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Substantiation: Pediatric rehabilitation is a field where child’s compliance is closely related to the parent’s one, and, for a successful therapy, it is necessary to convey the information and include the parent in the process. Therefore, it is important to know the degree of parent involvement. Objective: Assessment of the degree of parents’ compliance with the method of therapy induction during the period of child hospitalization for rehabilitation treatment. Materials and methods: One used an anonymous questionnaire with 23 questions and preformulated answers. One used statistical analysis with Excel software. Results: In most of the cases, mothers are those who accompany children to therapy, show interest in their involvement in the therapeutic programme after discharge, deem that the induction method and communication with the therapist and the medical team are very important. Children age and pathology were assigned to 5 categories. A significant segment of the participants in the study acknowledged the need to continue the programme at home but approached a healthcare professional for this. A small number did not continue the programme at home. Conclusions: mothers are open to continuing the therapy programme at home, the hospitalization period should be increased and access to outpatient pediatric services should by improved. [ABSTRACT FROM AUTHOR]

The aim of this case report is to present an early individualized rehabilitative plan for a post-stroke patient with limb spasticity given that stroke is a leading cause for disability that involves prolonged hospital stay and neurorehabilitation strategies. The rehabilitation plan consisted of conventional physical therapy and radial extracorporeal shock wave therapy (rESWT), and the results were evaluated through clinical assessment together with an innovative gait analysis system. Two rESWT sessions and conventional physical therapy program decreased spasticity grade and pain intensity, and improved ankle range of motion, balance and gait. [ABSTRACT FROM AUTHOR]

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]

Objectives: Stroke is followed by an inflammatory response lasting up to several months. Moreover, many of the stroke-related comorbidities (i.e., diabetes mellitus, dyslipidemia, cardiovascular disease, and atherosclerosis) are characterized by an pro-inflammatory status. Material and Methods: We designed this pilot study to evaluate the relation between the consumption of a nutritional supplement (ALAnerv®) and the dynamic of the inflammatory status in post-acute stroke patients undergoing rehabilitation. The study population comprised 28 patients which were assigned into two study groups, named (-) ALA and (+) ALA. All subjects followed the same rehabilitation program. There were no significant differences in respect to the standard medication between the groups. Moreover, patients from the (+) ALA group received ALAnerv® for two weeks (2 pills/day). We assessed IL-1α, IL-6, TNF-α, sICAM-1, and myeloperoxidase in blood samples taken at the beginning and at the end of the study period. Outcomes: In the (+) ALA group only IL-1α (- 9.9% ± 3.7, P = 0.013) and IL-6 (- 26.5% ± 8.2, P = 0.003) significantly decreased during the study period. The multiple regression analysis indicated that the ALAnerv® treatment was responsible for the significant decrease of IL-6 level (P = 0.008). Moreover, the percentage of IL-6 variation between the study groups reached statistical significance (8.4% ± 11.5 vs. - 26.5% ± 8.2, P = 0.034). Conclusions: These results indicate that ALAnerv® could be beneficial for the correction of the inflammatory status in post-acute stroke patients and underline the need of a longer treatment period with a higher dose. [ABSTRACT FROM AUTHOR]

Stroke is a pathologic condition associated with redox imbalance. This pilot study was designed to evaluate the effect of the consumption of the nutritional supplement ALAnerv on some oxidative stress markers in postacute stroke patients undergoing rehabilitation. To achieve this goal, we assigned 28 patients to 2 study groups: (−)ALA and (+)ALA. Patients in both groups participated in the same rehabilitation program and received comparable standard medications; however, patients in the (+)ALA group received ALAnerv for 2 weeks (2 pills per day). We assessed total and nonproteic thiols, protein carbonyls, ceruloplasmin, oxidized low-density lipoprotein (LDL) particles, lipid hydroperoxide concentrations, gamma-glutamyl transpeptidase activity, and total antioxidant capacity. Regression analysis indicated that supplementation with ALAnerv was responsible for the significant decrease in glucose ( p = 0.002) and oxidized LDL particles ( p < 0.001) during the study period. For both parameters, the variation in the percent of concentration between the 2 groups during the study period reached statistical significance ( p = 0.012 and p < 0.001, respectively). Moreover, Barthel Index values at discharge were significantly influenced by ALAnerv treatment. These preliminary results indicate that ALAnerv might be helpful because it rapidly corrects plasma fasting glucose and corrects serum oxidized LDL particle concentrations, suggesting the need for longer treatment with 2 pills or more per day. [ABSTRACT FROM AUTHOR]

Stroke is a pathological condition associated with an enhanced inflammatory response that has a multifactorial etiology. We evaluated the dynamic of plasma concentrations of IL-1α, IL-6, IL-8, TNF-α, soluble form of intercellular adhesion molecule 1, and lipoprotein (a) [Lp(a)] during the rehabilitation of post-acute stroke patients ( n = 20), in parallel with control subjects ( n = 24). Stroke patients had significantly increased concentrations of IL-6, TNF-α, and Lp(a) when compared to healthy controls. It was found that the changes in the IL-6, IL-8, and TNF-α concentrations associated with the pathological condition were statistically significant ( χ = 4.81, p = 0.028, χ = 10.40, p = 0.005 and χ = 6.73, p = 0.034, respectively). The decrease of Lp(a) during the rehabilitation had statistical significance ( p = 0.043), while the decrease of IL-1α had marginal significance ( p = 0.071). IL-1α, TNF-α, and Lp(a) concentrations were significantly negatively correlated with the Barthel index values, suggesting that the decrease of these inflammatory markers was beneficial for patients' recovery. [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]

Low dorsalgia associated with pregnancy is an important but often neglected pathology that may have a potentially negative impact on quality of life, with an estimated incidence rate of 60-70%. Dorsalgias that occurred during pregnancy and during the confinement have been known and recognized for centuries, being described by Hippocrates, Vesalius, Pinean and Hunter. In1962, Walde was the first to recognize and differentiate pelvic pain from lumbar pain. The prevalence of pregnancy associated with inferior dorsalgia is higher in the third trimester when postural changes and weight increase occur. Submaximal maternal exercise does not adversely affect fetal heart rate. No studies în pregnant women have shown that mild exercise would cause fetal impairment. The benefits of medical rehabilitation vary depending on the age of the pregnancy, the period of confinement, and the aim is to reduce pain, increase functionality and limit disability. [ABSTRACT FROM AUTHOR]

(1) Background: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a tool designed to measure disability in accordance with the International Classification of Functioning, Disability and Health. Measuring disability is becoming increasingly important due to its high prevalence, which continues to rise. Rehabilitation interventions can reduce disability and enhance functioning. (2) Objective: The present study aims to assess the impact of rehabilitation interventions on reducing disability, as measured by the WHODAS 2.0 questionnaire. It also seeks to identify which specific rehabilitation interventions are more effective and to explore other disability assessment questionnaires. (3) Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a systematic review, with the protocol registered with the identifier CRD42023495309, focused on "WHODAS" and "rehabilitation" using PubMed and Web of Science electronic databases. (4) Results: We identified 18 articles from various regions encompassing patients with various health conditions, related to stroke, the cardiovascular system (cardiovascular disease, chronic heart failure), the pulmonary system (chronic obstructive pulmonary disease), the neurologic system (Parkinson's disease, cerebral palsy, neurodegenerative disease), the musculoskeletal system (orthopaedic surgery), cancer, and chronic pain, and among frail elderly. These patients have received a wide range of rehabilitation interventions: from conventional therapy to virtual reality, robot-assisted arm training, exergaming, and telerehabilitation. (5) Discussion and Conclusions: A wide range of rehabilitation techniques can effectively improve disability with various comorbidities, offering numerous benefits. The WHODAS 2.0 questionnaire proves to be an efficient and reliable tool for measuring disability, and scores have a tendency to decrease after rehabilitation. [ABSTRACT FROM AUTHOR]

Dorsalgia joasă asociată sarcinii reprezintă o patologie importantă, dar deseori neglijată, care poate avea un potenţial impact negativ asupra calităţii vieţii, fiind estimată la aproximativ 60-70%. Dorsalgiile apărute pe parcursul sarcinii şi în perioada lăuziei au fost cunoscute şi recunoscute de multe secole, fiind descrise de Hipocrate, Vesalius, Pinean şi Hunter. În 1962, Walde a fost primul care a recunoscut şi diferenţiat durerile pelviene de durerile lombare. Prevalența sarcinii, asociată cu dorsalgia inferioară, este mai crescută în trimestrul al treilea, când apar modificările posturale şi greutate crescută. Exerciţiile materne submaximale nu afectează în mod negativ frecvența cardiacă fetală. Niciun studiu la gravide nu a demonstrat că exerciţiile fizice uşoare ar produce deteriorarea funcţiilor fetale. Beneficiile reabilitării medicale sunt diferite în funcţie de vârsta sarcinii, de perioada de lăuzie şi vizează reducerea durerii, creşterea funcţionalităţii şi limitarea dizabilităţii. [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]

Most studies on patients with normal pressure hydrocephalus (NPH) regard pre-post Tap test and long-term follow-up after shunt surgery. Quantitative and qualitative assessment tools specific to rehabilitation medicine can provide an objective measurement of the benefit of the neurosurgical intervention at 1-month follow-up. The aim of this retrospective study was to assess the early benefit of the ventriculoperitoneal shunt with low or medium pressure valve on the gait capacity of persons with NPH, one month after surgery. This is a retrospective study reviewing 19 inpatients with NPH who underwent neurosurgery for ventriculoperitoneal shunt with low or medium pressure valve, one month after a positive result on a tap test, in a 5-year period. The assessments regarding the gait abilities were performed 24 hours before the surgical intervention and one month after surgery. Assessment tools used were: the 3 meters Timed Up and Go Test (TUG), the 10 Meters Walking Test (10MWT) and the Berg Balance Scale. A positive response to the tap test predicted improvements of gait and balance in patients with NPH after shunt surgery. Best results in regards to gait and balance are achieved when early diagnosis and intervention are performed. Complex comorbidities generate and enhance significant and persistent gait impairment. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia is a syndrome characteristic in elderly patients and is also associated with a significant proportion of chronic disorders such as inflammatory bowel disease (IBD). In this case, it can lead to a worse prognosis of the disease and a decreased quality of life. Study Aim: This study aims to identify the best ways to diagnose sarcopenia in patients with IBD, establish its impact on the course of the disease, and find preventive methods to counteract the effects of sarcopenia in the outcome of patients with IBD and, therefore, minimize disabilities and increase the health-related quality of life (HRQoL). Material and Methods: A systematic review with the Prospero registration number CRD42023398886 was performed in PubMed and Web of Science databases, evaluating all original articles published in the last 10 years (clinical trials and randomized control trials) that describe sarcopenia and IBD in the human adult population. Results: From the 16 articles that were included, 5 articles defined sarcopenia by the skeletal muscle index (SMI) and reported data regarding its correlation with body composition: BMI; visceral fat (VF); subcutaneous fat (SC); and VF/SC index. Other articles evaluated the link between sarcopenia and the total psoas muscle area, thigh circumference, calf circumference, subjective global assessment, hand grip strength, and appendicular SMI, alongside inflammatory markers such as IL-6 and C-reactive protein, level of disability, malnutrition, frailty, resistance training alone and in combination with whey protein, and infliximab treatment. Discussions and Conclusions: There is a great heterogeneity regarding the assessment criteria and methods used to diagnose sarcopenia due to the variability of population characteristics, both anthropometric and socio-cultural, alongside the high variability in the cut-offs. Therefore, any method which identifies sarcopenia in IBD patients, thus enabling intervention, may provide good results for patient quality of life and outcomes. [ABSTRACT FROM AUTHOR]

The study aimed to evaluate the effectiveness of radial extracorporeal shock wave therapy (rESWT) and conventional physical therapy (CPT) protocol on the gait pattern in stroke survivors through a new gait analysis technology. Fifteen (n=15) stroke survivors took part in this prospective, observational study and were assessed clinically and through an instrumented treadmill before and after rESWT and CPT. Spasticity grade 95% CI 0.93 (0.79 +/- 1.08), pain intensity 95% CI 1.60 (1.19 +/- 2.01), and clonus score decreased significantly 95% CI 1.13 (0.72 +/- 1.54). The sensorimotor function 95% CI -2.53 (-3.42 +/- 1.65), balance 95% CI -5.67 (-6.64 +/- - 4.69), and gait parameters were enhanced at the end of the program. Step length 95% CI -3.47 (-6.48 +/- 0.46) and step cycle were improved 95% CI -0.09 (-0.17 +/- -0.01), and hip 95% CI -3.90 (-6.92 +/- -0.88), knee 95% CI -2.08 (-3.84 +/- -0.32) and ankle flexion-extension 95% CI -2.08 (-6.64 +/- -4.69) were augmented. Adding the quantitative analysis to the clinical assessment, we gained easy access to track progress and obtained an individualized therapeutic approach for stroke survivors. [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]

Objectives: Stroke is a pathological condition associated with a redox imbalance. Both the acute and the post-acute phases after a stroke are characterized by a pro-oxidant state, which could be corrected through antioxidant supplementation. The aim of the present study was to evaluate the effect of the ALAnerv® upon the redox status of erythrocytes. Material and Methods: For this pilot study were enrolled 28 post-acute stroke patients. They were randomly divided into a control group [(-) ALA] and a study group [(+) ALA]. Patients were hospitalized for a period of two weeks. Blood samples were taken at the beginning and at the end of this period. Patients from (+) ALA group received the nutritional supplement ALAnerv®. Catalase, SOD, GPx, GRed and GT activities were assessed on erythrocytes' lysates. Also, the total antioxidant capacity as well as the concentration of total thiols were evaluated. Outcomes: During the study period only SOD (1393.48 ± 69.14 U/g Hb vs. 1514.06 ± 60.80) and GRed (4.47 ± 0.37 U/g Hb vs. 5.06 ± 0.24) significantly increased in (+) ALA group. Catalase (173.70 ± 14.62 k/g Hb vs. 123.41 ± 8.71) and GT (5.55 ± 0.26 U/g Hb vs. 4.95 ± 0.23) activities significantly decreased during the study period. Multiple regression indicated that only SOD, GT and GRed activities were influenced by the ALAnerv® consumption. There was no significant increase if the total thiols concentration. Conclusions: ALAnerv® consumption could be associated with a correction of the erythrocytes' redox status. There is a need to investigate if administration of ALAnerv® over a longer time period could have a more significant influence on the erythrocytes' antioxidant system. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes mellitus is one of the most frequent stroke-related comorbid states, and it is characterized by accumulation of reactive carbonyl compounds (RCOs), leading to "carbonyl stress". This pilot study was aimed to evaluate the effect of the consumption of the nutritional supplement ALAnerv® on some serum carbonyl stress markers, as well as on the activity of erythrocytes' glyoxalases in post-acute stroke patients undergoing rehabilitation. Material and Methods: We created a study population of 28 patients, organized into (-) ALA and (+) ALA groups. Patients from (+) ALA group received ALAnerv® for two weeks (2 pills/day). All the subjects followed the same rehabilitation program. In both groups, blood samples were taken at the hospitalization and at the discharge moments, respectively. On these samples we assessed lactic acid, fructosamine and RCOs concentrations, as well as the activities of glyoxalases 1 and 2 from erythrocytes' lysates. Outcomes: In (-) ALA group the concentrations of fructosamine and RCOs significantly increased (0.90 ± 0.04 vs. 1.02 ± 0.04, p = 0.020; 0.19 ± 0.03 vs. 0.28 ± 0.07, p = 0.027) during the study period. Also, glyoxalase 2 activity decreased in this group (27.04 ± 6.10 vs. 14.43 ± 3.02, p = 0.027). In (+) ALA group, the variation of these parameters did not reach statistical significance. Only, the activity of Glo1, which catalyzes the rate-limiting step in the glyoxalase pathway, had an increasing trend in (+) ALA group. The percentage of variation of fructosamine between (-) ALA and (+) ALA groups reached statistical significance (14.8 ± 5.2 vs. - 1.0 ± 13.3, p = 0.047). Regression analysis indicated that the activity of glyoxalase 2 was significantly influenced by the treatment with ALAnerv® (p < 0.001), while the concentration of RCOs was significantly influenced by diabetes mellitus (p = 0.030). Conclusions: Our preliminary results suggest that ALAnerv® could be useful for the correction of the carbonyl stress status in post-acute stroke patients with diabetes. Also, this study underlines the need of a longer treatment period with a higher dose. [ABSTRACT FROM AUTHOR]

Stroke remains one of the leading causes of disability in adults, and lower limb spasticity, affected stance, and balance impact everyday life and activities of such patients. Robotic therapy and assessment are becoming important tools to clinical evaluation for post-stroke rehabilitation. The aim of this study was to determine in a more objective manner the effects of visual feedback balance training through a balance trainer system and radial extracorporeal shock wave therapy (rESWT), along with conventional physiotherapy, on lower limb post-stroke spasticity, trunk control, and static and dynamic balance through clinical and stabilometric assessment. The study was designed as a randomized controlled trial. The experimental group underwent conventional physiotherapy, visual feedback balance training, and rESWT. The control group underwent conventional physiotherapy, visual feedback training and sham rESWT. The statistical analysis was performed using GraphPad Software and MATLAB. Primary clinical outcome measures were The Modified Ashworth Scale (MAS), passive range of motion (PROM), Visual Analogue Scale (VAS), and Clonus score. Secondary outcome measures were trunk performance, sensorimotor, and lower limb function. Stabilometric outcome measures were trunk control, static balance, and dynamic balance. Visual feedback training using the Prokin system and rESWT intervention, along with conventional physiotherapy, yielded statistically significant improvement both on clinical and stabilometric outcome measures, enhancing static and dynamic balance, trunk performance, sensorimotor outcome, and limb function and considerably diminishing lower limb spasticity, pain intensity, and clonus score in the experimental group. [ABSTRACT FROM AUTHOR]

Lately, easier and shorter tests have been used in the functional evaluation of cardiac patients. Among these, walking speed (WS) and Timed Up and Go (TUG) tests are associated with all-cause mortality, mainly cardiovascular and the rate of re-hospitalization, especially in the elderly population. We prospectively analyzed a group of 38 patients admitted to the Cardiology Clinic from Elias Hospital, Romania, with chronic coronary syndrome (CCS) (n=22) and STEMI (n=16). We assessed the patients immediately after admission and before discharge with G-WALK between the 1st and 30th of September 2019. Our study group had a mean age of 62.7±12.1 years. Patients with a low WS were older (69.90±12.84 vs. 59.90±10.32 years, p=0.02) and had a lower serum hemoglobin (12.38±1.20 vs. 13.72±2.07 g/dl, p=0.02). The WS significantly improved during hospitalization (p=0.03) after optimal treatment. The TUG test performed at the time of admission had a longer duration in patients with heart failure (14.05 vs. 10.80 sec, p=0.02) and was influenced by patients' age (r=0.567, p=0.02), serum creatinine (r=0.409, p=0.03) and dilation of right heart chambers (r=0.399, p=0.03). WS and TUG tests can be used in patients with CCS and STEMI, and are mainly influenced by age, thus having a greater value among the elderly. [ABSTRACT FROM AUTHOR]

The physical rehabilitation of patients with cardiovascular pathology is poorly studied and developed in our country, especially in patients with heart failure. There are studies in the literature that confirm that a decrease in the grasping force of the hand is associated with an increase in morbidity and mortality. The physical deconditioning of patients with heart failure can be assessed with the help of the Amadeo robot, which is a device capable of measuring the flexion and extension force of the hand in kilograms. Material and methods. We prospectively analyzed a group of 44 patients diagnosed with heart failure class II-III NYHA who were hospitalized between June 17 and July 15, 2019 in the Cardiology Department of Elias Hospital. We evaluated the grasping force of the hand of patients with heart failure using the Amadeo robot. The Amadeo robot is a device used in the rehabilitation of stroke patients, which can measure the flexion and extension force of the hand using sensors attached to the hand and fingers. Results. By evaluating patients with heart failure using the Amadeo robot, the average value of the hand extension force was 2.364 kg at admission and 2.264 kg at discharge. The flex-ion force of the hand was 6.78 kg at admission and 7.361 kg at discharge. Patients enrolled in the study who had valvulopathies, atrial fibrillation and diabetes had a lower value of the extension force of the hand compared to patients with heart failure who did not have these pathologies. Patients with valvulopathies, high blood pressure, and ischemic heart disease also had a lower flexion strength than those without these diseases. Conclusions. It is known that the grasping force of the hand is an important indicator in assessing the fragility status of patients. Patients with heart failure are frail patients with multiple comorbidities in which physical deconditioning acts as a negative prognostic factor on morbidity, mortality, and increased hospitalization rates. Thus, the physical rehabilitation of patients with heart failure is essential for increasing the quality of life and also for decreasing morbidity and mortality and the rate of hospitalization. [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]

Platelet-rich plasma (PRP) has emerged as a significant regenerative therapy used alone or combined mainly with stem cells, autologous fat grafts, hyaluronic acid, and biomaterials in a variety of medical fields, especially in hair regrowth, wound healing, and sports and rehabilitation medicine. However, the results obtained with this biologic therapy are heterogeneous and conflicting. The observed disparities in the effectiveness of PRP therapies may be due to a lack of standardization in blood processing and preparation. This article is aimed at reviewing the main biological parameters that need to be documented for a thorough reporting of quantitative and qualitative characteristics of the PRP injected, to allow a comparison between the quality of samples and the clinically obtained results and advance the efforts towards treatment standardization. [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]

Physical rehabilitation programs for patients with heart failure (HF) are underdeveloped in our country. In order to establish the correct rehabilitation plan, the first step is to evaluate the patient’s functional capacity. G-Walk is a simple and effective test in assessing functional capacity. The aim of the study is to analyze the correlation between the results obtained in Timed Up and Go (TUG) and walking speed test and the prognosis of patients with heart failure. Material and methods. We prospectively analyzed a group of 44 patients with heart failure class II-III NYHA hospitalized in the Cardiology Department of Elias Hospital between June 17 and July 15, 2019.We evaluated the functional mobility of the patients with heart failure with the G-Walk device that contains a wireless sensor. The G-Walk device represents a gait analysis system, performing – according to a protocol – 2 tests: Walk (patient’s walking speed) and TUG (measures balance and mobility). Results. After analyzing the walking speed, the patients were divided into 2 groups: those with a speed <0.8 m/s and those with a speed> 0.8 m/s. Out of 44 patients, 21 patients had a walking speed < 0.8 m/s and 23 patients had a walking speed > 0.8 m/s. It was seen that patients with lower walking speed (V < 0.8 m/s) versus patients with better walking speed (V > 0.8 m/s) were older, had a lower body weight, a lower blood pressure value, a lower value of the oxygen saturation, a lower value of sodium and a higher blood glucose value. After analyzing the value of the TUG test, patients were divided into 2 groups: patients with a TUG test duration < 15 seconds and patients with a TUG test duration > 15 seconds. Thus, out of 44 patients studied, 19 patients had a TUG value < 15 seconds and 25 patients had a TUG value over 15 seconds. It was observed that patients with a higher TUG value (> 15 seconds) versus patients with normal TUG value (< 15 seconds) were older, had a higher creatinine value and a higher blood glucose value. Conclusions. It has been shown that a low value of walking speed and mobility is associated with increased morbidity and mortality of all causes in elderly patients with cardiovascular disease. The physical rehabilitation of patients with heart failure is very important for improving the quality of life. [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]

The COVID-19 pandemic had a great negative impact on nursing homes, with massive outbreaks being reported in care facilities all over the world, affecting not only the residents but also the care workers and visitors. Due to their advanced age and numerous underlying diseases, the inhabitants of long-term care facilities represent a vulnerable population that should benefit from additional protective measures against contamination. Recently, multiple countries such as France, Spain, Belgium, Canada, and the United States of America reported that an important fraction from the total number of deaths due to the SARS-CoV-2 infection emerged from nursing homes. The scope of this paper was to present the latest data regarding the COVID-19 spread in care homes worldwide, identifying causes and possible solutions that would limit the outbreaks in this overlooked category of population. It is the authors' hope that raising awareness on this matter would encourage more studies to be conducted, considering the fact that there is little information available on the impact of the SARS-CoV-2 pandemic on nursing homes. Establishing national databases that would register all nursing home residents and their health status would be of great help in the future not only for managing the ongoing pandemic but also for assessing the level of care that is needed in this particularly fragile setting. [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]

Objective: We evaluated the effects of neuromuscular electrical stimulation (NMES) therapy on functional capacity and oxidative stress in patients hospitalized for acute heart failure (AHF). Design: We included 30 consecutive patients admitted for AHF with a left ventricular ejection fraction ≤ 50% who were randomized into two groups: NMES therapy added on conventional rehabilitation (CR) (n = 15, 67.2 ±13.35 years) and CR alone (n = 15, 63.26 ± 10.29 years). NMES therapy was performed at the level of the quadriceps muscle bilaterally, daily, for 60 minutes with a frequency of 10 Hz. Results: The mean duration of NMES therapy was 6.93 ± 2.54 days. Functional capacity assessed by the 6 minute walk test was significantly improved in the group with NMES therapy (p=0.036). The oxidized LDL value showed a decreasing trend compared to the admission value in the group with NMES therapy, but without statistical significance. Conclusion: This paper shows that for patients with AHF, NMES therapy used for a short term and initiated early during the hospitalization period improves exercise tolerance, suggesting the importance and possible necessity of including it as standard cardiac recovery therapy. NMES did not influence the plasmatic value of oxidized LDL. [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]

Paraoxonase 1 (PON1) belongs to a family of enzymes with related functions, being the best studied member. PON1 is a HDL-associated protein of which function is to protect LDL particles from oxidative modifications. The status of PON1 is influenced by different genetic, life style and dietary factors. This short review is aimed to present some new aspects regarding the antioxidant properties of PON1 with emphasis on the influence exerted by different factors. Also, a special attention is paid to the relationship between PON1 and low- and high-density lipoproteins in the context of atherosclerosis which affects the endothelial cells. [ABSTRACT FROM AUTHOR]

The article outlines the usefulness and importance of informatics solution in evaluating disability in Romania. It discusses disability, the physical and rehabilitation medicine (PRM), the goal of the Electronic Health Record (EHR), and the goal of e-Health. It also relates the adoption of the information and communication technologies solutions for the whole health system.

Using informatics solutions in medicine is not news, but creating a disability data base that has the purpose to evaluate disability on all its levels is imposed, considering the ascending trend of the number of population living with different categories and different levels of disability. A multidisciplinary team decided to focus efforts in designing a new online web application, able to respond to most of the specifications of an ideal disability survey tool. The aim is to develop a valuable instrument, worthy of being adopted as a national IT solution for disability degree evaluation [ABSTRACT FROM AUTHOR]

Introduction: Low vitamin D (VD) is associated with secondary hyperparathyroidism and both contribute to deleterious consequences (reduced bone mineral density (BMD), risk of fractures and falls). Objective: To study the VD status and biological correlates in a group of postmenopausal women. Material and methods: We studied 123 postmenopausal women evaluated in the C.I.Parhon National Institute of Endocrinology, the Pituitary and Neuroendocrine Diseases department. All cases had been reffered for the evaluation of BMD by the general practitioner. The evaluation included serum measurements of total and ionised calcium, phosphorus, alkaline phosphatase (ALP), 25 hydroxi vitaminD (25OHD), parathyroid hormone (PTH), osteocalcin, betacrosslaps. Central DXA osteodensitometry was performed. Results: 91.9% of cases had 25OHD serum levels below 30 ng/ml (74.8% had VD deficiency, 17.1% VD insufficiency). Only 8.1% had sufficient VD levels. A history of fragility fractures was present in 45.83% of the osteoporotic patients, 27.27% of the osteopenic ones and 15.15% of the women with normal BMD. 32 women (26%) were on VD supplementation at the time of evaluation. Among these subjects, the 25OHD level was significantly higher in those with prior fragility fractures (p=0.018) and osteoporosis (p=0.008). 25OHD concentration negatively correlated with PTH, alkaline phosphatase (ALP) and osteocalcin. The bone markers evaluated had a significant inverse correlation with the radius BMD, T and Z scores (p=0.004). 27.17% of the cases with VD deficiency had secondary hyperparathyroidism. The 25OHD concentration was significantly lower in these cases (p=0.000). Conclusions: VD insufficiency is widely prevalent but still under-recognized and under-treated, possibly leading to secondary hyperparathyroidism. The compliance to VD supplementation is lower in subjects without osteoporosis or fragility fractures. Primary prevention measures should be more actively implemented. [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]

Lower Limb Prosthesis is an artificial external device that replaces all or a part of the lower extremity. Prosthesis is used to provide an individual who has an amputated limb with the opportunity to perform functional tasks, particularly ambulation (walking), which may not be possible without the limb. The design of the prosthesis is dependent on the functional level of the patient and is geared toward comfort and minimizing limitations. There are several levels of lower limb amputation, including partial foot, ankle disarticulation, transtibial (below the knee), knee disarticulation, transfemoral (above the knee), and hip disarticulation. Therefore, the component parts of a lower limb prosthetic include a prosthetic foot, knee, and ankle, a pylon (to provide vertical support), and a socket (to hold the residual limb). Lower limb prosthetic care services have two stages: prosthesis fabrication and rehabilitation of the prosthetic gait. The prosthetic health care team is an interdisciplinary team which includes: surgeon, rehabilitation MD, neurologist, diabetologist, nutritionist, nurse, physical therapist, prosthetics technician, prosthetics engineer, occupational therapist, social worker, prosthetics health care quality specialist. The quality of the custom-made medical devices is legislated and standardized by the European Directive EC 93/42 (GD 54/2009 in national legislation), ISO 9001:2007 "Quality Management Systems", ISO 13485-2012 Medical devices''. Quality management systems. Requirements for regulatory purposes'', ISO 14971:2012 "Medical Devices-Application of Risk Management to Medical Devices". The lower limb prosthetics, in terms of European and national regulations, are custom made medical devices. For the purposes GD 54/2009 (European Directive 93/42), we know that the custom-made medical devices manufacturer must comply with the indication from prescription and issue a declaration of conformity covering specific product characteristics described on the prescription. The most durable and widely cited definition of healthcare quality was formulated by the Institute of Medicine (IOM) in 1990. According to the IOM, quality consists in the "degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." World Health Organization defines the healthcare quality as "The intrinsic achieve the goals of the health system to improve health and overall responsiveness to the expectations of the population". The Prosthetics Care Quality must to be focused on the patients needs and expectations and the prostetics devices providers must respect the quality assurance procedures in terms of patient safety to avoid all the possible medical devices adverse effects and/or the possible medical devices sentinel events. The prosthetics care quality management's main core must be the identification of the root cause of the quality problem which could appear and to find out the most easier way for a permanent quality improvement. It is mandatory that all prosthetics health care outcome to be patient centered in terms of amputee's satisfaction ( patient satisfaction). [ABSTRACT FROM AUTHOR]

Chronic Obstructive Pulmonary Disease (COPD) and Chronic Heart Failure (CHF), two major causes of worldwide morbidity and mortality have important systemic components, affecting additional tissues, other than the lung or the heart, such as the skeletal muscle. Muscle function (or dysfunction) may not only influence the symptoms that limit exercise, but may contribute directly to the poor exercise performance, health status and increased healthcare utilization. The present review tries to summarize the muscular abnormalities in COPD and CHF and the mechanisms underlying these alterations, which are strikingly similar, despite the obvious differences concerning the primary impairment in these two chronic diseases. The muscles therefore represent a potential site to improve patients' functioning level and quality of life of COPD and CHF. Only one practical therapeutic intervention currently exists that can reverse some of the muscle abnormalities observed in COPD and CHF, namely exercise training, which becomes nowadays the "cornerstone" of the whole rehabilitation. [ABSTRACT FROM AUTHOR]