Mariusz Pawłowski

Interaction Between Heart Rate Variability and Heart Rate in Pediatric Population

Background: Heart rate variability (HRV) is primarily heart rate (HR) dependent, and therefore, different HR may exert different impact on HRV. The objectives of the study were to evaluate the effect of HR on HRV in children and to determine whether HRV indices normalized to HR are sex- and age-related. Methods: Short-term ECG recordings were performed in 346 healthy children. Standard time and frequency domain HRV parameters and HR were analyzed in four age subgroups (6–7, 8–9, 10–11, and 12–13 years old). To investigate the HR impact on HRV, standard HRV parameters were normalized to prevailing HR. Results: Standard HRV measures did not differ between age subgroups, however, HR significantly decreased with subjects age and turned out to be the strongest determinant of HRV. The normalization of HRV to prevailing HR allowed to show that sex-related differences in standard HRV resulted from differences in HR between boys and girls. The normalized HRV significantly decreased with age—before the normalization this effect was masked by age-related HR alterations. Conclusions: HR significantly impacts HRV in pediatric population and turns out to be the strongest determinant of all standard HRV indices. The differences in standard HRV between boys and girls result from differences in their HR. The normalized HRV is decreasing with age in healthy children and it is accompanied by the reduction of HR—as a net result, the standard HRV is constant in children at different ages. This may reflect the maturation of the autonomic nervous system.

Association of Vitamin D Deficiency and Degree of Coronary Artery Disease in Cardiac Patients with Type 2 Diabetes

Several modifiable factors may influence cardiac function in diabetic patients. The aim of the study was to evaluate the influence of vitamin D level on the stage of coronary atherosclerosis in cardiac patients diagnosed with type 2 diabetes. The study was performed in 337 consecutive patients undergoing coronarography. The stage of atherosclerosis was evaluated using Coronary Artery Surgery Study Score. The plasma 25(OH)D concentration was determined by an electrochemiluminescence method. Patients without significant lesions in coronary arteries presented the highest 25(OH)D level, significantly higher than patients with one-, two-, and three-vessel coronary artery disease (CAD) (p < 0.01). Significantly lower level of the 25(OH)D was observed in patients hospitalized due to acute coronary syndrome (ACS) in comparison to patients hospitalized due to stable CAD (p < 0.001). Lower 25(OH)D levels were observed in patients with the history of myocardial infarction (MI) in comparison to patients without previous MI (p < 0.001). In cardiac patients with diabetes, the higher number of stenotic coronary arteries is associated with lower values of the 25(OH)D. A group of male cardiac patients with diabetes with significant stenosis in three coronary arteries, hospitalized due to acute coronary syndrome, with a history of previous MI and hyperlipidemia presented the lowest vitamin D level.

Zastosowanie wybranych testów korytarzowych w ocenie funkcji chodu dzieci i młodzieży z mózgowym porażeniem dziecięcym

STRESZCZENIE Wstęp. Główne zaburzenia funkcji chodu obserwowane w grupie pacjentów z mózgowym porażeniem dziecięcym (MPD) to zmniejszenie prędkości i wytrzymałości chodu oraz brak jego stabilności. Jedną z popularnych, nielaboratoryjnych metod oceny chodu oraz efektywności leczenia usprawniającego nastawionego na poprawę wybranych jego parametrów są testy korytarzowe. Celem pracy było przedstawienie najbardziej rozpowszechnionych testów korytarzowych stosowanych w grupie pacjentów z MPD. Metoda. Najczęściej stosowane testy korytarzowe zidentyfikowane zostały przy użyciu medycznych baz danych EMBASE, PubMed, Cochrane i PEDro. Testy korytarzowe. Istnieje wiele testów korytarzowych, a wybór odpowiedniego powinien być związany z celami programu leczenia usprawniającego. Sześciominutowy test korytarzowy służy do oceny wytrzymałości i jest to odległość, jaką badana osoba może pokonać podczas swobodnego 6-minutowego marszu. Dziesięciometrowy test korytarzowy wykorzystywany jest do oceny prędkości chodu poprzez pomiar czasu, w którym badany pokonuje 10-metrowy odcinek. Test Wstań i idź ocenia mobilność i ryzyko upadku wynikające z problemów związanych z zaburzeniami stabilności podczas chodu. Podsumowanie. Ocena wyników i efektów leczenia nastawionego na poprawę funkcji chodu powinna być istotną częścią procesu usprawniania. Testy korytarzowe są proste do wykorzystania w praktyce klinicznej ze względu na brak kosztów oraz sprzętu niezbędnego do ich wykonania. Wnioski. Testy korytarzowe są proste i łatwe do przeprowadzenia, w związku z czym powinny być powszechnie przeprowadzane w praktyce klinicznej jako forma oceny funkcji chodu w grupie pacjentów z MPD. Słowa kluczowe: chód, testy korytarzowe ABSTRACT Introduction. The core features of declined walking ability observed in patients with cerebral palsy (CP) is a reduction in speed and endurance and deficits in postural balance during walking. One of the most popular methods in clinical practice for non-laboratory assessment of gait dysfunction and checking effectiveness of a walking programs in group of patients with CP are walk tests. Aim of the study was to present the most popular walk tests used in group of patients with CP. Method. Relevant articles for this paper were identified by searching the EMBASE, PubMed, Cochrane and PEDro electronic databases. Walk tests. There are many walk test available and the choice of the adequate one should be related to the objectives of rehabilitation program. The 6-minute walk test evaluates endurance and it is the distance a person can walk at an unhurried, selfdetermined pace in 6 minutes. 10meter walk test assesses speed of walking evaluated by the time it takes for a child to cover 10meter section, measured in seconds. Timed Up and Go test assesses mobility and risk of falling due to balance or gait problems. Summary. Evaluation of the results and effects of gait treatment should be an essential part of the rehabilitation process. Walk tests are feasible to use in the clinical settings due to the lack of costs and equipment necessary for their implementation. Conclusions. Walk tests are simple and easy to administer therefore they should be commonly used in clinical practice in gait assessment of patients with CP.

The use of Kinesiology Taping in physiotherapy practice: a systematic review of the literature

Wojciech Kiebzak, Ireneusz M.Kowalski, Mariusz Pawłowski, Jakub Gąsior, Katarzyna Zaborowska-Sapeta, Olga Wolska, Zbigniew Śliwiński 1 Wy dział Na uk o Zdro wiu, Uni wer sy tet Hu ma ni stycz no -Przy rod ni czy Ja na Ko cha now skie go, Kiel ce 2 Od dział Fi zjo te ra pii, Wo je wódz ki Spe cja li stycz ny Szpi tal Dzie cię cy, Kiel ce 3 Za kład Re ha bi li ta cji, Wy dział Na uk Me dycz nych, Uni wer sy tet War miń sko -Ma zur ski, Olsz tyn 4 Wy dział Re ha bi li ta cji, Aka de mia Wy cho wa nia Fi zycz ne go Jó ze fa Pił sud skie go, War sza wa 5 Stu denc kie Ko ło Na uko we Fi zjo te ra pii, War szaw ski Uni wer sy tet Me dycz ny 6 Cen trum Me dycz no Re ha bi li ta cyj ne Krio so nik, War sza wa 1 Fa cul ty of He alth Scien ces, The Jan Ko cha now ski Uni ver si ty of Jan Ko cha now ski, Kiel ce 2 De part ment of Phy sio the ra py, Chil dren’s Ho spi tal, Kiel ce 3 De part ment of Re ha bi li ta tion, Fa cul ty of Me di cal Scien ces, Uni ver si ty of War mia and Ma zu ry, Olsz tyn 4 Di vi sion of Re ha bi li ta tion, Jó zef Pił sud ski Uni ver si ty of Phy si cal Edu ca tion, War saw 5 Stu dent Scien ti fic So cie ty at Di vi sion of Re ha bi li ta tion, Me di cal Uni ver si ty of War saw 6 Me di cal and Re ha bi li ta tion Cen ter Krio so nik, War saw, Po land

Assessment of Maximal Isometric Hand Grip Strength in School-aged Children.

Abstract Background Hand grip strength (HGS) test is commonly used as an indicator of overall muscle strength in medical and sport practices. Recently, several studies have proposed that the measurement of the maximal HGS depends on dynamometer’s handle position. The aim of the present study was to identify the optimal handle position to obtain maximal HGS using the hand grip dynamometer (HGD) for school-aged children. Methods HGS was assessed with the Jamar digital HGD. Each participant performed three maximum contractions of each hand on three handle positions progressing from first to third position. Results A total of 135 healthy children aged 5–9 years participated in the study. Participants obtained significantly higher results using position 2 than using positions 1 or 3. The maximal mean (± SD) HGS achieved was 9.9 (± 3.1) kg with position 1, 10.4 (± 3.1) kg with position 2, and 9.0 (± 3.2) kg with position 3. Handle position 2 was the most comfortable position for 73% of participants. Conclusions Our results provide useful methodological information indicating that the second handle position of the Jamar digital HGD is optimal to measure maximal HGS in non-athletic healthy pediatric participants aged 5–9 years.

Normative values for heart rate variability parameters in school-aged children: simple approach considering differences in average heart rate.

Background: Heart rate variability (HRV) analysis is a clinical tool frequently used to characterize cardiac autonomic status. The aim of this study was to establish normative values for short-term HRV parameters by considering their main determinants in school-aged children. Methods: Five-minute electrocardiograms were taken from 312 non-athlete children (153 boys) at age of 6 to 13 years for computation of conventional time- and frequency-domain HRV parameters. Heart rate (HR), respiratory rate, age, body mass index, and sex were considered as their potential determinants. Multiple regression analysis revealed that HR was the principal predictor of all standard HRV indices. To develop their universal normative limits, standard HRV parameters were corrected for prevailing HR. Results: The HRV correction for HR yielded the parameters which became independent on both sex and HR, and only poorly dependent on age (with small effect size). Normal ranges were calculated for both time- and frequency-domain indices (the latter computed with either fast Fourier transform and autoregressive method). To facilitate recalculation of standard HRV parameters into corrected ones, a calculator was created and attached as a Supplementary Material that can be downloaded and used for both research and clinical purposes. Conclusion: This study provides HRV normative values for school-aged children which have been developed independently of their major determinants. The calculator accessible in the Supplementary Material can considerably simplify determination if HRV parameters accommodate within normal limits.

The smartphone as an instrument for blood pressure measurement

Introduction: Number of population suffering from hypertension is increasing. So that, monitoring of this phenomenon should concentrate attention of medical industry, and receive high priority. One of the recommended procedure in hypertension treatment, and control is home blood pressure monitoring, which can be tested using smartphone application. Aim of the research: To evaluate the feasibility of a new blood pressure (BP) measurement tool – a smartphone application. Material and methods: The study included 50 subjects with the diagnosis of hypertension. Blood pressure measurement was tested in the following conditions: using a sphygmomanometer and using a smartphone by a specialist, and using a smartphone by the patient him/herself. The total number of results that differed from the measurement performed by the specialist by more than 5 mm Hg, and by 10% or more, was counted. Results: Mean results of systolic and diastolic BP did not differ significantly between measurements done by a specialist using a sphygmomanometer and those done using a smartphone application. There were 82% of results of systolic and 92% of diastolic BP that differed from Korotkoff sound technique in a range greater than 5 mm Hg and 36% in systolic and 86% in diastolic BP by 10% or more. Conclusions: The tested application should not yet be used for BP monitoring.

Trening siłowy w rehabilitacji osób dorosłych z mózgowym porażeniem dziecięcym

Jakub Sławomir Gąsior1,2, Piotr Jeleń3, Mariusz Pawłowski1,2, Marcin Bonikowski2