Association Between Serum Vitamin D Levels and Physical Outcomes of Patients Who Underwent Rehabilitation Following Ischemic Stroke.

BACKGROUND Ischemic stroke is the most common cause of disability in adults. Deficiency of vitamin D in patients with cardiovascular diseases is increasing. Only a few studies have assessed the relationship between serum vitamin D levels and functional capacity and degree of disability. This study aimed to evaluate the association between serum vitamin D levels and physical outcomes of 94 patients who underwent physical rehabilitation following ischemic stroke. MATERIAL AND METHODS A group of 94 patients was enrolled; however, 80 patients (61.8±6.9 years) were included. They underwent a 6-week rehabilitation using proprioceptive neuromuscular facilitation (PNF, 60 min daily), mirror therapy (MT, 30 min daily), and occupational therapy (OT, 45 min daily). The Barthel Index (BI) and modified Rankin scale (mRS) were used for functional assessments. Laboratory blood tests for serum vitamin D and insulin-like growth factor 1 (IGF-1) levels were conducted. RESULTS There was a significant increase in BI scores (median difference=2.0 points [pts]; P<0.001) and IGF levels (median difference=124.6 ng/ml; P<0.001) after rehabilitation. There was a significant decrease in mRS scores (median difference=7.0 pts; P<0.001), but there was no significant difference in vitamin D levels (P=0.40). The effect of age (B=-0.01, P=0.04) and serum vitamin D level (B=-0.02, P=0.01) on the BI score was demonstrated. The effect of body mass index (BMI) results (B=-0.07, P=0.02) on the mRS score was observed. CONCLUSIONS Lower serum vitamin D levels and more advanced age may be associated with worse functional outcomes in first-ever ischemic stroke patients.

Assessment of Changes in Serum C-Reactive Protein Levels in Patients after Ischemic Stroke Undergoing Rehabilitation-A Retrospective Observational Study.

Inflammation plays a key role in the pathogenesis and prognosis of ischemic stroke. C-reactive protein (CRP) is an inflammatory biomarker of inflammation and may reflect the progression of vascular disease. Using a biomarker such as CRP to predict recovery rather than mortality may present clinical value in providing rehabilitation. The primary aim of the study was to analyze changes in serum CRP levels in patients after ischemic stroke during the regenerative-compensatory period and to assess the usefulness of CRP as a potential biomarker during the rehabilitation period. The project was carried out as a retrospective analysis of prospectively collected data from post-stroke patients from the Department of Neurological Rehabilitation of the Regional Specialist Hospital in Wroclaw. A group of 52 patients, after their first-ever ischemic stroke with subsequent hemiplegia, was finally qualified to participate in the study. Serum CRP levels were determined during blood laboratory tests. The Modified Rankin Scale (mRS) and Barthel Index (BI) were used to assess functional outcomes. Rehabilitation using neurophysiological methods was applied five days a week (each session lasted 60 min, and the entire period was 42 days). At the first test, serum CRP levels were found to be above 5 mg/L in 19 patients, the second test in 12 patients, the third test in five patients, and the fourth test in 9 patients. Only three patients had values higher than 5 mg/L in all consecutive assessments (p > 0.05). There was a statistically significant increase in BI scores after therapy (p < 0.001) as well as a decrease in the mRS score by 2.2 points (p < 0.001), in CRP values by 5.02 mg/L (p = 0.019), and in cortisol levels by 2.5 nmol/L (p = 0.002). Statistically significant relationships were observed between the CRP levels after rehabilitation and the corresponding mRS scores (rs = 0.29, p = 0.038). Furthermore, the effect of BMI on CRP levels was demonstrated (B = 0.20, p = 0.038). In conclusion, despite demonstrating a significant relationship between CRP levels and corresponding mRS scores, CRP levels alone may not serve as an independent predictor of long-term functional outcomes in ischemic stroke patients undergoing rehabilitation.

Assessment of the Elastographic and Electromyographic of Pelvic Floor Muscles in Postmenopausal Women with Stress Urinary Incontinence Symptoms.

BACKGROUND: Shear wave elastography is an effective method for studying the condition of various musculoskeletal soft tissues. The primary aim of this study was the objective elastographic and electromyographic assessment of the pelvic floor during the rest and contraction of the pelvic floor muscles (PFM) in postmenopausal women. METHODS: This was a prospective observational study that was carried out at the University Hospital in Wroclaw, Poland, between January 2017 and December 2019. PATIENTS: The target group of the study included postmenopausal women with stress urinary incontinence. The primary outcomes were the features of the elastographic assessment of the pelvic floor during rest and contraction of the PFM obtained using shear wave elastography. RESULTS: Based on the inclusion and exclusion criteria for the study, 14 patients took part in the measurements. There was a significant difference between the elastographic assessment of the pelvic floor during rest and contraction of the PFM at all locations in front of the urethra. No statistically significant correlation was found between the results of elastography and the bioelectrical activity of PFM. CONCLUSION: The elasticity of the periurethral structures is higher during active pelvic floor muscle contraction than at rest, it seems that shear wave elastography is an effective test that objectively assesses the strength of PFM contraction.

Immediate Effects of Kinesio Taping on Rectus Abdominis Diastasis in Postpartum Women-Preliminary Report.

BACKGROUND: Rectus abdominis diastasis (RAD) is an excessive divarication of the rectus abdominis muscle with concurrent stretching and thinning of the linea alba, which occurs due to mechanical and functional disturbances in the anterior abdominal wall and the whole body. The primary objective of this study is a palpation assessment of RAD in postpartum women before and after the application of KT tapes and a subsequent comparison of the results with those from a sham intervention group. METHODS: A randomized clinical trial was conducted in the Physical Therapy Department at Wroclaw Medical University. The participants were randomly assigned to one of two groups: the KT group (intervention), in which KT tapes were applied (48 h intervention) and the sham KT group (control, sham intervention), in which non-stretch tapes were used (cloth surgical tape, 48 h intervention). In all participants, a palpation assessment of RAD was conducted and the inter-recti distance was measured using a digital caliper at three sites: at the umbilicus and 4.5 cm above and below it. Measurements were taken before and after the intervention. RESULTS: The gathered results show a statistically significant reduction in rectus abdominis diastasis at each of the observed sites after the application of KT tapes in the intervention group (p < 0.05). In the intergroup comparison, a statistically significantly lower RAD (at umbilicus) was found after the intervention (p = 0.005) in KT group. CONCLUSIONS: the application of KT tapes using the corrective technique can contribute to reducing RAD in women up to 12 months after delivery.

The Rolf Method of Structural Integration and Pelvic Floor Muscle Facilitation: Preliminary Results of a Randomized, Interventional Study.

The management of pelvic floor dysfunctions might need to be based on a comprehensive neuro-musculoskeletal therapy such as The Rolf Method of Structural Integration (SI). The aim of the study was to evaluate the pelvic floor muscle (PFM) after the tenth session of SI by using surface electromyography (sEMG). This was a randomized, interventional study. Thirty-three healthy women were randomly assigned to the experimental (SI) or control group. The outcome measures included PFM bioelectrical activity, assessed using sEMG and endovaginal probes. An intervention in the SI group included 60 min of SI once a week, and teaching on how to contract and relax PFMs; in the control group, only the teaching was carried out. In the SI group, a significant difference was found between the PFM sEMG activity during "pre-baseline rest" (p < 0.014) and that during "rest after tonic contraction" (p = 0.021) in the supine position, as were significant increases in "phasic contraction" in the standing position (p = 0.014). In the intergroup comparison, higher PFM sEMG activity after the intervention "phasic contraction" (p = 0.037) and "pre-baseline rest" (p = 0.028) was observed in the SI group. The SI intervention significantly changes some functional bioelectrical activity of PFMs, providing a basis for further research on a new approach to PFM facilitation, particularly in clinical populations.

The Prognostic Value of the Surface Electromyographic Assessment of Pelvic Floor Muscles in Women with Stress Urinary Incontinence.

BACKGROUND: The use of surface electromyography (sEMG) measurements to evaluate the bioelectrical activity of the pelvic floor muscle (PFM) during therapeutic intervention is now well established. This study investigates the diagnostic possibilities of sEMG in women with stress urinary incontinence (SUI). The aim of this study was to carry out objective assessments of the bioelectrical activity of the PFM in women after menopause and determine the prognostic value of sEMG for assessing the PFM in patients with SUI. METHODS: This was a prospective, observational study that evaluated the bioelectrical activity of the PFM in postmenopausal women with or without SUI (SUI group, n = 89 vs. non-SUI group, n = 62). The study was carried out between January 2013 and December 2018 at the Clinic of Urology (Wroclaw, Poland). The protocol for all sEMG measurements of PFM activity consisted of following elements: "baseline", "quick flicks", "contractions", "static hold", and "rest tone"; we then compared these results between groups. To determine the optimal cutoff level for sEMG activation of the PFM to detect the occurrence of SUI, we performed receiver operating characteristic (ROC) curve analysis (with Youden's index). RESULTS: Significantly lower results were obtained for all PFM measurements in women with SUI. The optimum diagnostic cutoff for "baseline" was 3.7 µV (area under curve (AUC), 0.63), "quick flicks" was 9.15 µV (AUC, 0.84), "contractions" was 11.33 µV (AUC, 0.80), "static hold" was 9.94 µV (AUC, 0.84), and "rest" was 3.89 µV (AUC, 0.63). CONCLUSIONS: Measuring sEMG activity in the PFM may be a useful diagnostic tool to confirm the absence of SUI. We can expect that the sEMG activity of subjects with SUI will be lower than that of healthy people. In order to determine appropriate reference values for assessing sEMG activity data in the PFM, it is now necessary to conduct multicenter studies.

Assessment of the Short-Term Effects after High-Inductive Electromagnetic Stimulation of Pelvic Floor Muscles: A Randomized, Sham-Controlled Study.

BACKGROUND: Physiotherapy should be performed by patients with stress or mixed urinary incontinence (SUI and MUI) to increase the strength and endurance of the pelvic floor muscles (PFMs). A method that can positively affect the pelvic floor is stimulation with high-inductive electromagnetic stimulation (HIES). The aim of the study was to evaluate the PFMs after the application of HIES in women with SUI and MUI by using surface electromyography (sEMG). METHODS: This was a prospective, randomized, single-blind study with a sham intervention group. The participants were randomly assigned to the HIES group or sham group. The outcomes were features of the bioelectrical PFM activity assessed using sEMG and endovaginal probes. A single-session intervention in the HIES group included 20 min of HIES with an electromagnetic induction intensity of 2.5 T. RESULTS: In the HIES group, there was a statistically significant difference in the PFM sEMG activity during "contractions" (p < 0.001) and "quick flicks" (p = 0.005). In the intergroup comparison, higher PFM sEMG activity after the intervention ("contraction") was observed in the HIES group than in the sham group (after: p = 0.047; 1 h after: p = 0.017). CONCLUSIONS: The assessed HIES method seems effective for SUI and MUI patients in the short term and shows an advantage over the sham intervention in the assessment of PFM contractions.

Shock Waves as a Treatment Modality for Spasticity Reduction and Recovery Improvement in Post-Stroke Adults - Current Evidence and Qualitative Systematic Review.

PURPOSE: This systematic review examines intervention studies using extracorporeal shock wave therapy (ESWT) application in post-stroke muscle spasticity with particular emphasis on the comparison of two different types of radial (rESWT) and focused shock waves (fESWT). METHODS: PubMed, PEDro, Scopus, and EBSCOhost databases were systematically searched. Studies published between the years 2000 and 2019 in the impact factor journals and available in the English full-text version were eligible for inclusion. All qualified articles were classified in terms of their scientific reliability and methodological quality using the PEDro criteria. The PRISMA guidelines were followed and the registration on the PROSPERO database was done. RESULTS: A total of 17 articles were reviewed of a total sample of 303 patients (age: 57.87±10.45 years and duration of stroke: 40.49±25.63 months) who were treated with ESWT. Recent data confirm both a subjective (spasticity, pain, and functioning) and objective (range of motion, postural control, muscular endurance, muscle tone, and muscle elasticity) improvements for post-stroke spasticity. The mean difference showing clinical improvement was: ∆=34.45% of grade for fESWT and ∆=34.97% for rESWT that gives a slightly better effect of rESWT (∆=0.52%) for spasticity (p<0.05), and ∆=38.83% of angular degrees for fESWT and ∆=32.26% for rESWT that determines the more beneficial effect of fESWT (∆=6.57%) for range of motion (p<0.05), and ∆=18.32% for fESWT and ∆=22.27% for rESWT that gives a slightly better effect of rESWT (∆=3.95%) for alpha motor neuron excitability (p<0.05). The mean PEDro score was 4.70±2.5 points for fESWT and 5.71±2.21 points for rESWT, thus an overall quality of evidence grade of moderate ("fair" for fESWT and "good" for rESWT). Three studies in fESWT and four in rESWT obtained Sackett's grading system's highest Level 1 of evidence. CONCLUSION: The studies affirm the effectiveness of ESWT in reducing muscle spasticity and improving motor recovery after stroke.

Immediate effects of the respiratory stimulation on ventilation parameters in ischemic stroke survivors: A randomized interventional study (CONSORT).

BACKGROUND: Post-stroke brain damage, which affects the central control of respiration, leads to various respiratory disorders. They can be caused by the weakening of the respiratory muscles and chest movements, which can indirectly contribute to an impairment of the ventilation function. The aim of the study is an objective assessment of the effect of a single-session intervention of respiratory stimulation through Proprioceptive Neuromuscular Facilitation (PNF) on chosen respiratory parameters and the following comparison of these changes with a group in which positioning was used (intra- and intergroup comparison). METHODS: This was a randomized interventional study evaluating the respiratory parameters depending on the applied respiratory stimulation in patients after ischemic stroke. The patients qualified to participate in the study were randomly assigned to 1 of 2 groups: PNF-treated group - in which respiratory stimulation through PNF was used, PNF untreated group - in which positioning was used. The research procedure consisted of several stages. First, an interview was conducted with each participant and basic data was collected. Then, spirometry was conducted, after which each patient underwent a single-session intervention according to their assigned group. Finally, the patients were given another spirometry examination. The main outcomes will be to compare the results of a spirometry test (FVC, FEV1, FEV1/ FVC%, PEF) before and after single-session intervention and between groups. RESULTS: Based on the inclusion and exclusion criteria for the study, 60 patients took part in the measurement. The values of FEV1/FVC% were higher in PNF-treated group than in PNF-untreated group, if the post-intervention measures (P = .04) are considered. The difference between the pre- and post-intervention results of the FEV1/FVC% values in PNF-untreated group was substantially lower than in PNF-treated group (P = .001). CONCLUSION: A single application of respiratory stimulation through PNF positively affect air flow in the respiratory tract. Application of PNF stimulation contributed to an increase in the FEV1/FVC% parameter. However, no positive changes were noted in the other parameters, which would provide proof of the beneficial effect of facilitation on the respiratory system function.

Electromyographic evaluation of synergist muscles of the pelvic floor muscle depending on the pelvis setting in menopausal women: A prospective observational study.

BACKGROUND: Pelvic floor muscle (PFM) training is recommended to increase their strength and endurance. Muscles which act synergistically with PFM are taken into consideration in the therapeutic management of weakened PFM. RESEARCH QUESTION: how does electromyography activity of the synergists muscle to PFM change concerning pelvis position and does the greater bioelectric activity of synergist muscles affect PFM function? METHODS: A prospective, observational study evaluating the surface electromyography (sEMG) activity of selected synergist muscles of the PFM depending on the orientation of the pelvis. One hundred thirty-one menopausal women registered for the study were screened for inclusion and exclusion criteria, and by the results, eighty-two participants were enrolled for measurements. The comparisons of results between the values obtained in different positions of the pelvis (anterior pelvic tilt - P1, posterior pelvic tilt - P2 and neutral pelvic tilt - P3) were performed using Kruskal-Wallis test. A multivariate linear regression analysis was used to assess relationships between the bioelectrical activity of PFM and activity of all tested muscles - rectus abdominis (RA), gluteus maximus (GM), and adductor magnus (AM). RESULTS: Higher RA, GM, AM bioelectrical activity was observed in the P2 as compared to P3 (during resting and functional PFM activity)(p < 0.05). Multivariate linear regression did not find the association between the bioelectrical activity of PFM and the activity of all synergist muscles in each position. SIGNIFICANCE: sEMG activity of selected muscles acting synergistically with PFM differ depending on the pelvis position and is the highest in the posterior pelvic tilt. Greater activity of the synergists, resulting from the pelvic position, does not affect the myoelectric activity of PFM. It seems that muscles that act synergistically with PFM may not play such a significant role in the therapeutic management of PFM.