Cervical Spondylotic Myelopathy-Diagnostics and Clinimetrics

Cervical myelopathy is referred to in many ways in the English literature, for example, as cervical spondylotic myelopathy (CSM), spondylotic radiculomyelopathy (SRM) or degenerative cervical myelopathy (DCM). In addition, more frequent occurrences are noted in older adults and to a greater extent in men. The causes of the effects of cervical myelopathy may be the appearance of lesions on the spinal cord, ischemia due to compression of the vertebral artery and repeated micro-injuries during maximal movements-hyperflexion or hyperextension. It is well known that lesions on the spinal cord may occur in a quarter of the population, and this problem is clearly noted in people over 60 years old. The symptoms of SCM develop insidiously, and their severity and side (unilateral or bilateral) are associated with the location and extent of spinal cord compression. Neurological examination most often diagnoses problems in the upper limbs (most often paresis with developing hand muscle atrophy), pyramidal paralysis in one or both lower limbs and disorders in the urinary system. To make a diagnosis of CSM, it is necessary to perform MRI and neurophysiological tests (such as EMG or sensory and/or motor-evoked potentials). The use of appropriately selected scales and specific tests in diagnostics is also crucial. This narrative review article describes the latest knowledge on the diagnosis and clinimetrics of cervical spondylotic myelopathy in adults and provides future directions.

Is There a Standard Rehabilitation Procedure in Cervical Dystonia?

Introduction: Idiopathic cervical dystonia, also known as spasmodic torticollis, is the most common form of focal dystonia in adults. Cervical dystonia usually appears between the ages of 30 and 50, twice as often in women, and is characterised by uncontrollable painful contractions of the sternocleidomastoid muscle, which results in misalignment of the head and shoulder. Over time, the disease becomes very burdensome for the patient and reduces his/her independence and quality of life; falls happen.Aim: The aim of the article is to present the current state of knowledge on comprehensive rehabilitation in cervical dystonia. Data on the prevalence, symptoms, diagnosis, clinical assessment, pharmacological treatment (including the most commonly used botulinum toxin), neurosurgical treatment and comprehensive rehabilitation are presented.Methods: The applied methods was a narrative critical review of scientific reports.Results: Out of several hundred publications, works worthy of particular attention were selected. In them, are described of conducting exercises, the main goal of which is to stretch and relax the dystonic muscles while strengthening the antagonistic muscles and correcting the position of the head. The selected authors used manual therapy, exercises at the patient's home, EMG biofeedback, magnetic stimulation of the cerebellum, vibration of the neck muscles, functional electrostimulation (FES) of antagonistic muscles, mobilisation of the cervical spine, postural exercises, isometric exercises, muscle relaxation, the PNF method, relaxation training, balance exercises, coordination, corrective exercises, massage, relaxation exercises, stretching and kinesiotaping.Conclusions: The variety of disease forms (10 head positioning patterns are described) and different severity of symptoms make it impossible to draw up a scheme of rehabilitation. In each case, rehabilitation must be tailored individually, and the physiotherapist taking care of the patient should have extensive experience. Physiotherapy can alleviate the disability caused by dystonia, however, due to the many non-motor symptoms, a holistic approach to the patient should also be kept in mind.

Do Knee Joint Orthoses Affect the Functional Status of Stroke Patients? A Literature Review

Stroke is the leading cause of adult disability in developed countries. As a result of damage to the central nervous system, the patient's independence in performing everyday activities is reduced, which often leads to dependence on the environment. The symptoms of syndromes affect many functions, including: speech, the upper limb, gait, balance and coordination disorders. These disorders lead to a decrease in the patient's quality of life. Many patients require knee braces to learn to walk. In this review article, the most commonly used scales used to assess the functional status of patients after stroke are discussed, with particular attention being paid to gait assessment. We described simple (basic ADL) and instrumental (extended) scales of activities of daily living (instrumental, extended ADL), methods of clinical gait and balance assessment, International Classification of Functioning, Disability and Health, ICF), as well as recommendations of the European Stroke Organisation (ESO, Neurorehabilitation Committee). These guidelines regard methods of evaluating the results of post-stroke rehabilitation for clinical use - Outcome Measures for Clinical Use, in which, among others, the Berg scale and the timed Up & Go test are recommended for the lower limb, the Barthel scale and the Functional Independence Measure for ADL, and the Stroke Impact Scale for the participation column in all 3 ICF domains. In the article, the current state of knowledge is presented regarding the impact of knee braces on the functional status of people after stroke. Mechanical knee and ankle orthoses are called KAFO (Knee Ankle Foot Orthosis). Their main tasks include immobilisation of the knee joint and aid in learning to walk.

Home-Based Exercise to Improve Motor Functions, Cognitive Functions, and Quality of Life in People with Huntington's Disease: A Systematic Review and Meta-Analysis

Exercise in different settings has become a fundamental part of Huntington's disease (HD) management. The aim of this systematic review and meta-analysis was to investigate the effectiveness of home-based exercises (HBE) in HD. Randomized controlled trials (RCTs) investigating the effect of HBE on motor, cognitive, or health-related quality of life (QoL) outcomes in HD were included. Standardized mean difference (SMD), the 95% confidence interval, and p-values were calculated by comparing the outcomes change between HBE and control groups. Seven RCTs met the inclusion criteria. The included RCTs prescribed different types of HBEs, i.e., aerobic strengthening, walking, balance, and fine motor exercises. The HBE protocol length was between 6 and 36 weeks. The meta-analyses showed a significant effect of HBE intervention on motor function measure by Unified Huntington Disease Rating and overall QoL measure by Short Form-36 post-treatment respectively, [SMD = 0.481, p = 0.048], [SMD = 0.378, p = 0.003]. The pooled analysis did not detect significant changes in cognition, gait characteristics, or functional balance scales. The current study shows the positive effect of HBE in HD, especially on motor function and QoL. No significant adverse events were reported. The current results support the clinical effect of HBE intervention on motor function and QoL in HD patients. However, these results should be taken with caution due to the limited available evidence. Well-designed clinical studies that consider the disease severity and stages are required in the future.

Osteoporosis in Polish Older Women: Risk Factors and Osteoporotic Fractures: A Cross-Sectional Study

Background: Osteoporosis is a skeletal disease. It is still not known which of the risk factors have the greatest impact on osteoporosis development. The study aimed to determine how the selected osteoporosis risk factors contribute to the development of the disease and to assess the risk of osteoporotic fractures in older women. Methods: A cohort of 99 older females was divided into two groups (with and without osteoporosis). The risk of osteoporosis was determined using assessment forms and bone densitometry data subjected to logistic regression. The risk of osteoporotic fractures was assessed by the FRAX tool (FRAX, Center for Metabolic Bone Diseases, University of Sheffield, UK). Results: The logistic regression analysis showed that the highest risk of developing osteoporosis associated with lifestyle, mainly cigarette smoking (odds ratio: OR = 2.12), past gynecological operations (OR = 1.46), corticosteroid therapies (OR = 1.38). More than half of participants were at a medium risk of femoral neck fractures (over 90% in the osteoporotic group). Conclusion: Most of the Polish women living in care facilities are at medium risk of low-energy fractures. Smoking appeared to have the strongest effect on osteoporosis among analyzed risk factors. The results may contribute to the creation of more appropriate prevention strategies.

Effect of Physical Activity on the Quality of Life in Osteoporotic Females Living in Residential Facilities: A Randomized Controlled Trial

BACKGROUND AND PURPOSE

The study aimed to assess the effect of a program of modified Sinaki exercises and Nordic Walking on the life quality in osteoporotic and osteopenic females living in residential care facilities, taking into account their baseline level of activity and risk of falling. The study was designed as a randomized controlled trial.

METHODS

A sample of 91 females 65 to 98 years of age, the residents of Upper Silesian residential care facilities, was randomized into 4 groups. All groups received the same pharmacological treatment. In group 1 (control group), drugs were the only therapy; in group 2, the therapy was enhanced by program of modified Sinaki exercises; group 3 participated in Nordic Walking workout; and group 4 did both Sinaki exercises and Nordic Walking. Locomotor activity of the participants was estimated from pedometer readings. The risk of falling was assessed with the "Timed Up and Go" Test and the Functional Reach Test. With the QUALEFFO-41 questionnaire, the life quality of the participants was evaluated at baseline and after 12 months of intervention.

RESULTS AND DISCUSSION

The study revealed that the studied women were at high risk of falling and that their physical activity was relatively low, likewise the quality of their lives. Their satisfaction with life was reduced by poor health, limited mobility, and the lack of social activities. Life quality improved in all 3 intervention groups, but in the control group, it decreased. The results of Bonferroni's post hoc test pointed to statistically significantly better quality of life in groups 2 (P = .01) and 4 (P < .01).

CONCLUSION

Both modified Sinaki exercises and Nordic Walking significantly improved the participants' quality of life, but the most effective therapeutically was the combination of both these forms of physical activity.

Are short forms of Barthel Index equally useful in assessment of ADL?

It has been more than 50 years ago, when in 1965 Florence Mahoney and Dorothea Barthel published an article entitled "Functional evaluation: the Barthel Index." Since then, Barthel scale, also known as a Basic ADL Index (BI), Barthel Score and Maryland Disability Index, is one of the most well-known scales ADL (Activities of Daily Living) and is still popular. This simple scale is still used by the representatives of a number of medical workers for many pur-poses, including the assessment of the results of treatment, rehabilitation, prognosing, assess-ment of self-reliance, assessment of needs for care and for the purposes of the judgment. De-spite its simplicity, the administration of the original Barthel questionnaire takes about 5-10 minutes; that`s why there is a demand for a shortened form of BI. Based on a review of the literature the advantages and disadvantages of the abbreviated BI versions in assessing activities of daily living has been presented. Key Words ADL, Barthel Index, Barthel scale, clinimetrics, short forms Opara J. Are short forms of Barthel Index equally useful in the assessment of ADL? Med Rehabil 2018; 22(2): 40-44. DOI: 10.5604/01.3001.0012.6932

Effect of physical activity on the sequelae of osteoporosis in female residents of residential care facilities

BACKGROUND

Osteoporosis is one of the most common diseases that develop with age and cause high morbidity and mortality among elderly people.

OBJECTIVES

This study was set out to evaluate the influence of a program of modified Sinaki exercises, Nordic walking (NW) and a combination of these physical activities on people with osteoporosis.

MATERIAL AND METHODS

A sample consisting of 91 women aged 65-98 years living in residential care facilities was randomized into 4 groups. The control group (group 1) received only pharmacological treatment. In the other 3 groups, the same drug therapy was enhanced by a program of modified Sinaki exercises (group 2), Nordic walking (group 3), and Sinaki exercises and Nordic walking applied together (group 4). At baseline and after 12 months of intervention, the participants were assessed for bone density, rib cage mobility, motor abilities, risk of falling (Timed Up and Go Test - TUG, Functional Reach Test - FRT), and locomotor activity (based on pedometer readings). The intervention was completed by 83 participants.

RESULTS

Bone density (T-score) was higher in all intervention groups and in the control group (p < 0.003). The improvement in rib cage mobility was statistically significant in groups 2 (p < 0.001) and 4 (p < 0.002). Locomotor activity significantly improved in groups 3 (p < 0.000) and 4 (p < 0.000). The post-intervention results of the TUG and FRT tests showed a significantly lower risk of falling in group 4. In groups 1 and 2, the risk was higher, but not statistically significantly, and in group 3, it did not change.

CONCLUSIONS

Modified Sinaki exercises and Nordic walking significantly improved the mobility of the rib cage, locomotor activity and motor abilities in the women comprising groups 2 and 3, but the best results of the intervention were noted in the group treated with both forms of physical activity.

Quality of Life and Burden in caregivers of Multiple Sclerosis patients

Multiple sclerosis (MS) is one of the most disabling disorders of the central nervous system. Caregivers of individuals with MS may experience unique caregiver strain due to the age at onset and progressive nature of the disease. Additionally, because MS is more prevalent in women, men often become spousal caregivers. This places women in the position of being care recipients rather than caregivers. Some results also supported hypothesis that female caregivers reported a higher need for emotional support than male caregivers. As with female caregivers, decreased emotional support predicted poorer QoL among male caregivers. Caring for a MS patient may negatively impact several objective and subjective aspects of caregiver's life, such as physical and emotional health, morale, work life, finances, social mobility, interpersonal relationships and sexual life. In studies assessing the psychological consequences of care a higher level of anxiety and depression in caregivers than in the general population has been reported. Caregivers who experience burden are more likely to have a higher risk of depression and a lower quality of life. Early recognition of caregiver burden is important in determining appropriate interventions. In this review report the current state of knowledge about the QoL of MS caregivers as well the burden of MS caregivers has been described.

Motor assessment in Parkinson`s disease

Parkinson's disease (PD) is one of most disabling disorders of the central nervous system. The motor symptoms of Parkinson's disease: shaking, rigidity, slowness of movement, postural instability and difficulty with walking and gait, are difficult to measure. When disease symptoms become more pronounced, the patient experiences difficulties with hand function and walking, and is prone to falls. Baseline motor impairment and cognitive impairment are probable predictors of more rapid motor decline and disability. An additional difficulty is the variability of the symptoms caused by adverse effects of drugs, especially levodopa. Motor assessment of Parkinson`s Disease can be divided into clinimetrics, assessment of balance and posture, arm and hand function, and gait/walking. These are many clinimetric scales used in Parkinson`s Disease, the most popular being the Hoehn and Yahr stages of progression of the disease and Unified Parkinson's Disease Rating Scale. Balance and posture can be assessed by clinimetric scales like the Berg BS, Tinetti, Brunel BA, and Timed Up and Go Test, or measured by posturometric platforms. Among skill tests, the best known are: the Purdue Pegboard Test, Nine-Hole Peg Test, Jebsen and Taylor test, Pig- Tail Test, Frenchay Arm Test, Action Research Arm Test, Wolf FMT and Finger-Tapping Test. Among motricity scales, the most popular are: the Fugl-Meyer Motor Assessment Scale and Södring Motor Evaluation. Gait and walking can also be assessed quantitatively and qualitatively. Recently, the most popular is three-dimensional analysis of movement. This review article presents the current possibilities of motor assessment in Parkinson`s disease.

European core curriculum in neurorehabilitation

To date, medical education lacks Europe-wide standards on neurorehabilitation. To address this, the European Federation of NeuroRehabilitation Societies (EFNR) here proposes a postgraduate neurorehabilitation training scheme. In particular, the European medical core curriculum in neurorehabilitation should include a two-year residency in a neurorehabilitation setting where trainees can gain practical experience. Furthermore, it should comprise six modules of classroom training organized as weekend seminars or summer/winter schools. In conclusion, after defining the European medical core curriculum in neurorehabilitation, the next activities of the EFNR will be to try and reach the largest possible consensus on its content among all national societies across Europe in order to further validate it and try to extend it to the other, non-medical, professionals on the neurorehabilitation team in line with their core curricula defined by each professional association.

Where is the idea of Early Supported Discharge after stroke going?

In 2009 and in 2012 we published two articles in “Medical Rehabilitation” regarding the development of idea of Early Home Supported Discharge in stroke rehabilitation. Today, omitting the word “Home”, the abbreviation ESD is more popular. The aim of this article is to present the latest developments around the idea of continuing rehabilitation after early discharge from the hospital in a home setting. We primarily focus on the most recent reports, particularly systematic reviews. Each country has its own eligibility criteria which are different for early hospital discharge and follow-up rehabilitation in the place of residence, and sometimes the rehabilitation team staff also differs. So far, studies have shown that the optimal role of the rehabilitation team is coordination and delivery of rehabilitation in a home setting. It is also clear that the ESD model brings tangible economic benefits, mainly by shortening hospital stays. Specific organizational solutions used in different countries depend on cultural traditions, capabilities and financial sources.

[The neuroprotective effect of mild therapeutic hypothermia after out-of-hospital cardiac arrest with successful reanimation - a case report]

The use of mild therapeutic hypothermia (MTH) in adult patients remaining in a coma following cardiac arrest, regardless of its mechanism and location, is recommended by the European Resuscitation Council. The study presents a case of a 52-year-old man in whom MTH was used following successfully resuscitated out-of- hospital sudden cardiac arrest caused by ventricular fibrillation. On the basis of this case it was indicated that the use of low temperatures may be an effective method of neuroprotective treatment since such activity is compatible with later observed great possibility of the brain to compensate and with the maintenance of brain plasticity which is crucial for neuropsychological rehabilitation.

The application of virtual reality in neuro-rehabilitation: motor re-learning supported by innovative technologies

The motor function impairment resulting from a stroke injury has a negative impact on autonomy, the activities of daily living thus the individuals affected by a stroke need long-term rehabilitation. Several studies have demonstrated that learning new motor skills is important to induce neuroplasticity and functional recovery. Innovative technologies used in rehabilitation allow one the possibility to enhance training throughout generated feedback. It seems advantageous to combine traditional motor rehabilitation with innovative technology in order to promote motor re-learning and skill re-acquisition by means of enhanced training. An environment enriched by feedback involves multiple sensory modalities and could promote active patient participation. Exercises in a virtual environment contain elements necessary to maximize motor learning, such as repetitive and diffe-rentiated task practice and feedback on the performance and results. The recovery of the limbs motor function in post-stroke subjects is one of the main therapeutic aims for patients and physiotherapist alike. Virtual reality as well as robotic devices allow one to provide specific treatment based on the reinforced feedback in a virtual environment (RFVE), artificially augmenting the sensory information coherent with the real-world objects and events. Motor training based on RFVE is emerging as an effective motor learning based techniques for the treatment of the extremities.

The prevalence of stress urinary incontinence in women studying nursing and related quality of life

Urinary incontinence is a growing problem that affects millions of people worldwide. The purpose of this study was to assess the prevalence of stress urinary incontinence (SUI) in women studying nursing. Respondents completed a questionnaire assessing urinary incontinence, severity of symptoms and quality of life. Short forms to assess symptoms of distress for urinary incontinence and quality of life: UDI-6 and IIQ-7 have been used. The study's conclusions are as follows: 1) among the 113 interviewed women, stress urinary incontinence (SUI) was observed in 25% of respondents; this prevalence is similar to the age-matched population; 2) among the triggering factors mentioned in stress urinary incontinence the most frequent were: coughing, laughing and sneezing; 3) moderate impact of incontinence on quality of life has been shown, but this effect was not statistically significant.

[Differential diagnosis of multiple sclerosis and autoimmune rheumatic diseases]

Multiple sclerosis (MS) is a progressive demyelinating-inflammatory disease of the central nervous system, probably of autoimmune etiology. Characteristic qualities include multifocal demyelination, which result in varied clinical pictures of the disease. MS must be differentiated from chronic or recurring diseases, as well as from those with multifocal neurological manifestations and multifocal lesions revealed in a MR scan. Particular signs may precede the development of the full-blown MS, but they may be initial manifestations of autoimmune disease such as systemic lupus, antiphospholipid syndrome, Behçet's disease or Sjögren's syndrome as well. Diagnosis is easier in the later stages due to appearance of characteristic manifestations, absent in the course of MS. Nevertheless, the mildly symptomatic nature of those diseases may lead to misdiagnosis, putting the patient at risk of an expensive and inefficient treatment, which may only exacerbate the symptoms. In many cases a long-term follow-up is necessary to confirm the diagnosis.

Early post-stroke rehabilitation facilities in Poland in 2010

Purpose

The aim of this work was to survey the contemporary facilities of early post-stroke rehabilitation in Poland.

Relevance

Growing costs of health care enforced managers to be looking for new organizational solutions of services which could enable as early as possible rehabilitation after disease onset. Early post-stroke rehabilitation consists of many elements of modern strategy of rehabilitation. It realizes the idea of early rehabilitation and its continuation after discharge from stroke unit.

Participants

A questionnaire evaluating neuro-rehabilitation of persons who undergo stroke has been designed and distributed to 221 neurological wards and to 154 rehabilitation departments in Poland.

Methods

We were asking about time needed to wait for admission from neurological wards to rehabilitation departments, about the number of sessions per day, time duration of one session, number of sessions per week, average time of stay in department, methods of outcome measures etc.

Analysis

Until the end of 2010 we received 129 fulfilled questionnaires of 375, i.e. 35%. We received 78 fulfilled questionnaires from neurological wards and 51 from rehabilitation departments.

Results

Twenty-five percent of all patients after stroke were moved from neurological wards to rehabilitation department (15% directly). Fifty-four percent of all patients after stroke in rehabilitation departments were treated early post-stroke, i.e. up to three months after stroke.

Conclusions

Taking into account that about 60% of stroke survivals (30 days after onset), the contemporary facilities of early post-stroke rehabilitation in Poland in the year 2010 are not satisfied.

Implications

The delivery of post-stroke services should be improved. The Information on benefits of EHSD and implementation of Early Home Rehabilitation post stroke in Poland might help to solve this problem.

[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.

[Quality of life in visual disturbances in multiple sclerosis]

In multiple sclerosis (MS) often the visual pathway is impaired. Very early symptom which precedes neurological signs is the retrobulbar optic neuritis. In MS patients near as well as distance, color and peripheral vision can be disturbed. Many patients are not aware of visual impairment which could cause the delay in diagnosis. The assessment of the visual field in patients with MS enables early diagnosing as well as monitoring of the course of the disease. In monitoring of the course of disease most important is the evaluation of quality of life. The assessment of quality of life in MS is well known, even better than in other neurological diseases. Less known is the question of quality of life diminished because of visual field defects in MS. In review report the value of perimetry in diagnosing MS, visual disturbances in MS and contemporary possibilities of evaluation of quality of life in MS patients including those with defects in visual field has been described. The VFQ-25 questionnaire is a sensitive and useful tool in self-assessing visual function in MS patients.

Amphetamine and mCPP effects on dopamine and serotonin striatal in vivo microdialysates in an animal model of hyperactivity

In the neonatally 6-hydroxydopamine (6-OHDA)-lesioned rat hyperlocomotor activity, first described in the 1970s, was subsequently found to be increased by an additional lesion with 5,7-dihydroxytryptamine (5,7-DHT) (i.c.v.) in adulthood. The latter animal model (i.e., 134 microg 6-OHDA at 3 d postbirth plus 71 microg 5,7-DHT at 10 weeks; desipramine pretreatments) was used in this study, in an attempt to attribute hyperlocomotor attenuation by D,L-amphetamine sulfate (AMPH) and m-chlorophenylpiperazine di HCl (mCPP), to specific changes in extraneuronal (i.e., in vivo microdialysate) levels of dopamine (DA) and/or serotonin (5-HT). Despite the 98-99% reduction in striatal tissue content of DA, the baseline striatal microdialysate level of DA was reduced by 50% or less at 14 weeks, versus the intact control group. When challenged with AMPH (0.5 mg/kg), the microdialysate level of DA went either unchanged or was slightly reduced over the next 180 min (i.e., 20 min sampling), while in the vehicle group and 5,7-DHT (alone) lesioned group, the microdialysate level was maximally elevated by approximately 225% and approximately 450%, respectively--and over a span of nearly 2 h. Acute challenge with mCPP (1 mg/kg salt form) had little effect on microdialysate levels of DA, DOPAC and 5-HT. Moreover, there was no consistent change in the microdialysate levels of DA, DOPAC, and 5-HT between intact, 5-HT-lesioned rats, and DA-lesioned rats which might reasonably account for an attenuation of hyperlocomotor activity. These findings indicate that there are other important neurochemical changes produced by AMPH- and mCPP-attenuated hyperlocomotor activity, or perhaps a different brain region or multiple brain regional effects are involved in AMPH and mCPP behavioral actions.

Effectiveness of botulinum toxin A in the treatment of spasticity of the lower extremities in adults - preliminary report

BACKGROUND

Botulinum toxin (BTX is currently a recognised treatment for local spasticity, especially in children with cerebral palsy. The following paper presents the early result of BTX treatment for adult patients with spastic paresis of the lower limbs.

MATERIAL AND METHODS

Twenty adult paraplegic patients (mean age 42 years) following cervical or thoracic SCI or suffering from MS, with moderate-to-severe spasticity in the lower extremities received BTX for the first time in life into the thigh adductor, knee flexor and foot flexor muscle groups. Results were evaluated using Modified Ashworth's Scale, Visual (Analogue) Scale for Pain Assessment, Modified Rivermead Mobility Index and Repty Functional Index prior to and three weeks after the administration of the toxin.

RESULTS

Improvement was observed in most patients, usually manifesting as reductions or resolution of pain. Mild side effects (low-grade fever and flu-like symptoms) occurred in only one patient.

CONCLUSIONS

Our study confirmed the efficacy and safety of BTX for focal lower limb spasticity in adults.

Walking index for spinal cord injury

This review reports on the contemporary possibilities of objective evaluation of walking ability in patients with paraplegia following a spinal cord injury. Current methods of evaluation of walking function, i.e. the ASIA Classification, Functional Independence Measure (FIM), Barthel Index and Spinal Cord Independence Measure (SCIM) are described. The latest classification, known as the WISCI (Walking Index for Spinal Cord Injury) is described in detail. WISCI is the most detailed scale that is also the most sensitive to changes in the patient's walking ability compared to the other scales.

EFNS guideline on diagnosis and management of post-polio syndrome. Report of an EFNS task force

Post-polio syndrome (PPS) is characterized by new or increased muscular weakness, atrophy, muscle pain and fatigue several years after acute polio. The aim of the article is to prepare diagnostic criteria for PPS, and to evaluate the existing evidence for therapeutic interventions. The Medline, EMBASE and ISI databases were searched. Consensus in the group was reached after discussion by e-mail. We recommend Halstead's definition of PPS from 1991 as diagnostic criteria. Supervised, aerobic muscular training, both isokinetic and isometric, is a safe and effective way to prevent further decline for patients with moderate weakness (Level B). Muscular training can also improve muscular fatigue, muscle weakness and pain. Training in a warm climate and non-swimming water exercises are particularly useful (Level B). Respiratory muscle training can improve pulmonary function. Recognition of respiratory impairment and early introduction of non-invasive ventilatory aids prevent or delay further respiratory decline and the need for invasive respiratory aid (Level C). Group training, regular follow-up and patient education are useful for the patients' mental status and well-being. Weight loss, adjustment and introduction of properly fitted assistive devices should be considered (good practice points). A small number of controlled studies of potential-specific treatments for PPS have been completed, but no definitive therapeutic effect has been reported for the agents evaluated (pyridostigmine, corticosteroids, amantadine). Future randomized trials should particularly address the treatment of pain, which is commonly reported by PPS patients. There is also a need for studies evaluating the long-term effects of muscular training.

[Current possibilities of assessment of quality of life in multiple sclerosis]

An overall aim of treatment in multiple sclerosis is to minimize the negative impact of the disease on functioning and quality of life of patients. Therefore, a measurement of functioning and quality of life should be included in the evaluation of the effectiveness of treatment. In this paper, the most commonly used quality of life questionnaires, either generic or specific, are presented. The information about clinical and functional status are useful in the interpretation of the quality of life assessment results. Therefore, the instruments for the assessment of depression, cognitive functions, functional ability and fatigue in multiple sclerosis are also described.

Monitoring the treatment of low back pain using non-steroid anti-inflammatory drugs and aromatic oil components

Background. The nervous system, in reaction to pain, restrains the range of motion in the affected limb, increasing the amplitude on the healthy side. Thus the asymmetry of a given motion can be used in the quantitative assessment of the impact of pain on the nervous system. The main aims of our study were: (1) to apply Lasegue's asymmetry coefficients, static and dynamic podoscopy, and the test of changed contour to the description of human spinal asymmetry caused by vertebral-nerve root pain in the lumbar spine, and (2) to apply the numerical coefficients of asymmetry to compare the analgesic effectiveness of ketoprofen (P) and vegetable extracts of aromatic oils (A) administered percutaneously by electrophonophoresis. Material and methods. The study population of 42 people was treated with A and P in a double blind trial, and then the asymmetry coefficients before and after therapy were compared. We used a program that analyzes the contour of the patient's back, a podoscopic scanner, a tensometric scanner, and an electromechanical analyzer of Lasegue's test. Results. Treatment A (aromatic oils) was significantly (p < 0.05) more effective (ca. 12.5%) than treatment P (ketoprofen). Conclusions. The regression coefficients ASRB and TB, and the asymmetry coefficients LM, PS, PD, and PG, are suitable for the description of human spinal asymmetry caused by low back-pain. When asymmetry coefficients were used to assess outcome, analgesic treatment with vegetable extracts of aromatic oils (A) was more effective than ketoprofen (P).

Classification systems and quality of life in back pain

Low back pain often has an impact on the patient's quality of life, in many cases leading to deterioration. This article contains a comprehensive review of the literature relating to classification systems for the clinical evaluation of low back pain, and questionnaires for evaluating the quality of life of persons suffering from low back pain. The psychological, social, professional and occupational implications of low back pain are also discussed.

[Current possibilities of evaluation of quality of life in Parkinson disease]

In this review report current possibilities of evaluation of quality of life in Parkinson's disease has been critically presented. Health Related Quality of Life (-HRQoL) comprise wide spectrum of consequences of disease. Measurement of quality of life has become increasingly relevant as an outcome parameter, especially in long-term trials. Most of the available QoL instruments depend on patient self-reports. The data can be collected by written questionnaires. There are universal questionnaires of QoL--for many diseases and the specific ones--specially created for one disease. Among universal questionnaires the Sickness Impact Profile (SIP) and the Short-Form Health Status Survey (SF-36) are most popular in Parkinson's disease. As for specific questionnaires: the Parkinson's Disease Questionnaire (PDQ-39) (by Peto and Jenkinson, 1995) and the Parkinson's Disease Quality of Life Questionnaire (PDQL) (by de Boer and al., 1996) has been described.

Quality of life following spinal cord injury

Spinal cord injuries often have impact on patient;s further life. In early period after trauma there are many medical problems, later on one can observe the decrease of quality of life. In this article a comprehensive review of liteature relating to the situation of persons after SCI has been presented. It means social condition, familiar life, education, vocational status, sport, recreation and psychological implications.

The usefulness of evaluation of Activities of Daily Living for prediciting the return to the gainful job after rehabilitation of patients suffering from lumbar discopathy

Is this elaboration the analysis of a return to gainful work by 76 consecutive suffering from back pain and ischiadic neuralgia due to the lumbar discopathy after rehabilitation has been presented. The following parameters which might have influenced the return to work: age, sex, treatment, employment, education, the length of incapaticy for work has been analysed. The relevancy of the opinion given by doctors at rehabilitation centre on the patients capacity for work in relation to their future return to the gainful work in relation to their future return to the gainful work has been analysed. The utility of measuring activities of daily living (ADL), level of depression and quality of life (HRQoL) for predicting return work has been estimated. As the tools the Functional Index "Repty", Beck's Depression Scale and an own Simple Life Satisfaction Scale has been used.

[Possibilities of subjective and objective evaluation of spasticity]

In this paper the most commonly used methods of assessment patients with spasticity has been presented. "Measuring" of spasticity is necessary for evaluation of new methods of treatment. This could be made directly or indirectly--in that case the sequela of spasticity is measured. In this elaboration as well subjective as objective methods of examination in spasticity has been described. The tone intensity scales, spasm frequency scores, global scales of motor impairment, ADL scales, upper extremity dexterity and strength testing, examination techniques and maneuvers to differentiate rectus femoris from iliopsoas and gastrocnemius from soleus tightness, clinical gait scores, EMG and goniometric pendulum test has been mentioned.

Prediction of pharmacokinetic parameters and the assessment of their variability in bioequivalence studies by artificial neural networks

PURPOSE

The methodology of predicting the pharmacokinetic parameters (AUC, cmax, tmax) and the assessment of their variability in bioequivalence studies has been developed with the use of artificial neural networks.

METHODS

The data sets included results of 3 distinct bioequivalence studies of oral verapamil products, involving a total of 98 subjects and 312 drug applications. The modeling process involved building feedforward/backpropagation neural networks. Models for pharmacokinetic parameter prediction were also used for the assessment of their variability and for detecting the most influential variables for selected pharmacokinetic parameters. Variables of input neurons based on logistic parameters of the bioequivalence study, clinical-biochemical parameters, and the physical examination of individuals.

RESULTS

The average absolute prediction errors of the neural networks for AUC, cmax, and tmax prediction were: 30.54%, 39.56% and 30.74%, respectively. A sensitivity analysis demonstrated that for verapamil the three most influential variables assigned to input neurons were: total protein concentration, aspartate aminotransferase (AST) levels, and heart-rate for AUC, AST levels, total proteins and alanine aminotransferase (ALT) levels, for cmax, and the presence of food, blood pressure, and body-frame for tmax.

CONCLUSIONS

The developed methodology could supply inclusion or exclusion criteria for subjects to be included in bioequivalence studies.

[Possibilities of objective evaluation of treatment and rehabilitation effects after the stroke]

The development of scoring scales has been initiated because of the need of documentation of results as well treatment as rehabilitation of stroke hemiplegic patients. Directly after onset at stroke unit there is demand for defining of prognosis. In rehabilitation the interest in stroke scales has been aroused from the need of evaluation of functional state (activities of daily living), disability, handicap, quality of life, statement of capacity for work or need of home-care. For evaluation of outcome after rehabilitation the most usefull seem to be functional scales (ADL) and quality of life measures (QOL). It is also suitable to mention the scales that evaluate motor function--those functions are the most important task in poststroke rehabilitation.

[Clinimetrics in parkinsonism]

Clinimetrics, which has been developed beginning from stroke scales, nowadays is used in evaluation of many other diseases. It is needed as well for evaluation of impairment and functional state as for clinical assessment of new drugs. Lately one can observe shifting of attention to psychosocial issues. In this paper the most commonly used scales for evaluation of impairment, activities in daily living and quality of life in parkinsonism have been critically presented. Those scales are reliable and valid in the assessment of treatment, prognosis, classification of invalidity and social care decisions.

["Repty" stroke scale . "Repty" Scale for the evaluation of the degree of injury after cerebral stroke. Part I]

Own modification of stroke scale, which enables evaluation of impairment in hemiplegic patients is presented. The scale named "Repty" consists of 15 items, including bowel and bladder function, enables precise evaluation of neurological impairments. The comparison between "Repty" scale and Orgogozo scale was carried out. Interobserver agreement and correlation between both scales was calculated.

["Repty" scales of strokes. Functional index "Repty" for the evaluation of ADL in hemiplegic patients after cerebral stroke. Part II]

Own modification of the Functional Independence Measure, which enables evaluation of activities of daily living in hemiplegic stroke patients is presented. The index of function "Repty", shorter and simpler, consists of 15 items, and makes possible exact estimation of functional state. This is useful in evaluation of the effects of treatment, and rehabilitation, and state of disability as well. The advantage of the "Repty" index over Barthel index results from evaluation of verbal communication and more extended scoring system.

[Comprehensive rehabilitation of multiple sclerosis patients]

Rehabilitation of Multiple Sclerosis patients is one of the most specific problems because of its variable and unforeseeable course. Rehabilitation procedures of those patients must be performed individually and very elastic in every case. In this elaboration the most commonly appeared forms and course of MS have been presented. According to it the planing of the rehabilitation has been adapted. Basic rules of the exercises during the relapse and during the remission have been presented. The greatest attention has been paid to the problems of managing spasticity and the reeducation of neurogenic bladder.

[Functional marker "Repty" for evaluation of independence in patients with paraplegia]

The use of "Repty" index for functional assessment of treatment results in 40 patients with paraplegia aged 13-65 (mean 37) is presented. The outcome has been compared with Barthel Index- the oldest scale assessing activities of daily living. High correlation of both scales sensitivity was found; in some functional parameters "Repty" index was more sensitive.