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Background. It is considered relevant to contextualize the health care process to amputated people since the hospitalization until the acquisition of the prosthesis to adapt to the new living condition and determine the bioethical aspects involved in this process. In that sense, the research question in this study was: how did health care to people submitted to limb amputation take place from the perspective of bioethical analysis? And the study objectives were: to analyze the care delivered by health professionals throughout the amputation process from the perspective of the amputees and discuss the health care process for amputated people from the perspective of bioethical analysis. Aims. The overall objective of the standards and guidelines is to establish a basis for the provision of a service of excellence to the amputee population with equity of access throughout the Romania. It also aims to assist clinical governance and service development with standards presented in a format easily accessible for audit purposes. Methods. A qualitative, descriptive and exploratory study was conducted through semi-structured questionnaires with 175 people undergoing amputation in the period 2008-2020, in SC. Theranova Protezare SRL in Romania. The objectives were to analyze the care provided by health professionals throughout the amputation process in the perspective of the amputee patient; and discuss the process of health care to the person with amputation in the bioethical analysis perspective. Data were analyzed according to content analysis. Three thematic categories emerged: the process of amputation; team performance and rehabilitation. Bioethics permits reflection on the care provided to amputees and problematizes the relationship of the health care process with support available through public health policies. The professional involved in this process has to take responsibility for putting the process in practice and interdisciplinary is essential for the recovery of the amputated patient. Results. It was verified that the causes leading to amputation can be triggered by a chronic illness as well as by trauma, the latter determined by external causes. Despite different motives for the amputation, however, the care process is the same. In other words, based on the statements, it can be inferred that, despite the stakeholders’ different ages and needs, both end up in the same health care context: slow and fragmented. Conclusions. In addition, in the interval of almost twelve years since they were submitted to the respective amputation, a precarious situation of physical, social and economic independence was evidenced. In short, these qualitative research results do not permit generalizations but questions: is these people’s right to socio-professional integration being guaranteed? The question is: the amputated people and/or the health team’s lack of knowledge, or the disorganization of the health care process? [ABSTRACT FROM AUTHOR]

In the context of the onset of the COVID-19 pandemic, the European Commission adopted a series of measures meant to ensure a good cooperation between member states, which target both cross-border medical assistance and the financing and procurement of monetary resources necessary for the efficiency and cover of medical services required for the treatment of patients affected by this virus. In order to support this endeavor, conventions were adopted for the medical assistance of cross-border patients and for the acknowledgement of the medical professionals' qualifications, as well as for the formation of emergency medical teams with the aim of coordinating and financing cross-border medical assistance and emergency transport of patients infected with COVID-19. [ABSTRACT FROM AUTHOR]

The premises for adopting Decree no. 195 of March 16, 2020 regarding the establishment of the state of emergency on Romanian territory were the evolution of the epidemiological situation in Romania and the assessment of public health risks for the next period. This indicated a massive increase in the number of people infected with the SARS-CoV coronavirus 2, and considering the fact that failure to take urgent, exceptional social and economic measures to limit the infection with SARS-CoV-2 coronavirus among the population would have had a particularly serious impact, mainly on the right to live, and, alternatively, on the individuals' right to health. [ABSTRACT FROM AUTHOR]

Oxidative stress is an imbalance of oxidants/antioxidants in favor of oxidants as stated by Sies in 1985, and may arise due to excessive sports, physical and mental stress, high altitude exposure, diets, temperature variations, extreme cold or heat weather, smoking, hypoxia, immobilization stress and so on. It is also the main cause of the most common illnesses of the current age: cardiovascular disease, diabetes, infection, chronic fatigue syndrome, depression, malignancy, and neurodegenerative disorders. The early determination of oxidative stress, although important for health, is not always simple and often requires laborious and expensive analysis. Biocrystallization, also called sensitive crystallization, is a simple and inexpensive qualitative method used for almost 100 years in the study of herbs, foods and also in human health for orientation of diagnosis. The method also allows a rapid assessment of the therapeutic effectiveness of remedies or recommended procedures for patients with a certain pathology. In this paper we are looking to answer the following question: is it possible to use this method in order to assess the level of oxidative stress induced by varying environmental or internal factors and to observe the efficiency of the treatment? [ABSTRACT FROM AUTHOR]

Oxidative stress is an imbalance of oxidants/antioxidants in favor of oxidants as stated by Sies in 1985, and may arise due to excessive sports, physical and mental stress, high altitude exposure, diets, temperature variations, extreme cold or heat weather, smoking, hypoxia, immobilization stress and so on. It is also the main cause of the most common illnesses of the current age: cardiovascular disease, diabetes, infection, chronic fatigue syndrome, depression, malignancy, and neurodegenerative disorders. The early determination of oxidative stress, although important for health, is not always simple and often requires laborious and expensive analysis. Biocrystallization, also called sensitive crystallization, is a simple and inexpensive qualitative method used for almost 100 years in the study of herbs, foods and also in human health for orientation of diagnosis. The method also allows a rapid assessment of the therapeutic effectiveness of remedies or recommended procedures for patients with a certain pathology. In this paper we are looking to answer the following question: is it possible to use this method in order to assess the level of oxidative stress induced by varying environmental or internal factors and to observe the efficiency of the treatment? [ABSTRACT FROM AUTHOR]

The artery structure modifies with aging involving internal and external factors. The term "arterial stiffness" has been defined as a resistance to dilatation (diameter variation) caused by a force (contraction of the heart) exerted on an elastic body (arterial vascular wall). Vascular stiffness appears as atherosclerosis and its occurrence may be regarded as one of the major cardiovascular risk factors; arterial stiffness is characterized by the augmentation index (Aix), pulse wave velocity in the aorta (PWVao), central aortic systolic pressure from emerging (SBPao). Each of these parameters represents independent predictors of cardiovascular morbidity and mortality. Currently, many methods are being used to measure arterial stiffness. TensioMed™ arteriography enables determining such indices of cardiovascular prognosis, a new non-invasive method oscillometric. Functional hemodynamic parameters listed above can thus be evaluated and followed over tie on the arteriograma of patients with major cardiovascular events (stroke, MI) hospitalized in clinical recovery units and subject to complex specific treatment, adapted to their pathology. Physical exercise favourably modulates several expressions of arterial stiffening, thus preserving vascular function and possibly reducing the risk of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background. Postural stability and dynamic balance can be the gradual indicators of some neurological dysfunctions, the normality, or of some exceptional aptitudes (performance shooting, circus arts etc.), provided that they are objectively assessed. Aims. To identify the marks, the deviations and the way of scaling the frequency spectrums of the gravity center projection oscillations on the postural sustentation surface, in subjects apriorically representing different categories (from the postural stability and the dynamic balance points of view). Methods. Complex podometric investigations, on platforms and on carpets with pressure sensor matrices (about 10,000 sensors and a processing sofware), of the mechanogram and frequency density of the gravity center projection oscillations. Subjects were divided into four samples, as follows: a non-randomized sample made up of 30 subjects belonging to the statistical population called "healthy youth practicing sports (but not at the performance level) on a regular or moderate basis"; a sample of 30 "shooters (performance athletes)", with a rich experience in sports training and competitions; a sample of 30 persons diagnosed with sight impairments and a sample of 30 persons with dental pathology aspects. The standard postural indicators, with and without visual control, the balance dynamics in normal walking and the pressure distribution on soles (with a topographic scanning) were recorded. The computer-based processing assessed 18 intrinsic or relative parameters of postural stability and dynamic balance in normal walking. Results. Significant differences, at an acceptable threshold (p>0.05), among the investigated samples, regarding the postural stability classes (normostability, hyperstability, hypostability and instability), were obtained only for the histograms of the frequency density of the control and regulation feed-back systems. The synthetical indicators, the most relevant for the dynamic balance labeling, particularly the walking ones, seemed to be the gravity center projection trace on the sustentation surface and the gravity center position changing speed. Conclusions. There was a significant negative correlation (Cohen large coofficient = -0.65) between the frequency density in the somesthesic zone and the postural stability quality. In other words, the significant improvement of the postural stability quality is associated with the diminution of the low frequency oscillation incidence, which is probably due, to a great extent, to the somesthesic feed-backs, and less to the causal relation. The graphs of the frequency density show that the visual feedback has a tendency to increase its role in the postural stability adjustment in athletes, as compared to the control group, and a tendency to diminish its role in subjects with sight impairments or with dental pathology aspects. There are not significant statistical differences regarding the density of the oscillations controlled at the vestibular level, among the analyzed categories of subjects. It is hypothesized therefor that the postural stability degradation tendency is greater on the anterior-posterior plan than on the lateral one. [ABSTRACT FROM AUTHOR]

Cerebral palsy is one of the most important causes of disability in children. Intensive rehabilitation in cerebral palsy is personalized in accord with the deficits, activity limitations and participation restrictions, but an early etiological and clinical diagnosis in a multidisciplinary approach, to differentiate cerebral palsy from other causes of neurodevelopmental disorders, is required to direct the pharmacological approach and prognosis. This paper presents the first study on a Romanian population in terms of the most relevant cerebral palsy risk factors and their relation to the age when cerebral palsy was diagnosed, aiming to support a possible early diagnosis prediction model. Retrospective study conducted on a group of 320 children diagnosed with developmental disorder admitted to the Department for Children Neuro-Psychomotor Rehabilitation of the Psychiatry Hospital in Sibiu during 2015-2018. The number of neurodevelopmental disorders generated by cerebral palsy in the examined group is relatively small (11.56%). The highest proportion of neurodevelopmental disorders in children with cerebral palsy (according to the subsequent diagnosis) was seen in children born under 30 weeks of pregnancy, exhibiting perinatal intracranial hemorrhage and displaying increased muscle tone and seizures. The study establishes correlations between the variables assessed, which may point to a formula for predicting the diagnosis of cerebral palsy in children initially examined for a developmental disorder. [ABSTRACT FROM AUTHOR]

Idiopathic scoliosis evaluation remains a challenge for both the clinician and the patient for the entire period of morphological changes related to pubertal growth. Traditionally, idiopathic scoliosis evaluation and monitoring involves repeated exposure to X-rays, which can increase the risk of cancer in children. To reduce the consequences on human health, modern computer technology has developed non-invasive methods to monitor the evolution of scoliosis, such as raster-stereography, computerized photogrammetry and ultrasonography. The aim of the study is to identify, on the one hand, the methods of diagnosis and evaluation of scoliosis and, on the other hand, to present the advantages and disadvantages of each method, so that the clinician can establish an accurate diagnosis and risk-free monitoring over time. [ABSTRACT FROM AUTHOR]

Background. In recent years, gait rehabilitation research has focused on developing systems for central neurological diseases affecting the gait patterns of patients. However, most systems lack pelvis mechanisms that can control the rotational movements of the pelvis. RELIVE overground gait rehabilitation is a system designed to control obliquity. Aims. This study investigates how the alternator - the RELIVE’s subsystem that controls translational and rotational movement of the pelvis – influences gait in healthy subjects and is part of a more complex research. Methods. The study took place in 2021 in the Elias Emergency University Hospital and 15 healthy subjects participated. We used in-shoe sensors from Tekscan, for gathering data regarding plantar pressure distribution, during various gait sessions with the RELIVE system. The gait sessions included walking with hands alongside the body, with the alternator turned on or off and with different degrees of body weight support. The gathered data was statistically analyzed with IBM SPSS Statistics v28 tool. Results. When the alternator was turned on, the values of average plantar pressure decreased during the sessions characterized by walking hands free with the same percentage of body weight support. Statistically significant differences (p-value<0.05) were recorded comparing the gait sessions at 0 and 20% body weight offload. At 10% body weight offload, the differences were not statistically significant. Conclusions. The results showed that the alternator subsystem might be able to offload the participant’s weight to some extent. More investigations should be considered in the following studies, including more comparisons between other gait sessions. [ABSTRACT FROM AUTHOR]

Pain is the most important reason an individual seeks the help of a physician. It is a complex sensation which results from noxious stimulation by physical or chemical agencies. The subtle biochemical mechanisms of pain production have been well studied, and actual knowledge has helped us to better understand and treat pain. Pain appears only in the presence of a painful stimulus sensitizing the nociceptors - nervous cells capable of decoding the signal transmitted by the stimulus, transforming chemical into electrical energy. From this level, the painful signal is transmitted to the central nervous system where pain becomes a complex sensation, generating defense reactions. Physiological pain theories involve intense activity of sodium channels, TRP ion channels, sodium and potassium ions, among with many other physical and chemical mediators. Among this, the presence of acethilcoline, serotonine, histamine, plasma kinins, adenosin triphosphate, in different concentrations sensitizing the nociceptors, produce pain. Muscle pain appears during intense physical exercise, as a result of muscle fiber ability to receive and respond to a noxious stimulus. It is a normal evolution of intense physical exercise, under physiological circumstances, meaning the mismatching between the oxygen demand and offer at the muscle cell. With this review, we tried to open new research pathways to explore pain and muscle pain production and therapy. [ABSTRACT FROM AUTHOR]

Osteoporotic vertebral fractures in the elderly appear secondary to slow loss of axial bone mass, but also because of increased fall risk in this particular category of patients. Until now, extraskeletal prevention factors have not received special attention. Most prevention stategies of vertebral fractures have focused on increasing biomechanical resistance, especially by drug decrease of bone turnover, usually the first line therapy for these patients. These therapies are addressed to bone density loss more than for pain reduction or physical impairments. Considering muscle performance connected to bone quality, the fall risk and the outlook on this special category of patients, the particularities of functional rehabilitation adapted on elder patients will be evidenced. A complete program of re-education regarding intensity, frequency and duration of physical exercise for eldery patients with osteoporotic vertebral fractures has not been established yet. Decreased muscle and functional performance, lack of coordination, and spinal cord damage (kyphosis, scoliosis), are almost physiological impairments in the eldery, but also the increase of postural balance, slow walking velocity have been identified as fall risk factors. Vertebral osteoporotic fractures may be prevented or treated using complex multidisciplinary programs, including patient re-education and individual traning programs, adapted to every patient. [ABSTRACT FROM AUTHOR]

Background. Stroke is a leading cause of long-term disability. Gait impairment post-stroke has a major implication for health and it is an essential predictor for functional independence. A common gait impairment is the presence of genu recurvatum in post-stroke patients, whether spastic or non-spastic. Aims. To evaluate the efficacy of the rehabilitation program and botulinum toxin upon gait spatial and temporal parameters, muscle spasticity, functionality of lower limb and risk of fall in post-stroke patients with spastic and non-spastic genu recurvatum. Methods. We conducted a two-year prospective study (April 2018 - April 2020) of forty hemiparetic patients with spastic (20) and non-spastic (20) genu recurvatum who underwent a rehabilitation program for three weeks and ultrasound guided botulinum toxin injection for the spastic group. Results. In the non-spastic group, statistically significant differences were observed post-treatment (after 3 weeks) in the case of gait speed from 0.457 meters/sec (T0) to 0.6265 m/sec (T1), TUG from 16.3 (T0) to 14.15 (T1) and LEFS from 32.45 (T0) to 34.7 (T1). In the spastic group, gait speed also had significant differences, from 0.467 (T0) to 0.7145 (T1). LEFS had an increase from 32.45 (T1) to 34.75 (T2). MAS had a decrease from 2.65 (T0) to 1.55 at (T1). Conclusions. Following a 3-week rehabilitation program and using ultrasound guided botulinum toxin injections, in the case of spasticity, improves gait spatiotemporal asymmetry and ameliorates functionality, lowering the risk of fall in hemiparetic patients with post-stroke genu recurvatum whether spastic or non-spastic. [ABSTRACT FROM AUTHOR]

Background. Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system and the main cause of disability in young people. Drug therapy cannot completely control many disabling symptoms in MS, such as cramps, pain, depression, and cognitive impairment. Non-invasive brain stimulation (NIBS) technology can be used as a tool to regulate changes in cortical excitability and plasticity in MS patients, thereby improving the disability symptoms that affect such patients. Aims. Our objective was to explore the effectiveness and safety of non-invasive brain stimulation in the treatment of fatigue in patients with multiple sclerosis. Methods. We performed a literature review in different databases: PubMed, Web of Science, Cochrane Library, Medline, Google Scholar. Full text articles that used NIBS for exercise performance improvement in athletes were included (only articles in English were found). We searched for articles available in each database until 30 October 2019. We used articles published in journals, randomized or pseudo-randomized, sham-controlled clinical trials to evaluate the effects of noninvasive brain stimulation (NIBS). The main result is the fatigue score before and after stimulation; the secondary result is the adverse event. Results. The general inverse variance method was used to aggregate data from cross-group and parallel group studies. A total of 14 studies (tDCS 11, TMS 2 and tRNS 1) which recruited 186 patients were included in the study. No qualified tACS, transcranial electrical therapy stimulation or non-invasive cortical electrical stimulation study with reduced impedance was found. The short-term and long-term therapeutic effects are for tDCS, TMS is significant, and TMS and tRNS are not superior to sham stimulation. Existing evidence supports the effectiveness of the 1.5 mA subgroup and the bilateral S1 subgroup of tDCS. Adverse events are mild and transient, but are comparable between real and sham stimulation. Conclusions. tDCS is a safe and effective way to treat fatigue in MS patients. However, there is further research needed to confirm our results in a large population and investigate the effectiveness of other NIBS subtypes. [ABSTRACT FROM AUTHOR]

Pelvis mobility plays a big role during normal walking. There are six pelvic movements that allow natural gait patterns and center of mass trajectories. The pelvis mechanism is an underdeveloped component in gait rehabilitation systems. Mobility constraints and human-robot joint misalignment appear during gait if pelvis motion is restricted or not actuated. This is why systems should provide pelvis mobility control. The aim of this review is to help researchers identify weaknesses and come up with solutions for new generations of gait rehabilitation devices. The data on current gait systems with pelvic mechanisms was collected from various databases on 26 August 2020. The selection criteria included all devices that had at least one pelvic degree of freedom actuated by a pelvis mechanism and excluded all devices with all pelvic degrees of freedom passive or restricted and all devices with pelvic support only for registering data and not for controlling pelvic motion. A number of 16 devices were identified. Different characteristics are compared, including: the type of system, the system mechanical components, the type of surface, the pelvic robot – human interface, the allowed human pelvis movements and the types of pelvic movements (actuated, free or blocked), the pelvis actuation, the operating modes and the center of mass trajectory. There is no perfect system; each one of them has both strong and weak points. Research directions are suggested for system improvements that might help future gait rehabilitation devices. [ABSTRACT FROM AUTHOR]

Background. When transcranial direct current stimulation (tDCS) was reintroduced as a non-invasive brain stimulation technique, it had been known for more than 50 years that the main mechanism of action was the sub-threshold regulation of neuronal membrane potential, which depended on changing the cortical excitability and activity through the current flow of the target neuron. In this review we concentrated on the progress made for tDCS in the last few years in sports, which so far has partially found entrance into the design of clinical studies, and on results obtained in recently conducted clinical pilot studies. Aims. Our objective was to analyze the effects of tDCS în sport exercises, for normal or high-level practitioners. Methods. We performed a literature review în different databases: PubMed, Web of Science, SCOPUS, SportDiscus, Google Scholar. Full text articles that used tDCS for exercise performance improvement in athletes were included (only articles in English were found). We searched for articles available in each database until 15 January 2018. We used articles published in journals, randomized sham controlled trials comparing anodal stimulation and cathodal stimulation to a sham / control for performance in isometric, isokinetic or dynamic strength exercise and whole-body exercise. Results. We included 23 studies that met our selection criteria, in which tDCS produced changes in cycling training for: the whole body (9 articles), for muscle strength in isometric exercise (7 articles), for maximal isometric voluntary contraction (MIVC) (2 articles), for isokinetic exercises (3 articles) and during dynamic exercise (2 articles). Conclusions. The anodal stimulation (a-tDCS) on the motor cortex (M1) had better results than sham stimulation especially for cycling exercises; consequently, more studies and attempts of different montages are needed. Interest in tDCS is constantly growing, as evidenced by the growing number of studies in recent years. Consequently, positive results will appear more and more with the discovery of optimal stimulation parameters. In other words research must continue for this therapy of the future to become a consistent therapeutic alternative, especially in performance athletes. [ABSTRACT FROM AUTHOR]

Background. Walking aids are often prescribed in the aftermath of an orthopedic condition of the lower limbs to ensure balance and reduce loading of the injured limb. Correct use of these crutches is difficult because efficient instruments are lacking to monitor the forces acting on the lower limb and crutches. Aims. The aim of this project was to produce an atraumatic, cheap, and portable tool to assist patients and therapists in rehabilitation, and in conducting gait analysis. With the development of these instrumented crutches, the authors hope to increase their possibilities to monitor the functional evolution of a person during recovery after musculoskeletal ailments. Methods. We describe the development of a wireless instrumented forearm crutch to monitor the gait of eighteen orthopedic patients during their convalescence. Seven volunteers served as a control group. By using four strain gauges installed as a full Wheatstone bridge, pure compression in the crutch bar is measured. A tri-axial accelerometer is used for determining the movement speed of the crutch in the sagittal plane. The pitch and roll angles in the frontal plane were measured using a tri-axial accelerometer and gyroscope. Results. Unfortunately, no difference was found between a control group of healthy volunteers and the group of orthopedic patients. Also, the authors did not find a relation between the different gait parameters. Conclusions. Using the three parameters obtained from the wireless connected forearm crutch, we could not create an algorithm to characterize gait in a group of patients with different orthopedic conditions of the lower leg. The results were not different from the parameters obtained from a group of healthy volunteers. [ABSTRACT FROM AUTHOR]

Background. Camptocormia (CC), also known as "bent spine syndrome", is still an unfamiliar affliction to many practitioners. Although it has no definitive treatment, when diagnosed in time, its signs and symptoms can be significantly alleviated by physical therapy. Aim. The aim of this paper is to present a clinical case along with recent literature data, in the hope of raising awareness of this condition that has serious implications on patient quality of life. Case. In the current paper, we present the case of an 85-year-old female patient who was admitted to the hospital for chronic lumbar pain and an inability to maintain vertical posture while walking, symptoms that had emerged more than ten years before, but worsened in the last year. After ruling out alternate disorders, the patient was diagnosed with idiopathic camptocormia. During her two-week stay in the Rehabilitation Department, the patient benefited from physical and pharmacological therapy, with minimal alleviation of her symptoms probably due to the long-term evolution of the disease. Conclusions. Camptocormia is a serious disorder that usually has a long evolution (years) and severely affects the patient's independence and quality of life. When diagnosed in time, specific rehabilitation treatment can be administered, with significantly better results than those achieved after chronic muscle alterations are established, like in the case of our patient. [ABSTRACT FROM AUTHOR]

Background. The definition of genu recurvatum is the presence of more than 5° hyperextension of the knee. Biomechanically, genu recurvatum appears during the stance phase, with the ground reaction force line passing anterior to the knee. From a practical point of view, retraining the gait in patients with genu recurvatum is relatively complex because of diverse etiologies. Aims. To present multiple approaches of rehabilitation strategies and their outcomes for treating patients with genu recurvatum. Methods. We performed a systematic literature review in different databases, PubMed, Science Direct, using the following key words: "genu recurvatum", "knee hyperextension", "rehabilitation". Results. Ten articles met our selection criteria. Three assessed retraining methods (functional electric stimulation or electrogoniometric feedback), five articles focused on orthoses and two articles on botulinum toxin. Conclusions. Genu recurvatum has a multifactorial etiology mechanism such as spasticity, muscle weakness and many others, and among post-stroke patients almost half of them develop genu recurvatum. Genu recurvatum is a disability factor, affecting gait, the quality of life of patients, generating pain and increasing the risk of fall-related injuries. [ABSTRACT FROM AUTHOR]

Background. TXB-A injections are the first-line treatment of many movement disorders, and the safety of doing them is essential to the effectiveness of therapy. Aims. Evaluation of safety of TXB-A guided injections in upper limb spasticity of post-stroke patients. Methods. The study group comprised 60 patients distributed in 3 subgroups of 20 based on background medication administered in post-stroke management: 20 patients in the antiplatelet background subgroup, 20 patients in the subgroup of anticoagulant background medication, and 20 without anticoagulant/antiplatelet background medication. From the 60 patient group, based on the number of TXB-A injection cycles, 3 other subgroups were produced: 20 patients performed 3 injection cycles, 20 performed 2 cycles, and 20 completed a single injection cycle. Every patient received a total dose of 1000 UI of TXB-A. After each set of local injections, ultrasounds were performed at the injection site searching for local hematomas. The moments evaluated were: T0 (the initial time - injection time), T1 (one month after the injection), T2 (3 months from T0 or 2 months from T1), T3 (1 month after T2), T4 (3 months after T2 or 2 months after T3) and T5 (1 month after T4). Results. The lowest p value of the 3 possible comparisons of the anticoagulant, antiplatelet, no anticoagulant/antiplatelet group of patients was 0.856, showing a purely random distribution of adverse effects manifested by local hematomas following ultrasound guided injections. Conclusions. Multiple cycles of US guided TXB-A injections with a minimum 3-month frequency between injections do not increase the risk of local haematomas. [ABSTRACT FROM AUTHOR]

Background. Spasticity is well known as one of the most common after stroke complications, providing a series of negative effects including decreased range of motion, muscle spasm, different levels of contracture, local pain in the affected area. Aims. Clinical-functional evaluation of the short and medium term effect of ultrasonographically guided injections with botulinum toxin type A (TxB-A) on the spasticity of the upper limb in post-stroke patients and the quantification of effects on international scales of spasticity and functionality. Methods. The groups studied were composed of 60 patients, which were divided based on the doses provided in each muscle of the hand and wrist flexors (250 IU versus 333 IU). Every patient received a total dose of 1000 IU of TxB-A. The parameters that were assessed were: Modified Ashworth Scale (MAS) and Activities of Daily Living Scale (ADL), international scales for spasticity and functionality. The moments evaluated were: T0 (the initial time - injection time), T1 (one month after the injection) and T2 (3 months from T0 or 2 months from T1). Results. Evaluation of MAS and ADL scales from T0 to T1 and T2 for the 250 IU group shows great improvements at T1 on both scales, MAS (<0.001) and ADL (<0.001), while maintaining the efficacy at T2, MAS (p-value 0.214 ), ADL (p-value 0.166). Evaluation of MAS and ADL scales from T0 to T1 and T2 for the 333 IU group also shows effective improvements on both scales at T1, MAS (<0.001), ADL (<0.001), and T2, MAS (0.849), ADL (0.013). Correlations between the two groups, 250 IU vs 333 IU, performed for each of the scales used in the study evidenced better results at T1 in favor of the 333 IU group on both MAS (p-value 0.034) and ADL score (p-value 0.078), with the proportion maintained in favor of the 333 IU group at T2, MAS (p-value 0.024), ADL (p-value 0.035). Conclusions. a) TxB-A is efficient as a prime line treatment for spasticity, helping the patients in the muscle neurorehabilitation effort; b) TxB A is effective in reducing spastic muscle tone (MAS); c) TxB A is a useful asset in managing hand function (ADL). [ABSTRACT FROM AUTHOR]

Background. Chronic non-specific low back pain is a common disorder associated with a high degree of physical deconditioning. Aims. To assess the effect of tramadol administration on pain and aerobic exercise capacity in human subjects with chronic non-specific low back pain. Methods. The study was conducted from June to December 2015, at the Clinical Rehabilitation Department of the Elias Emergency University Hospital in Bucharest. The study population consisted of 25 subjects suffering from chronic non-specific low back pain. They were divided into a placebo group and a tramadol group. The medication consisted of tramadol (50 mg) capsules, and placebo respectively, disposed as identical capsules. Both tramadol and placebo were administered orally twice a day, for a period of seven days. All subjects completed the visual analogue scale and underwent cardiopulmonary exercise testing using a cycle ergometer with progressively increasing work rate until the exercise was symptom limited at the baseline and at the end of the study. For each subject, pain response, peak oxygen uptake (VO2 max), aerobic contribution to exercise (VO2/WR), ventilatory efficiency (VE/VCO2) were investigated baseline and after 7 days of treatment. Results. The results of VAS were significantly lower for the tramadol group; in this group, VO2 max and VO2/WR significantly increased. The ventilatory efficiency improved, the VE/VCO2 values significantly decreasing in the tramadol group. Conclusions. In chronic non-specific low back pain subjects, tramadol reduces pain, improves aerobic exercise capacity and effort tolerance. [ABSTRACT FROM AUTHOR]

Neuromuscular Electrical Stimulation (NMES) is a form of electrical stimulation that uses the application of electric current through electrodes, leading to the depolarization of the motoneuron, thus eliciting a muscular contraction (stimulation over the motor threshold). Although its beneficial effects on strength training are widely recognized, some controversial aspects concerning the underlying physiological mechanisms of this strength gain still persist. This paper reviews the main aspects of motor unit recruitment in NMES versus Voluntary Muscular Contraction (VMC) and of the involvement of the Central Nervous System - through spinal and supraspinal mechanisms - in the muscle strength gain during NMES. [ABSTRACT FROM AUTHOR]