Search results

1

Assessment of the efficacy of rehabilitation with concomitant use of botulinum toxin in patients with cerebral palsy qualified for this therapy by means of objective gait analysis

100%

Święcicka A., Syczewska M.

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PL

Wstęp: Toksyna botulinowa jest coraz częściej stosowana w leczeniu rehabilitacyjnym dzieci z mózgowym porażeniem dziecięcym (mpdz), zwłaszcza u pacjentów poniżej 10 roku życia. Jej skuteczność zależy m.in. od prawidłowej kwalifikacji pacjentów i planowania leczenia, oraz prawidłowo prowadzonej rehabilitacji po jej podaniu. Celem pracy jest ocena skuteczności leczenia rehabilitacyjnego z zastosowaniem toksyny botulinowej u pacjentów z mpdz przy wykorzystaniu obiektywnej analizy chodu do kwalifikacji pacjentów i oceny wyników postępowania skojarzonego leczenia rehabilitacyjnego. Materiał i Metody: Pacjenci: 20 dzieci z mpdz w wieku od 2 do 15 lat. Po wstępnej kwalifikacji (badanie kliniczne: zakres ruchu biernego w stawach, ocena spastycznosci oraz du;ej motoryki) pacjenci przechodzili badanie analizy chodu za pomocą systemu VICON 460 współpracującego z 16-kanałowym systemem Motion Lab do elektromiografii dynamicznej. Rejestrowano kilka przejść pacjenta (od 3 do 6), a wszystkie wyniki uśredniano. Mierzono parametry czasowo-przestrzenne, kinematyczne, oraz EMG wybranych mięśni. Na podstawie wyników badan klinicznych oraz analizy chodu ustalano indywidualnie dla każdego pacjenta plan poda- y botulinowej z określeniem konkretnych mięśni i dawek. Kolejne badanie i analizę chodu przeprowadzono po 3 i 9 miesiącach od podania toksyny botulinowej. Przez cały okres obserwacji pacjenci byli rehabilitowani. Wyniki: U wszystkich pacjentów stwierdzono poprawę stereotypu chodu. Poprawa dotyczyła zarówno parametrów czasowoprzestrzennych jak i parametrów kinematycznych. Wnioski: Prawidłowe podanie toksyny botulinowej, dzięki wykorzystaniu wyników analizy chodu, w połączeniu z intensywnym programem rehabilitacyjnym w okresie jej najsilniejszego działania wydaje sie powodować trwała poprawę stereotypu chodu u pacjentów z mpdz.

EN

Introduction: Botulinum toxin is more and more frequently used in rehabilitation treatment of CP patients, especially in children younger than 10 years. Its efficacy depends on several factors including proper qualification, planning of the treatment, and rehabilitation program following the injections. The aim of this paper was to evaluate the efficacy of rehabilitation treatment with botulinum toxin in CP patients using objective gait analysis as one of the qualification tools.Material and Methods: Patients: 20 CP patients, aged from 2 to 15 years old. After the first assessment (passive ROM in joints, spasticity evaluation and assessment of motor development), patients underwent the objective gait analysis. The VICON 460 system synchronized with the 16-channel Motion Lab system for dynamic electromyography was used. Several trials were conducted and recorded in each patient (from 3 to 6). The following variables were recorded: spatio-temporal and kinematic parameters, as well asEMG of selected muscles. Based on clinical tests and results of objective gait analysis an individual treatment plan was established for each patient (dosage and sites for botulinum toxin injections). Clinical evaluation and gait analysis was repeated after 3 to 9 months. Patients underwent a rehabilitation program after the botulinum toxin injections.Results: An improvement of gait pattern was found in all patients; there were no cases showing deterioration or no change. Both spatio-temporal and kinematic parameters were improved.Conclusions: Botulinum toxin exerts its effects for 3 to 6 months; therefore, the second evaluation was performed after the direct effect disappeared. Appropriate planning, which takes into account results of the objective gait analysis, and the intensive rehabilitation program allow permanent improvement of gait pattern in CP children.

2

Changes in gait pattern in patients with scoliosis

81%

Syczewska M., Łukaszewska A., Górak B., Graff K.

Medical Rehabilitation

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2006

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vol. 10(4)

18-24

PL

Wstęp. Boczne skrzywienie kręgosłupa to najczęściej występujące wśród dzieci i młodzieŜy schorzenie ortopedyczne, stanowiące poważny problem społeczny. Wielopłaszczyznowa deformacja kręgosłupa zaburza mechanikę ciała. Celem pracy była ocena zmian stereotypu chodu u pacjentów z bocznym skrzywieniem kręgosłupa. Materiał i metody. 25 dziewcząt w wieku 12-16 lat z bocznym idiopatycznym skrzywieniem kręgosłupa powyżej 20 stopni, nie leczonych wcześniej. Metody: analiza chodu za pomocą systemu VICON 460 z systemem do elektromiografii dynamicznej oraz z platformą dynamograficzną. Mierzono parametry czasowo-przestrzenne, kinematyczne oraz EMG wybranych mięśni kończyn dolnych i tułowia. Obliczenia wykonano za pomocą programu Polygon. Wyniki. U 90% pacjentek stwierdzono zmniejszone przodopochylenie miednicy, zwiększony zakres ruchu miednicy w pł. strzałkowej. U 2/3 miednica była ustawiona skośnie w pł. czołowej, a u większości takŜe skręcona względem linii kierunkowej chodu w pł. poprzecznej. U połowy ustawienie stawów biodrowych w pł. czołowej i poprzecznej było nieprawidłowe, a kontakt z podłożem odbywał się przy lekko zgiętych kolanach. U części pacjentek stwierdzono zmniejszenie zakresu ruchu w stawach biodrowych w pł. strzałkowej, ze zwiększoną rotacją wewnętrzną miednicy w chwili kontaktu z podłożem. U wszystkich stwierdzono zgięcie grzbietowe stóp w fazie wymachu oraz wewnętrzną rotację stóp względem goleni, a takŜe nieprawidłowy, asymetryczny zapis EMG mm. pośladkowych wielkich oraz wzdłuż kręgosłupa. Wnioski. Boczne skrzywienie kręgosłupa zaburza mechanikę ciała, zmienia orientację miednicy podczas chodu przynajmniej w jednej płaszczyźnie, w większości przypadków we wszystkich trzech. Pojawiają się mechanizmy kompensacyjne, które mogą stać się źródłem kolejnych nieprawidłowości. Zaskakującym zjawiskiem jest zgięcie grzbietowe stóp w fazie wymachu. PoniewaŜ u wszystkich pacjentek zgięcie kolan w fazie wymachu jest prawidłowe nie może to być mechanizm ułatwiający przenoszenie kkd nad podłoŜem.

EN

Introduction. Scoliosis is the most common orthopaedic disorder among children and adolescents thus constituting a serious social problem. 3D deformation of the spine changes the mechanics of the whole body. The aim of this work was to assesschanges in gait pattern in patients with scoliosis.Material and methods. Patients: 25 girls aged 12-16 years with idiopathic scoliosis greater than 20 degrees, not treated earlier. Method: objective gait analysis using the system VICON 460 synchronized with dynamic electromyography system and dynamographic platform. Measured parameters: spatio-temporal, kinematic, surface EMG of selected limb and trunk muscles. Calculations were performed with Polygon software.Results. Decreased pelvic tilt was found in 90 % of patients, together with an increased pelvic tilt range. In 2/3 of patients, the pelvis was obliqued in the frontal plane, and in the majority, the pelvis was rotated in the transverse plane with respect to the line of progression. The orientation of the hip joints in the frontal and transverse planes was incorrect in half of the patients, and the knees were slightly flexed at initial contact. In some patients, there was a diminished range of motion of the hip joints in the saggital plane, accompanied by an increased internal pelvic rotation at the initial contact. In all patients, the feet were dorsiflexed in the ankle joints in the swing phase, and in the transverse plane, there was an internal rotation of the feet with respect to the shank. In all patients, there was also an abnormal, asymmetrical activity of the trunk muscles, and of the greatest gluteal muscles.Conclusions. Scoliosis changes body mechanics and the orientation of the pelvis at least in one plane (in most cases – in all three planes). Compensatory mechanisms occur that may lead to further pathologies. The increased dorsiflexion of the feet in the swing phase was a surprising finding. As the maximum flexion of the knees in this phase is correct, the increased dorsiflexion could not have served as a compensatory mechanism helping in foot clearance.

3

Gait kinematics and clinical test changes in post-stroke patients during rehabilitation. Preliminary results of 12 patients of randomized clinical trial

81%

Krawczyk M., Syczewska M., Szczerbik E.

Advances in Rehabilitation

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2012

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vol. 26

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issue 1

13-18

EN

More precise knowledge concerning gait patterns of movement in stroke patients incorporating modern diagnostic tools is necessary. Exact information about qualitative and quantitative changes during the process of rehabilitation based on reeducation of functions and relating it to possible changes of motor deficit will possibly lead to better physiotherapy planning. Goal of this study is to assess some components and changes of gait pattern and motor deficit after stroke to develop better physiotherapy this group of patients Materials and methods Consecutively admitting to rehabilitation unit first stroke patients who met inclusion criteria ( time from the onset of stroke between 1st and 3th month, independent walking skills on the distance of 10m, motor deficit, self awareness of disease, signed inform consent form) were enrolled to the study. Patients were participating in physiotherapy five days a week for 12 weeks. Rivermead Motor Assessment (Lower Extremity Section), Fugl-Meyer Motor Deficit Scale, Nottingham Extended Activities of Daily Living Scale and three-dimension motion analysis system Vicon 460 (amplitude of hip joint range of motion, walking speed, cadence, steps length) were used. All measurement procedures were carried out three times: before therapy, after 6 weeks and after 12 weeks of treatment. Results: Twelve patients were enrolled to the study (4 female, 8 man, mean age 58 years old, 5 persons suffering from right side paresis). All patients improved after 6 and 12 weeks. Alterations were related both to clinical assessment and to objective movement analysis and they were positively correlated. Mean motor deficit (FM) stated 140,148, 161p, ADL -30, 42, 47p., walking speed: 0,4m/s, 0,5m/s, 0,6m/s, cadence (steps/min):70, 81, 89. Conclusions: Results indicate relatively constant progress of motor abilities in this group of patients however it decreased during second period. Clinical improvements were accompanied by similar progress of walking speed and cadence. Further studies are necessary

4

Hip and Knee Kinematics in Sagittal Plane during Stair Ascent and Descent in Children, Adolescents and Young Adults

81%

Syczewska M., Szczerbik E., Kalinowska M.

Journal of Human Kinetics

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2010

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vol. 26

45-49

EN

Ascending and descending stairs is a frequent activity in every-day living. Available data usually describe the ascent and descent pattern of young healthy adults, or elderly people.In order to assess the problems of peadiatric patients during stair ascent and descent, and to evaluate how treatment changes this pattern, a normative data base is needed. This data is lacking in the literature. Therefore, the aim of this study was to collect the kinematic data of healthy children, adolescents and young adults during stair locomotion and to assess the changes in range of movement in hip and knee joints in the sagittal plane. Twenty-seven healthy subjects, aged 6 to 21 years old, participated in the study. The subjects were climbing stairs with dimensions comparable to steps in public building.The data were collected using optoelectronic motion system VICON 460. Helen Hayes marker set and Plug-In-Gait model were used. The data were further processed using Polygon and Matlab softwares. The subjects were divided into 6 subgroups, according to their body stature.Hip and knee kinematics in sagittal plane during stair ascent and descent are reported for all 6 subgroups.The main factor determining the dynamic range of movement in the hip and knee joints during stair locomotion is the body stature / step height ratio. The present paper presents detailed data, which could be used as reference data for assessment of stair locomotion of paediatric patients.

5

Gait Pattern In Patients After Mandible Reconstruction Using Free Fibula Or Iliac Crest Flaps In The Treatment Of Head And Neck Tumors

71%

Kirwil M., Syczewska M., Jaworowski J., Tchórzewska-Korba H., Krajewski R.

Advances in Rehabilitation

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2013

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vol. 27

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issue 2

16-22

EN

Introduction: Surgical treatment of tumors of the head and neck region is associated with extensive tissue defects. The introduction of modern reconstructive surgery techniques allows replace the resected bone and soft tissue. The aim of reconstruction is to fill the defect and ensure proper appearance and functioning of affected area, but functional defects caused by harvesting the graft are also important for the patient. The aim of this paper is to describe changes in gait pattern and gait parameters after harvesting free fibular flap and the flap from the iliac crest for reconstruction of the mandible in patients treated for head and neck cancer. Material and methods: Two patients who underwent reconstruction with fibular and iliac crest flaps had gait tests performed three times: before, one month and three months after surgery. The patients had an intensive rehabilitation and physiotherapy started on 1st postoperative day and it was continued for 2 months. Results: The analysis of tests results showed deterioration in gait parameters one month after operation. 3 months after operation these parameters returned to the level before surgery. Conclusions: Harvesting fragment of fibula and of iliac crest affects the function of gait. Systematic physical therapy and rehabilitation on inpatient and outpatient basis allowed the patients to return to the same level of gait functioning as before the operation. Further research is needed to develop a more complete picture of patobiomechanic after bone resection. The results will help to create standard procedure after both treatments.

6

Use of instrumented spasticity tests in clinical applications. Preliminary results

61%

Szczerbik E., Kalinowska M., Graff K., Olczak-Kowalczyk D., Dąbrowska-Gontarczyk A., Jelonek E., Syczewska M.

Biomedical Human Kinetics

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2015

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vol. 7

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issue 1

EN

Study aim: the aim of the study was to evaluate whether the use of instrumented versions of spasticity tests would provide us with clinically more useful information on the patient’s status. Material and methods: the study included 19 children, 8–17 years old: 7 girls and 12 boys. Pendulum, velocity, and popliteal tests were performed using the Vicon system (knee joint angle, 8 muscles EMG). Dynamic movement ranges of the knee joint during velocity and popliteal tests (ROM), indices of the pendulum test, and muscle activity in dependence of velocity of movement (MA, MAST) were calculated. Correlation coefficients between ROM, Vmax, MA, and MAST were calculated to show whether instrumentation of clinical tests can validate the patient’s status more precisely. Results: Vmax value from the pendulum test does not always correlate with ROM. Scores of MA and MAST do not correlate with ROM. Vmax generally does not correlate with MA or MAST. Conclusions: ROM is one of the most important parameters reflecting the level of spasticity but it is not sensitive enough to detect small changes in the patient’s status. In that case, Vmax of the pendulum test and the number of activated muscles in velocity and popliteal tests could become important tools to assess changes in spasticity level, especially when motion systems are more commonly available.

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