An evaluation of the effectiveness of magnetotherapy as a factor supporting rehabilitation on the basis of selected biomechanic and psychotechnical indices

Mirosław Janiszewski, Anna Błaszczyk

Mirosław Janiszewski, Anna Błaszczyk – An evaluation of the effectiveness of magnetotherapy as a factor supporting rehabilitation on the basis of selected biomechanic and psychotechnical indices. Fizjoterapia Polska 2001; 1(1); 39-42

Abstract
The aim of this study was to examine the impact of longterm magnetic field stimulation on the rehabilitation of post-stroke patients and to determine how quickly these patients gain locomotor efficiency. A group of 180 patients 50-70 years old after stroke received rehabilitation and low frequency magnetic field stimulation. As a criterion for evaluation purposes the authors used selected biomechanical and psychotechnical indices. The study shows that magnetotherapy in post-stroke patients undergoing rehabilitation has a positive effect in the improvement of muscle function, motor coordination indices, and some biomechanical parameters (strength under dynamic and static circumstances).

Key words:
Stroke, magnetic fields, Rehabilitation

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Thermovisual evaluation of vascular behavior in the paretic upper limb after local cryostimulation in stroke patients

Zbigniew Śliwiński, Piotr Plaza

Zbigniew Śliwiński, Piotr Plaza – Thermovisual evaluation of vascular behavior in the paretic upper limb after local cryostimulation in stroke patients. Fizjoterapia Polska 2002; 2(2); 112-117

Abstract
Background. Stroke is the third most common cause of death, one of the most common causes of handicap, and the most common cause of disability among persons older than 40. Each year 4.6 million people around the world die from strokes, including 3.2 million in developing countries and 1.2 million in highly industrialized countries. In view of the high morbidity rate and the serious consequences of stroke, in the form of limb paresis, the authors decided to use a thermovision camera to check vascular reactions in the paretic limb by evaluating temperature changes on the skin subsequent to cryostimulation by liquid nitrogen vapors. Material and methods. Our research involved 28 patients with an average age of 61.3 years. The procedure was performed on the forearm of the paretic upper limb, which was cooled for 6 minutes (from the hand to the elbow cavity, the dorsal surface and the palm surface). Thermovision images were made 5 times for each patient. Results. The authors observed that as a result of the procedure the temperature of the cooled limb went down 12°C, and 2.6°C in the other limb. Conclusions. The results cannot be easily interpreted. In the authors’ opinion, the temperature reduction in the limb that was not cooled results from contralateralization of the consensual reflex. The present study is a preliminary report describing the phenomenon we observed.

Key words:
Stroke, Cryostimulation, thermovision, vascular behavior

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Constraint-induced movement therapy in the rehabilitation of stroke patients

Janusz Otfinowski, Bożena Jasiak-Tyrkalska, Agnieszka Bogunia, Beata Buda

Janusz Otfinowski, Bożena Jasiak-Tyrkalska, Agnieszka Bogunia, Beata Buda – Constraint-induced movement therapy in the rehabilitation of stroke patients. Fizjoterapia Polska 2004; 4(1); 19-24

Abstract

Background. This article presents some preliminary results from the rehabilitation of patients with impaired hand function after stroke. The basis for therapy was the method introduced by Taub, known as Constraint-Induced Movement Therapy (CIMT), which involves the temporary constraint of the healthy upper limb, with simultaneous intensive motor rehabilitation of the dysfunctional limb. Material and methods. Our research involved 10 patients treated in the Rehabilitation Clinic at the Jagiellonian University College of Medicine for post-stroke hemiparesis. There were 5 men and 5 women in this group, ranging in age from 57 to 77 years (ave. 66.5). The time since onset ranged from 1 to 50 months (ave. 11.4 months). CIMT was used in all patients. Results. After 2 weeks of rehabilitation all the patients required less time to perform manual tests, and showed marked functional improvement in the affected hand. Conclusions. The CIMT method is effective in the rehabilitation of patients with post-stroke hemiparesis.

Key words:
Stroke, rehabilitation of the hand, CIMT
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Selected demographic and clinical factors and the efficacy of the Constraint-Induced Movement Therapy (CIMT) of the hand after stroke

Bożena Jasiak-Tyrkalska, Janusz Otfinowski, Beata Buda

Bożena Jasiak-Tyrkalska, Janusz Otfinowski, Beata Buda – Selected demographic and clinical factors and the efficacy of the Constraint-Induced Movement Therapy (CIMT) of the hand after stroke. Fizjoterapia Polska 2007; 7(1); 21-28

Abstract

Background. The authors attempted to evaluate the effect of selected demographic and clinical factors on the efficacy of Constraint-Induced Movement Therapy (CIMT) in improving the mobility of a paretic hand following cerebral stroke. The analysis focussed on factors such as age, gender, side of paresis and time elapsed since stroke. It is commonly known that post-stroke rehabilitation is relatively difficult and poses a challenge not only to the therapeutic team, but also to the patient’s family. Despite activities geared towards improved mobility, satisfactory effects cannot always be achieved. Until recently, physiotherapy was mainly geared towards the compensation of deficits rather than functional restoration. Nowadays, specialised neurological rehabilitation centres introduce novel methods based on the concept of brain adaptability, aimed primarily at functional restoration. The CIMT method is being used more and more frequently. It can be succinctly defined as a strategy for the activation of paretic parts of the body through constraining or totally preventing the use of their healthy counterparts. Material and methods. The study group comprised 21 persons (11 women and 10 men) following cerebral stroke. Mean patient age was 65 years. The efficacy end-point for the rehabilitation approach was time required to carry out 10 basic everyday activities using the affected hand. This assessment was carried out four times: at baseline, after two weeks of intensive exercise in a hospital rehabilitation ward as well as at 4 and 12 weeks of independent practice at home. Results. The therapeutic programme lead to a highly significant (p<0.001) improvement of the performance of the motor function impaired hand. Subgroup analysis did not demonstrate any significant influence of individual factors on the efficacy of the method used to improve hand motor function after cerebral stroke. Conclusions. Regardless of the age and gender of cerebral stroke patients, the CIMT method demonstrated significant efficacy in improving hand motor function. Time elapsed since stroke has no impact on the improvement of the paretic hand using the C1MT method. Regardless of the affected side, the method activates the motor functions of the paretic hand.

Key words:
stroke, improvement of hand mobility, CIMT
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Prognostic efficacy of Berg Balance Test in assessing the risk of fall in patients after stroke

Waldemar Brola, Małgorzata Fudala, Jan Czernicki

Waldemar Brola, Małgorzata Fudala, Jan Czernicki – Prognostic efficacy of Berg Balance Test in assessing the risk of fall in patients after stroke. Fizjoterapia Polska 2009; 9(1); 31-38

Abstract
Background. The risk of fali within the first year after a cerebral stroke amounts to approximately 40%. Numerous attempts have been made to propose a simple, yet sensitive and specific test to facilitate effective identification of patients at a particularly high risk of fall. The present study therefore aimed to assess the risk of fall among post-stroke patients undergoing physical rehabilitation with the Berg Test (Berg Functional Balance Scale). Material and methods. A total of 312 patients treated initially at the Stroke Ward and later at the Department of Physical Rehabilitation and attending the Vascular Disease Outpatient Clinic of the Hospital in Końskie in 2004 were followed up over 12 months. Each patient was assessed during the initial rehabilitation period and then allocated to one of four risk groups depending on his/her score in the Berg Test. Every subsequent fali was recorded together with a brief description of any consequences. Results. 119 patients (35%) fell at least once during the 12-month period, with 36 (11.5%) sustaining serious injuries as a result. The majority of the falls (78 patients) occurred in Berg Group IV (highest risk) patients, who also sustained multiple falls and the most serious consequences. The respective number of incidents in the other groups was 24 falls in Group III, 15 falls in Group II, and only 2 falls in Group I. Conclusions. The Berg Test appears to be a simple, reliable and sensitive instrument for identifying patients most at risk of sustaining an accidental fali. Ensuring particular care for those patients may help them avoid serious consequences of falls and enhance overall rehabilitation outcomes.
Key words:
stroke, falls, risk factors, Berg Balance Scale
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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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Factors influencing the incidence of shoulder pain in post-stroke patients

Teresa Pop, Agnieszka Dziedzic, Katarzyna Łach-Pop

Teresa Pop, Agnieszka Dziedzic, Katarzyna Łach-Pop – Factors influencing the incidence of shoulder pain in post-stroke patients. Fizjoterapia Polska 2010; 10(2); 103-112

Abstract
Pain and functional impairment of the paretic shoulder are a frequent complication in post-stroke patients. The pain is mostly localised to the glenohumeral joint, but sometimes radiates to the upper arm and, infrequently, to the forearm. The paper aims at assessing the incidence of shoulder joint pain in post-stroke patients, and at investigating the predisposing factors. Material and method. The study group consisted of 81 stroke survivors (41 females and 40 males) hospitalized due to stroke in the Stroke Unit of the Neurology Ward and in the Rehabilitation Ward.The study used a questionnaire to obtain characteristics of the study group, a VAS scale to assess pain intensity, as well as the Ashworth scale and Barthel index. Shoulder joint pain occurred in 58% of the participants. Mean pain intensity was 5 according to the VAS scale. Muscle tone in the upper extremity in the study group averaged at 2 in the Ashworth scale. Among those suffering from shoulder pain, 53% experienced it in the morning.
Key words:
stroke, complications, shoulder, pain
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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 &lt;0.01), which was due to significant intra-group differences in Group B (p&lt;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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Poststroke physiotherapy of the patient with pusher syndrome – case study

Jakub Stolarski, Jan Kochanowski, Joanna Trochimiuk, Sebastian Wójtowicz

Jakub Stolarski, Jan Kochanowski, Joanna Trochimiuk, Sebastian Wójtowicz – Poststroke physiotherapy of the patient with pusher syndrome – case study. Fizjoterapia Polska 2010; 10(4); 317-323

Abstract
Postural disturbances in stroke patients may present as pusher syndrome. The aim of the study was to describe the treatment process and outcomes of physiotherapy of a post-ischaemic stroke patient with co-existing pusher syndrome. We describe a 78-year-old patient (S.L.) with left hemiplegia and pusher syndrome. Magnetic Resonance Imaging (MRI) revealed an ischaemic focus with a small haemorrhage in the posterior thalamus and posterior limb of the internal capsule. The patient underwent physiotherapy based on Proprioceptive Neuromuscular Facilitation (PNF). The pusher syndrome, which was diagnosed in the late stage of hospitalisation, was measured with the Scale for Contraversive Pushing (SCP), in which the patient scored 3.75 pts. Intensive rehabilitation started in the early post-stroke phase helped the patient achieve independence in changing position and sitting without assistance or support. The pushing behaviour did not improve in spite of appropriate therapy and verbal instructions. After 33 days of hospitalisation and physiotherapy at a Neurology Department, the patient was transferred to a Neurorehabilitation Unit for further rehabilitation. The pusher syndrome slowed down the recovery and reduced possibilities for applying rehabilitation in high positions (sitting and standing) in the early stage of post-stroke physiotherapy.
Key words:
physiotherapy, Stroke, pusher syndrome, PNF
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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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