Introduction. Aesthetic appearance is one of the major concerns in adolescent idiopathic scoliosi... more Introduction. Aesthetic appearance is one of the major concerns in adolescent idiopathic scoliosis (AIS) patients and its improvement is one of the main treatment's goals. Poor trunk appearance is associated with reduced quality of life in adolescents with idiopathic scoliosis. Aim. To review instruments that have been created to evaluate poor trunk appearance in these children. Material and methods. PubMed database and the Consortium of Libraries of Serbia for Unified Acquisition - KoBSON were searched using the keywords "adolescent scoliosis", "aesthetic appearance", "evaluation" and "questionnaires". Results. In order to evaluate the aesthetic impairment in these patients, various instruments have been created. They can roughly be classed as instruments that assess subjective perception or objective aesthetic appearance. The first group consists primarily of self-administered quality of life questionnaires that include an aesthetic comp...
Introduction: Conventional methods of neurological assessment of infants can detect nervous syste... more Introduction: Conventional methods of neurological assessment of infants can detect nervous system damage, but also have a weakness, i.e., the inability to make predictions for neurological deficits. Prechtl's general movement assessment is a diagnostic tool for the functional assessment of young nervous system. The aim of the study was to assess the quality of spontaneous motor activity in preterm newborns as well as to determine the neurological outcome at the age of 24 months. After that, the predictive value of spontaneous motor activity for neuro-developmental outcome at the age of 24 months was determined. The study included 160 pre-terms children, and designed as a prospective clinical study. Observation of spontaneous motor activity was performed according to the principles of Prechtl's method. Results: Spontaneous motor activity was observed in three periods for each newborn: within 5 days of birth, in the period of 44-46 gestation weeks, and in the period of 50-54 gestation weeks of post-menstrual age. Neurological outcome was assessed at the age of 24 months, and was classified as: normal finding, minimal neurological dysfunction, and cerebral palsy. All preterms, who presented normal patterns of spontaneous movements in neonatal and infant periods had a normal neurological functional outcomes at the age of 24 months. Newborns with pathological patterns of movement (cramped synchronized and absence of fidgety movements) in neonate and infant periods in the final outcomes had minimal neurological dysfunction or cerebral palsy. Conclusions: Assessment of general movement in preterms is a valuable method in prediction of dysfunctions in later neurological development. Early detection of symptoms of minimal neurological deficit and cerebral palsy is of crucial importance since it enables timely inclusion of children into neuro-developmental treatment.
The aim of this study was to assess the diagnostic reliability of the estimated glomerular filtra... more The aim of this study was to assess the diagnostic reliability of the estimated glomerular filtration rate based on serum creatinine and body height (eGFR-Cr Schwartz) as compared to the glomerular filtration rate (GFR) measured by a radioisotope method using Tc-99m-DTPA clearance in healthy children and in children with urinary tract infections (UTI) with and without a vesicoureteral reflux (VUR) using Bland-Altman analysis. The retrospective study enrolled 451 paediatric patients (104 male and 347 female, aged 7.07 ± 3.02, range of 2-15) from a single-institution database. Groups of participants were formed according to their diagnosis: the control group (CG, n = 64), the group with UTI with no documented VUR (UTI, n = 299), and the group with UTI and VUR (VUR, n = 88). The GFR was measured by the Tc-99m-DTPA clearance from a single blood sample drawn 180 minutes after administering the radiopharmaceutical. The eGFR-Cr was determined from an equation which included body height and the serum creatinine level. When compared to Tc-99m-DTPA GFR, the eGFR-Cr yielded the following mean deviation values in the examined groups: CG: 1.937 ml/min/1.73m 2 (95% limits of agreement [LOA]: -36.759-40.633 ml/min/1.73m 2 ), UTI: -3.010 ml/min/1.73m 2 (LOA: -57.292-51.272 ml/min/1.73m 2 ) and VUR: 2.183 ml/min/1.73m 2 (LOA: -64.019-68.385 ml/min/1.73m 2 ). eGFR-Cr demonstrated comparable accuracy to Tc-99m-DTPA GFR in the CG and UTI groups with 95% and 82% of values within 30% of the Tc-99m-DTPA GFR. The eGFR-Cr demonstrated a lower measurement reliability in the VUR group, amounting to only 68% of the values within 30% of the Tc-99m-DTPA clearance. The results proved eGFR-Cr to be a reliable alternative to the radioisotope method in children with preserved renal function and children with a urinary tract infection with no reflux, but a less reliable method in children with both VUR and renal impairment.
The number of candidates for total hip replacement (THR) is steadily increasing. Judging by the c... more The number of candidates for total hip replacement (THR) is steadily increasing. Judging by the clinical results and implant longevity, THR is one of the most common and most successful orthopedic interventions of all times. Material, design, surgical techniques and subsequent rehabilitation continue to evolve. Choice of the prosthesis and fixation technique depends on the patients' bone structure and joint stability and their individual characteristics, such as age, weight and level of activity. Rehabilitation after THR is as important as the surgery. Rehabilitation protocols vary with the type of endoprosthesis. There is some controversial evidence about the differences in the surgical approach, the role of the preoperative education and exercises, as well as the implementation of the most efficient rehabilitation protocol. Despite many uncertainties and dilemmas, most studies have shown that majority of patients are satisfied with their arthroplasty results.
Early detection of cerebral palsy and minimal neurological deficit symptoms in newborns and infan... more Early detection of cerebral palsy and minimal neurological deficit symptoms in newborns and infants is of crucial importance since it enables timely inclusion of children in neurodevelopmental treatment which contributes to the improvement of motor functional status at a later age, taking into account a biological phenomenon known as "brain plasticity". Conventional methods of neurological assessment of newborns and infants include neurological examination, quantitative assessment of motor functions using scales and tests, and utilization of additional diagnostic neuroimaging procedures as well. All the aforementioned methods are absolutely necessary for wider use in clinical practice as well. They enable fast diagnosis of neurological disorders and fast detection of central nervous system impairments, but they also share a common defect-inability of making adequate prognosis of neurological deficits. Thanks to Prechtl's Method based on qualitative assessment of spontaneous motor activity, specific neurological patterns that are excellent predictors of a child's neurological development can be defined even in the prenatal stage, as well as after birth in preterm and term newborns. The aim of the paper is to review literature data on the possibilities and importance of Prechtl's method in comparison to other conventional methods for ultra-early identification of newborns and infants at risk of the development of permanent neurological deficit-cerebral palsy and/or minimal neurological dysfunction. Prechtl's method is the most sensitive and specific clinical diagnostic procedure for the assessment of future neurological outcomes in high-risk newborns and infants.
Background: Dysfunctional voiding (DV) in neurologically normal children is characterized by invo... more Background: Dysfunctional voiding (DV) in neurologically normal children is characterized by involuntary intermittent contractions of either the striated muscle in external urethral sphincter, or the pelvic floor during voiding. Urinary incontinence, pelvic holding maneuvers, voiding difficulties, urinary tract infections (UTIs), constipation and vesicoureteral reflux are highly associated with DV. Aim: To investigate the role of abdominal and pelvic floor muscle (PFM) retraining in children with DV. Design: Prospective clinical controlled study Setting: Outpatient clinical facility Population: Forty-three children, 5-13 years of age, with dysfunctional voiding Methods: In addition to standard urotherapy (education, timed voiding, adequate fluid intake, voiding posture and pattern, constipation management and hygiene issues), children were assigned abdominal and PFM retraining. Diaphragmatic breathing exercises were done in lying and sitting positions, for the purpose of achieving abdominal muscle relaxation. PFM retraining consisted of low-level three-second contractions followed by thirty-second relaxation periods. Selected children received pharmacotherapy (anticholinergics or desmopressin). Recurrent symptomatic UTIs were treated with antibiotic prophylaxis. Uroflowmetry with PFM electromyography and ultrasound residual urine volumes were obtained before and at the end of the 12-month treatment period. Clinical manifestations and uroflowmetry parameters were analysed before and after the therapy. Results: After one year of therapy, urinary incontinence was cured in 20 out of 24 patients (83%), nocturnal enuresis in 12 out of 19 children (63%), while 13 out of 19 children (68%) were UTI free. All 15 patients recovered from constipation. Post-treatment uroflowmetry parameters showed significant improvements and a bell-shaped curve was observed in 36 out of 43 children. Conclusion: In combination with standard urotherapy, abdominal and pelvic floor muscle retraining is beneficial for curing urinary incontinence, nocturnal enuresis and UTIs in children with DV, as well as for normalizing urinary function. Further trials are needed to define the most effective treatment program which would result in the best treatment outcome. Clinical rehabilitation impact: To improve clinical and objective treatment outcome in dysfunctional voiders. Diaphragmatic breathing and pelvic floor muscle exercises are simple and easy to learn and could be assigned to children aged 5 or older. As they do not require special equipment, they can be performed at all health care levels.
Congenital brachial palsy (CBP) can have long-term consequences such as deformities, contractures... more Congenital brachial palsy (CBP) can have long-term consequences such as deformities, contractures and growth imbalance of the affected arm and shoulder girdle that can lead to severe handicap. The aim of the paper was to determine the effectiveness of early habilitation in infants with CBP. This retrospective clinical study included 34 infants who were habilitated in the Physical Medicine and Rehabilitation Clinic, Clinical Center Niš, during the period from 2000 to 2017. The protocol consisted of passive and active-assisted range of motion exercises for the affected arm, neurodevelopmental treatment, warm packs and electrotherapy, starting from the 3rd week of life. At the Clinic, 20 sessions were conducted and parents were educated with handling and home exercise program. The infants were re-evaluated each month during the first year of life. The modification of the manual muscle test (MMT) was used to assess the muscle strength (grades 0- 3). At 6 and 12 months of age, the outcom...
The aim of this paper is to determine the influence of Ki-67 proliferation index on somatostatin ... more The aim of this paper is to determine the influence of Ki-67 proliferation index on somatostatin receptor scintigraphy (SSRS) with Tc-99m-EDDA-HYNIC-TOC (Tc-99m-Tektrotyd) somatostatin analogue in patients with carcinoid tumors. Sixty-one patients (31 female, 30 male; age range: 33-76 years) were examined: 13 patients highly suspected of having a carcinoid, and 48 patients who had undergone the surgical removal of the tumor. Whole body SSRS at 4 h postinjection, spot scintigrams and SPECT of the selected regions were obtained for all patients. Tc-99m-Tektrotyd scintigraphy was classified as true positive in 26 out of 30 and true negative in 24 out of 28 patients. The sensitivity of Tc-99mTc-Tektrotyd scintigraphy was found to be as high as 94.74% in the group of patients with low mitotic index Ki67 (<2%), and it progressively decreased in patients with higher mitotic index (77.78% for Ki67 2-15% and 20% for Ki67% >20%). The likelihood of Tc-99m-Tektrotyd scan being positive wh...
Pelvic Floor Dysfunction - Symptoms, Causes, and Treatment, 2022
Dysfunctional voiding is a functional voiding disorder characterized by an intermittent uroflow r... more Dysfunctional voiding is a functional voiding disorder characterized by an intermittent uroflow rate due to involuntary intermittent contractions of the striated muscle of the external urethral sphincter or pelvic floor muscles (PFMs) during voiding in neurologically normal children. Symptoms include voiding difficulties as well as urgency, voiding frequency and, in some instances, urinary incontinence and/or nocturnal enuresis. Recurrent urinary tract infections, chronic constipation and/or fecal incontinence and vesicoureteral reflux (VUR) contribute to this condition. Urotherapy is the mainstay of the treatment. It starts with education and demystification and simple behavioral modifications. Specific measures include PFM exercises with various forms of biofeedback concentrating at the recognition of PFM function and their relaxation. However, the PFMs are part of the abdominal capsule and they act in coordination with lower abdominal muscles. These muscles need to be relaxed dur...
Conclusions: In SSc patients, both protocols improve TMJ and cervical mobilization, TMJ disabilit... more Conclusions: In SSc patients, both protocols improve TMJ and cervical mobilization, TMJ disability, and skin score. with some of the results confirmed at follow-up. P2, also improving SSc face disability, seems to ameliorate more items than P1 and to be more efficacious than P1.
p=<.0001) and between muscle strength and proprioception (r=-.488, p=<.0001). Multivariate analys... more p=<.0001) and between muscle strength and proprioception (r=-.488, p=<.0001). Multivariate analysis revealed associations between muscle strength and CRT (B: .334(.13), p=.007), 6MWT (B: .366(.03), p=<.0001) and HAQ (B:-.267(.04), p=<.0001). Indicating that muscle weakness is associated with activity impairments. Proprioception was associated with activity impairment but only when quantified by CRT (B:-.381(.14), p=.005). Interaction effects were found between muscle strength and proprioception which contributed independently to activity impairment (CRT: B:-.175(.06), p=.006, HAQ: B:-.144(.05), p=.002). Conclusions: Muscle strength is an important factor related to activity impairments in patients with EDS-HT. Activities that require more motor control, such as transfers, are more dependent on proprioceptive information. However, with regard to functional ability, controlling muscle force seems to be dependent on the amount of proprioceptive information available rather than being the product of only muscle power. References: Rombaut L, De Paepe A, Malfait F et al. Joint position sense and vibratory perception sense in patients with Ehlers-Danlos syndrome type III.
Objective. To evaluate the effects of interferential current (IC) stimulation and diaphragmatic b... more Objective. To evaluate the effects of interferential current (IC) stimulation and diaphragmatic breathing exercises (DBE) in children with bladder and bowel dysfunction. Patients and methods. Seventy-nine children with dysfunctional voiding and chronic constipation who were failures of primary care interventions were included in the prospective clinical study. All the children were checked for their medical history regarding LUTS and bowel habits. Physical examination including abdominal and anorectal digital examination were performed. Children kept a bladder and bowel diary, and underwent urinalyses and urine culture, the ultrasound examination of bladder and kidneys and uroflowmetry with pelvic floor electromyography. Eligible children were divided into 3 groups (A,B,C). All groups were assigned education and behavioral modifications. Additionally, group A underwent DBE and IC stimulation, while group B received only DBE. In all 3 groups, the treatment was conducted for 2 weeks in the clinic.The behavioral modifications and DBE were continued at home for one month. Clinical manifestations, uroflowmetry parameters and postvoided residual urine were analyzed before and after 6 weeks of therapy. Results. After the treatment, significant improvement in defecation frequency and fecal incontinence was noticed only in group A (P<0.001, P<0.05, respectively). These children demonstrated significant improvement in LUTS and postvoided residual urine (P<0.001,P<0.05, respectively). Bell-shaped uroflowmetry curve was observed in 73.3% group A patients (P< 0.001). Conclusions. IC stimulation and DBE are beneficial in chronically constipated dysfunctional voiders. Further trials are needed to define the long-term effects of this program.
Background/Aim. Botulinum toxin is a basic, recommended method of treatment in controlling cervic... more Background/Aim. Botulinum toxin is a basic, recommended method of treatment in controlling cervical dystonia (CD). Physical therapy has limited effect due to the nature of the disease that is a result of a disorder in structures and relationships of the basal ganglia. The aim of this study was to analyze the effect of physical therapy applied as monotherapy, or with parallel application of botulinum toxin in patients with CD. Methods. Randomized controlled clinical pilot study included 14 patients diagnosed with idiopathic CD. All patients were initially assessed by using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and Torticollis Rating Scale (Tsui scale). In the control group, composed of 5 patients, the treatment included only physical therapy. The experimental group (9 patients) was first given botulinum toxin, and physical therapy was applied after five days. Physical therapy was conducted five times a week in the period of two weeks at the Clinic. Patients ...
Adverse neurologic outcome in preterm infants could be associated with abnormal heart rate (HR) c... more Adverse neurologic outcome in preterm infants could be associated with abnormal heart rate (HR) characteristics as well as with abnormal general movements (GMs) in the 1st month of life. To demonstrate to what extent GMs assessment can predict neurological outcome in preterm infants in our clinical setting; and to assess the clinical usefulness of time-domain indices of heart rate variability (HRV) in improving predictive value of poor repertoire (PR) GMs in writhing period. Qualitative assessment of GMs at 1 and 3 months corrected age; 24h electrocardiography (ECG) recordings and analyzing HRV at 1 month corrected age. Seventy nine premature infants at risk of neurodevelopmental impairments were included prospectively. Neurodevelopmental outcome was assessed at the age of 2 years corrected. Children were classified as having normal neurodevelopmental status, minor neurologic dysfunction (MND), or cerebral palsy (CP). We found that GMs in writhing period (1 month corrected age) predicted CP at 2 years with sensitivity of 100%, and specificity of 72.1%. Our results demonstrated the excellent predictive value of cramped synchronized (CS) GMs, but not of PR pattern. Analyzing separately a group of infants with PR GMs we found significantly lower values of HRV parameters in infants who later developed CP or MND vs. infants with PR GMs who had normal outcome. The quality of GMs was predictive for neurodevelopmental outcome at 2 years. Prediction of PR GMs was significantly enhanced with analyzing HRV parameters.
The present study investigated the relationship between fear of falling and functional status, an... more The present study investigated the relationship between fear of falling and functional status, and sociodemographic and health-related factors in nursing home residents aged older than 65 years. The cross-sectional study involved 100 participants who were residents of a nursing home and aged older than 65 years. Fear of falling was assessed using the Falls Efficacy Scale. Functional status was assessed by four performance-based measures. Balance was assessed by the Berg Balance Scale, mobility by the Timed Up and Go test, lower limbs muscle strength by the Chair Rising Test and participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; functional ability by the motor Functional Independence Measure. There was a significant negative correlation between the Falls Efficacy Scale and Berg Balance Scale (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and motor Functional Independence Measure (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) scores; and a positive correlation with the Timed Up and Go test (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and Chair Rising Test (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) values. Falls Efficacy Scale score increase is associated with age, being a widower/widow and the number of falls in the previous year. Higher fear of falling is associated with an increase in the number of falls in the previous year and with a decrease in Berg Balance Scale score. The study found a significant associations between Falls Efficacy Scale score and all of the examined parameters of functional status, the number of falls in the previous year, age and marital status of widower/widow. The major finding was that poor balance and an increase in the number of falls in the previous year are independent factors significantly associated with the fear of falling. Geriatr Gerontol Int 2016; ••: ••-••.
Background/Aim. The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire repre... more Background/Aim. The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire represents a region- specific instrument for functional outcome measurement of hand function. The aim of the study was to analyze the correlation between the values of modified DASH questionnaire and change of elbow function after supracondylar fracture (SCF) of humerus and to analyze the effects of early rehabilitation. Methods. The study included 35 schoolaged children with flexion of SCF of humerus without lesion of nerves. The patients were divided into two groups: group A in which rehabilitation started up to 14 days after the removal of fixation (20 children), and group B in which rehabilitation started after 15 days and more (15 children). The effects of the applied rehabilitation procedures were analyzed by measuring the range of motion of elbow and using modified DASH questionnaire. Testing was performed during the first examination, on the first day of rehabilitation (retest) and af...
Introduction. Aesthetic appearance is one of the major concerns in adolescent idiopathic scoliosi... more Introduction. Aesthetic appearance is one of the major concerns in adolescent idiopathic scoliosis (AIS) patients and its improvement is one of the main treatment's goals. Poor trunk appearance is associated with reduced quality of life in adolescents with idiopathic scoliosis. Aim. To review instruments that have been created to evaluate poor trunk appearance in these children. Material and methods. PubMed database and the Consortium of Libraries of Serbia for Unified Acquisition - KoBSON were searched using the keywords "adolescent scoliosis", "aesthetic appearance", "evaluation" and "questionnaires". Results. In order to evaluate the aesthetic impairment in these patients, various instruments have been created. They can roughly be classed as instruments that assess subjective perception or objective aesthetic appearance. The first group consists primarily of self-administered quality of life questionnaires that include an aesthetic comp...
Introduction: Conventional methods of neurological assessment of infants can detect nervous syste... more Introduction: Conventional methods of neurological assessment of infants can detect nervous system damage, but also have a weakness, i.e., the inability to make predictions for neurological deficits. Prechtl's general movement assessment is a diagnostic tool for the functional assessment of young nervous system. The aim of the study was to assess the quality of spontaneous motor activity in preterm newborns as well as to determine the neurological outcome at the age of 24 months. After that, the predictive value of spontaneous motor activity for neuro-developmental outcome at the age of 24 months was determined. The study included 160 pre-terms children, and designed as a prospective clinical study. Observation of spontaneous motor activity was performed according to the principles of Prechtl's method. Results: Spontaneous motor activity was observed in three periods for each newborn: within 5 days of birth, in the period of 44-46 gestation weeks, and in the period of 50-54 gestation weeks of post-menstrual age. Neurological outcome was assessed at the age of 24 months, and was classified as: normal finding, minimal neurological dysfunction, and cerebral palsy. All preterms, who presented normal patterns of spontaneous movements in neonatal and infant periods had a normal neurological functional outcomes at the age of 24 months. Newborns with pathological patterns of movement (cramped synchronized and absence of fidgety movements) in neonate and infant periods in the final outcomes had minimal neurological dysfunction or cerebral palsy. Conclusions: Assessment of general movement in preterms is a valuable method in prediction of dysfunctions in later neurological development. Early detection of symptoms of minimal neurological deficit and cerebral palsy is of crucial importance since it enables timely inclusion of children into neuro-developmental treatment.
The aim of this study was to assess the diagnostic reliability of the estimated glomerular filtra... more The aim of this study was to assess the diagnostic reliability of the estimated glomerular filtration rate based on serum creatinine and body height (eGFR-Cr Schwartz) as compared to the glomerular filtration rate (GFR) measured by a radioisotope method using Tc-99m-DTPA clearance in healthy children and in children with urinary tract infections (UTI) with and without a vesicoureteral reflux (VUR) using Bland-Altman analysis. The retrospective study enrolled 451 paediatric patients (104 male and 347 female, aged 7.07 ± 3.02, range of 2-15) from a single-institution database. Groups of participants were formed according to their diagnosis: the control group (CG, n = 64), the group with UTI with no documented VUR (UTI, n = 299), and the group with UTI and VUR (VUR, n = 88). The GFR was measured by the Tc-99m-DTPA clearance from a single blood sample drawn 180 minutes after administering the radiopharmaceutical. The eGFR-Cr was determined from an equation which included body height and the serum creatinine level. When compared to Tc-99m-DTPA GFR, the eGFR-Cr yielded the following mean deviation values in the examined groups: CG: 1.937 ml/min/1.73m 2 (95% limits of agreement [LOA]: -36.759-40.633 ml/min/1.73m 2 ), UTI: -3.010 ml/min/1.73m 2 (LOA: -57.292-51.272 ml/min/1.73m 2 ) and VUR: 2.183 ml/min/1.73m 2 (LOA: -64.019-68.385 ml/min/1.73m 2 ). eGFR-Cr demonstrated comparable accuracy to Tc-99m-DTPA GFR in the CG and UTI groups with 95% and 82% of values within 30% of the Tc-99m-DTPA GFR. The eGFR-Cr demonstrated a lower measurement reliability in the VUR group, amounting to only 68% of the values within 30% of the Tc-99m-DTPA clearance. The results proved eGFR-Cr to be a reliable alternative to the radioisotope method in children with preserved renal function and children with a urinary tract infection with no reflux, but a less reliable method in children with both VUR and renal impairment.
The number of candidates for total hip replacement (THR) is steadily increasing. Judging by the c... more The number of candidates for total hip replacement (THR) is steadily increasing. Judging by the clinical results and implant longevity, THR is one of the most common and most successful orthopedic interventions of all times. Material, design, surgical techniques and subsequent rehabilitation continue to evolve. Choice of the prosthesis and fixation technique depends on the patients' bone structure and joint stability and their individual characteristics, such as age, weight and level of activity. Rehabilitation after THR is as important as the surgery. Rehabilitation protocols vary with the type of endoprosthesis. There is some controversial evidence about the differences in the surgical approach, the role of the preoperative education and exercises, as well as the implementation of the most efficient rehabilitation protocol. Despite many uncertainties and dilemmas, most studies have shown that majority of patients are satisfied with their arthroplasty results.
Early detection of cerebral palsy and minimal neurological deficit symptoms in newborns and infan... more Early detection of cerebral palsy and minimal neurological deficit symptoms in newborns and infants is of crucial importance since it enables timely inclusion of children in neurodevelopmental treatment which contributes to the improvement of motor functional status at a later age, taking into account a biological phenomenon known as "brain plasticity". Conventional methods of neurological assessment of newborns and infants include neurological examination, quantitative assessment of motor functions using scales and tests, and utilization of additional diagnostic neuroimaging procedures as well. All the aforementioned methods are absolutely necessary for wider use in clinical practice as well. They enable fast diagnosis of neurological disorders and fast detection of central nervous system impairments, but they also share a common defect-inability of making adequate prognosis of neurological deficits. Thanks to Prechtl's Method based on qualitative assessment of spontaneous motor activity, specific neurological patterns that are excellent predictors of a child's neurological development can be defined even in the prenatal stage, as well as after birth in preterm and term newborns. The aim of the paper is to review literature data on the possibilities and importance of Prechtl's method in comparison to other conventional methods for ultra-early identification of newborns and infants at risk of the development of permanent neurological deficit-cerebral palsy and/or minimal neurological dysfunction. Prechtl's method is the most sensitive and specific clinical diagnostic procedure for the assessment of future neurological outcomes in high-risk newborns and infants.
Background: Dysfunctional voiding (DV) in neurologically normal children is characterized by invo... more Background: Dysfunctional voiding (DV) in neurologically normal children is characterized by involuntary intermittent contractions of either the striated muscle in external urethral sphincter, or the pelvic floor during voiding. Urinary incontinence, pelvic holding maneuvers, voiding difficulties, urinary tract infections (UTIs), constipation and vesicoureteral reflux are highly associated with DV. Aim: To investigate the role of abdominal and pelvic floor muscle (PFM) retraining in children with DV. Design: Prospective clinical controlled study Setting: Outpatient clinical facility Population: Forty-three children, 5-13 years of age, with dysfunctional voiding Methods: In addition to standard urotherapy (education, timed voiding, adequate fluid intake, voiding posture and pattern, constipation management and hygiene issues), children were assigned abdominal and PFM retraining. Diaphragmatic breathing exercises were done in lying and sitting positions, for the purpose of achieving abdominal muscle relaxation. PFM retraining consisted of low-level three-second contractions followed by thirty-second relaxation periods. Selected children received pharmacotherapy (anticholinergics or desmopressin). Recurrent symptomatic UTIs were treated with antibiotic prophylaxis. Uroflowmetry with PFM electromyography and ultrasound residual urine volumes were obtained before and at the end of the 12-month treatment period. Clinical manifestations and uroflowmetry parameters were analysed before and after the therapy. Results: After one year of therapy, urinary incontinence was cured in 20 out of 24 patients (83%), nocturnal enuresis in 12 out of 19 children (63%), while 13 out of 19 children (68%) were UTI free. All 15 patients recovered from constipation. Post-treatment uroflowmetry parameters showed significant improvements and a bell-shaped curve was observed in 36 out of 43 children. Conclusion: In combination with standard urotherapy, abdominal and pelvic floor muscle retraining is beneficial for curing urinary incontinence, nocturnal enuresis and UTIs in children with DV, as well as for normalizing urinary function. Further trials are needed to define the most effective treatment program which would result in the best treatment outcome. Clinical rehabilitation impact: To improve clinical and objective treatment outcome in dysfunctional voiders. Diaphragmatic breathing and pelvic floor muscle exercises are simple and easy to learn and could be assigned to children aged 5 or older. As they do not require special equipment, they can be performed at all health care levels.
Congenital brachial palsy (CBP) can have long-term consequences such as deformities, contractures... more Congenital brachial palsy (CBP) can have long-term consequences such as deformities, contractures and growth imbalance of the affected arm and shoulder girdle that can lead to severe handicap. The aim of the paper was to determine the effectiveness of early habilitation in infants with CBP. This retrospective clinical study included 34 infants who were habilitated in the Physical Medicine and Rehabilitation Clinic, Clinical Center Niš, during the period from 2000 to 2017. The protocol consisted of passive and active-assisted range of motion exercises for the affected arm, neurodevelopmental treatment, warm packs and electrotherapy, starting from the 3rd week of life. At the Clinic, 20 sessions were conducted and parents were educated with handling and home exercise program. The infants were re-evaluated each month during the first year of life. The modification of the manual muscle test (MMT) was used to assess the muscle strength (grades 0- 3). At 6 and 12 months of age, the outcom...
The aim of this paper is to determine the influence of Ki-67 proliferation index on somatostatin ... more The aim of this paper is to determine the influence of Ki-67 proliferation index on somatostatin receptor scintigraphy (SSRS) with Tc-99m-EDDA-HYNIC-TOC (Tc-99m-Tektrotyd) somatostatin analogue in patients with carcinoid tumors. Sixty-one patients (31 female, 30 male; age range: 33-76 years) were examined: 13 patients highly suspected of having a carcinoid, and 48 patients who had undergone the surgical removal of the tumor. Whole body SSRS at 4 h postinjection, spot scintigrams and SPECT of the selected regions were obtained for all patients. Tc-99m-Tektrotyd scintigraphy was classified as true positive in 26 out of 30 and true negative in 24 out of 28 patients. The sensitivity of Tc-99mTc-Tektrotyd scintigraphy was found to be as high as 94.74% in the group of patients with low mitotic index Ki67 (<2%), and it progressively decreased in patients with higher mitotic index (77.78% for Ki67 2-15% and 20% for Ki67% >20%). The likelihood of Tc-99m-Tektrotyd scan being positive wh...
Pelvic Floor Dysfunction - Symptoms, Causes, and Treatment, 2022
Dysfunctional voiding is a functional voiding disorder characterized by an intermittent uroflow r... more Dysfunctional voiding is a functional voiding disorder characterized by an intermittent uroflow rate due to involuntary intermittent contractions of the striated muscle of the external urethral sphincter or pelvic floor muscles (PFMs) during voiding in neurologically normal children. Symptoms include voiding difficulties as well as urgency, voiding frequency and, in some instances, urinary incontinence and/or nocturnal enuresis. Recurrent urinary tract infections, chronic constipation and/or fecal incontinence and vesicoureteral reflux (VUR) contribute to this condition. Urotherapy is the mainstay of the treatment. It starts with education and demystification and simple behavioral modifications. Specific measures include PFM exercises with various forms of biofeedback concentrating at the recognition of PFM function and their relaxation. However, the PFMs are part of the abdominal capsule and they act in coordination with lower abdominal muscles. These muscles need to be relaxed dur...
Conclusions: In SSc patients, both protocols improve TMJ and cervical mobilization, TMJ disabilit... more Conclusions: In SSc patients, both protocols improve TMJ and cervical mobilization, TMJ disability, and skin score. with some of the results confirmed at follow-up. P2, also improving SSc face disability, seems to ameliorate more items than P1 and to be more efficacious than P1.
p=<.0001) and between muscle strength and proprioception (r=-.488, p=<.0001). Multivariate analys... more p=<.0001) and between muscle strength and proprioception (r=-.488, p=<.0001). Multivariate analysis revealed associations between muscle strength and CRT (B: .334(.13), p=.007), 6MWT (B: .366(.03), p=<.0001) and HAQ (B:-.267(.04), p=<.0001). Indicating that muscle weakness is associated with activity impairments. Proprioception was associated with activity impairment but only when quantified by CRT (B:-.381(.14), p=.005). Interaction effects were found between muscle strength and proprioception which contributed independently to activity impairment (CRT: B:-.175(.06), p=.006, HAQ: B:-.144(.05), p=.002). Conclusions: Muscle strength is an important factor related to activity impairments in patients with EDS-HT. Activities that require more motor control, such as transfers, are more dependent on proprioceptive information. However, with regard to functional ability, controlling muscle force seems to be dependent on the amount of proprioceptive information available rather than being the product of only muscle power. References: Rombaut L, De Paepe A, Malfait F et al. Joint position sense and vibratory perception sense in patients with Ehlers-Danlos syndrome type III.
Objective. To evaluate the effects of interferential current (IC) stimulation and diaphragmatic b... more Objective. To evaluate the effects of interferential current (IC) stimulation and diaphragmatic breathing exercises (DBE) in children with bladder and bowel dysfunction. Patients and methods. Seventy-nine children with dysfunctional voiding and chronic constipation who were failures of primary care interventions were included in the prospective clinical study. All the children were checked for their medical history regarding LUTS and bowel habits. Physical examination including abdominal and anorectal digital examination were performed. Children kept a bladder and bowel diary, and underwent urinalyses and urine culture, the ultrasound examination of bladder and kidneys and uroflowmetry with pelvic floor electromyography. Eligible children were divided into 3 groups (A,B,C). All groups were assigned education and behavioral modifications. Additionally, group A underwent DBE and IC stimulation, while group B received only DBE. In all 3 groups, the treatment was conducted for 2 weeks in the clinic.The behavioral modifications and DBE were continued at home for one month. Clinical manifestations, uroflowmetry parameters and postvoided residual urine were analyzed before and after 6 weeks of therapy. Results. After the treatment, significant improvement in defecation frequency and fecal incontinence was noticed only in group A (P<0.001, P<0.05, respectively). These children demonstrated significant improvement in LUTS and postvoided residual urine (P<0.001,P<0.05, respectively). Bell-shaped uroflowmetry curve was observed in 73.3% group A patients (P< 0.001). Conclusions. IC stimulation and DBE are beneficial in chronically constipated dysfunctional voiders. Further trials are needed to define the long-term effects of this program.
Background/Aim. Botulinum toxin is a basic, recommended method of treatment in controlling cervic... more Background/Aim. Botulinum toxin is a basic, recommended method of treatment in controlling cervical dystonia (CD). Physical therapy has limited effect due to the nature of the disease that is a result of a disorder in structures and relationships of the basal ganglia. The aim of this study was to analyze the effect of physical therapy applied as monotherapy, or with parallel application of botulinum toxin in patients with CD. Methods. Randomized controlled clinical pilot study included 14 patients diagnosed with idiopathic CD. All patients were initially assessed by using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and Torticollis Rating Scale (Tsui scale). In the control group, composed of 5 patients, the treatment included only physical therapy. The experimental group (9 patients) was first given botulinum toxin, and physical therapy was applied after five days. Physical therapy was conducted five times a week in the period of two weeks at the Clinic. Patients ...
Adverse neurologic outcome in preterm infants could be associated with abnormal heart rate (HR) c... more Adverse neurologic outcome in preterm infants could be associated with abnormal heart rate (HR) characteristics as well as with abnormal general movements (GMs) in the 1st month of life. To demonstrate to what extent GMs assessment can predict neurological outcome in preterm infants in our clinical setting; and to assess the clinical usefulness of time-domain indices of heart rate variability (HRV) in improving predictive value of poor repertoire (PR) GMs in writhing period. Qualitative assessment of GMs at 1 and 3 months corrected age; 24h electrocardiography (ECG) recordings and analyzing HRV at 1 month corrected age. Seventy nine premature infants at risk of neurodevelopmental impairments were included prospectively. Neurodevelopmental outcome was assessed at the age of 2 years corrected. Children were classified as having normal neurodevelopmental status, minor neurologic dysfunction (MND), or cerebral palsy (CP). We found that GMs in writhing period (1 month corrected age) predicted CP at 2 years with sensitivity of 100%, and specificity of 72.1%. Our results demonstrated the excellent predictive value of cramped synchronized (CS) GMs, but not of PR pattern. Analyzing separately a group of infants with PR GMs we found significantly lower values of HRV parameters in infants who later developed CP or MND vs. infants with PR GMs who had normal outcome. The quality of GMs was predictive for neurodevelopmental outcome at 2 years. Prediction of PR GMs was significantly enhanced with analyzing HRV parameters.
The present study investigated the relationship between fear of falling and functional status, an... more The present study investigated the relationship between fear of falling and functional status, and sociodemographic and health-related factors in nursing home residents aged older than 65 years. The cross-sectional study involved 100 participants who were residents of a nursing home and aged older than 65 years. Fear of falling was assessed using the Falls Efficacy Scale. Functional status was assessed by four performance-based measures. Balance was assessed by the Berg Balance Scale, mobility by the Timed Up and Go test, lower limbs muscle strength by the Chair Rising Test and participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; functional ability by the motor Functional Independence Measure. There was a significant negative correlation between the Falls Efficacy Scale and Berg Balance Scale (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and motor Functional Independence Measure (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) scores; and a positive correlation with the Timed Up and Go test (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and Chair Rising Test (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) values. Falls Efficacy Scale score increase is associated with age, being a widower/widow and the number of falls in the previous year. Higher fear of falling is associated with an increase in the number of falls in the previous year and with a decrease in Berg Balance Scale score. The study found a significant associations between Falls Efficacy Scale score and all of the examined parameters of functional status, the number of falls in the previous year, age and marital status of widower/widow. The major finding was that poor balance and an increase in the number of falls in the previous year are independent factors significantly associated with the fear of falling. Geriatr Gerontol Int 2016; ••: ••-••.
Background/Aim. The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire repre... more Background/Aim. The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire represents a region- specific instrument for functional outcome measurement of hand function. The aim of the study was to analyze the correlation between the values of modified DASH questionnaire and change of elbow function after supracondylar fracture (SCF) of humerus and to analyze the effects of early rehabilitation. Methods. The study included 35 schoolaged children with flexion of SCF of humerus without lesion of nerves. The patients were divided into two groups: group A in which rehabilitation started up to 14 days after the removal of fixation (20 children), and group B in which rehabilitation started after 15 days and more (15 children). The effects of the applied rehabilitation procedures were analyzed by measuring the range of motion of elbow and using modified DASH questionnaire. Testing was performed during the first examination, on the first day of rehabilitation (retest) and af...
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Papers by Vesna Zivkovic