Therapy for limb apraxia in a patient with the Melas syndrome

Maria Pąchalska, Bogusław Frańczuk, Tadeusz Gałkowski, Bożena Grochmal-Bach, Henryk Knapik, Ewa Gostyk, Bruce MacQueen, Adam Pąchalski, Piotr Pąchalski, Rafał Stabrawa, Irena Jeleńska-Szyguła

Maria Pąchalska, Bogusław Frańczuk, Tadeusz Gałkowski, Bożena Grochmal-Bach, Henryk Knapik, Ewa Gostyk, Bruce MacQueen, Adam Pąchalski, Piotr Pąchalski, Rafał Stabrawa, Irena Jeleńska-Szyguła – Therapy for limb apraxia in a patient with the Melas syndrome. Fizjoterapia Polska 2001; 1(1); 26-38

Abstract
Introduction. The authors report the results of four years of research and therapy of apraxia occurring in a patient with a mitochondrial cytopathy known as the MELAS syndrome, which causes heterogeneous organic changes in the brain. This is an original contribution, since the clinical literature contains no references to apraxia therapy in MELAS. Slowly progressive apraxia of the upper and lower limbs is described, and the rehabilitative potential of a specially developed authorial program entitled “Semantically Controlled Patterns of Motion” (referred to as “SSWR” from the Polish abbreviation) is measured.Material and methods. The patient, K.S., female age 22, diagnosed with MELAS, is under treatment in the Department of Medical Rehabilitation at the Cracow Rehabilitation Center. The extraordinarily complicated clinical picture of her illness (one of the mitochondrial cytopathies) consists of episodic exacerbation overlaid on a patient of slowly progressive symptoms, including dementia, fluctuating aphasia, tactile agnosia, sensorineural deafness, cortical blindness, and slowly progressive ideomotor apraxia. The holistic therapy program involves the indicated pharmacological treatment and comprehensive neurorehabilitation aimed at the polymodal reintegration of higher cortical functions, including voluntary limb movements. The SSWR program is comprised of an authorial set of patterns of limb motion involving both gross and fine movements, along with descriptive humorous names for the individual patterns, in order to support the process of remembering and recalling, since the patient exhibits cognitive disturbances. The effectiveness of the therapy program developed for this patient was assessed by means of standard neuropsychological tests, including the Boston Test of Praxis and the Test of Activities of Daily Life (ADL). Results. It was found that despite the continued development of the illness as measured by the results of MRI examinations, the patient achieved considerable progress in respect to conscious control of limb movements, as indicated by significant improvement in the results from successive administrations of the Boston Test of Praxis. Improvement in general ability to adapt as well as emotional and social functioning, is indicated by the results from standard neuropsychological tests and from the Test of Activities of Daily Life (ADL). Discussion. The authors present the theoretical foundations of the program. Imitating a movement requires that a mental representation of the intended movement be evoked in the brain, after which a motor program (in the seanse of praxis) is formulated and executed. The significance of this discovery for contemporary physiotherapy will be demonstrated.

Key words:
MELAS syndrome, limb apraxia ideomotor apraxia, patterns of motion, neurorehabilitation

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The effectiveness of post-traumatic rehabilitation of the talocrural joint using the Kattenborn mobilization technique

Henryk Knapik, Michał Żuławiński

Henryk Knapik, Michał Żuławiński – The effectiveness of post-traumatic rehabilitation of the talocrural joint using the Kattenborn mobilization technique. Fizjoterapia Polska 2001; 1(1); 23-25

Abstract
Background. The goal of this paper is to evaluate the effectiveness of the Kaltenborn mobilization technique in the rehabilitation of post-traumatic dysfunctions of the talocrual joint. Material and methods. The research involved 40 patients from the Surgical and Orthopedic Clinic in Nowy Targ, Poland, where Kaltenborn mobilization techniques were not used prior to the experiment. The control group (K) consisted of 20 persons treated from March to September 1997, using a standard rehabilitation program that included physiotherapy and kinesitherapy along with redressing techniques, while the experimental group consisted of 20 persons treated from October 1997 to March 1998 under the same rehabilitation program, but with Kaltenborn mobilization techniques substituted for redressing techniques. The procedures were conducted for a period of 10 days, one session daily.The range of passive and active moment, dorsal and plantar flexion, pronation and supination were tested in the affected joint each day just before and just after rehabilitation procedures, while the healthy joint was tested for comparative purposes on the first and last day of rehabilitation. Results. The patients from group K were found to have smaller increases in the range of movement than those in group E, where the range of movement on the last day was very close to the physiological norm. Conclusions. The Kaltenborn technique is more effective in the rehabilitation of patients with joint dysfunctions and is to be recommended. Procedures for diagnosis and therapy should be closely matched, however, to the needs of the patient.

Key words:
ankle joint trauma, joint mobilization, Kaltenborn technique

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Evaluating the manner of performing selected activities of daily living in the light of early prevention of low back pain

Aleksandra Rudzińska, Olga Nowotny-Czupryna, Henryk Knapik

Aleksandra Rudzińska, Olga Nowotny-Czupryna, Henryk Knapik – Evaluating the manner of performing selected activities of daily living in the light of early prevention of low back pain. Fizjoterapia Polska 2001; 1(4); 381-384

Abstract
Background. Low back pain is both a medical and a social problem. One way to limit its dimensions is prevention, broadly understood. In our research we attempted to determine how activities of daily living that are particularly burdensome for the spine are performed. Material and methods. Our research involved 265 healthy subject (i.e. without spinal pain symptoms at the moment of testing), among whom 136 were manual laborers and 129 were white-collar workers. The subject were asked to perform 3 movement tasks: to change body position from lying to standing, to assume a sitting position on a chair, and to lift a weigh from the floor. Results. The results we obtained indicate a lack of proper movement habits, which are essential in the prevention of low back pain in the great majority of subjects. Conclusions. It would be advisable to conduct training in the area of preventing strain on the spine, as a result of which spinal pain symptoms can develop. The general public should be made aware of the importance of the problem, with particular emphasis on the consequences of the errors committed on a daily basis.

Key words:
Low Back Pain, prevention, back school

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An evaluation of familiarity with the principles of preventing cervical spinal pain and their application in the daily living activities of women

Aleksandra Rudzińska, Olga Nowotny-Czupryna, Henryk Knapik

Aleksandra Rudzińska, Olga Nowotny-Czupryna, Henryk Knapik – An evaluation of familiarity with the principles of preventing cervical spinal pain and their application in the daily living activities of women. Fizjoterapia Polska 2002; 2(1); 6-10

Abstract
Background. The cervical spine is expose to overload resulting from lifestyle, work-related strain, and unawareness of the principles governing the ergonomics of exertion. In our research we examined the manner of performing activities of daily living that are particularly burdensome for the cervical spine and ascertained how often exercises were performed to compensate for incorrect behavior.Material and methods. The research involved 166 women who were not complaining of pain in the cervical spine, either during the research or in the past. Among the subject 84 persons were performing physical labor, while 82 were office workers. The research questionnaire contained questions pertaining to those aspects of their behavior that were essential from the point of view of preventive spinal pain symptoms.Results. In the great majority of subjects the results indicate a lack of proper performance of daily living activities that have an impact on the prevention of cervical spinal pain.Conclusions. In a distinct majority of the young women we studied, the cervical spine is exposed in daily life to various kinds of overload, especially incorrect unilateral spinal load resulting from improper carrying of object, especially in women engaged in manual labor. Regular exercising to relieve spinal overload is performed by only a small percentage of women engaged in manual labor, the results obtained by women engaged in white-collar occupation were somewhat better.

Key words:
Neck Pain, Activities of Daily Living, ergonomics

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The treatment of Peyroni’s disease by combined laser and ultrasound therapy: a trial

Krystyna Kwaśny, Marek Chorąży, Dariusz Bielecki, Rafał Kurzyk, Henryk Knapik

Krystyna Kwaśny, Marek Chorąży, Dariusz Bielecki, Rafał Kurzyk, Henryk Knapik – The treatment of Peyroni’s disease by combined laser and ultrasound therapy: a trial. Fizjoterapia Polska 2002; 2(3); 181-184

Abstract
Background. Given the known impact of laser beams and ultrasound waves on human tissues, the authors decided to assess the results of therapy using these modalities for a relatively unfamiliar illness: Peyroni’s disease, also known as soft penile sclerosis. The theoretical premise was that a laser beam targeted at atherosclerotic plaque would cause initial softening, after which the ultrasound wave would knock out the calcium molecules from the plaque structure, lead to its breakdown. This was expected to result in resolution or reduction of fibrotic plaque, as well as regression or reduction of the angle of penile curvature. Undoubtedly the synergistic action of both methods should also be of significance here, as for example the analgesic effects of laser and ultrasound.Material and methods. The tests were performed in the period 1996 – 2001 on 25 men who presented with various levels of sclerotic lesions in the vicinity of the cavernous bodies of the penis. We attempted to measure the impact of the proposed therapy on the size of fibrotic plaque, penile curvature and pain symptoms.Results. Of the patients we studied, 22 (88%) were found to have fibrous plaques. In 12 of these cases (54.5%), the plaques had disappeared completely after therapy, while in 8 patients (36.4%) the sclerotic lesions were significantly reduced. No improvement was seen in 2 patients (9%). Conclusions. The results we obtained confirmed the theoretical premises; however, verification over a longer follow-up period is necessary.

Key words:
soft penile sclerosis, Physical Medicine, Peyroni’s disease

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General functional dependencies required in the design of sauna complexes in public access facilities

Hanna Adamczyk-Bujniewicz, Janusz Kubacki, Krystyna Kwaśny, Henryk Knapik

Hanna Adamczyk-Bujniewicz, Janusz Kubacki, Krystyna Kwaśny, Henryk Knapik – General functional dependencies required in the design of sauna complexes in public access facilities. Fizjoterapia Polska 2003; 3(1); 85-90

Abstract
The increasing tempo of modern life is causing greater demand for various forms of recreation. New types of facilities are being constructed, among which are so-called Water Parks. An integral element of these facilities is the sauna complex. This is an area containing an aggregation of saunas and baths with a broad spectrum of effects. For the proper design and operation of these complexes it is essential to be familiar with the broad range of possibilities offered by the sauna, and to possess some basic knowledge of physiological reactions. Sauna complexes for public use should be designed on the basis of familiarity with stimuli and all the elements that influence the desired outcome of a sauna session. A properly designed environment in such facilities enables them to be fully and effectively utilized.

Key words:
recreation, biological renovation, regeneration

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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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