EEG study of visual reactivity in aphasic patients.

AIM: To compare patients with good and poor recovery after 1 and 3 months from onset of poststroke aphasia and to correlate the quality of recovery with quantitative EEG (QEEG) measures (frequency analysis with the limits of variability, and index of asymmetry). METHODS: The investigation was performed on the sample of 32 patients with poststroke aphasia, 15 females (46.88%) and 17 males (53.12%), mean age +/- standard deviation (SD) being 50.65 +/- 9.93 years. QEEG measures of this sample were compared with those in a group of 86 healthy controls, 39 (45.35%) females and 47 (54.65%) males, mean age +/- SD being 51.08 +/- 10.08 years. Frequency analysis was performed in eyes closed and eyes open conditions in both controls and in aphasics who were tested just before and two month after rehabilitative treatment with speech therapy. RESULTS: We have got normal distribution for all derivations and all frequency bands in the group of healthy subjects. On the basis of this finding, we determined coefficients of variation in patients with poststroke aphasia and discovered that their maximal variability scores were significantly decreased. Compared to healthy subjects, the index of asymmetry between two hemispheres and between main brain regions was significantly higher in the aphasic patients than in controls. However, the differences in the index of asymmetry and limits of variability significantly decreased after two month treatment in the subgroup of patients with good improvement compared with the subgroup of patients with poor improvement of poststroke aphasia. CONCLUSION: QEEG measures may have predicitive value in post-stroke aphasia.

Mobilization with movement and kinesiotaping compared with a supervised exercise program for painful shoulder: results of a clinical trial.

OBJECTIVE: The purpose of this study was to compare the efficacy of Mobilization with Movement (MWM) and kinesiotaping (KT) techniques with a supervised exercise program in participants with patients with shoulder pain. METHODS: Twenty subjects with shoulder pain were included if subjects were diagnosed by the referring physician with either rotator cuff lesion with impingement syndrome or impingement shoulder syndrome. Participants were randomly assigned to 1 of 2 groups after clinical and radiologic assessment: group 1 was treated with MWM and KT techniques, whereas group 2 was treated with a supervised exercise program. The main outcome measures were active pain-free shoulder abduction and flexion tested on days 0, 5, and 10. RESULTS: Improvement in active pain-free shoulder range of motion was significantly higher in the group treated with MWM and KT. Repeated-measures analysis of variance indicated significant effects of treatment, time, and treatment×time interaction. CONCLUSION: This study suggests that MWM and KT may be an effective and useful treatment in range of motion augmentation of subjects with rotator cuff lesion and impingement syndrome or impingement shoulder syndrome.

[Effects of functional electrical therapy on upper extremity functional motor recovery in patients after stroke--our experience and future directions].

INTRODUCTION: New neurorehabilitation together with conventional techniques provide methods and technologies for maximizing what is preserved from the sensory motor system after cerebrovascular insult. The rehabilitation technique named functional electrical therapy was investigated in more than 60 patients in acute, subacute and chronic phase after cerebrovascular insult. The functional sensory information generated by functional electrical therapy was hypothesized to result in the intensive functional brain training of the activities performed. FUNCTIONAL ELECTRICAL THERAPY: Functional electrical therapy is a combination of functional exercise and electrical therapy. The functional electrical therapy protocol comprises voluntary movement of the paretic arm in synchrony with the electrically assisted hand functions in order to perform typical daily activities. The daily treatment of 30 minutes lasts three weeks. The outcome measures include several tests for the evaluation of arm/hand functionality: upper extremity function test, drawing test, modified Aschworth scale, motor activity log and passive range of movement. RESULTS OF FUNCTIONAL ELECTRICAL THERAPY STUDIES: Results from our several clinical studies showed that functional electrical therapy, if applied in acute and subacute stroke patients, leads to faster and greater improvement of functioning of the hemiplegic arm/hand compared to the control group. The outcomes were significantly superior at all times after the treatment for the higher functioning group. DISCUSSION: Additional well-planned clinical studies are needed to determine the adequate dose of treatment (timing, duration, intensity) with functional electrical therapy regarding the patient's status. A combination with other techniques should be further investigated.

[Visual vs. quantitative electroencephalographic analysis in patients with and without posttraumatic epilepsy].

INTRODUCTION: We investigated traces of EEG records from two groups of patients with brain trauma: with and without posttraumatic epilepsy (PTE) with respect to the control group by means of two methods: visual and quantitative EEG (QEEG) analysis. The aim of this study was to compare these methods in their sensibility for traumatic and epileptic alterations of the brain tissue in the two experimental conditions: after hyperventilation (HV) and after photo stimulation (FS), and in regard to the basic condition. MATERIAL AND METHODS: 36 patients with PTE and 33 without PTE, and the control group of 34 healthy subjects participated in this study. EEG was registered in three 1-min epochs: before activation, after HIV, and after FS on digital 32-channel EEG apparatus XLTEK. Mean amplitudes were calculated in 10 frequency ranges from 0 to 30 Hz on projections F7-C3, T5-O1, F8-C4 and T6-O2 from 16-s segments without artefacts. Data evaluation was performed using program package PERSYST Insight II (Persyst Development Co). Statistical package GRAPII-PAD was used for ANOVA test and Bonferroni post-test. RESULTS: Visual analysis used to distinguish between normal EEG, with pathological alterations, non-epileptiform and epileptiform transients showed that there was no statistically significant difference between patients with and without post-traumatic epilepsy. On the contrary, QEEG of registered epochs before activation, after HV and after FS showed statistically significant differences between the control group and the patients without PTE and with PTE. CONCLUSION: These results indicate that quantitative analysis provides more subtle data about el ectrophysiological alterations after traumatic brain injury, which leads to better classification of patients.

Low-level laser therapy for acute neck pain with radiculopathy: a double-blind placebo-controlled randomized study.

OBJECTIVE: The objective of the study was to investigate clinical effects of low-level laser therapy (LLLT) in patients with acute neck pain with radiculopathy. DESIGN: Double-blind, randomized, placebo-controlled study. SETTING: The study was carried out between January 2005 and September 2007 at the Clinic for Rehabilitation at the Medical School, University of Belgrade, Serbia. PATIENTS AND INTERVENTION: Sixty subjects received a course of 15 treatments over 3 weeks with active or an inactivated laser as a placebo procedure. LLLT was applied to the skin projection at the anatomical site of the spinal segment involved with the following parameters: wavelength 905 nm, frequency 5,000 Hz, power density of 12 mW/cm(2), and dose of 2 J/cm(2), treatment time 120 seconds, at whole doses 12 J/cm(2). OUTCOME MEASURES: The primary outcome measure was pain intensity as measured by a visual analog scale. Secondary outcome measures were neck movement, neck disability index, and quality of life. Measurements were taken before treatment and at the end of the 3-week treatment period. RESULTS: Statistically significant differences between groups were found for intensity of arm pain (P = 0.003, with high effect size d = 0.92) and for neck extension (P = 0.003 with high effect size d = 0.94). CONCLUSION: LLLT gave more effective short-term relief of arm pain and increased range of neck extension in patients with acute neck pain with radiculopathy in comparison to the placebo procedure.

[Effects of physical training on the lipid profile of patients after myocardial infarction].

INTRODUCTION: Positive effects of physical training on blood lipoprotein have been clearly demonstrated and they are constituive elements in prevention and treatment of hyperlipoproteinemia. The aim of this study was to evaluate the effects of physical training (PT) on lipid risk factors in patients with myocardial infarction (MI) during posthospital rehabilitation (PHR) and prolonged rehabilitation (48 months). MATERIAL AND METHODS: The prospective clinical study included 230 patients after MI. Patients were divided into two groups: group A (180 patients) participated in organized PT (PHR and prolonged rehabilitation at home) that lasted 48&6.4 months and the control group (50 patients) without PT. The intensity of PT was recommended to be 70% of maximal heart rate obtained during the exercise test (ET). Evaluation of lipid profile was done after the last control (48+/-6.4 months after MI). Parameters in the control group were compared with the parameters in the examined group of patients. RESULTS: Hyperlipidemia, as a risk factor, was present in 39% of patients of group A and in 38% of patients ofthe control group just after MI. A statistically significant difference wasn't established in lipoprotein levels in examined groups of patients before MI (p>0.05). Prolonged PT leads to significant deacrese of total cholesterol (p< 0.01), LDL/cholesterol (p < 0.05) and triglycerides (p<0.01), but increase in HDL/holesterol (p 0.01), in patients after MI with organized rehabilitation in comparison with the control group. CONCLUSION: Prolonged PT has a beneficial effect on hyperlipoproteinemia inl patients after MI. We have to practice PT over the "threshold" of physical activities if we want to achieve optimal results.

[Functional outcome evaluation after total hip arthroplasty].

INTRODUCTION: Total hip arthroplasty improves the hip functional status and quality of life of operated patients. The surgery outcome is determined by several numerical methods. The aim of this study was to evaluate the hip functional status 1 and 5 years after total hip arthroplasty using a modified Harris hip score. MATERIAL AND METHODS: 75 patients with 78 primary total hip arthroplasties were included in the study. All patients underwent clinical evaluation 1 and 5 years after operation using our modified Harris hip score. From the original score 2 questions, that evaluated the range of motion (5 points) and deformity (4 points), were excluded, and 2 questions that assessed the hip function were added: rising from a chair after an hour of sitting (5 points) and bathing (4 points). Also, we added one question regarding patient's satisfaction after surgery. RESULTS: I and 5 years after the surgery, very good hip functional status was verified in 77% and 82.4% of patients respectively (excellent and good total Harris hip score). 92% of patients were satisfied with the outcome 1 and 5 years after the operation. CONCLUSION: Our modified Harris hip score can be used for long-term evaluation of patients after total hip arthroplasty.

[Quality of life in patients with subacute low back pain treated with physiotherapy rehabilitation].

INTRODUCTION: Low back pain is one of the most frequent health problems. The aim of the study was to investigate clinical effects of complex rehabilitation programs on quality of life of patients with subacute lumbar pain, and also to investigate the relationship between quality of life and the intensity of pain and local functional status of the lumbar spine. MATERIAL AND METHODS: The prospective study included 60 patients suffering from subacute low back pain with radiculopathy caused by lumbar disc syndrome, without any previous treatment, and who did not need surgery. In a single blind trial patients were divided into two groups. The first group (A group, n=30) was treated by low level laser therapy (wavelength 904 nm, frequency 4000 Hz, at dose 2J per point); the whole dose of 12J, then with TENS (frequency 80 Hz, 30 minutes, pulse duration 200 micros), with exercise, and simultaneously with conventional therapy with NSAIDs which inhibit COX-2 (meloxicam, 15 mg per day). Patients were treated 5 times a week, a total of 15 treatments. The second group (B group, n =30), was treated only by meloxicam (15 mg per day). The subjects were evaluated before the first treatment and three days after the last treatment (21st to 24th day). Data were analyzed using Student's t test and with analytic statistical methods. RESULTS: The mean Oswestry scores before and after therapy for group A have reduced from 25+/-2 to 16+/-3, with statistical significance (t= 8.84 p<0.001) and in group B from 24+/-2.5 to 22+/-2.5 (t=2.56 p<0.05). Statistical analysis has shown an increase of mean values for the 12-item health survey (SF-12) from 22.33+/-4.66 to 36.33+/-3.66 (t=9.12 p<0.001), in group A and from 23.66+/-3.66 to 30.33+/-4.66 (t=3.15 p <0.001) in group B. Mean values of intensity of pain in group A have been reduced from 82+/-6.50 to 46+/-5.50, (t=7.85, p<0.001) and from 80+/-5.50 to 62+/-6.50 in group B (t=5.65; p<0.001). No significant changes have been recorded in Schober measurement. The intensity of pain was in positive correlation with Oswestry score (Ft=7.84; p<0.001) in group A and also in group B (Ft=5.25: p<0.05), as for the 12-item health survey (SF-12) (Ft=8.34: p<0.001) in group A and in group B (Ft=5.98; p<0.05). Two measurements of quality of life have shown close relationship (Ft=5.45; p<0.05) in group A and group B (Ft=6.45: p<0.05). CONCLUSION: Results of this study showed that better results were achieved in group treated with complex rehabilitation methods in comparison with patients treated only with anti-inflammatory drugs. Also, the 12-item health survey (SF-12) has shown positive correlation with intensity of pain reduction and with Oswestry disability score and so it is valid for measuring the effectiveness of therapeutic modalities in subacute lumbar pain.

[The effects of balneotherapy on knee osteoarthritis].

INTRODUCTION: Effects of two types of balneotherapy on patients with knee osteoarthritis (OA) were compared. MATERIAL AND METHODS: 58 patients were included in the study and treated in the "Rusanda Spa" in Melenci. The patients were divided into two groups: group I (n=30) received a spa treatment and a mud pack per day, group II (n=28) received only two spa treatments per day. Thermal water components are: Na, Cl, Ca, HCO3, SO4 homeoterms (38 degrees C) and mud pack components are alkaline Na, Cl, Ca, HCO3, SO4. The effects of two traditional spa therapies were evaluated using Lequesne index. Secondary measures were pain intensity (visual analogue scale), 10 meters walking time, 3 squats and 10 stairs climbing time. RESULTS AND DISCUSSION: Improvements were found in Lequesne knee index. In group I it was higher (44%), than in group 11 (30.7%), p<0.001. Vascular pain has decreased in both groups (38.2% and 31.1%). In group I it was more significant (p=0.003). CONCLUSION: The results of secondary measures show a better improvement in the first, in regard to the second group. Both traditional spa therapies are good in treatment of functional status and pain in patients with OA. A combination of these two spa therapies is the best solution, but it is not clinically relevant.

[Rehabilitation of children with apallic syndrome of traumatic or ischemic etiology].

INTRODUCTION: Apallic syndrome may be defined as the complete lack of cortical function - paragnosia and parapraxia. Vegetative functions and other sub cortical functions are maintained (sleep rhythm, suckling and swallowing reflex). The aim of the study was to investigate the recovery of children with Apallic syndrome depending on the etiology and differences among various modalities like self-care, motor control and speech during rehabilitation. MATERIAL AND METHODS: The study was conducted among eight children (mean age 9.4) (SD-2.6). Four had a post-traumatic and four Apallic syndrome of ischemic etiology. Friedman and Kruskal-Wallis tests were used for statistical analysis. RESULTS: There was no evident difference in recovery among children with Apallic syndrome of different etiology. In regard to self-care, motor control and speech, all children showed the same level of improvement during rehabilitation therapy. These results correspond with similar research findings. CONCLUSION: Rehabilitation is essential to aid recovery and it does not depend on the etiology. Recovery success is the same regardless of the chosen modality.

The drawing test: assessment of coordination abilities and correlation with clinical measurement of spasticity.

OBJECTIVE: To assess the correlation between kinematic measures of movement (Drawing Test) and a clinical measure of spasticity (Ashworth Scale). DESIGN: Correlation study of Drawing Test and the Ashworth Scale scores. SETTING: Inpatient rehabilitation center. PARTICIPANTS: Forty-five poststroke hemiplegic subjects with various levels of spasticity (up to Ashworth Scale score of 3) and 8 able-bodied subjects with no sensorimotor deficits in their upper extremities. INTERVENTIONS: Subjects made self-paced, radial point-to-point movements between the left, and the right corners of a square (200 x 200 mm) on the surface of a drawing tablet. Hand coordinates were recorded from the mouse, which was attached to the hand. MAIN OUTCOME MEASURES: Correlation between (1) Drawing Test scores (time to perform the movement, radial [ y ] and tangential [ x ] distances between the end point of the movement and the target endpoint, standard error of the mean calculated as distances between the recorded path and its radial linear fit), and (2) Ashworth Scale scores. RESULTS: Drawing Test scores correlated highly with Ashworth Scale scores in 49 of 53 subjects, based on the multiple linear regression analysis. CONCLUSIONS: The Drawing Test, a quantitative metric of movement ability, correlated highly to the Ashworth Scale, a clinical measure of spasticity.