REHABILITATION PROTOCOL AFTER ACHILLES TENDON RECONSTRUCTION WITH AN AUTOLOGOUS HAMSTRING GRAFT

Introduction One of the treatment options in chronic damage or unsuccessful suturing of the Achilles tendon is a surgical treatment consisting of its reconstruction using the tendon of semitendinosus and gracilis muscle. The multitude of types of reconstruction causes discrepancies in rehabilitation protocols. All of them aim to return to full functional fitness as the ultimate goal. Aim This study aims to present the proprietary rehabilitation protocol after Achilles tendon reconstruction using the tendon of semitendinosus and gracilis muscle. Material and methods The presented rehabilitation program lasts about 12 months and is divided into six stages. Stage I consists of standing up and anticoagulant exercises, and isometric exercise. Stage II, lasting up to 2 weeks after the procedure, consists of the patient’s independent work in the home environment. Stage III, lasting up to 4 weeks, involves learning to walk and putting weight on the limb in a cam Walker. In the third stage, after the postoperative wounds have healed, exercises in water conditions are started. Stage IV, lasting from 4 weeks after the operation, involves loading the limb with support, increasing the range of dorsiflexion motion, and progressive muscle strengthening. Stage V, which lasts up to 8–12 months after surgery, eliminates functional deficits and prepares the patient for a functional biomechanical assessment. Stage VI is the stage of work on the compensation of deficits resulting from the analysis of the results of the functional biomechanical assessment necessary to return to the full sports activity. Results The rehabilitation time, in accordance with the assumptions of the above protocol, is 8–12 months. After this time, the patient should proceed to a functional biomechanical assessment. Discussion and conclusions The rehabilitation protocol presented by our team describes in detail the stages of post-operative rehabilitation after Achilles tendon reconstruction with a hamstring graft. It provides the conditions necessary for the patient to meet before starting the next phase and returning to sport. Our requirements are consistent with the assumptions available in the scientific base. Keywords: Achilles tendon reconstruction, return to sport, rehabilitation program.

AN UPDATE ON EUROPEAN SOCIETY FOR SHOULDER AND ELBOW REHABILITATION SCIENTIFIC COMMITTEE STRATEGY, VISION, BREXIT AND ITS IMPACT ON FUTURE COLLABORATION

Introduction The European Society for Shoulder and Elbow Rehabilitation (EUSSER) is made up of health professionals who specialise or have an interest in the field of shoulder & elbow dysfunction. The scientific committee of the EUSSER developed their strategies and vision and post-Brexit to work in collaboration with The European Society of Surgery for the Shoulder and Elbow (ESSSE), Société Europeenne de Chirurgeie I’Epaule et du Coude (SECEC), and British Elbow and Shoulder Society. Aim We aim to share EUSSER scientific committee’s achievements, our vision, Brexit, and its impact on our future collaborations for education and research. Materials and methods We developed our strategy in discussion with the EUSSER Board, evidence synthesis of published literature, monitoring and mapping the EUSSER scientific committee’s activities along with other equivalent professional networks scientific committee and with EUSSER scientific committee members consensus. Results Integration, collaboration, and transformation were three key areas of focus for the scientific committee this year. We worked together with other professional networks and societies, delivered a scientific lecture, and are working on developing collaborative research projects across Europe. Conclusion Despite Brexit and Covid-19 pandemic challenges, EUSSER scientific committee has worked towards expanding this year, developed strategies and vision to work with various stakeholders. Keywords: shoulder, elbow, rehabilitation, scientific, education, research, Brexit.

BRAIN IN SPACE. HOW DOES SPACE AFFECT THE HUMAN BRAIN?

Introduction Nowadays more and more people and international companies are interested in Human Spaceflights. Aim and method In this review, the negative effects from space radiation, microgravity and the factor of isolation on the central nervous system will be described in relation to space neuroscience and the relevant studies examined. Results Space radiation can damage neuronal connections with both acute and chronic effects, manifested as altered cognitive function, reduced motor function, and behavioral changes. Moreover, some astronauts report a condition known as Spaceflight Associated Neuro-ocular Syndrome (SANS). The brain scans performed upon those astronauts, who came back from space travel suggest that due to reduced gravity conditions the brain and the fluids in the human body shift upwards, which increases pressure in the skull and may result in opticnerve swelling that causes blurred vision. Another interesting part of space neuroscience is the research of structural neuroplasticity. A study conducted on cosmonauts revealed an increase in the neuronal tissue of sensorimotor structures responsible for movement coordination. In addition to the space radiation and microgravity, long-term confinement also affects the microstructure of the brain white matter, which was proven in the study that used DTI (Diffusion Tensor Imaging). Conclusions To conclude, to continue understanding the risks posed by spaceflight to astronauts’ health research in the field of space neuroscience is important. In addition, the acquired insight could be relevant for terrestrial vestibular patients, patients with neurodegenerative disorders, as well as the elderly population, coping with neurological deficits. Keywords: space medicine, brain, space neuroscience, SANS, space radiation.

20 YEARS OF RSP – THE 5 MOST IMPORTANT LESSONS I’VE LEARNED

Introduction and aim This paper reports on 5 key aspects to consider when planning a successful RSA procedure, including patient selection, glenosphere positioning, glenoid fixation, humeral fixation, and soft tissue management/tensioning. Material, methods, results, and discussion Key in patient selection for RSA is understanding the relationship between indications, outcomes, patient mental state, and their expectations. When placing a glenosphere, prioritize sound principles of shoulder kinematics but always consider bone preservation and ease of placement. Glenoid fixation must take advantage of structural features of individual implant designs while factoring in specific-bone morphology/morphometry to optimize the resultant glenohumeral loading. For the stem, fixation prioritizes press-fit where bone quality and quantity permit. Always aim to achieve anatomical pivot point restoration with planning for stem position and avoid distalization that may lead to nerve injury and scapular spine fractures. Conclusions To increase the chances of a successful RSA procedure, a surgeon should emphasize picking the right patient, placing the implant in an optimum position, ensuring adequate glenoid and humeral fixation, and correctly balancing soft tissues. Keywords: reverse shoulder arthroplasty, surgeon education, patient optimization

FUNCTIONAL ASSESSMENT OF STROKE PATIENTS

Stroke is one of the leading causes of adult disability. As indicated by numerous studies, early rehabilitation may positively affect the reduction of dysfunctions resulting from a stroke. A stroke can cause both mild and severe disabilities. In order to effectively help the patient and create a good rehabilitation program, the patient’s functional state should be determined. Therefore, functional tests should be carried out before starting the rehabilitation process. Patients should be assessed in several areas. The most frequently used are functional scales (ADL scale, Barthel index), balance and gait tests (Timed Up & Go test, Berg balance scale, Tinetti test), and scales to assess motor functions (Fugl-Meyer Motor Assessment Scale). The analysis of the obtained results is necessary to determine the degree of functional deficits in a patient and establish short- and long-term treatment goals. The same tests should be repeated systematically during rehabilitation to monitor the patient’s functional state improvement. The aim of the study was to describe selected functional scales and tests used in the rehabilitation process of patients after stroke. Keywords: stroke, functional assessment, scale, ICF

RELATIONSHIP BETWEEN URODYNAMIC PARAMETERS AND LEVEL OF SPINAL CORD INJURY

Introduction Low back pain and comorbid afflictions influence negatively on the quality of life, postural control and gait. Facet joint syndrome is one of the causes of low back pain. Cryoablation is a minimal invasive percutaneuous technique for zygapophysial joint syndrome. Aim The aim of the study was to investigate the effectiveness of the cryoablation in patients with chronic low back pain on pain, disability and spatiotemporal gait parameters in the course of facet joint syndrome. Material and methods The study included 19 patients (13 women, 7 men) with chronic low back and facet arthropathic changes in MRI, and with failure in conservative treatment. The evaluation was performed before and with one-month follow-up after cryoablation and included pain assessment (Numeric Rating Scale), the evaluation of functional state and disability (Revised Oswestry Low Back Pain Disability Index, Roland-Morris Disability Questionnaire) and an analysis of spatiotemporal gait parameters (treadmill). Results A significant improvement in pain, functioning and spatiotemporal gait parameters such as distance and the number of steps were found. Conclusions Cryoablation is an effective method for pain reduction in facet joint syndrome, which improves functioning and gait. Cryoanalgesia is a safe procedure for the treatment of low back pain related to facet joint syndrome if earlier conservative management failed. Keywords: cryoablation, low back pain, functional assessment, gait

IMAGING IN ANTERIOR SHOULDER DISLOCATION

Shoulder dislocation is a very common musculoskeletal injury. Imaging in such cases serves an important role in the diagnostic and therapeutic process. Despite a pretty simple clinical diagnosis, the process itself is long for the patient and associated with multiple steps and decision making to regain function with low risk of prolonged disability (Zygmunt et al., 2013; Lubiatowski et al., 2016). There are also many controversies as well as significant diversity among surgeons regarding the timing and choice of particular diagnostic modalities used in diagnostics of different scenarios of shoulder dislocation. The aim of imaging in shoulder dislocation is to confirm dislocation and its direction and finally successful reduction. That usually is served by conventional radiography. Additionally, imaging may be required to identify soft tissue or bone injuries or, when necessary vascular and nerve injuries using different modalities (CT, MR, US). The selective radiographic evaluation may reduce the number of X-rays, costs, and most of all time before reduction and spent by a patient in an emergency unite. That should be used carefully to avoid misdiagnosis. Keywords: shoulder dislocation, imaging, radiography, instability, magnetic resonance

THE EFFECT OF CRYOABLATION ON FUNCTIONING AND GAIT IN PATIENTS WITH LOW BACK PAIN

Introduction Low back pain and comorbid afflictions negatively influence the quality of life, postural control and gait. Facet joint syndrome is one of the causes of low back pain. Cryoablation is a minimal invasive percutaneuous technique for zygapophysial joint syndrome. Aim The aim of the study was to investigate the effectiveness of the cryoablation in patients with chronic low back pain on pain, disability and spatiotemporal gait parameters in the course of facet joint syndrome. Material and methods The study included 19 patients (13 women, 7 men) with chronic low back and facet arthropathic changes in MRI, and with failure in conservative treatment. The evaluation was performed before and with one-month follow-up after cryoablation and included pain assessment (Numeric Rating Scale), the evaluation of functional state and disability (Revised Oswestry Low Back Pain Disability Index, Roland-Morris Disability Questionnaire) and analysis of spatiotemporal gait parameters (treadmill). Results A significant improvement in pain, functioning and spatiotemporal gait parameters such as distance and the number of steps were found. Conclusions Cryoablation is an effective method for pain reduction in facet joint syndrome, which improves functioning and gait. Cryoanalgesia is a safe procedure for the treatment of low back pain related to facet joint syndrome if earlier conservative management failed. Keywords: cryoablation, low back pain, functional assessment, gait

MOTOR REACTIONS OF INFANTS IN RESPONSE TO OPTICAL FLOW – LITERATURE REVIEW

Introduction Eyesight is crucial for each child to achieve the stages of gross and fine motor development. One of the essential processes during movement is the effect of optical flow on the organ of vision and its influence on the performance of the movement. The phenomenon of optical flow is ubiquitous in everyday activities, and it is still not fully understood how it triggers a reaction. Aim The article is a presentation and summary of the research methodology of various research teams studying the influence of the optical flow on motor reactions in infants. Material and methods Review of publications searched using keywords (optical flow, motor reaction, reflexes, newborn, infant) in databases such as PubMed and ScienceDirect. The methods and conditions presented by various authors are summarized in one table. Results and conclusions Optical flow studies and the influence on motor reactions differ significantly in methodology and study groups, making it impossible to compare the results between all found publications. Most cited studies have shown that optical flow can induce or intensify a motor response in infants. Keywords: newborn, optical flow

STAFF ABSENTEEISM AND DELIVERY OF HEALTHCARE SERVICES DURING THE COVID-19 PANDEMIC AT WIKTOR DEGA ORTHOPEDIC AND REHABILITATION CLINICAL HOSPITAL IN POZNAŃ, POLAND

Introduction The COVID-19 pandemic has led to various interruptions in the implementation of healthcare services provided by hospitals. Aim The aim of this study was to evaluate the staff absenteeism during the COVID-19 pandemic at Wiktor Dega Orthopedic and Rehabilitation Clinical Hospital in Poznań as well as to present the standard of providing the healthcare services assigned to the Hospital under the contract with the National Health Fund. Material and methods Work attendance of more than 700 hospital employees at Wiktor Dega Orthopedic and Rehabilitation Clinical Hospital in Poznań was evaluated. The assessment of the number of medical services that were provided during the study time was based on monthly reports prepared for the national payer of health services. A retrospective analysis covered the period of JanuaryApril 2019 and January-April 2020. Results In the months of March and April 2020, a significant increase in staff absenteeism was reported. An evaluation of the relative values of the implementation rate of medical services for the months January-April of 2019 and 2020 showed that in April 2020, there was a substantial reduction (10%) in the implementation rate of medical services on orthopaedic wards, while on rehabilitation wards, the reduction in the implementation rate started in March 2020 and was also reported in April 2020 (6%). Conclusions The COVID-19 pandemic resulted in higher staff absenteeism rates in various professional groups working in our hospital. A reduction in the performance of healthcare procedures in our hospital, both orthopaedic and rehabilitation, will lead to a re-analysis of costs and will result in applying economizing mechanisms. Keywords:COVID-19, hospitals, health services, absenteeism, healthcare, hospital employees.