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Computational gait analysis constitutes a useful tool for quantitative assessment of gait disturbances, improving functional diagnosis, assessment of treatment planning, and monitoring of disease progress. There is little research on use of computational gait analysis in neurorehabilitation of post-stroke survivors, but current evidence on its clinical application supports a favorable cost-benefit ratio. The research was conducted among 50 adult people: 25 of them after ischemic stroke constituted the study group, and 25 healthy volunteers constituted the reference group. Study group members were treated for 2 weeks (10 neurorehabilitation sessions). Spatio-temporal gait parameters were assessed before and after therapy and compared using a novel fuzzy-based assessment tool, fractal dimension measurement and gait classification based on artificial neural networks. Measured results of rehabilitation (changes of gait parameters) were statistically relevant and reflected recovery. There is good evidence to extend its use to patients with various gait diseases undergoing neurorehabilitation. However, methodology for properly conducting and interpreting the proposed assessment and analysis procedures, providing validity and reliability of their results remains a key issue. More objective clinical reasoning, based on proposed novel tools, requires further research. [ABSTRACT FROM AUTHOR]

Rob AB Oostendorp,1– 4 JW Hans Elvers,5,6 Emiel van Trijffel,7,8 Geert M Rutten,9,10 Gwendolyne GM Scholten-Peeters,11 Marcel Heijmans,4 Erik Hendriks,12,13 Emilia Mikolajewska,14,15 Margot De Kooning,3,16 Marjan Laekeman,17,18 Jo Nijs,3,16,19 Nathalie Roussel,20 Han Samwel21 1Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; 2Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; 3Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; 4Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, the Netherlands; 5Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; 6Department of Allied Health Care, Methodological Health-Skilled Institute, Beuningen, the Netherlands; 7Department of Master Education, SOMT University of Physiotherapy, Amersfoort, the Netherlands; 8Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; 9Institute of Health Studies, Faculty of Health and Social Studies, HAN University of Applied Science, Nijmegen, the Netherlands; 10Campus Venlo, Faculty of Science and Engineering, Maastricht University, Maastricht, the Netherlands; 11Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; 12Department of Epidemiology, Center of Evidence Based Physiotherapy, Maastricht University, Maastricht, the Netherlands; 13Practice Physiotherapy ‘Maasstaete, Druten, the Netherlands; 14Department of Physiotherapy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland; 15Neurocognitive Laboratory, Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Toruń, Poland; 16Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; 17Department of Nursing Sciences, Ph.D.-Kolleg, Faculty of Health, University Witten/Herdecke, Witten, Germany; 18Department of Physiological Psychology, University of Bamberg, Bamberg, Germany; 19Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; 20Department of Physiotherapy and Rehabilitation Sciences (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; 21Revalis Pain Rehabilitation Centre, S Hertogenbosch, the NetherlandsCorrespondence: Rob AB OostendorpScientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, p/a Oude Kleefsebaan 325, AT Berg En Dal 6572, Nijmegen, the NetherlandsTel +31 246423419Email oostendorp.rob@gmail.comBackground: Whiplash-associated disorders (WADs) constitute a state of health characterized by a wide diversity of symptoms as a result of impairments of functions, activity limitations, and participation restrictions. Patient-reported outcome measurements (PROMs) and patient-reported outcomes (PROs) seem appropriate when describing and evaluating the health status of patients with WAD.Aim: To measure the use of PROMs and PROs as quality indicators in clinical reasoning, and to analyze and evaluate pre- and post-treatment ‘pain intensity’ and ‘functioning’, and for ‘perceived improvement’ in patients with WAD in primary care physiotherapy practice by year of referral, with the phase after accident and prognostic health profile embedded in the clinical reasoning process.Materials and Methods: Data were collected over a period of 10 years. Pain intensity, functioning, and perceived improvement were measured using the Visual Analogue Scale for Pain (VAS-P), the Neck Disability Index (NDI) and the Global Perceived Effect scale (GPE). Pre- and post-treatment mean differences were tested for statistical significance and compared to minimal clinically important differences (MCID). Effect sizes were expressed as Cohen’s d. Multivariable regression analysis was performed to explore independent associations of year of referral, phase after the accident, and the patient’s prognostic health profile with post-treatment pain intensity and functioning.Results: A consecutive sample of 523 patients was included. Pre- and post-treatment mean differences on VAS-P and NDI were statistically significant (P< 0.000) and clinically relevant, with ‘large’ effect sizes for pain intensity and functioning. MCIDs were achieved by 80% for VAS-P and for 60% for NDI. Year of referral and phase after the accident were independently associated with worse post-treatment functioning. About half of the patients (n=241 [46.1%]) perceived themselves as improved.Conclusion: The PROMs and PROs pain intensity, functioning and perceived improvement were integrated as quality indicators in the physiotherapy clinical reasoning process for patients with WAD. Significant differences in pain intensity and functioning were found but were unrelated to year of referral, phase after whiplash-related injury or prognostic health profile. The MCID VAS-P scores did not differ depending on experienced pain.Keywords: whiplash-Associated Disorders, neck pain, physiotherapy, patient-reported outcomes measures, routinely collected data

Rob AB Oostendorp, 1–4 JW Hans Elvers, 5, 6 Emiel van Trijffel, 7, 8 Geert M Rutten, 9, 10 Gwendolyne GM Scholten–Peeters, 11 Marcel Heijmans, 4 Erik Hendriks, 12, 13 Emilia Mikolajewska, 14, 15 Margot De Kooning, 3, 16 Marjan Laekeman, 17 Jo Nijs, 3, 16 Nathalie Roussel, 18 Han Samwel 19 1Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; 2Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; 3Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; 4Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, the Netherlands; 5Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; 6Methodological Health-Skilled Institute, Beuningen, the Netherlands; 7SOMT University of Physiotherapy, Amersfoort, the Netherlands; 8Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; 9Institute of Health Studies, Faculty of Health and Social Studies, HAN University of Applied Science, Nijmegen, the Netherlands; 10Faculty of Science and Engineering, Maastricht University, Maastricht, the Netherlands; 11Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Free University Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; 12Department of Epidemiology, Center of Evidence Based Physiotherapy, Maastricht University, Maastricht, the Netherlands; 13Practice Physiotherapy ‘Klepperheide’, Druten, the Netherlands; 14Department of Physiotherapy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus Univerisity, Toruń, Poland; 15Neurocognitive Laboratory, Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Toruń, Poland; 16Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; 17Department of Nursing Sciences, Ph.D.-Kolleg, Faculty of Health, University Witten/Herdecke, Witten, Germany; 18Department of Physiotherapy and Rehabilitation Sciences (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; 19Revalis Pain Rehabilitation Centre, ‘s Hertogenbosch, the NetherlandsCorrespondence: Rob AB OostendorpScientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, p/a Oude Kleefsebaan 325, Berg en Dal 6572 AT, the NetherlandsTel +31 2464234219Email oostendorp.rob@gmail.comBackground: Quality indicators (QIs) are measurable elements of practice performance and may relate to context, process, outcome and structure. A valid set of QIs have been developed, reflecting the clinical reasoning used in primary care physiotherapy for patients with whiplash-associated disorders (WAD). Donabedian’s model postulates relationships between the constructs of quality of care, acting in a virtuous circle.Aim: To explore the relative strengths of the relationships between context, process, and outcome indicators in the assessment of primary care physiotherapy in patients with WAD.Materials and Methods: Data on WAD patients (N=810) were collected over a period of 16 years in primary care physiotherapy practices by means of patients records. This routinely collected dataset (RCD-WAD) was classified in context, process, and outcome variables and analyzed retrospectively. Clinically relevant variables were selected based on expert consensus. Associations were expressed, using zero-order, as Spearman rank correlation coefficients (criterion: rs > 0.25 [minimum: fair]; α-value = 0.05).Results: In round 1, 62 of 85 (72.9%) variables were selected by an expert panel as relevant for clinical reasoning; in round 2, 34 of 62 (54.8%) (context variables 9 of 18 [50.0%]; process variables 18 of 34 [52.9]; outcome variables 8 of 10 [90.0%]) as highly relevant. Associations between the selected context and process variables ranged from 0.27 to 0.53 (p≤ 0.00), between selected context and outcome variables from 0.26 to 0.55 (p≤ 0.00), and between selected process and outcome variables from 0.29 to 0.59 (p≤ 0.00). Moderate associations (rs > 0.50; p≤ 0.00) were found between “pain coping” and “fear avoidance” as process variables, and “pain intensity” and “functioning” as outcome variables.Conclusion: The identified associations between selected context, process, and outcome variables were fair to moderate. Ongoing work may clarify some of these associations and provide guidance to physiotherapists on how best to improve the quality of clinical reasoning in terms of relationships between context, process, and outcome in the management of patients with WAD.Keywords: physiotherapy, whiplash injuries, outcome and process assessment, healthcare quality indicators, collected data

Rob AB Oostendorp,1–4 Hans Elvers,5,6 Emiel van Trijffel,7,8 Geert M Rutten,9,10 Gwendolyne GM Scholten–Peeters,11 Marcel Heijmans,4 Erik Hendriks,12,13 Emilia Mikolajewska,14,15 Margot De Kooning,3,8,16 Marjan Laekeman,17 Jo Nijs,3,8,16 Nathalie Roussel,18 Han Samwel191Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; 2Department of Manual Therapy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; 3Pain in Motion International Research Group, Free University Brussels, Brussels, Belgium; 4Practice Physiotherapy and Manual Therapy, Heeswijk-Dinther, the Netherlands; 5Department of Public Health and Research, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; 6Methodological Health-Skilled Institute, Beuningen, the Netherlands; 7SOMT University of Physiotherapy, Amersfoort, the Netherlands; 8Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Free University Brussels, Brussels, Belgium; 9Institute of Health Studies, Faculty of Health and Social Studies, HAN University of Applied Science, Nijmegen, the Netherlands; 10Faculty of Science and Engineering, University College Venlo, Maastricht University, Maastricht, the Netherlands; 11Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; 12Department of Epidemiology, Center of Evidence-Based Physiotherapy, Maastricht University, Maastricht, the Netherlands; 13Practice Physiotherapy ‘Klepperheide’, Druten, the Netherlands; 14Department of Physiotherapy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland; 15Neurocognitive Laboratory, Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Torun, Poland; 16Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; 17Department of Nursing Sciences, Faculty of Health, University Witten/Herdecke, Witten, Germany; 18Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; 19Department of Medical Psychology, Canisius Wilhelmina Hospital, Nijmegen, the NetherlandsPurpose: To develop valid quality indicators (QIs) for physiotherapy care based on best available evidence, and to use these QIs to explore trends in the quality of physiotherapy care of patients with Whiplash-associated disorders (WAD) using guideline-based routinely collected data (RCD) gathered between 1996 and 2011.Materials and methods: The study consisted of two phases: 1) development of QIs and 2) analysis of patient records. A set of QIs was developed based on recommendations in the scientific literature and the Dutch Clinical Practice Guideline (CPG) “Physiotherapy Management and WAD”. QIs were expressed as percentages, allowing target performance levels to be defined (≥80% or ≤30% depending on whether desired performance required a high or low score on a QI). We then analyzed WAD patient data (N = 810) collected over a period of 16 years in two physiotherapy practices, separating patients into two groups defined as before (Group A 1996–2002; n = 353) and after (Group B 2003–2011; n = 457) implementation and transition to the Dutch CPG “Physiotherapy Management and WAD”.Results: Using an iterative process and input from both experts and users, 28 QIs were developed and subsequently classified per step of the clinical reasoning process for physiotherapy care. Based on 16 years of RCD, we found that the clinical reasoning process differed significantly (P ≤ 0.05) between the groups, in favor of Group B. Twelve of the 25 indicators (48.0%) in Group A and 19 of 26 indicators (73.1%) in Group B met predetermined performance targets. The number of target indicators also differed significantly between groups, favoring Group B (P ≤ 0.05).Conclusion: A preliminary set of novel QIs was developed. Using RCD and these QIs, we conclude that physiotherapy care in our study setting improved over the period 1996–2011. Furthermore, the QIs met the performance targets set for the clinical reasoning process after the transition to the Dutch CPG “Physiotherapy Management and WAD”. Keywords: quality of physiotherapy care, Whiplash-associated disorders, clinical guidelines, quality indicators, clinical reasoning process, routinely collected data

Study aim: The aim of this study was to compare the outcomes of a study of post-stroke gait reeducation using the Bobath neuro‑developmental treatment (NDT-Bobath) method and the traditional approach.

New technologies such as 3D printing and reverse engineering are becoming increasingly popular, including in medical applications. The paper presents possible ways to use 3D printing in the area of increasing the level of medical training specialists in their daily clinical practice and in the selection of the appropriate scenario before a real surgical operation. Descriptions of the projects carried out with the surgeons aimed at achieving the aforementioned goals were presented. The presented concepts are relatively new solutions, but their further development may lead to the extension of the field of application of these techniques in medicine, among others in relation to other specialties.

The research described in this article is a continuation of work on a computational model of quality of life (QoL) satisfaction. In the proposed approach, overall life satisfaction is aggregated to personal life satisfaction (PLUS). The model described in the article is based on well-known and commonly used clinimetric scales (e.g., in psychiatry, psychology and physiotherapy). The simultaneous use of multiple scales, and the complexity of describing the quality of life with them, require complex fuzzy computational solutions. The aim of the study is twofold: (1) To develop a fuzzy model that allows for the detection of changes in life satisfaction scores (data on the influence of the COVID-19 pandemic and the war in the neighboring country were used). (2) To develop more detailed guidelines than the existing ones for further similar research on more advanced intelligent systems with computational models which allow for sensing, detecting and evaluating the psychical state. We are concerned with developing practical solutions with higher scientific and clinical utility for both small datasets and big data to use in remote patient monitoring. Two exemplary groups of specialists at risk of occupational burnout were assessed three times at different intervals in terms of life satisfaction. The aforementioned assessment was made on Polish citizens because the specific data could be gathered: before and during the pandemic and during the war in Ukraine (a neighboring country). That has a higher potential for presenting a better analysis and reflection on the practical application of the model. A research group (physiotherapists, n = 20) and a reference group (IT professionals, n = 20) participated in the study. Four clinimetric scales were used for assessment: the Perceived Stress Scale (PSS10), the Maslach Burnout Scale (MBI), the Satisfaction with Life Scale (SWLS), and the Nordic Musculoskeletal Questionnaire (NMQ). The assessment was complemented by statistical analyses and fuzzy models based on a hierarchical fuzzy system. Although several models for understanding changes in life satisfaction scores have been previously investigated, the novelty of this study lies in the use of data from three consecutive time points for the same individuals and the way they are analyzed, based on fuzzy logic. In addition, the new hierarchical structure of the model used in the study provides flexibility and transparency in the process of remotely monitoring changes in people's mental well-being and a quick response to observed changes. The aforementioned computational approach was used for the first time.

Currently, there is an intensive development of bipedal walking robots. The most known solutions are based on the use of the principles of human gait created in nature during evolution. Modernbipedal robots are also based on the locomotion manners of birds. This review presents the current state of the art of bipedal walking robots based on natural bipedal movements (human and bird) as well as on innovative synthetic solutions. Firstly, an overview of the scientific analysis of human gait is provided as a basis for the design of bipedal robots. The full human gait cycle that consists of two main phases is analysed and the attention is paid to the problem of balance and stability, especially in the single support phase when the bipedal movement is unstable. The influences of passive or active gait on energy demand are also discussed. Most studies are explored based on the zero moment. Furthermore, a review of the knowledge on the specific locomotor characteristics of birds, whose kinematics are derived from dinosaurs and provide them with both walking and running abilities, is presented. Secondly, many types of bipedal robot solutions are reviewed, which include nature-inspired robots (human-like and birdlike robots) and innovative robots using new heuristic, synthetic ideas for locomotion. Totally 45 robotic solutions are gathered by thebibliographic search method. Atlas was mentioned as one of the most perfect human-like robots, while the birdlike robot cases were Cassie and Digit. Innovative robots are presented, such asslider robot without knees, robots with rotating feet (3 and 4 degrees of freedom), and the hybrid robot Leo, which can walk on surfaces and fly. In particular, the paper describes in detail the robots' propulsion systems (electric, hydraulic), the structure of the lower limb (serial, parallel, mixed mechanisms), the types and structures of control and sensor systems, and the energy efficiency of the robots. Terrain roughness recognition systems using different sensor systems based on light detection and ranging or multiple cameras are introduced. A comparison of performance, control and sensor systems, drive systems, and achievements of known human-like and birdlike robots is provided. Thirdly, for the first time, the review comments on the future of bipedal robots in relation to the concepts of conventional (natural bipedal) and synthetic unconventional gait. We critically assess and compare prospective directions for further research that involve the development of navigation systems, artificial intelligence, collaboration with humans, areas for the development of bipedal robot applications in everyday life, therapy, and industry.

Classical massage is one of the most popular forms of conservative treatment in various diseases. Despite the wide scope of research, the mechanisms of massage are not fully known and understood. Apart from the well-described effects on individual body systems, there are few scientific reports on the effects of massage on the human body at the subcellular level. The study was designed to assess changes in oxidative stress parameters in healthy volunteers after a single session of classical massage. 29 healthy volunteers aged 22.24 ± 3.64 participated in the study. Before and 30 minutes after the massage procedures, blood samples were taken by experienced personnel. Biochemical markers of oxidative homeostasis were assessed with highly specific methods for each parameter: oxidase ceruloplasmin, glutathione, malondialdehyde, glutathione peroxidase, glutathione S-transferase, and superoxide dismutase. The study demonstrates that massage therapy caused statistically significant decrease in the concentration of glutathione peroxidase (red blood cells) and increase in the level of glutathione peroxidase (plasma), superoxide dismutase, and malondialdehyde. In contrast, statistically significant changes in the hematocrit, glutathione, NO 2- /NO 3- , and oxidase ceruloplasmin were not observed. The results show that complex influence of classical massage therapy on human organism may be reflected in parameters of the oxidative stress. To understand this mechanism clearly, further research is needed., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Zofia Skubisz et al.)

Background: The use of an exoskeleton elbow is considered an effective treatment in several pathologies, including post-stroke complications, traumatic brain injury (TBI) and spinal cord injury (SCI), as well as in patients with neurodegenerative disorders. The effectiveness of rehabilitation is closely linked to a suitably chosen therapy. The treatment can be performed only by specialized personnel, significantly supported by the use of automated devices., Objectives: The aim of this study was to present a novel exoskeleton for elbow rehabilitation without a complicated control system., Material and Methods: Single-degree-of-freedom (SDOF) solution in constructing the prototype of an elbow exoskeleton for rehabilitation purposes has been applied. The simplicity of the actuation mechanism was set as one of the priorities in the design; thus, a single-axis stepper motor with a controller was found to be adequate for providing a reliable and precise source of motion for the exoskeleton., Results: Technological development may provide novel solutions, such as an exoskeleton - a wearable, external structure which supports or (in selected applications) even replaces the muscle actuation in the patient. The reported advantages of the proposed exoskeleton reflect current state-of-the-art. The proposed control strategy relies on closed-loop position control, performance, low manufacturing cost, and predicted performance in a rehabilitation scenario. All these factors play an important role in establishing the directions for further research, e.g., an integrated force sensor in the device, measurements of torque interactions on the elbow joint, and assessment and response to an overload of articulation., Conclusions: This study suggests not only the clinical but also the possible economic and logistical advantages offered by the portability of the system, and its effective support for therapists applying an elbow exoskeleton.

Background: Tinnitus is defined as a phantom auditory perception, i.e., sound experience despite the lack of acoustic stimuli in the environment. The aim of this study was to assess the state of the natural antioxidant barrier of a body in patients complaining about the presence of tinnitus., Material and Methods: The study included a total of 51 patients aged from 20 to 62 years with diagnosed idiopathic tinnitus and 19 healthy subjects as a control group. All patients underwent the audiometric tone test, speech audiometry, distortion otoacoustic emission product testing, study of evoked auditory potentials of short latency, and biochemical analysis of venous blood concerning values of activity or concentration of glutathione, glutathione peroxidase, S-transferase, glutathione reductase superoxide dismutase, malondialdehyde, and ceruloplasmin as the selected parameters of oxidative stress., Results: Disorders of the auditory pathway were not only limited to the cochlea but also covered its further episodes. Mean values of activity or concentration of the selected parameters of oxidative stress in the study and control groups showed reduced effectiveness of the body's natural antioxidant barrier., Discussion: Patients complaining about the presence of tinnitus showed reduced effectiveness of the body's natural antioxidant barrier compared to the control group., Conclusions: The main indication to undertake further research on the functioning of the antioxidant barrier in people suffering from ailments in the form of tinnitus is to determine a suitable therapy aimed at improving the quality of life of these patients, which might be the administration of antioxidant medications.

More profound understanding of the relationship between the burnout and the limbic system function can provide better insight into brain structures associated with the burnout syndrome. The objective of this review is to explore all evidence of limbic brain structures associated with the burnout syndrome. In total, 13 studies were selected. Four of them applied the neuroimaging technology to investigate the sizes/volumes of the limbic brain structures of burnout patients. Six other studies were to investigate the hypothalamus-pituitary-adrenal (HPA) axis of burnout patients. Based on the results of the studies on the HPA-axis and neuroimaging of the limbic brain structures, one can see great impact of the chronic occupational stress on the limbic structures in terms of HPA dysregulation, a decrease of BDNF, impaired neurogenesis and limbic structures atrophy. It can be concluded that chronic stress inhibits the feedback control pathway in the HPA axis, causes the decrease of brain-derived neurotrophic factor (BDNF), then impaired neurogenesis and eventually neuron atrophy., (Copyright © 2017 Medical University of Bialystok. Published by Elsevier B.V. All rights reserved.)

Background: The goal of this study is to assess the natural antioxidant barrier of the organism and selected psychological aspects of the aging process in patients above 60 years old., Methods: The study included a total of 52 patients aged above 60 (mean age 67 ± 3.4) and 32 healthy subjects (mean age 22 ± 3.4) as a control group. All patients underwent psychological assessment using Test of Attentional Performance version 2.3 (TAP 2.3, four subtests: alertness, cross-modal integration, neglect with central task, and working memory) and biochemical analysis of venous blood concerning values of the selected parameters of oxidative stress (HT, GSH, GPXOS, GPXRBC, GRRBC1, SODRBC1, MDARBC1, NO 2 - /NO 3 - , and CP)., Results: Disorders of attention were observed mainly in elderly people, but an assumption that elderly people have developed more efficient ways of working memory use than younger people may be true. Results showed the reduced effectiveness of the body's natural antioxidant barrier in elderly people. Moderate positive and negative correlations among parameters of oxidative stress and psychological parameters were observed in the control group., Discussion: Intensification of the attention deficits and oxidative stress may be observed as one of the pathogenic factors of age-dependent diseases.

Background: Vitamin D influences the immune system significantly. Previous studies have found that vitamin D deficiency in adolescence can play a significant role in increasing the risk of developing autoimmune diseases including multiple sclerosis. The aim of this study was to investigate the relationship between the vitamin D status in serum and clinical and radiological outcomes in a treated population in Poland., Methods: Inclusion criteria met 83 adult patients aged 20-61 years with diagnosis of relapsing-remitting multiple sclerosis, who underwent immunomodulatory treatment which lasted at least 12 months. Levels of serum 25-hydroxyvitamin D were determined using radio-immuno assay. Magnetic resonance imaging of the brain and cervical part of a spinal cord was performed each time after 12 months of the treatment. Patients were assessed neurologically after 12 months of treatment, the level of disability was also assessed using Extended Disability Status Scale., Results: The largest group (63.8%) showed significant vitamin D deficiency (<20 ng/ml), 21.7% showed the suboptimal level of vitamin D (20-30 ng/ml). The normal level of 25(OH)D (>30 ng/ml) was observed in 14.5% of the patients. Statistically significant correlation was observed between the vitamin D status and frequency of relapses., Conclusions: Our findings confirm that deficiency of vitamin D in patients with MS is correlated with clinical and radiological course of the disease.

Objective: To develop and evaluate process indicators relevant to biopsychosocial history taking in patients with chronic back and neck pain., Methods: The SCEBS method, covering the Somatic, Psychological (Cognition, Emotion, and Behavior), and Social dimensions of chronic pain, was used to evaluate biopsychosocial history taking by manual physical therapists (MPTs). In Phase I, process indicators were developed while in Phase II indicators were tested in practice., Results: Literature-based recommendations were transformed into 51 process indicators. Twenty MTPs contributed 108 patient audio recordings. History taking was excellent (98.3%) for the Somatic dimension, very inadequate for Cognition (43.1%) and Behavior (38.3%), weak (27.8%) for Emotion, and low (18.2%) for the Social dimension. MTPs estimated their coverage of the Somatic dimension as excellent (100%), as adequate for Cognition, Emotion, and Behavior (60.1%), and as very inadequate for the Social dimension (39.8%)., Conclusion: MTPs perform screening for musculoskeletal pain mainly through the use of somatic dimension of (chronic) pain. Psychological and social dimensions of chronic pain were inadequately covered by MPTs. Furthermore, a substantial discrepancy between actual and self-estimated use of biopsychosocial history taking was noted. We strongly recommend full implementation of the SCEBS method in educational programs in manual physical therapy.

Disorders of consciousness (DoCs) are chronic conditions resulting usually from severe neurological deficits. The limitations of the existing diagnosis systems and methodologies cause a need for additional tools for relevant patients with DoCs assessment, including brain-computer interfaces (BCIs). Recent progress in BCIs' clinical applications may offer important breakthroughs in the diagnosis and therapy of patients with DoCs. Thus the clinical significance of BCI applications in the diagnosis of patients with DoCs is hard to overestimate. One of them may be brain-computer interfaces. The aim of this study is to evaluate possibility of non-invasive EEG-based brain-computer interfaces in diagnosis of patients with DOCs in post-acute and long-term care institutions.

Background: In patients after a stroke there are variable disorders. These patients often need rehabilitation in more than one area beceause of multiple limitations of the ability to perform everyday activities., Objectives: The aim of the study was to assess correlations - statistical relationships between observed gait parameters, ADL and hand functions - results of rehabilitation of patients after ischaemic stroke according to the NDTBobath method for adults., Material and Methods: The investigated group consisted of 60 patients after ischaemic stroke, who participated in the rehabilitation programme. 10 sessions of the NDT-Bobath therapy were provided in 2 weeks (10 days of the therapy). The calculation of correlations was made based on changes of parameters: Bobath Scale (to assess hand functions), Barthel Index (to assess ADL), gait velocity, cadence and stride lenght. Measurements were performed in every patient twice: on admission (before the therapy) and after last session of the therapy to assess rehabilitation effects., Results: The main statistically relevant corellations observed in the study were as follows: in the whole group of patients: poor and moderate (negative) correlation between changes of gait parameters and Bobath Scale and Barthel Index, moderate and severe (negative) correlation between changes of gait parameters and Bobath Scale and Barthel Index in the group of women, correlation between changes in Bobath Scale and Barthel Index in the group of patients with left side of paresis, (negative) correlation between changes of gait parameters and Bobath Scale in group of patients younger than 68 years, moderate, high and very high correlations between changes in gait parameters in groups of women, men, younger than 68 years and older than 68 years., Conclusions: There have been observed statistically significant and favourable changes in the health status of patients, described by gait parameters, changes in hand functions and ADL. Based on the presented correlations there is an assumption that it is hard to achieve simultaneous recovery in all areas: gait parameters, hand functions and ADLs in two weeks of rehabilitation.

Cornelia de Lange syndrome (CdLS, also called Brachmann-de Lange syndrome - BdLS) is a multisystem developmental disorder characterized by distinctive facial features, growth and mental retardation, microcephaly, and various malformations. According to their clinical status, patients with CdLS require individual interdisciplinary therapy. The therapy is difficult and mainly symptomatic. To optimize the therapy results, early diagnosis programs and appropriate developmental and therapeutic intervention are recommended. The interdisciplinary approach described in the article needs further clinical research and detailed guidelines.

Background: Stroke is perceived a major cause of disability, including gait disorders. Looking for more effective methods of gait reeducation in post-stroke survivors is one of the most important issues in contemporary neurorehabilitation., Objectives: Following a stroke, patients suffer from gait disorders. The aim of this paper is to present the outcomes of a study of post-stroke gait reeducation using the NeuroDevelopmental Treatment-Bobath (NDT-Bobath) method., Material and Methods: The research was conducted among 60 adult patients who had undergone ischemic stroke. These patients were treated using the NDT-Bobath method. These patients' gait reeducation was assessed using spatio-temporal gait parameters (gait velocity, cadence and stride length). Measurements of these parameters were conducted by the same therapist twice: on admission, and after the tenth session of gait reeducation., Results: Among the 60 patients involved in the study, the results were as follows: in terms of gait velocity, recovery was observed in 39 cases (65%), in terms of cadence, recovery was observed in 39 cases (65%), in terms of stride length, recovery was observed in 50 cases (83.33%)., Conclusions: Benefits were observed after short-term therapy, reflected by measurable statistically significant changes in the patients' gait parameters.

Background: Ischaemic stroke is responsible for 80-85% of strokes. There is great interest in finding effective methods of rehabilitation for post-stroke patients., Objectives: The aim of this study was to assess the results of rehabilitation carried out in the normalization of upper limb muscle tonus in patients, estimated on the Ashworth Scale for Grading Spasticity., Material and Methods: The examined group consisted of 60 patients after ischaemic stroke. 10 sessions of NDT-Bobath therapy were provided within 2 weeks (ten days of therapy). Patient examinations using the Ashworth Scale for Grading Spasticity were done twice: the first time on admission and the second after the last session of the therapy to assess rehabilitation effects., Results: Among the patients involved in the study, the results measured on the Ashworth Scale (where possible) were as follows: recovery in 16 cases (26.67%), relapse in 1 case (1.67%), no measurable changes (or change within the same grade of the scale) in 8 cases (13.33%)., Conclusions: Statistically significant changes were observed in the health status of the patients. These changes, in the area of muscle tone, were favorable and reflected in the outcomes of the assessment using the Ashworth Scale for Grading Spasticity.

Neuroprostheses are electronic devices using electrophysiological signals to stimulate muscles, electronic/ mechanical devices such as substitutes for limbs or parts of limbs, or computers. The development of neuroprostheses was possible thanks to advances in understanding of the physiology of the human brain and in the capabilities of hardware and software. Recent progress in the area of neuroprosthetics may offer important breakthroughs in therapy and rehabilitation. New dedicated solutions for disabled people can lead to their increased participation in social, educational and professional areas. It is worth focussing particular attention on new solutions for people with paralysis, people with communication disorders and amputees. This article aims at investigating the extent to which the available opportunities are being exploited, including current and potential future applications of brain-computer interfaces.