Cervical Spondylotic Myelopathy-Diagnostics and Clinimetrics.

Cervical myelopathy is referred to in many ways in the English literature, for example, as cervical spondylotic myelopathy (CSM), spondylotic radiculomyelopathy (SRM) or degenerative cervical myelopathy (DCM). In addition, more frequent occurrences are noted in older adults and to a greater extent in men. The causes of the effects of cervical myelopathy may be the appearance of lesions on the spinal cord, ischemia due to compression of the vertebral artery and repeated micro-injuries during maximal movements-hyperflexion or hyperextension. It is well known that lesions on the spinal cord may occur in a quarter of the population, and this problem is clearly noted in people over 60 years old. The symptoms of SCM develop insidiously, and their severity and side (unilateral or bilateral) are associated with the location and extent of spinal cord compression. Neurological examination most often diagnoses problems in the upper limbs (most often paresis with developing hand muscle atrophy), pyramidal paralysis in one or both lower limbs and disorders in the urinary system. To make a diagnosis of CSM, it is necessary to perform MRI and neurophysiological tests (such as EMG or sensory and/or motor-evoked potentials). The use of appropriately selected scales and specific tests in diagnostics is also crucial. This narrative review article describes the latest knowledge on the diagnosis and clinimetrics of cervical spondylotic myelopathy in adults and provides future directions.

Lumbar Pain in Patients with Multiple Sclerosis and Knowledge about Physiotherapeutic Methods for Combating Pain.

BACKGROUND: The purpose of this study was to evaluate the intensity and frequency of low back pain (LBP) in people with multiple sclerosis (PwMS) and patients' knowledge of physiotherapeutic methods for combating LBP. METHODS: This study included all MS patients attending consecutive follow-up visits for treatment related to MS between March and May 2023. Only current pain sensations in the lumbar spine were taken into account. The inclusion criteria were age 18-60 years, a definite diagnosis of MS according to the 2017 McDonald criteria, treatment with disease-modifying drugs (DMTs), and consent to participate in the study. This study was carried out using an original survey questionnaire and a Visual Analogue Scale. PwMS were divided into three age groups: 18-30 years, 31-50 years, and over 50 years. RESULTS: Ninety PwMS (68 women and 22 men) were included in the study. The mean duration of the disease was 9.5 ± 4.9 years, and the mean EDSS was 3.5 ± 1.6. Most patients had a relapsing-remitting form of the disease. Overall, 68.9% of PwMS felt low back pain (n = 62). The relationship tested was statistically significant (p < 0.001), and the strength of the relationship was high (rc = 0.695). The average level of low back pain among PwMS was 4.7 out of 10 on the VAS. The prevalence of LBP was higher in female patients (p < 0.001), patients with a secondary progressive form of MS (p < 0.001), and patients with a longer duration of disease (p < 0.05). The most widely used methods for treating LBP were kinesitherapy and manual therapy. CONCLUSIONS: LBP is common in patients with multiple sclerosis. Female sex, a secondary progressive form of MS, and a longer duration of disease increase the risk of LBP. It is important to implement properly planned physiotherapy activities and educate patients on how to combat LBP.

Home-Based Exercise to Improve Motor Functions, Cognitive Functions, and Quality of Life in People with Huntington's Disease: A Systematic Review and Meta-Analysis.

Exercise in different settings has become a fundamental part of Huntington's disease (HD) management. The aim of this systematic review and meta-analysis was to investigate the effectiveness of home-based exercises (HBE) in HD. Randomized controlled trials (RCTs) investigating the effect of HBE on motor, cognitive, or health-related quality of life (QoL) outcomes in HD were included. Standardized mean difference (SMD), the 95% confidence interval, and p-values were calculated by comparing the outcomes change between HBE and control groups. Seven RCTs met the inclusion criteria. The included RCTs prescribed different types of HBEs, i.e., aerobic strengthening, walking, balance, and fine motor exercises. The HBE protocol length was between 6 and 36 weeks. The meta-analyses showed a significant effect of HBE intervention on motor function measure by Unified Huntington Disease Rating and overall QoL measure by Short Form-36 post-treatment respectively, [SMD = 0.481, p = 0.048], [SMD = 0.378, p = 0.003]. The pooled analysis did not detect significant changes in cognition, gait characteristics, or functional balance scales. The current study shows the positive effect of HBE in HD, especially on motor function and QoL. No significant adverse events were reported. The current results support the clinical effect of HBE intervention on motor function and QoL in HD patients. However, these results should be taken with caution due to the limited available evidence. Well-designed clinical studies that consider the disease severity and stages are required in the future.

The Current State of Knowledge on the Clinical and Methodological Aspects of Extracorporeal Shock Waves Therapy in the Management of Post-Stroke Spasticity-Overview of 20 Years of Experiences.

In many patients after stroke, spasticity develops over time, resulting in a decrease in the patient's independence, pain, worsening mood, and, consequently, lower quality of life. In the last ten years, a rich arsenal of physical agents to reduce muscle tone such as extracorporeal shock therapy (ESWT) wave has come through. The aim of this narrative review article is to present the current state of knowledge on the use of ESWT as a supplement to the comprehensive rehabilitation of people after stroke suffering from spasticity. The PubMed and PEDro databases were searched for papers published in English from January 2000 to December 2020, 22 of which met inclusion criteria for clinical studies related to post-stroke spasticity management with ESWT. A total of 22 studies including 468 post-stroke patients-11 reports with the upper limb (267 patients) and 10 reports within the lower limb (201 patients), as well as one report including both upper and lower limb. We focused our attention on clinical and methodological aspects. Therefore, we performed the assessment of enrolled studies in terms of methodological quality using the PEDro and level of evidence using the National Institute for Health and Clinical Excellence (NICE) guidelines. Furthermore, we indicated implications for clinical practice in using ESWT for post-stroke spasticity management. Moreover, we discussed a suggestion for future research directions. In conclusion, an ESWT effectively reduces muscle tone in people with spastic limb after stroke. Further, ESWT is safe and free of undesirable side effects. The mechanism of action of ESWT on muscles affected by spasticity is still unknown. To date, no standard parameters of ESWT in post-stroke spasticity regarding intensity, frequency, location, and the number of sessions has been established. Further research, meeting the highest standards, is needed to establish uniform muscle stimulation parameters using ESWT.

Osteoporosis in Polish Older Women: Risk Factors and Osteoporotic Fractures: A Cross-Sectional Study.

Background: Osteoporosis is a skeletal disease. It is still not known which of the risk factors have the greatest impact on osteoporosis development. The study aimed to determine how the selected osteoporosis risk factors contribute to the development of the disease and to assess the risk of osteoporotic fractures in older women. Methods: A cohort of 99 older females was divided into two groups (with and without osteoporosis). The risk of osteoporosis was determined using assessment forms and bone densitometry data subjected to logistic regression. The risk of osteoporotic fractures was assessed by the FRAX tool (FRAX, Center for Metabolic Bone Diseases, University of Sheffield, UK). Results: The logistic regression analysis showed that the highest risk of developing osteoporosis associated with lifestyle, mainly cigarette smoking (odds ratio: OR = 2.12), past gynecological operations (OR = 1.46), corticosteroid therapies (OR = 1.38). More than half of participants were at a medium risk of femoral neck fractures (over 90% in the osteoporotic group). Conclusion: Most of the Polish women living in care facilities are at medium risk of low-energy fractures. Smoking appeared to have the strongest effect on osteoporosis among analyzed risk factors. The results may contribute to the creation of more appropriate prevention strategies.

Assessment of Anxiety and Depression in Polish Primary Parental Caregivers of Children with Cerebral Palsy Compared to a Control Group, as well as Identification of Selected Predictors.

BACKGROUND: Taking care of a child with Cerebral Palsy (CP) may be linked with adverse effects in the parents' physical and mental health. The causes of anxiety and depression symptoms associated with childcare are still not fully understood. AIM: To assess the intensity of anxiety and depression symptoms in parents of children with CP compared to a control group and to identify selected mental health predictors. DESIGN AND METHODS: Data were collected from 301 respondents, including 190 parents of children with CP (study group) and 111 parents taking care of children developing normally (control group). Intensity of anxiety and depression was rated using the Hospital Anxiety and Depression Scale (HADS) scale. Gross Motor Function Classification System for Cerebral Palsy (GMFCS), Sense of Coherence Scale (SOC-29), Berlin Support Social Scales (BSSS) scales and a specially designed questionnaire were used to assess the predictors. The investigated variables included the children's and the parents' characteristics, as well as environmental factors. The analyses applied Spearman's rank correlation coefficient, M(SD) as well as multiple regression. RESULTS: The level of anxiety and depression was clearly higher in the parents of children with CP-the mean levels of anxiety and depression in the study group and the controls amounted to 8.1 vs. 4.7 and 6.8 vs. 3.7, respectively. The factors associated with intensity of anxiety and depression in the parents of children with CP included lack of social support, mainly perceived and received support, unsatisfying parental health status, poor economic status of the family, as well as difficult living conditions, sense of coherence, loneliness, the parent's gender, and the child's intellectual disability. CONCLUSIONS: Identification of significant anxiety and depression predictors, understood as modifiable factors, should be considered in determining and planning comprehensive support for a child with CP and his/her primary parental caregiver.

Effect of Physical Activity on the Quality of Life in Osteoporotic Females Living in Residential Facilities: A Randomized Controlled Trial.

BACKGROUND AND PURPOSE: The study aimed to assess the effect of a program of modified Sinaki exercises and Nordic Walking on the life quality in osteoporotic and osteopenic females living in residential care facilities, taking into account their baseline level of activity and risk of falling. The study was designed as a randomized controlled trial. METHODS: A sample of 91 females 65 to 98 years of age, the residents of Upper Silesian residential care facilities, was randomized into 4 groups. All groups received the same pharmacological treatment. In group 1 (control group), drugs were the only therapy; in group 2, the therapy was enhanced by program of modified Sinaki exercises; group 3 participated in Nordic Walking workout; and group 4 did both Sinaki exercises and Nordic Walking. Locomotor activity of the participants was estimated from pedometer readings. The risk of falling was assessed with the "Timed Up and Go" Test and the Functional Reach Test. With the QUALEFFO-41 questionnaire, the life quality of the participants was evaluated at baseline and after 12 months of intervention. RESULTS AND DISCUSSION: The study revealed that the studied women were at high risk of falling and that their physical activity was relatively low, likewise the quality of their lives. Their satisfaction with life was reduced by poor health, limited mobility, and the lack of social activities. Life quality improved in all 3 intervention groups, but in the control group, it decreased. The results of Bonferroni's post hoc test pointed to statistically significantly better quality of life in groups 2 (P = .01) and 4 (P < .01). CONCLUSION: Both modified Sinaki exercises and Nordic Walking significantly improved the participants' quality of life, but the most effective therapeutically was the combination of both these forms of physical activity.

Functional differences in upper limb movement after early and chronic stroke based on kinematic motion indicators.

AIMS: The main purpose of this study was to determine the changes in kinematic parameters of ischemic stroke affected upper limbs, during simple functional activity, to determine the most relevant changes. METHODS: The OptiTrack system was used for motion capture. To determine upper extremity function in Activities of Daily Living (ADL) tasks. During particular phases, the following matrices were chosen: mean and peak speed, normalized movement unit, normalized jerk and phase movement time. The chosen matrices represent the speed and smoothness profile of end-point data. The the arm-trunk compensation was also taken into consideration. Twenty stroke patients, in early (G1 from 1 to 3 months after stroke) and chronic stage (G2 from 6 months to 1 year), were studied. The large and small cylinder forward and back transporting phases were evaluated. RESULTS: The most significant differences between groups G1 and G2 were in mean and peak speed of the forward transport of the large and small cylinders for the paretic limb. Significant differences were also found for the smoothness (measured by movement unit, mean and peak speed and jerk) where the G2 group had a rougher motion. There were also differences in arm-trunk compensation in the frontal plane. CONCLUSION: The variables used in the study showed applicability in assessing kinematic parameters in both the early and chronic period after stroke.

Effect of physical activity on the sequelae of osteoporosis in female residents of residential care facilities.

BACKGROUND: Osteoporosis is one of the most common diseases that develop with age and cause high morbidity and mortality among elderly people. OBJECTIVES: This study was set out to evaluate the influence of a program of modified Sinaki exercises, Nordic walking (NW) and a combination of these physical activities on people with osteoporosis. MATERIAL AND METHODS: A sample consisting of 91 women aged 65-98 years living in residential care facilities was randomized into 4 groups. The control group (group 1) received only pharmacological treatment. In the other 3 groups, the same drug therapy was enhanced by a program of modified Sinaki exercises (group 2), Nordic walking (group 3), and Sinaki exercises and Nordic walking applied together (group 4). At baseline and after 12 months of intervention, the participants were assessed for bone density, rib cage mobility, motor abilities, risk of falling (Timed Up and Go Test - TUG, Functional Reach Test - FRT), and locomotor activity (based on pedometer readings). The intervention was completed by 83 participants. RESULTS: Bone density (T-score) was higher in all intervention groups and in the control group (p < 0.003). The improvement in rib cage mobility was statistically significant in groups 2 (p < 0.001) and 4 (p < 0.002). Locomotor activity significantly improved in groups 3 (p < 0.000) and 4 (p < 0.000). The post-intervention results of the TUG and FRT tests showed a significantly lower risk of falling in group 4. In groups 1 and 2, the risk was higher, but not statistically significantly, and in group 3, it did not change. CONCLUSIONS: Modified Sinaki exercises and Nordic walking significantly improved the mobility of the rib cage, locomotor activity and motor abilities in the women comprising groups 2 and 3, but the best results of the intervention were noted in the group treated with both forms of physical activity.

Virtual Reality for Upper Limb Rehabilitation in Subacute and Chronic Stroke: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effectiveness of reinforced feedback in virtual environment (RFVE) treatment combined with conventional rehabilitation (CR) in comparison with CR alone, and to study whether changes are related to stroke etiology (ie, ischemic, hemorrhagic). DESIGN: Randomized controlled trial. SETTING: Hospital facility for intensive rehabilitation. PARTICIPANTS: Patients (N=136) within 1 year from onset of a single stroke (ischemic: n=78, hemorrhagic: n=58). INTERVENTIONS: The experimental treatment was based on the combination of RFVE with CR, whereas control treatment was based on the same amount of CR. Both treatments lasted 2 hours daily, 5d/wk, for 4 weeks. MAIN OUTCOME MEASURES: Fugl-Meyer upper extremity scale (F-M UE) (primary outcome), FIM, National Institutes of Health Stroke Scale (NIHSS), and Edmonton Symptom Assessment Scale (ESAS) (secondary outcomes). Kinematic parameters of requested movements included duration (time), mean linear velocity (speed), and number of submovements (peak) (secondary outcomes). RESULTS: Patients were randomized in 2 groups (RFVE with CR: n=68, CR: n=68) and stratified by stroke etiology (ischemic or hemorrhagic). Both groups improved after treatment, but the experimental group had better results than the control group (Mann-Whitney U test) for F-M UE (P<.001), FIM (P<.001), NIHSS (P≤.014), ESAS (P≤.022), time (P<.001), speed (P<.001), and peak (P<.001). Stroke etiology did not have significant effects on patient outcomes. CONCLUSIONS: The RFVE therapy combined with CR treatment promotes better outcomes for upper limb than the same amount of CR, regardless of stroke etiology.

Motor assessment in Parkinson`s disease.

Parkinson's disease (PD) is one of most disabling disorders of the central nervous system. The motor symptoms of Parkinson's disease: shaking, rigidity, slowness of movement, postural instability and difficulty with walking and gait, are difficult to measure. When disease symptoms become more pronounced, the patient experiences difficulties with hand function and walking, and is prone to falls. Baseline motor impairment and cognitive impairment are probable predictors of more rapid motor decline and disability. An additional difficulty is the variability of the symptoms caused by adverse effects of drugs, especially levodopa. Motor assessment of Parkinson`s Disease can be divided into clinimetrics, assessment of balance and posture, arm and hand function, and gait/walking. These are many clinimetric scales used in Parkinson`s Disease, the most popular being the Hoehn and Yahr stages of progression of the disease and Unified Parkinson's Disease Rating Scale. Balance and posture can be assessed by clinimetric scales like the Berg BS, Tinetti, Brunel BA, and Timed Up and Go Test, or measured by posturometric platforms. Among skill tests, the best known are: the Purdue Pegboard Test, Nine-Hole Peg Test, Jebsen and Taylor test, Pig- Tail Test, Frenchay Arm Test, Action Research Arm Test, Wolf FMT and Finger-Tapping Test. Among motricity scales, the most popular are: the Fugl-Meyer Motor Assessment Scale and Södring Motor Evaluation. Gait and walking can also be assessed quantitatively and qualitatively. Recently, the most popular is three-dimensional analysis of movement. This review article presents the current possibilities of motor assessment in Parkinson`s disease.

European core curriculum in neurorehabilitation.

To date, medical education lacks Europe-wide standards on neurorehabilitation. To address this, the European Federation of NeuroRehabilitation Societies (EFNR) here proposes a postgraduate neurorehabilitation training scheme. In particular, the European medical core curriculum in neurorehabilitation should include a two-year residency in a neurorehabilitation setting where trainees can gain practical experience. Furthermore, it should comprise six modules of classroom training organized as weekend seminars or summer/winter schools. In conclusion, after defining the European medical core curriculum in neurorehabilitation, the next activities of the EFNR will be to try and reach the largest possible consensus on its content among all national societies across Europe in order to further validate it and try to extend it to the other, non-medical, professionals on the neurorehabilitation team in line with their core curricula defined by each professional association.

The follow-up posturography in rehabilitation after total hip arthroplasty.

PURPOSE: Presentation of the results of clinical study on new supplementary method applied in the physical rehabilitation of patients who underwent total hip arthroplasty. The standard rehabilitation program was supplemented with the lower limb loading symmetry training based on the follow-up posturography with an adaptively modified visual biofeedback, performed on a double plate posturographic platform. METHODS: The research involved 60 randomly selected patients included in prospective and comparative clinical study in the scheme of the parallel groups. The subjects were divided into two groups comprised of 30 patients each. In both groups a conventional 21-day rehabilitation was carried out. Additionally, in experimental group the limb loading symmetry restoration training based on the follow-up posturography with an adaptively modified biofeedback was implemented. The biofeedback coefficient reflected the distribution of loading exerted on a given patient's legs and was evaluated during the static posturography examinations carried out before each symmetry training session. RESULTS: The eyes-open static posturography examinations indicated significant improvement in the lower limb loading symmetry in 29 (97%) patients from the experimental group ( p = 0.000003). In the control group, such an improvement was observed in 20 (67%) patients ( p = 0.034796). In the eyes closed examinations correction in the limb loading symmetry was evident in 23 (77%) patients from the experimental group ( p = 0.000247) and 18 (60%) patients from the control group ( p = 0.043327). CONCLUSIONS: Significant improvement in the lower limb loading symmetry was observed in patients who underwent rehabilitation supplemented with the herein discussed training method.

Effectiveness of Mirror Therapy for Subacute Stroke in Relation to Chosen Factors.

PURPOSE: The aim of this study was to determine the effectiveness of mirror therapy (MT) combined with comprehensive treatment and to investigate the possible relationships of functional state. DESIGN: Prospective, controlled trial of 60 stroke inpatients. METHODS: The Functional Index "Repty" (FIR) was an outcome measure to assess changes of independence in daily activities. The Frenchay Arm Test (FAT) and Motor Status Score were outcome measures to assess changes in hand function. FINDINGS: The analysis of pre- and posttest data indicated a significant improvement in hand function ([INCREMENT]FAT in the Mirror group p = .035, N = 30). Age factor indicated a significant change in relation to FIR outcome ([INCREMENT]FIR in the Mirror group p = .005, N = 30 and [INCREMENT]FIR in the Mirror group [left hand paresis] p = .037, N = 15). CONCLUSIONS: Additional MT influenced improvement in hand function. The age is significant in terms of functional state. The older adults are likely to benefit from MT. CLINICAL RELEVANCE: A positive impact of combining MT with other treatment was indicated.

Computational models and motor learning paradigms: Could they provide insights for neuroplasticity after stroke? An overview.

Computational approaches for modelling the central nervous system (CNS) aim to develop theories on processes occurring in the brain that allow the transformation of all information needed for the execution of motor acts. Computational models have been proposed in several fields, to interpret not only the CNS functioning, but also its efferent behaviour. Computational model theories can provide insights into neuromuscular and brain function allowing us to reach a deeper understanding of neuroplasticity. Neuroplasticity is the process occurring in the CNS that is able to permanently change both structure and function due to interaction with the external environment. To understand such a complex process several paradigms related to motor learning and computational modeling have been put forward. These paradigms have been explained through several internal model concepts, and supported by neurophysiological and neuroimaging studies. Therefore, it has been possible to make theories about the basis of different learning paradigms according to known computational models. Here we review the computational models and motor learning paradigms used to describe the CNS and neuromuscular functions, as well as their role in the recovery process. These theories have the potential to provide a way to rigorously explain all the potential of CNS learning, providing a basis for future clinical studies.

[The neuroprotective effect of mild therapeutic hypothermia after out-of-hospital cardiac arrest with successful reanimation - a case report]. / Neuroprotekcyjne dzialanie lagodnej hipotermii terapeutycznej po pozaszpitalnym zatrzymaniu krazenia ze skuteczna reanimacja - opis przypadku.

The use of mild therapeutic hypothermia (MTH) in adult patients remaining in a coma following cardiac arrest, regardless of its mechanism and location, is recommended by the European Resuscitation Council. The study presents a case of a 52-year-old man in whom MTH was used following successfully resuscitated out-of- hospital sudden cardiac arrest caused by ventricular fibrillation. On the basis of this case it was indicated that the use of low temperatures may be an effective method of neuroprotective treatment since such activity is compatible with later observed great possibility of the brain to compensate and with the maintenance of brain plasticity which is crucial for neuropsychological rehabilitation.

Symptomatology and pathogenesis of different types of pain in multiple sclerosis.

Multiple sclerosis (MS) is a progressive disease of the central nervous system. It is characterized by disseminated foci of demyelination, which are responsible for the diverse clinical picture of MS. Pain is a frequent but underestimated symptom of multiple sclerosis. It is estimated to affect 29-86% of MS patients in various stages of the disease and severely influences rehabilitation and quality of life. The pain experienced by MS patients is generally caused by nervous system damage during the course of the disease process and can usually be characterized as central neuropathic pain (less frequently as peripheral or nociceptive pain). The most frequent symptoms include dysesthetic extremity pain, painful tonic spasms, Lhermitte's sign, trigeminal neuralgia, headaches and low back pain. This paper discusses the probable mechanisms behind the development of pain in MS, the prevalence, classification, types of pain, as well as the most effective treatment methods.

The prevalence of stress urinary incontinence in women studying nursing and related quality of life.

Urinary incontinence is a growing problem that affects millions of people worldwide. The purpose of this study was to assess the prevalence of stress urinary incontinence (SUI) in women studying nursing. Respondents completed a questionnaire assessing urinary incontinence, severity of symptoms and quality of life. Short forms to assess symptoms of distress for urinary incontinence and quality of life: UDI-6 and IIQ-7 have been used. The study's conclusions are as follows: 1) among the 113 interviewed women, stress urinary incontinence (SUI) was observed in 25% of respondents; this prevalence is similar to the age-matched population; 2) among the triggering factors mentioned in stress urinary incontinence the most frequent were: coughing, laughing and sneezing; 3) moderate impact of incontinence on quality of life has been shown, but this effect was not statistically significant.

Prevalence of stress urinary incontinence in elite female endurance athletes.

The goal of the study was to assess the prevalence of stress urinary incontinence in a group of elite female endurance athletes, as professional sport is one of the risk factors for stress urinary incontinence. SUI rates in the groups of female cross-country skiers and runners were compared to determine whether the training weather conditions like temperature and humidity influenced the prevalence of urinary incontinence. An anonymous questionnaire was distributed among 112 elite female athletes ie., 57 cross-country skiers and 55 runners. We used a short form of the Urogenital Distress Inventory (UDI-6) to assess the presence of SUI symptoms and the level of urogenital distress. Only women who had been practicing sport professionally for at least 3 years, on an international and national level, were included in the research. The study group consisted of 76% nulliparous and 24% parous women. 45.54% of all participants reported leakage of urine associated with sneezing or coughing which indicates stress urinary incontinence. 29.46% were not bothered by the urogenital distress symptoms. 42.86% of the participants were slightly bothered by the symptoms, 18.75% were moderately bothered, 8.04% were significantly bothered and 0.89% were heavily bothered. The absence of statistically significant differences between both groups seems to indicate that training weather conditions did not influence the prevalence of SUI in elite female endurance athletes.