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Aim: The aim of this pragmatic observational study was to identify for which purposes Functional electrical stimulation (FES) has been prescribed in University Rehabilitation Institute of Republic of Slovenia – Soča (URI-Soča) for long term treatment at home and whether prescribing practice has been changed over time in the last 10 years. Methods: A pragmatic cohort retrospective study included 373 stroke patients that performed inpatient rehabilitation at the Department for rehabilitation of patients after stroke URI-Soča between January 2010 and December 2019, and used FES at home after discharge. Results: FES was most often prescribed to patients with mild disability and severely affected upper extremity after stroke. Half of the patients used FES on the paretic upper extremity, 46.9% on the hemiparetic upper and lower extremity and only minority (2.9%) on the affected lower extremity alone. The upper limb stimulation predominated almost in the whole observational period. 22.3% of the patients used FES for more than 1 year, on average 3.5 years. A combination of FES and botulinum toxin therapies was used as a spasticity treatment of affected upper extremity in almost one third of patients (29.8%). In a group that used FES for more than one year, botulinum toxin therapies were statistically significantly more frequent (P, Cilj: Cilj ove pragmatične opservacijske studije bio je utvrditi u koje se svrhe upotrebljava funkcionalna električna stimulacija (FES) u Univerzitetnom institutu za rehabilitaciju Republike Slovenije u Soči (URI-Soča) nakon moždanog udara za dugotrajno liječenje kod kuće i je li se praksa propisivanja mijenjala tijekom vremena u posljednjih deset godina. Metode: U pragmatičnu kohortnu retrospektivnu studiju bila su uključena 373 bolesnika s moždanim udarom koji su provodili stacionarnu rehabilitaciju na Odjelu za rehabilitaciju bolesnika nakon moždanog udara u URI-Soča između siječnja 2010. i prosinca 2019., a koristili su FES kod kuće nakon otpusta. Rezultati: FES je bio najčešće propisivan bolesnicima s lakšim oštećenjem i teškom parezom gornjeg ekstremiteta nakon moždanog udara. Polovina bolesnika koristila je FES na paretičnom gornjem ekstremitetu, 46,9 % na hemiparetičnom gornjem i donjem ekstremitetu i manjina (2,9 %) samo na paretičnom donjem ekstremitetu. Stimulacija gornjih udova prevladavala je gotovo u cijelom razdoblju promatranja. 22,3 % pacijenata koristilo je FES dulje od jedne godine, u prosjeku 3,5 godine. Kombinacija FES-a i terapije botulinskim toksinom korištena je za liječenje spasticiteta zahvaćenog gornjeg ekstremiteta kod gotovo jedne trećine bolesnika (29,8 %). U skupini koja je koristila FES dulje od godinu dana, terapije botulinskim toksinom bile su statistički značajno češće (P < 0,001). Zaključci: Gotovo jedna trećina pacijenata u našoj studiji primila je FES za kućnu upotrebu za liječenje spastičnosti. Više od polovine onih koji su godinama koristili FES kod kuće, koristilo je kombinaciju botulinskog toksina i FES terapije, što sugerira da su osjetili učinkovitost kombiniranog pristupa liječenju.

Uvod: Namen fizioterapije pri pacientih po možganski kapi je ponovno vzpostavljanje in vzdrževanje optimalnega gibanja ter funkcijske sposobnosti posameznika, ob upoštevanju omejitev zaradi posledic možganske kapi in drugih osebnih ter okoljskih dejavnikov. Namen teh priporočil pa je višja kakovost, preglednost in enotnost fizioterapevtske obravnave pacientov po možganski kapi v Sloveniji. Metode: Pregledane so bile aktualne z dokazi podprte fizioterapevtske in večdisciplinarne klinične smernice za rehabilitacijo po možganski kapi, iz katerih so bila povzeta priporočila za fizioterapijo. Vsa predstavljena priporočila so bila dopolnjena s pregledom ugotovitev sistematičnih preglednih člankov. Rezultati: Postopki oziroma ukrepi so razdeljeni na predpremično in premično fazo fizioterapije, ta pa poleg splošnega dela še na ravnotežje, hojo, zmogljivost mišic in vzdržljivost srčno-dihalnega sistema, funkcijske sposobnosti zgornjega uda ter senzorične funkcije. Podanih je 49 močnih priporočil, v 28 primerih je priporočen razmislek o uporabi oziroma izvedbi, v šestih primerih pa je postopek oziroma ukrep odsvetovan. Zaključek: Ta priporočila naj služijo kot vodilo za klinično odločanje v fizioterapiji po možganski kapi, ob upoštevanju drugih značilnosti, okoliščin in pacientovih prioritet. Background: The goal of physiotherapy in patients after stroke is to restore and maintain maximum movement and functional ability, taking into account the limitations caused by the stroke and other personal and environmental factors of an individual. The aim of these recommendations is to improve the quality, transparency and uniformity of physiotherapy care for patients after stroke in Slovenia. Methods: Current evidence-based clinical guidelines for physiotherapy and physiotherapy interventions in multidisciplinary clinical guidelines for rehabilitation after stroke were reviewed. All presented recommendations were supplemented with results of systematic reviews. Results: Interventions are divided into pre-mobilisation and mobilisation phases of physiotherapy. The latter is further divided into the general part, balance, walking, muscular strength and cardiovascular endurance, functional abilities of the upper limbs and sensory functions. There are 49 strong recommendations, 28 cases recommended to consider the intervention and 6 cases advised against it. Conclusions: These recommendations should guide clinical decision making in physiotherapy for patients after stroke, considering other patient characteristics, circumstances, and preferences.

A common approach to managing lower-limb motor impairments resulting from a stroke is to use an orthotic device, mainly an ankle orthosis (AO) or an ankle-foot orthosis (AFO), to provide direct control of the ankle and foot and facilitate the swing phase of gait. AOs and AFOs have a favourable impact on walking speed, walking impairment (step/stride length), and balance (weight distribution in standing) in stroke patients. The contemporary stroke rehabilitation guidelines therefore recommend that AFOs should be used for ankle instability or dorsiflexor weakness and to improve walking ability and safety. The manuscript presents AOs and AFOs that are available on the Slovenian market, and some of our findings regarding the effects of the use of AOs and AFOs in stroke patients. V rehabilitaciji bolnikov po možganski kapi za zmanjšanje motoričnih disfunkcij spodnjega uda pogosto uporabljamo ortoze, najpogosteje ortoze za gleženj (OG) in ortoze za gleženj in stopalo (OGS), ki omogočajo večjo stabilnost gležnja in stopala med prenosom teže na okvarjeni spodnji ud in olajšajo fazo zamaha. Dokazano je, da imajo OG/OGS pri bolnikih po možganski kapi ugoden učinek na funkcijo hoje (hitrost), nepravilnosti hoje (dolžina koraka) in ravnotežje (porazdelitev teže v stoječem položaju). Veljavne smernice za rehabilitacijo bolnikov po možganski kapi zato priporočajo, da bolnikom nameščamo OGS za stabilizacijo skočnega sklepa in stopala, pomoč pri učinkovitosti, nadzoru in varnosti hoje. V prispevku so predstavljene OG in OGS, ki so na voljo na slovenskem trgu. Navedenih je tudi nekaj naših ugotovitev v zvezi z učinki nameščanja OG/OGS.

Background: Rehabilitation of persons after stroke is using virtual reality (VR) in therapeutic practice more than ever. The objective of our study was to determine whether the balance training exercise within virtual environment can be as effective as the conventional balance training for persons after stroke. We used three specific "exergames" from the REWIRE system designed for balance training that were functionally very close to the conventional balance training for patients after stroke. Methods: Between June 2016 and May 2017, 20 patients of the Department for Rehabilitation of Patients After Stroke of the University Rehabilitation Institute in Ljubljana participated in the study. The participants were randomised into two groups: the experimental group training with additional VR "exergames" and the control group receiving additional conventional balance training. The additional balance exercises were limited to 5 days for both groups. Before and after the exercises, a set of clinical tests (the 10m walking test, the Timed up & go test, the Four Square Step Test and modified sensory integration tests) were conducted. Results: The Timed Up & Go test and the Four Square Step Test showed statistically significant improvements in the test group. The control group showed statistically significant improvement in 10m walk test and also the Timed Up & Go test. However, there were no statistically significant differences between the groups after the exercises. Conclusions: Balance training with REWIRE exergames was relatively simple to use and comparable with conventional balance training in terms of effectiveness. We believe that the additional therapeutic procedure may be useful in rehabilitation of persons after a stroke. Izhodišče: V rehabilitaciji po možganski kapi se v terapevtski praksi vedno pogosteje uporablja vadba v navidezni resničnosti (VR). Namen naše raziskave je bil ugotoviti, ali je vadba ravnotežja s pomočjo navideznega okolja pri bolnikih po možganski kapi enako učinkovita kot konvencionalna vadba ravnotežja. V ta namen smo uporabili tri specifične video igre za vadbo ravnotežja iz sistema REWIRE, ki jih je bilo možno funkcionalno posnemati s konvencionalno vadbo ravnotežja pri bolnikih po možganski kapi. Metode: V raziskavo, ki je potekala od junija 2016 do maja 2017 na Oddelku za rehabilitacijo bolnikov po možganski kapi na Univerzitetnem rehabilitacijskem inštitutu - Soča (URI - Soča), je bilo vključenih 20 bolnikov, ki so bili naključno razdeljeni v testno (vadba ravnotežja s pomočjo navideznega okolja) in kontrolno skupino (konvencionalna vadba ravnotežja). Dodatna vadba ravnotežja je v obeh skupinah trajala pet dni. Dan pred začetkom vadbe in dan po koncu vadbe smo pri vseh bolnikih izvedli test hitrosti hoje na 10 metrov, časovno merjeni test vstani in pojdi, test korakanja v štirih kvadratih ter Modificirane klinične teste senzorične integracije. Rezultati: Po vadbi so bili rezultati testa hoje na 10 metrov in testa korakanja v štirih kvadratih pri testni skupini statistično značilno boljši, pri kontrolni skupini so se statistično značilno izboljšali izidi časovno merjenega testa vstani in pojdi in testa hitrosti hoje na 10 metrov. Med skupinama statistično pomembnih razlik po vadbi ni bilo. Zaključek: Vadba ravnotežja v navideznem okolju s sistemom video iger REWIRE je bila razmeroma preprosta in primerljivo učinkovita kot konvencionalna vadba ravnotežja. Ocenjujemo, da je lahko koristen dodaten terapevtski postopek pri rehabilitaciji bolnikov po možganski kapi.

Introduction: We present the effects of individually prescribed aerobic training using exercise bike on aerobic capacity, functional status and walking performance of patients in the subacute stage after stroke. Methods: Forty stroke patients admitted to comprehensive inpatient stroke rehabilitation program were randomised into control and treatment group. In addition to standard neurorehabilitation program in both groups, the patients in the treatment group had individually prescribed aerobic training on exercise bike. With weekly progression of intensity and duration of exercise, the patients reached 30 minutes of aerobic training per day, five times a week at the intensity of 80% of peak work capacity achieved on stress-testing performed at admission. In all patients, the number of training units of dynamic exercises were recorded and oxygen consumption (VO2peak), 6-minute walking test (6 MWT), Stand up and Go test and Functional Independence Measure (FIM) assessment were performed before and after four weeks of exercise. Results: Thirty-eight patients were included in the statistical analysis (19 in each group). The groups were balanced regarding age, gender, time to admission, mean oxygen consumption, walking distance during 6MWT, the time to perform the Stand up and Go test and the Functional Independence Measure score. After four weeks of training all the measured parameters improved in both groups, the improvement being larger in the treatment group, though not statistically significantly. Only the number of training units of dynamic exercises in was statistically significantly higher in the test group. Conclusion: The individually prescribed aerobic training improves cardiovascular performance, walking ability and functional performance in patients in the subacute stage after stoke. The four-week period of aerobic training was probably too short for demonstrating chronic cardiovascular and metabolic adaptation on regularly aerobic activity. The most important goal of the training is that the patients gain knowledge and feeling of how to continue the program after discharge from inpatient rehabilitation. Uvod: V članku prikazujemo učinke individualno načrtovane in stopnjevane aerobne vadbe na sobnem kolesu na povečanje telesne zmogljivosti, hojo ter funkcijsko stanje v subakutnem obdobju po možganski kapi. Metode: V raziskavo smo vključili 40 bolnikov v subakutnem obdobju po možganski kapi in jih naključno razdelili v testno in kontrolno skupino. Testna skupina je poleg ustaljenega programa rehabilitacije izvajala individualno načrtovan aerobni trening na sobnem kolesu. S postopnim večanjem intenzivnosti in daljšanjem trajanja treninga so bolniki ob koncu treninga vadili pol ure dnevno, pet dni v tednu, z intenzivnostjo 80 % maksimalne obremenitve, dosežene pri obremenitvenem testu na kolesu ob sprejemu. Pri vseh bolnikih smo beležili število vadbenih enot dinamične vadbe, pred pričetkom in po štirih tednih vadbe pa izmerili največjo porabo kisika (VO2peak), v šestih minutah prehojeno razdaljo, izvedli časovni test vstani in pojdi in ocenili funkcijsko stanje bolnikov z Lestvico funkcijske neodvisnosti (FIM). Rezultati: V statistično analizo je bilo vključenih 38 bolnikov, po 19 v vsaki skupini. Skupini sta bili izenačeni po spolu, starosti, času od nastopa možganske kapi do pričetka rehabilitacije, začetni povprečni vrednosti VO2peak, po prehojeni razdalji v šestih minutah, času izvedbe testa vstani in pojdi in oceni FIM. Po štiritedenski vadbi smo pri bolnikih obeh skupin beležili izboljšanje vseh merjenih parametrov, večje v testni skupini, vendar razlike med skupinama niso bile statistično značilne. Statistično značilno večje je bilo le število vadbenih enot dinamične vadbe v testni skupini. Zaključek: Individualno predpisana aerobna vadba ima ugoden učinek na telesno zmogljivost, hojo in funkcijsko stanje bolnikov tudi v subakutnem obdobju po možganski kapi. Štiritedensko obdobje izvajanja aerobnega treninga pri naših bolnikih je bilo prekratko, da bi se pokazali učinki prilagoditve srca in ožilja ter presnove v mišicah zaradi redne aerobne telesne dejavnosti. Bolniki pa so pridobili znanje in občutek, na kakšen način lahko z aerobnimi aktivnostmi varno nadaljujejo po odpustu iz rehabilitacijske ustanove.

Background: In a pilot study of telerehabilitation at home for patients after stroke, we wanted to develop a rehabilitation service that would enable the patients after discharge from inpatient rehabilitation to work out at home over a longer period under the supervision of a therapist. Methods: We developed a model of telerehabilitation service, established the technological infrastructure for its implementation via Internet and prepared 19 multimedia contents (videos) - 14 to show correct postures and transfers and 5 comprising a variety of exercises for stretching. Five stroke patients who completed the inpatient rehabilitation program at the University Rehabilitation Institute in Ljubljana were included in the study. An occupational therapist and a physiotherapist supervised the telerehabilitation for 3 months after patient%s discharge. They selected multimedia contents for each patient and weekly adapted them to his needs during videoconferencing. Results: During the telerehabilitation service, 14 different videos were selected for two patients, 13 for another patient, and 10 for two others. The therapists held 13 videoconferences with three patients and 12 with two. With all patients, there were some problems with the Internet connection. Especially in the beginning of telerehabilitation, all patients needed a support of their relatives or other persons. The most viewed videos were those with the exercises for stretching. Conclusions: Responses of patients and their assistants to telerehabilitation service were positive. Further development should particularly address the identification of appropriate contents of telerehabilitation, adapted to the heterogeneous needs of patients after stroke. Izhodišča: S pilotsko raziskavo storitev telerehabilitacije na domu za bolnike po možganski kapi smo želeli razviti storitev rehabilitacije na daljavo, s katero bi omogočili bolnikom po odpustu iz rehabilitacijske ustanove vadbo doma skozi daljši čas ob strokovnem nadzoru terapevta. Metode: Izdelali smo model telerehabilitacijske storitve, vzpostavili tehnološko infrastrukturo za izvajanje telerehabilitacije s pomočjo svetovnega spleta in pripravili 19 multimedijskih vsebin (filmov). Od teh filmov jih je 14 prikazovalo vadbo pravilnih telesnih položajev in pravilno premeščanje, pet pa jih je prikazovalo različne vaje za razgibavanje. V raziskavi je sodelovalo pet bolnikov, ki so preboleli možgansko kap in so bili vključeni v rehabilitacijske programe na Univerzitetnem rehabilitacijskem inštitutu - Soča. Storitve sta izvajala delovni terapevt in fizioterapevt tri mesece po odpustu iz rehabilitacijske ustanove. Za vsakega bolnika sta pripravila individualni izbor multimedijskih vsebin in ga tedensko prilagajala bolnikovim zmožnostim s pomočjo videokonferenc. Rezultati: V času telerehabilitacijske storitve smo dvema bolnikoma predpisali uporabo 14 različnih filmov, enemu 13 različnih filmov in dvema 10 različnih filmov. Terapevta sta imela s tremi bolniki videokonferenco 13-krat in z dvema 12-krat. Pri vseh bolnikih so se nekajkrat pojavile težave s povezavo preko svetovnega spleta. Predvsem v začetku vadbe so vsi bolniki potrebovali pomoč svojca ali druge osebe. Več ogledov filmov smo zabeležili za vsebine, ki so prikazovale vaje za razgibavanje. Zaključek: Odzivi bolnikov in njihovih pomočnikov na telerehabilitacijsko storitev so pozitivni. V nadaljnjem razvoju bo storitev potrebno predvsem vsebinsko izpopolniti in bolje prilagoditi raznovrstnostim potrebam bolnikov po možganski kapi.

Background: It is known that ankle and foot orthoses ways improve gait pattern in patients after stroke in many. Mass-produced orthoses for the ankle are available on the Slovenian market to patients with impaired upper motor neuron. The aim of our study was to assess the influence of such ankle orthoses on irregularities in gait, the pressure on the impaired foot and walking speed in patients after stroke with mild abnormalities in gait. Methods: Fourteen patients after stroke who were admitted to inpatient rehabilitation at the University Rehabilitation Institute in Ljubljana for the first time were included in the study. They were fitted with a mass-produced ankle orthosis and then clinical analysis of their gait pattern was conducted, and the 10-meter walking test and the timed-up-and-go test were performed. Plantar pressures were measured using the F-Scan system with and without the orthosis. Results: Clinical gait analysis showed that the ankle orthosis partially prevented foot drop in the swing phase. The F-Scan measurements did not show any significant differences in the distribution of pressure when comparing the patients' walking with and without the ankle orthosis. The timed tests showed significant improvement when using the orthosis: the mean time of the 10-meter walking test with an ankle orthosis was 15.6 seconds and without orthosis it was 17.3 seconds (p

Patients with neurological disorders often face disturbances of balance that lead to limitations in the performance of different functional activities. A frequent goal of rehabilitation set by the physical therapist and the patient together is improvement of balance. First, different tests are used to determine the probable causes of the patient's disability to maintain balance, and then appropriate methods for balance improvement are selected. The physical therapist can only work with one patient within a limited time, so rehabilitation is sometimes less intense. The training often requires considerable physical strength to assist the patient in performing different activities correctly. For that reason, physical therapists often use different devices and technical aids. Some of the devices are mainly used in laboratories, some are used clinically and some can be used by patients independently at home. Visual and/or audio feedback makes balance training easier and more appealing for patients and physical therapists alike. There are many assistive devices for improving patient's body symmetry when standing, as well as his/her static or dynamic balance. One of the devices for improvement of dynamic balance is a dynamic mechanical device that saves the physical therapist's time and energy and offers a fall-proof environment for safe training of various functional activities. Recently, different virtual environments have been used to make the training more appealing, easier to grade and its results more objectively analysed, which all contributes to the patient's motivation. In future, balance training might be conducted at distance by means of telerehabilitation. Pri bolnikih z okvarami osrednjega živčevja je zelo pogosta težava moteno ravnotežje, ki bolniku onemogoča izvajanje različnih funkcionalnih aktivnosti. Izboljšanje ravnotežja je cilj, ki si ga fizioterapevti postavimo skupaj z bolnikom. Pri vsakem bolniku je zato potrebno najprej z različnimi testi ugotoviti vzroke, ki so pripeljali do izgube sposobnosti ohranjanja ravnotežja in šele nato izbrati metodo, s katero ga ponovno poskušamo izboljšati. Fizioterapevt lahko terapijo izvaja z enim bolnikom v omejenem času, zato je včasih rehabilitacija manj intenzivna, prav tako pa mora le-ta včasih pri bolnikovi vadbi uporabiti veliko svoje telesne moči, da bolniku pomaga varno in pravilno izvajati aktivnosti. Zato pri vadbi ravnotežja fizioterapevti velikokrat uporabljamo različne pripomočke in naprave. Nekatere naprave so namenjene predvsem za delo v laboratorijih, nekatere za klinično uporabo, nekatere pa lahko bolnik uporablja tudi v domačem okolju. S pomočjo vidne in/ali slušne povratne informacije je vadba ravnotežja lažja in bolj zanimiva tako za bolnika kakor tudi za fizioterapevta. Poznamo različne naprave, s katerimi lahko vplivamo na simetrijo pri stoji ter statično ali dinamično ravnotežje. Ena izmed naprav za izboljšanje dinamičnega ravnotežja je dinamično oporno stojalo, s pomočjo katerega lahko prihranimo čas in napor fizioterapevta, bolnik pa lahko v okolju, varnem pred padci, vadi različne funkcijske aktivnosti. V zadnjem času veliko uporabljajo različna navidezna okolja, z uporabo le-teh lahko vadba za bolnika postane bolj zanimiva, lažje jo stopnjujemo in objektivno analiziramo rezultate, kar bolnika lahko še bolj motivira. V prihodnje bomo mogoče lahko vadbo ravnotežja izvajali tudi na daljavo s telerehabilitacijo.

Telerehabilitation is a rapidly developing field of telemedicine that enables the provision of rehabilitation services in the user's home environment by means of communication technologies. The article starts with a short outline of the current state in telerehabilitation systems based on haptic robotics and virtual reality training tasks in rehabilitation of upper limbs. That is followed by a description of our own telerehabilitation system developed for balance training during standing. The article closes with a discussion on the open questions related to telerehabilitation that need to be addressed in the future development in order to fully integrate telerehabilitation into clinical practice.

Background: The flexor (withdrawal) reflex can be more easily excited in upper motor neuron lesions than in intact state of nervous system. It is already introduced into routine gait training in selected patients with spastic paraplegia. Flexion response synchronized with gait cycle in patients with hemiparesis is rarely successful. Methods: Flexion response convenient for correction of the swing phase of stride was tried to be elicited in 15 patients with spastic hemiparesis. The following parameters of electrical stimulation were chosen in the first group of 9 patients: pulse width 0.3ms and frequency 40Hz; in the subsequent 6 patients, pulse width 0,1ms and frequency 60Hz were added. The stimulation electrodes were positioned at the medial side of the sole and at the lateral side of the dorsum of the foot. The intensity was individually adjusted. Results: In 13 patients, flexion response could be elicited during testing (in sitting and supine position), but it was inconvenient for the practical use in gait training. It was disturbed mainly by painful stimulation and relatively rapid habituation. In the other two patients, the reflex was convenient regarding flexion in hip and knee, but accompanying internal rotation in hip, partial supination and plantar flexion of the foot prevented functional application. Conclusions: The parameters and the localization of electrical stimulation used did not bring about convenient flexion responses for gait training. Therefore, not only are further studies of suitable parameters and positioning of stimulation electrodes necessary, but also the selection of patients should be more specific.

The work desribes findings that established that gizzerosine administration in food negatively influences on lymphopcyte proliferation in laying hens, and suggest that their food should be free of gizzerosine.