Wojciech Kiebzak

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.

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.

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.

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.

Effect of a nonsurgical treatment program on the gait pattern of idiopathic toe walking: a case report

Background Recent studies have reported many possibilities for the treatment of idiopathic toe walking (ITW); however, none of them have been sufficiently documented. The purpose of this case study was to document the evolution of the gait pattern of a child with severe ITW using the Gillette Gait Index before and after the third and sixth weeks, a nonsurgical treatment program and then every 3 months to 1 year from the start of the treatment. This is significant because the case study shows that a nonsurgical treatment program can be an alternative treatment method for children with severe ITW. Case description The case study involved a 5-year-old boy diagnosed with severe ITW. An orthopedist recommended a surgical treatment, but his parents refused to provide consent. Intervention The subject participated in a 12-week nonsurgical treatment program that used tone-inhibiting casts (TICs) combined with physiotherapy based on neurodevelopmental treatment principles. The treatment protocol included the following: 1) precast preparation; 2) TICs with treatment; and 3) post-cast treatment to improve the gait pattern. Outcomes After treatment with TICs, the range of motion of ankle dorsiflexion during stance had increased, resulting in an almost normalized gait. The patient stopped toe walking for at least 1 year. Discussion This study demonstrates that nonsurgical treatment should be considered first, with surgical options reserved for resistant cases; however, further research is required given the current lack of knowledge about treatment outcomes using TICs and the wide use of this treatment modality in children with ITW.

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

Vojta method in the treatment of developmental hip dysplasia - a case report.

Background Developmental dysplasia of the hip joint is one of the most common congenital defects and often results in functional and structural disorders. Such cases particularly demand optimizing therapeutic effects and maximally reducing the duration of therapy. Purpose The aim of this case report is to present the therapeutic process in a child with developmental hip dysplasia. Case report This is a case report of a female child with a birth weight of 2,800 g and an Apgar score of 9 points born to a gravida 3 para 3 mother at 37 weeks. The child was delivered by cesarean section, and the pregnancy was complicated by oligohydramnios. Subluxation of the left hip joint was diagnosed by an orthopedist in the third month of life. The treatment followed was the Vojta method (the first phase of reflex turning and reflex crawling). Results During the 6 weeks of the Vojta treatment, the left half of the femoral head was centralized, and the process of formation of the hip joint acetabulum was influenced effectively enough to change the acetabulum’s Graff type from the baseline D to IIb after 41 days of treatment. Conclusion The diagnostic work-up of congenital hip joint dysplasia should involve a physiotherapist who will investigate the child’s neuromuscular coordination, in addition to a neonatologist and a pediatrician. The therapy for a disorder of hip joint development of neuromotor origin should involve the application of global patterns according to Vojta. Children with congenital dysplasia of the hip joint should commence rehabilitation as early as possible.

Occupational burnout and satisfaction with life in female physiotherapists

STRESZ CZE NIE Wstep. Ter min wy pa le nia za wo do we go okre śla psy chicz ne i emo cjo nal ne wy czer pa nie, szcze gol nie w efek cie dlu go ter mi no we go dzia la nia stre su. Ba da nia wska zu ją, ze wy pa le nie za wo do we jest ści śle zwią za ne z za wo dem le ka rza, fi zjo te ra peu ty, pie le gniar ki, psy cho lo ga, pra cow ni ka so cjal ne go. Wśrod ko biet zja wi sko wy pa le nia ma ni fe stu je sie wy czer pa niem emo cjo nal nym. Celem pra cy bylo zba da nie po zio mu za do wo le nia z zy cia, sa tys fak cji za wo do wej ko biet pra cu ją cych w za wo dzie fi zjo te ra peu ty ze szcze gol nym uwzgled nie niem wy ste po wa nia zja wi ska wy pa le nia za wo do we go. Ma te rial i me to dy. W ba da niach wy szcze gol nio no gru pe ba da ną 30 fi zjo te ra peu tek oraz 30 oso bo wą gru pe kon tro l ną, do kto rej za li czo no 30 far ma ceu tek. Za sto so wa no kwe stio na riusz za do wo le nia z zy cia oraz ska le wy pa le nia sil. Ana li ze sta ty stycz ną opar to na śred nich aryt me tycz nych, od chy le niach stan dar do wych i istot no ści ro znic po mie dzy śred ni mi dla po szcze gol nych grup za wo do wych. Istot no ści ro znic ozna czo no te stem t-Stu den ta. Wy ni ki. Da ne wska zu ją, ze glo bal ny wy nik za do wo le nia z zy cia w gru pie fi zjo te ra peu tek i w gru pie kon tro l nej istot nie ro zni cu je obie ba da ne gru py. Wnio ski. Za ob ser wo wa no ist nie nie sil ne go chro nicz ne go zme cze nia wśrod fi zjo te ra peu tek, co wy ma ga pod je cia na tych mia sto wych dzia lan pro fi lak tycz nych.