The Prevalence of Neck and Back Pain among Paramedics in Poland.

Neck Pain (NP) and low back pain (LBP) are ubiquitous musculoskeletal conditions and some of the major causes of disability worldwide. The aim of the study was to assess the incidence and risk factors of back pain among paramedics and their correlation with the nature of work, anthropometric features and the level of recreational physical activity. A group of 201 individuals (39 females (19.40%); 162 males (80.60%)), licensed to practice as paramedics in Poland completed a questionnaire containing the author's interview as well as the Neck Disability Index (NDI) questionnaire and the Revised Oswestry Disability Index (ODI). Among the examined paramedics, 92% of the subjects reported the presence of back pain in different parts of the spine (36% C; 17% Th; and 85% LBP). The pain intensity, determined by VAS, was on average 4.26 (SD 1.77). The level of disability, assessed by NDI, was 7.67 (SD 5.73) on average, while the ODI was 7.51 (5.90). Work-related spinal strain has a major impact on the intensity and incidence of spinal pain. Spinal pain in paramedics mainly occurs in the lower back.

The extent of damage to the blood-brain barrier in the hypercholesterolemic LDLR-/-/Apo E-/- double knockout mice depends on the animal's age, duration of pathology and brain area.

One of the effects of hypercholesterolemia (Hch) exerted on the central nervous system (CNS) is damage to the blood-brain barrier (BBB). Increased permeability of BBB results from structural changes in the vascular wall, loss of the tight junctions and barrier function, as well as alterations in the concentration of proteins located in the layers of the vascular wall. These changes occur in the course of metabolic and neurodegenerative diseases. The important role in the course of these processes is attributed to agrin, matrix metalloproteinase-9, and aquaporin-4. In this study, we aimed to determine: 1) the extent of Hch-induced damage to the BBB during maturation, and 2) the distribution of the above-mentioned markers in the vascular wall. Immunohistochemical staining and confocal microscopy were used for vascular wall protein assessment. The size of BBB damage was studied based on perivascular leakage of fluorescently labeled dextran. Three- and twelve-month-old male LDLR-/-/Apo E-/- double knockout mice (EX) developing Hch were used in the study. Age-matched male wild-type (WT) C57BL/6 mice were used as a control group. Differences in the concentration of studied markers coexisted with BBB disintegration, especially in younger mice. A relationship between the maturation of the vascular system and reduction of the BBB damage was also observed. We conclude that the extent of BBB permeability depends on animal age, duration of Hch, and brain region. These may explain different susceptibility of various brain areas to Hch, and different presentation of this pathology depending on age and its duration.

Suicidal intoxication with mercury chloride.

PURPOSE: Poisoning with elemental metals and metallic compounds was much more frequent in the past, and was related, among other things, to lifestyle and the lack of appropriate toxicological diagnostics. One example is mercury, which is being gradually eliminated but still has many different applications as a pure metal or in the form of various compounds. The paper presents a case of suicidal poisoning with mercury chloride (corrosive sublimate). METHODS: Forensic and toxicological tests including inductively coupled plasma mass spectrometry (ICP-MS) were at the Department of Forensic Medicine, PMU in Szczecin. RESULTS: The patient before death had a range of symptoms such as epigastric pain, vomiting of the stomach contents, central cyanosis with tachycardia, tremors, severe shortness of breath with wheezing, difficulty swallowing, slurred speech, rales in the lungs, and diarrhea. The concentration of mercury measured by ICP-MS was 191 mg/L for a blood sample collected antemortem, and 147 mg/L for a blood sample collected at autopsy. Both concentrations of mercury are regarded as lethal. The post-mortem examination revealed signs of extensive thrombotic necrosis in some internal organs. CONCLUSIONS: Mercuric chloride has an estimated human fatal dose of between 1 and 4 g. It can produce a range of toxic effects, including corrosive injury, severe gastrointestinal disturbances, acute renal failure, circulatory collapse, and eventual death. The presented case of fatal poisoning with mercury chloride, due to the type of agent used, is now interesting in toxicological practice.

Influence of Risk Factors on Exercise Tolerance in Patients after Myocardial Infarction-Early Cardiac Rehabilitation in Poland.

(1) Background: Prognosis in patients with cardiovascular diseases is significantly influenced by lifestyle and the control of risk factors. Patients after myocardial infarction require special care and promptly introduced cardiac rehabilitation. The primary aim of this study was to identify risk factors and their influence on exercise tolerance before and after cardiac rehabilitation (CR) provided under the Coordinated Specialist Care Programme-Infarct (CSC-Infarct). (2) Methods: The study was carried out at the Cardiac Rehabilitation Centre of Slupsk Specialist Hospital on a group of 112 patients aged 35-87 (62.78 ± 10.09 years) after myocardial infarction (MI), participating in CSC-Infarct. An exercise test (treadmill ECG test), the 6 min walk test (6MWT), echocardiography, blood test (total cholesterol, HDL, LDL, TG), measurement of diastolic pressure ratio (DPr), waist-to-hip ratio (WHR), and BMI were performed in participants on the first and last day of CR. Rating of perceived exertion was assessed with Borg's scale. (3) Results: The overweight variable had the strongest effect on the increased value of initial: HR rest, HR max, and HR 1 min after exercise compared to subjects with normal BMI. DPr values before and after CR were also higher in overweight patients. Scores of 6MWT were higher in smokers compared to non-smokers. The final MET value was significantly higher in non-diabetic subjects. Hyperlipidaemia was associated with a higher initial HR max and initial HR 1 min after exercise. DPr before CR was also higher. The initial and final MET values were lower in hypertensive patients. Borg's rating of perceived exertion measured after the final exercise test was also higher in hypertensive patients. Hypertension influenced the initial and final 6MWT scores, which were significantly higher in normotensive patients. (4) Conclusions: CR within CSC-infarction in patients after myocardial infarction improves exercise tolerance. Exercise tolerance in post-MI patients with concomitant risk factors is lower compared to post-MI patients without risk factors.

Influence of Occupation on the Prevalence of Spinal Pain among Physiotherapists and Nurses.

(1) Background: Neck pain (NP) and low back pain (LBP) are common musculoskeletal disorders, one of the major causes of disability globally. The aim of the study was to determine the influence of medical occupation (physiotherapist and nurse) on the prevalence of spinal pain, functional status and degree of disability. (2) Methods: a total of 544 people (462 females (84.9%) and 82 males (15.1%)), licensed to practice as a physiotherapist (n1 = 240 (44.1%)) or nurse (n2 = 304 (55.9%)) in Poland completed a special questionnaire designed by the authors of the study, and were assessed using the Neck Disability Index (NDI, Polish language version) and Revised Oswestry Disability Index (ODI, Polish language version). (3) Results: Compared to physiotherapists, nurses were older, shorter, had higher BMI, and longer work experience. In the whole study group, 30.2% of subjects reported NP, 17.7% reported thoracic pain (ThP) and 80.5% reported LBP. During working life, 90.9% of physiotherapists and 97.7% of nurses experienced spinal pain. Pain intensity measured with Visual Analogue Scale (VAS) was higher among nurses (mean 5.37) than among physiotherapists (mean 4.64). Nurses had a higher degree of disability caused by LBP and NP measured with ODI and NDI compared to physiotherapists. (4) Conclusions: Excessive strain of the spine associated with occupational activities has a strong impact on the intensity and frequency of spinal pain episodes. Physiotherapists and nurses mainly suffer from low back pain. Pain scores measured with VAS are higher in nurses than in physiotherapists.

Control of Brushless Direct-Current Motors Using Bioelectric EMG Signals.

(1) Background: The purpose of this study was to evaluate the analysis of measurements of bioelectric signals obtained from electromyographic sensors. A system that controls the speed and direction of rotation of a brushless DC motor (BLDC) was developed; (2) Methods: The system was designed and constructed for the acquisition and processing of differential muscle signals. Basic information for the development of the EMG signal processing system was also provided. A controller system implementing the algorithm necessary to control the speed and direction of rotation of the drive rotor was proposed; (3) Results: Using two muscle groups (biceps brachii and triceps), it was possible to control the direction and speed of rotation of the drive unit. The control system changed the rotational speed of the brushless motor with a delay of about 0.5 s in relation to the registered EMG signal amplitude change; (4) Conclusions: The prepared system meets all the design assumptions. In addition, it is scalable and allows users to adjust the signal level. Our designed system can be implemented for rehabilitation, and in exoskeletons or prostheses.

Influence of Pregnancy on the Occurrence of Lumbar Spine Pain in Polish Women: A Retrospective Study.

(1) Background: Low Back Pain is a major health concern. Pregnancy-related lower back pain is a common complaint among women. The aim of this study was to determine the influence of pregnancy history on the occurrence and profile of pain in the lower spine. (2) Methods: The diagnosis of Lower Back Pain during pregnancy was based on the authors' questionnaire, Visual Analogue Scale (VAS), Oswestry Disability Index and Roland Morris Disability Questionnaire. The research group consisted of 1112 women who were students or came for various reasons to the Gynecology and Obstetrics Clinical Hospital of Poznan University of Medical Sciences and completed the questionnaires. Patients were divided into two groups. The first group consisted of women who had never been pregnant (never-pregnant, n = 872 (78.4%), and the second group consisted of women who had been pregnant at least once in their lives (ever-pregnant, n = 240 (21.6%)). (3) Results: In the never-pregnant and the ever-pregnant women, respectively, the intensity of pain was 4.6 ± 1.6 and 5.0 ± 2.0 on the VAS scale, the degree of disability on the Oswestry Disability Index Questionnaire was 5.0 ± 3.9 and 5.5 ± 4.4, while the impact of pain on functioning on the Roland Morris Disability Questionnaire was 3.9 ± 3.1 and 3.9 ± 3.3. There were no significant differences (Mann-Whitney U test) between the studied groups in the parameters tested. (4) Conclusions: Pregnancy is a risk factor for back pain during pregnancy, but one year or more after pregnancy the occurrence of back pain is similar to that in women who have never been pregnant.

A kinematic model of a humanoid lower limb exoskeleton with pneumatic actuators.

PURPOSE: Although it is well-established that exoskeletons as robots attached to the human body's extremities increase their strength, limited studies presented a computer and mathematical model of a human leg pneumatic exoskeleton based on anthropometric data. METHODS: By using Inertial Measurement Units a lower limb joint angles (hip, knee and ankle in sagittal plane) during walking and running were calculated. The geometric model of a human leg pneumatic exoskeleton was presented. Joint angle data acquired during experiments were used in the mathematical model. RESULTS: The position and velocity of exoskeleton actuators in each phase of the movement were calculated using the MATLAB package (Matlab_R2017b, The MathWorks Company, Novi, MI, USA). CONCLUSIONS: The obtained results demonstrate the efficiency of the proposed approach that can be utilized to analyze the kinematics of pneumatic exoskeletons using the dedicated design process. The developed mathematical model makes it possible to determine the position of lower limb segments and exoskeleton elements. The proposed model allows for calculating the position of the human leg and actuators' characteristic points.

Prevalence and risk of spinal pain among physiotherapists in Poland.

BACKGROUND: The purpose of this study was to determine the prevalence, symptoms of, and risk factors for spinal pain in physiotherapists, as well as to analyse the correlation between these factors and the nature of the work, anthropometric features of the respondents, and the level of their physical activity. METHODS: The study was conducted among 240 physiotherapists (71 male and 169 female) with a mean age of 38.7 years. They were divided into three groups: physical therapy (37), kinesitherapy (158) and massage (45). Physiotherapists were evaluated with a specially designed questionnaire, the postural discomfort chart, the Neck Disability Index (NDI) questionnaire, and the Oswestry Disability Index (ODI) questionnaire. RESULTS: The analysis showed a 91.7% incidence of spinal pain in physiotherapists (91.1% for kinesitherapy, 97.3% for physical therapy, and 88.9% for massage). The study revealed that 50.2% of physiotherapists indicated one to five pain episodes in their careers. Most respondents reported pain in the lumbosacral spine (82%) and the cervical spine (67%). Most respondents (58.5%) scored the pain as moderate (VAS scale). Carrying (62.6%) and torso bending (37.4%) were indicated as the causes of pain. CONCLUSIONS: Physiotherapists demonstrate a high prevalence of spinal pain. Physical activity reduces the frequency of pain episodes.

Cardiac Rehabilitation and Physical Performance in Patients after Myocardial Infarction: Preliminary Research.

(1) Background: Cardiovascular diseases, in particular, myocardial infarction (MI), are the main threats to human health in modern times. Cardiac rehabilitation (CR), and especially increased physical activity, significantly prevent the consequences of MI. The aim of this study was to assess physical performance in patients after MI before and after CR. (2) Methods: 126 patients after MI were examined. They were admitted to the cardiac rehabilitation ward twice: in the 3rd month after MI, and then in the 6th month after the last rehabilitation session. CR lasted 20 treatment days (4 weeks with 5 treatment days and 2 days' break). The exercise stress test on the treadmill and a 6-minute walk test (6MWT) were used to assess physical performance. Patients were assigned to an appropriate rehabilitation model due to their health condition. (3) Results: In the studied group, the exercise stress test time and the metabolic equivalent of task (MET), the maximal oxygen consumption (VO2max), and 6MWT score increased significantly (p = 0.0001) at two time-points of observation. (4) Conclusion: CR significantly improves physical performance in patients after MI.

Dynamic Model of a Humanoid Exoskeleton of a Lower Limb with Hydraulic Actuators.

Exoskeletons are the mechanical systems whose operation is carried out in close cooperation with the human body. In this paper, the authors describe a mathematical model of the hydraulic exoskeleton of a lower limb. The coordinates of characteristic points of the exoskeleton in the sagittal plane as a function of user height are presented. The mathematical models, kinematics, and kinetics equations were determined. The masses of the actuators and their dimensions were selected based on catalog data. The force distribution in the wearable system during the squat is shown. The proposed models allowed us to determine the trajectory of individual points of the exoskeleton and to determine the forces in hydraulic cylinders that are necessary to perform a specific displacement. The simulation results show that the joint moments depend linearly on actuator forces. The dynamics equations of the wearable system are non-linear. The inertia of the system depends on the junction variables and it proves that there are dynamic couplings between the individual axes of the exoskeleton.

A Kinematic Model of a Humanoid Lower Limb Exoskeleton with Hydraulic Actuators.

Although it is well-established that exoskeletons as robots attached to the extremities of the human body increase their strength, limited studies presented a computer and mathematical model of a human leg hydraulic exoskeleton based on anthropometric data. This study aimed to examine lower limb joint angles during walking and running by using Inertial Measurement Units. The geometry and kinematic parameters were calculated. Twenty-six healthy adults participated in walking and running experiments. The geometric model of a human leg hydraulic exoskeleton was presented. Joint angle data acquired during experiments were used in the mathematical model. The position and velocity of exoskeleton actuators in each phase of movement were calculated using the MATLAB package (Matlab_R2017b, The MathWorks Company, Novi, MI, USA). The highest velocity of the knee actuator during walking and running was in the swing phase, 0.3 and 0.4 m/s, respectively. For the ankle and hip joints, the highest velocity of actuators occurred during the push-off phase. The results with 26 healthy subjects demonstrated that the system's compliance can be effectively adjusted while guiding the subjects walking in predefined trajectories. The developed mathematical model makes it possible to determine the position of lower limb segments and exoskeleton elements. The proposed model allows for calculating the position of the human leg and actuators' characteristic points.

Risk Factors Associated with Low Back Pain among A Group of 1510 Pregnant Women.

BACKGROUND: Low Back Pain (LBP) is a frequent, very common, and costly health problem. LBP, which occurs during pregnancy, may become a lifelong problem. The aim of this study was to determine the risk factors associated with LBP in pregnant women. METHODS: The study included 1510 pregnant women. A questionnaire assessing demography, lifestyle, prevalence, and characteristics was designed and used in the study. Pain intensity was assessed with the VAS (Visual Analogue Scale). The RMDQ (Roland Morris Disability Questionnaire) was used to assess the effect that low back pain had on the functional capacity of a pregnant woman. Middle (thoracic) and low back pain disability was measured with the help of the ODI (Oswestry Disability Index) questionnaire. RESULTS: The study confirmed that lying/sleeping (49.6%) and sitting positions (38.7%) as well as walking (37.2%) are the most significant factors causing LBP. It was also found that women who had not engaged in physical activity were more likely to experience LBP. CONCLUSIONS: Predisposing factors for LBP in pregnancy are LBP in previous pregnancies, back pain during menstruation, a younger age and a lack of physical activity. Most women in pregnancy with LBP experienced minimal and mild disability.

SPIDER as A Rehabilitation Tool for Patients with Neurological Disabilities: The Preliminary Research.

(1) Background and purpose: SPIDER (Strengthening Program for Intensive Developmental Exercises and activities for Reaching health capability) is dedicated for patients suffering from Cerebral Palsy, Sclerosis Multiplex, Spinal Bifida, Spinal Muscular Atrophy and strokes. Authors proposed a computer model for the evaluation patient's condition and the rehabilitation progress. (2) Methods: The 2-year-old and 76-year-old patients with neurological problems, who underwent individual therapy included balancing and coordination practising with SPIDER device. The model comparing the forces, which act during the therapy process, such as the expander and gravity forces, was worked out using Matlab software. (3) Results: The model allowed controlling the changes into the patients centre of gravity forces continuous adjustment and postural stability during any patient's movement. After rehabilitation sessions, lasted for 28 days during which patients received the progress information and the therapist got the numeric data, regarding the period of the therapy. (4) Conclusions: The first patient was able to move, dramatically improved the ability to balance and coordination. The second one presented change in gait, improvement in mobility, motor function and decreased fall risk. The proposed computer model gives information about the forces acting to the patient body. The physiotherapist can evaluate the progress of patient verticalization and receive information, in the form of numbers and charts.

Inertial Sensors as a Tool for Diagnosing Discopathy Lumbosacral Pathologic Gait: A Preliminary Research.

BACKGROUND: the goal of the study is to ascertain the influence of discopathy in the lumbosacral (L-S) segment on the gait parameters. The inertial sensors are used to determine the pathologic parameters of gait. METHODS: the study involved four patients (44, 46, 42, and 38 years). First, the goal of the survey was to analyze by a noninvasive medical test magnetic resonance imaging (MRI) of each patient. Next, by using inertial sensors, the flexion-extension of joint angles of the left and right knees were calculated. The statistical analysis was performed. The wavelet transform was applied to analyze periodic information in the acceleration data. RESULTS: in the patients with discopathy, the amount of knee flexion attained during stance phase is significantly lower than that of normal (health side), which could indicate poor eccentric control or a pain avoidance mechanism. The biggest differences are observed in the Initial Swing phase. Bending of the lower limb in the knee joint at this stage reaches maximum values during the entire gait cycle. CONCLUSIONS: It has been difficult to quantify the knee angle during gait by visual inspection. The inertial measurement unit (IMU) system can be useful in determining the level of spine damage and its degree. In patients in the first stages of the intervertebral disc disease who may undergo conservative treatment, it may also partially delay or completely exclude the decision to perform a complicated imaging examination which is MRI, often showing a false positive result in this phase of the disease.

An exoskeleton arm optimal configuration determination using inverse kinematics and genetic algorithm.

PURPOSE: This paper deals with the kinematic modelling of an arm exoskeleton used for human rehabilitation. The biomechanics of the arm was studied and the 9 Degrees of Freedom model was obtained. The particular (optimal) exoskeleton arm configuration is needed, depending on patient abilities and possibility or other users activity. METHODS: The model of upper arm was obtained by using Denavit-Hartenberg notation. The exoskeleton human arm was modelled in MathWorks package. The multicriteria optimization procedure was formulated to plan the motion of trajectory. In order to find the problem solution, an artificial intelligence method was used. RESULTS: The optimal solutions were found applying a genetic algorithm. Two variants of motion with and the visualization of the change of joints angles were shown. By the use of genetic algorithms, movement trajectory with the Pareto-optimum solutions has been presented as well. Creating a utopia point, it was possible to select only one solution from Pareto-optimum results. CONCLUSIONS: The obtained results demonstrate the efficiency of the proposed approach that can be utilized to analyse the kinematics and dynamics of exoskeletons using the dedicated design process. Genetic algorithm solution could be implemented to command actuators, especially in the case of multi-criteria problems. Moreover, the effectiveness of this method should be evaluated in the future by real experiments.