The impact of intensive functional rehabilitation on improved sensorimotor control and locomotor capabilities in a patient with spinal cord injury (SCI)

Grzegorz Srokowski, Anna Srokowska, Jan Talar, Wojciech Hagner, Agnieszka Połomska

Grzegorz Srokowski, Anna Srokowska, Jan Talar, Wojciech Hagner, Agnieszka Połomska – The impact of intensive functional rehabilitation on improved sensorimotor control and locomotor capabilities in a patient with spinal cord injury (SCI). Fizjoterapia Polska 2004; 4(3); 272-283

Abstract

Background. Contemporary rehabilitation is developing in many different directions. In view of the scope of research and practice, it is a discipline that joins many sciences sharing a common goal: to help the patient. This task is performed by an interdisciplinary rehabilitation team composed of the attending physician and the physiotherapist, along with other specialists. The constantly growing number of patients and increasing financial constraints are making it essential to seek new therapeutic solutions. One of many possible strategies is the PNF concept. This method is characterized by a holistic approach to the patient, based on behaviors and daily life situations with which the patient is familiar, and using available rehabilitation equipment. Case description. This article presents a case study of a female patient admitted for rehabilitation after a spinal cord injury (SCI) to the Department of Rehabilitation at the Bydgoszcz Medical University. Examples are provided of functional exercises used in the intensive rehabilitation program developed for this patient. The ASIA scale was used to assess outcome, along with functional tests for patients with paraplegia, a modified version of the Barthel test. Conclusions. The successful outcome in this case resulted from the cooperation of the entire therapeutic team, and from the exchange of information regarding the patient’s clinical status and progress in treatment. Close cooperation makes it possible to chose the optimal method, ensuring effective and safe work with the patient.

Key words:
PNF, interdisciplinary approach, rehabilitation team
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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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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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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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Analysis of therapy results in patients with cervical spine pain according to PNF concept and elements of manual therapy

Tomasz Maicki, Rafał Trąbka, Wojciech Szwarczyk, Magdalena Wilk-Frańczuk, Bogusław Figura

Tomasz Maicki, Rafał Trąbka, Wojciech Szwarczyk, Magdalena Wilk-Frańczuk, Bogusław Figura – Analysis of therapy results in patients with cervical spine pain according to PNF concept and elements of manual therapy. Fizjoterapia Polska 2012; 12(3); 263-273

Abstract
This study shows an analysis of two rehabilitation methods in order to determine the differences between groups and changes after the therapy in terms of reducing pain, restoration of mobility and proper function of the cervical spine. The study was conducted on a group of 80 patients referred to rehabilitation due to restricted mobility and pain in the cervical spine, which resulted in impairment in everyday life. Patients were divided into two groups: group 1 consisted of 40 patients treated with PNF concept, and group 2 consisted of 40 patients treated with manual therapy elements. The study used a survey: Functional Index Scale and Oswestry scale for cervical and McGill pain Questionnaire. Additionally range of motion in certain planes was measured by the CROM device. Statistically significant differences were obtained in both groups of patients according to their individual rehabilitation program based on PNF concept and elements of manual therapy. However, patients who received PNF treatment showed greater improvement in mobility, function and pain relief. Results based analysis shows that therapy in group 1 and 2 was efficient, however PNF method proved to be more effective in comparison to treatment with manual therapy elements.
Key words:
Deep neck muscles, PNF, manual therapy, functional rehabilitation
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The use of local cryotherapy and PNF method in the procedure that improves the functioning of patients with subacromial impingement syndrome

Łukasz Kopacz, Żaneta Ciosek, Elżbieta Kubala, Zbigniew Śliwiński, Marek Kiljański, Danuta Lietz-Kijak

Ł. Kopacz, Ż. Ciosek, E. Kubala, Z. Śliwiński, M. Kiljański, D. Lietz-Kijak – The use of local cryotherapy and PNF method in the procedure that improves the functioning of patients with subacromial impingement syndrome. FP 2017; 17(2); 148-156

Abstract

Considering the serious nature of complications pertaining to the trauma of the glenohumeral joint, the priority is to address the underlying cause as well as symptoms. This research was conducted in order to evaluate the effectiveness of localized cryotherapy and the PNF method on the mobility of the glenohumeral joint, in patients presenting with subacromial impingement syndrome. Each group (test and control) consisted of 18 patients. Patients in the test group were subjected to treatment of local cryotherapy and PNF therapy in the treatment of the shoulder girdle for fifteen days whilst the control group were treated with local cryotherapy procedures for the duration. There is little doubt that local cryotherapy is and effective treatment for various kinds of dysfunction however when combined with other treatment methods (such as PNF) a better outcome is achieved.

Key words:
subacromial impingement syndrome, PNF, cryotherapy

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Ease to Control vs Control of Ease – How to Tackle the Functioning of Hand in the Process of Physiotherapy

Ewa Górna, Zbigniew Śliwiński, Marek Wiecheć, Jan W. Raczkowski

E. Górna, Z. Śliwiński, M. Wiecheć, J. W. Raczkowski – Ease to Control vs Control of Ease- – How to Tackle the Functioning of Hand in the Process of Physiotherapy. FP 2016;16(2);32-41

Abstract

A human hand is a highly specialized organ, with a wide range of functions. The aim of this report is to present physiotherapy treatment of the patient after surgery, which has resulted from an extensive injury to his hand, forearm and arm. During rehabilitation process, the ICF guidelines and the patient’s concerns, as well as his expected functional goals, have been observed. Intermediate therapy and irradiation phenomena, standard of the PNF concept, have allowed to minimize the risk of irritation of the grafted soft tissue and skin, and of damage to the internal connections within the coadunate areas of the hand and thumb. The report contains illustrations showing the stimuli applied, it also discusses other therapeutic actions, which had been employed.

Key words:
stages of motor control, feedback system, PNF concept, goals of therapy after hand injury

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