Alvydas Juocevicius

Intrathecal Baclofen Therapy for the Treatment of Spasticity in Lithuania

Spasticity of cerebral or spinal origin severely impairs an individuals functional ability and quality of life. Intrathecal baclofen (ITB) therapy via an implantable pump is indicated for use in patients unresponsive to oral antispasmodics. ITB therapy improves the daily caring for and relief of painful spasms. In Lithuania, ITB therapy was introduced in clinical practice just recently. We share our experience of spasticity management with the ITB pump system in five patients at Vilnius University Hospital Santariskiu Klinikos. Four patients had spastic tetraplegia associated with cerebral palsy, and one patient developed spastic paraplegia after a spinal epidural abscess.

People with Spinal Cord Injury in Lithuania

EPIDEMIOLOGY OF SPINAL CORD INJURY IN LITHUANIA Approximately 2500 people with spinal cord injury (SCI), both paraplegia and tetraplegia, live in Lithuania, divided between 1900 traumatic and 600 nontraumatic cases. The prevalence of traumatic SCI is 660 per million cases and 200 per million for nontraumatic. According to a recent retrospective study, the mean annual incidence rate for traumatic SCI in 2015 was 24 per million persons, with men accounting for 18.8 per million and women 5.2 per million. This annual incidence rate appears to have decreased from 32 per million in the period 1994–2006 to the current 24 per million rate. Age-adjusted incidence rates, however, did not change for men or women from the period 1994 on, although the mean age at onset increased among men (from 34.6 to 42.4 years) and women (from 35.8 to 40.4 years). For men and women 55 years or older, the incidence rate per million was significantly higher in 2007–2015 than in 1994–2006. In another unpublished study, it was noticed that there has been since the early 1990s an increasing incidence rate of nontraumatic SCI (39%) among older persons with corresponding decreasing incidence rates of traumatic SCI (61%) for younger inhabitants. The most common causes of SCI in Lithuania are road traffic crashes at 31.7%, falls at 41.6%, violence at 4.9%, and unspecified for 21.8% of cases. The proportion of traumatic SCI due to falls and household injuries increased among those 55 years or older but decreased in the case of diving accidents and weather among younger persons. Spinal cord injury lesion level-adjusted incidence rates during the 1994–2006 period were 60.6% for paraplegia and 39.4% for tetraplegia. During the 2007–2015 period, there was an increased incidence rate of tetraplegia to 45.9% and a decreased incidence of paraplegia to 54.1%. Mortality at the early, acute phase ranges between 4.4% and 16.7%, with patients dying within the first days after the injury. The main causes of these deaths were reperfusion injury, respiratory system problems, and urological complications.

The role of the European physiatrist in traumatic brain injury.

Sale P, Zampolini M, Juocevicius A, Lains JM, Giustini A, Negrini S, Franceschini M: The Role of the European Physiatrist in Traumatic Brain Injury. Am J Phys Med Rehabil 2011;90:83Y86.

Positive impact of a 4-week duration supervised aerobic training on anthropometric, metabolic, hemodynamic and arterial wall parameters in metabolic syndrome subjects

Summary Objectives: Metabolic syndrome (MetS) is linked to the development of type 2 diabetes and increased risk of cardiovascular disease (CVD). Physical inactivity is one of the main pathophysiological factors of MetS subjects. The aim of this study was to evaluate if 4-week supervised aerobic training had any impact on anthropometric, metabolic, hemodynamic and arterial wall parameters in MetS subjects. Design and methods: 57 MetS subjects were randomly selected from a Lithuanian High Cardiovascular Risk (LitHiR) national primary prevention programme. Hemodynamic, cardiometabolic risk and arterial wall parameters were evaluated after the 4-week supervised aerobic training. Results: After 4 weeks of aerobic training there was statistically significant decrease in body mass index from 30.58 ± 3.7 to 30.3 ± 3.55 kg/m2 (p = 0.010), waist circumference from 104.24 ± 9.46 to 102.9 ± 9.48 cm (p = 0.003), decrease of LDL cholesterol from 4.21 ± 1.15 to 3.78 ± 1 mmol/l (p = 0.032) and high sensitivity C-reactive protein from 2.01 ± 2.36 to 1.64 ± 1.92 mg/l (p = 0.009), decrease of diastolic blood pressure (BP) from 83.06 ± 10.18 to 80.38 ± 8.98 mmHg (p = 0.015), mean BP from 100.03 ± 10.70 to 97.31 ± 8.88 mmHg (p = 0.027) and aortic stiffness, assessed as carotid-femoral pulse wave velocity, from 8.34 ± 1.26 to 7.91 ± 1.15 m/s (p = 0.034). Conclusions: In subjects with MetS even short-duration (4-week) supervised aerobic exercise training is associated with improvement of some anthropometric, metabolic and hemodynamic parameters as well as the decrease in aortic stiffness. This training modality could be recommended for initiation of physical training and could increase motivation for further physical activity.

ALTERNATIVE METHOD OF UPPER EXTREMITY FUNCTION ASSESSMENT OF STROKE PATIENTS BY ANGULAR KINEMATIC PARAMETERS

This study focuses on the functional assessment of the upper extremity of stroke patients via analysis of angular kinematics features. Amplitudes and angular velocities of multi-joint movements more precisely describe functional state at different impairment levels. However, the arm movement as a whole could be analyzed by means of joint angle–angle diagrams, which illustrate the 2D trajectory of upper extremity during movement and show the visual ranges of upper extremity in different cycles of motion. The functional range of motion of each upper extremity segment in all patient groups for more accurate assessment of capability was calculated. Moreover, we calculated the area (S) between two curves in joint angle–angle diagrams as a novel index of the complete upper extremity movement range evaluation. Our findings correspond to clinical rates and upper extremity assessment based on joint angle–angle diagrams seems to be a promising method for accurate assessment and/or predicting the outcomes of rehabilitation programs.

Role of Physical Activity in Reduction of Metabolic Syndrome Elicted Risk of Cardiovascular Disease and Diabetes

Metabolic syndrome consists of a cluster of the cardio-metabolic risk factors - abdominal obesity; glycemic disorder, dyslipidemia and hypertension. Presence of metabolic syndrome elevates the risk of development of diabetes as well as progression of cardiovascular disease. The high prevalence of metabolic syndrome in most developed countries, including Lithuania is reported in various studies. Evidence suggests that regular moderate to vigorous intensity physical activity may reverse cardio-metabolic risk factors as well as may be preventive of the metabolic syndrome. That helps to avoid cardiovascular diseases as well as the development of diabetes. Resistance exercise is recommended as an adjunct to regular aerobic exercise in subjects with metabolic syndrome.