Changes in skeletal muscle mass index and fat mass index during rehabilitation for traumatic brain injury and stroke measured by bioelectrical impedance analysis.

Although malnutrition may negatively impact the outcomes of rehabilitation and increase the cost of care, there are still no valid nutritional assessment methods appropriate for specific groups of patients undergoing rehabilitation. This study aimed to determine if a multifrequency bioelectrical impedance is suitable for monitoring the changes in body composition of brain-injured patients for whom individualized nutritional goals were set during rehabilitation. Fat mass index (FMI) and skeletal muscle mass index (SMMI) were examined by Seca mBCA515 or portable Seca mBCA525 device within 48 h of admission and before discharge in 11 traumatic brain injury (TBI) and 11 stroke patients with admission Nutritional Risk Screening 2002 scores ≥2. The changes in outcomes and plausible interactions were examined between the admission values and the values estimated for the 18th day (minimum length of stay in the sample) using a repeated measure mixed-sample analysis of covariance. In patients with low FMI at admission (mainly younger, TBI patients, with longer ICU stay), there was no change over time whereas, in those with high admission FMI (older, stroke patients, with shorter ICU stay), a decrease was observed (significant interaction F(1,19) = 9.224 P  = 0.007 Part. η² = 0.327). The SMMI significantly increased over time (F(1,19) = 5.202 P  = 0.034 Part. η² = 0.215) independently of gender, age, days spent in ICU and cause of brain injury. Our results suggest that bioelectrical impedance analysis is feasible and informative for monitoring the changes in body composition during rehabilitation, which also requires consideration of demographic and pre-rehabilitation characteristics.

[Development of rehabilitation medicine in Hungary, results of the last decades]. / A rehabilitációs medicina fejlodése hazánkban, az elmúlt húsz év eredményei.

In recent decades, medicine has undergone incredible development, the boundaries of the specializations have changed, they have become more differentiated, and new specialities have emerged. The evolution of rehabilitation medicine and the development of its current competencies correspond to this process. An independent new interdisciplinary clinical specialty was born in Hungary. The purpose of this publication is to present the development and results of rehabilitation medicine in Hungary over the past twenty years. A descriptive presentation of the results was made using Hungarian publications and data of rehabilitation medicine, without a systematic analysis. In the past 20 years, significant changes have taken place in the field of rehabilitation. A national network was established in inpatient care, and specialized departments for special tasks were organized. In 1998, only nearly 2,941 beds were used for rehabilitation, currently there are more than 6,500 rehabilitation beds in the country. The number of treated cases was 11,384 (1987), which rose to 95,693 in 2019. Since the beginning, 552 doctors have obtained rehabilitation qualifications, but the work of other team members (nurses, physiotherapists, occupational therapists, psychologists, speech therapists, social workers) is also indispensable for carrying out rehabilitation activities. Rehabilitation departments and chairs have been established at the four medical faculties, and graduate and postgraduate training is coordinated. The national institute remained the center of research and education. The development of the field of rehabilitation and the results of research were also presented at international conferences organized in Hungary. Orv Hetil. 2023; 164(19): 722-728.

[Stroke rehabilitation outcome in an inpatient neurological rehabilitation unit]. / Stroke-ot követo rehabilitáció eredménye rehabilitációs intézetben.

Background and purpose:

To examine the rehabilitation outcome of patients who have suffered a stroke and subsequently received priority rehabilitation in hospital inpatient care, with a focus on changes in functional status.

Retrospective descriptive study. Functional impairment was measured at admission and discharge using the Barthel Index and the Functional Independence Measure scale. The subjects of the study were patients admitted to the Brain Injury Rehabilitation Unit of the National Institute of Medical Rehabilitation for inpatient rehabilitation with a stroke diagnosis between January 1 and December 31, 2018. 

Eighty-six stroke patients were treated in 2018 at the unit. Data were available for 82 patients (35 women and 47 men). Fifty-nine patients with acute stroke participated at primary rehabilitation and 23 patients with chronic stroke were involved in secondary rehabilitation. Ischaemic stroke was diagnosed in 39 cases and haemorrhagic stroke in 20. Patients were admitted for rehabilitation on the mean of 36th day (range: 8-112) after stroke and length of stay at rehabilitation unit was 84 days (14-232). The mean age of the patients was 56 years (range 22-88). Speech and language therapist treatment was necessary for 26 patients with aphasia, for 11 patients with dysarthria, and for 12 dysphagic patients. Neuropsychologic examination and training was necessary at 31 patients, severe neglect was found in 9 cases, ataxia was found in 14 cases. As a result of rehabilitation Barthel Index changed from 32 to 75, and the FIM scale from 63 to 97. At the end of the rehabilitation the majority (83%) of the stroke patients could be discharged to home, 64% became independent in daily living activities, and 73% of them regained the ability to walk.  

The rehabilitation of stroke patients transferred from the acute wards who received priority rehabilitation was successful as a result of the rehabilitation activities carried out in the ward as part of a multidisciplinary team approach. The successful rehabilitation of patients with above average functional impairment from the acute ward is attributed to almost 40 years of experience and well-organised multidis­ciplinary teamwork.

Analysis of the effect of patients' health status on efficiency: Application of data envelopment analysis in healthcare.

The effective and efficient operation of public healthcare systems is more and more important as a consequence of the increasing amount of money spent on their operation. For this reason, accurate and science-based efficiency information is needed for managers and healthcare policy makers. The evaluation of the efficiency in this sector is particularly difficult because several measures and indicators are used. Data envelopment analysis (DEA) can provide aggregate and overall measures of efficiency. The purpose of this paper is the examination of the efficiency of in-patient rehabilitation units curing musculoskeletal disorders in Hungary. The research presented focuses on rehabilitation units which attend to patients recovering from stroke or other acquired brain injuries. Output-oriented, slack-based DEA models are applied for the evaluation of in-patient rehabilitation units using data of a national survey. The novelty of the method presented is the consideration of the change in patients' functional status when efficiency is evaluated using DEA.

Possibility of bioimpedance-based nutritional status assessment in rehabilitation / A tápláltsági állapot bioimpedancia-alapú meghatározásának lehetosége a rehabilitációban

Introduction: We do not have a diagnostic method for malnutrition yet that can monitor the nutritional status of patients in rehabilitation institutions and its changes in an objective, accurate, reproducible way. Objective: The aim of this study was to determine the risk of malnutrition in patients at the National Institute for Medical Rehabilitation of Hungary completing with bioimpedance-based body composition in order to develop adequate nutrition therapy. Method: The Nutritional Risk Screening 2002 questionnaire was used. Body composition analysis was determined by the multifrequency bioimpedance-based seca mBCA 525 device. Results: The association between the risk of malnutrition measured by a validated screening method of 41 patients was weaker with fat-free mass index (r = -0.487, p = 0.001) and skeletal muscle mass (r = -0.476, p = 0.002) than with body mass index (r = -0.662, p<0.001). It was not correlated with fat mass. Strong correlations of body mass index with body composition were significantly weakened in the case of brain injuries. A strong correlation between skeletal muscle and fat mass was observed in all cases. Body mass index correlated with extracellular and total body water ratio only in the case of brain injuries. The extracellular and total body water ratio presented a strong correlation with the phase angle in each case (r = -0.711, p<0.001). Phase angle showed the strongest correlations with fat-free mass index (r = 0.638, p<0.001), skeletal muscle (r = 0.544, p<0.001) and fat mass (r = 0.588, p<0.001) in the case of brain-injured patients. Conclusion: Malnutrition screening tools are not sensitive enough for patient groups of rehabilitation institutions, and with body mass index, less risky patients can be screened out than with body composition analysis. Combining screening with bioimpedance-based body composition analysis is a suitable method for rehabilitation hospitals.

[Rehabilitation results after severe traumatic brain injury]. / Balesetben súlyos agysérülést szenvedett betegek rehabilitációjának eredményei.

BACKGROUND AND PURPOSE: To assess the rehabilitation outcome after severe traumatic brain injury. METHODS: Retrospective evaluation of the rehabilitation process and prospective follow-up five years after discharge. Patients - Patients treated in 2013 at the Traumatic Brain Injury Unit, National Institute for Medical Rehabilitation were included in the study (n = 232). RESULTS: Ninety-nine of 232 patients were treated with severe traumatic brain injury. Data were available for 66/99 patients (67%). Fifty patients (13 women and 37 men) were successfully contacted for follow-up (51%), three patients deceased. The mean age of the patients was 42 years (range: 22-72). The majority of them (36/50) was injured in traffic accidents. The mean duration of coma and post-traumatic amnesia were 19 (1-90) and 45 days (5-150), respectively. Patients were admitted for rehabilitation on the 44th (11-111) day after the injury and were rehabilitated for 95 days (10-335). Thirty-eight patients became independent at daily living activity during the rehabilitation period, and none during the follow-up. Two patients needed moderate and one a little help for the daily life. After successful rehabilitation 4 patients continued their higher education, 24 patients worked (six in sheltered, six in the original, 12 in other workplaces). Twenty-two patients did not have permanent jobs, two of whom were retired. CONCLUSION: The majority of the patients were successfully reintegrated into society. More than half of the patients returned to work or continued their studies. These successes were greatly facilitated by the 40 years of experience and the multidisciplinary team working in the National Institute for Medical Rehabilitation.

When can maximal efficacy occur with repeat botulinum toxin injection in upper limb spastic paresis?

Repeated injection cycles with abobotulinumtoxinA, a botulinum toxin type A, are recommended in current clinical guidelines as a treatment option for adults with upper limb spastic paresis. However, the magnitude of the maximal therapeutic effect of repeated abobotulinumtoxinA treatment across different efficacy parameters and the number of injection cycles required to reach maximal effect remain to be elucidated. Here, we present a post hoc exploratory analysis of a randomized, double-blind, placebo-controlled trial (12-24 weeks; NCT01313299) and open-label extension study (up to 12 months; NCT0131331), in patients aged 18-80 years with hemiparesis for ≥6 months after stroke/traumatic brain injury. Two inferential methods were used to assess the changes in efficacy parameters after repeat abobotulinumtoxinA treatment cycles: Mixed Model Repeated Measures analysis and Non-Linear Random Coefficients analysis. Using the latter model, the expected maximal effect size (not placebo-controlled) and the number of treatment cycles to reach 90% of this maximal effect were estimated. Treatment responses in terms of passive and perceived parameters (i.e. modified Ashworth scale in primary target muscle group, disability assessment scale for principal target for treatment or limb position, and angle of catch at fast speed) were estimated to reach near-maximal effect in two to three cycles. Near-maximal treatment effect for active parameters (i.e. active range of motion against the resistance of extrinsic finger flexors and active function, assessed by the Modified Frenchay Scale) was estimated to be reached one to two cycles later. In contrast to most parameters, active function showed greater improvements at Week 12 (estimated maximal change from baseline-modified Frenchay Scale overall score: +0.8 (95% confidence interval, 0.6; 1.0) than at Week 4 (+0.6 [95% confidence interval, 0.4; 0.8]). Overall, the analyses suggest that repeated treatment cycles with abobotulinumtoxinA in patients chronically affected with upper limb spastic paresis allow them to relearn how to use the affected arm with now looser antagonists. Future studies should assess active parameters as primary outcome measures over repeated treatment cycles, and assess efficacy at the 12-week time-point of each cycle, as the benefits of abobotulinumtoxinA may be underestimated in the studies of insufficient duration. Abbreviated summary In this post hoc analysis of repeated abobotulinumtoxinA injection cycles in upper limb spastic paresis, Gracies et al. used statistical modelling to elucidate the maximal therapeutic effect of abobotulinumtoxinA. Notably, the number of injections required to reach this maximal effect was higher for active (e.g. active function) compared with passive (e.g. tone) parameters.

Role of diversity in assembling of rehabilitation teams in Central Europe.

BACKGROUND: Multiprofessional teamwork in physical and rehabilitation medicine (PRM) allows achieving patient-centered goals in accordance with the assumptions of the bio-psycho-social model of functioning. Team composition and methods of collaboration depend of the specificity of goals to be achieved, as well local contextual factors. International comparative studies on rehabilitation teamwork are lacking, despite data on how teams differ between countries are crucial for the process of harmonization of PRM practice across Europe. AIM: To compare models of collaboration within rehabilitation teams in Central Europe. DESIGN: A cross-sectional explorative study. SETTING: The data were collected in Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Slovakia between February and June 2018. POPULATION: PRM physicians. METHODS: An anonymous questionnaire inquiring of rehabilitation teamwork details was spread through national PRM societies, and other organizations associating PRM physicians. An ordered logit regression was applied to analyze the results. RESULTS: Responses were obtained from 455 respondents. Significant differences between the studied countries in the composition of rehabilitation teams and frequencies of team meetings were detected. In the analyzed population of PRM physicians, we found positive associations between the chance of participation in team meetings and working in a hospital, the amount of time devoted to PRM practice, and older age. The chance for patients and caregivers to participate in rehabilitation team meetings was correlated with PRM physician's hospital practice, activity as a PRM teacher, older age and devoting more time to PRM practice. Country specificities of rehabilitation team content were analyzed with regards to local economic, legal, and historical backgrounds, and availability of human resources. Underrepresentation of key professionals (e.g. occupational therapists, orthotists/prosthetists), inadequate distribution of professionals in healthcare and as well as outdated educational systems in some countries may affect the efficacy of the comprehensive care in rehabilitation. CONCLUSIONS: Central European countries differ in rehabilitation teamwork with regard to the contribution of professionals, meeting frequencies, and participation of patients and caregivers. Well-designed studies on teamwork models delineating ways to improve teamwork efficacy are in demand. CLINICAL REHABILITATION IMPACT: Between-country diversity of rehabilitation team content should be considered while planning activities aimed at European harmonization of PRM practice.

[Malnutrition risk screening in inpatient rehabilitation]. / Alultápláltságkockázat-szurés a rehabilitációs fekvobeteg-ellátásban.

Introduction: There are no satisfying data about the difficulties of nutritional therapy during rehabilitation, but malnutrition and secondary sarcopenia increase the number of complications. Aim: The aim of this cross-sectional study was measuring of patients' malnutrition risk in the National Institute for Medical Rehabilitation of Hungary. Method: Malnutrition Universal Screening Tool was used in this study. Results: 44% of the patients had a risk of malnutrition (n = 331; average age: 59 years), 19% of the patients presented moderate risk and 25% had high risk of malnutrition. The sample consisted of 176 males and 155 females (53%/47%). The interquartile range of body mass index of patients was between 22-29.9 kg/m2 (s = 6.36). Comparison of units showed that the Brain Injury Rehabilitation Unit has the most malnutrition-risked patients (62.5%, 25 patients). Conclusions: Malnutrition screening tools are not sensitive enough in the case of special patient groups of rehabilitation, therefore a combined screening method is needed. Orv Hetil. 2020; 161(1): 11-16.

[Rehabilitation possibilities and results after neurosurgical intervention of brain tumors]. / Az agydaganat mutéti kezelését követo rehabilitáció lehetosége, eredményei.

BACKGROUND AND PURPOSE: Authors examined the rehabilitation possi-bi-lities, necessities, and results of patients after operation with brain tumor, and report their experiences. METHODS: Retrospective, descriptive study at the Brain Injury Rehabilitation Unit, in National Institute for Medical Rehabilitation. Patients were admitted consecutively after rehabilitation consultation, from different hospitals, following surgical intervention of brain tumors, between 01 January 2001 and 31 December 2016. Patients participated in a postacute inpatient rehabilitation program, in multidisciplinary team-work, leaded by Physical and Rehabilitation Medicine specialist included the following activities: rehabilitation nursing, physical, occupational, speech, psychological and neuropsychological therapy. RESULTS: At the rehabilitation unit, in the sixteen-year period 84 patients were treated after operation with brain tumor. Patients arrived at the unit after an average of 41 days to the time of the surgical intervention (range: 10-139 days), and the mean length of rehabilitation stay was 49 days (range: 2-193 days). The mean age of patients was 58 years (20-91), who were 34 men and 50 women. The main symptoms were hemiparesis (64), cognitive problems (26), dysphagia (23), aphasia (16), ataxia (15), tetraparesis (5), and paraparesis (1). The mean Barthel Index at the time of admission was 35 points, whereas this value was 75 points at discharge. After the inpatient rehabilitation, 73 patients improved functionally, the status of 9 patients did not show clinically relevant changes, and 2 patients deteriorated. During the rehabilitation 10 patients required urgent interhospital transfer to brain surgery units, 9 patients continued their oncological treatment, two patients continued rehabilitation treatment at another rehabilitation unit, and after rehabilitation 73 patients were discharged to their homes. CONCLUSION: Inpatient rehabilitation treatment could be necessary after operation of patients with brain tumor especially when functional disorders (disability) are present. Consultation is obligatory among the neurosurgeon, rehabilitation physician and the patient to set realistic rehabilitation goals and determine place and method of rehabilitation treatment, but even at malignancies cooperation with oncological specialist also needed. Authors' experience shows benefits of multidisciplinary rehabilitation for patients after brain tumor surgery.

Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for Adults with Acquired Brain Injury. The European PRM position (UEMS PRM Section).

BACKGROUND: Acquired brain injury (ABI) is damage to the brain that occurs after birth caused either by a traumatic or by a nontraumatic injury. The rehabilitation process following ABI should be performed by a multi-professional team, working in an interdisciplinary way, with the aim of organizing a comprehensive and holistic approach to persons with every severity of ABI. This Evidence Based Position Paper represents the official position of the European Union through the UEMS Physical and Rehabilitation Medicine (PRM) Section and designates the professional role of PRM physicians for people with ABI. The aim was to formulate recommendations on the PRM physician's professional practice for persons with ABI in order to promote their functioning and enhance quality of life. METHODS: This paper has been developed according to the methodology defined by the Professional Practice Committee of the UEMS-PRM Section: a systematic literature search has been performed in PubMed and Core Clinical Journals. On the basis of the selected papers, recommendations have been made as a result of five Delphi rounds. RESULTS: The literature review as well as thirty-one recommendations are presented. CONCLUSIONS: The expert consensus is that structured, comprehensive and holistic rehabilitation program delivered by the multi-professional team, working in an interdisciplinary way, with the leadership and coordination of the PRM physician, is likely to be effective, especially for those with severe disability after brain injury.

Evaluation of a companion robot based on field tests with single older adults in their homes.

The growing number of older adults places insurmountable load on family members and professional caregivers. Assistive technology with the aid of robots can present a possible solution. The goal of this article was to test a companion robot supporting older adults in their home environments. Eight senior volunteers were involved in the field test. They all lived alone and were self-supporting. The robot was capable of providing cognitive assistance to manage the user's daily routine. Each participant used the robot for 94.9 ± 19.6 days. The primary communication modality was voice communication in their natural language, while the touch screen display was also available for interaction with the robot. The assistance given in daily living was evaluated by subjective (the user's opinion) and objective (logged data) criteria. The most useful and the least reliable robot functions according to the users were the navigation and the verbal communication. Entertainment, locomotion, and weather forecast were the most frequently used functions, while the shopping list was the least popular. The companion robot used in the test was accepted enthusiastically by the senior subjects. Specific robot functions (mainly navigation in the apartment and the speech recognition) require improvement to better accommodate real circumstances.

Case report of a woman with anti amphiphysin positive stiff person syndrome.

Stiff person syndrome is a rare neuroimmunological disease, characterized by severe, involuntary stiffness with superimposed painful muscle spasms, which are worsened by external stimuli. The classical form is associated with high levels of antibodies against glutamic acid decarboxylase. One of the variant forms is associated with antibodies against amphiphysin. This entity is a paraneoplastic syndrome, caused primarily by breast cancer, secondarily by lung cancer. Symptomatic therapy of anti amphiphysin positive stiff person syndrome includes treatment with benzodiazepines and baclofen (including intrathecal baclofen therapy). The effect of immunological therapies is controversial. Treatment of the underlying cancer may be very effective. In this report, we describe a 68 year old female presenting with an unusally rapidly developing anti amphiphysin positive stiff person syndrome, which was associated with breast cancer. Her painful spasms abolished after intrathecal baclofen treatment was initiated. Her condition improved spontaneously and significantly after cancer treatment, which enabled to start her complex rehabilitation and the simultaneous dose reduction of the intrathecal baclofen. The bedridden patient improved to using a rollator walker and the baclofen pump could be removed 18 monthes after breast surgery. This highlights the importance of cancer screening and treatment in anti amphiphysin positive stiff person syndrome cases.

What medical doctors and medical students know about physical medicine and rehabilitation: a survey from Central Europe.

BACKGROUND: Physical and rehabilitation medicine (PRM) is a relatively new and dynamically developing branch of the contemporary medicine. The unique role of PRM is bridging pure clinical outcomes with overall functional improvement. The concepts of disability and rehabilitation may be difficult to comprehend by medical students (MS) and Non-PRM specialists (NPRMS). AIM: The aim of this study was to assess the level of knowledge of NPRMS and MS regarding the role of PRM in health care systems in Poland, Hungary and Croatia. DESIGN: Cross-sectional observational study. SETTING: Anonymous questionnaire distributed in Hungarian, Polish and Croatian universities. RESULTS: Knowledge of definitions of a person with disability and PRM was poor (MS: 58% and 35%, NPRMS: 39% and 30%, PRMT: 72% and 62%). Prevalence of disability was correctly estimated by 58% of MS and 62% of doctors. 76% of MS, 72% of NPRMS and 99% of PRMT perceived PRM as a basic medical specialty. Leading role of PRM physician in comprehensive management of patients with stroke, multiple injury, spinal cord injury and congenital limb defect was perceived respectively by 42%, 49%, 53% and 64% of respondents. Functional statement as an important criterion in referring a patient for rehabilitation was perceived by 48% of NPRMS. Inadequate perception of the PRM role in health care system results from the lack of unified programme and scope of PRM in under- and postgraduate medical education, inappropriate allocation of funds in public PRM services, and claims of certain paramedical professions to extend their qualifications over interventions assigned to PRM doctors. CONCLUSIONS: Low knowledge of PRM among all studied groups testifies to the inadequacy of education of the medical community in rehabilitation. CLINICAL REHABILITATION IMPACT: The existing system of under- and postgraduate education of PRM should be urgently rearranged according to European harmonized guidelines.

[Knowledge of physical and rehabilitation medicine among physicians and medical students in Poland]. / Wiedza lekarzy i studentów wydzialów lekarskich w Polsce na temat rehabilitacji medycznej.

INTRODUCTION: Physical and Rehabilitation Medicine (PRM) since 1959 has been a basic medical specialty in Poland. Recently PRM is practiced by around 1,12% of professionally active physicians in Poland. Due to specificity and unfavorable health care regulations PRM may be inadequately perceived by the medical profession in Poland. THE AIM: Evaluation of basic knowledge of PRM in PRM trainees, non-PRM specialists and medical students in Poland. MATERIAL AND METHODS: 500 respondents (225 non-PRM specialists--NPRMS, 61 PRM trainees--PRMT and 214 medical students who accomplished undergraduate education in PRM--MS) underwent testing with an anonymous questionnaire elaborated at Semmelweis University, Budapest, Hungary and modified at Medical University of Warsaw, Poland. SELECTED RESULTS: 404 (80,8%) respondents (88.3% MS; 68.9% NPRMS and 98.3% PRMT) perceived PRM as a basic medical specialty. 49.1% of MS, 47.1% of NPRMS and 73.4% of PRMT noticed the leading role of a PRM physician in comprehensive rehabilitation of persons with exemplary disabilities. 408 (81.6%) participants (77.6% MS, 82.2% NPRMS and 93.4% PRMT) knew who was eligible to refer a patient to PRM physician. Rate of disabled persons in Poland was properly reported by 330 (66%) participants (63.1% MS; 69.3% NPRMS and 63.9% PRMT). Correct definition of disability was given by 256 (51.2%) respondents (65%) MS, 33.8% NPRMS and 67.2% PRMT), whereas 200 (40%) participants (43.5% MS; 31.1% NPRMS and 60.7% PRMT were familiar with the definition of PRM. CONCLUSIONS: Poor knowledge of PRM role in health care system among MS and NPRMS and Low awareness of cardinal PRM issues among PRMT reflects inadequate undergraduate and postgraduate education in PRM, disadvantageous healthcare system solutions and misleading information in mass media in Poland. Education on PRM role in a contemporary healthcare should be urgently improved.

[Bronchoscopy-guided decannulation of tracheostomy in patients with brain injury]. / Agysérült betegek tracheostomájának dekanülálása bronchoszkópos ellenorzés mellett.

INTRODUCTION: Progress in intensive care management of patients with severe brain injury due to trauma or vascular lesion significantly improved the mortality and increased the number of patients with tracheostomy who undergo treatment in rehabilitation departments. AIM: The aim of the authors was to describe the safe tracheostomy decannulation method of patients with brain injury during rehabilitation. METHOD: A prospective, descriptive study performed at the rehabilitation departments of the National Institute for Medical Rehabilitation in Budapest, Hungary. RESULTS: From January 1 until December 31, 2013, thirty examinations with flexible bronchoscope for tracheostomy decannulation were performed in 20 patients. The patients were admitted to the rehabilitation wards with various brain injuries: 6 patients suffered from trauma, 5 had ischemic stroke, 3 patients had brain stem haemorrhage, 2 patients cerebellar and one patient bifrontal haemorrhage. One patient had menangioma, and one had multiple organ failure and anoxic brain injury caused by pneumonia. The average age of patients was 44 years (range, 18-80 years). During the procedure successful decannulation was performed in 13 patients. Decannulation occurred 62 days after tracheostomy on average. CONCLUSIONS: Safe patient care requires that various medical departments keep pace with the development of different specialities. To ensure early rehabilitation of patients with severe brain injury having tracheostomy, safe treatment and, if possible, decannulation should be performed. This procedure requires the involvement of a physician with bronchoscopy skills as well as the development of local protocols.

[Neurorehabilitation, neurology, rehabilitation medicine]. / Neurorehabilitáció, neurológia, rehabilitácios medicina.

We have read several publications of great authority on the neurological profession in the last two years in which were expressed assessments of the current situation combined with opinions about neurology and the necessity to reorganize neurological patient care. These articles took up the question of neurorehabilitation too. The authors, who on a daily basis, deal with the rehabilitation of people with disabilities as a consequence of neurological conditions, summarize some important definitions of rehabilitation medicine and the present system of neurological rehabilitation, as it is defined by the rehabilitation profession.

[Results of intrathecal baclofen therapy on spasticity in patients with brain injury]. / Az intrathecalis baclofenkezelés tapasztalatai agykárosodást szenvedett, spasticus felnott betegek esetében.

OBJECTIVES: To evaluate the results of intrathecal baclofen (ITB) therapy on the spasticity in patients with brain injury. METHOD: Retrospective study in Brain Injury Rehabilitation Unit between January 2001 and December 2010. RESULTS: During the last ten years, in our unit 13 patients were involved into ITB therapy on severe spasticity, after brain injury, while more than 100 Baclofen pumps were implantated in Hungary with coordination of the Multidisciplinary Team. ITB therapy was indicated in severe spasticity that developed in seven cases of traumatic brain injuries, five cases of strokes and one case of anoxic brain injury. The mean age of patients was 26 years (18-52). At the time of pump implantation three patients were in vegetative state. The shortest period elapsed between the brain injury and pump implantation was three months and the longest period was nine years, mean 15 months. Baclofen pump had to be changed in six cases after six years, and was removed in three cases due to decreasing spasticity. Catheter revision was performed in two cases due to flow problem. We had no complication in association with ITB therapy. CONCLUSIONS: Intrathecal baclofen therapy seems to be an effective and safe treatment in patients with severe spasticity of cerebral origin. We suggest team (neurosurgeon and rehabilitation professionals) decision in a spasticity center before involving the patient into ITB therapy, and follow up in the rehabilitation unit. The severity of spasticity as a consequence of brain injury can change during years and it is necessery to follow it with dosage and dynamics of baclofen therapy. Baclofen pump removal is suggested if the ITB therapy is further not reasonable.

[Physicians' and medical students' knowledge on rehabilitation]. / Rehabilitációs ismeretek kórházi orvosok és szigorlók körében.

UNLABELLED: There are few data on the rehabilitation knowledge of medical specialists and medical students. AIM: Assessment of the rehabilitation knowledge of medical specialists working in general hospitals and of final year medical students. METHODS: A paper form survey was performed using a questionnaire containing seven multiple choice questions and three definitions. Questionnaires were filled in independently on the spot. The three answering groups were physicians (specialized in orthopedic surgery, neurology or neurosurgery) working in a general hospital that had a rehabilitation ward, final year medical students from Semmelweis University, and trainees in rehabilitation medicine. The survey was voluntary and anonymous. RESULTS: Forty physicians, 42 students and 39 rehabilitation trainees filled in the questionnaire. Half of the students gave correct answers to questions about rehabilitation specialization, the existing university chairs, the percentage of people with disabilities in Hungary, and the way of sending patients for rehabilitation consultation. The number of beds designed for rehabilitation was unknown, but with regard to the existence of regulation by law the rights of people with disabilities were well-known by all groups. Very few were able to define the basic categories (rehabilitation, disability). Rehabilitation knowledge of physicians was not better than that of students, but rehabilitation trainees were better informed. CONCLUSIONS: According to findings of the authors, students and physicians do not have enough rehabilitation knowledge to perform medical activities adequately. Enlargement of the medical curriculum with basic rehabilitation knowledge is essential. A rehabilitation training course is necessary for physicians to be better equipped to carry out their daily hospital work.

[The role of pharmacotherapy audit in the improvement of drug therapy during inpatient rehabilitation care. Experience at the National Institute of Medical Rehabilitation, Hungary]. / Gyógyszerauditok szerepe a gyógyszeres terápia javításában a kórházi rehabilitációs ellátásban. Tapasztalatok az Országos Orvosi Rehabilitációs Intézetben.

UNLABELLED: Pharmacotherapy is one of the most important and dangerous area in hospital health care, that explains why innumerable efforts are made worldwide to improve this process and prevent mistakes. Although clinical audit is a well known and widely used method, it is very rarely used for this purpose and scientific papers dealing with this topic can be scarcely found. In the last 20 years different quality management systems were introduced into the Hungarian hospitals, but most of them are not specific for the medical care. The most important element of quality management systems is the internal, professional audit that serves patient safety. AIMS AND METHODS: Authors report their experience on pharmacotherapy audits performed for over a decade at the National Institute of Medical Rehabilitation, Hungary. They review the method of audit meetings in details and discuss the most frequent problems. RESULTS: The results indicate that characteristics of therapeutic mistakes in the rehabilitation practice are similar to those reported in scientific literature. CONCLUSIONS: Improving knowledge on pharmacotherapy audits of rehabilitation specialists may be an important part of continuous professional advancement providing facility for dispute on other issues of patient care.