaches to rehabilitation of patients after cerebral stroke

Tomasz Wolny, Edward Saulicz, Rafał Gnat, Mirosław Kokosz, Michał Kuszewski, Andrzej Myśliwiec

Tomasz Wolny, Edward Saulicz, Rafał Gnat, Mirosław Kokosz, Michał Kuszewski, Andrzej Myśliwiec – Subjective assessment of the effects of different approaches to rehabilitation of patients after cerebral stroke. Fizjoterapia Polska 2009; 9(3); 223-231

Abstract
Background. Paying attention to the individual needs of the patient during treatment planning is becoming an important element of contemporary rehabilitation of post-stroke patients. The patient should not only be the recipient, but also a co-author of the programme of rehabilitation administered to him or her. The study hypothesis was that the type of rehabilitation treatment would influence the patient’s subjective evaluation of the effects of rehabilitation. Material and methods. The study involved a group of 64 stroke patients. All subjects were divided randomly into three groups (A, B and C). Subjective assessment of the efficacy of rehabilitation was based on a specially prepared questionnaire. Patients were followed up for about 21 days, during which period they were administered comprehensive rehabilitation. Group A received traditional post-stroke therapy. The rehabilitation programme for Group B included individual kinesiotherapy based on the PNF method. The programme for Group C comprised individual kinesiotherapy based on the PNF method supplemented with tensing neuromobilisations of peripheral nerves of the paretic upper extremity. Results. Overall, the highest average number of points (x = 11.5394), corresponding to the most marked subjective impro -vement, was recorded in Group C, while the least marked effect was noted in Group A (x = 8.1751). Conclusions. The subjective assessment of the effects of rehabilitation treatment correlated significantly with the type of rehabilitation administered.
Key words:
self-assessment, physiotherapy, stroke, therapeutic effects
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Evaluation of the effectiveness of Butler’s neuromobilisations in reducing disorders of stereognosis of impaired upper extremity in late-stage stroke patients

Tomasz Wolny, Edward Saulicz, Rafał Gnat

Tomasz Wolny, Edward Saulicz, Rafał Gnat – Evaluation of the effectiveness of Butler’s neuromobilisations in reducing disorders of stereognosis of impaired upper extremity in late-stage stroke patients. Fizjoterapia Polska 2010; 10(2); 95-102

Abstract
Background: A review of contemporary literature indicates that the rehabilitation of stroke patients is chiefly based on reeducation and compensation techniques addressing motor deficits, even though pure motor hemiparesis occurs very rarely. We assumed that tensional neuromobilisations of the impaired upper extremity in late-stage post-stroke patients influence disorders of stereognosis (tactile perception of natural objects)Material and method: The study involved a group of 64 stroke patients. The subjects were divided randomly into two subgroups (A and B). To assess tactile perception, all patients had to identify 10 commonly used objects by touch. During the 21-day follow-up, all patients were subjected to comprehensive rehabilitation. The therapeutic programme for Group A included selected physical modalities and individual kinesiotherapy based on the PNF method. The treatment in Group B additionally included tensional neuromobilisations of peripheral nerves of the impaired upper extremity. Results: Analysis of variance showed significant variation only for the test measurement factor (p <0.01), which was due to significant intra-group differences in Group B (p<0.05; Tukey test).Conclusions: The greatest improvement in the assessment of the tactile perception of everyday objects was obtained in the group which received PNF therapy supplemented with neuromobilisations of peripheral nerves of the impaired upper extremity.
Key words:
stereognosis, physiotherapy, stroke, therapeutic effects
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Effectiveness of PNF method in improving symmetry of lower extremity loading in late-stage post-stroke patients

Tomasz Wolny, Edward Saulicz, Rafał Gnat, Mirosław Kokosz, Andrzej Myśliwiec, Michał Kuszewski

Tomasz Wolny, Edward Saulicz, Rafał Gnat, Mirosław Kokosz, Andrzej Myśliwiec, Michał Kuszewski – Effectiveness of PNF method in improving symmetry of lower extremity loading in late-stage post-stroke patients. Fizjoterapia Polska 2010; 10(4); 263-270

Abstract
Early comprehensive multidisciplinary rehabilitation is crucial for achieving satisfactory results in the conservative management of post-stroke patients. Gait re-education is a major goal in post-stroke rehabilitation regardless of how much time has elapsed since the stroke. The study hypothesis was that therapy based on PNF (Proprioceptive Neuromuscular Facilitation) would significantly improve loading symmetry of the lower limbs, thus enabling faster restoration of the support and locomotor function and improving gait efficiency in post-stroke patients. A total of 64 stroke patients were randomly divided into two groups. A Loading Symmetry Index (LSI) of the lower limbs was calculated basing on data recorded in the ‘two-scales’ test. Patients were followed up for a mean of 21 days (during which they stayed at a Neurological Rehabilitation Ward). Group A received conventional rehabilitation while Group B also received individual kinesiotherapy based on the PNF method. Analysis of variance showed significant differences in LSI values (interaction: group x measurement – p=0.0075). Post hoc Tukey test revealed significant intra-group differences in Group B (p=0.0002). There were no significant intra-group differences in Group A or significant differences between the groups. PNF-based rehabilitation of late-stage post-stroke patients significantly improved loading symmetry of the lower extre – mities.
Key words:
PNF, physiotherapy, symmetry, Locomotion
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