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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Direct and short-term effects of mobilization with movement according to B. Mulligan in patients with non-specific pain & overload conditions of the shoulder girdle

Mirosław Kokosz, Witold Sodel, Edward Saulicz, Tomasz Wolny, Andrzej Knapik

Mirosław Kokosz, Witold Sodel, Edward Saulicz, Tomasz Wolny, Andrzej Knapik – Direct and short-term effects of mobilization with movement according to B. Mulligan in patients with non-specific pain & overload conditions of the shoulder girdle. Fizjoterapia Polska 2009; 9(4); 301-311

Abstract
Background. Pain and overload conditions ofthe shoulder girdle are a complex problem for physiotherapists. Various manuał therapy techniąues are used to reduce the patienfs complaints. The aim ofthe work was to compare direct and short-term effects ofmobiliza-tions with movement on pain intensity and shoulder rangę of motion. Material and methods. The participants were divided into two groups of 20. Mobilizations with movement (Mulligan techniąues) were performed in the experimental group, while the control group carried out standard mobilizing and strengthening exercises. Changes in rangę of motion of shoulder girdle elevation through flexion and elevation through abduction and pain intensity were evaluated. The data were statistically elaborated. Results. More rapid and morę distinct reduction in pain and ROM improvement were obsen/ed in the experimental group. Conclusions. Mobilizations with movement applied to patients with overload-related pain of the shoulder girdle produce morę beneficial direct and short-term therapeutic effects.
Key words:
shoulder girdle, Mulligan approach, effectiveness
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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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Influence of proprioceptiveneuromuscular facilitation (PNF) on the degree of spasticity in late-stage 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 – Influence of proprioceptiveneuromuscular facilitation (PNF) on the degree of spasticity in late-stage stroke patients. Fizjoterapia Polska 2011; 11(1); 1-8

Abstract
The complex pathophysiology of spasticity depends on the interaction between facilitation and inhibition of spinal and supraspinal neural centres and pathways. Contemporary medicine has developed several methods to treat spasticity. However, none of them has offered superior efficacy. This study aimed to investigate differences in the degree of spasticity between patients subjected to traditional post-stroke rehabilitation and rehabilitation based on the PNF method.A total of 64 stroke patients were enrolled. They were randomly divided into Group A and Group B. The modified six-grade Ashworth scale was used to evaluate the level of spasticity. During a 21-day follow-up, all subjects underwent intensive comprehensive rehabilitation. Group A received traditional stroke therapy. Group B received kinesiotherapy based on the PNF method.Both groups demonstrated significant improvements. In Group A, the degree of improvement in the final examination was 1.8% compared to baseline. In Group B, an improvement of 7.8% was registered already after the first session. The degree of improvement at the end of treatment was 16.86%. No significant inter-group differences were noted at baseline. The final evaluation showed significant differences.A regimen based on the PNF method resulted in greater reduction in spasticity than the traditional approach.
Key words:
spasticity, PNF, physiotherapy, Stroke, Therapeutic effects
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Strength and kinesthetic differentiation of deep muscles stabilizing lumbar spine in low back subclinical pain complaints

Mirosław Kokosz, Edward Saulicz, Tomasz Wolny, Mariola Saulicz, Andrzej Myśliwiec, Łukasz Gębala, Oliwia Mokrus, Paweł Linek

Mirosław Kokosz, Edward Saulicz, Tomasz Wolny, Mariola Saulicz, Andrzej Myśliwiec, Łukasz Gębala, Oliwia Mokrus, Paweł Linek – Strength and kinesthetic differentiation of deep muscles stabilizing lumbar spine in low back subclinical pain complaints. Part 1. Fizjoterapia Polska 2012; 12(2); 101-112

Abstract
Background. Lumbar spine pain is one of the most frequent malfunctioning of the locomotor system. The aim of this article was to examine whether there is a co-relationship between the preliminary, subclinical symptoms of pain and the strength and kinesthetic differentiation of deep muscles stabilizing the lumbar spine in the lower section of spine. Material and methods. Appearance of pain in lumbar spine was taken as an independent variable. The average intensity of the ailment was 8.81 points (±3.68) in the Oswestry scale in 52 subjects. The second group composed of 48 persons who, at the time of the examination, felt no pain in the low back. Both groups were matched regarding the basic parameters: age, body weigh, height, level of physical activities and sex. Results of tests carried out with the use of pressure stabilizer in the supine and prone positions constituted the dependent variables. Results. Statistical analysis showed that there are significant dependencies between the presence of pain and strength and kinesthetic differentiation in the prone position. No such dependencies were registered in the supine position. Conclusions. Weakness of the deep stabilizing muscles is characteristic for persons with perceived minor lumbar spine pain. The ability to differentiate pressure force is also disturbed. It seems that an examination performed in a prone position is useful in detecting the above changes.
Key words:
Low Back Pain, muscular stabilization, Proprioception
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USG-feedback – novelty in Polish physiotherapy

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

T. Wolny, E. Saulicz, A. Myśliwiec, M. Kuszewski, M. Kokosz  – USG-feedback – nowość w polskiej fizjoterapii. FP 2012; 12(4); 293-304

Abstract

Ultrasounds have been used in the physiotherapy for a long time, however up till now their application was connected with the therapeutic process. They are applied in the treatment of pain syndromes, in the course of degenerative diseases of peripheral and spinal articulations, neuralgia, soft tissue overload syndromes and after sport injuries. The ultrasound application for diagnostic purposes, as well as support for exercises (sonofeedback), is a new approach which takes its first steps in the Polish physiotherapy and arouses some controversies of the formal-legal as well as factual nature. The great value of the USG application in physiotherapy is primarily connected with the fact that it makes it possible to dynamically assess various tissues in real time at rest as well as during movement. It is a perfect tool to specify the functional diagnosis and to detect contraindications for a therapy. Its application both in a functional diagnosis as well as in a therapy improves the clinical analysis of the osteo-articulo-muscular system which is emphasized and recommended by many authors.
Applying the USG in physiotherapy is beneficial, both for the physiotherapists and their patients. For the physiotherapists – because it improves the efficiency and effectiveness of the therapy program and increases in the range of provided services and for the patients becouse of a significantly higher level of treatment.

Keywords

Ultrasonography, sonofeedback, physiotherapy

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