FUNCTIONAL CLASSIFICATION OF CHILDREN WITH CEREBRAL PALSY IN KRAPINA-ZAGORJE COUNTY.

The aim was to study functional abilities and to create functional classification of children with cerebral palsy (CP) in Krapina-Zagorje County, based on the classification of gross and fine motor skills and associated impairments. Classification was performed according to the SCPE (Surveillance of Cerebral Palsy in Europe) criteria. We used standardized and complementary functional classification systems for cerebral palsy to create a functional profile. Research included 44 children with CP in the age range of 4 to 18 years. The results showed that the majority of children had bilateral spastic CP (63.6%), followed by unilateral spastic (22.7%) while the representation of dyskinetic CP was 9.09% and ataxic CP 4.55%. Based on the classification of gross and fine motor skills, 43.2% of children had the ability to walk, 11% of children could walk with assistive mobility devices, while 45.4% of children had a low functional level. The study also analyzed the associated impairments where higher classification score of motor impairment correlated with the severity of impairment. The results showed that children with dyskinetic CP and severe motor impairment could have mild cognitive impairment. We systematically present the neuropsychological and functional profile according to the CP type.

Lumbar spondyloptosis after severe polytrauma: a case report.

A rare case of thoracolumbar spondyloptosis after a severe polytraumatic event is presented. Spondyloptosis accounts for a minor proportion of all spine trauma cases and is usually accompanied by complete neurological deficit. A 48-year-old man suffered severe polytrauma after having been hit by a truck at the work place. Radiographic scanning revealed multiple traumatic injuries and spondyloptosis at the L1/L2 level in coronal plane. However, despite extensive injuries, ASIA score was estimated as D. The patient underwent urgent multidisciplinary surgery due to severe head injuries. The next surgery was performed to stabilize the thoracolumbar segment and to preserve neurological functions. The surgery included implantation of transpedicular titanium screws via posterior approach. Good postoperative recovery was achieved during early postoperative rehabilitation at our Department, which was estimated as ASIA score D. In conclusion, prompt operative treatment to achieve neural integrity and early rehabilitation should be considered as the gold standard in such complicated injuries. Postoperative recovery largely depends on the quality of rehabilitation, which leads to improvement of patient self-care and normal social and psychological functions. In our case, the good preoperative neurological status of the patient also contributed to better postoperative outcome.

Assessment of long-term activity limitations and participation restrictions of persons with traumatic brain injury using the disability rating scale.

The rehabilitation of patients with traumatic brain injury (TBI), or intracranial injury, is the most complex segment of rehabilitation. The majority of patients with TBI are young, and the consequences are temporary or permanent limitation of activities and participation. Rehabilitation is primarily carried out in special hospitals for medical rehabilitation, and occasionally continues with rehabilitation on an outpatient basis or in the patient's home. The question of when treatment and rehabilitation is complete is often posed. An investigation of 40 patients with TBI was conducted at the completion of hospital rehabilitation and again three to five years after the completion of hospital treatment to assess the disability rating scale (DRS). The average age of patients was 33 years at the time of occurrence of the TBI, and the great majority were male (90%). The follow-up survey was conducted at the patient's home, and only in a few cases in the Osijek University Hospital or the Krapinske Toplice Special Hospital for Medical Rehabilitation. The DRS is an assessment of the level of activity and participation through four components: arousability, awareness, responsivity; cognitive ability for self-care activities; dependence on others; psychosocial adaptability and total DRS. Statistical testing was conducted at a significance level of 95%, and data analysis was carried out on the licensed programme STATISTICA 6.1 (StatSoft inc. 1983-2003, license no. AGA304B211928E61). The Wilcoxon test was used to determine statistical differences. After three to five years, there were no cases of statistically significant worsening or improvement of arousability, awareness and responsivity (0.067890, p > 0.05) or cognitive ability for self-care activities (0.108810, p > 0.05). However, there was a statistically significant improvement in dependence on others (0.000012, p < 0.05) and psychosocial adaptation (0.011719, p < 0.05). The TBI patients in the study had statistically significant improvement of their activities and progression three to five years after the completion of hospital rehabilitation monitored using the DRS (0.000004, p < 0.05). These results refer only to those patients who continued to live in a family environment. It is necessary to conduct further study to determine an improvement or worsening of activities and participation of patients with TBI who continued living outside a family (senior rest home, social care institute, private home for seniors and the disabled). The present study established that there is improvement in patients with TBI living in a family environment even three to five years after the completion of inpatient medical rehabilitation, particularly in the segments of dependence on others in activities of everyday life, education and employment.

Utility of the Croatian translation of the community integration questionnaire-revised in a sample of adults with moderate to severe traumatic brain injury.

PURPOSE: To examine the utility of the Community Integration Questionnaire-Revised, translated into Croatian, in a sample of adults with moderate to severe traumatic brain injury. METHOD: The Community Integration Questionnaire-Revised was administered to a sample of 88 adults with traumatic brain injury and to a control sample matched by gender, age and education. Participants with traumatic brain injury were divided into four subgroups according to injury severity. RESULTS: The internal consistency of the Community Integration Questionnaire-Revised was satisfactory. The differences between the group with traumatic brain injury and the control group were statistically significant for the overall Community Integration Questionnaire-Revised score, as well as for all the subscales apart from the Home Integration subscale. The community Integration Questionnaire-Revised score varied significantly for subgroups with different severity of traumatic brain injury. CONCLUSIONS: The results show that the Croatian translation of the Community Integration Questionnaire-Revised is useful in assessing participation in adults with traumatic brain injury and confirm previous findings that severity of injury predicts community integration. Results of the new Electronic Social Networking scale indicate that persons who are more active on electronic social networks report better results for other domains of community integration, especially social activities. Implications for rehabilitation The Croatian translation of the Community Integration Questionnaire-Revised is a valid tool for long-term assessment of participation in various domains in persons with moderate to severe traumatic brain injury Persons with traumatic brain injury who are more active in the use of electronic social networking are also more integrated into social and productivity domains. Targeted training in the use of new technologies could enhance participation after traumatic brain injury.

Rehabilitation medicine in Croatia -- sources and practice.

Sources of rehabilitation medicine, the need for rehabilitation and its practice in Croatia were studied, based on available data. The study revealed that current practice has advanced since the country's independence, but that there are many shortcomings; adequate care is not provided to all who could benefit from it, and there is wastage of resources.