Cerebro-vascular diseases are socially important diseases in many countries. The World Health Org... more Cerebro-vascular diseases are socially important diseases in many countries. The World Health Organization reports that stroke is one of the most frequent conditions, leading to a serious disability and reduced quality of life. Neurorehabilitation (NR) is an interdisciplinary thematic field between Neurology, Neurosurgery, Physical and rehabilitation medicine (PRM). According the White Book of PRM, Rehabilitation (including NR) is a functional therapy, based on a detailed functional assessment. Grasp, Balance and Gait recovery are important goal in NR-clinical practice, essential for the independence of patients in activities in daily living. Our objective was to emphasize the potential of neurorehabilitation as a combination of traditional and modern NR-methods, oriented to diagnosis (functional tests and scales, stabilometry and gait assessment; International Classification of Functioning) and therapy (proprioceptive neuromuscular facilitation; electrostimulations; mirror box, grasp training and occupational therapy; balance and gait training; exoskeleton and robotic rehabilitation). We will present some results and typical cases of our own clinical practice of 30+ years. The evolutive and clinical polymorphism of cerebrovascular diseases is the cause of our therapeutic difficulties and (in some cases) impotence on the way to functional recovery. We will explain the clinical significance of complex NR algorithms for different types of cerebrovascular diseases: transitory ischemic attack; middle and anterior cerebral artery stroke; cerebral lacunas; chronic vertebro-basilar insufficiency; medullar stroke; intra cranial hemorrhage; rupture of cerebral aneurysm; etc.). The role of systematic medication and patients' education is underlined. We estimate the measures for prevention and treatment of possible complications (muscle and joint contractures; decubitus ulcers; deep vein thrombosis; pulmonary thromboembolism and bronchopneumonia; urinary infections). Author considers that the complex NR-algorithms are very useful for training the neuroplasticity, especially usedependent brain plasticity. We emphasize the impact of NR for functional recovery, amelioration of autonomy and quality of life of different types of patients with cerebro-vascular diseases Ivet Borissova Koleva is a medical doctor, specialist in Neurology and in Physical & Rehabilitation Medicine (PRM). Her PhD thesis and her thesis for Doctor-es-Medical Sciences (DMedSc) are in the field of Neurorehabilitation (NR). The title of the DSc thesis is: "Neurorehabilitation algorithms for functional recovery and amelioration of autonomy in patients with socially-important neurological diseases", with special attention on stroke, multiple sclerosis, Parkinson, diabetic polyneuropathy, peripheral radiculopathy due to spondylarthrosis and discal hernia. She is author of series of books and monographs in the thematic field of rehabilitation, grasp and gait rehabilitation, pain management, and NR. She has publications in national and international scientific journals. She is Editor-in-Chief of the Bulgarian scientific journal "Neurorehabilitation".
Book Publisher International (a part of SCIENCEDOMAIN International), May 25, 2021
Introduction: The introduction of portable devices in the everyday life imposed the necessity to ... more Introduction: The introduction of portable devices in the everyday life imposed the necessity to evaluate the possible consequences (of the abuse) on the spine and on the central nervous system, respectively to create programs for the prevention of these consequences. The goal of current article is to evaluate the impact of different physical modalities (including physiotherapy, ergotherapy, manual therapy, deep oscillation, lasertherapy, magnetic field) in the prevention and the complex rehabilitation of the onset of cervical myofascial pain and headache, due to spinal malposition in users (abusers) of smart phones. Material and Methods: We observed a total of 165 patients with cervical myofascial pain and headache, divided into 5 groups (of 33 patients each). The age of the patients was between 19 and 50 years, with posture (position) alterations of the cervical spine, but without significant cervical pathology. All patients used a mobile device in their everyday activities (minimum 2 hours daily) for at least 6 months. Functional evaluation was effectuated before, during and after treatment, and one month after the end of the rehabilitation. In all patients we applied a complex physical-therapeutic program (PT), including analytic exercises for paravertebral muscles and soft tissue techniques [massages, post-isometric relaxation (PIR) for the respective upper trapezius and sterno-cleido-mastoideus muscle] and stimulation of patients’ active participation in the process of prevention (education in principles of back-school, self-massage, auto-PIR). The patients in the first group effectuated only these procedures. In the second group, we added elements of manual therapy (MT - tractions, mobilizations, manipulations; and auto-mobilizations). In patients of the next groups, a paravertebral application of a preformed modality was added to the PT and the MT: in group 3 – Deep Oscillation (DO); in group 4 – lasertherapy (LT); in group 5 - magnetic field (MF). Statistical evaluation was performed by SPSS programme, version 17; using t-test (analysis of variances ANOVA) and Wilcoxon rank test (non-parametrical correlation analysis). Results and Analysis: All patients reported a significant decrease of the intensity of cervical pain and headache (evaluated by Visual analogue scale of pain and by pressure dolorimetry). In all patients we observed amelioration of the static position of the cervical spine, reduced amount of paravertebral muscle spasm and of the sensibility of trigger and tender points; and augmentation of range of active motion of the cervical region of the spine. During the rehabilitation period the results were most important in the second group (with manual therapy), but one month later there is not statistical differences between both groups. Discussion and Conclusion: Techniques of PT and MT are very useful for the prevention and the rehabilitation processus of cervical myofascial pain and headache. The program of care includes active (analytic) exercises, PIR and stretching techniques, tractions and mobilizations, education of the patient, and (in some cases) manipulations. The inclusion of preformed modalities (DO, LT, MF) in the complex prevention and rehabilitation program accelerates the effects on pain and spine mobility and ameliorate the stabilization of the results. We consider that every medical doctor - specialist in Physical and rehabilitation medicine, every physiotherapist and ergotherapist must adapt the general algorithm for the needs of the concrete patient.
Physical analgesia is the application of physical modalities for pain relief. Our objective is to... more Physical analgesia is the application of physical modalities for pain relief. Our objective is to present the potential of some physical factors and correspondent methods of application; and to explain their mechanisms of action. For pain reduction we use: low and middle frequency electric currents (e.g. TENS, interferential currents), electrostatic field (Deep oscillation), magnetic field, light (including Laser), some mineral waters and peloids, physiotherapy (e.g. analytic exercises, mechanotherapy, post-isometric relaxation, massage), reflexotherapy (e.g. acupuncture, acupressure). In rehabilitation practice, we use reflectory connections between the surface of the body and the internal organs (cutaneous-visceral, subcutaneousvisceral, proprio-visceral, periostal-visceral). The theory of Melzack and Wall for gate-control explains some effects of physical factors. We propose our own theory for explanation of mechanisms of physical analgesia. We propose our concept about rehabilitation algorithms in diseases of the nervous and locomotor systems, accentuating on conditions after surgical intervention (neurosurgical and orthopedic operations, including joint endoprosthesis and limb amputations). We present some of our own results in patients with post-operative pain.
HSOA journal of clinical studies & medical case reports, Dec 26, 2022
Ultimately, contemporary Information and Communication Technologies (ICT) were introduced in the ... more Ultimately, contemporary Information and Communication Technologies (ICT) were introduced in the rehabilitation practice. We use Exoskeletons, virtual reality, robotic rehabilitation with Locomat (Hocoma system for balance and gait training) and ThyroMotion system (for grasp training). Our purpose was to emphasize the impact of robotic rehabilitation in the process of recovery of patients with neurological complications of COVID-19, as follows: cerebral vascular accidents, spinal ischemic stroke, relapses of multiple sclerosis, Guillain-Barre syndrome, development of rare diseases (as cerebellar ataxia or amyotrophic lateral sclerosis /motor neuron disease), etc. We present typical and rare clinical cases (consequences and complications of COVID-19), treated by robotic neurorehabilitation. Our results demonstrated positive effects of ICT-application on the neuroplasticity, functional recovery and quality of life of neurological patients. We consider introduction of robotics as necessary tool in the process of neurorehabilitation.
The World Report on Disability defines the goals of rehabilitation: prevention of the loss of fun... more The World Report on Disability defines the goals of rehabilitation: prevention of the loss of function; slowing the rate of loss of function; improvement or restoration of function; compensation for lost function; maintenance of current function. Orthopedic rehabilitation is part of the rehabilitation sciences, needed frequently in clinical practice. Our opinion is that rehabilitation is an essential element in the patients' management of Orthopedics and Traumatology. In this article, we present basic theoretical knowledge, necessary for a successful orthopedic rehabilitation, and we cite practical skills of rehabilitation in patients with the most frequent orthopedic conditions, including after orthopedic surgery. We explain our own proposal for OT rehabilitation algorithms, with the goal to stimulate the functionality of our patients and to assure their independence in activities of daily living, respectively their autonomy.
Physical medicine and rehabilitation research, 2016
Aim: On the base of systematic review of the literature, clinical observations and investigations... more Aim: On the base of systematic review of the literature, clinical observations and investigations, specific complex neurorehabilitation algorithms were structured (including natural and preformed physical modalities). GOAL: Comparative evaluation of the efficacy of different physical-therapeutic and rehabilitation programs on the functional recovery, the autonomy in activities of daily living and the capacity for different activities of patients suffering from post-stroke hemiparesis. Materials and methods: A total of 366 post-stroke in-patients were observed. The neurorehabilitation complex includes physiotherapy, occupational therapy; thermotherapy or cryotherapy; in some groups we added electrostimulations of hand extensors and mirror therapy (grasp training). Patients were investigated before and after therapy, and one month later; according a Protocol with all patients' data (including neurological and functional status, hemiparesis level-Brunnstrom's test; evaluation of capacity of independence in self-care, familiar activities, professional activities; evaluation of prehension). Statistical evaluation: t-test (analysis of variances ANOVA) and Wilcoxon rank test (non-parametrical correlation analysis). Results and discussion: Comparative analysis of results proved a statistically significant favorable effect (p<0,001) on some parameters: increase of the muscle force, the range of motion and the functional capacity of the hand (precision grips); stabilization of the balance and the locomotion (test of Brunnstrom); improvement of the autonomy in different activities-self-service and domestic care. The stability of the results one month after the end of neurorehabilitation is satisfactory. Conclusion: In conclusion we must underline the impact of electrostimulations and grasp training before mirror for functional recovery and patients' autonomy.
Archives of rheumatology & arthritis research, Oct 7, 2020
Osteoarthritis (OA) is a socially important disease, with a high level of alteration of the quali... more Osteoarthritis (OA) is a socially important disease, with a high level of alteration of the quality of life of many persons. Pain is a frequent symptom of several conditions, treated with numerous drugs. The goal of current article is to remain the potential of physical factors for treatment of pain (physical analgesia) and for functional recovery. Our purpose was to emphasize the potential of some contemporary physical modalities and to propose complex rehabilitation algorithms for pain management and for functional recovery of OA-patients. Principal clinical and instrumental treatment methods are stated: electrotherapy (with low and middle frequency electric currents); magnetic field; ultrasound; laser; hydrotherapy and balneotherapy (mineral waters); physiotherapy (analytic exercises, mirror therapy, soft-tissue techniques, massage), balneophysiotherapy (underwater exercises, swimming); manual therapy, device-assisted mechano-therapy (passive, active or combined), robotic rehabilitation, etc. In rehabilitation practice, for diagnostic: we apply functional scales, International Classification of Diseases and International Classification of Functioning. For treatment: we combine synergically different natural and preformed physical modalities. We insist on the importance of technical aids (canes, walking sticks, etc.). Authors recommend structured rehabilitation algorithms for OA-patients, including elements of preformed physical modalities, physiotherapy, ergotherapy, and patient's education. We present details of the application of these algorithms on typical forms of hip and knee OA, including after hip and knee arthroplasty.
Cerebro-vascular diseases are socially important diseases in many countries. The World Health Org... more Cerebro-vascular diseases are socially important diseases in many countries. The World Health Organization reports that stroke is one of the most frequent conditions, leading to a serious disability and reduced quality of life. Neurorehabilitation (NR) is an interdisciplinary thematic field between Neurology, Neurosurgery, Physical and rehabilitation medicine (PRM). According the White Book of PRM, Rehabilitation (including NR) is a functional therapy, based on a detailed functional assessment. Grasp, Balance and Gait recovery are important goal in NR-clinical practice, essential for the independence of patients in activities in daily living. Our objective was to emphasize the potential of neurorehabilitation as a combination of traditional and modern NR-methods, oriented to diagnosis (functional tests and scales, stabilometry and gait assessment; International Classification of Functioning) and therapy (proprioceptive neuromuscular facilitation; electrostimulations; mirror box, grasp training and occupational therapy; balance and gait training; exoskeleton and robotic rehabilitation). We will present some results and typical cases of our own clinical practice of 30+ years. The evolutive and clinical polymorphism of cerebrovascular diseases is the cause of our therapeutic difficulties and (in some cases) impotence on the way to functional recovery. We will explain the clinical significance of complex NR algorithms for different types of cerebrovascular diseases: transitory ischemic attack; middle and anterior cerebral artery stroke; cerebral lacunas; chronic vertebro-basilar insufficiency; medullar stroke; intra cranial hemorrhage; rupture of cerebral aneurysm; etc.). The role of systematic medication and patients' education is underlined. We estimate the measures for prevention and treatment of possible complications (muscle and joint contractures; decubitus ulcers; deep vein thrombosis; pulmonary thromboembolism and bronchopneumonia; urinary infections). Author considers that the complex NR-algorithms are very useful for training the neuroplasticity, especially usedependent brain plasticity. We emphasize the impact of NR for functional recovery, amelioration of autonomy and quality of life of different types of patients with cerebro-vascular diseases Ivet Borissova Koleva is a medical doctor, specialist in Neurology and in Physical & Rehabilitation Medicine (PRM). Her PhD thesis and her thesis for Doctor-es-Medical Sciences (DMedSc) are in the field of Neurorehabilitation (NR). The title of the DSc thesis is: "Neurorehabilitation algorithms for functional recovery and amelioration of autonomy in patients with socially-important neurological diseases", with special attention on stroke, multiple sclerosis, Parkinson, diabetic polyneuropathy, peripheral radiculopathy due to spondylarthrosis and discal hernia. She is author of series of books and monographs in the thematic field of rehabilitation, grasp and gait rehabilitation, pain management, and NR. She has publications in national and international scientific journals. She is Editor-in-Chief of the Bulgarian scientific journal "Neurorehabilitation".
Book Publisher International (a part of SCIENCEDOMAIN International), May 25, 2021
Introduction: The introduction of portable devices in the everyday life imposed the necessity to ... more Introduction: The introduction of portable devices in the everyday life imposed the necessity to evaluate the possible consequences (of the abuse) on the spine and on the central nervous system, respectively to create programs for the prevention of these consequences. The goal of current article is to evaluate the impact of different physical modalities (including physiotherapy, ergotherapy, manual therapy, deep oscillation, lasertherapy, magnetic field) in the prevention and the complex rehabilitation of the onset of cervical myofascial pain and headache, due to spinal malposition in users (abusers) of smart phones. Material and Methods: We observed a total of 165 patients with cervical myofascial pain and headache, divided into 5 groups (of 33 patients each). The age of the patients was between 19 and 50 years, with posture (position) alterations of the cervical spine, but without significant cervical pathology. All patients used a mobile device in their everyday activities (minimum 2 hours daily) for at least 6 months. Functional evaluation was effectuated before, during and after treatment, and one month after the end of the rehabilitation. In all patients we applied a complex physical-therapeutic program (PT), including analytic exercises for paravertebral muscles and soft tissue techniques [massages, post-isometric relaxation (PIR) for the respective upper trapezius and sterno-cleido-mastoideus muscle] and stimulation of patients’ active participation in the process of prevention (education in principles of back-school, self-massage, auto-PIR). The patients in the first group effectuated only these procedures. In the second group, we added elements of manual therapy (MT - tractions, mobilizations, manipulations; and auto-mobilizations). In patients of the next groups, a paravertebral application of a preformed modality was added to the PT and the MT: in group 3 – Deep Oscillation (DO); in group 4 – lasertherapy (LT); in group 5 - magnetic field (MF). Statistical evaluation was performed by SPSS programme, version 17; using t-test (analysis of variances ANOVA) and Wilcoxon rank test (non-parametrical correlation analysis). Results and Analysis: All patients reported a significant decrease of the intensity of cervical pain and headache (evaluated by Visual analogue scale of pain and by pressure dolorimetry). In all patients we observed amelioration of the static position of the cervical spine, reduced amount of paravertebral muscle spasm and of the sensibility of trigger and tender points; and augmentation of range of active motion of the cervical region of the spine. During the rehabilitation period the results were most important in the second group (with manual therapy), but one month later there is not statistical differences between both groups. Discussion and Conclusion: Techniques of PT and MT are very useful for the prevention and the rehabilitation processus of cervical myofascial pain and headache. The program of care includes active (analytic) exercises, PIR and stretching techniques, tractions and mobilizations, education of the patient, and (in some cases) manipulations. The inclusion of preformed modalities (DO, LT, MF) in the complex prevention and rehabilitation program accelerates the effects on pain and spine mobility and ameliorate the stabilization of the results. We consider that every medical doctor - specialist in Physical and rehabilitation medicine, every physiotherapist and ergotherapist must adapt the general algorithm for the needs of the concrete patient.
Physical analgesia is the application of physical modalities for pain relief. Our objective is to... more Physical analgesia is the application of physical modalities for pain relief. Our objective is to present the potential of some physical factors and correspondent methods of application; and to explain their mechanisms of action. For pain reduction we use: low and middle frequency electric currents (e.g. TENS, interferential currents), electrostatic field (Deep oscillation), magnetic field, light (including Laser), some mineral waters and peloids, physiotherapy (e.g. analytic exercises, mechanotherapy, post-isometric relaxation, massage), reflexotherapy (e.g. acupuncture, acupressure). In rehabilitation practice, we use reflectory connections between the surface of the body and the internal organs (cutaneous-visceral, subcutaneousvisceral, proprio-visceral, periostal-visceral). The theory of Melzack and Wall for gate-control explains some effects of physical factors. We propose our own theory for explanation of mechanisms of physical analgesia. We propose our concept about rehabilitation algorithms in diseases of the nervous and locomotor systems, accentuating on conditions after surgical intervention (neurosurgical and orthopedic operations, including joint endoprosthesis and limb amputations). We present some of our own results in patients with post-operative pain.
HSOA journal of clinical studies & medical case reports, Dec 26, 2022
Ultimately, contemporary Information and Communication Technologies (ICT) were introduced in the ... more Ultimately, contemporary Information and Communication Technologies (ICT) were introduced in the rehabilitation practice. We use Exoskeletons, virtual reality, robotic rehabilitation with Locomat (Hocoma system for balance and gait training) and ThyroMotion system (for grasp training). Our purpose was to emphasize the impact of robotic rehabilitation in the process of recovery of patients with neurological complications of COVID-19, as follows: cerebral vascular accidents, spinal ischemic stroke, relapses of multiple sclerosis, Guillain-Barre syndrome, development of rare diseases (as cerebellar ataxia or amyotrophic lateral sclerosis /motor neuron disease), etc. We present typical and rare clinical cases (consequences and complications of COVID-19), treated by robotic neurorehabilitation. Our results demonstrated positive effects of ICT-application on the neuroplasticity, functional recovery and quality of life of neurological patients. We consider introduction of robotics as necessary tool in the process of neurorehabilitation.
The World Report on Disability defines the goals of rehabilitation: prevention of the loss of fun... more The World Report on Disability defines the goals of rehabilitation: prevention of the loss of function; slowing the rate of loss of function; improvement or restoration of function; compensation for lost function; maintenance of current function. Orthopedic rehabilitation is part of the rehabilitation sciences, needed frequently in clinical practice. Our opinion is that rehabilitation is an essential element in the patients' management of Orthopedics and Traumatology. In this article, we present basic theoretical knowledge, necessary for a successful orthopedic rehabilitation, and we cite practical skills of rehabilitation in patients with the most frequent orthopedic conditions, including after orthopedic surgery. We explain our own proposal for OT rehabilitation algorithms, with the goal to stimulate the functionality of our patients and to assure their independence in activities of daily living, respectively their autonomy.
Physical medicine and rehabilitation research, 2016
Aim: On the base of systematic review of the literature, clinical observations and investigations... more Aim: On the base of systematic review of the literature, clinical observations and investigations, specific complex neurorehabilitation algorithms were structured (including natural and preformed physical modalities). GOAL: Comparative evaluation of the efficacy of different physical-therapeutic and rehabilitation programs on the functional recovery, the autonomy in activities of daily living and the capacity for different activities of patients suffering from post-stroke hemiparesis. Materials and methods: A total of 366 post-stroke in-patients were observed. The neurorehabilitation complex includes physiotherapy, occupational therapy; thermotherapy or cryotherapy; in some groups we added electrostimulations of hand extensors and mirror therapy (grasp training). Patients were investigated before and after therapy, and one month later; according a Protocol with all patients' data (including neurological and functional status, hemiparesis level-Brunnstrom's test; evaluation of capacity of independence in self-care, familiar activities, professional activities; evaluation of prehension). Statistical evaluation: t-test (analysis of variances ANOVA) and Wilcoxon rank test (non-parametrical correlation analysis). Results and discussion: Comparative analysis of results proved a statistically significant favorable effect (p<0,001) on some parameters: increase of the muscle force, the range of motion and the functional capacity of the hand (precision grips); stabilization of the balance and the locomotion (test of Brunnstrom); improvement of the autonomy in different activities-self-service and domestic care. The stability of the results one month after the end of neurorehabilitation is satisfactory. Conclusion: In conclusion we must underline the impact of electrostimulations and grasp training before mirror for functional recovery and patients' autonomy.
Archives of rheumatology & arthritis research, Oct 7, 2020
Osteoarthritis (OA) is a socially important disease, with a high level of alteration of the quali... more Osteoarthritis (OA) is a socially important disease, with a high level of alteration of the quality of life of many persons. Pain is a frequent symptom of several conditions, treated with numerous drugs. The goal of current article is to remain the potential of physical factors for treatment of pain (physical analgesia) and for functional recovery. Our purpose was to emphasize the potential of some contemporary physical modalities and to propose complex rehabilitation algorithms for pain management and for functional recovery of OA-patients. Principal clinical and instrumental treatment methods are stated: electrotherapy (with low and middle frequency electric currents); magnetic field; ultrasound; laser; hydrotherapy and balneotherapy (mineral waters); physiotherapy (analytic exercises, mirror therapy, soft-tissue techniques, massage), balneophysiotherapy (underwater exercises, swimming); manual therapy, device-assisted mechano-therapy (passive, active or combined), robotic rehabilitation, etc. In rehabilitation practice, for diagnostic: we apply functional scales, International Classification of Diseases and International Classification of Functioning. For treatment: we combine synergically different natural and preformed physical modalities. We insist on the importance of technical aids (canes, walking sticks, etc.). Authors recommend structured rehabilitation algorithms for OA-patients, including elements of preformed physical modalities, physiotherapy, ergotherapy, and patient's education. We present details of the application of these algorithms on typical forms of hip and knee OA, including after hip and knee arthroplasty.
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