Electrostimulation as an improved physical therapy treatment of lymphoedema

Krzysztof Gieremek, Jolanta Rojczyk-Chmarek, Zbigniew Śliwiński

Krzysztof Gieremek, Jolanta Rojczyk-Chmarek, Zbigniew Śliwiński – Electrostimulation as an improved physical therapy treatment of lymphoedema. Fizjoterapia Polska 2002; 2(4); 300-305

Abstract
Introduction. Morphological and electrophysiologic properties of unstriated muscles of lymphatic vessels were outlined in the present study. The most common disordes observed in lymphatic system, as well as the mechanism of lymphoedema were discussed. Well known and commonly applied means of physical therapy treatment such as external pressure, pneumatic compression, pressure-massage, manual drainage and therapeutic exercises were reviewed in this paper. Material and methods. The main subject of the present study is the orginal method of electrostymulation of unstriated muscles, which takes into consideration individual character of electrophysiological proper-tiesof muscles located in lymphatic vessels. Types of electrical impulses used in this treatment, programme modes (therapy and prophylactic mode), as well as methodology of the treatment were discussed in details. The examples of protocols used in treatment of particular conditions and their clinical aplication were presented as well.Conoclusion. The presented apparatus for application of described methods of electrostimulation in the first construction of this type, wich considers individual structure and function of lymphatic system. This method of stymulation would be probably useful in variety of medical conditions, where lymphoedema is a major therapeutic problem.

Key words:
Lymphatic System, lymphoedema, physical therapy treatment, electrostymulation

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A new type of cervical traction generating mechanical pulsations (vibration) in the comprehensive treatment of patients with cervical spondylosis

Krzysztof Gieremek, Edward Saulicz, Zbigniew Śliwiński, Monika Grygorowicz, Aleksander Socha, Janusz Kubacki

Krzysztof Gieremek, Edward Saulicz, Zbigniew Śliwiński, Monika Grygorowicz, Aleksander Socha, Janusz Kubacki – A new type of cervical traction generating mechanical pulsations (vibration) in the comprehensive treatment of patients with cervical spondylosis. Fizjoterapia Polska 2003; 3(2); 99-105

Abstract
Background. The objective of the present study was to evaluate the therapeutic effectiveness of a new type of vibration traction (Glisson type) as compared to traditional cervical traction (Glisson type) in patients diagnosed with degenerative disc disease or spondylarthrosis of the cervical spine. Material and methods. Two groups of ambulatory patients treated for spondylosis of the cervical spine were included in this study. The study group (n=35) and the control group (n=33) were subjected to the standard comprehensive treatment (massage therapy, short wave diathermy, infrared therapy, electrotherapy using Bernard’s current, ultrasound therapy). The cervical traction set used in the study group was additionally equipped with a device generating vibration (frequency 100 Hz, amplitude 0,2 mm), installed just above the cervical loop. Results. The statistical analysis (Chi2 = 9,672, for a = 0,046) revealed considerable correlation between the type of cervical traction used and the results of the treatment, indicating higher effectiveness of vibration traction. Statistical analysis also proved increased range of motion in the cervical spine in the all planes, as well as improved left and right hand grip function. Conclusions. The study proved that the treatment of cervical traction (Glisson type) equipped with additional vibration device was well tolerated by patients. The use of this type of traction resulted in sooner subsidence of existing symptoms such as pain, increased muscle tone and hypersensitivity to touch of cervical spine musculature.

Key words:
Glisson traction, wibration massage, cervical spondylosis

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High-tone therapy in the comprehensive rehabilitation of children with cerebral palsy

Zbigniew Śliwiński, Bartłomiej Halat, Krzysztof Gieremek, Beata Ufniak, Jolanta Chmarek-Rojczyk

Zbigniew Śliwiński, Bartłomiej Halat, Krzysztof Gieremek, Beata Ufniak, Jolanta Chmarek-Rojczyk – High-tone therapy in the comprehensive rehabilitation of children with cerebral palsy. Fizjoterapia Polska 2003; 3(3); 231-242

Abstract

Background. This article describes the possibilities of using high-tone therapy in the comprehensive rehabilitation of children with cerebral palsy (CP). This device stimulates nerves and muscles with an electrical current at a frequency corresponding to acoustic vibrations, from 4400 to 12300 Hz. High-tone therapy produces many desirable effect; it disperses foci of pain and inflammation, intensifies metabolism, increases local blood supply, promotes cellular diffusion, improves tissue nutrition, accelerates resorption of edema, rebuilds original tissue structure (including muscles), and reduces tension in transversely striated muscle. Material and methods. We studied 19 children with CP-related spastic tetraplegia, age 4-17, inpatients at the Pediatric and Adult Rehabilitation Center in Zgorzelec, Poland. Manual dexterity was tested, as well as range of movement in the radiocarpal and ankle joints. The circumference of the hands and feet was measured and the gait stereotype assessed before and after treatment. The therapeutic program included a 30-minute procedure with the hoSti-Scan program, using a WaDiT-12 apparatus, followed by stimulation of the muscles responsible for dorsal flexion of hands and feet. Results. The evaluation of manual dexterity using the Munich Functional Developmental Diagnosis program indicated that a 4-week rehabilitation program combined with high-tone hterapy had a significant impact on improvement in the manual function of the hands in the subject children. All the children tolerated high-tone therapy very well. Conclusions. In view of the improvement in manual dexterity, radiocarpal and ankle mobility, and gait stereotype, hightone therapy is useful in the rehabilitation of children with spastic cerebral palsy.

Key words:
high tone therapy, methodology of procedure, determinants of gait, Munich Functional Developmental Diagnosis
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Isokinetic measurements – areas of application in physiotherapy

Monika Grygorowicz, Janusz Kubacki, Bogdan Bacik, Krzysztof Gieremek, Anna Polak

Monika Grygorowicz, Janusz Kubacki, Bogdan Bacik, Krzysztof Gieremek, Anna Polak – Isokinetic measurements – areas of application in physiotherapy. Fizjoterapia Polska 2006; 6(3); 238-244

Abstract
The aim of the paper is to present the concept of isokinetic exercises, which was introduced by Hislop and Perrine in 1967 for the first time. No article was found in Polish literature that in consolidated way would discuss mentioned subject. Hence, in support to numerous foreign scientific reports, authors have decided to present the isokinetic exercise to Polish physiotherapists and medical doctors. Thisle et al define isokinetic exercise as dynamic muscle contraction with controlled and holded speed of movement (iso-steady kinetic-movement) performed with specific devices used to that kind of exercises. isokinetic tests are a very precise diagnostic tool that enable an estimation of degree of soft tissues damage. General use of isokinetic strength measurement in clinical practice is based on its obvious validity and reliability in qualification of state and neuromuscular function. Followers of isokinetic tests confirm that it gives possibilities of precise assessment of muscle properties as well as objectification of results. Results enable very precise diagnostic of tested muscles in different biomechanical conditions of performing movement. Tests allow functional muscle assessment through comparison of contralateral, ipsilateral work, with confrontation with corresponding data or with results in control groups. Moreover, graphical presentation of dependence between recorded parameters in every point of tested range of movement is possible. It favors isokinetics in using it to diagnostic in postinjured states of movement system. The areas of application and rules of performance isokinetic testing were described in this article. The main biomechanical parameters which are used in analysis of muscle dynamic properties were discussed additionally.

Key words:
isokinetic exercises, peak torque, biomechanical indicators, dynamic conditions

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Restrictions, impediments and requirements in physiotherapy of the elderly

Krzysztof Gieremek, Janusz Nowotny, Tadeusz Szymon Gaździk, Wojciech Cieśla

Krzysztof Gieremek, Janusz Nowotny, Tadeusz Szymon Gaździk, Wojciech Cieśla – Restrictions, impediments and requirements in physiotherapy of the elderly. Fizjoterapia Polska 2007; 7(2), 198-205

Abstract

Aging is an inevitable and dynamic process that leads to a number of adverse changes in both the locomotor system and internal organs as well as the weakening of the body’s regenerative and compensatory abilities. The full recovery of mobility following an illness or dysfunction is difficult and sometimes impossible, affecting the quality of life of the elderly patient. Concomitant psychological problems related to the elderly patient’s attitude to their illness and their expectations about those around them require a modified approach to many aspects of rehabilitation, including physiotherapy, of the elderly. This article describes the tasks that should be addressed in preventative physiotherapy and treatment modalities used in socalled main therapy and secondary prevention of geriatric patients. Emphasis is placed on the principles of planning customised active exercise sessions with particular regard to functional status assessment in individual patients. Besides examples of forms of physical activity and exercise devices for geriatric patients, the article provides comments and descriptions of the most common problems related to selected physiotherapy procedures for the elderly.

Key words:

geriatrics, determinants of physiotherapy, physiotherapy of elderly, kinesitherapy

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Thermovisual evaluation of temperatures of the upper limbs following cryostimulation in post-stroke patients

Zbigniew Śliwiński, Piotr Płaza, Krzysztof Gieremek, Wojciech Kufel, Beata Michalak, Bartłomiej Halat, Grzegorz Śliwiński, Magdalena Wilk

Zbigniew Śliwiński, Piotr Płaza, Krzysztof Gieremek, Wojciech Kufel, Beata Michalak, Bartłomiej Halat, Grzegorz Śliwiński, Magdalena Wilk – Thermovisual evaluation of temperatures of the upper limbs following cryostimulation in post-stroke patients. Fizjoterapia Polska 2008; 8(1); 23-34

Abstract
Background. Cerebral stroke is a very serious life-threatening condition regardiess of the clinical picture at the onset. In most cases cerebral stroke is a consequence of systemic vascular diseases such as atherosclerosis or hypertension. Material and methods. The study group comprised 103 patients, including 52 post-stroke patients with a paretic upper limb and 51 healthy participants. The group of stroke patients included 18 women and 34 men, while the healthy group consisted of 41 women and 10 men. The mean age of the male patients was 55.6 and of the female patients 66.1 years. The mean age of the control group was 37.2 years. Local cryostimulation was applied to the hand and forearm of the paretic limb in the stroke patients and to the hand the forearm of the right upper limb in the healthy group. The limb was exposed to cold for 6 minutes. The temperatures were measured using an Agema 570 thermovision camera.Results. Subjecting only one forearm to cryotherapy procedures results in a decrease in temperature. In the post-stroke patients the return to the basseline value after the procedure was more rapid. This is possibly connected with more efficient mechanisms protecting the body against loss of warmth, since in this group temperature values were higher. In the control group the temperature in the non-cooled limb decreases by an average of 1.6 st.C, compared to only 1.3 st.C in the stroke patients. Conclusions. The temperatures of an area in the forearm exposed to 6 minutes of cryotherapy were different in the post-stroke patients and in the healthy controls. This is probably attributable to stroke-related brain damage. Contralateralization, i. e. the decline of temperature in the non-cooled limb, occurred both in the post-stroke patients and in the healthy controls. Temperature decreases produced by the exposure of limbs to cold were higher in the stroke patients than in the healthy participants. The temperature returned to baseline more rapidly in the post-stroke patients. The temperature in the cooled limb dod not return to, or exceed, baseline value fifteen minutes after the procedure.
Key words:
cerebral stroke, cryostimulation, thermovision, vascular play
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Assessment of the effect of high-tone power therapy in rehabilitation of stroke patients

Zbigniew Śliwiński, Piotr Płaza, Krzysztof Gieremek, Wojciech Kufel, Beata Michalak, Bartłomiej Halat, Grzegorz Śliwiński, Magdalena Wilk

Zbigniew Śliwiński, Piotr Płaza, Krzysztof Gieremek, Wojciech Kufel, Beata Michalak, Bartłomiej Halat, Grzegorz Śliwiński, Magdalena Wilk – Assessment of the effect of high-tone power therapy in rehabilitation of stroke patients. Fizjoterapia Polska 2008; 8(2); 197-205

Abstract
Background. High-tone power therapy is a new method of nerve and muscle stimulation with electric current of a frequency corresponding to the acoustic band of electric oscillation between 4 400 Hz to 12 300 Hz. The usa of two pairs of electrodes serves to generate a dynamic electric field deep inside the tissues. The aim of the study was to assess upper limb function in hemiparetic stroke patients who undrwent high-tone power therapy in the course of rehabilitation. Materials and methods. The study group consisted of 16 men aged 46-72 years (mean 54) and 4 women aged 67-74 years (mean 71) who had suffered strokes of various aetiologies. Arm function was determined on the basis of grip strength testing, ranges of motion (ISOM) and spasticity level (Ashworth scale). Results. Grip strength increased with simultaneous improvement in angular ranges of motion in the radiocarpal joint of the paretic limb. Spastic tone in the limb decreased by 0.35 on the Ashworth scale. Analysis of linear measurements revealed statistically significant changes of circumferences only at the upper arm level. Conclusions. Comprehensive physiotherapy including horizontal therapy performed in stroke patients produced significant functional improvements in the paretic upper limb. High-tone power therapy is well tolerated by hemiparetic patients with despite the long duration of the procedure.
Key words:
Ashworth test, high-tone power therapy, hoSti-Scan stimulation, secondary effect
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Assessment of changes in the excitability of the medial antebrachial cutaneous nerve caused by localised cooling procedures

Edyta Jarzębska, Anna Polak, Janusz Kubacki, Krzysztof Gieremek

Edyta Jarzębska, Anna Polak, Janusz Kubacki, Krzysztof Gieremek – Assessment of changes in the excitability of the medial antebrachial cutaneous nerve caused by localised cooling procedures. Fizjoterapia Polska 2009; 9(1); 39-50

Abstract
Background. The reasons for taking advantage of low temperatures for therapeutic purposes include their anaesthetic and anti-inflammatory effeets. The present stucly aimed to assess changes in the excitability of the medial antebrachial cutaneous nerve (MACN) resulting from local cryotherapeutic procedures. Materials and methods. The investigation involved 108 healthy volunteers aged 20-25 years and randomly assigned to three groups (A, B and C). Immediately before the cryotherapy procedure, skin temperature was measured in the area innen/ated by the medial antebrachial cutaneous nerve in all participants. The chronaxy of this nerve was also determined. Groups A and B subse-ąuently received cooling procedures at -10°C with a gel compress applied to the arm and forearm area (i. e. the area innen/ated by the MACN). In Group A, the compress was applied for 20 minutes and in Group B for 4 minutes. In Group C this area was sub-jected to a 2-minute cooling procedure using liquid nitrogen vapour at -160C. Chronaximetry and skin temperature measurements were repeated immediately on completion of the cooling procedure and 20 minutes later. Results. A statistically significant prolongation of chronaxy in relation to its baseline values was obsen/ed in Group A both immediately after the procedure and 20 minutes later. In Group B, statistically significant prolongation of chronaxy was seen between the values obtained immediately after the procedure and those measured before the procedure. In group C, chronaxy was signifi-cantly longer 20 minutes after the procedure vis-a-vis its baseline value. Conclusions. All cooling procedures applied reduced excitability of the medial antebrachial cutaneous nen/e. Decreased exci-tability was maintained over the longest period in Groups A and C.
Key words:
cutaneous nerve, excitability, cryotherapy
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Physiotherapist Ethical Code in Polish Republic

Wojciech Kiebzak, Krzysztof Gieremek, Marian Florczyk, Marek Kiljański

Wojciech Kiebzak, Krzysztof Gieremek, Marian Florczyk, Marek Kiljański – Physiotherapist Ethical Code in Polish Republic. Fizjoterapia Polska 2009; 9(3); 266-272

Abstract
Work is what differs human beings from other creatures. A man as a subjective existence is capable of intentional and methodical actions. A man aims at finding self-fulfillment; he decides about his own future and the future of others. Work is being done with others and for others. Work has a common naturę. The concern for a human dignity and common good re-quires obsen/ance ofcrucial values and ethical norms as well as adopting certain attitudes resulting from them. Showing re-lations between a physiotherapist and a patient, the Ethical Code of Physiotherapist outlines professional and ethical beha-viors in those relations. The Code is not limited only to those special relations, it also includes the obligations of a physiotherapist towards society doctors and associales. Among seven chapters, there are those which determine ways ofrespon-sible preparation for this profession and constant training. Therefore, the code deserves the highest recognition. Its first sen-tence, reffering to phisiotherapisfs life and work.: „to honor rights and dignity of every human being is the soul and the ve-ry fundamenta! thought of this code. This code should be extremely helpful for students as well. Deontology as professional ethics expects from aplicants for the university to make not only free but will be responsible for the well-being of men. Therefore, bearing in mind his future professional duties, he should primum non nocere!!!
Key words:
Physiotherapist Ethical Code
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Study of the effects of cryotherapy and diathermy on cutaneous nerve excitability in healthy people

Barbara Szpotowicz, Anna Polak, Krzysztof Gieremek, Cezary Kucio, Janusz Kubacki, Piotr Czech

Barbara Szpotowicz, Anna Polak, Krzysztof Gieremek, Cezary Kucio, Janusz Kubacki, Piotr Czech – Study of the effects of cryotherapy and diathermy on cutaneous nerve excitability in healthy people. Fizjoterapia Polska 2011; 11(2); 123-134

Abstract
The study was designed to assess the changes of sensory excilability of the medial anlebrachial culaneous nerve (MACN) following the application of cooling and diathermy procedures in healthy people. The study involved a group of 133 healthy volunteers (aged 19 – 36 years), randomly assigned to four comparison groups A, B, C and D. In all groups, the subjects skin temperature in the medial nerve area was measured, as well as sensory excitability of the nerve. The measurements were taken immediately before and after the cooling and heating procedures, and then 20 minutes after the respective procedure was terminated. Group A received 20-minute cryotherapeutic procedures with frozen gel packs (-10oC). Group B received two-minute cooling with liquid nitrogen (at -160°C). In group C 12-minute microwave diathermy procedures (100 W) were performed. Group D received 12-minute shortwave diathermy procedures (280 W).In groups A, B and C chronaxie measured immediately after the procedure and 20 minutes later was statistically significantly longer than before the procedure. In group D no statistically significant changes were observed in chronaxie.Cooling procedures applied to the culaneous nerve at the temperatures of -10°C and -160°C and microwave diathermy reduce sensory excitability. Shortwave diathermy does not affect the cutaneous nerve excitability.
Key words:
excitability, cutaneous nerve, Cryotherapy, Diathermy
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