2013 Vol. XV No. 1

zsim-fizjoterapia-tom-xv-zeszyt-1Kamila Gworys, Jacek Ratuszyński, Przemysław Gworys, Anna Puzder, Tomasz Adamczewski, Jolanta Kujawa


Background. Knee osteoarthritis is one of the most frequent painful conditions in the human population. Total knee replacement is the standard treatment for patients with severe knee osteoarthritis. The objective of the study was to evaluate the efficacy of the rehabilitation protocol on the functional status of patients after total knee replacement.

Materials and methods. 47pts after total knee replacement were included in the study. The effectiveness of therapy was evaluated with the use of: Knee injury and Osteoarthritis Outcome Score (KOOS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC knee). The individual program of rehabilitation and education was performed in the patients. The evaluation was performed twice: at the beginning and after 2 month of rehabilitation. The statistical analysis of results was performed with the MedCalc v.

Results. A significantly improvement in KOOS (from 112,6 to 73,2 point) and in WOMAC (from 80,2 to 44,6 point) was observed. in the subjects of group after rehabilitation protocol.

Conclusions. The patient directly after total knee replacement have poor physical condition measured by KOOS and WOMAC knee scale. The improvement of physical condition was received after rehabilitation. The rehabilitation after total knee replacement reduces pain and stiffness, and improves functional ability, such as bringing up, dressing, riding car.

Keywords: knee osteoarthritis, total knee replacement, physiotherapy

Barbara Górnik


Abstract The aim of this publication is to show the dynamic of therapeutic progress compared to the time it was started. The article is divided into two parts: theoretical and practical. In the first part speech area and other brain structures responsible for the regulation of speech capacity were characterized. The practical part includes date of two patients of Neurological Department of Regional Hospital in Hrubieszów. These two patients underwent extensive neurological rehabilitation at a different time since the neurological incident. The information collected before the beginning of the therapy (medical interview, clinical observation, the evaluation of speech capacity and dysarthric disorders) was compared to the final results (received on the basis of repeated specialist examinations — after almost nine-week of intensive rehabilitation process). Having analysed the received research materials thoroughly, final results were collected and systematized: the earlier the speech rehabilitation is started, the quicker disordered functions are controlled in a rational way; early therapeutic activity allows to exploit processes of spontaneous resumption of disordered functions and protect from the wrong compensations. The therapy of persistent aphasia disorders brings little progress; persistent dysarthric disorders subjected to intensive treatment are better improved.

Keywords: the speech area, aphasia, dysarthric disorders, speech rehabilitation


Justyna Podgórska-Bednarz, Justyna Drzał-Grabiec, Sławomir Snela, Justyna Rykała, Justyna Leszczak


Introduction. Scoliosis as a three dimensional deformity of the spine affects its functioning as part of the musculoskeletal system, causes changes in the spinal column also entail changes in its biomechanics. This type of irregularity, even when the value of curvature is low, can lead to significant changes of the spine.

Aim of the study. The aim of this study was to determine whether the occurrence of low values scoliosis curvature affects the formation of anterior-posterior curvature of the spine in the age group between 7 to10 years.

Material and methods. The study involved 3Ą0 children studying in primary schools located in the Podkarpackie Province. The age range 7-10 years. From whole group was selected 60 children with low value of scoliotic curve. Control group (without scoliosis) was chosen from the same population, consisted 60 children. The measurement of 20 selected parameters was done using a photogrammetric method (System Mora AGenetion).

Results. Statistically significant differences between the two groups was found in the case of the GKP (depth between the top of thoracic kyphosis and the point of transition kyphosis in lordosis) parameter (p = 0,0227). The differences between the groups for the rest of parameters were not statistically significant.

Conclusions. In the case of scoliosis with the low values of curvature observed in analyzed group, changes in the anterior-posterior curvature of the spine have been noticed in the thoracic spine.

Keywords: anterior-posterior curvature, scoliosis, photogrammetric method


Grzegorz Mizerski, Paweł Kiciński, Andrzej Prystupa, Sylwia Przybylska-Kuć, Andrzej Jaroszyński


Introduction. Regular physical effort is an important method of therapy of type 2 diabetes mellitus (DM t.2). Physical activity increases use of glucose at peripheral tissues, reduces body mass, reduces visceral fat tissue, in effect decreases glycaemia and resistance to insulin.

The aim of this study was define the role of sanatorium treatment and physical effort as a factors changing glycaemia at patient with DM t.2

Matherial and methods. The study included 102 patient with DM t.2, staying at Sanatorium for Farmers in Nałęczów in years 2009-2011. 53 persons (including 27 men) in age 59,9±7,7 years, having exertions with physical effort were test group, and 49 persons (including 27 men) in age 60,2±7,2 without effort were control group. The patients with modified pharmacological therapy of diabetes were excluded. There were no significant differences between the both groups for the sake of sex (p = 0,52) and age (p = 0,86). Fasting glycaemia (FG) was measured in capillary blood according to glucometer at the 1st and 21st day of staying.

Results. There were no statistically differences of FG at first day between the both groups (128,1±16,1 mg/dl vs 133,2±18,3 mg/dl; p = 0,14). Final FG were significantly decreased when compared with initial FG both in test group and control group (respectively p < 0,000001 and p = 0,000002). Final FG in test group were 116,3±10,8 mg/dl and were indeed decreased when compared with control group (127,5±13,9 mg/dl; p = 0,000015).

Conclusions. Treatment at sanatorium helps to reduce glycemia. This effect is increasing by physical effort during staying in sanatorium.

Keywords: physical activity, diabetes, fasting glycemia, sanatorium


Grzegorz Przysada, Aneta Weres, Joanna Glista, Elżbieta Piechota, Teresa Pop


Introduction. Low back pain becomes one of the most serious problems in present day medicine. It carries out a lot of medical dangers, reduces patient’s life convenience and can be a great economic burden. One of the physical therapy methods which are used with these disorders is low level laser therapy. However, its effectiveness is not appraised equally by different authors.

Aim of the study. The aim of the carried out research was to assess the use of laser in low back pain therapy, as well as to assess the impact of laser light on low back spine mobility.

Material. The research was carried out on two groups of patients. Each of the group consisted of 30 patients aged 30-55. In the first group only a laser was used, and in the second one the laser along with kinesitherapy were used. Each of the two groups of researched people consisted of 30 patients, aged 30-55.

Method. Otto-Wurma and Schobera Tests were used, aim of which was to find an impact of conducted treatment on low back mobility, as well as Visual Analogue Scale (VAS) to test analgesic effectiveness of this therapy. A survey, prepared for the needs of this thesis was also used. The first part of this research was carried out on the first day of treatment and the second part on the last day of treatment. The results allowed to conduct an analysis which became the theme of this thesis.

Results. The number of people suffering from low back pain has been reduced, thanks to this rehabilitation. 22 patients claimed lack of pain, (it is 37% of overall number of patients) no matter what treatment they were a subject of. Other patients claimed that the level of pain has been reduced. Spine mobility also has been improved in thoracic and lumbar vertebrae.

Conclusion. This research allows to appraise in positive way the impact of laser therapy on spine mobility increase and reduction of low back pain. Laser biostimulation brings about rational therapeutic effects in connection with kinesiotherapy, as well as separate method. It also shows rational effects with regards to life standards of patients suffering from low back pain.

Keywords: pain syndrome, laser, spine mobility


Justyna Rykała, Andrzej Kwolek, Justyna Leszczak, Justyna Podgórska-Bednarz, Piotr Puskarz


Abstract Degenerative changes increasing with age, comorbidities, used drugs and a history of injuries predispose to imbalances. Decrease the ability to maintain a stable posture is associated with the risk of falling and mechanical trauma. Balance disorders can be caused by various factors: both the own activities as well as by the influence of the surrounding environment. Decrease the ability to retain a stable posture is associated with the risk of falling and mechanical trauma. The risk increases in elderly. During the whole life they are exposed to numerous loads and overloads. This excessive exploitation may also impact on occurring in them balance disorder and predispose to fall.

The aim of this study was to evaluate the balance and risk of falls in the elderly as well as to assess the relationship between age, sex and body weight and balance. The study included 60 respondents over 60 years of age (n = 60) in the age range 60 to 90 years (mean 71 years). To evaluate balance and fall risk Berg Scale and the Step Test were used. Functional examination was supplemented by brief interview concerning the personal data and diseases.

Analysis of the results showed that in elderly had problems with ability to maintain balance. These problems are more noticeable in people over 70 years of age. Younger participants of study showed a better ability to maintain balance. There was no correlation between body weight of patients and their gender, and the ability to maintain balance.

Conclusions. With age there are significant changes in the process of maintaining a balance — in subjects over 70 years of age is observed a reduced ability to maintain balance, and therefore an increased risk of falls. Body weight don’t have a significant impact on the ability to maintain balance.

Keywords: balance, elderly


Ewelina Dziaduch, Marta Dziaduch, Wiesław Dziaduch, Katarzyna Golec, Natalia Ścirka


Introduction. Rheumatoid arthritis is a chronic, progressive and disabling autoimmune disease that causes inflammation of symmetrical joints, the tissue around the joints and affecting multiple organs in the body. The process leads to an irreversible destruction of joints’ structure and total joint immobility, what is the direct reason of patient’s disability. It is stated, that about 13-16% of people with rheumatoid arthritis are also diabetes mellitus sufferers. Unstable glucose levels puts the patient at the risk of serious complications, such as diabetic foot syndrome, what may result in leg’s amputation.

Aim. Presented case relates to the women with long history of rheumatoid arthritis after below-the-knee amputation as a result of diabetes foot treatment.

Methods. Medical history and interview, examination of the patient, medical publications mentioned in the bibliography.

Results. The patient’s general condition was an indication for multidirectional rehabilitation.

Conclusions. Common adverse effect of rheumatoid arthritis pharmacological therapy is diabetes mellitus. Not well-controlled blood sugar levels in such condition may lead to serious complications, such as neuropathy and angiopathy. Our patient was diagnosed with diabetes foot and underwent radical treatment involving amputation, what was the major indication for intensive hospitalization. The multidirectional rehabilitation was introduced, to improve a quality of life, reduce the pain and gain mental health. Those goals can be achieved by learning how to walk with a prothesis (vertical position), increasing mobility in knee and elbow joints, treating the symptoms of prolonged immobilization, providing psychological support (especially reduction of phantom pain). Effective rehabilitation, both physical and mental, should help the patient to adapt to a situation after amputation and minimize the symptoms of rheumatoid arthritis. Not to mention the constant control of sugar level as an essential element of adequate therapy to prevent a progression of disease.

Keywords: rheumatoid arthritis, diabetes foot, diabetes mellitus, rehabilitation, amputation


Jan Sobstyl, Paulina Sobstyl, Paulina Chwil, Karol Terlecki, Lidia Kotuła, Janusz Kocki


The course of long-term diabetes can lead to many complications associated with micro- and macroangiopathy. Diabetic foot is a microangiopathic complication and occurs in 6-10% diabetic patients. One form of the diabetic foot is ischemic foot, as a consequence of severe atherosclerosis of the lower extremities. The treatment of choice for arteriosclerosis obliterans of the lower extremities is revascularization. The progress of the atherosclerosis can lead to necrosis, and amputation remains the only possible treatment.

Objectives. Methods and effectiveness of rehabilitation conducted in order to improve motor skills and ambulation of the patient.

Material and Methods. A retrospective analysis in patient, age 74 who was treated on The Department of Neurological Rehabilitation Independent Public Teaching Hospital No 4 in Lublin. We asses case history, operation method, comorbid condition, clinical signs and symptoms, results of the imaging studies, and results of the treatment.

Results. As a result of rehabilitation treatment an improvement of the overall efficiency, reduced contracture of the left hip joint, and regeneration of the locomotion function was observed.

Conclusions. Therapy resulted in the improvement of the quality of life and the prosthetic ambulation of the amputee.

Keywords: above-knee amputation, diabetic foot, ischemic foot, arteriosclerosis obliterans, prosthesis


Joanna Szczuka, Maksymilian Pańczyk


Abstract A group of 28 inpatients with depression and 28 healthy controls (N = 56) were the participants in the study. The Beck Depression Inventory and the Patient’s Biographic Inventory by Płużek were used. People suffering from depression see themselves as having a positive attitude towards the near but during their illness they notice a significant decrease in strength of the emotional bonds. Although, most of the inpatients describe their spouses as cordial and their children as loving, indifference (referring to spouses) and sorrow (referring to children) are the additional emotions the impatients experience. Mothers in general are assessed as cordial and over-caring, fathers as cordial and demanding, whereas during the illness mothers are presented as lenient and fathers as dominant. As far as differences in description are concerned they pertain to attitude towards other people and the emotional state: healthy ones significantly more often describe their mothers as joyful and tend to perceive them as cheerful and sociable. When it comes to fathers, healthy ones present them as joyful, cordial and friendly men.

Keywords: depression, family relations


Robert Sak, Krzysztof Marczewski


Introduction. The police is a professional group which is characterized from one side very good health at the time of start of work, on the other side high multi-disease during its duration. Searching for traits responsible for this state, rarely we think about the study of temperament as a factor responsible for the risk of of disease and perception disease.

Aim of the study is to determine the temperament which are characterized by the officers police.

Materials and method. To evaluate the affective temperament was used Polish version of the scale TEMPS-A. The study was conducted among 55 officers police within August and September 2013.

Results. In the group of respondents were the most visible features of temperament hipertymic and depression and least visible feature is the irritability.

Conclusions. The results indicate the existence of specific temperament traits in a group of people who have work higher risk, shall take quickly responsible decisions. Perhaps the confrontation of such decisions with their effects is one of the factors responsible for the phenomenon multi-disease.

Keywords: temperament, multiple morbidities, policeman


Grzegorz Nowicki, Alina Dzirba, Ewa Chemperek, Katarzyna Zielonka, Jadwiga Woźniak, Patryk Rzońca, Andrzej Prystupa, Mariusz Goniewicz


Abstract: Head injuries are nowadays a major challenge for the medical rescue teams. Furthermore, except superficial injuries, there can be severe damage to the central nervous system leading to death or permanent disability. The research aims at presenting the rules of conduct with casualties which have suffered this type of injury. Therefore, it was presented the essence of the proceedings including quick response regarding reaching the victim, accurate diagnosis through well-conducted trauma examinations, proper identification concerning the mechanism of the injury, aptly conducted interview and assessment of vital signs. However the rescue proceeding on the scene of the emergency cannot reverse sustained injuries, they can delay or prevent most secondary outcomes. As a result, it is recommended that the training of emergency medical staff pay proper attention to the accurate diagnosis regarding threats to the life and health of head trauma victims.

Keywords: head injuries, emergency medical services, qualified medical


Katarzyna Miska


Abstract: The alcohol addiction, alcoholic toxicomania or alcoholic disease. Are synonyms of alcoholism a disease because of which people cannot control the amount of drinked alcohol. Overusing alcohol is caused by a somatic and psychological compulsion. The main causes of overusing alcohol are: individual tendency to addictions, susceptibility for stress and life crisis, demographical factors as age or gender and sociocultural factors as social position, place of residency or education. Dynamic pace of civilization development and constant social changes generates factors which are in favour of alcohol disease phenomenon. A person who is not able to manage with the challenge of the present reality and his or her own problems, more than once may became addicted to alcohol, that give people feeling of relaxation and separation from mortal life. A problem becomes visible when the situation gets the form of regular actions, which are taken up even by a very young people.

Keywords: alcoholism, epidemiology, abusing of alcohol


Wojciech Kwolek, Grzegorz Przysada, Justyna Leszczak, Justyna Rykała, Justyna Podgórska-Bednarz


Introduction. The necessity for cardiac rehabilitation in patients after acute coronary syndromes and cardiac surgical procedures is beyond any doubt. It is recommended by both American and European cardiac societies. Ambulatory cardiac rehabilitation in patients with coronary disorders and after cardiac surgical procedures aims at improving physical efficiency and in consequence physical activity and psychological condition of the patient as well as preventing complication and increasing length of life.

Aim of work. The aim of this piece of work has been the evaluation of treatment effects in patients using ambulatory cardiac rehabilitation at the Day Ward of Cardiac Rehabilitation at the Voivodship Hospital no. 2 named by Saint Jadwiga the Queen in Rzeszow.

Material and method. In the period from January to October 2013 at the Day Ward of Cardiac Rehabilitation 21 patients were rehabilitated. The average age was 60,2 years old. In the researched group the majority were men (19 people) and there were 16 patients after myocardial infarction invasively treated, 1 patient with congestive heart failure, 1 patient with stable coronary heart disease, 2 patients after corneal transplantation due to other reasons than myocardial infarction and 1 patient after coronary artery bypass graft. Rehabilitating procedure included 30-minute-long warm-up and 30-minute-long workout on an bicycle ergometer five times a week. Patients were evaluated with regard to the result of their 6-minutelong march, pulse, blood pressure, tiredness marked on the Borg’s scale and work done during the first and the last day of workout. Statistical analysis used Wilcoxon signed-rank test. In order to analyze the dependence between chosen parameters Spearman’s rank correlation coefficient was used.

Results. The distance covered in the test of six-minute march in the researched group increased from on average 485 meters on the first day of rehabilitation to 514,6 meters on the last day (p < 0,01). Work done during the first training in the researched group was on average 94,2 kJ and during the last one it was 143,8 kJ (p < 0,01). Average maximum pulse during the first training was 105 bpm and during the last one 108 bpm, average blood pressure measure about 20 minutes from the beginning of the workout during the first workout in the researched group was 130/80 mmHg and during the last one 136/83 mm Hg. After the first workout patients estimated their tiredness at 10,7 points on the Borg’s scale and after the last one 11 points.

Conclusions. In the research a significant increase in work done with low increase in the parameters of blood pressure and pulse and with comparable tiredness declared by the patients according to the Borg’s scale has been observed. Despite a low number of patients included in the researched these data confirm purposefulness and effectiveness and encourage to continue research in this group of patients.

Keywords: cardiac rehabilitation, physical fitness, coronary disorders, cardiac surgical procedures


Adam Topolski, Rafał Sapuła, Marta Wolanin, Marta Topolska, Antoni Wolanin, Krzysztof Marczewski


Background. It is well known that physical activity counteracts with the processes of human motor skills regression, alleviates the problems of aging. Regular physical activity also contributes to delay disability due to a variety of musculoskeletal dysfunctions. The study is an attempt to determine the relation between the effects rehabilitation and physical activity of women with low back pain.

Material and methods. The subjects participated in 102 womens treated at The Rehabilitation Clinic of Zamość because of low back pain. The patients ranged in age from Ą0 to 65 years, ‘mean age was 55 years (SD = 6 years). The study used the International Physical Activity Questionnaire (IPAQ), Oswestry Disability Questionnaire (ODI) and the Roland-Morris Disability Questionnaire (RMDQ).

Results. A statistically significant relationship between physical activity and the degree of disability after rehabilitation measured Oswestry Questionnaire (p < 0,001). Was also found a statistically significant relationship between physical activity and the degree of disability after rehabilitation measured of Roland-Morris Disability Questionnaire (p < 0,001).

Conclusions. Physical activity improves the results of rehabilitation in women treated for pain syndrome lower back.

Keywords: physical activity, rehabilitation, low back pain


Małgorzata Rycyk, Dorota Boniek-Poprawa, Marek Maciejewski, Krzysztof Marczewski


Introduction. Nowadays, most of the patients at branch of internal medicine are suffering from multiple morbidities. Our aim is to draw attention to the fact that the muscle strength is one of the most important index of their general condition. Consequently, muscle strength reflects the progress in patients’ treatment. When our patients perform the exercises which improve their athleticism, we should also observe the changes of their muscle strength. Especially if rehabilitation equipment is used.

The aim of this study is assessment of the use of record torque among patients who were trained on the rotor Thera Trainer in the diagnosis of geriatric.

Materials and methods. The study was conducted among patients of internal medicine department SP Provincial Hospital of Pope John Paul II in Zamość. Patients with multiple morbidities were qualified to the training session by the doctor. The range of the effort depended on their abilities and individual feelings.

Results. The study included 25 patients aged from 42 to 86 (21 took part in the training of the upper and lower limbs, 2 of them practiced only upper limb and 2 others only lower limbs). Depending on the length of hospitalization we compared patients who took part in at least 2 training sessions. The current increase or decrease of such indicators as torque patient, strength or traveled distance were compared with the results of the basis laboratory tests; CBC with differential, electrolytes, Creactive protein and their anthropometric characteristics.

Conclusions. The torque forces may be an element of pointing to the current clinical status of the patient. Evaluation between the increase or decrease of torque forces and changes in laboratory values requires a representative group.

Keywords: torque, muscle strength, exercise, multiple morbidities


Askold Kucher, Yuriy Rybert, Valentyn Makeyev, Oksana Zhyznomyrska


Introduction. Damage and dysfunction of the temporomandibular joint (TMJ) is the cause of reduced quality of patients’ lives making it one of the most important problems in clinical dentistry and rheumatology.

Aim of the study was to investigate the possibilities of ultrasonography (USS) in visualization of TMJ elements and identify USS-criteria of TMJ damage in inflammatory and degenerative processes.

Material and method. To achieve this goal and deal with the challenges three series of studies were performed that examined 29 healthy volunteers with no clinical signs of TMJ pathology, 36 patients with arthritis and 14 patients with TMJ osteoarthritis.

Results of the study revealed that the TMJ components can be displayed by the USS, which is a highly reproducible method. USS-criteria relating to TMJ arthritis and osteoarthritis were determined in the result of the study.

Conclusion. Thus, it can be stated that USS method can be used to diagnose pathological changes in TMJ therefore limiting the radiation exposure, reducing the cost of examination and making it more accessible.

Keywords: temporomandibular joint, disorders of temporomandibular joint, ultrasonog-raphy