Ireneusz M. Kowalski

Effectiveness of Chêneau brace treatment for idiopathic scoliosis: prospective study in 79 patients followed to skeletal maturity.

BackgroundProgressive idiopathic scoliosis can negatively influence the development and functioning of 2-3% of adolescents, with health consequences and economic costs, placing the disease in the centre of interest of the developmental medicine. The aim of this study was to evaluate the effectiveness of Chêneau brace in the management of idiopathic scoliosis.MethodsA prospective observational study according to SOSORT and SRS recommendations comprised 79 patients (58 girls and 21 boys) with progressive idiopathic scoliosis, treated with Chêneau brace and physiotherapy, with initial Cobb angle between 20 and 45 degrees, no previous brace treatment, Risser 4 or more at the final evaluation and minimum one year follow-up after weaning the brace. Achieving 50° of Cobb angle was considered surgical recommendation.ResultsAt follow-up 20 patients (25.3%) improved, 18 patients (22.8%) were stable, 31 patients (39.2%) progressed below 50 degrees and 10 patients (12.7%) progressed beyond 50 degrees (2 of these 10 patients progressed beyond 60 degrees). Progression concerned the younger and less skeletally mature patients.ConclusionConservative treatment with Chêneau orthosis and physiotherapy was effective in halting scoliosis progression in 48.1% of patients. The results of this study suggest that bracing is effective in reducing the incidence of surgery in comparison with natural history.

Evaluation of the effectiveness of Chêneau brace treatment for idiopathic scoliosis – own observations

Abstract Introduction Progressive nature of scoliosis significantly affects the development and functioning of a young organism. The extensive interest of medical experts in spinal deformities stems from their high incidence in the population of youth (2–3%), health consequences resulting from the disease progression as well as high economic and social costs. Aim Evaluation of the effectiveness of the Cheneau brace in the treatment of idiopathic scoliosis. Materials and methods The research material comprised 302 patients treated in the Chair and Teaching Hospital of Rehabilitation and the Provincial Childrens Hospital in Ameryka near Olsztyn, for idiopathic scoliosis, ranging in ages from 8 to 17. The observation period was from 2 to 5 years. Qualification for orthopedic brace was conducted according to the recommendations of an international group of experts. We analyzed radiograms in the antero-posterior projection taken during the treatment and assessed the Cobb angles. The treatment was finished after skeletal maturity was achieved. Results At the stage of research material analysis some patients were excluded for the following reasons: lack of skeletal maturity – 66 (21.8%), interrupted treatment – 110 (36.4%), co-existing diseases impacting on the clinical course of scoliosis – 47 (15.5%). The study group, i.e. 79 patients, who completed their treatment, were divided into sub-groups depending on the effect of their treatment. 20 patients improved (24.7%), 18 (22.2%) were stable, 9 (11.1%) worsened, and 32 (41.9%) were qualified for surgical procedure. Discussion Meta-analyses of international literature have shown that bracing is an effective therapeutic method for idiopathic scoliosis. However, our studies have shown that a large number of patients decide to finish their therapy too early or do not undertake brace treatment at all. Conclusions A large number of patients in the lowest mean age group (12.4 years) who were eventually qualified for surgical procedure is disconcerting. The best outcome of the Cheneau brace treatment was achieved in the group of the highest mean age of 14.3.

Objective parallel-forms reliability assessment of 3 dimension real time body posture screening tests.

BackgroundScreening tests play a significant role in rapid and reliable assessment of normal individual development in the entire population of children and adolescents. Body posture screening tests carried out at schools reveal that 50-60% of children and adolescents demonstrate body posture abnormalities, with 10% of this group at risk for progressive spinal deformities. This necessitates the search for effective and economically feasible forms of screening diagnosis. The aim of this study was to assess the reliability of clinical evaluation of body posture compared to objective assessment with the Zebris CMS-10 system (Zebris Medical GmbH).MethodsThe study enrolled 13-15-year-old pupils attending a junior secondary school (mean age 14.2 years). The study group consisted of 138 participants, including 71 girls and 67 boys, who underwent a clinical evaluation of the body posture and an examination with the Zebris CMS 10 system.ResultsStatistically significant discrepancies between the clinical and objective evaluation were noted with regard to lumbar lordosis in boys (n = 67) and thoracic kyphosis in girls (n = 71). No statistically significant differences in both groups were noted for pelvic rotation and trunk position in the frontal plane.Conclusions1. The finding of significant discrepancies between the results of assessment in the sagittal plane obtained in the clinical examination and Zebris CMS-10-based assessment suggests that clinical evaluation should be used to provide a general estimation of accentuation or reduction of spinal curvatures in the sagittal plane.2. The clinical evaluation of posture is reliable with regard to assessment in the frontal plane.3. The Zebris CMS-10 system makes the clinical examination significantly more objective with regard to assessment of the physiological curvatures and may be used to make screening tests more objective with regard to detecting postural defects.

Ensuring rehabilitation and a full quality of life for patients with chronic non-infectious diseases

Abstract Introduction Chronic non-infectious diseases (CNID), such as heart and vascular disorders, malignant tumors, diabetes mellitus, chronic obstructive lung disease, obesity, are one of the most topical health problems for Lithuanian and Polish residents. In solving the problems of CNID three areas of medicine (prophylactics, diagnosis and treatment, rehabilitation) are important, as the diseases that begin in childhood are diagnosed most often in the mature age, and their consequences are manifested in an older age. Aim The aim of this article was to discuss issues concerned with providing help for patients afflicted with CNID and devising an effective rehabilitation system for them. Discussion Efficiency of pharmacological and surgical treatments for patients with CNID is much lower than for patients with acute disorders. They progress slowly and exert damaging effects on patients’ biopsychosocial functions. When the outcomes of a disease are manifested as impaired biopsychosocial functions, a life of full quality can only be ensured with the establishment of effective rehabilitation. Conclusions Rehabilitation should be long-term, complex and should involve elements of prophylactics. Investment in such a system is an investment in an inevitable future for each of us, and it always pays positive dividends.

Assessment of visual perception in adolescents with a history of central coordination disorder in early life – 15-year follow-up study

Introduction Central nervous system damage in early life results in both quantitative and qualitative abnormalities of psychomotor development. Late sequelae of these disturbances may include visual perception disorders which not only affect the ability to read and write but also generally influence the childs intellectual development. This study sought to determine whether a central coordination disorder (CCD) in early life treated according to Vojtas method with elements of the sensory integration (S-I) and neuro-developmental treatment (NDT)/Bobath approaches affects development of visual perception later in life. Material and methods The study involved 44 participants aged 15-16 years, including 19 diagnosed with moderate or severe CCD in the neonatal period, i.e. during the first 2-3 months of life, with diagnosed mild degree neonatal encephalopathy due to perinatal anoxia, and 25 healthy people without a history of developmental psychomotor disturbances in the neonatal period. The study tool was a visual perception IQ test comprising 96 graphic tasks. Results The study revealed equal proportions of participants (p < 0.05) defined as very skilled (94-96), skilled (91-94), aerage (71-91), poor (67-71), and very poor (0-67) in both groups. These results mean that adolescents with a history of CCD in the neonatal period did not differ with regard to the level of visual perception from their peers who had not demonstrated psychomotor development disorders in the neonatal period. Conclusions Early treatment of children with CCD affords a possibility of normalising their psychomotor development early enough to prevent consequences in the form of cognitive impairments in later life.

Immunohistochemical characterization of superior cervical ganglion neurons supplying porcine parotid salivary gland

The main goal of our study was to investigate the chemical coding of the superior cervical ganglion (SCG) sympathetic neurons supplying the porcine parotid gland. Additionally, the chemical nature of the vicinal nerve fibers surrounding the parotid SCG perikarya was investigated. Fast blue (FB) retrograde tracing of the parotid gland and immunofluorescent labelling of SCG neurons were studied in juvenile female pigs. Microscopic analysis revealed that only ipsilateral SCG neurons were retrogradely labelled. The labelled neurons formed a discrete cluster in the middle and caudal region of the ganglion. Immunofluorescent labelling revealed that virtually all of the FB-positive parotid gland neurons were immunoreactive to tyrosine hydroxylase (TH), confirming their sympathetic nature. In addition to TH, the majority of the FB-positive neurons were found to be immunoreactive to calbindin (CB) and to a lesser extent for neuropeptide Y (NPY), leu-enkephalin (LENK) and galanin (GAL). In the close proximity of the FB-traced perikarya, a large number of immunoreactive (IR) vasoactive intestinal peptide (VIP-IR), pituitary adenylate cyclase-activating polypeptide (PACAP-IR), nitric oxide synthase (NOS-IR) processes were identified. Moreover, calcitonin gene related peptide-immunoreactive (CGRP-IR), substance P-immunoreactive (SP-IR), vesicular acetylcholine transporter (VAChT-IR), calretinin (CRT-IR), GAL-IR, LENK-IR and CB-IR protrusions were observed. The results of the present study provide a detailed characteristic of the location and neurochemical coding of sympathetic SCG neurons innervating the parotid salivary gland of the pig and lay ground for more advanced, clinical studies on salivary gland innervations.

Early detection of idiopathic scoliosis – analysis of three screening models

Introduction The prevalence of lateral curvatures of the spine ranges from 0.3% to 15.3% in the general population. The aim of the study was to develop and compare three different screening tests for idiopathic scoliosis (IS) with respect to their effectiveness and costs. Material and methods The Delphi method was used to assess the efficacy of each screening algorithm in detecting IS in the population. An economic analysis was also performed. Results Diagnostic Algorithm 1 for IS comprised a screening examination performed by nurses and a general practitioner (GP) with verification by specialists. The unit cost of carrying out diagnostic work-up for IS in Algorithm 1 was €94 per child. The second algorithm involved the use of the moiré computer method, followed by verification by a specialist. The lower unit cost of €86 per child of diagnostic work-up according to Algorithm 2 was due to fewer stages compared to Algorithm 1. The highest effectiveness with the highest costs were found for the third algorithm, with only one stage, a specialists consultation (cost €153 per child). Conclusions The number of stages in an algorithm does not correlate positively with its efficacy or cost. The recommended scheme is Algorithm 3, where children are examined by rehabilitation specialists or a physiotherapist using a scoliometer and an inclinometer. The use of the apparently most expensive scheme (Algorithm 3) should result in lowering the costs of treatment of established idiopathic scoliosis and, in the long term, prove to be the most cost-effective solution for the health care system.

Fibromyalgia Syndrome - a multidisciplinary approach

According to American College of Rheumatology fibromyalgia syndrome (FMS) is a common health problem characterized by widespread pain and tenderness. The pain and tenderness, although chronic, present a tendency to fluctuate both in intensity and location around the body. Patients with FMS experience fatigue and often have sleep disorders. It is estimated that FMS affects two to four percent of the general population. It is most common in women, though it can also occur in men. FMS most often first occur in the middle adulthood, but it can start as early as in the teen years or in the old age. The causes of FMS are unclear. Various infectious agents have recently been linked with the development of FMS. Some genes are potentially linked with an increased risk of developing FMS and some other health problems, which are common comorbidities to FMS. It is the genes that determine individual sensitivity and reaction to pain, quality of the antinociceptive system and complex biochemistry of pain sensation. Diagnosis and therapy may be complex and require cooperation of many specialists. Rheumatologists often make the diagnosis and differentiate FMS with other disorders from the rheumatoid group. FMS patients may also require help from the Psychiatric Clinic (Out-Patients Clinic) due to accompanying mental problems. As the pharmacological treatment options are limited and only complex therapy gives relatively good results, the treatment plan should include elements of physical therapy.

Pulmonary rehabilitation within intensive care units exemplified by traffic collisions casualties

Abstract Introduction The early introduction of a rehabilitation procedure is of vital importance in the process of acting upon the respiratory system. In comprehensive therapy, pulmonary rehabilitation is perceived as an integral part of treatment for mechanically ventilated patients. Aim The aim of this work was to conduct a comparative analysis of pulmonary rehabilitation concerning patients who had sustained an injury as the result of traffic collisions, and were subsequently treated in an intensive care unit (ICU). Materials and Methods Research material consisted of information contained in the medical documentation of 43 patients, ranging in ages from 15 to 57 years, treated in the ICU for injuries sustained during traffic collisions. This analysis involved the values of the parameters recorded first on admission of the patient to the unit, and then every 7 days thereafter, and finally upon discharge from the ICU, and included: arterial blood gasometry, pulsoxymetry, capnometry, body temperature, arterial blood pressure, and pulse rate. Results and Discussion Pneumonia occurred most frequently in patients ventilated mechanically during the period from the 15th to the 28th day of hospitalization and constituted 60% of the total occurring pneumonias. Deaths were observed more often in patients with acidosis and hypercapnia. Values of arterial oxygen saturation of hemoglobin (SaO2) below 94% were recorded in that group of patients for whom therapeutic procedures ended in failure (40%). For the remaining patients, SaO2 values exceeded 94%. The analysis of our material showed divergences concerning the values of partial pressure of end-tidal carbon dioxide (PetCO2) and partial pressure of carbon dioxide in the arterial blood (PaCO2). The mean values of SaO2 and percutaneous monitoring of hemoglobin oxygen saturation (SpO2) were similar. Conclusions The length of stay within the ICU is significant with respect to the occurrence of complications in the form of pneumonia. Patients whose parameter values were within the norm during pulmonary rehabilitation attained spontaneous respiration at discharge. SpO2 and PetCO2 are of vital importance in the pulmonary rehabilitation process, complemented by regularly taken arterial blood gasometry measurements.

The Research of Physical Activity and Physical Fitness for 11-15 Years Old Teenagers

Many studies in different countries show the tendency of decrease of teenagers physical activity and grow of number of health problems, diseases and physically weak pupils. The aim of research work: to examine physical activity and physical fitness for 11-15 years old teenagers, to search for relationship between these factors. The research was carried out in February–December 2011 at Utena Vyturiai Basic School. The study included 11-15 years old teenagers. There were performed the analysis of medical documentation; anonymous questionnaire; anthroposcopy; anthropometry; Eurofit tests; heart rate counting; Rufje test. Data statistical analysis was performed using SPSS 20.0 and Microsoft Excel 2010 software package. The results of the research showed, that there are less than one-third completely healthy teenagers who belong to the first health group, most common health problems are: cardiovascular diseases (29,7 percent)., optical disorders (24,1 percent)., musculo-skeletal disorders (14,8 percent). These health problems are more frequent among 14-15 years old teenagers. Physical fitness of 14-15 years old teenagers is worse compared to 11-13 years old teenagers: almost one-third (28 percent) 14-15 years old teenagers are overweight, 15 percent have poor posture and 14 percent - incorrect shape of lower extremities, while 11-13 year old teenagers only: 4 percent, 6 percent and 6 percent. Physical capacity of the majority of pupils is moderate and only 2,6 percent of pupils have high physical capacity. Physical fitness of teenagers is poor: investigated physical characteristics have range from 3,2 to 6,3 points. Physical activity of teenagers is not sufficient: a large part of teenagers avoid the activity in physical education classes, does not participate in after school sports activities, take exercises too rarely or don’t take exercise at all, spend a lot of time for passive recreation. Frequency of physical exercises, activity in physical education and time of passive leisure are factors which have impact to 11-15 years teenagers physical condition: their body mass index, posture and functional capacity of cardiovascular system. Article in Lithuanian