Yannis Dionyssiotis

Impact on bone and muscle area after spinal cord injury

Spinal cord injury (SCI) causes inactivation and consequent unloading of affected skeletal muscle and bone. This cross-sectional study investigated correlations of muscle and bone in spinal cord-injured subjects compared with able-bodied subjects. Thirty-one complete SCI paraplegics were divided according to the neurological level of injury (NLoI) into group A (n=16, above thoracic 7 NLoI, age: 33±16 years, duration of paralysis (DoP): 6±6 years) and group B (n=15, thoracic 8-12, age: 39±14 years, DoP: 5.6±6 years), compared with 33 controls (group C). All were examined with peripheral quantitative computed tomography at 66% of tibia length (bone and muscle area, bone/muscle area ratio). In able-bodied subjects, muscle area was correlated with bone area (P<0.001, r=0.88). Groups A and B differed significantly from the control group in terms of bone and muscle area (P<0.001). In paraplegics, less muscle per unit of bone area (bone/muscle area ratio) was found compared with controls (P<0.001). Bone area was negatively correlated with the DoP in the total paraplegic group (r=-0.66, P<0.001) and groups A and B (r=-0.77, P=0.001 vs r=-0.52, P=0.12, respectively). Muscle area and bone/muscle ratio area correlations in paraplegic groups with DoP were weak. Paraplegic subjects who performed standing and therapeutic walking had significantly higher bone area (P=0.02 and P=0.013, respectively). The relationship between bone and muscle was consistent in able-bodied subjects and it was predictably altered in those with SCI, a clinical disease affecting bone and muscle.

Assessment of musculoskeletal system in women with jumping mechanography

The purpose of this study was to investigate and add reference data about the musculoskeletal system in women. The mechanography system of the Leonardo™ platform (Novotec, Germany) was used to measure parameters of movement (velocity, force, power) in 176 healthy Greek women aged 20–79 years, separated according to age decade in six groups: group 1 (n = 12), 20–29 years; group 2 (n = 14), 30–39 years; group 3 (n = 33), 40–49 years; group 4 (n = 59), 50–59 years including 21 postmenopausal; group 5 (n = 31), 60–69 years including 12 postmenopausal; and group 6 (n = 27), 70–79 years all postmenopausal. This system measures forces applied to the plate over time, calculates through acceleration the vertical velocity of center of gravity and using force and velocity it calculates power of vertical movements. All women performed a counter-movement jump (brief squat before the jump) with freely moving arms. Weight was recorded on the platform before the jump and height was measured with a wall-mounted ruler. Body weight and body mass index were gradually increased; on the contrary height and all movement parameters except force (velocity, power) were statistically decreased during aging and after menopause.

Modern Rehabilitation in Osteoporosis, Falls, and Fractures

In prevention and management of osteoporosis, modern rehabilitation should focus on how to increase muscular and bone strength. Resistance exercises are beneficial for muscle and bone strength, and weight-bearing exercises help maintain fitness and bone mass. In subjects at higher risk for osteoporotic fractures, particular attention should be paid to improving balance – the most important element in falls prevention. Given the close interaction between osteoporosis and falls, prevention of fractures should be based on factors related to bone strength and risk factors for falls. Fractures are the most serious complication of osteoporosis and may be prevented. The use of modern spinal orthosis helps to reduce pain and improve posture. Vibration platforms are used in rehabilitation of osteoporosis, based on the concept that noninvasive, short-duration, mechanical stimulation could have an impact on osteoporosis risk. Pharmacologic therapy should be added for those at high risk of fracture, and vitamin D/calcium supplementation is essential in all prevention strategies. Success of rehabilitation in osteoporotic and fractured subjects through an individualized educational approach optimizes function to the highest level of independence while improving the overall quality of life.

Bone And Soft Tissue Changes In Patients With Spinal Cord Injury And Multiple Sclerosis.

Abstract In patients with spinal cord injury and multiple sclerosis, deterioration of body composition (changes in bone, fat and muscle mass) is associated with increased risk for diseases such as coronary artery heart disease, non-insulin dependent diabetes mellitus, lipid metabolism abnormalities, and osteoporotic fractures in these patients. Immobility leads to a changing pattern of loading in the paralyzed areas, and secondary alteration in structure. However, bone and soft tissue changes in these patients are usually neglected. The purpose of this article is to update on the pathophysiological mechanisms leading to bone and soft tissue changes, and to increase the awareness of the treating physicians with respect to bone, muscle and fat loss and their consequences aiming to obtain measures to prevent bone and soft tissue loss in these patients.

Clinical management of Friedreich’s Ataxia: a report of two cases

IntroductionFriedreich’s ataxia (FDRA) is the most common autosomal recessive, early-onset ataxia. FDRA is a progressive neurodegenerative disease that mainly affects the posterior (dorsal) columns of the spinal cord resulting in sensory ataxia. It manifests in initial symptoms of poor coordination and gait disturbance.Case presentationWe present two cases, a brother (54 years old) and sister (56 years old), with FDRA that are chronically institutionalized for incomplete quadriplegia without spasticity. Gait and postural ataxia, cerebellar dysarthria, oculomotor dysfunction, musculoskeletal deformities, hearing impairment, hypertrophic cardiomyopathy, and diabetes mellitus are also present. Neurological examination reveals extensor plantar responses and diminished to absent tendon reflexes. Both are wheelchair bound, cannot perform daily tasks and need assistance.DiscussionAlthough there is no cure that can alter the natural course of the disease physiotherapy, management of spasticity and neuropathic pain, symptomatic treatment of heart failure and diabetes and nursing care can grant the patients quality of life.

Mobilization and Stimulation of Neuromuscular Tissue (MASONT) for Stroke Survivors

Abstract Mobilization and Stimulation of Neuromuscular Tissue (MASONT) is a newly invented somatosensory intervention used for the recovery of function in stroke patients. This paper aims to offer a more spherical view on the new technique. To that end, a basic manual of MASONT’s application is provided, along with its rational of use. Moreover, clinical observations on the application of the technique and its effects on neurological patients are presented, as well as, a report on its safety.

An Epidemiological Study of Non-specific Low Back Pain in Non-professional Female Greek Classic Ballet Dancers

Abstract Aim: Epidemiological study of the incidence of mechanical low back pain (LBP) in non-professional female Greek classic ballet dancers over a year and therapeutic interventions required to address symptoms. Materials and methods: Forty-six female classic ballet dancers members of preprofessional schools, aged 16-37 years (mean 28.8 ±5.44 yrs) practicing and training in classic dance for 6-40 hours/week (mean 10.8±6.68) and 2-27 years experience (mean 11.9±4.20 yrs) participated in an epidemiological study concerning the incidence of LBP episodes within the last year, the treatment they received, as well as the period of absence of training and performance due to LBP. A selfadministered questionnaire was employed. Information regarding incidence, duration, and intensity of mechanical low back pain was gathered as well as length of time away from practice or performance. A secondary aim was to investigate the type of conservative treatment that participants in this study received. Results: Thirty-one (67.4%) participants in the study experienced 1-10 (mean 3.26±1.7) episodes of mechanical LBP in the previous 12 months. They had to refrain from dancing activities from 2 to 90 days (mean 16.9±16.22). Twenty one of the participants received some kind of conservative treatment. Conclusion: The incidence of LBP was found to be high among Greek amateur classic ballet dancers resulting in absence from dancing activities for a considerable length of time and raising the need for therapeutic intervention for a considerable percentage of the studied population. Effective prevention strategies of LBP are of vital importance, particularly in younger dancers.

Evaluation of commonly used nutritional assessment methods in hip fracture patients

Objective: Malnutrition is a common problem in hip fracture patients. The prevalence of malnutrition and available nutritional markers for use for nutritional assessment in this population group was investigated. Methods: This is a case control study including 214 patients with a hip fracture from “KAT” Hospital in Athens, Greece, and 108 controls from three Elderly Open Protection Centers. Main outcome measures were anthropometric [Body Mass Index (BMI), triceps skinfold thickness (TST) and mid-arm muscle circumference (MAMC)] and biochemical parameters (serum albumin and serum cholesterol). Mini Nutritional Assessment (MNA) was used for malnutrition assessment. Results: Based on MNA score only, we found 19.5 % vs. 0.9% malnourished, 54.6% vs. 32.4% at risk and 25.9% vs. 66.7% well-nourished, in hip fracture group and controls, respectively. All anthropometric parameters of malnutrition were significantly lower in the hip fracture patients compared to controls (p value<0.05). Serum albumin and serum-cholesterol levels correlated negatively significantly with s-CRP levels (R2=0.247, p<0.001 and R2=0.06, p<0.001, respectively) in the hip fracture group. Conclusions: Hip fracture patients are often malnourished. MNA application may be helpful in identifying malnourished hip fracture patients. Moreover, serum cholesterol may be a useful marker of malnutrition in hip fracture patients.

Sarcopenia: From definition to treatment

1Physical Medicine & Rehabilitation Department, European Interbalkan Medical Center, Thessaloniki, Greece; 2Medical School of Patras, Rio, Patras, Greece; 3Medical School of Thessaly, Larissa, Greece; 4Department of Medical Laboratories, Technological Educational Institute of Athens, Athens, Greece; 5Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, Bulgaria; 62nd Orthopaedic Department, Athens University; Konstantopoulio General Hospital; Athens, Greece; 7Endocrinology Department, General Hospital Asklepieio Voulas, Voula, Greece; 8Laboratory for Research of the Musculoskeletal System, University of Athens, Kifissia, Greece Commentary HORMONES 2017, 16(4):429-439

Nutritional Alterations Associated with Neurological and Neurosurgical Diseases

Neurological and neurosurgical diseases lead to complications producing malnutrition increasing pathology and mortality. In order to avoid complications because of malnutrition or overcome deficiencies in nutrients supplements are often used for these subjects. The physiopathological mechanisms of malnutrition, methods of nutritional assessment and the supplemental support are reviewed in this paper based on the assumption that patients need to receive adequate nutrition to promote optimal recovery, placing nutrition as a first line treatment and not an afterthought in the rehabilitation.