Strength of knee flexors of the paretic limb as an important determinant of functional status in post-stroke rehabilitation

OBJECTIVE

The purpose of the study was to assess the effectiveness of the multi-modal exercise program (MMEP) in patients after stroke, and to identify muscles that are the best predictors of functional performance and changes in functional status in a 3-week rehabilitation program.

METHODS

Thirty-one post-stroke patients (60.6±12.7 years) participating in a 3-week MMEP took part in the study. Measurements of extensor and flexor strength of the knee (F_ext, F_flex) were done. Functional performance was measured using Timed Up & Go test (TUG), 6-Minute Walk Test (6-MWT) and Tinetti Test.

RESULTS

The rehabilitation program improved all the results of functional tests, as well as the values of strength in the patients. Both baseline and post-rehabilitation functional status was associated with knee flexor and extensor muscle strength of paretic but not of non-paretic limbs. At baseline examination muscle strength difference between both F_flexkg^-1 and F_extkg^-1 had an influence on functional status. After rehabilitation the effect of muscle strength difference on functional status was not evident for F_extkg^-1 and, interestingly, even more prominent for F_flexkg^-1.

CONCLUSIONS

MMEP can effectively increase muscle strength and functional capacity in post-stroke patients. Knee flexor muscle strength of the paretic limb and the knee flexor difference between the limbs is the best predictor of functional performance in stroke survivors.

[The effect of solar ultraviolet radiation (UVR) on induction of skin cancers]

Ultraviolet radiation is a physical mutagenic and cancerogenic factor. About 95% of ultraviolet A (UVA) (320-400 nm) and 5% of UVB (280-320 nm) reach the Earth's surface. Melanin is a natural skin protective factor against UV radiation. Skin cancers associated with long-term exposure to UV radiation are: basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and cutaneous malignant melanoma (CMM). The high risk of BCC development is related to acute and repeated exposure to UV causing sunburn. Molecular studies of BBC demonstrated disorders in sonic hedgehog (SHH) cell signaling regulation pathway, associated with the suppressor protein patched homolog 1 gene (PTCH1) mutations. The risk of the BCC development is related to the polymorphism of melanokortin-1 receptor gene (MC1R). Tumor P53 gene mutations observed in BCC cells has been classified as secondary genetic changes. In SCC cells UV-induced mutations were mostly related to P53 gene. Increased expression of cyclooxigenase- 2 gene (COX-2) plays a significant role in the development of SCC. Other pathogenetic factors include intensification of the synthesis of pro-inflammatory cytokines (tumor necrosis factor α (TNF-α), interleukin-1 α (IL-1α), IL-1β and IL-6). Currently, the role of UVB has been recognized in the pathogenesis of CMM. In CMM cells the following gene mutations were noted: cyclindependent kinase inhibitor 2A INK4A (p16INK4A), cyclin-dependent kinase 4 (CDK4), Ras, phosphatase and tensin homolog deleted on chromosome 10 (PTEN) and proto-oncogene B-Raf (BRAF). The BRAF gene mutations were observed in ~50% of CMM cases. Mutations of P53 gene are not characteristic of CMM cells. Med Pr 2016;67(2):255-266.

The influence of NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke

In stroke patients, the NDT - (Bobath - Neurodevelopmental Treatment) and PNF (Proprioceptive Neuromuscular Facilitation) methods are used to achieve the main objective of rehabilitation, which aims at the restoration of maximum patient independence in the shortest possible period of time (especially the balance of the body). The aim of the study is to evaluate the effect of the NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke. The study included 72 patients aged from 20 to 69 years after ischemic stroke with Hemiparesis. The patients were divided into 4 groups by a simple randomization. The criteria for this division were: the body side (right or left) affected by paresis and the applied rehabilitation methods. All the patients were applied the recommended kinesitherapeutic method (randomized), 35 therapy sessions, every day for a period of six weeks. Before initiation of therapy and after 6 weeks was measured the total area of the support and path length (COP (Center Of Pressure) measure foot pressure) using stabilometer platform - alpha. The results were statistically analyzed. After treatment studied traits decreased in all groups. The greatest improvement was obtained in groups with NDT-Bobath therapy. NDT-Bobath method for improving the balance of the body is a more effective method of treatment in comparison with of the PNF method. In stroke patients, the effectiveness of NDT-Bobath method does not depend on hand paresis.

A comparative analysis of analgesic efficacy of ultrasound and shock wave therapy in the treatment of patients with inflammation of the attachment of the plantar fascia in the course of calcaneal spurs

INTRODUCTION

Troublesome heel spur is a nuisance condition that affects people of all ages. Treatment of patients with heel spur is a difficult and lengthy process requiring patience from both the patient and the therapist. Sometimes, the only and ultimate method of treatment is surgery, although spurs tend to recur. The aim of the study is a comparative analysis of the analgesic efficacy of ultrasound and shock wave therapy in patients with heel spur. The cause of pain in the course of calcaneal spur is inflammation of the attachment of the plantar fascia, which plays an important role in the process of walking and is seriously strained during different types of movement. Treatment of patients is a difficult and lengthy process.

MATERIALS AND METHODS

The study was conducted on a group of 47 patients of both sexes, aged 38-60 years (mean 51.3) with a plantar calcaneal spur confirmed by X-ray images. Patients were randomly assigned into two groups using a simple randomization: Group 1-ultrasound therapy group (a series of ten treatments) and Group 2-the radial shock wave group (series of four treatments). In all patients, pain intensity was assessed three times: before therapy, after the first and second weeks of treatment. A version of Laitinen's pain assessment questionnaire and the Huskisson visual analogue scale (VAS) were used. Of the group of studied respondents, 47 patients of both sexes and aged 38-60 years (mean age 51.3) with a heel spur (confirmed on X-rays), who had pain for at least a month, were randomly included in the study. The patients were classified into: Group 1-US therapeutic group (a series of ten treatments) and Group 2-with RSWT (a series of five treatments). Pain intensity was assessed three times: before the treatment, after the first and second week of the treatment with the application of the VAS and the Leitinen Pain Questionnaire.

RESULTS

However, a decrease in pain sensation was reported in all test intervals, and its largest decrease occurred in both groups within 1 week of beginning treatment. More dynamic change in this period was recorded in Group 1.

CONCLUSION

The conclusion is that while ultrasound and shock wave therapy show significant analgesic efficacy in patients with heel spur, fewer shock wave therapy sessions are needed than ultrasound sessions for effective relief, suggesting that the shock wave therapy has greater analgesic efficacy. A similar analgesic effect was achieved with the administration of a smaller number of shock wave treatments and a full series of ultrasound treatments.

Influence of the surface electrostimulation controlled by muscle contraction on the bioelectric muscle activity and restoration of the hand function in cerebral stroke patients

BACKGROUND

Impaired limb mobility is the most troublesome condition in patients after cerebral stroke. The application of the electrode-glove might reduce dysfunctions in patients treated due to stroke.

OBJECTIVE

The electrode-glove use in rehabilitation is investigated. The study was conducted on 54 patients aged 28 - 72 (the mean age 54.3 ± 10.3) with hemiparesis who had suffered from cerebral stroke. The patients from Group 1 were applied bipolar stimulation of forearm muscles (flexors and extensors of the wrist joint and hand) with the use of two flat electrodes of the same size. With regards to Group 2, in the study used an electrode-glove.

METHODS

The excitation threshold was determined once a week with the use of the EMG.

SECONDARY OUTCOMES

The evaluation of the electromyographic bioelectric activity of flexor and extensor muscles in the forearm, of the functional mobility of the hand according to the Brunnström test and of the functional mobility of the hand according to the seven-graded task Frenchay scale.

RESULTS

The authors of the study observed a much greater improvement in the function of the hand in Group 2, where the mean value increased by 2.1 points. With regards to Group 1, the mean value increased by 1 point and the differences of the results in the studied groups after the therapy were statistically significant (p = 2.830).

CONCLUSIONS

The electrical stimulation method controlled/triggered by muscle contractions is an effective method of normalization of muscle tension in the forearm and hand as well as restoration of the hand function in patients with cerebral stroke.

[Evaluation of effectiveness of local cryotherapy in patients with post-stroke spasticity]

INTRODUCTION

Spasticity is a source of functional limitations in patients. It leads to weakening of muscles, reduced mobility, muscle fatigue and irreversible changes in tissues. The aim of the study is to evaluate the effectiveness of local cryotherapy in patients with post-stroke spasticity.

MATERIAL AND METHODS

The study was conducted in 56 patients with post-stroke spasticity. They were divided into two groups (Group 1 was administered cryotherapy and kinesitherapy and Group 2- kinesitherapy only). The researchers assessed the level of spasticity according to the Modified Ashworth Scale as well as functions of lower limbs, upper limbs and hands according to the Brunnström Scale twice (before and after the therapy). The findings were statistically analyzed.

RESULTS

In the treatment groups decreased muscle tone. An improvement of the efficiency of locomotion and hand in performing activities of daily living. More favorable results were observed in group 1.

CONCLUSIONS

Local cryotherapy combined with kinesitherapy appeared to be more effective in treating spasticity rather than kinesitherapy alone. A decrease in spasticity and an improvement of the limb function indicate a stabilization of muscular tension in patients with disorders upper motor neuron.

The evaluation of dorsal asymmetry in children and adolescents: ten years' follow-up

INTRODUCTION

The study is a retrospective and prospective analysis of the results of examinations of children for the occurrence of dorsal asymmetry carried out ten years ago and repeated recently.

MATERIAL AND METHODS

A group of 100 children and adolescents aged 4-16 years, including 58 girls and 42 boys, was examined initially in 1997 and then re-examined after 10 years (at the age of 14-26). The clinical assessment (Adam's test) was performed each time by the same examiner, the 1st author of this study, using the same methodology and in the same conditions. A Rippstein plurimeter was used for the examination, with differences of 2 degrees or more being regarded as a sign of asymmetry. The prevalence of particular types of dorsal asymmetry was calculated separately for girls and boys, and these results were compared statistically using the squared Chi test.

RESULTS

The prevalence of back asymmetry had increased by the time of the second examination, especially the type Th-L sin, the difference being statistically significant (p<0.005). The prevalence of type Th dex- L sin asymmetry had also increased, but the difference was not statistically significant. A statistically significant decrease in prevalence was found for the type Th dex. The prevalence of double-arch and single-arch asymmetry was found to have increased in both genders. The difference between first and second examinations was statistically significant for double-arch asymmetry (p<0.05).

CONCLUSIONS

1. The prevalence of slight dorsal asymmetries increased as the children grew older. 2. The location of dorsal asymmetry often changes after puberty. 3. The 2nd examination showed significant asymmetry indicating scoliosis among some children and adolescents with minor asymmetry observed in the 1st examination.

[Polish adaptation and validation of the Visual Function Questionnaire (VFQ-25) in multiple sclerosis patients]

INTRODUCTION

Visual disturbances very often accompany of multiple sclerosis (MS) and affect patients' quality of life (QoL). There have been no tools for investigation of the effect of visual disturbances on QoL in MS patients available in Poland. The aim of this study was validation analysis of Polish adaptation of Visual Function Questionnaire VFQ-25.

MATERIAL AND METHODS

VFQ-25 published by Mangione in 2001, consists of 25 questions concerning general well-being, assessment of vision, social functioning, mental health, and self-sufficiency. According to the applicable translation principles, the original English version was adapted into Polish, and validation analysis of the convergent validity as well internal reliability was carried out. 108 randomly selected patients, diagnosed with MS according to McDonald's criteria were included in this study: 63 women and 45 men aged on the average 37.8 +/- 9.2 years, with mean disease duration of 11.2 +/- 5.6 years. All patients underwent assessment of disability based on Expanded Disability Status Scale (EDSS). Besides the analyzed VFQ-25 questionnaire, the patients completed also the Functional Assessment of Multiple Sclerosis (FAMS) questionnaire and SF-36 Health Survey.

RESULTS

The internal consistency of the questionnaire was satisfactory (Cronbach's alpha reached 0.95). The accuracy of the scale was confirmed by positive correlations of the results between VFQ-25 and EDSS, FAMS and SF-36.

CONCLUSIONS

Statistical analysis has demonstrated that the Polish version of VFQ-25 is a valuable tool for investigation of the effect of visual disturbances on QoL in MS patients.

[Analgesic efficacy of magnetoledotherapy in patients with low back pain syndromes]

INTRODUCTION

Low back pain syndromes most often occur due to overloading of the musculoskeletal system. The cause is a frequent, improper lifting of heavy objects, most commonly by those working physically, with repetitive movements of bending and straightening of the trunk (turning and bending with load). This problem affects not only adults but also children and adolescents. There is a growing interest in new forms of analgesic therapy nowadays, especially in those that exhibit synergistic therapeutic effects. The aim of this work is to evaluate the analgesic efficacy of magnetoledotherapy in patients with lumbar--sacrum spinal pain syndromes caused by joints degenerative changes.

MATERIAL AND METHODS

The examination was carried out in 66 patients of both sexes aged 30 to 76 (average 54.7 +/- 13.8) with low back pain syndrome caused by spinal degenerative changes. The patients were divided into three groups according to the applied analgesic therapy (magnetoledotherapy, magnetostimulation, TENS currents). Level of pain has been evaluated four times in all patients--before the start of therapy and after 5, 10 and 15 applications with the use of the modified Laitinen Questionnaire and Visual-Analoque Scale (VAS).

RESULTS

Post therapy levels of pain in the studied patients decreased significantly. According to Laitinen questionnaire, the greatest improvement was observed in the group treated with magnetoledotherapy and TENS currents and the smallest improvement was observed in the group treated with magnetostimulation.

CONCLUSIONS

1. Magnetoledotherapy shows significant analgesic efficacy in patients with low back pain syndrome and shows no side effects. 2. Concurrent application of both the infrared radiation generated by LED's and magnetostimulation synergistically reinforces analgesic effect in patients with low back pain syndrome, especially in level of pain and frequency of its occurrence, which results in the increase of movement activity and decrease in administration of analgesics.

Assessment of muscle strength of hip joints in children with idiopathic scoliosis

BACKGROUND

The choice of an appropriate approach to the treatment of idiopathic scoliosis is considerably complicated owing to the lack of a clear-cut aetiology of this condition. Idiopathic scoliosis impairs the body's biomechanical balance and adversely affects body statics.

MATERIAL AND METHODS

The muscle torques of the flexor and extensor muscles of the hip joints were assessed in 123 children (96 girls and 27 boys) aged from 8 to 16 with the I degrees scoliosis. Statistically significant differences (p>0.05) were revealed.

RESULTS

The primary lumbar scoliosis was to the left in 109 patients (Group 1) and to the right in 14 patients (Group 2). All children participated in a 6-month exercise programme to strengthen the weakened muscle groups. Torque measurements were performed twice: immediately after the child joined the rehabilitation programme and on completion of the programme. The strength of the weakened muscles was seen to increase to a statistically non-significant level (p>0.05).

CONCLUSIONS

1. Exercises strengthening weakened muscles of the hip joint improve the posture of scoliotic children and can be helpful in treating idiopathic scoliosis. 2. Differences in the strength of the flexors and extensors of the hop joint impair body statics and may constitute one of the causes of idiopathic scoliosis in children.

[Fatigue syndrome in chronic neurological disorders]

Fatigue without coincident depression may accompany many neurological disorders, including multiple sclerosis, Parkinson's disease, motor neuron disease, stroke and post-polio syndrome, and is frequently reported by patients as a predominant complaint. The pathophysiology of fatigue is unknown. The role of various mechanisms has been suggested, including the effect of proinflammatory cytokines (TNF-alpha, IL-1beta and IL-6) on glutaminergic transmission, hypothalamo-pituitary-adrenal (HPA) axis dysfunction, disturbances of astroglia metabolism and decreased levels of the neurotransmitters noradrenaline and serotonin. The diagnosis of fatigue syndrome is based on exclusion of depression and additional organic conditions (anaemia, cardiovascular disorders, kidney diseases or hypothyroidism). The treatment of fatigue syndrome is complex. Physical activity, rehabilitation, psychotherapy and avoidance of factors which may increase fatigue, such as fever, anxiety, depression, pain, sleep disturbances, as well as some drugs like opioids and benzodiazepines, are important. Pharmacological treatment leads to slight improvement. Amantadine, modafinil and pemoline are administered to such patients.

[Effect of low frequency magnetic fields used in magnetotherapy and magnetostimulation on the rehabilitation results of patients after ischemic stroke]

New methods of rehabilitation should be introduced in order to reduce disability resulting from stroke. During the twelve months of follow-up, effect of low frequency magnetic field (If mf) on the course of patient rehabilitation following ischemic stroke was evaluated on in-patient (acute and subacute period of the stroke) and outpatient (chronic period) basis with the use of Mathew et al's and Barthel's scales. Lf mf (20 procedures of 20-min. duration) of magnetotherapy (I group--placebo, II--group 5.6 mT induction, 10 Hz frequency and sinusoidal shape, III group--2.8 mT induction, 10 Hz frequency and sinusoidal shape) and magnetostimulation (IV group--M1P1 program of Viofor JPS system, 16 min a day) was applied as early as in the subacute period of the stroke (1-8 weeks). The data obtained were presented in the form of percentage changes in the pain levels as well as in the form of the arithmetical mean and standard deviation (X +/- SD). The ANOVA test was used for a statistical evaluation of the data obtained in the tests. The results obtained indicate beneficial effects of If mf in the III and IV group of patients in the Barthel's scale and Mathew scale, which were observed during the examination 12 months after the stroke. The recommended doses of If mf seem to be adequate to obtain therapeutic effects and may be used in the early period of rehabilitation. The neurological and functional improvement persisted for a long-period of the out-patient treatment, which was confirmed during the control examination 12 months after the ischemic stroke. As no adverse effects (which could be attributed to If mf), were observed, this method of physical therapy can be recognized as a safe one and worth making popular in clinical practice.

The influence of chronic exposure to low frequency pulsating magnetic fields on concentrations of FSH, LH, prolactin, testosterone and estradiol in men with back pain

OBJECTIVES

There is widespread public concern that electromagnetic fields might be hazardous. However, studies on the biological effects of magnetic fields (MFs) have not always been consistent. Influence of extremely-low frequency MFs used in physiotherapy on endocrine system was rarely examined. Therefore, the aim of the present study was to investigate the concentrations of some pituitary (FSH, LH, prolactin) and sex (testosterone, estradiol) hormones in men with back pain exposed to magnetic fields applied during magnetotherapy or magnetostimulation over the period of three weeks.

MATERIAL AND METHODS

The study was performed on 20 men aged 28-62 years (mean+/-SEM: 46.4+/-2.0 years) suffering from chronic low back pain who underwent magnetotherapy (10 patients, mean age+/-SEM: 48.4 years, range: 28-62 years) or subjected to magnetostimulation (10 patients, mean age+/-SEM: 44.3 years, range: 34-52 years) for 15 days (daily at 10:00 h, with weekend breaks). Blood samples were collected at 08:00 before magnetic field application, one day and one month following the application. Concentrations of hormones were measured by micromethod of chemiluminescence.

RESULTS

Both magnetotherapy and magnetostimulation lowered levels of prolactin. The levels of LH decreased significantly one month after magnetotherapy in comparison with the baseline whereas following magnetostimulation slight but insignificant increase was observed. Estradiol concentrations were significantly lower one day and one month following magnetosimulation in comparison to the baseline and did not change after magnetotherapy. No statistically significant changes were observed in levels of FSH and testosterone after either magnetotherapy or magnetosimulation at any time examined.

CONCLUSION

Magnetic fields applied in physiotherapy exert no or very subtle effect on concentrations of FSH, LH, prolactin, testosterone, and estradiol in men.

[Influence of steroid therapy local injection of steroidal in the region of the stylomastoid foramen and physiotherapy on the recovery of stapedial reflex in patients with facial nerve paralysis]

There are much more publications which informates about positive effects of advisability propose steroid's cure in patients with facial nerve palsy. The aim of the studies was to evaluate the influence of steroidal and physical treatment on the recovery of stapedial reflex and of functions of the damaged nerve. The studies were performed on 37 patients with palsy of facial nerve. Taking into account the stapedial reflex (before the beginning of the treatment) and local injection of steroidal in the region of the stylomastoid foramen, the patients were divided into two groups: I group--21 persons with lacking stapedial reflex, who were not given steroid, II group--16 persons with lacking stapedial reflex who received steroid. Evaluation of results of treatment was performed by means of the Pietruski, House and Brackmann scales, registration of stapedial reflex and accommodation coefficient. The results indicate that local steroid in palsy facial nerve is the treatment of choice in cases of intratemporal branches injury (lack of stapedial reflex) and shortens of duration of stapedial reflex and the nerve function recovery.

[Evaluation of magnetostimulation effectiveness in physiotherapy--questionnaire research]

The anonymous questionnaires which had been filled in by patients were analysed after the end of the magnetostimulation applied with Viofor JPS. The applicator in form of a mattress with maximum induction 45 microT was used. In the analysed group of 1742 patients, 5% of patients suffered from rheumatoid arthritis, 16% from central nervous system illnesses, 9% from injuries, 1.5% from allergies, 2% from infections, 5.4% from vessel illnesses, 1% from skin illnesses. 0.5% of the patients used monotherapy. 8% suffered from radicular symptoms, 30.7% from pseudoradicular symptoms, 17.4% from arthrosis, and 3.4% patients suffered from migraines and headaches. The complete abatement of complaints or the improvement was noted in 95.5% of patients, no improvement in 4.3% and 0.2% of patients became worse--82% of deteriorated patients were the ones that suffered from infections. The strongest analgesic action and the most frequent abatement were noted in patients after injuries and patients with headaches.

[Advances in diagnosis of facial nerve paralysis: pathophysiology and clinical symptoms]

Facial palsy is important clinical and social problem because of frequently appearance and to cause facial symmetry troubles which are visible for surroundings. Clinical picture of facial palsy, independently of its reason, contains a lot of symptoms depending on degree and place of nerve damage. The most visible and unpleasant for sick person unpleasant symptoms are abolition (in palsy) or considerably handicap (in paresis) function of facial countenance muscles which are hard to endure for patients. In special accidents patients demand psychology consultation and antidepression treatment to modify imagination about role of appearance in shape social relation. In place of damage nerve for particular attention deserve objective treatment the stapedius muscle reflex. It allows to objective estimation the facial nerve damage. Regress in paresis of this nerve decides on treatment. This treatment has a prognostic sense too--return of the stapedius muscle reflex announces return the function of damage nerve.

[Influence of pulsating magnetic field used in magnet therapy and magnet stimulation on cortisol secretion in human]

The aim of our study was to test the influence of magnetic fields during magnetotherapy and magnetostimulation over a longer period of time (like in physiotherapy) on cortisol secretion in humans. The study population was divided into two groups: magnetotherapy group (16 men) and magnetostimulation group (10 men). Magnetotherapy in the form of magnetic field induction (2.9 microT; frequency--40 Hz; square wave; bipolar; Magnetronic MF--10 apparatus) was applied for 20 min to the lumbar area in patients with chronic low back pain. Magnetostimulation (Viofor JPS system; M2P2 program; induction--25-80 microT; frequency--200 Hz, complex saw-like shape with a plateau halfway the height of the wave; bipolar) was applied every day for 12 min in patients with the same health problem. In both groups, the procedures were repeated 15 times (about 10:00 a.m.) with weekend breaks. Serum samples were collected at 6:00, 12:00, 16:00 and 24:00 and estimated by the micromethod of chemiluminescence (DPC Poland; Cat. No. LKC01). The circadian profile of cortisol was determined prior to the application, a day and a month after application. The data were analyzed statistically, using paired and unpaired Student's test. Magnetotherapy affects the cortisol secretion in the circadian profile by decreasing its level at 16:00 a day after 15 applications, whereas magnetostimulation by increasing its level at 12:00 a month after 15 applications, which may suggest its long-term effect on hypothalamic-pituitary axis. The comparison of the results indicated that a day after magnetotherapy and magnetostimulation, the circadian curves of cortisol secretion differed significantly by about 100%. All hormone oscillations did not exceed the physiological norms of the circadian cortisol level, not reaching the level so high as in an intense stress. This suggests rather their controlling effect on the cortisol level than their significant stressogenic nature.

[Biological effects produced by the influence of low frequency electromagnetic fields on hormone secretion]

The article discusses the role of (electro)magnetic fields in hormone secretion in humans and animals. The best known hormone whose secretion may be disturbed by magnetic field is melatonin. The level of serotonin positively reacts to the presence of magnetic field in the environment-its level is raised. The effect of magnetic fields on other hormones has not as yet been described. It seems necessary to continue experimental and epidemiological research on living organisms (their hormone secretion) to standardise the norms of exposure with the aim of diagnostic and therapeutic application.

[Effect of variable magnetic field on motor impairment and quality of life in patients with multiple sclerosis]

Modern treatment of multiple sclerosis (SM) takes into consideration the current stage of the disease, symptomatic treatment and modification of the course of the disease. The most promising method of management is immunotherapy. It is, however, effective only in some cases, in patients with low degree of disability, and it is rather expensive. In view of some recent reports concerning the possibility of utilisation of variable magnetic fields in the treatment of SM, the study was undertaken to evaluate the effectiveness of impulses generated by magnetic field obtained by means of VIOFOR JPS stimulator. The study was carried out on 76 subjects with long-term history of clinically confirmed SM. The mean duration of the disease was 8.5 years, and the mean age of the patients 37.8 years. The patients were divided into two groups: the study group and the controls. In the study group the patients were exposed to magnetic fields generated by VIOFOR JPS. Magnetic stimulation was not applied in the control group. The progress of the disease according to EDDS and the quality of life according to Testa and Simonson Questionnaire were assessed on admission and after 21 days of stimulation. No significant differences between the groups were found with respect to motor impairment evaluated using the EDDS score (6.2 at the beginning of the study and 5.1 after 21 days; in the control group--6.1 and 5.6, respectively). The quality of life was found to be significantly better in the group exposed to magnetic field stimulation than in the controls (p < 0.01). Particular variables contributing to the physical, psychological and social component of quality of life were analysed in detail. The most significant difference was observed with respect to the improvement of mental condition of the patients (alleviation of depression, elimination of anxiety, better emotional control), as well as to the decrease of muscle tone, dysaesthesia and painful sensations. No side effects were observed in any of the cases. The obtained effects encourage us to recommend magnetic stimulation as a method supplementing symptomatic treatment of patients with multiple sclerosis.

[Comparison of principles for establishing disability pension eligibility for orthopedic cases used in Germany and in Poland. I. German rules for establishing eligibility in orthopedics]

The aim of the present paper is to compare the rules used in Germany and Poland to establish an individual's eligibility for a disability pension in cases of orthopedic disorders. Harmonizing these rules is one of the basic factors needed to create the proper platform for cooperation among health care systems in all the countries associated with the European Union. This first part of the work discusses the German rules for eligibility proceedings in orthopedic cases. The example of spinal disorders is used to explain the scheme of the examination conducted by the specialist to determine the disability group to which the person should belong. Attention is drawn to the rules governing the use of additional tests and eligibility proceedings.

[Spasticity and physical methods for controlling it]

Spasticity is one of the greatest difficulties in patients with central nervous system injuries and diseases. Severe spasticity makes treatment, rehabilitation and care of patient very difficult and sometimes even impossible. It has been sought for many years for an objective method to evaluate the degree of spasticity, necessary to establish the results of treatment and rehabilitation. In this study we present subjective and objective methods of evaluating the spasticity in order to classify every patient to adequate therapeutic group. The authors present physical methods that not only contribute to control of spasticity together with pharmacotherapy and surgical treatment, but can be used alone. The big advantage of this therapy is a low invasiveness and the very few side effects.

Chronic exposure to 25-80-microT, 200-Hz magnetic field does not influence serum melatonin concentrations in patients with low back pain

There is substantial evidence that magnetic field (MF) exposure influences melatonin secretion in animals. However, data on its influence on human melatonin levels are scarce, and seemingly contradictory. Because of its many beneficial effects, very low-frequency MF exposure is used in physiotherapy of some neurological diseases and overloading syndromes of the locomotor system. In previous studies, we observed a decrease in human serum melatonin nocturnal concentrations after exposure to MF (2.9 mT, 40 Hz), and we suggested that differences among various studies may depend on different characteristics of the applied MF. Therefore, in the present study, we examined whether or not MF of different parameters exerts the same effect. The study was performed in seven men (mean age: 36.7 +/- 3.8 years; range: 32-42) suffering from low back pain. Patients were exposed to a pulsating MF (induction: 25 80 microT; frequency: 200 Hz, modulated, automatically programmed; complex saw-like impulse shape; bipolar) generated by a Quatronic MRS 2000 apparatus ("magnetic bed") for 3 wk (5 days/wk, twice a day at 08:00 and 13:00 hr for 8 min each), applied to the whole body in patients laying in a horizontal position. The study was performed in spring. Diurnal serum melatonin profiles were estimated 1 day before exposure to MF (baseline), and 1 day and 1 month after the last exposure. No changes in melatonin concentrations were observed either after 1 day or after 1 month following the exposure in comparison to baseline.

[Examination of the quality of life in post stroke patients]

The clinical assessment of patients after stroke is usually focused on the detection and determination of neurological deficits. However, the full picture of the patient after stroke should take into account also cognitive deficits, emotional and intellectual disturbances as well as limitations in performing one's social functions. Thus, assessing quality of life after stroke is an alternative to traditional methods of evaluation of the patient's condition. The study presents the attempts to define quality of life determined by the health status and to review questionnaires devised for the examination of post-stroke patients. Despite a considerable variety of methods used, reliable evaluation of all the areas of the patients life after stroke seems impossible using only one research tool. There is also an urgent need to develop an uniform system of evaluation, appropriate for Polish cultural standards.

[Evaluation of quality of life in patients after stroke]

The investigations concerning quality of life after stroke provide an alternative approach in comparison with traditional evaluation of the patient's condition focused only on neurological deficits. The full picture of the patient after stroke should take into account not only locomotor inefficiency, but also cognitive deficits, emotional disturbances and limitations in performing one's social functions. The study present attempts to define health related quality of life and reviews questionnaires devised for the examination of post-stroke patients. Despite a wide variety of methods used, the evaluation of all the areas of the patient's life after stroke seems impossible using only one research tool. There is also an urgent need to develop a uniform system of evaluation, appropriate for Polish cultural standards.

Chronic exposure to 2.9 mT, 40 Hz magnetic field reduces melatonin concentrations in humans

Diurnal rhythm of serum melatonin concentrations was estimated in 12 men with low back pain syndrome before and after exposure to a very low-frequency magnetic field (2.9 mT, 40 Hz, square wave, bipolar). Patients were exposed to the magnetic field for 3 weeks (20 min per day, 5 days per week) either in the morning (at 10:00 hr) or in the late afternoon (at 18:00 hr). Significant depression in nocturnal melatonin rise was observed regardless of the time of exposure. This phenomenon was characteristic for all the subjects, although the percent of inhibition of melatonin secretion varied among the studied individuals.

[A prognostic value of of stapedius reflex and accommodation coefficient in patients with Bell's palsy]

At 25 patients with Bell's palsy every 7 days stapedius reflex (SR), accommodation coefficient as well as improvement of mimical facial movements were examined. At 5 patients SR was noticed before treatment, at 13 after 14 days, at 4 after 21 and at 3 after 28 days since disease beginning. There was significant correlation between return SR and improvement of mimical facial movements, but there wasn't correlation between SR and accommodation coefficient.

[Evaluation of the prognostic value of general motor activity for rehabilitation of patients after cerebral stroke]

Following cerebral stroke motor activity of the patient is dependent on the extensiveness of brain ischemia. Evaluation of this activity may be an exponent of brain ischemia extent. It can be used for the determination of predictability of patient survival and results of rehabilitation. Using Mathew and Barthel scales effectiveness of treatment and rehabilitation was evaluated four times during 12-month follow-up in patients of General Motor Activity Clinical Group II i III. The results obtained may be evidence of significant prognostic importance of evaluation of general motor activity of the organism in the initial period of treatment and rehabilitation only, i.e. within 3 months following cerebral stroke. However, it is no importance for evaluation of remote results (one year following cerebral stroke). The evaluation of general activity cannot be used to predict the dynamics of the improvement of neurological and functional status of patients undergoing rehabilitation following cerebral stroke.

[The effect of pentoxifylline on treatment results and course of rehabilitation of patients after ischemic stroke]

The study has been taken up to compare the effect of treatment with pentoxifylline and typical treatment in early ischaemic stroke. The study included 107 patients aged 42-85, with the ischaemic stroke confirmed by CT scan, in early stage of stroke (within 24 hours after onset). Excluded from the study were patients with severe physical diseases. The patients were divided into two groups. Group I was treated typically, group II had been profited from a typical, appropriate therapy and pentoxifylline delivery during 30 days as well, with a daily dose of 1200 mg i.v. within the first 5 days followed by an oral dose of 800 mg subsequent days. Such a treatment has been continued until 12th month. The neurological state was assessed according to the European Stroke Scale (ESS) and Mathew Scale (MS), general fitness according to the Kamofsky Scale (KS) and Barthel Index (IB) at the admission, after 30 days and 12 months of the treatment. Quality of life assessment using by Oxford Handicap Scale and Frenchay Activities Index. After 30 days and 12 months of the treatment, no statistically significant differences between all study groups was found in: 1) mortality, 2) mean survival time, 3) neurological and functional state, 4) quality of life. According to the above results the beneficial influence of pentoxifylline treatment of ischaemic stroke was not confirmed.

[The influence of laser radiation on blood flow in patients with ischemia of the lower limbs (based on the analysis of the hyperemia reactive test)]

The aim of this paper was to assess the influence of low power infra red laser radiation on blood flow in patients with atherosclerotic disease of the lower limbs. The investigations were based on the hyperemic reactive test and the ankle/brachial pressure index. Analysis of the hyperemic reactive test allows to evaluate microcirculation mechanisms. The results obtained indicate that treatment of low power laser radiation allows to improve microcirculation mechanisms and blood flow in the lower limbs.

Red blood cell superoxide dismutase and catalase activities in patients suffering from multiple sclerosis treated with adrenocorticotropic hormone

The purpose of this study was to determine superoxide dismutase (SOD) and catalase (CAT) activities in erythrocytes of patients with multiple sclerosis treated with ACTH. SOD activity in hemolysates was determined according to the method of Misra and Fridovich and calculated as units per gram of hemoglobin (Hb). CAT activity in hemolysates was determined with Beers and Sizer's method and expressed in IU/g Hb. SOD activity in control group was (1.61 +/- 0.45) x 10(3) U/g Hb whereas, the activity of CAT amounted to (5.88 +/- 1.36) x 10(4) U/g Hb. Before the treatment, SOD activity was decreased by approximately 20% ((1.25 +/- 0.25) x 10(3) U/g Hb) while that of CAT-by about 7.7% ((5.43 +/- 0.68) x 10(4) U/g Hb) in comparison to the normal control. After treatment with ACTH, activity of both enzymes increased: SOD-by about 34.4% to (1.68 +/- 0.38) x 10(3) U/g Hb and CAT-by about 7% to (6.29 +/- 0.55) x 10(4) U/g Hb. Results of investigations showed that ACTH caused an increase in CAT and SOD activities in erythrocytes of patients after three-week treatment.

[Methods for evaluating treatment and rehabilitation progress in patients with stroke]

Based on the contemporary literature review, we have been introduced generally used neurological scales estimating the influence of new method of treatment on stroke progress. They are used to evaluate to treatment and rehabilitation progress. We also paid attention on the necessary elements, which every scale should contain and have been characterized generally used scales in neurological practice.

Activity of adenosine deaminase in red blood cells of patients suffering from multiple sclerosis treated with adrenocorticotropic hormone

Adenosine deaminase (ADA) activity was studied in red blood cells of patients suffering from multiple sclerosis treated with adrenocorticotropic hormone (ACTH). ADA activity in hemolysates was determined according to the method of Hopkinson and calculated as units per g of hemoglobin. Activity of adenosine deaminase in healthy subjects was 0.871 +/- 0.251 U/g Hb. In patients with multiple sclerosis, before treatment ADA activity was 0.765 +/- 0.131 U/g Hb and was about 15.2% lower than in the control group (p < 0.02). After treatment with ACTH, ADA activity increased to 1.005 +/- 0.211 U/g Hb (p < 0.001). We have suggested that increased activity of adenosine deaminase in red blood cells of patients suffering from multiple sclerosis after treatment with ACTH is caused by diminution of superoxide generation, and therefore its sparing effect on cell membrane and enzyme is connected with membranes.

[Effect of laser biostimulation on leg blood flow in the course of arteriosclerosis]

Blood flow pattern (maximum moment velocity, mean velocity, artery diameter and minute flow) in the superficial femoral artery and in the foot artery was evaluated in 30 patients, subjected to laser biostimulation for symptoms of atherosclerotic ischemia of the lower limbs. The blood flow examination was performed before the treatment and immediately afterwards (20 procedures) and 6 months following the therapy. It was found that laser biostimulation had a favorable effect on the blood flow pattern, particularly in the initial stage of ischemia (Io), and may be a useful method of medical treatment in atherosclerotic ischemia of the lower limbs.

Red blood cell glutathione peroxidase activity in multiple sclerosis

Glutathione peroxidase (GSH-Px) activity of red blood cells of 23 multiple sclerosis (MS) patients (10 men and 13 women, aged 22-64 years) was examined and compared to the enzyme activity of 26 healthy persons (15 men and 11 women, aged 19-50 years). It was found that the mean GSH-Px activity was significantly higher (P less than 0.001) in red blood cells of MS patients (39.1 +/- 8.1 IU/g Hb) as compared to the group of healthy persons (25.9 +/- 5.2 IU/g Hb). There was no difference according to sexes in both the MS patients and the control group. The results are discussed based on the hypothesis that organic peroxides play a role in the etiology of multiple sclerosis.

[In vitro cytotoxic activity of peripheral blood lymphocytes in patients with multiple sclerosis. Preliminary report]

Using as target cells chicken erythrocytes labelled with chromium 51Cr the cytotoxic activity (spontaneous and induced with PHA and Con A mitogens) of peripheral blood lymphocytes was studied in patients with multiple sclerosis. The control group comprised healthy subjects, patients with systemic lupus erythematosus and other central nervous system diseases. No changes were observed in the cytotoxic activity of lymphocytes of patients with multiple sclerosis without respect to the course and a duration of the disease process. On the other hand, in patients with SLE a decrease of cytotoxic activity was observed in vitro, both spontaneous activity (p less than 0.01) and mitogen-induced (p less than 0.05) as compared with other group of patients.

[A case of Guillain-Barré syndrome]

The authors describe a case of Guillain-Barré syndrome with a high protein level in the cerebrospinal fluid. During the treatment corticotherapy was found to be of low effectiveness but a gradual improvement followed a combined treatment with imuran and corticosteroids with simultaneous intrathecal hydrocortisone administration despite persistence of changes in the concentration of total protein and immunoglobulins in the cerebrospinal fluid.

Participation of granulocytes in in vitro regulation of suppressor cell activity

In in vitro investigations factors were found in the specific granules of peripheral blood granulocytes of healthy subjects, which inhibited the induction of non-specific suppressor cells (S cells) in doses of 10 and 25 micrograms per 1 ml (1 X 10(6) cells) of 48-hour culture. In two-stage culture the S cells decreased the proliferation of responder lymphocytes (R cells) stimulated with Con A and pokeweed mitogen (PWM) by 56.8 +/- 2.4 per cent and 19.7 +/- 5.9 per cent, respectively. The above mentioned granulocyte factors (GF) caused a statistically significant reduction of S cell activity (p less than 0.01) or even its complete inhibition, depending on the mitogen stimulating the R cells (this inhibition was greater after stimulation of lymphocytes by PWM). Inactivation of proteolytic enzymes with di-isopropylfluorophosphate (DFP) failed to decrease the biological activity of these factors, which are released from the granulocytes after 30 minutes of granulocyte adherence to Petri dishes. Lymphocyte culture in a medium containing the supernatant from a culture of 1 X 10(6)/ml adherent granulocytes demonstrated increased proliferation of these lymphocytes and reduced activity of suppressor cells. On the other hand, an increase in the number of adherent granulocytes to 5 X 10(6)/ml of the medium produced a reverse effect: impairment of the proliferative response and enhancement of the activity of S cells.

Concentrations of cAMP and activity of pertinent enzymes in certain brain structures of the rabbit

The concentrations of cAMP and the activity of adenyl cyclase and specific cAMP-phosphodiesterase were determined in certain structures of rabbit brain. Statistically significant differences were found in the concentrations of cAMP; and enzyme activity between certain structures of the brain, particularly in the structures of the brain stem: mesencephalon, diencephalon and the pontine structures.

The effect of lysosome factors derived from PMNL of multiple sclerosis and systemic lupus erythematosus patients on suppressor cell activity in vitro

The lysosomal factors obtained from PMNL of healthy persons and patients with multiple sclerosis, systemic lupus erythematosus and other neurological diseases inhibited in vitro the generation of Con A-induced suppressor cell activity. The results obtained proved that these factors from granulocytes of MS-relapse and active LE have a stronger inhibitory effect on suppressor cell activity than on healthy ones.

[T-lymphocytes with a receptor for the immunoglobulin Fc fragment in the blood of multiple sclerosis patients]

In 12 multiple sclerosis patients and 15 healthy subjects the suppressor activity in vitro by the method of Shou et al. was determined parallelly with the number of T-lymphocytes with the receptor for the Fc fragment of immunoglobulin G (TG lymphocytes). In healthy subjects a correlation (p less than 0.05) was demonstrated between the suppressor activity of lymphocytes in vitro and the number of TG lymphocytes in the peripheral blood. On the other hand, in multiple sclerosis patients a decrease was observed frequently in the suppressor activity of these cells in vitro (especially during exacerbation of the disease) while the number of TG lymphocytes in the peripheral blood was normal or raised sometimes. Different causes of the this phenomenon in multiple sclerosis are discussed.

Suppressor cells function in healthy persons

The investigations were performed on lymphocytes isolated from peripheral blood of 26 healthy persons aged from 20 to 68 years. The following parameters were evaluated: T suppressor cell activity in two-step culture, concanavalin A (Con A) responsiveness in three-day culture and number of T lymphocytes carrying receptor for Fc portion of immunoglobulin G (TG cells). A slight increase in T suppressor activity and diminished responsiveness to Con A have been shown to be age-dependent. A correlation has been found between suppressor cells activity in vitro and the percentage of TG cells (r = 0.62, p less than 0.05). The level of suppressor activity of lymphocytes was independent of their Con A responsiveness.

[Cerebrospinal fluid cAMP and cGMP in various peripheral and central nervous system diseases. Preliminary report]

In a group of 51 patients the concentrations of cAMP and cGMP and their ratio were determined in the cerebrospinal fluid in certain neurological diseases. Statistically significant differences were found in the values of the concentrations of the above metabolites in selected groups of neurological diseases. Generally speaking, apart from a group of multiple sclerosis cases the values of cAMP concentration were higher in central nervous system diseases than in peripheral nervous system diseases. The highest values of the cAMP/cGMP ratio were observed in the group of patients with inflammatory conditions of the central nervous system. This method of cerebrospinal fluid examination may have an important role in the diagnosis of neurological diseases, particularly in multiple sclerosis.

[Suppressor cell activity in multiple sclerosis and other nervous system diseases. Preliminary report]

3H-Thymidine incorporation was assessed in concanavalin A-stimulated cultures of peripheral blood lymphocytes of healthy subjects and multiple sclerosis patients. At the same time the counts of T and B lymphocytes were determined in peripheral blood and the activity of suppressor cells was determined in vitro by the method of Shou et all. in these patients and in other neurological diseases. The studied immunological parameters showed some variability in patients with multiple sclerosis: at the time of exacerbations the activity of suppressor cells decreased and the mitogenic response to Con A was impaired. In remissions and in slowly progressive cases of multiple sclerosis the activity of suppressor cells was increased, particularly in elderly patients. The reported investigations demonstrated that disturbances in the functions of suppressor cells occur also in other neurological diseases. The role of the observed disturbances in the pathogenesis of multiple sclerosis is discussed.