SCIENTIFIC COMMUNICATIONS

Neurorehabilitation

G Pošćić, K Willheim (Rijeka):

PNF in rehabilitation of patients with spastic paresis

Proprioceptive neuromuscular facilitation (PNF) is a treatment concept based on the
philosophy, that each person, including even those with disabilities, has some unused
psychophysical ability (Kabat 1950.). The treatment aims at facilitating effective and co-
ordinated patterns of movement at the same time providing the physiotherapist with the
feedback from the patient in order to improve regular movement patterns. The approach
during the treatment is always positive, using the best psychophysical abilities of the patient.
It is focused on the patient as a whole and not segmentally.
The objective of the study is to present the results of PNF treatment of 10
hemispastical patients after stroke and of 5 patients with spastical paraparesis of different
causes. The age of the treated patients was from 11 to 70 years. Aschworth scale and test of
mobility were used for the assessment of the condition. These parameters were measured at
the beginning of treatment and on its completion. All the patients received the treatment twice
a week over a 3-month period.
The treatment results for 11 patients show that spasticity has been reduced at least by 1
on the scale. No significant improvement has been noticed with the remaining 4 patients.The
mobility has improved in all the patients and particularly as a subjective feeling of
improvement.
In conclusion we can underline that the PNF concept of treatment gives good results in
rehabilitation and improves quality of life of such patients.
Keywords: PNF concept, spastic paresis
References: 1. Adler S. Beckers D. Buck M. PNF in Practice, An illustrated Guide 2nd edition
Springer Verlag 2000. 2,6,60 2. Grzebellus M. Schafer C. Irradiation- The Biomehanical
Point of View, IPNFA meeting Hamburg 1997. 3. Horst R. PNF and Spasticity, IPNFA
meeting Lausanne 2001. 4. Knott M. Some suggestions for reducing spasticity in
neurological condition 5. Musa M. The role of Afferent Input in Reduction of Spasticity; An
hypothesis Phisiotherapy 1986. 17-182 6. Šefman Z. Vpliv iradijacije na spastično zvišan
mišićni tonus, Diplomsko delo Ljubljana 2001. 20-28,49-50
Gordana Poščić, PT, Private Practice, Physical Therapy and Rehabilitation, Rijeka, Prof.
Ksenija Willheim, D.Sc., Head, Dpt. of Neurology, Rijeka University Hospital Centre, Rijeka,
Croatia
A Šel, M Clemenz (Ljubljana):

Rehabilitation study of two patients with Moya-Moya disease

Moya Moya disease (MMD) is an intracranial vascular disease of unknown origin
with two peaks of onset. Pathologic characteristics of the disease include narrowing of the
main trunk of the intracranial skull base. Secondary parenchymatous changes include infarcts
and intracranial bleedings. Cerebral angiography reveals bilateral stenosis or occlusion of
terminal internal carotid artery (ICA) and proximal anterior cerebral artery (ACA) to middle
cerebral artery (MCA). The MMD is an angiographic pattern associated with progressive
intracranial arterial occlusions and secondary telangiectasias. Collaterals appear distal to the
arterial occlusions. Aneurysms occur in 5 to 15 % of patients. Clinical manifestations include
repeated ischemic and/or hemorrhagic strokes and seizures. Children and young persons are
prone to transient ischemic attacks and cerebral infarcts, complications such as subarachnoid
and intraparenchymal hemorrhage are more prevalent in adults.
The aim of our study was to investigate methods of rehabilitation measurements and
rehabilitation course in correlation with nature of the disease, in two female patients with
MMD. The Orgogozo stroke score (total 100), is one amongst many stroke scales which
evaluate the impairment. It incorporates the estimation of consciousness, verbal
communication, facial movements, limbs tone and movements. Functional Independence
Measure (FIM) reveals degree of functional disability. It consists of 7 levels from total
assistance to complete independence (in total 126 points). Rehabilitation approach in both
patients was equal: continuous, sensory-motor integrative and neurodevelopmental,
restorative and less substitutional, educative for patients and their family. Rehabilitation
process was performed in a team and partly transdiciplinary.
Cerebral ischemic stroke was the principal clinical manifestation in a young female
patient, P.K. (23 y). She was admitted to the Clinical Centre in December 1994 with signs of
mild left side hemiparesis. The CT showed an ischemic lesion in the right parietal, subcortical
region. In the left frontal region there was a minor ischemic change. The MR angiography
revealed decreased caliber of terminal ICA and occlusion of branches MCA and PCA in the
right side. During the treatment in the Clinical Centre, neurological sequels regressed.
Rehabilitation programs continued at IRRS from February to April 1995. Orgogozo score for
impairment (admission 60, discharge 80) and results of the FIM (admission 111, discharge
117) revealed high level of motor and functional recovery. One year later ischemic stroke
recurred with signs of right hemiparesis, hemianopia and aphasia. Cerebral carotis and
vertebralis angiograpy confirmed MMD angiograhic patterns. Treatment in the Neurological
Department of the Clinical Centre was extended. Partial recovery occurred in the following
months. Continuous rehabilitation programs were performed at the IRRS from April 1996 to
July 1996. Orgogozo stroke score (admission 35, discharge 55) and FIM (admission 39,
discharge 43) showed poor rehabilitation outcome resulting from repeated ischemic strokes.
Another female patient, G.M. (43) suffered from the bleeding type of MMD. Her first
episode of intracranial bleeding dated on August 1992 when she was admitted to Neurological
department of the Clinical Centre. Cerebral angiography uncovered bilateral stenosis and
occlusion of terminal ICA. There was collateral blood flow from the posterior to the anterior
ACA and MCA circulation. Minor aneurysms occurred in ICA bilateral and BA. Despite
grave nature of bleeding type of MMD, clinical course was good, without neurological
sequels. Rebleeding occurred within 6 years, on September 1998. The patient was readmitted
to Neurologic department with disturbances of consciousness, cranial nerves impairments and
left side hemiparesis. When she became neurologically stable, rehabilitation continued at our
Institute. Estimation of the impairments, Orgogozo stroke score (admission 65, discharge 85)
and FIM (admission 90, discharge 109) showed good outcome, despite the severe nature of
bleeding type MMD. We presented two patients with two different types of MMD and
different rehabilitation courses. According to our experience, good personal adjustment,
adequate motivation and cooperative relatives influenced better rehabilitation results in the
last patient, despite history of severe bleeding.
Antonina Šel, M Clemenz, Institute of Rehabilitation, Ljubljana, Slovenia