Przemysław Lisiński

The body balance training effect on improvement of motor functions in paretic extremities in patients after stroke. A randomized, single blinded trial

OBJECTIVE Study evaluates movement selectivity improvement in hemiparetic post-stroke patients after balance training. METHODS Study included 26 patients and 15 healthy subjects (control group C). Patients were divided into two groups with 20-day balance training (A) and without (B). Normal standing weight distribution was expressed in percentages, center of feet pressure (COP) sway velocities were evaluated in anterior-posterior and medio-lateral (Y, X) directions for normal standing with eyes open and closed (EO, EC) and for tandem. Brunnström scale assessed movement selectivity. RESULTS Weight distribution dissymmetry (Δ10%) was found. It was reduced (Δ2%) after training in group A. COP were higher for X direction (±6mm/s vs ±12mm/s) in normal standing. Difference (±12mm/s) was found for Y in tandem. Brunnström score increased in group A from 0.3 to 0.6. It was negatively correlated with average COP for EO and EC in Y and X and for tandem in X. CONCLUSION Training reduces weight-bearing dissymmetry and improves movement selectivity.

Reinvestigation of the dysfunction in neck and shoulder girdle muscles as the reason of cervicogenic headache among office workers

Purpose: Dysfunction of cervical and shoulder girdle muscles as reason of cervicogenic headache (CEH) was reinvestigated with clinical and neurophysiological studies. Methods: Forty office workers were randomized into two groups to verify efficiency of supervised kinesiotherapy (N = 20) aimed with improvement of muscle’s activity and headache symptoms releasing. Headache intensity was evaluated with visual analog scale (VAS), range of cervical movement (ROM) with goniometer, trigger points (TrPs) incidence with palpation and muscle’s strength with Lovett’s scale. Reaction of patients for muscle’s elongation was also evaluated. Surface electromyographical recordings were bilaterally analyzed at rest (rEMG) and during maximal contraction (mcEMG). Results: Deficits of cervical flexion and muscles strength were found in all patients. TrPs occurred predominantly in painful trapezius muscle. Incidence of trigger points coexisted with intensity of CEH. Results indicated on muscles dysfunction which improved only after supervised therapy. Positive correlations between increase in rEMG amplitudes and high VAS scores, high-amplitude rEMG recordings incidence and increased number of TrPs were found. Negative correlation was detected between amplitude in mcEMG and amplitude of rEMG recordings. Conclusions: Dysfunction of trapezius muscle was most responsible for CEH etiology. Proposed algorithm of kinesiotherapy was effective as complementary method of the CEH patients treatment.

The effect of early isometric exercises on clinical and neurophysiological parameters in patients with sciatica: An interventional randomized single-blinded study

Objective: To determine the effects of early introduction of isometric exercises on pain intensity and trunk and lower extremity muscles strength in patients with sciatica. Methods: Fifty two patients treated for disc herniation with sciatica were included in this randomized controlled single-blinded study. They were examined twice, before and after twenty days of rehabilitation, with neuroimaging, visual analog scale (VAS), straight leg rising test (SLR), range of spine movement in a saggital plane, muscle strength, electromyography (EMG), electroneurography (ENG) and intensity of current vs stimulus duration tests (IC-SD). Twenty-six patients, selected randomly, were ordered to reduce the physical activity and frequent loading of the spine (conventional [C] group) while 26 patients underwent a program of supervised isometric exercises (intervention [I] group). A control group of healthy subjects performed once the same examination. Results: Following treatment the muscle strength and flexibility of the spine showed significant (P < 0.05) improvement in I group with a significantly lower pain level and number of positive SLR tests. The same tests performed in C group indicated no parallel improvement. EMG Parameters increased in almost all muscles, but only in the I group were they associated with simultaneous improvement in ENG examinations of peroneal nerves. Conclusion: Early introduction of isometric exercises, 14 days after the incidence, is a relevant choice in cases of patients with sciatica caused by the disc herniation.

Investigation of the relationship between stimulus parameters and a human muscle contraction force during stimulation of the gastrocnemius muscle.

The article presents the results of investigations on the influence of biphasic stimulus parameters such as duration and stimulus interphase interval (IPI) on a gastrocnemius muscle contraction force. Seven healthy volunteers participated in this experiment, and 24 different stimuli patterns were tested. Special attention was paid to the comfort level of a sensory perception while the electrostimulation was applied. During the test, an optimal stimulus pattern evoking contraction at the level over 15% maximum voluntary contraction force and preserving a good comfort perception reported by all of the participants was investigated. It was found that bursts of pulses with width 175 micros and the IPI from 50 to 1000 micros satisfied these criteria. Moreover, it was observed that the increase of the IPI duration generated a significantly stronger contraction force in comparison with the stimulation with the standard biphasic pulses (IPI = 0 micros) having the same amplitude, frequency, and pulse duration. This shows that the modulation of the IPI might be a potentially useful support for the standard force-control methods and may find an application in neuromuscular electrical stimulation systems.

The Effectiveness of the Conservative Versus Myofascial Pain Physiotherapy in Tennis Elbow Patients: Double-Blind Randomized Trial of 80 Patients

Objective The aim was to check usefulness of a conservative [C] or myofascial pain [MFP] approach in low-level laser therapy [LLLT] or ultrasound [US] therapy for patients with tennis elbow [TE], independent of the presence of trigger points [TrPs]. Methods Eighty patients [38 males, 42 females] with TE, in acute or subacute states, were randomly divided into four groups: LLLT-C, LLLT-MFP, US-C, or US-MFP. Doses of LLLT were 1 J/cm2 in the conservative group and 5 J/cm2 for each TrP related to TE in the MFP group. US: 0.5 W/cm2 3 MHz for conservative and 0.7 W/cm2 1 MHz on each TrP and each taut band. Evaluations of each patient at baseline and at the end of therapy [10 interventions] included: the presence and sensitivity of TrPs [algometer], level of pain [VAS], Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire, and hand grip strength [dynamometer]. After one year of therapy, the patients were rechecked. Results Improvement of the VAS was 36.7 percent with LLLT-C, 36.9 percent with US-C, 48.4 percent with LLLT-MFP, and 55.4 percent with US-MFP [P < 0.005]. The Outcome of Disabilities of the Arm, Shoulder and Hand correlated with the VAS [r = 0.464]. Improvement of the grip strength was, respectively, 5.1 percent, 16.0 percent, 9.5 percent, and 109.0 percent for US-MFP [only US-MFP P < 0.01]. The only worsening of grip strength was after classic LLLT [−2.8 percent] among TrP-positive patients. TrPs were confirmed in 35 percent of patients. In that group, MFP methods were more effective than were conservative measures. After one year symptoms reappeared in 37.5 percent of patients. Conclusion We suggest that though both agents and both approaches for therapy of TE patients are equally effective, but the authors still favor US-MFP.

Supervised versus uncontrolled rehabilitation of patients after rotator cuff repair-clinical and neurophysiological comparative study.

Purpose The purpose of this study was the evaluation of the effectiveness of supervised rehabilitation in comparison to uncontrolled exercise therapy after surgical reconstruction of rotator cuff interrupted tendons. Methods Twenty two patients with comparable level of disability after the same type of surgery were randomly divided into two equal groups. The first group took part in a supervised therapy and the second one performed simple exercises without supervision. Clinical and neurophysiological examinations were performed prior to rehabilitation and after 20 and 40 days of treatment. The evaluation included the assessment of the pain level with visual analog scale, active range of motion with goniometer, activity of muscles motor units at rest and during maximal effort with electromyography and transmission of motor fibers in brachial plexus with electroneurography (M-wave stimulation studies). Results In the group of supervised patients the active range of movement changed significantly from 26.4° to 101.5° on average for flexion with adduction while flexion with abduction improved from 21° to 95.5°. Pain sensation changed from 6.4 to 3.2. The mean resting electromyogram amplitude decreased to the greatest degree from 80.9μV to 36.8μV in trapezius muscle while maximal effort electromyogram amplitude increased in this muscle from 381.8μV to 790.9μV. The mean values of amplitudes in electroneurographical suprascapular nerve examinations increased from 536.4μV to 1691μV. No significant differences at P=0.05 were found in these parameters recorded in the patients performing uncontrolled exercises. Conclusion The supervised exercise therapy is more effective than uncontrolled one after the rotator cuff surgical reconstruction.

Hallux valgus—a case for a physiotherapist or only for a surgeon? Literature review

[Purpose] Hallux valgus is one of the most common deformations of the human foot, and it causes great difficulties for the patients. The aim of this paper was to review available medical literature in search of evidence which would justify implementation of physiotherapy, based on its effectiveness for patients with hallux valgus. [Subjects and Methods] The following databases were searched for applicable papers: PubMed, Google Scholar, Clinical Key and UpToDate. Full-text articles from the last 15 years were subjected to a review, which ultimately selected seven papers about hallux valgus therapy published over the past 12 years. These studies were grouped according to their design and level of evidence and classified depending on whether they concerned physiotherapy as postoperative therapy or as the only treatment. [Results] The studies included in the present analysis used the following interventions for patients with hallux valgus: exercise, manual therapy, gait training, taping and orthosis. All the studies showed beneficial effects and the most frequently observed results were reductions in pain and improvements in function. [Conclusion] The evidence found in the reviewed materials clearly indicates that patients with hallux valgus should not only be subject to surgical procedures but also undergo physiotherapeutic treatment.

Visual biofeedback exercises for improving body balance control after anterior cruciate ligament reconstruction.

[Purpose] To evaluate the effects of balance training after arthroscopic anterior cruciate ligament reconstruction. [Subjects and Methods] Sixteen patients (mean 33 ± 8 years old) who underwent anterior cruciate ligament reconstruction three months prior to participating in a one-month rehabilitation program. The control group included 15 people aged 34 ± 4 years. Patients’ functional level was evaluated according to the Lysholm knee score, and balance quality was ascertained by static and dynamic tests. A balance platform was used to measure the center of foot pressure deflection. Two dynamic balance tests evaluated time of task execution. [Results] Lysholm knee score improved significantly after rehabilitation. Balance in the sagittal plane with eyes closed improved significantly after rehabilitation. The average velocity of center of foot pressure swing in both the frontal and sagittal planes with eyes closed differed significantly from those of controls. Execution time required for the two dynamic tests decreased significantly after rehabilitation and were significantly better than those in the controls. [Conclusion] Maintaining static balance with eyes closed is very challenging after anterior cruciate ligament reconstruction. Maintaining balance in the sagittal plane is particularly difficult. A one-month rehabilitation program partially improves static and dynamic balance.

Evolution of Muscles Dysfunction From Myofascial Pain Syndrome Through Cervical Disc-root Conflict to Degenerative Spine Disease.

Study Design. Comparative clinical and neurophysiological study in three groups of patients with general diagnosis of neck pain. Objective. To determine symptoms of muscles dysfunction in patients with myofascial pain syndrome, disc-root conflict, and degenerative changes at cervical spine. Summary and Background Data. The explanation for cervical pain origin should be based on results from chosen clinical and neurophysiological studies in correlation with neuroimaging findings. Methods. Three subgroups of patients (N = 60 each) with certain symptoms were examined. Clinical evaluation included examination of pain intensity in VAS scale, muscle strength in Lovett scale, evaluation of reflexes, Spurling test, assessment of active trigger points (TRPs), and superficial sensory perception. Neurophysiological testing included surface electromyography at rest (rEMG) and during maximal contraction (mcEMG) as well as electroneurography (ENG). Results. The greatest pain intensity with its decentralization phenomenon occurred in patients with disc-root conflict. Significant decrease of muscle strength was detected in trapezius muscle in myofascial pain syndrome subgroup. Weakness of abductor pollicis brevis muscle in patients with disc-root conflict differed them from patients with myofascial pain syndrome (P = 0.05). Patients with disc-root conflict and degenerative spine disease showed differences (P = 0.03) in reflexes evoked from triceps brachii. Positive Spurling symptom was most common (56.7%) in disc-root conflict subgroup. TRPs in trapezius muscle were found in all patients with myofascial pain syndrome. Results of rEMG amplitude measurements differed patients at P = 0.05. Only mcEMG recording from abductor pollicis brevis muscle allows for their clear cut differentiation. ENG studies showed abnormalities in patients with disc-root conflict and degenerative spine disease (P from 0.05 to 0.02). Positive correlation of VAS, TRPs, and rEMG as well as Lovett scores, mcEMG, and ENG results was found. Conclusion. Only applying several clinical and neurophysiological tests together makes it possible to differentiate patients with different etiological reasons of pain at cervical spine. Level of Evidence: 4

Effects of inpatient physical therapy on the functional status of elderly individuals

Purpose] The aim of the study was to analyze the impact of inpatient rehabilitation on the functional status of the elderly. [Subjects and Methods] A total of 100 patients (>65 years of age) in a rehabilitation ward were enrolled in this study. Age, absence of depression and signs of dementia in screening tests constituted the inclusion criteria. A comprehensive geriatric assessment was performed of all of the subjects twice, at the beginning and end of hospitalization (Assessments I and II, respectively), and included fall risk assessment (Timed Up and Go Test, TUG), evaluation of physical function (Short Physical Performance Battery Test, SPPB), the handgrip strength test, as well as patients’ self-reports of pain intensity, well-being and functional status. [Results] At the end of inpatient rehabilitation, significant improvement was observed in reduction the TUG time, physical function, and handgrip strength, as well as in subjective parameters such as self-reported pain intensity, well-being, and functional status. [Conclusion] Our results show the high efficacy of inpatient rehabilitation as a means of improving functional independence. Hospital rehabilitation should be recommended for elderly people, not only in cases of absolute indications for hospital admission, but also periodically for patients at risk of physical disability.