Disturbances of pelvic control in sitting and while assuming a sitting position as a manifestation of postural hypotonia in pre-school children

Małgorzata Matyja, Edward Saulicz, Mirosław Kokosz, Marta Syryjczyk

Małgorzata Matyja, Edward Saulicz, Mirosław Kokosz, Marta Syryjczyk – Disturbances of pelvic control in sitting and while assuming a sitting position as a manifestation of postural hypotonia in pre-school children. Fizjoterapia Polska 2004; 4(1); 31-39

Abstract

Background. The purpose of our research was to evaluate the connection between the pelvis in sitting position and posture in standing position, as well as the manner of changing from supine position to sitting position. Material and methods. We examined 37 six-year-old boys and girls. Posture was assessed according to Hoppe’s modified scale of posture measurement. The manner of maintaining upright sitting position and changing from supine position to sitting position was also examined. The angle of pelvic back tilt in sitting position was examined by means a Rippstein plurimeter. Statistical analysis was based on the Spearman test, the Manova-Anova test, and the Tukey test, taking p < 0.05 as the critical level. Results. There is a clear connection between the way a young child maintains sitting position and both pelvic back tilt and the quality of posture (in both cases r = 0.67, p < 0.001). We also found a smaller but equally important connection between the way of changing from supine to upright sitting position (r = 0,44 p < 0,01) and the other parameters. Conclusions. The evaluation of pelvic control in sitting position and in the course of sitting up is a good technique for the diagnosis of postural tone in young children.

Key words:
the body posture, defects of posture, postural hipotone, the pelvis control
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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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The effect of stabilization exercises and rotational mobilizations on postural reactions

Oliwia Mokrus, Mirosław Kokosz, Edward Saulicz, Bogdan Bacik, Mariola Saulicz, Łukasz Drożdż

Oliwia Mokrus, Mirosław Kokosz, Edward Saulicz, Bogdan Bacik, Mariola Saulicz, Łukasz Drożdż – The effect of stabilization exercises and rotational mobilizations on postural reactions. Fizjoterapia Polska 2007; 7(2), 95-106

Abstract

Background. The maintenance of stability and the performance of any motor task is possible thanks to the control function of the nervous system, which collaborates closely with both active and passive components of the locomotor apparatus. The aim of this study was to find out whether stabilizing exercises executed in closed kinetic chains (influencing active elements) and rotational mobilizations (engaging passive structures) could improve body balance. Material and methods. Twenty young, healthy, physically active women were randomly divided into two equal groups. The first group (I) performed stabilizing exercises and the second (II) was subjected to rotational mobilizations. Every woman was examined twice (before and after the exercise procedure). Stability in double-feet quiet stance with and without visual control was examined using a dynamometric platform. The resulting data were analysed statistically. Results. More evident changes could be seen in the frontal plane. These were more noticeable in the active stabilization exercise group (especially with reference to stiffness, where the differences were statistically significant). Conclusions. Some changes of the viscoelastic system were seen in response to both passive and active exercise procedures. More distinct changes were seen following active exercises in a closed kinetic chain (Group I), suggesting that this kind of exercise has a greater effect on postural reactions.

Key words:

stabilization, rotational mobilizations, equilibrium, visco-elastic system

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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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The role of passive stiffness of the hamstring muscies in body stability processes

Michał Kuszewski, Edward Saulicz, Andrzej Myśliwiec, Tomasz Wolny

Michał Kuszewski, Edward Saulicz, Andrzej Myśliwiec, Tomasz Wolny – The role of passive stiffness of the hamstring muscies in body stability processes. Fizjoterapia Polska 2009; 9(3); 195-201

Abstract
Two closely interrelated concepts of the biokinematic link have emerged in recent years. One of them divides human muscies functionally into stabilizing and motor ones, while the other concept describes three closely cooperating subsystems which, in a normal individual, function to secure an adeąuate level of stabilization. Each ofthese concepts can be linked with the notion of passive muscle stiffness. However, the majority of publications concerning stabilization processes seems to attach little importance to this property This paper introduces the concepts of development and role of increased passive stiffness of the hamstring muscies in the stabilization process. Basing on neurophysiological mechanisms, the authors present the latest research results, the mechanisms behind increased passive stiffness and ways of reducing it.
Key words:
stability, muscle stiffness, ACL, LPH complex
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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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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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