The neurorehabilitation of hemispatial neglect in patients with traumatic brain injury

Maria Pąchalska, Bogusław Frańczuk, Jan Talar, Wiesław Tomaszewski, Bruce MacQueen, Kay Neldon

Maria Pąchalska, Bogusław Frańczuk, Jan Talar, Wiesław Tomaszewski, Bruce MacQueen, Kay Neldon – The neurorehabilitation of hemispatial neglect in patients with traumatic brain injury. Fizjoterapia Polska 2001; 1(2); 143-154

Abstract
Background. The purpose of this article is to evaluate the relative effectiveness of differentiated rehabilitation programs for patients with hemispatial neglect subsequent to traumatic brain injury (TBI). In the literature, neglect is classified into two basic types: egocentric (“body-centered”), in which the patient neglect object situated in a given area of his field of vision, and allocentric )”objected-focused”), in which the patient neglects one side of objects presented to him, regardless of their location. The authors’ clinical practice indicates that the visual scanning technique traditionally used in neglect therapy is generally ineffective in patients with egocentric neglect. A spatio-motor training program has therefore been developed by the authors, elaborated on the basic of their program of semantically controlled motion patterns for the rehabilitation of apraxia, whose goal is to reestablish the proper relations between automatic and voluntary movements, to improve interhemisphere cooperation by symmetrical and asymmetrical modeling of motor exercises with both healthy and affected limbs, and to increase patient motivation by establishing clearcut goals and rewarding success. Both programs, visual scanning and spatio-motor training, have been implemented in clinical practice in the represented by the authors. Material and methods. The article describes in detail the rehabilitation of two TBI patients (JK, male, age 27, and AS, female, age 28) treated by the authors in the chronic phase of recovery after automobile accidents, as a result of which both patients were comatose for more than 4 weeks. In neuropsychological testing JK and AS both presented with persistent and significant leftsided hemispatial neglect: allocentric neglect in JK, and egocentric in AS. A modified AB-BA experimental design was used, where A represents spatio-motor training, and B is visual scanning. For patient JK, program A was first applied, followed by B, while for patient AS the reverse sequence was used. Each program included 10 therapy sessions, with a four-week interval between programs. The degree of neglect was measured using standard neuropsychological tests for quantitative and qualitative assessment of neglect, along with the analysis of drawings made during therapy by both patients. The patients were tested four times, before and after each of the two programs. Results. As the authors had hypothesized, patient JK did not show any progress in terms of neglect after conclusion of program A, while after program B he showed virtually no lingering neglect. In the case of patient AS the results were exactly opposite: after concluding program B (which she received first) there was no significant change, while after program A (administered second) there were no signs of neglect.Conclusion. The theoretical and clinical implications of these results for neuropsychological practice are discussed, and a model solution is proposed to explain the basic pathomechanism of both allocentric and egocentric neglect. These two types of neglect are sufficiently different in etiology and symptomatology to necessitate differentiated therapy programs in the course of neurorehabilitation.

Key words:
hemispatial neglect, traumatic brain injury, rehabilitation

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The modulating effects of laser radiation on the extra- and intracellular Ca2+ store and vascular resistance in the perfused tail artery of the rat

Leszek Szadujkis-Szadurski, Jan Talar, Krzysztof Wiśniewski, Wiesław Tomaszewski, Małgorzata Łukowicz, Rafał Szadujkis-Szadurski

Leszek Szadujkis-Szadurski, Jan Talar, Krzysztof Wiśniewski, Wiesław Tomaszewski, Małgorzata Łukowicz, Rafał Szadujkis-Szadurski – The modulating effects of laser radiation on the extra- and intracellular Ca2+ store and vascular resistance in the perfused tail artery of the rat. Fizjoterapia Polska 2002; 2(1); 11-20

Abstract
Background. Low-level laser radiation modulates many cell functions, but the operating mechanism of its effects has not been sufficiently explained. Our research indicates that these effects are closely with impact on the cellular signaling system, where the ion receptors and channels play a central role.Material and method. The research involved perfused rat tail arteries based on two independent experimental models: model I, in which only the intracellular Ca2+ ion store is ised in the contraction reaction of arterial smooth muscle tissue, and model II, in which the extracellular poor is used. In model I only phenylephrine (an agonist of the alpha-1-adrenergic receptor) elicits contraction, whereas in model II both phenylephrine and BAY K8644 elicit contractions. These models were used to study the impact of low-power laser radiation (10-110 mV).Results. Our research indicated that phenylephrine causes an increase in perfusion pressure as a result of mobilizing the both the intracellular and extracellular stores of Ca2+ ions. The increased perfusion pressure obtained in this way is maintained for ca. 20-30 minutes. The exposure of arteries to laser radiation (10-110 mV) in a manner dependent on the radiation power reduces this reaction. BAY K8644, acting directly on the L-type Ca2+ ion channels, under these conditions does not cause an increase in perfusion pressure. After the intracellular store of Ca2+ ions is emptied, the increased perfusion pressure reactions to phenylephrine and BAY K8644 can be triggered by supplementing the missing CaCl2 in EGTA-Krebs fluid without Ca2+. The exposure of arteries to similar laser radiation reduces the reactions of arteries to phenylephrine and has no impact on the reactions triggered by BAY K8644. The L-NAME inhibitor NO – synthase effectively protects the arteries against the modulating effect of laser radiation.Conclusions. The results obtained here confirmed the association between the effect of laser radiation the contraction reaction of arteries triggered by phenylephrine and NO synthesis. A comparison to the effect of phenylephrine with BAY K8644 suggests that the effect of modulating the arteries’ reactions is conditioned by binding of G protein with the receptor. This suggestion is consistent with the fact that is no inhibiting action of laser radiation on the direct effect of BAY K8644.

Key words:
Phenylephrine, perfusion pressure, BAY K 8644, NO synthesis

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The modulating effect of laser radiation and low-power ultrasounds on the contraction reaction in perfused arteries

Leszek Szajdukis-Szadurski, Wiesław Tomaszewski, Anna Talar, Rafał Szajdukis-Szadurski, Katarzyna Szajdukis-Szadurska, Jolanta Kujawa, Iwona Pyszczek

Leszek Szajdukis-Szadurski, Wiesław Tomaszewski, Anna Talar, Rafał Szajdukis-Szadurski, Katarzyna Szajdukis-Szadurska, Jolanta Kujawa, Iwona Pyszczek – The modulating effect of laser radiation and low-power ultrasounds on the contraction reaction in perfused arteries. Fizjoterapia Polska 2003; 3(2); 120-132

Abstract
Background. In vascular smooth muscle tissue, Ca2+ signal changes in response to the occupation of G-protein-linked receptors, such as the alpha-1 adrenoceptor, is composed of two parts: the release of Ca2+ from the intracellular store, triggered by inositol 1,4,5-trisphosphate (IP3), and Ca2+ influx. Material and methods. The increase of perfusion pressure in rat tail arteries induced by norepinephrine and phenylephrine or BAY K8644 and KCl in solution with or without Ca2+ can be used as a marker of both intracellular Ca2+ release through the IP3 receptor pathway and Ca2+ influx. In order to probe the relationship between these events, we monitored the increase of perfusion pressure before and after exposition to low power laser and low dose ultrasound. The present study was also designed to investigate whether low – power laser light and low-dose ultrasound could interfere with Ca2+ influx through the Ca2+ channels and modulate intracellular Ca2+ release through different pathways in vascular smooth muscle. Phasic contractions of the rat tail artery induced by norepinephrine (NE) and phenylephrine (PHE) in Ca2+-free solution were used to mark intracellular Ca2+ release through the IP3 receptor pathway. The increases of perfusion pressure evoked by NE and PHE in Ca – solution were used as indicators of Ca2+ influx via the Ca2+ channel. BAY K 8644 in a solution containing Ca2+ was used as an indicator of indirect action on Ca2+ influx through the L-type Ca2+ channels. KCl (60mM/l) served as an indicator of activation on the Ca2+ voltage open channel. Results. NE and PHE evoked an increase in perfusion pressure of the rat tail arteries in both Ca2+-free and Ca2+ – containing solutions in a dose-dependent manner. BAY K 8644 and KCl evoked contraction of the rat tail arteries only in solution containing Ca2+. Low-dose ultrasound increased vascular responses to NE and PHE in both solutions, with or without Ca2+. Ultrasound increased perfusion pressure induced by KCL and BAY K8644 in solution with Ca2+. Low-power laser significantly attenuated the NE- and PHE-induced contractions of the rat tail arteries in solutions with or without Ca2+. Low power laser had no effect on vascular contractions induced by KCl and BAY K 8644.Conclusions. Low-intensity ultrasound significantly increased both Ca2+ influx and Ca2+ release, and increased the phasic contractions evoked by NE and PHE. Ultrasound also increased phasic contraction of the rat tail evoked by BAY K8644 and KCl in calcium solutions. Low-power laser significantly decreased vascular response to NE and PHE by inhibition of both Ca influx and IP3-dependent Ca release, but had no effect on vascular contraction induced by KCL and BAY K 8644.

Key words:
laser radiation, ultrasounds, receptors, contraction arteries

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Evaluating quality of life in traumatic brain injury patients

Małgorzata Wiśniewska, Wiesław Tomaszewski, Ireneusz M. Kowalski, Teresa Wiśniewska

Małgorzata Wiśniewska, Wiesław Tomaszewski, Ireneusz M. Kowalski, Teresa Wiśniewska – Evaluating quality of life in traumatic brain injury patients. Fizjoterapia Polska 2006; 6(1); 13-21

Abstract

Background. According to the World Health Organization (WHO), quality of life (QOL) depends on how individuals perceive their position in life, in the context of the culture and value system in which they live, taken together with their own individual goals, standards, expectations and fears. As a result of traumatic brain injury (TBI), all aspects of the patient’s QOL undergo change to some extent. Neurosurgical treatment, followed by the long hard work of rehabilitation, speech therapy, psychotherapy – all these factors can contribute to significantly improved QOL, which can be measured using questionnaires developed for this purpose. Material and methods. The clinical material consisted of 30 patients (14 female, 16 male) ranging in age from 11 to 50 years, hospitalized in the Department of Rehabilitation at the UMK Collegium Medicum University Hospital in Bydgoszcz. All these patients filled out two widely used questionnaires pertaining to QOL: the WHOQOL-Bref and the SF-36. Results. Both the women and the men in the study population indicated a high QOL in the context of their immediate environment, but a low QOL in respect to social life. Conclusions. The WHOQOL-Bref is more suitable than the SF-36 for the evaluation of QOL in TBI patients, because the former contains questions pertaining to different aspects of life.

Key words:
questionnaire, coma, rehabilitation
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Assessment of kinematics of pathological gait after articular cartilage surgery

Andrzej Czamara, Sławomir Winiarski, Zbigniew Jethon, Andrzej Bugajski, Rafał Szafraniec, Andrzej Zaleski, Wiesław Tomaszewski

Andrzej Czamara, Sławomir Winiarski, Zbigniew Jethon, Andrzej Bugajski, Rafał Szafraniec, Andrzej Zaleski, Wiesław Tomaszewski – Assessment of kinematics of pathological gait after articular cartilage surgery. Fizjoterapia Polska 2006; 6(4); 304-309

Abstract
Background. This paper presents a biomechanical assessment of changes in the kinematics of gait of patients following selected types of articular cartilage surgery of the knee joint, examined with a 3D motion analysis system (SIMI Reality Motion Systems GmbH, Germany). Material and methods. The gait of thirty-two patients after articular cartilage surgery of the knee joint was analyzed in the course of 2 out of 4 stages of our original physiotherapy treatment. Monitoring the progress of the rehabilitation programme involved recording of spatial kinematic data of the gait and angle-time characteristics. The first measurement was taken between the 2nd and 3rd week postoperatively, the second was taken between the 6th and 8th postoperative week. The last measurement was taken between the 10th and 14th week postoperatively, when the patient’s gait was fully restored and being improved. Results. Satisfactory individual results in patients undergoing our rehabilitation programme were obtained in test patients compared to the control group between the 10th and 14th postoperative week. The spatial gait parameters: step and stride lengths were significantly increased and the stance-to-swing ratio decreased for the affected limb compared to the first measurement. Gait velocity was also found to have doubled. In addition the range of motion in the joints was increased and the angle characteristics were similar in the test patients and the control group. Conclusions. The extensive surgical and physiotherapeutic management improved gait parameters between the 10th and 14th postoperative week in all patients.

Key words:
gait analysis, pathological gait, articular cartilage, rehabilitation

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Physical performance and locomotor ability of patients with spinal cord impairments and following amputation of lower extremities

Zbigniew Jethon, Wiesław Tomaszewski

Zbigniew Jethon, Wiesław Tomaszewski – Physical performance and locomotor ability of patients with spinal cord impairments and following amputation of lower extremities. Fizjoterapia Polska 2006; 6(4); 276-279

Abstract
The most popular classification of physical disability includes patients following amputation of lower extremities and those with spinal cord impairments. The physical performance of those patients depends on a number of factors, the most important of which include age, sex, type and degree of disability, duration of immobilization or movement restriction, and life style factors, especially those related to physical activity. Physical performance itself is, in turn, a factor contributing to the locomotor ability of disabled patients. Assessment of physical performance relies primarily on determination of the volume and intensity of aerobic and anaerobic metabolism. Both types of metabolism are reduced in subjects with the two types of disability listed above, with more distinct reductions in patients with spinal cord injuries. In this group, physical performance is determined by the level of injury, with increasingly poorer performance in patients with more proximally localised injuries. At the same time, circulatory and respiratory fitness is also impaired and the sympathetic regulatory response is altered. The methods used for the assessment of physical performance are similar to those used in normal subjects, with load programmes and ergometric devices adapted to the type of injury.

Key words:
physically disabled, physical performance, testing methods, quality of locomotion

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Assessment of kinematics of pathological gait after articular cartillage surgery

Andrzej Czamara, Sławomir Winiarski, Zbigniew Jethon, Andrzej Bugajski, Rafał Szafraniec, Andrzej Zaleski, Wiesław Tomaszewski

Andrzej Czamara, Sławomir Winiarski, Zbigniew Jethon, Andrzej Bugajski, Rafał Szafraniec, Andrzej Zaleski, Wiesław Tomaszewski – Assessment of kinematics of pathological gait after articular cartillage surgery. Fizjoterapia Polska 2007; 7(1); 1-9

Abstract

Background. Thirty two male patients with the full-thickness lesion of articular cartilage on the load-bearing surface of the knee joint (Outerbridge Grade III-IV) were involved in the study. The goal of this paper is the biomechanical assessment of changes in the kinematics of gait of patients after selected articular cartilage surgeries of knee joint examined by the 3D motion analysis system (SIMI Reality Motion Systems GmbH, Germany). Material and methods. Gait of thirty two patients with the articular cartilage surgery of knee joint was analyzed while they underwent 2 out of 4 stages of our original physiotherapy treatment. In order to test the progress of the rehabilitation program the spatial kinematic data of the gait was collected and the angle-time characteristics acquired. The first measurement was taken between the 2nd and 3rd week postoperatively, the second was taken between 6th and 8th week postop. The last measurement was taken between 10th and 14th week postoperatively, when the patient’s gait was fully restored and being improved. The values of step and stride lengths (meters), gait velocity (meters per sec.) and the step cadence (steps per sec.) were monitored as well as the stance and swing ratios (percent of the gait cycle) of the affected and unaffected limb. Range of motion in the knee joint was examined in dynamics and the angles at heel-strike and toe-off measured for both lower limbs. Results. As a consequence of our rehabilitation procedure satisfactory results were obtained individually between 10th and 14th week postop. in test patients with reference to the control group. The spatial gait parameters step and stride lengths have significantly increased and the stance to swing ratio have decreased for the affected limb compared to the first measurement. The gait velocity was found to be doubled. In addition an increase in range of motion in the joints was noticed and the angle characteristics was similar to the one of the control group. Conclusions. The extensive surgical and physiotherapeutic procedures applied in the treatment have improved gait parameters between 10th and 14th week postop in all tested patients.

Key words:
biomechanics, gait, gait disorders, articular cartilage, surgery, rehabilitation
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Assessment of the efficacy of local cryotherapy in children with cerebral palsy

Marek Woszczak, Zbigniew Śliwiński, Marek Kiljański, Wojciech Kiebzak, Marcin Szczepanik, Wiesław Tomaszewski

Marek Woszczak, Zbigniew Śliwiński, Marek Kiljański, Wojciech Kiebzak, Marcin Szczepanik, Wiesław Tomaszewski – Assessment of the efficacy of local cryotherapy in children with cerebral palsy. Fizjoterapia Polska 2007; 7(3); 275-285

Abstract
Background. The author presents the results of a study of 60 children with infantile cerebral palsy carried out at a rehabilitation centre in the town of Zgorzelec. The study aimed to demonstrate that a 4-week programme of customised kinesiotherapy with cryostimulation of the lower limbs with liquid nitrogen vapour could have a beneficial effect on motor status as well as muscle tone and skin surface temperature in children with infantile cerebral palsy. Material and methods. A group of children of both sexes aged 3-14 with infantile cerebral palsy underwent 4 weeks of customised kinesiotherapy combined with cryostimulation of both lower limbs. Muscle tone was determined with a Szirmai myotonometer using special methodology. The level of spasticity was estimated with the Ashworth test, and motor activity assessment was made before and after the treatment according to a score table designed by the authors. Thermovisual recordings of skin surface temperature in the lower limbs were made immediately before and 5 and 15 minutes after cryostimulation procedures at the beginning and end of the 4-week programme. Results and Conclusions. A comparison of the results of the motor activity assessment, Ashworth test and myotonometry before and after the rehabilitation programme shows that the use of cryostimulation in the rehabilitation of children with infantile cerebral palsy results in a reduction of spasticity in the lower limbs and improvement in motor activity. Thermovisual analysis of skin surface temperature demonstrates full adaptation of the children’s vascular system, i.e. excellent safety of topical cryostimulation.
Key words:
infantile cerebral palsy, spastic muscle tone, local cryostimulation, Ashworth test, motor activity assessment, Szirmai myotonometer, thermovision
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The use of botulinum toxin in clinical practice

Olga Wolska, Wojciech Kiebzak, Wiesław Tomaszewski, Ireneusz Kowalski, Mariusz Majewski, Józef Szarek, Katarzyna Zaborowska-Sapeta

Olga Wolska, Wojciech Kiebzak, Wiesław Tomaszewski, Ireneusz Kowalski, Mariusz Majewski, Józef Szarek, Katarzyna Zaborowska-Sapeta – The use of botulinum toxin in clinical practice. Fizjoterapia Polska 2008; 8(2); 105-114

Abstract
Botulinum toxin is increasingly used in clinical practice as a basic or adjunctive agent in many fields modern medicine. In the field of rehabilitation of the musculoskeletal system, the introduction of botulinum toxin has opened new unexpected therapeutic avenues. This method broadens the possibilities for therapeutic intervention of doctors and physiotherapists, for whom complete recovery or improvement of the patient’s overall physical capacity is the measure of success. Because of its effectiveness and high safety for the patient, it is considered to be a modern and promising medicinal agent. The possibility of applying botulinum toxin selectively and, at the same time, precisely makes for a good clinical effect, while an appropriate pharmacological safety margin is also maintained. Although the range of indications is broad, it is in the treatment of spasticity of particular muscle groups who received the treatment as quickly as possible. Absolute contraindications include: myasthenia gravis, myasthenic syndrome, blood coagulability disorders. The most serious relative contraindications are pregnancy and breast-feeding. Intensive clinical research as well as numerous scientific meetings are making it possible for the method to gain more popularity and also to the clinical experience. Current standards of botulinum toxin use have been elaborated and published by an interdisciplinary group of experts. These standards are guidelines for practicing physicians. The author’s experience and available literature have served to present a state-of-the-art review of the use of botulinum toxin in clinical practice.
Key words:
spasticity, botulinum toxin, cerebral palsy
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Preliminary results of rehabilitation according to a Rehabilitation Protocol in the early post-operative period after arthroscopic, transportal single – and double-bundle reconstruction of the anterior cruciate ligament with semitendinosus and gracilis tendons

Magdalena Wilk, Rafał Trąbka, Wiesław Tomaszewski

Magdalena Wilk, Rafał Trąbka, Wiesław Tomaszewski – Preliminary results of rehabilitation according to a Rehabilitation Protocol in the early post-operative period after arthroscopic, transportal single – and double-bundle reconstruction of the anterior cruciate ligament with semitendinosus and gracilis tendons. Fizjoterapia Polska 2009; 9(1); 97-103

Abstract
Background. Damage to the anterior cruciate ligament results in marked functional impairment of the entire lower extremity and pro-prioceptive deficits. A number of arthroscopic techniques are now used for ACL reconstruction, the most important goal of the treatment always being complete restoration of joint function and the best possible stabilisation to allow the patient to return to professional and sports actiyity at pre-injury levels. Material and methods. The study was carried out at the Cracow Rehabilitation Centre in the years 2007-2008. Thirty-three patients recovering from arthroscopic ACL reconstruction were enrolled. The paper presents the model of physiotherapeutic rehabilitation practised at the Centre sińce 2006. Patients were examined twice: before and after the course of physiotherapy. Results. In the study group of 33 patients, 48.5% had left knee ACL damage and 51.5% had damage to the right knee joint. The range of motion was 53° at examinaiion 1, compared to 109° at examination 2. Muscle strength also increased by a mean of 1.6 degree on the Lovett scale (1.5 for the auadriceps femoris and 1.7 for the biceps femoris, semitendinosus and semimembranosus) and pain reduction as assessed with a VAS scale. 79% of the patients rated their treatment outcome as excellent or good and 21% rated it as satisfactory or poor.Conclusions. The treatment results show that the model of rehabilitation provides for quick restoration of normal function in the operated limb.
Key words:
transportal reconstruction, ACL, early rehabilitation model
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