The atteration of the value of muscle forces in the programme of physiotherapy after the reconstruction of anterior cruciate ligaments

Andrzej Czamara

Andrzej Czamara – The atteration of the value of muscle forces in the programme of physiotherapy after the reconstruction of anterior cruciate ligaments. Fizjoterapia Polska 2002; 2(4); 263-272

Abstract
Introduction. The aim of this research was the analysis of the alteration of the value of forces of the extensors and flexors of knee joints in the 13th week and the 6th month of physiotherapy of the patients after the reconstruction of anterior cruciate ligaments. Material and method. The research involved 46 patients, 25 of whom were women. 39 patients, 19 of whom were women, who had undergone at least a six-month physiotherapy were qualified for the analysis of the alteration of the value of forces. The author offered a four-step physiotherapy programme. In the 13th week and then at the beginning of the 6th month the moment of forces was measured and the analysis of the balance of the moment of forces of the flexors to extensors of knee joints was made. Results. A statistically essential increase of the moment of forces of traumatic limbs, both in a group of men and women, was reached in the 6th month as compared to the 13th week of physiotherapy. No statistically important differences were noted in a men’s group at the beginning of the 6th month. The results in the traumatic limbs were comparable the value of the moment of forces of healthy limbs. At the same time a women’s group got, in the traumatic limbs, about 80-90% of the value of the moment of forces of the muscle groups of healthy limbs. Some essential statistic differences were noted. The value of the balance of the moments of forces of the operated limbs’ muscles altered approaching in the 6th month the values of healthy limbs. Conclusions. The increase of the mean value of the moment of forces in traumatic limbs was reached in the treated groups. The dynamics of the increase of the value of the moment of forces proved better in men. It appears that the analysis of the changes of balance of flexors to extensors may prove useful in the monitoring of the process of physiotherapy.

Key words:
Anterior Cruciate Ligament, physiotherapy, moment of forces

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Physiotherapy following surgical repair of knee cartilage

Andrzej Czamara

Andrzej Czamara – Physiotherapy following surgical repair of knee cartilage. Fizjoterapia Polska 2003; 3(4); 401-411

Abstract

This article presents a four-stage physiotherapy program for use after certain surgical operations on knee joint cartilage, adapted to the dynamics of tissue healing and reconstruction. In the first stage, the load-bearing time of the operated lower limb in vertical configuration is differentiated, depending on the degree and site of damage and the surgical technique, as well as the patient’s own goals and personal characteristics. Physical agents are also used, along with passive movement of the knee joint without load on CPM devices. Isometric and co-contraction exercises are also used. The patient is taught to walk while relieving the operated limb with crutches. In the second phase of rehabilitation, in addition to routine methods, we use gradual loading on the limb in vertical position, using objective measurements obtained from tensometric platforms. In the third phase standard rehabilitation methods are used. In addition we have implemented monitoring of gradually increased loads, with the goal of restoring limb function, i.e. walking on a level surface and at a variable grade, and basic motor characteristics. The fourth stage is intended for persons whose goal is to return to sport or other professional work requiring a high level of physical activity.

Key words:
knee joint cartilage, knee joint cartilage injuries, physiotherapy, rehabilitation program
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Rehabilitation after total knee arthroplasty: a vital element in comprehensive management

Wojciech Widuchowski, Karol Szyluk, Grzegorz Kwiatkowski, Jerzy Widuchowski, Andrzej Czamara

Wojciech Widuchowski, Karol Szyluk, Grzegorz Kwiatkowski, Jerzy Widuchowski, Andrzej Czamara – Rehabilitation after total knee arthroplasty: a vital element in comprehensive management. Fizjoterapia Polska 2004; 4(4); 396-402

Abstract

A good outcome after arthroplasty depends on proper determination of the indications for surgery, good operative technique, and – especially important – proper postoperative treatment and medical rehabilitation. The aim of medical rehabilitation is to restore mobility to the highest possible degree and recover full muscular control of the operated knee: in other words, to restore normal static and dynamic function of the joint and the entire leg. This study presents a model of postoperative management and rehabilitation after total knee arthroplasty, based on a review of the current literature and the authors’ own clinical experience with 753 arthroplasties performed in 665 patients during the period 1996-2003.

Key words:
post-operative management, static function of the knee joint, dynamic function of the knee joint
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Changes in floor reaction force while ascending and descending steps in patients undergoing physiotherapy after surgical repair of articular cartilage in the knee

Andrzej Czamara, Jerzy Widuchowski, Wojciech Widuchowski

Andrzej Czamara, Jerzy Widuchowski, Wojciech Widuchowski – Changes in floor reaction force while ascending and descending steps in patients undergoing physiotherapy after surgical repair of articular cartilage in the knee. Fizjoterapia Polska 2004; 4(4); 337-344

Abstract

Background. The goal of our research was to evaluate changes in vertical floor reaction force (N) in lower limbs of patients between the 14th and 18th week of physiotherapy after selected operations to surgically repair articular cartilage in the knee. Material and methods. We examined 55 persons, 25 of whom were recovering from surgical repair of articular cartilage in the knee. The subjects, divided into 4 groups, were examined on MTD-Balance tensometric platforms while ascending and descending steps (19 cm per step). We examined the changes in the vertical floor reaction force (N) in the operated and healthy limbs. The results obtained between the 14th and 18th weeks of physiotherapy were compared to those of persons without damage to cartilage. Results and conclusions. While ascending stairs, the patients and healthy controls showed a 20-28% increase in floor reaction force in comparison to standing on one leg. While descending, both the patients and the healthy controls showed 80-90% increases. The results were roughly similar and no statistically significant differences were observed.

Key words:
tensometric platform, weight bearing, isometric exercises, electrostimulation
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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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Ground reaction forces of the gait in patients undergoing physiotherapy after articular cartilage surgeries

Andrzej Czamara, Tadeusz Trzaska

Andrzej Czamara, Tadeusz Trzaska – Ground reaction forces of the gait in patients undergoing physiotherapy after articular cartilage surgeries. Fizjoterapia Polska 2006; 6(4); 289-297

Abstract
Background. The goal of our study was the evaluation of the ground reaction forces (N) of vertical component in flat surface gait in patients undergoing 10 to 14 weeks of physiotherapy after chosen surgeries of the knee joint cartilage. Material and methods. We measured ground reaction forces of the gait in 58 people. 31 patients after the carrier surface of knee joint cartilage surgeries and 27 people with no cartilage injuries were examined. When the patients developed individual gait after 10 to 14 weeks of physiotherapy, we measured ground reaction forces of their gait. The examination was carried on a track with, computer programmed, mtd-balance tensometric platforms. Results and Conclusions. Between 10th and 14th week after the surgery, the patients regained the gait. The values of ground reaction forces of the gait during stance phase for the operated limbs were close to the results of healthy limbs. The results did not differ from the results reached by the people with no cartilage injuries and oscillated between 1,19 to 1,21 of body weight. Moreover, minor asymmetry was reported between left and right limbs in groups with no articular cartilage injuries and in patients which did not exceed 5%.

Key words:
physiotherapy, gait, knee joint cartilage, ground reaction forces

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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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Functional benchmarks of musculoskeletal fitness following knee joint anterior cruciate ligament reconstruction

Andrzej Czamara

Andrzej Czamara – Functional benchmarks of musculoskeletal fitness following knee joint anterior cruciate ligament reconstruction. Fizjoterapia Polska 2010; 10(4); 247-262

Abstract
The study presents five functional benchmarks (FBs) corresponding to various levels of knee function and physical fitness (from basic locomotion to sports-level performance) in patients undergoing physiotherapy (rehabilitation) after reconstruction of the anterior cruciate ligament (ACL). The FBs presented in the paper complement clinical evaluation of the outcomes of a comprehensive treatment plan for post-ACL reconstruction patients. We introduce our own classification of functional benchmarks (FBs) and propose examination methods which allow fairly objective assessment of the fitness level of the musculoskeletal system at a particular stage of rehabilitation. The following FBs are described: clinical (CFB), minimal (MFB), standard (SFB), optimal (OFB) and sports (SPFB). Two criteria are assumed separately for the sports benchmark, namely an amateur sports benchmark and a professional sports benchmark. The paper presents the author’s experience as well as a review of the literature basing on the experience of other authors.
Key words:
Functional Benchmarks (FBs), anterior cruciate ligament (ACL), physiotherapy, ACL injuries
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Computer-Based Medical Decision Support Systems – history, development, comparison of systems in selected European countries and the United States

Wiesław Tomaszewski, Grzegorz Bliźniuk, Roman Bronowski, Andrzej Czamara, Wojciech Widuchowski, Krzysztof Klukowski

Wiesław Tomaszewski, Grzegorz Bliźniuk, Roman Bronowski, Andrzej Czamara, Wojciech Widuchowski, Krzysztof Klukowski – Computer-Based Medical Decision Support Systems – history, development, comparison of systems in selected European countries and the United States. Fizjoterapia Polska 2011; 11(2); 91-106

Abstract
The world is facing many challenges connected with the need to increase health care effectiveness globally. One of the reasons behind the need to improve and optimise healthcare systems is change in the population age structure, which manifests as an increase in the elderly population of the compared to the population before and of productive age. It is thus absolutely necessary to find technical and organisational means to increase the effectiveness of health care, as well as optimise it and reduce the associated costs. Implementing information technologies in health care systems is now an absolute necessity, mainly due to the systematically growing amount of information on patient’s health status, number of diagnosable diseases and implementable treatments, diversity of pharmaceuticals and their effects, as well as the need to store and update this kind of data.The analysis presented in this work deals with issues and problems concerning health care systems in developed countries, including Poland. It was carried out on the basis of the authors’ research experience in analysing IT systems suppoiting the Polish health care system, gained by participating in the implementation of several projects, backed with direct contact with experts, mainly from the Scandinavian countries and the USA, who were involved in the development of information technologies to be used in health care systems in those countries, and an analysis of materials and experts’ reports available in the literature and online.
Key words:
information technologies in medicine, Guidelines, clinical pathways, computer-based decision support systems
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The method of evaluation of biomechanical parameters of human lower limbs in the jump from steps of different heights

Aleksandra Melińska, Andrzej Czamara, Łukasz Szuba, Romuald Będziński

Aleksandra Melińska, Andrzej Czamara, Łukasz Szuba, Romuald Będziński – The method of evaluation of biomechanical parameters of human lower limbs in the jump from steps of different heights. Fizjoterapia Polska 2011; 11(4); 327-340

Abstract
Background. The aim of this study was to identify the loads that occur when landing from different heights, achieved through analysis of selected kinetic and dynamic parameters in men without injuries of the musculoskeletal system. Understanding the characteristics of this type of transportation can play an important role in assessing the progress of rehabilitation after lower limb injuries.Material and methods. The sample comprised 26 men aged 20 to 26 years without lower limb injuries, who performed landing at three heights: 0.1, 0.2 and 0.3 m. For quantitative and qualitative assessment biomechanical studies were performed using motion measurement system, a dynamometric platform for ground reaction force measurement for the vertical component and a module for electromyography.Results. The maximum value of the ground reaction forces for the vertical component during the jump down on both lower limbs from 0.3 m increased to about 2.2 weight. The most active muscles during landing were: m. vastus medialis of the thigh (both limbs) and gastrocnemius, as demonstrated in the study of surface electromyography.Conclusions. 1. No statistically significant (up to 4%) differences were found in the values of maximum ground reaction forces for the vertical component between the left and right lower limb. 2. A positive correlation was found between the ground reaction force, and the height from which the subjects jumped and between the ground reaction force and muscle tension. 3. Muscle tone apparently increased during free standing before landing compared to the jump phase.
Key words:
Methodology, jump down, ground reaction force, muscle tension
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