Clinical-evolutive particularities and the main rehabilitation difficulties in a patient with schizophrenia who suffered from a TSCI by falling from height (affirmative suicidal attempt)- a case report

Introduction. Schizophrenia is a surprisingly common chronic psychiatric illness in the general population affecting 1 in 100 people worldwide. Although the symptoms widely differ from one case to another, schizophrenia is quite difficult to recognize because the patient can behave normally and appropriately in different social situations. Studies in the literature highlight that the majority of the patients with SCI and pre-existing schizophrenia have suffered accidents as a result of voluntary height adjustments. Also, 37.5% of the suicide attempts with SCI are caused by schizophrenia and depression. The main difficulties encountered in the recovery of these patients are the psychiatric manifestations. At the same time, the risk of suicide in patients with schizophrenia after suffering from SCI is higher than those with SCI without schizophrenia. Therefore, the recovery of the patients with SCI and schizophrenia is a complex process which requires the control of the psychiatric symptoms. A multidisciplinary team is required for such a purpose. Material and method. Having the patient's consent and approval of the Ethics Committee of “Bagdasar-Arseni” Clinical Emergency Hospital, N.O. 3159/30.01.2020, the paper presents the case of a 23-year-old female patient with AIS/ Frankel B flaccid paraplegia after TVML after falling from height (affirmative through window-suicide attempt) operated on, in a polytraumatic context. The patient is known with schizophrenia and she was being monitored by a psychiatrist at the time of the accident, but she voluntarily discontinued treatment during that period. The patient was clinically and functionally evaluated, according to the standardized protocols implemented in our clinic, through the assessment scales (ASIA, FIM, FAC, QoL, Ashworth and Penn) and also paraclinically, in order to evaluate her biological reserve and her bearing availability of the recovery program. Results and discussions. The patient presented a slowly favorable evolution (slowed down by her severe motor deficit, but also by her psychiatric symptoms such as affective ability with depressive, negative behavior, depersonalization). Conclusions. The main difficulties encountered in the recovery of these patients are the psychiatric manifestations. Therefore, the recovery of patients with SCI and schizophrenia is a complex process that first requires the control of psychiatric symptoms. A multidisciplinary team is required for such a purpose. Keywords: Schizophrenia, spinal cord injury, multidisciplinary, suicide attempt, rehabilitation,

Music, A “Body-Mind Medicine” In Rehabilitation Programs of Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by dyspnea and chronic cough. The main risk factor is cigarette smoking, but there are other ones implicated in the COPD etiology such as air pollution, childhood asthma, aging, chemical exposure, dietary factors, and genetic predisposition. Besides, COPD is associated with several comorbidities that influence prognostic and management, like asthma, lung cancer, obstructive sleep apnea, cardiovascular disease, metabolic syndrome, and depression or anxiety. The management is multidisciplinary and its role is to ease symptoms, prevent complications, slow disease progression, and improve the quality of life. In the last years, many alternative techniques have been implemented such as speleotherapy, halotherapy, muscular training, neuromuscular electrostimulation, acupuncture, thermotherapy, and music therapy. From those, music therapy has become a form of “mind-body medicine” indispensable in rehabilitation programs, whether used actively or passively, and has gained a lot of interest in alternative medicine. Keywords: COPD, music therapy, alternative medicine,

Very good neuromotor and psycho-cognitive rehabilitation outcomes in a post-TBI patient with initially severe fidget and breath insufficency with secondary eso-tracheal fistula, after necessity tracheostoma in subsequent important pulmonary complications - case report

The subject matter of the present scientific paper is the report of a sustained and persistent therapeutic rehabilitation team-run program in the case of a polytraumatized patient with severe TBI (severe psychomotor agitation and dislogia, bifrontal syndrome, post-traumatic encephalopathy) associated with locomotor and self-care dysfunction, neurogenic bladder and complicated with eso-tracheal fistula after necessity tracheostoma due to subsequent important pulmonary complications that led to a favorable progression despite the limitations imposed by the mental state of the patient during hospitalization and the presence of multiple severe pulmonary complications. Keywords: neuromuscular rehabilitation, traumatic brain injury, bifrontal syndrome, polytraumatism, eso-tracheal fistula,

Topical Systematic and Synthetic Literature Review Regarding Men Sexual Dysfunctions after Spinal Cord Injury

Introduction Spinal cord injury (SCI) is a life-altering event usually associated with loss of motor and sensory, as well as with bladder, bowel and sexual, functions impairment. Recovering sexual function is one of the most important function tightly coupled with the life quality. In this respect, in the related literature can be found data regarding mainly: diagnosis/evaluation issues therapeutic/assistive-rehabilitative interventions (including connected to fertility troubles) and of psychological and or educational specific counseling, kind. Materials and methods.This paper presents a current systematic (of Preferred Reporting Items for Systematic Reviews and Meta-Analyses – PRISMA – type) and synthetic literature review on sexual dysfunctions and respected available management options in male subjects with SCI, using the following search keywords/ combinations of key words: “men”, “sexual dysfunction”/ “fertility” / “erectile dysfunction”/ “ejaculatory problems” / “sexual disorder“, “spinal cord injury”, “paraplegia”/ ”tetraplegia” /“paraplegic”/ ”tetraplegic”, “management”/ “treatment”, by interrogating international renown data bases: NCBI/PubMed, NCBI/PMC, Elsevier, PEDro and respectively, ISI Web of Knowledge/Science – to check whether the selected articles are published in ISI indexed journals – considering publications from January 2009 to June 2019, written in English, open access articles and being “fair”/“high” quality on our PEDro inspired, customized quality classification of the selected papers – the basic criterion, being the weighted citations number per year. Results. We have found initially 647 articles and eventually, after accomplishing the PRISMA stages (without meta-analysis), we have selected 16 articles matching all the above mentioned quest method’s requests (see further the figure representing our PRISMA type completed flow-diagram), covering (together with knowledge acquired from extra bibliographic resources, too). Conclusions. Sexual disfunctions after SCI are complex and strongly add to the severe and multimodal disability the affected people – in the case of our work: men – experience. Therefore, they worth being fathomed and periodically reappraised. Keywords: Spinal Cord injury (SCI), men sexual dysfunctions, systematic literature review, rehabilitation,

Study on the postural rehabilitation devices used in the prevention of postural defects and the need to use a smart orthosis

Introduction. Postural defects are a real challenge for the contemporary world. Scoliosis, kyphosis and lordosis are diseases of the spine, with various evolutions and multiple changes of the other components of the thorax (shoulders, shoulder blades, ribs), as well as of the intrathoracic and even abdominal organs. Material and method. This paper presents a study on the need to use a smart orthosis in the prevention of postural defects, a study that is the preamble to the physical realization of such an orthosis. The smart orthosis will use inertial sensors capable of calculating orientation angles in a portable monitoring system that will calculate and represent the curvature of the spine. It is hoped that finding a non-invasive solution to identify the shape of the human back can help reduce the time required for medical rehabilitation sessions or can prevent possible postural defects. Results and discussions. In this study, the existing orthoses on the market that could fall into the category of rehabilitation devices used in the prevention of postural defects were evaluated and an intelligent orthosis was designed. Conclusions. At this time, the existence of an intelligent orthosis in the prevention of postural defects would lead to an improvement in health among the population. Also, this prosthesis would crown the work of physiotherapists by maintaining the results obtained. Keywords: postural defects, smart orthosis, prevention, rehabilitation, health improvement,

The ascent and decline of a great balneological resort: PUCIOASA

Introduction. Pucioasa is one of the greater and sadly, almost forgotten balneological resort of Romania. Known since the 18th century, where it was discovered a record of this area on the Austrian map in 1791 with sulphurous streams, the healing waters of the “Pe Pucioasa” hill enters the therapeutic balneological circle when the first water analysis occurred – 1821-1828 by Dr. Trangot von Schobel. In 1878, Ion Ghica, a prominent figure in Romania at that time initiated the exploitation of 14 wells from the 30 known streams of sulphurous and ferruginous waters, thus obtaining enough healing mineral water for a capacity of 60 beds of the balneological establishment. Since 1841, the Resort developed, transformed into a Rehabilitation Clinic (1969) and the number of patients treated there increased from 20 in the beginning to 1000 patient per day. Many of the patients included foreign elite society members who came regularly to benefit from the waters’ healing properties, both external and internal cures, setting Pucioasa on a high level of not only balneology treatment, but also of balneological tourism. Matherials and methods: Studying local industrializations and water analysis, we concluded that there were many factors that contributed to the decline of this great and international renowned balneological resort. The first wrong step in this direction was made when building and extending de gypsum carrier, the peek being between 1970 and 1975, when the industrial forging process made the sulphurous streams to migrate, and the waters from the wells diminished in its sulphur and iron concentration. Another possible factor for the decline can be the modernisation of the medical world, development of anti-inflammatory drugs and modern medical equipment which reduced the need for the elite society to come a long distance for the balneological treatment. Results: Whichever of the reasons, the once prosperous Balneological Resort of Pucioasa fell into an unknown, unimpressive place, known and frequented only by the locals. The Rehabilitation Clinic still has 60 beds, which are occupied to the maximum each month, it still prospers on a local level, but lost its glory from almost a century ago. Conclusions: The Romanian general population and the government must take an interest to one of the many once prosperous balneological resorts in order to revive the national treasure of Romania which is balneology, which many of the developed European countries only wish that they can possess. Keywords: Balneary Resort, Pucioasa,

The influence of natural mineral water on the structural and functional changes in the rat kidneys under urolithiasis modelling

In the experiment on the white Wistar rats, the authors evaluated kidneys changes in urolithiasis modelling (Kidney stone disease, KSD) and the possibility of correcting these changes by internal use of the mineral water (MW) with high organic matter content. The results of the studies revealed structural pathological changes in the kidneys in the form of changes of the part of glomeruli capillaries and gross changes in the kidneys tubules and interstitial layers. At the same time, the functional kidneys activity is manifested in the form of increased urination and a significant increase in urination. Urine metabolic characteristics are also change. The use of MW leads to an improvement in the capillaries of the renal corpuscles structure and almost complete restoration of the tubules structure. The functional activity of the kidneys and the quality of urine have significantly improving. The authors believe that the organic compounds of MW, which mainly determine its biological activity, contribute to the improvement of the regulation of metabolic processes and, accordingly, have a positive effect on the structural and functional parameters of the kidneys.. Keywords: urolithiasis, structural and functional characteristics of the kidneys, mineral water,

A complex case of neuro-muscular rehabilitation with favorable evolution, in a patient with incomplete tetraplegia post cervical and thoracic spinal cord injury - surgically treated, in a politraumatic context, by car accident

Introduction: Spinal cord injuries (SCI) are major conditions that usually determine severe and permanent dysfunctions, or even important loss of basic functions, generating severe or rather permanent sequels. They can have important chronic consequences such as: tetraplegia or paraplegia.(1). Materials and Methods: This paper presents the case of a young 19-year-old patient who suffered in March 2019, a car accident (passenger) with spinal cord injury (SCI) at cervical and thoracic level in a politraumatic context, hospitalized at the Neurosurgery Clinic (NS) II of TEHBA in a severe condition, for complete AIS/Frankel A tetraplegia, with a C7 fracture, T3, T4, T5 cominutive fractures with fragments in the medullary channel, minor traumatic brain injury, multiple costal fractures, abdominal trauma and respiratory failure. When the patient became hemodynamic and respiratory stable it was decided a neuro-surgical intervention, initially at cervical level through an anterior approach, with mixed osteo-sinthesis and C7 discectomy. Because of the spine instability, thoracic surgical treatment was delayed with 11 days, when he suffers a neurosurgery for medullary decompression, drainage and stabilization of the spine. In our clinical division, the patient was admitted with an incomplete AIS/Frankel B tetraplegia and initially followed a rehabilitation nursing program and subsequently continued with a recovery therapy according to clinical stages. The patient was assessed functionally using the following scales: AIS/Frankel, modified Ashworth, Functional Independence Measure (FIM), Life Quality Assessment (QOL), FAC International Scale, Independence Assessment Scale in Daily Activities (ADL / IADL), Walking Scale for Spinal Cord Injury (WISCI). Results: The patient benefited from a complex neuro-muscular rehabilitation program, having a favorable evolution, with an increase in the evaluated scales scores – passing from AIS/Frankel B classification to a severe AIS/Frankel C stage, and thus, at the moment he is performing walking on short distances, through parallel bars, with long left leg orthosis and support from another person. It was tried a sphincter re-education, but, after urologic examination, because of the important spasticity in the lower limbs and of the urinary catheterization discomfort, it was decided that for a while the patient to remain with fixed urinary catheterization. Conclusions: Even if there is still no cure for SCI sequels, the accurate clinical-functional evaluation, the neurosurgical prompt therapeutic approach, adding complex nursing measures, personalized rehabilitative and kinetotherapy programs, in a young patient with SCI by car accident, determined neuro-locomotor improvements with an increase in patient’s quality of life.(1),(2). Keywords: spinal cord injuries, tetraplegia, traumatism, rehabilitation,

The role of electrotherapy in reducing the pain of patients with knee osteoarthritis during the COVID-19 pandemic

Introduction. Osteoarthritis is considered to be the most common form of arthritis and a leading disability cause worldwide, especially due to the painful symptom. The latter is a clinical marker in evaluating the limits of joint mobility and therefore, the pain reduction is a goal of the recovery treatment for patients with knee osteoarthritis. The purpose of this study was to show whether the pain phenomenon characteristic of knee osteoarthritis can be reduced by electrotherapy, even in the context of the COVID-19 pandemic. Material and method. The study lasted 5 months and included 171 patients diagnosed clinically and radiologically with knee osteoarthritis. The followed parameters were pain, physical dysfunction in daily activities, anxiety and quality of life. Results and discussions. The two groups of studied patients were homogeneous in terms of weight by gender and age groups. The evaluation of patients according to scales enabled the registration of statistically significant values, the value of p <0.05, which explains the validation of the working hypothesis. The feeling of pain is closely related to the level of anxiety. Conclusions. Analgesic electrotherapy significantly reduced the pain syndrome of the patients for whom it was used. It has been shown that the patients' anxiety can influence the pain phenomenon. Given the conditions caused by the Covid-19 pandemic, the anxiety of the patients who were in the outpatient department to receive recovery treatment was increased, but after the recovery treatment there was a decrease, so these patients' quality of life increased. Keywords: pain, analgesic electrotherapy, knee osteoarthritis, recovery treatment,

Current aspects regarding “smart homes”/ ambient assisted living (AAL) including rehabilitation specific devices, for people with disabilities/ special needs

Introduction: The population life expectancy has increased (“over half the EU’s population predicted to be over-65 by 2070”), according to recent prevalence studies, being a result of the advancement of technology and medical science. This aging population has implications for society because there is increased number of older people requiring better quality of life. Materials and Methods: AAL represents the systems that may support completely the living area of a person and has the potential to facilitate the elderly to live longer and more safety in their family environments, allowing them to continue their current activities, facilitating participation in more activities at home and in the community and improving the cost-effectiveness, the quality of health and social services. A practical use of technology is the introduction of home networks, which involve notions such as: "smart homes ", “tele-health / tele-care” and even, possibly, “tele-medicine” to allow people with serious illnesses / conditions / and special needs to maintain an appropriate quality of life (QOL) at home. Discussions and Conclusions: AAL can contribute to an increased autonomy, self-confidence and mobility in people whose activity is limited to home environment, such as "the oldest olds” and/ or those with severe neuro-/ loco-motors disabilities, and so to reduce the risk of institutionalization, enhance security, prevent social isolation, thus allowing “older adults to age in place”. An important role in achieving this goal is representing by working in a multidisciplinary team (experts in the field of health - rehabilitation, gerontology -, social experts, technical/ informatics experts, engineering and robotics experts). Keywords: ambient assistive living, quality of life, special needs, tele-medicine, rehabilitation,