I.

R1
OSTEOPOROZA HOUL TCUT O MARE
PROBLEM DE SNTATE PUBLIC
Laura Andronache
INRM.B
Osteoporoza este rspunztoare de mai mult de 1,5 milioane fracturi anual, acestea incluznd 300000 fracturi de old,
aproximativ 700000 fracturi vertebrale, 250000 fracturi de pumn
i mai mult de 300000 fracturi in alte regiuni. Acestea survin, n
prezena osteoporozei, n timpul activitilor zilnice obinuite
(ridicarea unor greuti, aplecare), precum i dup cderi.
Ulterior, fracturile osteoporotice, mai ales cele vertebrale, se
asociaz cu sindrom dureros invalidant.
Dei boala afecteaz cu precdere persoanele n vrst,
ea poate s apar i la cele tinere, care au tulburri hormonale,
anorexie, tulburri ale ciclului menstrual din tineree.
Prevenirea precoce a bolii poate reduce incidena
fracturilor.
Schimbarea atitudinilor i clarificarea perspectivelor persoanelor cu osteoporoz pot duce la mbuntirea calitii vieii
i trebuie s fie un important obiectiv de ngrijire medical.
Deoarece este o lips de experien n evaluarea raportului
dintre costuri i eficiena efecturii screening - lui de rutin, precum i a iniierii tratamentului preventiv am decis s analizm
eficiena acestuia, acordnd atenie informrii corecte a pacientului
n ceeea ce privete dieta, posturi corecte, kinetoterapia (mai ales
mersul pe jos i banda terapeutic), msuri ce implic costuri
minime, dar au ca efect mbuntirea strii de sntate.
Am avut urmtoarele obiective:
nelegerea importanei msurilor preventive de ctre
pacient prin creterea gradului de nelegere al acestuia n ceea
ce privete depistarea precoce a bolii
reducerea riscului de fractur prin educaie i o diet
adecvat
dezvoltarea de strategii pentru atingerea acestor scopuri.
Concluzii:
educaia adecvat i ajustarea stilului de via scad riscul
apariiei sau agravrii osteoporozei
relaia cost/eficien este mbuntit prin aplicarea
acestor msuri.
OSTEOPOROSIS THE SILENT THIE. A MAJOR
PUBLIC HEALTH ISSUE
Laura Andronache
INRM.B
Osteoporosis is responsible for more than 1,5 milion
fractures annually, including 300000 hip fractures, aproximatively
700000 vertebral fractures, 250000 wrist fractures and more than
300000 fractures of other sites. In the presence of osteoporosis,
fractures can occur from normal lifiting and bending, as well as
from falls. .urthermore, osteoporotic fractures, particular vertebral
ones, can be associated with disabling pain.
Although it is thought as an old person s disease, it can
affect younger people who have hormonal difficulties, anorexia,
bleeding or menstrual abnormalities in their 20s.
Early prevention intervention can prevent devasting
fractures.
Changing attitudes and brightening the outlook of people
with osteoporosis lead to improving the quality of life and is important health care goal.
Because there is a lack of sufficient evidence regarding
the cost effectiveness of routine screening, or concerning the
efficacy early initiation of preventive treatment, we decided to
analize and evaluate the efficacy of preventing measures in

17

RAPOARTE

osteoporosis treatment, paying attention to the correct

information of the patient concerning diet, posture weight bearing
exercises (walking, the therapeutic band), improving balance,
muscle strengh, agility, measures which involve low costs and
clear improvement of the health status.
We had the following objectives:
expanding awareness and enhancing knowledge,
understanding of the prevention, early detection and treatment
of osteoporosis.
improving the clinical diagnosis of this condition
nutrition optimization
reducing the fracture risk through education
developing strategies for coping with all these issuses.
Conclusions:
comprehensive education and changing the lifestyle
make people less susceptible to osteoporosis
the balance costs efficiency of the treatment is improved
through these measures.

R2
ACHIZIII NOI PRIVIND CLASI.ICAREA
INTERNAIONAL A .UNCIONABILITII I
DIZABILITII N POLIARTRITA REUMATOID
Mioara Banciu, Georgeta Snmrghian, Ioana Handrea
Clinica de Medicin .izic i Recuperare Timioara
Conceptele, clasificrile internaionale ale funcionabilitii, dizabilitii i sntii (IC.) sunt de prim importan n
practica medical, nvmnt i cercetare. Au fost adoptate de
OMS n 2001 ca urmare a eforturilor depuse de specialiti din
65 de state OMS pe durat de 7 ani i constituie un instrument
standardizat cu aplicare global abordnd dizabilitatea i
funcionarea ca rezultate ale interaciunii ntre problemele de
sntate i factorii contextuali (de mediu atitudini, structuri
sociale, juridice, climatul i personal sex, vrst,
personalitate, educaie, profesie, experien, caracter).
n poliartrita reumatoid se folosesc standarde de sntate:
chestionarul de apreciere al sntii- indexul dizabilitii (HAQ);
scala 2 de msurare a impactului artritei (AIMS2) i urmrirea
strii de sntate pe termen scurt (S.36). Datele obinute sunt
comparate cu setul scorului complet al IC..
Incapacitatea de munc n PR este o problem social
(costuri mari), ct i individual (pierderea statutului, venitului,
durerea). S-au efectuat studii multicentrice pe durat de 6 ani
(1988-2004, Cinahl, Embase, Medline), care au urmrit urmtorii
parametri: activitatea bolii, durerea, factorii emoionali, distruciile
funcionale, limitarea activitii, factorii de mediu, factorii personali (vrst, sex, educaie, ras).
Concluziile finale confirm c incapacitatea de munc este
o determinant bio-psiho-social, fr legtur ntre factorii de
mediu i capacitatea individului, dar pregnant influenat de
munca fizic, HAQ necorespunztor, vrsta naintat i educaia
deficitar.
UPDATES IN THE INTERNATIONAL CLASSI.ICATION O.
.UNCTIONALITY AND DISABILITY IN RHEUMATOID
ARTHRITIS
Mioara Banciu, Georgeta Sanmargitan, Ioana Handrea
Department of Physical Medicine and
Rehabilitation,Timisoara
International concepts and classifications regarding
functionality, disability and health (IC.) have a major importance

18

I. RAPOARTE
in medical practice, teaching process and research. They
were adopted by WHO in 2001 following the 7-year efforts of
specialists from 65 WHO countries, and they represent a
standard method with global applicability concerning disability
and functionality as a result of the interaction between health
factors and contextual factors (environmental attitudes,
social and legal structures, climate and personal gender,
age, personality, education, profession, experience,
character).
Health standards are being used in rheumatoid arthritis
(RA): health assessment questionnaire (HAQ) disability index;
arthritis impact measurement scale 2 (AIMS2), and short-term
health assessment (S.36). The data obtained are compared
with the complete IC. score set.
Work incapacity in RA is both a social problem (high costs),
as well as an individual one (loss of status, of income, pain).
Six-year multicentric studies were carried out (1988-2004,
Cinahl, Embase, Medline) which assessed the following
parameters: disease activity, pain, emotional factors, functional
damage, limitation of activity, environmental factors, personal
factors (age, gender, education, race).
The final conclusions confirm that work incapacity is a biopsycho-social determinant, without connection to environmental
factors and the individual s capacity, but influenced by physical
work, improper HAQ, old age and deficient education.

R3
COMBATEREA .ACTORILOR DE RISC N
OSTEOPOROZ
Banciu Mioara, Sanmarghitan Georgeta, Cotulbea Raluca,
Popa D
Introducere
Osteoporoza constituie o problem de sntate public
cu impact medico-social i economic, prin creterea incidenei
fracturilor, mai ales old, prin mrirea costului de spitalizare, a
handicapului locomotor i a ratei de mortalitate.
Material i metod
S-au studiat 285 de bolnavi internai n Clinica de Recuperare, Reumatologie, ntre anii 2000-2004, dintre care
osteoporoz tip I 75,8% i osteoporoz tip II de involuie
24,2%, analizndu-se sexul, vrsta, mediul (urban/rural), bolile
asociate, markerii biochimici de formare osoas (osteocalcina,
fosfataza alcalin) i de rezorbie (hidroxiprolin urinar,
calciurie/creatinin), determinarea scorului T prin metoda de
screening prin ultrasunet i prin DEXA la nivelul coloanei lombare i col femural (neck, trigon ward, trohanter); considernduse valoare medie a masei osoase n coloan lombar 1,17 g/
cm2, iar pentru col femural 0,952 g/cm2.
S-au estimat factorii de risc generali n osteoporoz (greutatea actual, diferena de nlime, numr de ani de la
menopauz, vrst, antecedente familiale de osteoporoz,
aportul de calciu n primii 30 de ani de via, rahitismul n
copilrie, cantitatea de alcool consumat, numr de ani de fumat,
activitatea fizic redus).
Dintre indicii multipli de evaluare s-au folosit OST
(Osteoporosis Self assessment Tool) propus de Koch bazat pe
vrst i greutate cu valoare prag de -1 i indicele NO. (National
Osteoporosis .oundation) care include vrsta peste 65 ani,
greutate corporal sub 57,6 kg, istoric de fractur, istoric familial
de fractur, fumat, ct i cel mai recent OSIRIS (Osteoporosis
Index of Risk stability) de Ben Sedrina (nsumeaz vrsta, greutatea, tratament cu estrogeni de substituie, istoric de fractur
produs de traume minime).
Rezultate
Decelarea acestor coeficieni n concordan cu scorul T
minim de determinare a densitii minerale osoase a evideniat
c cei mai importani factori de risc n ordine descrescnd
sunt: greutatea sczut, diferena de nlime, vrsta peste 66
de ani, numr de ani de la instalarea menopauzei, activitate
fizic redus, antecedente familiale, aport redus de Ca. La

sexul masculin se adaug, ca elemente predictorii, abuzul de

alcool i tutun.
Am obinut la 75% din pacieni ameliorri evidente dup
instituirea programului de exerciii fizice.
Concluzii
1. Chestionarul clinic cu factorii de risc este deosebit de
util n identificarea grupurilor populaionale i selectarea pentru
metodele de calcul specifice i sensibile a indicelui respective
(OSIRIS, NO., OST)
2. Screeningul pentru identificarea femeilor post
menopauz cu risc crescut de a face osteoporoz i iniierea
unui tratament preventiv i curativ contribuie la cea mai eficient
strategie terapeutic.
3. Msurarea DMO prin absorbiometrie dual cu raze X
se consider baza diagnosticului de osteoporoz care a fost
influenat favorabil n 80% din cazuri prin medicaie corespunztoare i exerciiu fizic terapeutic.
CONTROLLING RISK .ACTORS IN OSTEOPOROSIS
Mioara Banciu, Georgeta Sanmnarghitan, Raluca Cotulbea,
D. Popa
Victor Babes University of Medicine and Pharmacy,
Timisoara
Introduction
Osteoporosis (OP) represents a problem of public health
with great medical, social and economic impact through the
incidence of hip fractures it determines and the ensuing high
hospital costs, locomotive handicap and morbidity rate.
Materials and method
The study was conducted on 285 patients admitted into
the Department of Rehabilitation and Rheumatology between
2000-2004. The patients suffered from type I OP 75.8 per
cent, and involution, type II OP 24.2 per cent. The patients
were examined considering the following parameters: age,
gender, background (urban/rural), associated disorders,
biochemical markers of bone formation (osteocalcine, alkaline
phosphatase), resorption markers (urinary hydroxyproline,
calciuria/creatinine), assessment of T score by the ultrasound
screening method and DEXA for the lumbar spine and femoral
neck (neck, trigon ward, trochanter); the average value of bone
mass in the lumbar spine was considered 1.17 g/cm
2 , and for
2 .
the femoral neck 0.925 g/cm
General risk factors in OP were assessed (current weight,
height difference, number of years since the onset of menopause, age, Op in patient s history, calcium intake in the first 30
years of life, childhood rickets, alcohol intake, number of years
of smoking, reduced physical activity).
.rom among the various assessment indexes, the
Osteoporosis Self assessment Tool (OST) was selected; it had
been proposed by Koch, and is based on age and weight with a
threshold value of -1, together with the NO. (National
Osteoporosis .oundation) index, which takes into consideration
age over 65, body weight below 57.6 kg, history of fracture,
family history of fractures, smoking and Ben Sedrina s most
recent Osteoporosis Index of Risk Stability (OSIRIS) (assessing
age, weight, treatment with substitution estrogens, minimal trauma fracture history).
Results
Correlating these coefficients with the minimum T score
of bone mineral density assessment revealed that the most important risk factors (in decreasing order) are: low weight, height
difference, age over 66, number of years since the onset of
menopause, reduced physical activity, family history, low calcium
intake. Besides these, in males, predictive elements were
considered alcohol and tobacco abuse.
Seventy-five per cent of the patients showed significant
improvement after taking up physical exercise.
Conclusions
1. The clinical questionnaire containing the risk factors is
extremely useful in identifying population groups and in selecting

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I. RAPOARTE
specific and sensitive calculus methods for the respective
indexes (OSIRIS, NO., OST).
2. The screening for identifying high-risk post-menopause
women and the initiation of a preventive and curative treatment
contribute to the most effective therapeutic strategy.
3. Assessment of BMD by X-ray dual absorptiometry is
considered to be a basic diagnosis of OP, which was positively
influenced by proper medication and therapeutic physical
exercise in 80 per cent of the patients.

R4
ACTUALITI N LOMBOSACRALGIE (LSA)
Mihai Berteanu
U.M... Carol Davila , Spitalul Universitar de Urgen ELIAS,
Bucureti
n ciuda percepiei generale nu exist date care s dovedeasc o cretere a prevalenei LSA n ultimi 30 de ani;
ceea ce a crescut ns este dizabilitatea generat de LSA
cronic nespecific. Dizabilitatea nu este numai o problem
de incapacitate fizic sau funcional ci este i o problem
de comportament i performan care depinde de resursele
psihologice i sociale ale individului. De aceea White i
Nachemson susin c originea majoritii cazurilor de LSA
nespecific este necunoscut.
LSA nespecific presupune existena instabilitii spinale
definit ca pierderea abilitii coloanei vertebrale de a-i menine
modelele fiziologice de mobilizare.
n LSA specific (15-20% din cazurile de LSA) apare
de cele mai multe ori durerea radicular i disfuncia senzitiv
i motorie a nervului. Pe lng deformarea mecanic a
rdcinii se descrie i aciunea biologic i biochimic a
nucleului pulpos. Rdcina nervoas are particulariti
anatomice i vasculare care o fac mai susceptibil la
compresie dect nervul periferic.
Nucleul pulpos conine pe ln colagen, proteoglicani cu
efect iritant direct i celule. Acestea din urm produc
metaloproteaze, IgG, PLA
, TN.-a, etc. TN.-a, s-a dovedit a
2
avea un rol foarte important n declanarea i meninerea
durerii radiculare.
UPDATE IN LOW BACK PAIN (LBP)
Mihai Berteanu
UM. Carol Davila , Elias Emergency University Hospital,
Bucharest
Despite general perception there are no data that support
increase in prevalence of LBP in the last 30 years; on the other
hand data show that disability generated by chronic nonspecific
LBP has increased. Disability is not only a matter of physical or
functional impairement, but also a problem of behavior that
depends on the individual psychologic and social resources.
That is why White and Nachemson stated that the precise origin
of chronic nonspecific LBP is almost impossible to determine.
Nonspecific LPB is generated by spinal instability, defined as
the loss of ability of the spine to maintain its physiologic pattern
of movement.
In specific LBP (15-20% of all LBP) the key symptoms are
radicular pain and motor and/or sensitive dysfunction. Apart from
mechanic compression of the nerve root, there is important
evidence of biologic and biochemical activity of the nucleus
pulposus. There are also anatomical and vascular particularities
that modulate the reaction of the nerve root to compression
compared to peripheral nerve.
Nucleus pulposus is made of calogen, proteoglicans (with
direct iritating effect or nerve root), and cells. The latter produce
metaloprotheases, IgG, PLA
, TN.-a, etc. TN.-a has proved to
2
be an important factor in triggering and maintaining radicular pain

R5
SPECIALITATEA MEDICINA .IZICA I DE RECUPERARE
O ANALIZ SWOT
Mihai Berteanu
U.M... Carol Davila , Spitalul Universitar de Urgen ELIAS,
Bucureti
Dorim s prezentm o analiz a avantajelor i dezavantajelor specialitii de Recuperare, Medicin .izic i Balneologie
att din punct de vedere european ct i la nivel naional.
n acest scop am aplicat un instrument utilizat n alctuirea
unui plan de afaceri anume analiza SWOAT (Strengths,
weaknesses, opportunities and threates punctele forte,
slbiciunile, oportunitile i ameninrile). Astfel am analizat
factorii interni care sunt favorabili punctele forte i nefavorabili
slbiciunile i factorii externi specialitii, care pot constitui
elemente favorabile oportuniti i elemente nefavorabile
ameninri.
n urma acestei analize se propun i cteva soluii, printre
care cele mai importante se refer la: cooperare, profesionalism, educaie medical continu, educaia studenilor, cercetaredezvoltare, comunicare etc.
Scopul final al acestei analize este de fapt identificarea
modalitilor optime de a SERVI PACIENTUL.
PHYSICAL & REHABILITATION MEDICINE A SWOT
ANALYSIS
Mihai Berteanu
UM. Carol Davila , ELIAS Emergency University Hospital,
Bucharest
We wish to present an analysis of advantages and
disadvantages of the specialty of Physical and Rehabilitation
Medicine at European and national level.
.or this we applied an instrument that is often used in
building a business plan namely the SWOT analysis: strengths,
opportunities, weaknesses and threats. Thus we resumed which
internal factors in our specialty represent favorable (strengths)
and unfavorable (weaknesses) forces and which factors external
to our specialty constitute favorable (opportunities) and
unfavorable (threats) forces.
.ollowing this analysis we propose some solutions and
the most important refere to: cooperation, professionalism,
continuous medical education, students education, R&D,
communication etc.
The ultimate goal of this analysis is to find the best solution
to SERVE OUR PATIENTS.

R6
SPONDILOLISTEZISUL EVALUARE CLINIC I
MANAGEMENT TERAPEUTIC
Adrian Bighea
Clinica de Medicin .izic i Recuperare, UM. Craiova
Dup definirea spondilolistezisului, autorul trece n revist
etiologia afeciunii, insistnd pe cele dou cauze principale, cea
traumatic i cea degenerativ. Clasificarea clasic, cu cele
patru grade de alunecare a vertebrei, este completat cu o clasificare modern anatomopatologic a spondilolistezisului:
displazic, istmic, degenerativ i traumatic.
Se subliniaz c majoritatea semnelor clinice ale afeciunii
sunt nespecifice, datorate stenozei de canal lombar pe care
spondilolistezisul o produce. n acest context, examenul imagistic
capt o i mai mare importan pentru stabilirea diagnosticului,
dei unele forme de spondiloliz sunt greu de pus n eviden
chiar i prin RMN.
Tratamentul nu este necesar n formele neprogresive dect
n perioadele de exacerbare a lombalgiei i const n repaus la

20

I. RAPOARTE
pat de 2-3 zile, limitarea activitilor care suprasolicit segmentul lombar, medicaie antialgic, terapie fizical antialgic. Orteza
pentru trunchi poate fi util.
Se intervine operator atunci cnd apare afectarea
neurologic sau cnd terapia conservatoare nu mai poate influena simptomatologia algic. Sunt menionate principalele tipuri
de intervenie operatorie, insistndu-se pe tehnicile moderne,
cu folosirea Bone Morphogenic Protein-2 n realizarea fuziunii
intervertebrale.
SPONDYLOLISTHESIS CLINICAL EVALUATION AND
THERAPY MANAGEMENT
Adrian Bighea
Physical Medicine and Rehabilitation Clinic, University of
Medicine and Pharmacy of Craiova
After defining spondylolisthesis, the author presents the
etiology of the disease, insisting on two main causes: traumatic
and degenerative. In addition to the standard X-Ray classification
with four degrees of vertebra slippage, a modern anatomopathological classification is provided: displasic, istmic,
degenerative and traumatic.
Most of the clinical findings are not specific, being caused
by the lumbar stenosis produced by spondylolisthesis. The
imagistic examination is very important, but some cases of
spondylolysis are difficult to diagnose even by MRI.
In non-progressive spondylolisthesis the treatment is
necessary only if low back pain is intense. Such a treatment
may consist in bed rest for 2-3 days, limiting the activities which
overcharge the lumbar spine, analgesics and physical therapy.
Lumbar orthosis can also be useful.
Surgery is indicated when a nerve root compression occurs
or when conservative therapy is no longer efficient. Various
techniques are mentioned, insisting on inter-vertebral fusion and
use of Bone Morphogenic Protein-2.

R7
CURA BALNEAR NTRE DERIZORIUL ACTUAL I
.UNDAMENTARE TIINI.IC
Delia Cintez, Mariana .lorian, J.Kiss, Iulia Belc, V. Lucescu,
Iu. Simionca, Mdlina Ciocan, Ana-Maria Szanto, Constantin
Zamfirescu
Utilizarea eficient a factorilor terapeutici naturali n scop
medical, strns legat de dezvoltarea cercetrii n domeniu, ar
trebui s suscite un interes deosebit, att tiinific, ct i practic.
Lipsa unei politici coerente n cercetare i subfinanarea au adus
la neglijarea i degradarea cercetrii tiinifice n diferite domenii,
inclusiv n balneoclimatologie, dei Romnia, una dintre cele
mai bogate ri n factori terapeutici naturali, dispune de o reea
de staiuni balneoclimatice recunoscute la nivel naional i internaional.
n ciuda faptului c anii 80 ai secolului trecut au adus,
prin munca riguroas a specialitilor de marc n domeniu,
fundamentarea tiinific necesar pentru cura balnear, ultimii
15 ani, caracterizai cel puin prin indiferen n acest domeniu,
au determinat cderea n desuetitudine a acestui tip de terapie.
Achiziiile cercetrii balneare din acel timp, reale i consistente,
sunt minimalizate sau, mai ru, ignorate, lipsind generaiile mai
noi i mai vechi de argumentele necesare desfurrii activitii
lor, att n relaiile cu alte specialiti, dar i cu factorii
administrativi sau patronali.
n condiiile actuale, de racordare a activitii tiinifice la
nivelul celei din Uniunea European, este necesar o schimbare esenial, la toate nivelurile, inclusiv decizionale, fa de
cercetarea tiinific. Se impune o analiz corect i deschis
a strii actuale a cercetrii balneoclimaterice, n conformitate
cu indicatorii de performan cerui la nivel internaional. Suntem de prere c promovarea unei activiti constructive i
reprezentative capabile s dezvolte domeniul i s pun n

valoare factorii terapeutici naturali de care dispune ara, va

apropia termenul de integrare n sistemul de valori tiinifice
acceptat de comunitatea internaional.
Elaborarea unei strategii naionale n scopul creterii capacitii de dezvoltare i valorificare a factorilor naturali
terapeutici (mofetelor, nmolurilor terapeutice, apelor minerale, salinelor i peterilor, factorilor bioclimatici i de talasoterapie),
dar altor factori fizici terapeutici (laser, ultrasunet, curentul
electric, caldura, exerciiul fizic) se justific prin:
Imensul capital terapeutic natural (factori balneoclimatici)
al Romniei.
Varietatea deosebit a acestora i varietatea afeciunilor
crora li se adreseaz
Hiatusul de peste 15 ani existent n cerecetarea medical
balnear; dificultatea aplicrii medicinii bazate pe dovezi n acest
domeniu
Necesitatea unor norme riguroase n cercetare i n asisten medical balnear, care s permit punerea n valoare
a acestui capital, n condiiile impuse de intrarea n UE
Degradarea sau untilizarea nejudicioas i fr
monitorizare medical a capitalului balnear existent
Asistena medical balnear implicat n toate tipurile
de asisten medical: profilactic, curativ i de recuperare.
Printre direciile de cercetare tiinific n domeniul
balneoclimatologiei n urmtorii ani propunem:
1. Realizarea i adoptarea unei metodologii privind
cercetarea balnear experimental i clinic: design, cod de
bioetic, baze de date. Adaptarea pricipiilor evidence based
medicine la cercetarea aciunii terapeutice a factorilor fizici
2. Elaborarea programelor de management sanitar pe
tipuri de cur balnear i pe tipuri de ghiduri de practic medical
de recuperare i de asisten medical balnear i evaluarea
acestora din punctul de vedere al indicatorilor de eficien; studii
de cost-eficacitate i studii de calitate n aplicarea terapeutic a
factorilor fizici; mbuntirea cadrului legislativ de desfurare
a asistenei medicale sanitare i a cercetrii medicale n domeniul factorilor fizici terapeutici.
3. Elaborarea unei hri informatizate a factorilor naturali terapeutici.
4. Reevaluarea tiinific n vederea aplicrii terapeutice
a apelor minerale, nmolurilor, turbelor, mofetelor, altor surse
de factori naturali terapeutici:
5. Studii i cercetri privind efectele factorilor bioclimatici
asupra fiziologiei i fiziopatologiei:
evaluarea potenialului terapeutic al microclimatelor din
peteri i saline i metode de conservare i reproducere artificial
a acestora;
studii privind factorii de bioclimat ai diferitelor tipuri de
litoral din Romnia; identificarea sau reevaluarea potenialului
lor terapeutic;
identificarea efectelor fiziologice i fiziopatologice induse
de modificrile bioclimatice la nivelul marilor aglomerri urbane;
cercetri privind aciunea staiunii balneare ca ni
ecologic asupra homeostaziei organismului uman;
determinarea potenialului staiunilor balneare din Romnia pentru realizarea curelor de wellness;
cercetri privind factorii de mediu spaiali.
6. Studii experimentale (microbiologice, imunologice,
farmacodinamice, de biologie celular i de fiziologie
experimental) i clinice privind efectele factorilor fizici, alii dect
cei balneoclimaterici (laser, ultrasunet, cldura, exerciiul fizic
etc).
7. Elaborarea unui normativ de amenajare i dotare a
bazelor de tratament din cadrul unitilor medicale cu activitate
de recuperare medical, respectiv asisten medical balnear,
pe profil de patologie
8. Cercetri privind evidenierea i valorificarea unor noi
factori fizici cu potenial terapeutic.
Pentru realizarea acestor direcii de cercetare sunt
necesare i alte activiti de management i financiare, precum:
1. Creterea calitii activitii i creterea numrului specialitilor implicai n cercetare-dezvoltare, inclusiv a celor tineri;
promovarea specialitilor cu experien i putere de decizie;

21

I. RAPOARTE
dezvoltarea serviciilor de consultan i marketing n
balneoclimatologie..
2. Co-interesarea factorilor economici cu activitate n
domeniu pentru susinere financiar (patronatul de turism
balnear, Ministerul Muncii, sindicatele, ali patroni ai societilor
comerciale de turism balnear) i a altor poteniali susintori
(autoritile locale, comunitile locale, organizaii non-guvernamentale).
3. mbuntirea parteneriatelor existente i extinderea
arealului de parteneriat n ar, inclusiv cu Academia de tiine
Medicale, Ministerul Sntii, Ministerul Educaiei i Cercetrii
cu organismele sale abilitate. Realizarea unei platforme de
cercetare n domeniu care s cuprind centrele universitare i
staiuni balneare sau balneoclimaterice pilot (reprezentative
pentru fiecare tip de factor terapeutic natural)
4. Realizarea parteneriatului internaional.

R8
BAZELE NEURO.IZIOLOGICE ALE RECUPERRII POST
ACCIDENT VASCULAR CEREBRAL
Delia Cintez
Clinica III Recuperare Medical, INRM.B, UM. Carol Davila
Conceptul de recuperare medical are la baz ideea
refacerii potenialului maxim posibil fizic, psihologic, social,
profesional i educaional al unei persoane, n concordan cu
infirmitile sale fiziologice sau anatomice, cu limitrile impuse
de mediul n care triete i cu idealurile i planurile sale de
via. Pentru atingerea acestui scop este necesar colaborarea permanent i concertat a pacienilor, familiilor acestora i
a echipei de recuperare.
Boala cerebrovascular reprezint un adevrat flagel al
lumii moderne, ocupnd, n lume, locul trei pe scara mortalitii.
Incidena suferinei nu este bine cunoscut pentru ara noastr,
dar practica zilnic ne demonstreaz creterea ngrijortoare a
numrului de pacieni cu AVC i, mai ales, scderea vrstei de
apariie.
Leziunile la nivelul sistemului nervos central determin
infirmiti fizice i cognitive, ale cror disfuncii secundare
diminu, de obicei, n cteva luni. Mecanismele care explic
refacerea funcional spontan sunt puin cunoscute; datorit
lor se produce resoluia efectelor toxice ale zonei infarctizate i
ale zonelor de ischemie relativ perilezional. esutul nervos
din vecintatea leziunii propriu-zise prezint diverse grade de
suferin reversibil, edem, deprimare metabolic, fenomene
ce se remit treptat i determin refacerea proprietilor normale. Se reface excitabilitatea neuronal, se reia activitatea n cile
nervoase cu leziuni pariale sau indemne. Ctigul funcional
este completat i prin strategiile comportamentale
compensatorii, care sunt nvate n timpul recuperrii.
Dou ntrebri apar n cazul recuperrii medicale post
AVC: dac i ct credit se poate acorda metodelor de recuperare care i propun s moduleze cile sistemului nervos i, pe
de alt parte, dac progresul funcional post AVC ar putea fi
explicat numai prin modificrile spontane la nivel lezional i
perilezional.
Recuperarea unui sechelar postAVC se bazeaz pe
mecanisme ce permit reorganizarea funcional i structural a
materiei nervoase; ele sunt denumite generic cu termenul de
neuroplasticitate. Recuperarea depinde i de puterea sinapselor
din reelele nervoase, care au un efect de protecie mpotriva
pierderii schemelor de micare sau comportamentale renvate
n timpul recuperrii i care dicteaz i modul n care se face
aceast renvare. Rezultatul final poate fi influenat de nivelul
de educaie al pacientului, de variabile demografice (vrsta),
genetice (rasa, istoricul familial), clinicopatogenice (numrul de
leziuni i secvenialitatea lor).
n activitatea practic se folosesc tehnici care dirijeaz
neuroplasticitatea n scopul optimizrii procesului de refacere;
astfel, se realizeaz manipularea adaptabilitii biologice a
esutului nervos i creterea capacitii de recuperare

neurologic. Pe termen scurt se vor obine modulri funcionale, iar pe termen lung se sper obinerea unor modificri
structurale. Aceste tehnici sunt construite pe baza cunotinelor
despre neuroplasticitate i a imaginilor funcionale cerebrale la
persoane normale sau la pacieni cu leziuni cerebrale.
NEUROPHYSIOLOGIC BASES O. STROKE
REHABILITATION
Delia Cintez
Clinica III Recuperare Medical, INRM.B, UM. Carol Davila
Rehabilitation concept is based on the attempt to fully
recover the physical, psychological, social, professional and
educational potential of a patient in concordance with his
anatomic and physiologic limitations, or those dictated by his
environment. .or this purpose is required a permanent and
efficient cooperation among patients, their families and
rehabilitation team.
Cerebrovascular diseases are a real scourge of the modern
world being on the third place on mortality scale. Even though
stroke s incidence is not precisely known it is proved that it is
increasing and the onset age is lower.
Cerebral lesions determine physical and cognitive
disabilities that are improved usually in several months. This
natural healing process is not very well explained but it is well
known that is responsible for toxin resorption in cerebral infarction
area and in perilesional areas. Perilesional nervous tissue
presents local edema, metabolic depression, all being completely
remitted. Neuronal excitability is restored and functional recovery
is completed by compensatory behavioral strategies learned
during rehabilitation.
Two questions should be asked in stroke s rehabilitation:
if rehabilitation s aim to modulate nervous system is realistic
and if only local lesional and perilesional changes could explain
functional recovery in stroke patients.
Stroke rehabilitation is based on functional and structural
reorganization of nervous tissues, process named neuroplasticity
and it is influenced by educational level, by patient s age, race,
family history and clinical and pathological particularities.
Neuronal synapses have a protective role against loosing motor and behavioral patterns.
Several techniques have been designed to use
neuroplasticity in order to enhance recovery process. On short
term the results consist of functional modulation and there are
hopes that after a longer period of time the changes could be
structural. These techniques are imagined on the basis of
neuroplasticity knowledge and on functional cerebral imagistic
on normal or on stroke patients.

R9
PARTICULARITI N RECUPERAREA .UNCIONAL A
ADULILOR TINERI CARE AU SU.ERIT UN AVC
Iaroslav Kiss
Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie
n SUA, din totalul de AVC nregistrate, 4% afecteaz
adulii tineri sub 45 de ani. Acestora li se adaug nc 26% de
cazuri cifr de reprezint aduli cu vrste cuprinse ntre 45-65
ani.
Cauzele producerii AVC la adultul tnr sunt foarte variate; au fost identificate peste 60, clasificate astfel; 20%
aterosclerotice, 20% embolii cardiace, 10% arteriopatii, 10%
coagulopatii, 20% prolaps de valv mitral, 5% accidente
peripartum iar 15% rmnnd neelucidate, n ciuda investigaiilor
complete efectuate.
Aproximativ 75% dintre pacienii care au suferit un AVC
sub vrsta de 65 de ani au o supravieuire medie de 5 ani sau

22

I. RAPOARTE
mai mult. Riscul de recidiv dup primul atac este de 5% pentru
fiecare an.
Dei simptomele neurologice nu difer fa de cele cunoscute la bolnavii vrstnici care au suferit un AVC, unele dintre
ele capt o semnificaie deosebit de care trebuie s se in
seama n programul de recuperare funcional. Acestea sunt:
labilitatea emoional, durerea, spasticitatea, tulburrile
sfincteriene, disfunciile sexuale i oboseala.
.iind vorba de un adult tnr, aflat n plin activitate
profesional i social problema principal a recuperatorului dar
i a bolnavului const din reintegrarea socio-profesional.
Din datele statistice cunoscute, procentajul reintegrrii
socio-profesionale variaz ntre limite foarte largi de la 11% la
81% n funcie de o serie de factori.
Pentru recuperator este esenial s cunoasc elementele prognostice favorabile dar i pe cele defavorabile obiectivului propus.
Elementele de prognostic favorabil sunt: hemipareza pur
motorie, o capacitate bun pentru autoservire i deplasare
absena afaziei i apraxiei, un nivel educaional ridicat, o profesie
ce nu reclam eforturi fizice sau abiliti motrice deosebite.
Elementele de prognostic nefavorabil: afectarea funciilor
cognitive, deficienele vizuale sau de percepie senzitivosenzorial.
Evaluarea privind reluarea activitii profesionale se face
n primele 6 luni de la debut.
PECULIARITIES IN THE .UNCTIONAL REHABILITATION
AT THE YOUNG ADULTS WHO SU..ERING A STROKE
Dr. Iaroslav Kiss
National Institute of Physical Medicine, Balneoclimatology and
Medical Rehabilitation
In USA from amount of stroke cases registered, 4% affect
young adults under 45 years old. Those are adding another 26%
of cases who represents adults between 45-65 years old.
The most causes of stroke produced on young adult are
very varied; was identified over 60; classified in: 20% from
atherosclerotic causes, 20% cardiac embolism, 10% arterial
diseases, 10% coagulation diseases, 20% mitral valve prolapse,
5% peripartum accidents and 15% remain unelucidate,
notwithstanding complete investigation effectuated.
Approximately 75% of patients who suffering a stroke
under age of 65 years old had an average of surviving of 5
years or much. The risk of recidive after the first attack is 5% for
each year.
Although neurological symptoms is not different from the
well-known at the elderly patients who suffering a stroke, some
of those acquire a distinct meaning who consider in the
functional rehabilitation programme. These are: emotional
lability, pain, spasticity, sphincteriene disorders, sexual
dysfunction and tiredness.
Represent the young adult, to be in full of social and
professional activity, the main problem of the rehabilitation
practitioner is the socio-professional reinstatement.
.rom known statistical dates, the percentage of socioprofessional reinstatement varied between comprehensive limits
from 11% to 81% depending on succession elements.
.or the rehabilitation practitioner is essential to know the
prognostic of favorable and the unfavorable elements of
proposed aim.
The favorable prognostic elements are: motor hemiparesis,
a good capacity of ADL in absence of aphasia and apraxia, a
high educational level, an occupation (job) who not claims special physical efforts and motrical abilities.
The unfavorable prognostic elements: affecting of cognitive
functions, visual deficients and sense perception.
The evaluation of professional activities resume performs
in the first 6 months from beginning.

R 10
OBSERVAII ASUPRA UNOR ASPECTE ALE CLINICII I
TERAPIEI N SINDROMUL BARRE LIEOU
Vasilescu Gh., Lucescu Viorel.
Clinica Grand Eforie Nord
Prezenta comunicare reprezint un studiu retrospectiv
efectuat bolnavilor internai n clinica noastr pentru un sindrom
Barre-Lieou.
Obiectivele urmrite au fost: evaluarea posibilitilor clinice
de precizare a diagnosticului precum i a metodologiei de
tratament.
Metoda de cercetare
Analiza datelor oferite de foile de observaie clinic
(anamnez, examenul clinic obiectiv, examenele paraclinice i
consemnrile privind evoluia afeciunii) i a fielor de tratament.
Astfel, au fost studiate 110 cazuri internate n perioada 2001
2005.
Rezultatul cercetrii const n urmtoarele observaii:
sindromul Barre-Lieou afecteaz preponderent bolnavii
de sex feminin (106 cazuri 96,36 %), cele mai multe cazuri se
ncadreaz n grupa de vrst 40-60 ani (88 cazuri 80,90 %),
datele furnizate de anamnez i interpretarea atent a
simptomelor subiective au reprezentat principalul suport al
diagnosticului pozitiv, examenul clinic obiectiv i examenele
paraclinice au avut doar rolul decelrii modificrilor de tip
degenerativ existente la nivelul coloanei cervicale.
obiectivele de tratament au vizat interceptarea
principalelor verigi fiziopatologice: sedarea reactivitii crescute
de tip psihonevrotic (prezent la multe bolnave), virarea
hipersimpaticotoniei spre vagotonie, corectarea tulburrilor de
static i dinamic a coloanei cervicale. Metodologia de
tratament: hidrotermoterapia cu factori terapeutici naturali specifici litoralului Mrii Negre (nmolul sapropelic i apa srat a
lacului Techirghiol), electroterapia adecvat, kinetoterapia i
psihoterapia. n unele cazuri am asociat i medicaia sedativ
general i cea simpaticolitic. Tratamentul a fost eficient n
toate cazurile, dar ameliorri mai importante i mai stabile s-au
consemnat la 78 bolnave (85,80 %).
Concluzii
anamneza i analiza simptomelor subiective sunt elementele de baz n stabilirea diagnosticului;
metodologia de tratament pe care am aplicat-o s-a demonstrat a fi mai eficient dect alte mijloace terapeutice utilizate anterior n alte specialiti, observaie ce pledeaz pentru
recomandarea tratamentului balneofizical n cazurile cu sindrom
Barre-Lieou n staiuni cu profil de tratament a afeciunilor
reumatismale.
OBSERVATIONS ON SOME ASPECTS O. CLINIC AND
THERAPY IN BARRE-LIEOU SYNDROME
Vasilescu Gh, Lucescu V.
The Clinic Hospital of Medical Reabilitation and Balneology
(Grand) Eforie Nord
This communication is a retrospective study of the patients
in our clinic regarding a Barre-Lieou syndrome.
The objectives in view were: evaluation of clinic possibilities
to make diagnosis as well as the methodology of treatment.
The method of research: the analysis of data offered by
the clinic observation records (anamnesis, objective clinic
examination, paraclinic examinations and the notes about the
evolution of the disease) and the treatment records. Thus 110
cases hospitalised between 2001 - 2005 have been studied.
The result of the research has revealed the following facts:
Barre-Lieou syndrome affects predominantly the female
patients

23

I. RAPOARTE
(106 cases 96,36%), most of whom aged between 40 60
years old (88 cases 80,90%). The results of the anamnesis
and the careful interpretation of the subjective symptoms
represented the main support for the positive diagnosis, while
the realistic clinic examinations had only the role of revealing
the degenerative changes of the cervical spine.
treatment objectives aimed at the interception of the main
physopatological links: the sedation of grown psychoneurotic
reactivity manifested at many female patients, the turning of
hypersympaticotony to vagotony, the correction of static and
dynamic disturbances of cervical spine.
Treatment methodology
Hydrothermotherapy with natural therapeutic factors
characteristic to the Black Sea coast (sapropelic mud and the
salty water of Techirghiol Lake), adequate electrotherapy,
psychotherapy.
In some cases we associated general sedative medication
with sympaticolitic medication. The treatment proved efficient
in all the cases, but more important and more stable
improvements were noticed at 78 female patients ( 85,80%).
Conclusions
amnesis and analysis of subjective symptoms are basic
elements in making the diagnosis.
the treatment methodology that we applied, proved to
be more effective than any other therapeutic means previously
used by patients in other departments (with different affections),
a fact which favours the recommendation of balneophysical
treatment for Barre-Lieou syndrome in special resorts focused
on the treatment of rheumatic affections.

R 11
DUREREA CRONIC A COLOANEI CERVICALE
Mariana Mihailov, Mariana Cevei, Daiana Popa, Nicoleta
Pacalu
Spitalul Clinic de Recuperare Medical - Bile .elix
Universitatea din Oradea, .acultatea de Medicin i .armacie
Durerea este definit ca o experien senzorial i
emoional neplcut asociat cu distrucie tisular actual sau
potenial. Iniial durerea are o funcie protectoare avertiznd
organismul asupra prezenei unor stimuli distructivi, promovnd
repausul zonei afectate, permind vindecarea; durerea acut
dispare cnd stimulii algogeni sunt ndeprtai.
Durerea cronic constituie ns mai mult dect un semnal
de protecie; n anumite condiii ea poate deveni boal nsi.
ntre stimulul algogen i severitatea durerii exist o relaie foarte complex datorit plasticitii sistemului nociceptor.
Rspunsul la anumii stimuli algogeni poate s varieze
mult, n funcie de condiiile exterioare i de relaiile dintre cele
trei nivele ale sistemului: periferic, spinal i central. Diferenele foarte mari n percepia durerii sunt explicate prin implicarea acestor trei nivele n mecanismul durerii, prin interrelaiile
dintre ele.
Durerea l aduce pe pacient la medic mai frecvent dect
orice alt simptom. Este poate cel mai complex i cel mai greu
de caracterizat dintre simptomele bolilor cronice, iar felul n care
este exprimat durerea cronic este infinit de variat.
Din punct de vedere epidemiologic durerea cronic sever
(cu o durat mai mare de 3 luni) atinge ntre 11 30% din
populaia general; femeile sunt mai numeroase (56%), iar n
ceea ce privete vrsta aceasta predomin ntre 31 - 60 ani.
Principalele cauze ale durerii cronice sunt: patologia
reumatismal inflamatorie sau degenerativ, cancerul, cefaleea
i sechelele traumatismelor, patologie a cror frecven crete
cu vrsta.
Autorii trec n revist principalele cauze de durere cronic
la nivelul coloanei cervicale, aspectele lor clinice i abordarea
terapeutic.

R 12
LIMITE ALE CREIERULUI IN NEURORECUPERAREA
DUP TRAUMATISME CRANIO-CEREBRALE
Ciurea A.V.

, Onose G. 2 , Mircea D. 1 , Muresan D. 3 , Teodora

Coman 1 , Brehar .. 1 , Afanasiuc N. 2
1 Clinica I Neurochirurgie, Spitalul Clinic de Urgen
Bagdasar-Arseni , Bucureti
2 Institutul Naional de Recuperare, Medicina .izic i
Balneoclimatologie, Bucureti
3 E.B.E.W.E., Cluj-Napoca
1

Lucrarea prezint unele consecinte majore (exceptnd

comoia: abolire autolimitativ - dei uneori, letal - n special a
funcionrii formaiei reticulate, datorat probabil unei alterri
extinse a metabolismului neural, ce afecteaz excitabilitatea
neuronal, conducnd la o agitaie difuz a celulelor nervoase
- comoie molecular - nensoit de evidene privind alterri
structurale ale traumatismelor cranio-cerebrale (TCC): principalele limite ale creierului , responsabile pentru rezultatele
nesatisfctoare i puternic dependente de factorul/
coeficientul de (auto)recuperare spontan, ce nc se
constat n neurorecuperarea dup astfel de traumatisme.
Sistematizarea acestor limite ale creierului, vizeaz:
- limite morfo-functionale ale creierului, intrinseci
disponibilitilor de auto-reparare i plasticitate
- limite ale creierului datorate proceselor lezionale - i
rezultatelor acestora -, din cascada de evenimente
fiziopatologice post-traumatice: leziuni cerebrale primare i
secundare ; acestea accentueaza limitele naturale ale
creierului n privina aptitudinilor de vindecare spontan i de
plasticitate (capacitatea creierului de a se reorganiza, ca
rspuns n anumite condiii - la stimuli, poate conduce, posttraumatism, chiar la un anumit tip de cretere a acestuia, dar
nesntoas) i pot conduce la boli (inclusiv accidente
vasculare) i respectiv, la tulburri: tumefactie, hipertensiune
intracraniana, crize comitiale hipotensiune arteriala, hipoxie,
diaschisis (afectarea unei arii distincta dar legat anatomic
de zone, neafectate poate determina oprirea activitii altei(or)
arii; s-a constatat c pot ncepe s funcioneze i pn la 5 ani
dupa traumatism), hyperexcitabilitate (dezechilibre ntre sisteme
excitatorii si inhibitorii cerebrale - exemplu: stimularea
receptorilor NDMA i inhibarea celor GABA), durere - toate
secundare TCC
- limite ale creierului de natur: sensitiv/senzorial (inclusiv - extrem de nou! -: zgomotul ), motorie, receptiv/
expresiv i/sau cognitiv - greveaz neurorecuperarea, inclusiv n privina capacitilor de utilizare a programelor i tehnologiilor recuperatorii sau/i asistive.
Anvizajnd o finalitate pozitiv, lucrarea abordeaz
rezumativ, din perspective mai recente i cteva concepte cunoscute: funcionarea ariilor redundante (diverse funcii integrative sunt produse n multe pri ale creierului i trunchiului
cerebral), devoalarea i - astfel, rectigarea unora dintre
funciuni mai degraba prin compensarea, cu preluarea de
ctre reelele neurale redundante a funciilor pierdute la nivelul
ariilor lezate; totodat, sunt sintetizate principalele progrese
de vrf din domeniu, propensive pentru reducerea certelor - n
prezent - limite ale creierului, n neurorecuperare.
Cnd va fi realizat efectiv, neuroregenerarea n
leziunile SNC, probabil, nu vor mai fi limite semnificative ale
creierului n neurorecuperarea dupa TCC, n conformitate cu
o paradigm rezonabil i dezirabil: cu ct mai complete procesele de regenerare, cu att mai aproape adevartele vindecri
(cu restitution ad integrum) i cu att mai putine obiectivele
recuperarii.
Cuvinte-cheie: limite ale creierului, comoie cerebral, boli
i tulburri primare i secundare n traumatismele cranio-cerebrale, stres de acceleraie rotaional, TPRM 7, traumatism
axonal difuz (TAD), neuroplasticitate, arii redundante, devoalare/
compensare funcional, neuroregenerare, vindecare, obiective n neurorecuperare.

24

I. RAPOARTE

BRAIN LIMITS IN NEUROREHABILITATION A.TER HEAD

INJURY
Ciurea A.V.

, Onose G. 2 , Mircea D. 1 , Muresan D. 3 , Teodora

Coman 1 , Brehar .. 1 , Afanasiuc N. 2
1 Neurosurgery Clinic I, Clinical Hospital Bagdasar-Arseni ,
Bucharest
2 The National Institute of Rehabilitation, Physical Medicine
and Balneoclimatology, Bucharest
3 E.B.E.W.E., Cluj-Napoca

R 13
MEDICINA BAZAT PE DOVEZI: O NOU PROVOCARE
PENTRU BALNEOLOGI

This work presents some major problems consequent to

head trauma, i.e. the main brain limits , responsive for the,
yet unsatisfactory - as well as strongly dependent of
spontaneous/self recovery, amount - outcomes of
neurorehabilitation, after brain injuries, excepting concussion:
a self-limited (although sometimes, even deadly) abolishment,
especially of the brain reticular formation s function - probably
due to a widespread altered neural metabolism, affecting
neuronal excitability and resulting from diffuse agitation of nerve
cells ( molecular commotion ) -, unassociated with evidence of
structural damage.
To highlight these brain limits, there are approached:
- morpho-functional, intrinsic, limits of the brain s selfrepair and plasticity, skills
- brain limits due to the lesional processes and
outcomes of the patho-physiological events cascade ,
following head injuries: primary and secondary brain
injuries ; these enhance brain s natural limits for
spontaneous healing and plasticity (the ability of brain to
reorganize itself in response under certain conditions - to
stimuli, can lead, post-injury, even to a growth, in some way,
but not in a healthy direction) resulting, possibly, in brain injury
diseases (including stroke) and damages/disorders:
swelling, intracranial hypertension, seizures, arterial
hypotension, hypoxia, diaschisis (damage to one area
separated, but anatomically connected to non-affected, areas
- can make another area(s) stop functioning; they have been
demonstrated starting to work up to 5 years after injury),
hyperexcitability (as a brain s excitatory / inhibitory systems
imbalance, for instance: NDMA receptors are up-regulated
and GABA receptors are down-regulated), pain
- brain limits of: sensitive /sensorial (including noise
extremely new !), motor, receptive / expressional and/or
cognitive kind, that impair neurorehabilitation, including
copping with rehabilitative/assistive programs and
technologies.
Holding positive finality, the paper synthetically encloses
new insights of some already known concepts, such as:
functioning of redundant areas (integrative cerebral functions
are produced in many parts of the brain and brainstem),
unmasking (the redundant neural networks can perform - by
taking over - functions lost by injured areas) and - thus, some
functions are regained rather by compensation; a brief state-of-the art of cutting-edge advances in the field - able to reduce nowadays certain brain limits in neurorehabilitation, is also
emphasized.
When effective neuroregeneration within the CNS
lesions will be achieved, there will be, probably, no more
significant brain limits in neurorehabilitation after head
injuries, according to a reasonable and desirable paradigm:
the more complete the regeneration processes the closer
to real cures (with restitutio ad integrum) the less
rehabilitation targets.
Key words: brain limits, concussion, primary and
secondary brain injury diseases and disorders, rotational
acceleration stress, TPRM 7, diffuse axonal injury (DAI),
neuroplasticity, redundant areas, unmasking/compensation,
neuroregeneration, cure, neurorehabilitation targets.

L. Pop, L. Irsay, Rodica Ungur, I. Onac, Monica Pop

U.M... Iuliu Haieganu Cluj
Spitalul Clinic de Recuperare - Cluj
Medicina bazat pe dovezi descurajeaz intuiia i experiena clinic nesistematizat, cere noi performane din partea
medicilor cu care pn acum au fost poate mai puin
familiarizate, incluznd cutare eficient n literatura de specialitate, aplicarea regulilor formale de eviden n evaluarea
literaturii de specialitate.
Prin prisma acestor puncte, balneoterapia, rmne poate
o arie mai puin explorat. Asta se ntmpl, probabil, pentru c
n ultimile decenii asistm la o degradare continu a majoritii
staiunilor balneare, mai ales a celor mici i medii (de interes
local, sezonier) n absena unor programe naionale
comprehensive de reabilitare a staiunilor.
Pe de alt parte, numrul studiilor n ara noastr n aceast arie a medicinii a sczut foarte mult, cu toate c ocupam
cndva un loc frunta pe plan european i poate i mondial
(anii 50- 70). Acest femonen apare nu numai datorit unei
finanri necorespunztoare, ci i dificultii efecturii studiilor
randomizate i multicentrice (ex. nu exist dou ape cu
compoziie complet identic, dificulatatea de a gsi modaliti
obiective de urmrire, gsirea de placebo etc.)
Lucrarea de fa are ca i scop prezentarea unor studii
care vin s susin valoarea balneoterapiei i s sperm ncurajeaz continuarea tradiiei romneti nceput acum cteva
decenii.

R 14
PRESCRIEREA DISPOZITIVELOR DE ASISTENTA I A
ORTEZELOR LA PACIENII CU TRAUMATISME
VERTEBRO-MEDULARE
Daiana Popa, Mariana Mihailov*, Mariana Cevei*
Traumatismul vertebro-medular constituie un eveniment
devastator, de natur sa influeneze viaa pacientului sub toate
aspectele sale. n faa unor astfel de cazuri, echipa
multidisciplinar alturi de pacient i familia acestuia sunt nevoiti
sa conlucreze aplicnd principiile practicii centrate pe client
pentru a gsi soluii n sprijinul dobndirii unui grad ct mai mare
de independen funcional n activitile de autongrijire, munc
i divertisment, facilitnd n acest mod participarea individului
la viaa social. Deficitul funcional rezultat este dependent n
primul rnd de nivelul lezional si tipul de leziune (complet sau
incomplet) dar nu trebuie neglijate nici aspectele emotionale
psihologice i sociale, care pot influiena hotrtor motivaia
individului de a participa la procesul de recuperare. n prezent
literatura de specialitate ne pune la dispoziie ghiduri de
prognostic, bazate pe dovezi tiinifice, care ne permit s
estimm efectele recuperrii asupra statusului funcional al
acestor pacieni precum i date realiste asupra dispozitivelor
de asisten cu adevrat utile, de care pacientul s poat
beneficia n activitile cotidiene pentru a-i asigura un grad optim
de independen funcional.

R 15
CALITATEA VIEII IMPORTANT PARAMETRU PENTRU
APRECIEREA REZULTATELOR N RECUPERARE
Roxana Popescu
UM. Craiova
Recuperarea reprezint o important component a
asistenei medicale, avnd ca obiectiv fundamental ameliorarea

25

I. RAPOARTE
statusului funcional al pacientului, a calitii vieii, indiferent de
tipul de patologie.
Calitatea viei, constituit dintr-o balan ntre oportunitile
funcionale i necesitile funcionale cotidiene, este obiectivul
studiului unui numr apreciabil de specialiti nc din perioada
anilor 1970.
Se prezint diverse scale de evaluare a calitii vieii cu
aplicabilitate larg n recuperare, n principal scala MOS-36 (S.36) i scala SIP (Sickness Impact Profile), dar i scala de evaluare
a ADN-urilor, cu avantajele, dar i limitele unora dintre ele.
QUALITY O. LI.E - AN IMPORTANT PARAMETER .OR
THE ASSESSMENT O. REHABILITATION RESULTS
Roxana Popescu
UM. Craiova
Rehabilitation, an important component of medical care,
has a basic purpose like increasing the functioning status and
quality of life in every types of pathology.
Quality of life- a balance between both functional
opportunities and needs, represents the main objective in many
clinical trials since 1970.
This report presents some scales for quality of life
evaluation widely used in medical rehabilitation, especially MOS36 (S.-36) and SIP (Sickness Impact Profile), as well as scales
for assessment of ADL, with both advantages and bounds.

R 16
TRAUMATISMELE NERVILOR PERI.ERICI N CURSUL
ANTRENAMENTULUI CU NCRCARE O PROBLEM
MODERN N RECUPERARE
Elena-Luminia Sidenco 1 , Olimpia Moldoveanu 1 , kt. Rodiac
Cotoman 1 , kt. S. Didilescu 1 , kt. Aura Vlceanu 2 ,
Graiela Vjial 2
1 Universitatea Spiru Haret - Catedra de Kinetoterapie
2 Institutul Naional de Cercetare pentru Sport
Traumatismele directe, compresia datorat hipertrofiei
musculare sau modificrilor secundare de esuturi moi, sau
tensionrile excesive ale nervilor periferice, mai ales la nivelul
membrului superior, pot dezvolta complicaii, uneori neobinuite,
dar cu implicaii funcionale serioase.
Am ntlnit tot mai multe astfel de leziuni n cursul
antrenamentelor de for ridicare de greuti, bodybuilding i
n general, pe msur ce antrenamentul cu greuti devine tot
mai popular. Simptomatologia este dominat de durere,
slbiciune, parestezii sau colaps funcional. Datele examenului
funcional, precum i studiile de electromiografie i
electroneurografie conduc la diagnostic. Majoritatea cazurilor
beneficiaz de tratament conservator repaus i corectarea
tehnicii inadecvate de antrenament dar uneori este necesar
sanciunea chirurgical pentru rezolvarea clinic complet a
cazurilor grave.
PERIPHERAL NERVE INJURIES IN WEIGHT TRAINING A
MODERN PROBLEM IN REHABILITATION
Professor Elena-Luminita Sidenco MD
, Olimpia Moldoveanu
MD1 , Rodica Cotoman 1 , S.Didilescu 1 , Aura Valceanu 2 ,
2
Professor Gratiela Vajaiala
1 University Spiru Haret - Chair of Kinetics
2 National Institute of Research in Sport
1

Direct trauma, compression caused by muscle hypertrophy

or soft tissue changes, or excessive stretching of a peripheral
nerve in the upper extremity may lead to uncommon but
potentially serious complications.
We are seeing more of these injuries as weight training,
power lifting, bodybuilding and general physical conditioning with
weights become more popular. Symptoms are pain, weakness,

paresthesia, or palsy. Physical exam findings, electromyography

and nerve conduction studies are used to make the diagnosis.
Most conditions respond well to conservative measures, such
as rest from the offending exercise and correction of poor
technique, but surgery may be required for complete clinical
resolution in severe cases.

R 17
VARIABILITATEA MERSULUI: METODE DE EVALUARE,
PATTERN-URI DE MICARE I MODELE DE
RECUPERARE
1 , dr. Olimpia Moldoveanu
Prof.dr. Elena-Luminia Sidenco
ing. Anabella Hani 2 , Prof.dr. Graiela Vjial 2
1 Universitatea Spiru Haret - Catedra de Kinetoterapie
2 Institutul Naional de Cercetare pentru Sport

Studiul variabilitii mersului ofer o cale complementar

de cuantificare a locomoiei i a modificrilor acesteia, n relaie
direct cu mbtrnirea i/sau cu boala, i deasemeni, un mijloc
de monitorizare a efectelor interveniilor terapeutice i a
recuperrii.
Lucrrile actuale au sugerat c evalurile variabilitii
mersului pot fi strns legate de riscul cderilor, o consecin
foarte serioas a tulburrilor de mers, ale cror evaluri se
bazeaz pe aceiai parametri fundamentali.
Prezentm cele mai recente rezultate ale investigaiilor
privind variabilitatea mersului, aa cum au fost ele analizate n
urma celor mai recente cercetri n domeniu. Aceste studii evoc
noile descoperiri privind factorii de regularizare a fluctuaiilor
mersului i pregtesc terenul extinderii cercetrilor n domeniul
controlului mersului i al aplicaiilor practice privind evaluarea
variabilitii clinice a ambulaiei.
GAIT VARIABILITY: METHODS, MODELING AND
REHABILITATION
1 , Olimpia Moldoveanu
Professor Elena-Luminita Sidenco MD
2
MD1 , Anabella Hani 2 , Professor Gratiela Vajaiala
1 University Spiru Haret - Chair of Kinetics
2 National Institute of Research in Sport

The study of gait variability offers a complementary way

of quantifying locomotion and its changes with aging and disease
as well as a means of monitoring the effects of therapeutic
interventions and rehabilitation.
Actual works has suggested that measures of gait
variability may be more closely related to falls, a serious
consequence of many gait disorders that are measures based
on mean values of other walking parameters.
We present reports on the results of recent investigations
into gait variability. These studies provide new insights into the
factors that regulate the fluctuations in walking and pave the
way for expanded research into the control of gait and practical
application of measures of fait variability in the clinical setting.

R 18
CONVERGENA PELOIDOTERAPIEI CU MEDICINA
CONVENIONAL I PRACTICILE MEDICALE
ALTERNATIVE
Olga Surdu
Sanatoriul Balnear i de Recuperare Techirghiol
Lucrarea face o enumerare a practicilor medicale neconvenionale, pornind de la dou clasificri: una a Institutului
Naional de Sntate din U.S.A i cealalt din Marea Britanie.
Terapiile neconvenionale sunt: terapii holistice, active, bazate
pe diverse forme de energie biologic si presupun schimbri n
modul de via. n Statele Unite i n Europa Occidental sunt

26

I. RAPOARTE
practicate terapii alternative cu originea n Extremul Orient Antic:
Tibet, China, Japonia etc. sau terapii izvorte din observaia
clinic sau din dezvoltarea mai recent unor domenii
(hipnoterapia, reflexologia, controlul minii i al trupului etc.).
Peloidoterapia este veriga de legatur dintre medicina
convenional i cea neconvenional, prin faptul c are caracteristici care o pot plasa n ambele zone descrise. Aciunea local
a nmolului (activitatea modulatorie enzimatic, schimbul ionic)
i cea general justificat stiinific (modificarea reactivitii
cutanate, neuro-endocrino-metabolice, imune) sunt elemente
care plaseaz peloidoterapia n cadrul terapiei allopate, n timp
ce factorul fizic de aciune care acioneaz asupra ntregului
organism i confer caracterul de terapie holistic o pot ncadra
n gama terapiilor complementare/neconvenionale/alternative.
Concluzia lucrrii este c aplicaia general de nmol
acioneaz complex asupra ntregului organism uman, iar
explicarea efectelor favorabile nu poate fi fcut altfel dect prin
prisma tuturor calitilor sale.
Cuvinte cheie: peloidoterapie, naturopatie, medicin
alternativ/complementar.

R 19
.IBROMIALGIA-REALITATE DIAGNOSTIC I
COMPLEXITATE TERAPEUTIC
Georgiana Ozana Tache
Spitalul Clinic de Urgen .loreasca, Bucureti
UM. Carol Davila
Dat fiind ponderea crescut a pacienilor care acuz
dureri musculoscheletale generalizate, cronice, nesistematizate
i dificil de ncadrat etiologic, s-a impus necesitatea studierii
simptomatologiei definite de ctre specialitii din domeniu drept
sindrom fibromialgic i de stabilit terapia optim acestuia.
Obiectivul urmrit
Se urmrete stabilirea unui cadru complex de confirmare
diagnostic i de instituire a terapiei complexa, etapizat,
farmacologic i non-farmacologic.
Material folosit/Sursa informaiilor
Informaiile utilizate au fost extrase din articolele i studiile
pe acest tem, publicate n paginile revistelor JAMA, ediia
romn, Annals of the Rheumatic Diseases ntre anii 2001-2005,
precum i din publicaia Myofascial Pain and .ibromyalgia
Syndromes, A
Clinical Guide to Diagnosis and Management, Peter E
Baldry, Churchill Livingstone 2001.
Metoda utilizat/Selecia studiilor
Selecia a constat dintr-o cercetare atent a tuturor
articolelor care aduceau n discuie i/sau obiectivau informaii
referitoare la sindromul fibromialgic, la elementele complexe de
diagnostic i la aplicarea terapiei complex, etapizat,
farmacologic si non-farmacologic.
Rezultate/Sinteza datelor
Datele extrase n urma studierii materialului parcurs, arat
faptul c sindromul fibromialgic este subevaluat sau
subdiagnosticat i greit interpretat iar cercetrile privind terapia aplicat nu beneficiaz de proba trecerii timpului, existnd
ns o modalitate terapeutic acceptat de comun acord, ce
urmeaz sa fie aprobat de forurile ndreptite.
Concluzii
Dei exist nc lacune importante n literatura de specialitate, se poate confirma diagnosticul de fibromialgie pe
criterii care subliniaz caracterul cronic i complex al suferinei.
n baza informaiilor actuale, pacienilor li se poate recomanda
un tratament complex, etapizat, axat pe instruirea acestora n
legatur cu diagnosticul stabilit. Tratamentul este
medicamentos sau farmacologic i tratament non-farmacologic
(program de exerciii fizice, tehnici chiropractice, acupunctura,
masaj, electroterapie, diatermie, balneoterapie, tehnici de
biofeedback etc).

.IBROMYALGIA-DIAGNOSIS AND COMPLEX THERAPY

Georgiana Ozana Tache
Spital Clinic de Urgen .loreasca Bucureti UM. Carol
Davila-ef lucr univ.
In order to increased percentage of pacients with
musculoscheletal complains, such as generalised, chronical and
having a incertain etiology pain, apeared the necesity to study
the described simptomatology, to define it as fibromyalgia and
to find a proper therapy.
Objective
This study has the main objective to establish and define
the diagnosis and to establish a complex, step by step,
pharmacological and non-pharmacological therapy.
Material/Info sources
The information that have been used were included in the
articles and studies published in JAMA Magazine, romanian
edition and Annals of the Rheumatic Diseases between 20012005, as well as from the Myofascial Pain and .ibromyalgia
Syndromes, A
Clinical Guide to Diagnosis and Management, Peter E
Baldry, Churchill Livingstone 2001.
Method/Study selection
The method consists on selection of articles and studies
that brought informations and data about myofascial pain and
fibromyalgia, as well as diagnosis elements and complex, step
by step, pharmacological and non-phatmacological therapy.
Results
The data and the information show that fibromyalgia is an
underevaluated, poor diagnosed and wrong explained syndrome
and the fact, that the studies upon applied therapy do not benefit
from the passing time experience on this, but on the other hand,
there are existing therapeutical modalites that have to be proved.
Conclusions
Even thought there are a lot of gaps in this field, the
diagnosis of fibromyalgia can be confirmed and can be based
upon the chronical and complex caracteristics of sufference.
According to actual information, patients can benefit from
a complex, step by step, pharmacological and nonpharmacological (exercices programe, chiropractice techniques,
acupuncture, massaj, electrotherapy, diathermy, balneotherapy,
biofeedback techniques etc) therapy.

R 20
OSTEOPOROZA NECESITATEA ELABORRII UNUI
ALGORITM DIAGNOSTIC BAZAT PE DATE CLINICOPARACLINICE
Georgiana Ozana Tache, Dan Constantin Putineanu
Spital Clinic de Urgen .loreasca Bucureti
Studiul pornete de la necesitatea identificrii osteoporozei
la persoanele de sex feminin i a stabilirii riscului apariiei fracturii
osoase.
Obiectivul
Evaluarea acurateei unui astfel de algoritm diagnostic
clinico-paraclinic n vederea stabilirii diagnosticului de
osteoporoz i a riscului de apariie a fracturii osoase la
persoanele de sex feminin, aflate ntr-un numit context.
Materialul folosit/Sursa datelor
Datele prelucrate i informaiile utilizate se regsesc n
coninutul articolelor publicate pe site-ul Medline, n numerele
coleciei Revistei Societii Romne de Reumatologie i a
Revistei JAMA, ediia romn, n intervalul 2000-2005.
Metoda utilizat/Selecia studiilor
Selecia a fcut obiectul unei activiti de cercetare atent
a tuturor articolelor care aduceau n discuie i/sau obiectivau

27

I. RAPOARTE
informaii referitoare la osteoporoz i la modalitile precoce
de diagnostic, menite s scad riscul apariiei fracturii osoase.
Rezultate/Sinteza datelor
Algoritmul diagnostic trebuie s cuprind elemente clinice
i paraclinice, pentru a se putea stabili apariia osteoporozei la
persoanele de sex feminin i a putea evalua riscul apariiei
fracturii osose.
Concluzii
Elementele clinice, precum indicele occiput-perete peste
0 cm, distana costo-pelvin sub dou laimi de deget (2-3 cm),
greutatea corporal i cifoza autodeclarat, alturi de
screeningul paraclinic, ce cuprinde efectuarea unei radiografii
standard, determinarea densitii minerale osoase cu ajutorul
osteodensitometrului cu ultrasunete, ct i realizarea testului
osteodensitometric DEXA, sunt n msura s stabileasc
diagnosticul precoce de osteoporoz i s ofere ansa scderii
riscului apariiei fracturii osoase la persoanele de sex feminin
aflate ntr-un anumit context, precum vrsta, patologie asociat,
rasa, antecedentele personale i cele heredocolaterale, mod
de alimentaie i stil de via.
OSTEOPOROSIS-THE NECESITY TO ELABORATE A
DIAGNOSIS PLAN BASED UPON CLINICAL AND
INVESTIGATIONAL DATA
Georgiana Ozana Tache, Dan Constantin Putineanu
Spital Clinic de Urgen .loreasca Bucureti
The study shows the necesity of early identifyed
osteoporosis on females and of establishing the fracture risk.
Objectives
To evaluate the acuracy of a clinical and investigational
diagnosis plan in order to establish osteoporosis diagnosis and
the fracture risk on females in a certain environment.
Material/Data sources
The data that has been used and the informative materials
are contained in the Medline site articles, in the Romanian
Society Magazine articles and in the JAMA Magazine, romanian
edition articles, published between 2000-2005.
Method/Studies selection
The selection was done by reading and searcing all the
news and information contained in certains articles, having the
subject linked to osteoporosis and to the early diagosis
modalities, in order to lower the fracture risk.
Results
The diagnosis plan has to contain clinical elements and
investigational data, in order to establish the osteoporosis onset
on females and to evaluate the fracture risk.
Conclusions
Clinical elements, such as over 0 cm occiput-wall index,
under 2-3 cm costal-pevis distance, weight and autodeclarative
cyphosis, as well as investigational screening, containing an Xray standard examination, ultrasound or DEXA
osteodensitometry, are able to determine bone mineral density
and to lead to the osteoporosis diagnosis, giving the chance of
lowering the fracture risk to females of a certain age, associated
pathology, personal and heredocolateral history, nutritional
pattern and life style.

R 21
TERAPIA OCUPAIONAL LA PACIENTUL ARTROZIC
Rodica Tristaru
UM., Craiova
Boala artrozic reprezint cea mai frecvent afeciune
articular, pe plan mondial. Pacientul artrozic prezint adesea
dificultate n derularea activitilor cotidiene, a celor

gospodreti, cu impact direct asupra calitii vieii. Asistena

medical complex, de recuperare, aplicat de o echip
medical interdisciplinar pentru ameliorarea calitii vieii, are
trei obiective: limitarea statusului algic, mbuntirea
funcionalitii i diminuarea disabilitilor. Metodele terapeutice
pot fi grupate n dou categorii: non-chirurgicale (medicaie,
dietoterapie, program de management articular terapie fizic,
terapie ocupaional, kinetoterapie, aspecte educaionale pentru modificarea stilului de via) i chirurgicale. Metodele
nonchirurgicale performate mbuntesc independena
funcioal i activitile vieii cotidiene (ADL-uri).
n managementul bolii artrozice, similar celorlalte boli
cronice, terapia ocupaional se definete prin performarea
tiinific, strict monitorizat a diferitelor tipuri de activiti care
asigur reducerea disfuncionalitilor. Indiferent aspectele
definitorii ale terapiei ocupaionale acestea se bazeaz pe
modele practice.
Pentru oricare pacient artrozic inclus ntr-un program de
reabilitare, terapeutul ocupaional (unul dintre membrii echipei
medicale) trebuie s evalueze ariile, componentele i contextul
performanelor sistemului neuro-mio-artrokinetic. Vor fi apreciate
abilitile pacientului de a performa ADL-urile i se vor face recomandri pentru mijloacele ajuttoare necesare. Terapeutul
ocupaional trebuie s cunoasc i principiile pentru adaptarea
ADL-urilor i s deprind pacientul cu modul n care i
protejeaz articulaiile (se va insista pe principiile de protecie
articular), i limiteaz durerea cu conservarea energiei. Toate
tehnicile aplicate asigur o mai mare independen funcional.
Terapia ocupaional este necesar n asistena medical
a pacientului artrozic pentru meninerea independenei funcionale i a capacitii de derulare optim a ADL-urilor. Beneficiile
programului de terapie ocupaioal se reflect n mbuntirea
interrelaiilor umane, a calitii vieii pacientului, n obinerea de
satisfacii evidente cu ameliorarea statusului mental, a
funcionalitii fizice n condiii de indoloritate i probleme
emoionale minime.
Dei nu exist studii controlate pentru aspectele diferite
pe care le implic terapia ocupaional performat n boala
artrozic, practica medical a dovedit eficacitatea acestora. Pn
n prezent, cercetrile n domeniu au evideniat modul n care
pacientul artrozic a adevenit mai activ i mai responsabil pentru
autongrijirea sa, cu implicarea direct n costurile vieii cotidiene
n condiiile unei caliti superioare a vieii. Indicaiile precise,
standardizarea programului de terapie ocupaional la pacientul
artrozic necesit studii viitoare.
Cuvinte cheie: terapie ocupaional, artroz, funcie
OCCUPATIONAL THERAPY IN PATIENT WITH
OSTEOARTHRITIS
Rodica Traistaru
UM. Craiova
Worldwide, osteoarthritis (OA) is the most common joint
disorder. In patient with OA even simple household tasks and
everyday activities are difficult and can impact quality of life.
Complex management requires an interdisciplinary rehabilitation
team. Treatment of OA has three goals: decrease of pain,
increase in function and decrease in disability, to achieve a
healthy lifestyle. Management methods can be divided into two
major groups: non-surgical (medications, nutritional supplementation, joint management programs - physical therapy,
occupational therapy, exercise, self-management and weight
loss, lifestyle changes) and surgical. Nonpharmacological
interventions can enhance the functional independence and
activities of daily living (ADL).
Occupational therapy is defined with emphasis on the
scientific and measurable use of activities to achieve reduction
of dysfunction in OA patient management, like any chronic

28

I. RAPOARTE
disease. All different occupational therapy theories are based
on practice models.
.or any OA patients with physical disabilities, the
occupational therapists have to appreciate the performance
areas, performance component and performance contexts.
Occupational therapist is a health professional who know the
principles for ADL adaptations and teach ways to protect joints,
minimize pain, and conserve energy. He focuses on teaching
techniques to enable people with OA to be more independent
at home or at work. An occupational therapist must evaluate a
person s ability to perform daily living activities and recommend
assistive devices.
OT is necessary to assist patients in maintaining
independence and self reliance in performing activities of daily
living. The benefits of the occupational therapy program consist
of better quality if interaction with other people, improved heath
status, more satisfaction with life, improved mental health,
physical functioning, vitality and social functioning, less pain and
fewer emotional problems. Despite the absence of formal
controlled trials of many OT interventions, there evidence of
their effectiveness in clinical practice. The precise indications
for referral to OT in patients with OA remain to be delineated.
All researches show how patients with OA can become more
active and responsible for their own care, make more informed
decisions, help to control the costs of health care and improved
their quality of life.
Key words: occupational therapy, osteoarthritis, function

R 22
ACTUALITI N TERAPIA RECUPERATORIE
VESTIBULAR
L. Lazr, Violeta Albu, Simona Brsan
Universitatea Oradea, .acultatea de Medicin i .armacie
Spitalul Clinic de Recuperare Bile .elix
Pacienii cu suferine ale urechii interne se adreseaz
frecvent terapiei fizice i ocupaionale datorit simptomelor
iniiale reprezentate de tulburrile de echilibru i ameelile
cauzate de mobilizare. Adiional, muli dintre aceti pacieni
dezvolt simptomatologie secundar incluznd pierderea
gradului de mobilitate, diminuarea forei musculare, creterea
tensiunii, n special la nivelul regiunii cervicale i a umerilor,
cauznd fatigabilitate i cefalee.
Simptomatologia se poate datora patologiei sistemului
vestibular care afecteaz capacitatea pacientului de a se
mobiliza n mediul nconjurtor fr apariia tulburrilor de
echilibru i a vertijului. Chiar prezena ameelilor de intensitate
moderat poate reprezenta o entitate disfuncional semnificativ care poate diminua calitatea vieii, afecta toate aspectele
vieii i reduce capacitatea profesional a pacienilor.
Echilibrul reprezint o funcie complex, meninut de
semnalele pe care creierul le recepioneaz de la nivelul
aparatului vizual, a aparatului musculoartrokinetic i a urechii
interne. Obiectivele terapiei recuperatorii vestibulare sunt ameliorarea stabilitii, minimalizarea cderilor i diminuarea
ameelilor prin restaurarea funciei vestibulare normale i
promovarea mecanismelor centrale de compensaie i adaptare.
Candidaii optimi ai terapiei recuperatorii vestibulare prezint deficite vestibulare centrale sau periferice stabile,
simptome cauzate de unele activiti sau stimuli specifici, precum i sisteme cognitive, cerebeloase, vizuale i proprioceptive
integre. Evaluarea comprehensiv realizat de ctre medic va
putea identifica tipurile de strategii utilizate n meninerea
echilibrului, integritatea sistemului musculoscheletic,
perturbrile mersului, coordonarea globilor oculari i a
extremitii cefalice i percepia micrii.

Dup evaluare, va fi implementat um program individualizat

de exerciii cu scopul de a ameliora controlul postural i
stabilizarea privirii i de a reduce ameelile cauzate de unele
posturi i de micare. De asemenea, pacienii vor fi instruii pentru executarea unor exerciii de relaxare cu scopul de a reduce
tensiunea muscular i fatigabilitatea. Va fi iniiat i un program
de condiionare fizic avnd ca obiectiv ameliorarea rezistenei
i a mobilitii. Va fi esenial ca anumite tipuri de activiti fizice
s fie continuate n permanen pentru a deveni o practic curent
de-a lungul ntregii viei a pacienilor. Educaia va fi extrem de
important n susinerea pacienilor pentru nelegerea cauzelor
simptomatologiei lor i a managementului acestor afeciuni.
Recuperarea vestibular va utiliza un program de exerciii
la domiciliu care va fi efectuat zilnic. Adiional acestor exerciii
de la domiciliu, unii pacieni vor fi urmrii intradepartamental o
dat sau de dou ori pe sptmn pentru constatarea
progreselor realizate i pentru eventuala modificare a exerciiilor.
n concluzie, recuperarea vestibular reprezint frecvent
o alternativ eficace a terapiei medicamentoase i chirurgicale
sau a unei viei marcate de imobilitate i frustrare.
UPDATE ON VESTIBULAR REHABILITATION THERAPY
L.Lazr, Violeta Albu, Simona Brsan
University of Oradea, .aculty of Medicine and Pharmacy
Clinical Rehabilitation Hospital .elix Spa, Romania
Patients with inner ear disorders are often referred to
physical and occupational therapy for primary symptoms of
balance disorders and movement-related dizziness. In addition,
many of these patients have developed secondary symptoms
including loss of range -of motion, decreased strength,
increased tension, particularly in the cervical and shoulder
region, leading to muscle fatigue and headaches.
The symptoms result from pathology within the vestibular
system that reduces the patient s ability to move about his or
her environment without imbalance and vertigo. Even moderate dizziness can result in a significant disabling condition that
can diminish quality of life, affect all aspects of one s life and
reduce employability.
Balance is actually a complicated function, maintained by
signals the brain receives from the eyes, muscles and joints,
and the inner ear. The goals of vestibular rehabilitation therapy
are to improve balance, minimize falls, and decrease dizziness
by restoring normal vestibular function and promoting
mechanisms of central adaptation and compensation.
Optimal candidates for vestibular rehabilitation therapy
have stable, central or peripheral vestibular deficits, symptoms
that are provoked by specific activities or stimuli, and intact
cognitive, cerebellar, visual, and proprioceptive systems.
A comprehensive assessment by a physician can identify
the types of strategies a person uses to balance, the integrity of
his musculoskeletal system, gait abnormalities, eye/head
coordination, and motion perception. After assessment, an
individualized exercise program is developed to improve postural
control and gaze stabilization, and to reduce movement or
positional dizziness. Patients may also be instructed in relaxation
exercises to reduce muscle tension and fatigue. A physical
conditioning program is also initiated to improve endurance and
increase mobility. It is essential that some kind of physical activity
be continued on an ongoing basis and become a life-long practice.
Education is extremely important to help patients
understand the cause of their symptoms and how to manage
them. Vestibular rehabilitation utilizes a home exercise program
that is performed daily. In addition to their home exercises, some
patients are seen in the department one to two time per week
for progression and modification of exercises.
In conclusion, vestibular rehabilitation is often an effective
alternative to medication and surgery or a life of frustration and
immobility.

II.

COMUNICRI

C1
SEMNI.ICAIA MEZOTERAPIEI N PRACTICA MEDICAL
Mioara Banciu
Clinica de Medicin .izic i Recuperare Timioara
S-a iniiat ca metod n 1952 de ctre medicul francez Michel
Pistor i const n injecii locoregionale intradermice cu mixturi
medicamentoase. Denumirea provine din efectul su asupra
esuturilor de origine embrionar mezodermal (Herbin 1994).
Mrejen a dezvoltat mezoterapia punctiform sistematizat (MPS) ,
n punctele trigger sau n legtur cu leziunile fiziopatologice ale
dezordinilor musculoscheletale i medicamentele utilizate.
Criteriile de aplicare in cont de sediul, numrul de puncte,
concentraia i cantitate (0,1-0,2 ml) folosind medicamente cu
proprieti farmacologice corespunztoare aciunii. Diagnosticul
trebuie efectuat corect dup anamnez, examenul clinic i
examen radiologic i imagistic.
Metod: se folosesc ace intradermice cu grosimea de 0,11,5 mm i lungime de 4 mm. Mixturile medicamentoase se
combin n funcie de efectele urmrite (xilin cu vitamina B1;
neuriplege cu heparin; xilin, heparin, vitamina B12,
calcitonin; diclofenac de sodiu + ser fiziologic, etc.).
Aciunea: analgezic, vasodilatatoare.
Indicaii: tendinite, bursite, periartrite scapuloumerale,
leziuni ale coifului rotatorilor, sindrom compresiv de nerv
suprascapular, epicondilite, epitrohleite, fibromialgie, sindroame
miofasciale.
Reacii adeverse: eritem, echimoze, epigastralgii, lipotimii.
THE SIGNI.ICANCE O. MESOTHERAPY IN MEDICAL
PRACTICE
Mioara Banciu
Department of Physical Medicine and Rehabilitation,
Timisoara
Mezotherapy was established as a method in 1952, by
the .rench physician Michel Pistor, and it consists of intradermal
locoregional injections with a mixture of medical substances.
The name comes from its effects on mesodermal embryonic
tissue (Herbin 1994). Mrejen developed systematized
punctiform mesotherapy (SPM), in the trigger points or in
connection with physiopathological damage of musculoskeletal
disorders and the drugs used.
Application criteria take into account the location, number
of points, concentration and quantity (0.1-0.2 ml), using drugs
that have pharmacological properties corresponding to the action
desired. Diagnosis has to be made accurately after anamnesis,
clinical exam, radiological and imagistic exams.
Method: intradermal needles 0.1 1.5 thick and 4 mm long
are used. Medical mixtures are combined according to the desired
effects (xiline + vitamin B1; neuripleges with heparin; xiline, heparin,
vitamin B 12, calcitonin; natrium diclofenac + saline, etc).
Action: analgesic, vasodilator.
Indications: tendonitis, bursitis, scapulohumeral arthritis,
rotator damage, suprascapular nerve compression syndrome,
epicondylitis, fibromyalgia, myofascial syndrome.
Adverse reactions: erythema, bruising, epigastralgia,
lipothymia.

C2
OSTEOPOROZA LA BARBAI
Mioara Banciu
U.M... Victor Babe Timioara
Definiia osteoporozei este revizuit, incluznd calitatea
osului, fora i rezistena osoas ct i riscul de fractur. La

29

sexul masculin are inciden sczut, iar cauzele implic

hipogonadismul periferic sau central, boli hepatice sau digestive cronice, boli tubulare, ingestie de medicamente sau toxice
(alcool), imobilizarea, caren proteic, endocrinopatie.
Brbaii peste 50 de ani au risc de fractur de old mai
mult de 6% i fracturi vertebrale la peste 5%.
Caracteristicile OP masculine const n peakul de mas
osoas mai mare, pierderea mai lent comparativ cu sexul
feminin i o reprezentare mai bun a masei osului cortical.
Cderea este cauza principal de fractur, influenat de calitatea osului, estimat la 30% fracturi de old cu mortalitate dubl
fa de femei.
Tratamentul vizeaz reducerea clinic a fracturilor,
scderea durerii, ameliorarea funciei i calitii vieii, modificarea densitii osoase i a markerilor de turn-over.
Se recomand bifosfonai (Alendronat, Risendronat,
Ca+Vit D, doze mici de PTH intermitent, monoflorofosfat doze
mici intermitent, androgeni la adultul hipogonadic i n anumite
cazuri administrare de GH)
OSTEOPOROSIS IN MEN
Mioara Banciu
Victor Babes University of Medicine and Pharmacy,
Timisoara
The definition of osteoporosis (OP) has been revised, now
including the quality of the bone, bone resistance and the risk of
fracture. In males, osteoporosis has a low incidence and its
causes involve peripheral or central hypogonadism, chronic liver
or gastric diseases, tubular disorders, drug intake (including
alcohol), immobilization, protein deficiency, endocrinopathy.
In men over 50, the risk of hip fracture is 6 per cent higher,
and that of spine fracture is 5 per cent higher.
The characteristics of male OP lie in the higher peak of
bone mass, a slower loss as compared to women, and a better
representation of cortical bone mass. .alling down is the main
cause of fractures, influenced by bone quality, and estimated to
30 per cent hip fractures with mortality, twice as compared to
women.
Treatment aims at clinical reduction of fractures, alleviation
of pain, improvement of function and quality of life, alteration of
bone density and of turnover markers.
Recommended treatment includes bi-phosphonates
(Alendronat, Rizendronat, Ca+Vit D, intermittent small doses of
PTH, intermittent small doses of monoflorophosphate, androgens
in the hypogonadic adult and, in some cases, GH administration).

C3
CORELAIE POSIBIL NTRE COMPOZIIA
ELEMENTAL A NMOLULUI DE TECHIRGHIOL I
VARIAIA MICROELEMENTELOR SERICE
Dr. Iulia Belc, .iz. Dr. Marius Belc, Chimist Dr. Mirela Bratu
1 Sanatoriul Balnear i de Recuperare Techirghiol
2, 3 .acultatea de .izic- Chimie, Universitatea Ovidius
Constana
Cu toate c efectele benefice ale nmolului de Techirghiol
sunt recunoscute de mult timp, mecanismul intim, chimic de
aciune nc nu este elucidat.
Studiul de fa ncearc s fac o corelaie ntre compoziia
microelemental a nmolului de Techirghiol i variaiile serice
ale acelorai elemente dup o cur balnear de 2 sptmni.
Metod: s-a studiat compoziia elementelor urm din
nmolul de Techirghiol cu ajutorul spectrometriei prin absorbie
atomic. S-a urmrit variaia seric a 8 elemente: Cu, .e, Mg,

30

II. COMUNICRI
Mn, Pb, Zn, Cd, Co, la nceputul i la sfritul unei cure balneare de 2 sptmni, constnd n 10 bi sau mpachetri de nmol,
la un lot de pacieni.
Rolul acestor microelemente nu este de neglijat, iar acest
studiu, care la acest moment nu este nc finalizat, poate fi nceputul unor cercetri ulterioare mai laborioase.

C4
BENE.ICIUL .UNCIONAL AL TRATAMENTULUI DE
VISCOSUPLIMENTARE N ARTROZA DE GENUNCHI
Mihai Berteanu, Luminia Dumitru, Liviu Dumitrescu,
Ruxandra Badea,
Clinica de Recuperare Medical a S.U.U.Elias
Introducere. Pierderea proprietilor viscoelastice ale
lichidului sinovial joac un rol important n fiziopatologia
osteoartrozelor. Viscosuplimentarea reprezint injectarea
intraarticular de acid hialuronic (produs natural sau obinut prin
procese biofermentative) n articulaia artrozic.
Obiective. Evaluarea clinico-funcional a eficienei
tratamentului intraarticular cu produsul Sinovial (hialuronat de
sodiu de orgine biofermentativ) la pacienii cu suferine artrozice
la nivelul genunchiului.
Material i metod. Au fost luai n studiu 24 de pacieni
(15 femei, 11 brbai) cu vrste cuprinse ntre 42-83 ani,
diagnosticai clinico-radiologic cu gonartroz stadiul II-III Kellgren
i Lawrence uni/bilateral. Au fost exclui pacienii cu disabilitate
major la nivelul membrelor inferioare, indiferent de etiologie.
S-a aplicat protocolul standard de tratament, 1 injecie
intraarticular/sptmn cu Sinovial timp de 5 sptmni, abord
lateral sau anterior; au fost abordate n total 30 de articulaii (6
pacieni articulaia genunchiului bilateral, 18 pacieni unilateral).
Evaluarea s-a fcut la 2 sptmni de la ultima injectare i la 3
luni de la ultima injectare, cuatificndu-se durerea (folosind o scal
analog VAS de la 0 la 10, scala WOMAC, indicele algo-funcional
Lequesne, rspunsul general la tratament, apreciat de pacient
ca fiind excelent, bun, satisfctor sau slab.
Rezultate . S-au constatat:
mbuntirea scoruri VAS pentru durere (n medie de
la 70 la 54mm), respectiv la 40mm
scderea scorului WOMAC (de la 55 la 42 puncte), respectiv 30 puncte
indicele funcional Lequesne (de la 9,4 puncte la 7,2 puncte),
rspunsul general la tratament:
w evaluarea de la 2 sptmni
excelent 7 pacieni, (29,1%)
bun 10 pacieni (41,7%)
satisfctor 6 pacieni (25%)
slab 1 pacient (4,2%)
w evaluarea la 3 luni
excelent 9 pacieni, ( 37,5%)
bun 13 pacieni (54,2%)
satisfctor 2 pacieni (8,3%)
slab 0 pacient (0 %)
Concluzii
Tratamentul intraarticular cu acid hialuronic aduce beneficii
importante n reducerea disfuncionalitii la pacienii cu gonartroz.
Cuvinte cheie: acid hialuronic, gonartroz, viscosuplimentare, Sinovial
Abrevieri: VAS - Visual Analog Scale; WOMAC Western Ontario and McMaster Universities osteoarthritis
.UNCTIONAL OUTCOMES O. THE
VISCOSUPPLIMENTATION TREATMENT IN KNEE
OSTEOARTHRITIS
Mihai Berteanu, Luminia Dumitru, Liviu Dumitrescu,
Ruxandra Badea
Elias Emergency Universitar Hospital
Background. The loss of the viscoelastic properties of
the synovial fluid plays an important role in the osteoarthritis

physiopathology. Viscosupplimentation is the intra-articular

injection of hyaluronic acid (natural product or obtained by
biofermentation) in the joint affected by osteoarthritis.
Objectives. To analyze the clinical and functional
outcomes of the treatment with SINOVIAL (sodium hialuronate
obtained from biofermentation) to the patient with knee
osteoarthrosis.
Material and methods. We ve studied 24 patients(15
women and 11 men), aged between 42 and 83 years, with knee
osteoarthritis stage II-III Kelllgren & Lawrence. Those with major
disabilities of the lower limb and those who underwent corticoid
intra-articular injection less than 3 months prior to inclusion or
chronic daily steroid therapy have been excluded. We ve applied
standard treatment protocol with 1 intr-articular injection per week
during 5consecutives weeks, anterior or lateral juxtapattelar
approach, totally 30 injected knees (18 patients with unilateral,
6 with bilateral injections). The patients have been evaluated 2
weeks and 3 months after the last injection, using: the VAS (010) for pain, the WOMAC OA Index, the Lequesne s Algo.unctional Index and a patient s judgment treatment response,
appreciated as excellent, good, fair, poor.
Results
improvement of the VAS mean score for pain from 70,8
mm to54,5, respectively to 30,2 mm
reduction of the mean WOMAC score from 55 to
42,respectivelly to 30
reduction of the Lequesne s Algo-.unctional Index from
9,4 to 7,2 and 5,8
patient s evaluation of the overall response to treatment:
w 2 weeks follow-up visit:
excellent-7 patients (29,1%)
good-10 patients (41,7%)
fair-6 patients (25%)
poor-1 patient (4,2%)
w 3 months follow-up visit:
excellent-9 patients (37,5%)
good-13 patients (54,2%)
fair-2 patients (8,3%)
poor-0 patients
Conclusions
Intra-articular treatment with hyaluronic acid is beneficial
to reduce disfunctionality at the patients with knee arthrosis.
Key-words: hyaluronic acid, knee arthrosis, viscosupplimentation.

C5
IMPORTANA CORELAIILOR NTRE PARAMETRI
CLINICI I BIOLOGICI N ARTRITA REUMATOID
A. C. Bighea 1 , Daniela Matei 2 , Simona Ptru 1 , Rahela Marcu
1 Clinica de Medicin .izic i Recuperare, UM. Craiova
2 Clinica de Medicin .izic i Recuperare, Spitalul Clinic de
Urgen Craiova
Obiectiv
Lucrarea i propune s evidenieze posibile grade de
corelare ntre diferii parametri clinico-biologici la pacieni
diagnosticai cu artrita reumatoid.
Metod
Studiul s-a desfurat pe un lot de 18 pacieni diagnosticai
cu artrit reumatoid (criteriile ACR) internai in Clinica de Medicin
.izic i Recuperare a Spitalului Clinic de Urgen din Craiova.
Pacienii au avut vrste cuprinse ntre 50 i 69 ani (media 62,55
ani), raportul ntre sexe ./B=8/1; vechimea bolii a fost n medie de
7,11 ani (variaii 3-15ani), n clasa funcional Steinbrocker II fiind
inclui 8 pacieni, iar 10 n clasa III. .iecrui pacient i s-au determinat
cantitativ diferii parametri biologici: proteina C reactiv (CRP),
factorul reumatoid (.R), VSH-ul, titrul anticorpilor anti-peptid ciclic
citrulinat (atc antiCCP) i a anticorpilor antinucleari (ANA). S-a
evaluat gradul de activitate a bolii prin: DAS28, aprecierea redorii
matinale (minute), a numrului de articulaii dureroase (NAD) i

31

II. COMUNICRI
tumefiate (NAT) i a durerii (prin SVA 10 cm). Rezultatele au fost
analizate prin programul de statistic SPSS.
Rezultate
O corelaie semnificativ a fost evideniat pentru clasa
funcional fa de titrul crescut antiCCP, .R i (R = 0,863, R
2 =
2 =
0,744 i ntre NAT fa de valorile VSH i CRP ( R = 0,947, R
0,949). Vrsta la debut i vechimea bolii s-au corelat satisfctor
2 = 0,349), precum i valorile
cu clasa funcional (R = 0,591, R
ANA fa de .R (R = 0,762, R 2 = 0,581) sau vechimea bolii fa
de antiCCP i .R (R
2 = 0,363, R = 0,603). Dimpotriv, s-a
evideniat o slab corelaie a redorii articulare fa de VSH i
CRP (R = 0,434, R 2 = 0,189) sau fa de valorile .R i antiCCP.
Gradul de activitate al bolii (DAS) nu s-a corelat cu NAT, valorile
.R, sau antiCCP.
Concluzii
Corelaia semnificativ ntre diferiii parametri analizai n
studiul de fa permite susinerea necesitii acordrii unei atenii
sporite pentru cazurile cu valori peste limita normalului a indicilor
biologici, n ideea unei corecte monitorizri a evoluiei artritei
reumatoide.
THE IMPORTANCE O. THE CORRELATIONS BETWEEN
THE CLINICAL AND BIOLOGICAL PARAMETERS IN
RHEUMATOID ARTHRITIS
A. C. Bighea 1 , Daniela Matei 2 , Simona Ptru 1 , Rahela Marcu
1 Physical and Rehabilitation Clinic, UM. Craiova;
2 Physical and Rehabilitation Clinic, Urgency Clinical Hospital
of Craiova
Aim
The objective of this study is to analyze the importance of
the correlations between the clinical and biological parameters
in the case of rheumatoid arthritis.
Method
We observed 18 patients with rheumatoid arthritis interned
in Physical Medicine and Rehabilitation Clinic of Hospital No1
Craiova. The patients are aged between 50 and 69 (an average
of 62,55) and the sex proportion was ./M = 8/1; the period of the
illness is on average 7,11 years (variations 3-15 years); 8 patients
are entered in the functional class Steinbrocker II and 10 patients
in class III. .or each patient different biological parameters were
established: the C reactive protein (CRP), the rheumatoid factor
(R.), erythrocyte sedimentation rate (ESR), the titer of the cyclic
peptide citrulinated antibodies (antiCCP) and of the antinuclear
antibodies (ANA). The activity level of the illness was established
with: DAS28, the evaluation of the morning stiffness (minutes), of
the PAN, number of painful and swollen joints (SAN) and of the
pain (with VAS 10 cm). The results were analyzed with the
statistics program SPSS.
Results
An important correlation was underlined for the functional
class towards high titer of anti CCP, R. titer (R = 0,863, R
0,744) and between SAN and the ESR and CRP values (R =
0,947, R 2 = 0,949). The starting age and the period of the illness
proved to be well correlated to the functional class (R = 0,591,
R2 = 0,349) and also the ANA values towards the R. (R = 0,762,
R2 = 0,581) or the oldness of the illness towards the anti CCP
and R. (R=0,603, R
2 = 0,363). On the contrary, a weak
correlation of the morning stiffness towards the ESR and the
CRP (R = 0,434, R 2 = 0,189) or towards the R. and antiCCP
values was noticed. The activity level of the illness DAS did not
correlate to the SAN, the R. values or the anti CCP.
Conclusions
The significant correlation between the parameters
analyzed in our study enables the supporting of the necessity
for paying a considerable attention in cases with values over
the normal limit of the biological indexes in order to watch
correctly the evolution of the rheumatoid arthritis.

C6
E.ECTUL HYALGAN ASUPRA DURERII I MOBILITII N
GONARTROZ
A.C. Bighea, Simona Ptru, Paulina Ciurea
Universitatea de Medicin i .armacie Craiova
Obiectiv
Obiectivul nostru a fost de a evalua efectul administrrii a
cinci fiole de Hyalgan, una pe sptmn, n ameliorarea durerii
i mobilitii n artroza de genunchi.
Metod
Au fost inclui n studiu 67 de pacieni, din care 84% au
fost femei. Vrsta medie a fost de 65 de ani pentru femei i 61
de ani pentru brbai. Gonartroza primar a fost diagnosticat
la 78% din pacieni. n 25% din cazuri tratamentul cu Hyalgan
s-a fcut n ambii genunchi. Am gsit o uoar prevalen a
numrului de administrri n genunchiul drept (55%).
Rezultate
Evaluarea durerii s-a fcut pe o scal vizual-analog (VAS)
de 100 mm, dup 50 m de mers pe teren plat, att la nceputul,
ct i la sfritul studiului, dup a cincea injecie intraarticular
de Hyalgan. Media pentru VAS iniial a fost de 58 mm, iar pentru
VAS final a fost de 36 mm, reprezentnd o mbuntire de 38%.
Am mai folosit o scal categorial cu cinci puncte (nimic, uoar,
moderat, medie, marcat) cernd pacienilor s-i aprecieze nivelul de ameliorare a durerii dup fiecare sptmn de tratament.
87% din pacieni au apreciat ameliorarea durerii ca fiind medie
sau marcat, 10% ca uoar sau moderat i 3% nu au simit
nici o ameliorare.
Am msurat flexia genunchiului nainte de prima injecie i
dup ultima. Am gsit o ameliorare a mobilitii de la o medie iniial
de 117 la o medie final de 126, mai puin n formele avansate de
gonartroz, cu modificri clinice i radiologice severe.
n 7% din cazuri s-au constatat efecte adverse minore,
cel mai frecvent durere la locul injectrii.
Concluzii
Hyalgan poate fi considerat ca fiind una din principalele
modaliti terapeutice n gonartroz, cu beneficii importante
pentru pacient n ameliorarea durerii i a mobilitii. Chiar dac
ameliorarea mobilitii este minim la pacienii cu gonartroz
avansat, putem obine i la aceast categorie de bolnavi o
semnificativ scdere a simptomatologiei algice.
THE E..ECT O. HYALGAN ON PAIN AND RANGE O.
MOTION IN OSTEOARTHRITIS O. THE KNEE
A.C. Bighea, Simona Ptru, Paulina Ciurea
University of Medicine and Pharmacy of Craiova

Objective
Our aim was to evaluate the effect of five doses of Hyalgan,
one per week, on pain relief and range of motion in osteoarthritis
of the knee.
Method
67 patients were included in this study, 84% of them were
women. Average age was 65 years for women and 61 years for
men. A primary osteoarthritis of the knee was found in 78% of
all cases. Treatment with Hyalgan was made in both knees in
25% of all cases. We found a slight prevalence of the right knee,
with 55% of total administrations.
Results
Pain relief evaluation was made on a visual-analogue scale
(VAS) of 100 mm after 50 m foot walk, at the beginning and at
the end of the study, after the fifth intra-articular injection. The
average of initial VAS was 58 mm and the average of final VAS
was 36 mm, representing an improvement of 38%. We also used
a 5 point categorical scale (none, slight, moderate, mild, marked),
asking patients to appreciate the level of pain relief after every
week of treatment. 87% of patients reported the pain relief to be

32

II. COMUNICRI
mild or marked, 10% reported slight or moderate pain relief and
3% reported no pain relief.
We measured the flexion of the knee before first injection
and after the last one. We found an improvement in range of
motion from an initial average of 117 to a final average of 126,
less for advanced forms of osteoarthritis of the knee with severe clinical and X-Ray modifications.
We found minor adverse events in 7% of cases, most
frequent being injection-site pain.
Conclusions
We can consider Hyalgan a significant method of therapy
in osteoarthritis of the knee with an important benefit towards
motion improvement and pain relief. Although motion
improvement is minimal for the patient with advanced
osteoarthritis, even in those cases we can obtain a good pain
relief.
We can obtain a good pain relief for the patients with
advanced osteoarthritis even if motion improvement is minimal.

C7
METODOLOGIA RECUPERRII PACIENILOR CU
TRAUMATISM VERTEBRO-MEDULAR N CONDIIILE
SPITALULUI CLINIC DE RECUPERARE BILE-.ELIX
M. Cprar, Anca Cprar, Ioana Cheregi, Erzsebeth Pasztay,
Z. Pasztay
Spitalul Clinic de Recuperare Bile-.elix
Incidena tot mai mare a cazurilor de TVM n lume, dar i
n ara noastr, necesit o ct mai eficient strategie terapeutic
att chirurgical, ct i postoperatorie, de recuperare.
Obiective
Obiectivul major al tratamentului de recuperare este cel
de obinere a unui maxim n ceea ce privete independena funcional a pacientului i o ct mai bun integrare socioprofesional
Material i metod
S-au luat n studiu retrospectiv 40 pacieni cu traumatism
vertebro medular (TVM) internai n Spitalul Clinic de Recuperare Bile-.elix n perioada 2003-2005.
Pentru evaluarea pacienilor s-au urmrit scala Ashworth
modificat, metod Weber, scala Barthel modificat.
Pentru motivarea pacienilor i informarea corect a
aparintorilor s-a aplicat fiecrui pacient ghidul de refacere funcional propus de Carole Adler, n funcie de nivelul lezional
medular.
S-au utilizat la aceti pacieni metodele kinetoterapice
cunoscute i s-a aplicat n plus metoda Vojta.
Metoda statistic utilizat a fost metoda Student.
Rezultate
Rezultatele studiului au scos n eviden o ameliorare a
tonusului muscular i uneori rectigarea unor funcii
sublezionale globale i/sau segmentare. La pacienii la care sa utilizat n plus metoda Vojta s-au obinut rezultate semnificativ mai bune comparative cu cellalt lot de pacieni (p<0,001).
Concluzii
Toate tehnicile i metodele utilizate au dus la grbirea
procesului de reintegrare socio-profesional i creterea
independenei funcionale a acestor pacieni.
THE METHODOLOGY O. TREATMENT IN PATIENTS
WITH SPINAL CORD INJURIES IN .ELIX SPA
REHABILIATATION HOSPITAL
Cprar M., Cprar A., Cheregi I., Pasztay E. Pasztay Z.
Clinic of Physical Medicine and Rehabilitation .elix Spa
The more higher incidence of pacients with spinal cord
injury in the world and in our country needs a most efficient
surgical and post-surgical rehabilitation therapy.
Aim
The aim of rehabilitation therapy is to obtain the most

higher level of functional independence of pacients and their

social integration.
Material and methods
.orty patients hospitalized in .elix Spa Rehabilitation
Hospital suffering from spinal cord injuries have been studied
closely during the time frame of 2003-2005.
In order to assess the patients data we have looked at
the modified versions of the Ashworth measurement scale,
Weber method, and Barthel modified measurement scale.
In order to motivate our group of patients and to provide
the correct set of information we have applied to each patient
Carole Adler s functional rehabilitation study guide, according
to the level in medullar lesion seen in each patient.
The well-known kinetic therapy methods as well as Vojta
method have been applied to the patients. In this study it was
used statistic Student t method.
Results
Upon the utilization of these methods an obvious
amelioration in the toning of their muscles has been observed.
Sometimes we have also able to notice that the patients have
regained some of the global and/or segmented sublesion s normal functions. The results were comparative obviously increased
to the pacients which benefits by Vojta method aplication
(p<0,001).
Conclusion
All methods and techniques used have led to the hastening
of the socio-professional incorporation process as well as an
incline in the functional independence of these patients.

C8
MANAGEMENTUL OBOSELII N SCLEROZA MULTIPL
Mariana Cevei, Daiana Popa, Mariana Mihailov, Dorina-Maria
.rca
Universitatea din Oradea, Spitalul Clinic de Recuperare
Medical Bile .elix
Oboseala este un simptom real i disabilitant n scleroza
multipl. Cercettorii americani (.ish et all 1994) au descoperit
inexistena unei corelri ntre oboseal i gradul afectrii
neurologice. Un alt grup de investigatori (Krupp et all 1995) ai
oboselii din scleroza multipl au confirmat c aceasta este o
problem independent, fiind un simptom extrem de disabilitant.
Oboseala este o experien subiectiv care poate fi apreciat
cu scala cu ajutorul mai multor scale. De exemplu: .atigue
Severity Scale (.SS), The MS Specific .atigue Scale, (MS.S),
The .atigue Impact Scale (.IS), The Modified .atigue Impact
Scale (M.IS). Evaluarea nivelului de oboseal este apanajul
terapiei ocupaionale. Programul de management al oboselii
trebuie s fie parte din programul de recuperare dac scala de
msurare indic un nivel important al acesteia, pe care l ntlnim
n majoritatea cazurilor. Planul de tratament al oboselii cuprinde principii legate de conservarea energiei, modificarea stilului
de via, tehnici de relaxare, controlul temperaturii, informarea
pacienilor despre boal.

C9
SINDROMUL IN.LAMATOR BIOLOGIC .ACTOR
PREDICTIV INDEPENDENT AL EVOLUIEI .UNCIONALE
POST ACCIDENT VASCULAR CEREBRAL
Delia Cintez, Daniela Poenaru, Cristina Constantinescu*,
Camelia Teleianu, Carmen Clin
INRM.B Clinica III Recuperare Medical
*SUUB Clinca de Cardiologie
Sindromul inflamator biologic, reprezentat n special prin
fibrinogen i proteina C reactiv, a fost incriminat ca element de
identificare a unui proces aterosclerotic activ la pacienii cu boal
cardiovascular, respectiv cerebrovascular. n consecin

33

II. COMUNICRI
prezena sa se asociaz cu risc crescut de mortalitate, respectiv recidiv a evenimentului acut cardio- sau cerebrovascular.
Obiectiv
Determinarea corelaiei dintre sindromul inflamator biologic
prezent la sechelarii post AVC i scorurile funcionale pe termen
scurt i mediu ale pacienilor inclui n programe de recuperare
precoce.
Material i metod
Lotul de studiu a cuprins 201 de pacieni sechelari post
AVC, inclui n programe de recuperare n urma aplicrii unor
criterii de excludere. Variabilele urmrite au fost demografice
comune, medicale generale i neurologice i funcionale; ele
au fost msurate la intrarea n studiu, la 3 sptmni i dup 3
luni. n funcie de prezena sindromului inflamator biologic, lotul
iniial a fost imprit n 2 grupuri: grupul A = 98 pacieni cu semne
de inflamaie prezente i grupul M martor = 103 pacieni. Datele
culese prelucrate statistic.
Rezultate
Sindromul inflamator biologic a fost prezent la 48,8% dintre
pacienii studiai. Aproape jumtate dintre acetia nu prezentau
afeciuni care s explice prezena acestuia, putnd fi apreciat
ca semn al unui proces ateroscerotic activ. Nu s-a gsit o
corelaie semnificativ a acestuia cu vrsta, sexul sau tipul de
AVC. Datele arat o asociere la limita semnificaiei statistice cu
scorurile funcionale msurate la 3 i la 12 sptmni.
Concluzii
Sindromul inflamator biologic poate fi asimilat unui factor
de risc pentru prognostic funcional negativ pe termen scurt i
mediu la sechelarii post AVC inclui n programe de recuperare
precoce.

C 10
OPIOIDELE N DUREREA LOMBAR CRONIC NONONCOGEN
Delia Cintez, Maria-Cristina Constantinescu*, Daniela
Poenaru, Carmen Clin
INRM.B
*SUUB Cardiologie
Premise:
- Durerea cronic problem de sntate public, avnd
o mare prevalen i impact major pe calitatea vieii
- Durerea lombar cronic (LBP) se asociaz cu
absenteism, scderea calitii vieii, cronicizare rapid, inciden
mare, complicaii redutabile mai ales la vrstnici, datorate
adesea unor scheme terapeutice clasice ineficace sau incorecte
- Abuzul de medicamente analgetice non-opioide, mai ales
antiinflamatoriile nesteroidiene, pot avea efecte secundare redutabile
Obiective
Determinarea rolului tratamentului medicamentos cu
opioide n durerea lombar cronic nononcogen.
Material i metod
Au fost urmarii 32 de pacieni, femei i brbai, cu durere
lombara multifactorial, cu durat continu de cel puin 2 luni.
Pacienii au fost mprii n dou loturi: 20 (lotul A) au primit ca
medicaie analgetic codein asociat cu paracetamol, iar ceilali
12 (lotul B) au primit paracetamol, piafen i antidepresiv triciclic.
Toi pacienii au fost inclui n programul de low back school . Au
fost evaluai urmtorii parametri: durerea, depresia, mobilitatea
lombar, perioada de timp fr durere pe parcursul unei zile,
compliana la kinetoterapie, calitatea vieii. Msurarea parametrilor
s-a fcut zilnic pe parcursul a trei sptmni de tratament.
Rezultate i discuii
Grupul A a prezentat evoluie similar cu grupul martor n
ceea ce privete intensitatea durerii i depresia n prima
sptmn de tratament, n urmtoarele 2 sptmni evoluia
grupului A fiind semnificativ mai bun. De asemenea, compliana
la kinetoterapie i percepia calitii vieii s-au situat la un nivel
superior faa de grupul B. Efectele secundare au fost rare i
nesemnificative ca intensitate.

Concluzii
Durerea lombar cronic beneficiaz de tratamentul cu
opioide, rezultatele transpuse n percepia calitii vieii fiind
superioare tratamentului cu analgetice clasice i antidepresive
triciclice.

C 11
DINAMICA I CARACTERIZAREA PARAMETRILOR
.IZICO-CHIMICI I MICROBIOLOGICI PRIVIND
INDIVIDUALIZAREA SURSELOR TERAPEUTICE EXISTENTE N STAIUNEA OLNETI
Drd. cercet. st. III Mdlina Ciocan, drd. biol Liana Ionescu,
asist. cercet. Gheorghiecivi Gh.
Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie, Bucureti
Lucrarea prezint dinamica n timp a chimismului i
microbiologiei apelor minerale terapeutice de la Olneti,
identific parametrii fizico-chimici i bacteriologici eseniali,
creeaz configuraia fizico-chimic a surselor studiate,
individualizeaz i structureaz aceste surse, n funcie de
indicaiile terapeutice preconizate.
Au fost luai n studiu toi parametrii fizico-chimici i
microbiologici care contribuie la valorificarea apelor minerale
terapeutice sulfuroase utilizate n prezent la surs.
Cuvinte cheie: parametrii fizico-chimici, indicatori
microbiologici, ap mineral sulfuroas, terapeutic.
THE DYNAMICS AND CHARACTERISTICS O. THE
PHYSICO-CHEMICAL AND MICROBIOLOGY
PARAMETERS RE..ERING TO THE INDIVIDUALIZATION
O. THE THERAPEUTIC SOURCES IN OLANESTI HEALTH
RESORT
Drd. cercet. st. III Madalina Ciocan, drd. biol Liana Ionescu,
asist. cercet. Gheorghievici Gh.
National Institute of Rehabilitation, Physical Medicine and
Balneoclimatology, Bucharest
The paper presents the dynamics of the therapeutic
mineral water chemism and microbiology in Olanesti on long
term, it identities the essential physico-chemical and bacteriology
configuration of the studied sources, it individualizes ang
organizes these sources depending on the forseen therapeutic
indications.
There have been studied all the physico-chemical and
microbiology parameters that contribute to the utilization of the
utilization of the sulphurous therapeutic mineral waters which
are used at the source at the moment.
Key words: physico-chemical parameters, microbiology
parameters, sulphurous mineral water, therapeutic.

C 12
OPTIUNI MOTIVATE DE PROGRESELE IN DOMENIUL
.IZIOPATOLOGIEI OSTEOPOROZEI, PENTRU
KINETOTERAPIA PRO.ILACTICA IN .RACTURILE DIN
OSTEOPOROZA.
Dr. Horatiu Dinu, Medic Specialist Medicina .izica si
Recuperare
Centrul Medical de Diagnostic, Tratament Ambulator si
Medicina Preventiva Bucuresti
Osteoporoza reprezinta o conditie patologica , caracterizata prin masa osoasa scazuta, alterari microarhitecturale
osoase, care induc microfracturi, cresterea fragilitatii osoase si
cresterea susceptibilitatii de a suferi fracturi.

34

II. COMUNICRI
Obiectivul cel mai important il reprezinta diagnosticarea
cat mai precoce, inainte de aparitia fracturilor, iar daca acest
deziderat nu se poate atinge intotdeauna, cel putin se incearca
evitarea altor fracturi, mai ales la nivelul soldului, deoarece acest
tip de fractura poate scade considerabil calitatea vietii.
Valoarea exercitiilor fizice in prevenirea pierderii osoase
a devenit din ce in ce mai putin controversata. In ultimii 20 de
ani numeroase publicatii mai mult sau mai putin documentate,
au incercat sa defineasca : ce tip de exercitii sunt realmente
eficace, ce program se impune, in ce maniera ar trebui
implementat si pentru cat timp.
Primul care a demonstrat complexitatea raspunsului
osteogenic la actiunea stimulilor mecanici a fost .rost in 1964.
.rost a introdus o multime de variabile intr-un mecanism foarte
simplu: stimulul mecanic si formarea de os nou. El a introdus
ipoteza mecanostatului (un sistem de reglare al celulei
multicelulare BMU) utilizata in refacerea osului, conform careia
daca stimulul depaseste rezistenta osoasa, balanta se va orienta
spre osteoformare-modelare, astfel incat sa creasca forta si
rezistenta osului la intindere.
Daca stimulii se menin sub pragul inferior de stimulare,
rezistenta osoasa in acest caz va fi superioara tensiunilor la
care osul este supus, iar balanta formarii osoase va fi orientata
ctre reducerea mecanismului de rezisten. Asa se explica de
ce scaderea fortei musculare, inerenta la varstnic, scade
incarcarea osului, care era adaptat sa suporte sarcini mult mai
mari. Apare o descarcare a osului care duce in final la
osteopenie.
Mai tarziu Duncan & co intr-un studiu amanuntit, au artat
c exerciiile cu impact nalt ce pot produce deformri semnificative n matricea osoas (in special trabeculara), cu transportul mai bun al fluidelor prin reeaua canalicular i mai ales
ntinderile aplicate la frecven nalt, stimuleaz n manier
efectiv osteogeneza.
.olosind experiena i studiile descrise anterior, Rubin &
Lanyon au artat ca sensibilitatea (receptivitatea) mecanica a
osului, scade daca stimulul se prelungeste.
Pornind de la aceste consideraii, Turner demonstreaza
c osul prezint un fenomen de desensibilizare, n urma unui
stimul prelungit de ntindere si propune indexul osteogenic ca
raspuns osteoformator la exercitiile care ar putea creste semnificativ densitatea osoasa.
Tot Turner demonstreaza in alt studiu, ca DMO - indicatorul
cel mai des utilizat in majoritatea studiilor - desi reprezinta unul
din factorii care descrie rezistenta osoasa, nu ofera nici o
informatie despre variatiile calitatii osului, deoarece masurarea
acestei DMO nu se realizeaza in locuri specifice si concordante
cu sarcina de incarcare.
Concluzii
Referitor la efectele exercitiului fizic, stimulul produs de o
intindere trebuie sa aiba anumite caracteristici :
- sa depaseasca un anumit prag al stimulului minim
eficient si sa fie corelat cu DMO situs respectiv, dar la un
nivel satisfacator al compliantei bolnavului;
- sa fie aplicat intermitent si dinamic;
- sa produca un stimul diferit de cel standard (cat mai
variat);
- sa se aplice cu viteza cat mai mare si cu repetari putine,
deoarece exista riscul aparitiei fenomenului de desensibilizare ;
- rspunsul osteogenic la stimul, poate fi mrit printr-un
regim de exerciii care prevede i o perioad de repaus ntre
sesiunile scurte de ntindere;
- sa fie aplicat pe o perioada de timp suficient de lunga
pentru a inregistra un efect pozitiv al balantei densitatii osoase,
astfel incat rezultatele sa fie relevante (timpul de remodelare a
unitatii osoase este de aproximativ 4 6 luni si astfel, orice
tratament care are drept scop prevenirea pierderii de os, trebuie sa fie de cel putin 2 3 ori mai lung).
Toate aceastea reprezint o premiz indispensabil n
studierea unui program de exercitii eficient n osteoporoza postmenopauz.

MOTIVATED OPTIONS O. THE OSTHEOPOROSIS

PATHOPHYSIOLOGY .IELD .OR THE PRO.ILACTIS
EXERCISES, IN THE OSTHEOPOROSIS .RACTURES
Dr. Dinu Horatiu, M.D. Physical Medicine and Rehabilitation
Medical Center of Diagnosis, Ambulatory Treatament and
Preventive Medicine Bucharest.
Osteoporosis is a condition characterized by a low bone
mass, bone micro architecture alteration that induces microfractures, the increase in bone fragility and the risk of fractures.
The main goal is an early diagnosis, before the apparition
of fractures, or at least the avoidance of other fractures,
especially those of the hip as this kind of fracture lowers
considerably the quality of life.
The value of physical exercise in preventing the bone loss
has become less and less controversial. In the past 20 years,
numerous articles have tried to define: what type of exercises
are genuinely effective, what program is more suitable, what is
the manner to apply it and for what period of time.
The first to demonstrate the complexity of the osteogenic
response at the action of mechanical stimulus was .rost in 1964.
.rost introduced many variables in a quite simple mechanism:
the mechanic stimulus and the formation of new bone. He
introduced the hypothesis of mecanostat (a regulatory system
of the multi cellular cell BMU) used in the turnover of the bone,
according to which if the stimulus exceeds the bone resistance,
the balance will orient toward osteo-formation and remodeling,
thus increasing the strength and the force of the bone as it
becomes larger. If the stimulus maintain under the lower
threshold of stimulation, the bone resistance will be superior to
the tensions over the bone, and the balance of the bone
formation will be oriented toward the decrease of the resistance
mechanism. This explains why the decrease of the muscular
force of the elder decreases also the bone loading, adapted to
support more weight. Thus, it appears an unloading of the bone
which leads eventually at osteopenia.
Later, Duncan & co showed that the exercises with high
impact that can produce significant deformations in the bone
matrix (especially trabecular), with a better transport of the fluids
through the canalicular network and especially the stretching
applied at a high frequency, stimulates effectively the
osteogenesis.
Based on the previous studies, Rubin & Lanyon showed
that the mechanical receptivity of the bone decreases if the
stimulus lasts longer.
According to these results, Turner demonstrates that the
bone suffers a phenomenon of desensitization after a prolonged
stretching stimulus, and suggests the osteogenic index as an
osteoformation response to the exercises that could increase
significantly the bone density.
Turner also demonstrates in another study that DMO
the most frequent indicator in the vast majority of the studies
does not offer any information about the variations in the quality
of the bone because the measurement of DMO is not done in
specific zones in accordance with the load of the bone.
Conclusions
Regarding the effects of the physical exercise, the stimulus
produced by a stretching must have the following characteristics:
w To be higher than a minimal effective threshold and to
correlate with DMO
w To be applied dynamic and intermittently
w To produce a different stimulus than the standard one
(as variant as possible)
w To be applied with high speed an few repetitions because
of the risk of desensitization
w The osteogenic response to the stimulus can be
increased by a program of exercises that has a short intermission
between the stretching sessions
w To be applied during a period of time long enough to
produce a positive effect on the balance of bone density, so
that the results to be relevant (the time of remodeling of bone

35

II. COMUNICRI
unit is about 4-6 months, and so, any treatment with the goal of
preventing bone loss must be 2-3 times longer)
All these aspects represent indispensable premises in the
study of a program of exercises effective in the postmenopausal
osteoporosis.

C 13
EVALUAREA MERSULUI N OSTEOARTRIT
Mihai Drgoi

, Cristian Milicin 1 ,2 , Oana Bereteu 2 , Mariana

Brzu 3 , Rzvan Drgoi 1
1 Universitatea de Medicin i .armacie V. Babe Timioara,
2 Spitalul Clinic Municipal Timioara, Clinica de Recuperare
3 Universitatea de Vest
Medical i Balneofizioterapie,
Timioara .acultatea de educaie fizic i sport
1,2

Introducere
Osteoartrita este o clas de afeciuni cronice cu inciden
crescnd dat de mbtrnirea populaiei. Majoritatea medicilor
caut s reduc durerile articulare din osteoartrit prin tratament
farmacologic i, n mai mic msur, prin tratament recuperator.
Un program de exerciii pentru pacientul cu osteoartrit se stabilete individualizat, n funcie de deficitul mioartrokinetic.
Metodele de evaluare i explorare n kinetoterapie au rolul de a
determina valoarea unui deficit/infirmitate/handicap iniial i evoluia acestuia sub tratament.
Obiectiv
Evaluarea cinematic-dinamic a mersului la pacienii cu
osteoartrit n scopul stabilirii unui tratament recuperator ct
mai individualizat.
Material i metod
Studiul s-a efectuat pe dou loturi de pacieni cu
osteoartrit, totaliznd un numr de 40, cu vrste cuprinse ntre
45 i 75 de ani. Lotul 1 a fost reprezentat de 20 de pacieni
avnd gonartroz, iar lotul 2 de acelai numr de pacieni cu
patologie de coxartroz. S-a efectuat evaluarea somatometric:
dimensiuni longitudinale, diametre transversale, dimensiuni ale
masei somatice. S-a evaluat tonusul muscular prin
miotonometrie. Evaluarea mersului s-a efectuat prin metoda
computerizat cu dou camere conectate la calculator care ne
ofer imaginea micrii din 2 unghiuri, metoda fiind superioar
evalurilor clasice ale mersului (scala Tinetti .a.).
Rezultate i concluzii
Constatm c evaluarea cinematic-dinamic prezint
avantajul studiului n dinamic a mersului fa de evalurile globale care evalueaz diferite momente ale dinamicii micrii ceea
ce permite iniierea i urmrirea unui program strict individualizat
de recuperare a diferitelor momente ale mersului.
THE EVALUATION O. HUMAN WALK IN
OSTEOARTHRITIS
Mihai Drgoi

, Cristian Milicin 1 ,2 , Oana Bereteu 2 , Mariana

Brzu 3 , Rzvan Gabriel Drgoi 1
1 V. Babe University of Medicine and Pharmacy Timioara,
2 Clinic Municipal Clinic Hospital Timioara, Clinic of
3 Vest
Balneophysiotherapy and Medical Rheabilitation,
University of Timioara Departament of Phizical education
1,2

Introduction
Ostheoarthritis is a class of chronical affections with a
highly risk in eldery population. The majority of doctors seek to
reduce the articular pain in ostheoarhritis by pharmacological
treatment and in a less measure by recuperational treatment.
An individualized program of exercises for the patient with
ostheoarthritis is being determined in function of the
mioarthrokinetik deficit. The metods of evaluation and exploration
in kinetotherapy have the goal to determine the value of an initial
deficit/infirmity/handicap and it s evolution under treatment.
Objective
The cinematic-dinamic evaluation of walking in patiens with

osteoarthritis in the purpose of deciding an individualized

recuparatory treatment.
Material and method
The study has been taken on two groups of 40 patients
with osteoarthritis, with ages between 45 and 75 years old. Group
1 has been reprezentated by 20 patients with gonarthrosis and
group 2 by the same number of patients with coxarthrosis. A
somathometric evaluation has been taken:longitudinal
dimensions, transversal diameters, somatic mass dimensions.
The muscular tonus has been taken by miotonomethry. The
evaluation of walk has been taken by computerized method with
two cameras connected to the computer witch offer us the image
of movemet in two different angles, the method is superior to
the classical evaluation of walking (the Tinetti scale etc.).
Results and conclusions
We took notice that the cinematic-dinamic evaluation
presents the avantage of the dinamic study of walking in stead
of the global evaluation wich evaluates different momets of the
movemet dinamics wich permits the initiation and following of a
strict individualized recuparatory program of the different
moments of walking.

C 14
VALOAREA BLOCURILOR ANESTEZICE DE NERV
SCIATIC N RECUPERAREA PACIENILOR SPASTICI
Luminia Dumitru, Mihai Berteanu, Alina Iliescu, Ruxandra
Badea, Gina Comnescu
Clinica de Recuperare Medical, S.U.U. Elias
Obiective Aprecierea eficacitii blocurilor anestezice
motorii de nerv sciatic la pacienii cu spasticitate important la
nivelul membrului inferior, supui tratamentului fizical-kinetic.
Material i metod S-a efectuat un studiu prospectiv
observaional asupra unui lot de 20 de pacieni cu spasticitate important la nivelul membrului inferior, care prezentau limitare de
mobilitate (deficit de extensie) la nivelul genunchiului. Pacienii au
fost internai n Clinica de Recuperare a S.U.U. Elias n perioada
decembrie 2004 august 2005. Caracteristicile demografice i de
morbiditate ale lotului de pacieni studiat au fost:
vrsta: 25-76 ani
sex: 13 brbai, 7 femei
patologie neurologic generatoare de spasticitate: accident
vascular cerebral (11), scleroz multipl (1), traumatism vertebromedular (5), mielopatii (1), traumatism cranio-cerebral (2).
Au fost exclui pacienii cu modificri degenerative avansate
sau posttraumatice la nivelul genunchiului care prezint limitare
de mobilitate, precum i pacienii in tratament anticoagulant.
S-au efectuat blocuri motorii anestezice (ropivacaina) ale
nervului sciatic, folosind tehnica clasic descris de Labat dup
examinare clinic i detecia nervului cu ajutorul stimulatorului
de nerv periferic. Parametrii urmrii au fost:
- sectorul de mobilitate la nivelul genunchiului prin
goniometrie
- durerea local prin Scala Vizuala Analoga (VAS)
- spasticitate prin Scala Ashworth Modificat
Aprecierea global a rspunsului la tratamentul fizicalkinetic printr-o scal vizual analog 0-5.
Rezultate Spasticitatea i sectorul de mobilitate s-au
ameliorat la 16 pacieni (80%), la care limitarea de mobilitate s-a
datorat exclusiv hipertoniei, acetia neasociind contractura fix;
S-a obinut ameliorarea durerii la 18 pacieni (94%), iar
rspunsul la tratamentul fizical-kinetic specific a fost considerat
ameliorat de 14 pacieni (70%).
Menionm c la nici unul dintre pacieni nu au aprut
complicaii; doi dintre acetia au beneficiat de tratament ulterior
cu toxina botulinic.
Concluzii Blocurile anestezice de nervi periferici constituie o metod diagnostic, prognostic i terapeutic important n managementul disfunctionalitii la pacienii spastici,
facilitnd aplicarea altor proceduri fizical-kinetice.
Cuvinte cheie: bloc anestezic, spasticitate, nerv sciatic

36

II. COMUNICRI
corporale i a plgilor experimentale cu proces infecios
inflamator indus la animalele de laborator supuse aeroionizarii
negative i pozitive de concentraii diferite.
Material i metoda
Studiul experimental a fost efectuat pe un numr de 64
obolani albi, linia Wistar, distribuii n 8 loturi omogene de animale. Pe partea dorsal a animalelor a fost indus un proces infecios
inflamator prin producerea unor plgi ulterior infectate cu cultur
9 /ml.
pur de Staphilococcus aureus n concentraie de 10
Ionizarea aerului, la care au fost expuse animalele, s-a
fcut cu un generator de ioni care a permis obinerea mai multor
concentraiide ioni n aer.
Rezultate i discuii
Din determinarile experimentale care au fost efectuate s-a
observat c sub aciunea ionilor negativi, n concentraie de 15
000 ioni / cm 3 , apar modificri pozitive ale plgii la a 4-a zi dup
expunere. De asemenea, prezint interes aciunea concentraiilor
3 ) asupra
mai mari de ioni negativi i pozitivi (230 000 ioni / cm
organismelor vii, efectele acestora fiind mai complexe.
Concluzii
Ionii negativi exercit, la nivelul suprafeei cutanate
infectate i inflamate, un efect favorabil asupra procesului de
vindecare a plgilor, acesta fiind mai rapid n comparaie cu
efectul similar produs de ionii pozitivi.
Cuvinte cheie: aeroioni, cutanat, infecie, obolani.

THE E..ICACY O. ANESTHETIC SCIATIC NERVE

BLOCKS IN THE REHABILITATION O. SPASTIC
PATIENTS
Luminia Dumitru, Mihai Berteanu, Alina Iliescu, Ruxandra
Badea, Gina Comnescu
Elias Emergency Universitary Hospital
Objectives The efficacy of the anesthetic sciatic nerves
blocks to the patients with important lower limb spasticity.
Material and method Observational prospective study of
a group of 20 patients with important lower limb spasticity and
limited ROM of the knee (extension deficit), in Elias Emergency
Universitary Hospital-Physical Rehabilitation Medicine
Department, september 2004-august 2005. The demographic
and morbidity characteristics of the group were:
age: 25-76 years
sex: 13 men, 7 women
spastic neurological pathology: stroke (11 patients),
multiple sclerosis (1), spinal cord injury (5), traumatic brain injury
(2), myelopathy (1).
We ve excluded the patients presenting advanced
degenerative or traumatic pathology of the ROM-limitated knee
and also those undergoing an anticoagulant treatment.
We ve made anesthesic motor sciatic nerve blocks (with
ropivacaine) using the classic technique described by Labat,
after clinical examination and nerve detection using the nerve
stimulator. The following parameters have been evaluated:
ROM of the knee (goniometry)
local pain (VAS 0-10)
spasticity (AMS)
global response to the standard physical-kinetic
procedures (VAS 0-5)
Results
the spasticity decreased and the ROM improved at 16
patients (80%), to those without associated fixed contracture of
the knee
pain diminished to 18 patients (94%)
global response to the standard physical-kinetic
procedures improved at 14 patients (70%)
Conclusions Periphereal anesthesic nerves blocks are
an important diagnostic, prognostic and therapeutical procedure in the management of the spasticity, facilitating the application
of other physical-kinetic procedures.
Abrevieri AMS: Ashworth Modified Scale, ROM Range
of Motion, VAS Visual Analogue Scale
Key words: anesthetic blocks, spasticity, sciatic nerve.

ASPECTS REGARDING THE ACTION O. THE AEROIONS

ON CUTANEOUS IN.ECTIOUS IN.LAMMATION PROSESS
INDUCED AT LABORATORY ANIMALS

C 15
ASPECTE PRIVIND ACIUNEA AEROIONILOR ASUPRA
PROCESULUI IN.ECTIOS IN.LAMATOR CUTANAT INDUS
LA ANIMALELE DE LABORATOR
L. Enache 1 , 2 , Ileana Georgescu 1 , Iu. Simionca 1 , Gh. Petec
M. Hoteteu 1 , Rodica Rogojan 1 , Simona Botea 3 , C. .ilipescu
Mihaela Mocanu 3 , Georgeta Tarni 3 , Iulia Bunescu 1
1 Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie, Bucureti
2 Universitatea de tiine Agronomice i Medicin Veterinar,
Bucureti
3 Institutul Naional de Cercetare-Dezvoltare n Domeniul
Patologiei i tiinelor Biomedicale Victor Babe , Bucureti,

.actori de mediu, precum ionizarea aerului, pot exercita

influene asupra organismelor vii. O serie de aspectele experimentale
pot fi studiate i atunci cnd acest parametru aeroelectric poate fi
amplificat prin intermediul unui generator artificial.
Obiective
Lucrarea ncearc s prezinte evoluia n timp a masei

,
3

Environmental factors, as air ionization, can exert

influences on living organisms. Some experimental aspects can
be studied even when this aeroelectric parameter can be
amplified by an artificial generator.
Objectives
The work tries to present the time evolution of the corporal
mass and of the experimental wounds with cutaneous infectious
inflammation process induced at the labaratory animals exposed
to negative and positive aeroionization with different concentrations.
Materials and method
The experimental study was carried out on a 64 white rats,
Wistar line, distributed in 8 lots of homogenous animals. On the
dorsal part of the animals was induced an infectious inflammatory
process by producing of some wounds ulterior infected with a pure
9 /ml.
culture of Staphilococcus aureus with a concentration of 10
The air ionization, at which the animals were exposed,
was made with an ion generator that has permited to obtain
many ion concentrations in the air.
Results and discussions
.rom experimental determinations which were effectuated
was observed that, under negative ions action, with a
3 , apear positive modifications
concentration of 15 000 ions / cm
of the wounds after the 4th exposure day. It presents interest,
also, the action of bigger positive and negative ions
3 ) on living organisms, their
concentrations (230 000 ioni / cm
effects being more complex.
Conclusions
Negative ions exert, at the level of the infected and
inflammated cutaneous surface, an favorable effect on cure
process of the wounds, this being more rapidly in comparison
with the similar effect generated by positive ions.
Key words: aeroions, cutaneous, infection, rats.

C 16
REEVALUAREA CONTRAINDICAIILOR REACIILOR
ADVERSE I RISCURILOR N TRATAMENTUL .IZICALKINETIC ASPECT IMPORANT I DE ACTUALITATE N
MBUNTIREA ACTULUI MEDICAL
Mihaela .iru,Gilda Mologhianu, Andreia Murgu,
Adriana Drgan*
INRM.B
*Sanatoriul Techirghiol

37

II. COMUNICRI
Obiective
Prezenta lucrare are ca scop reevaluarea contraindicaiilor
generale i specifice ale diverselor mijloace de terapie fizicalkinetice, precum i a riscurilor i accidentelor ce pot surveni n
timpul acestor terapii.
Necesitatea abordrii unui astfel de subiect a aprut ca
urmare a redimensionrii relaiei medic-pacient n condiiile socio-economice actuale.
Material i metod
Pentru a realiza aceast lucrare am consultat bibliografii
consacrate, mai vechi i mai noi, dar am folosit i experiena
profesional a colectivului nostru.
Concluzii
1. Responsabilitatea pentru evaluarea corect, stabilirea contraindicaiilor i prescripia adecvat a tratamentului
aparine medicului.
2. Reaciile adverse, riscurile de accidente sunt ns
impredictibile, de aceea este important informarea pacientului
asupra posibilitii producerii acestora (la fel ca i n cazul
tratamentelor medicamentoase sau a altor proceduri sau
manevre terapeutice).
3. Un aspect important este educarea i pregtirea
restului echipei asistent fizioterapeut, maseur, kinetoterapeut
n sensul:
respectrii cu strictee a indicaiilor terapeutice ale medicului
informrii prompte a medicului asupra incidentelor
aprute n cursul tratamentului
4. Este necesar elaborarea Ghidurilor de diagnostic
i tratament, precum i standardizarea tratamentului. Dei
algoritmurile terapeutice ucid elementul de art al actului
medical, experiena internaional a colegilor din alte specialiti
dovedete utilitatea practic a acestora n evitarea neplcerilor
legale ale malpraxisului medical.
A REASSEMENT O. CONTRAINDICATION, ADVERSE
REACTIONS AND RISKS IN THE PHYSICAL-KINETIC
TREATMENT AN IMPORTANT AND ACTUAL ISSSUE IN
IMPROVING MEDICAL CARE
The goal of the present article is the reassesment of general and specific conraindication of he various methods of
physical and kinetical therapy as well as the reconsidering of
the risks and possible accidents that can occur during these
therapies.
The necessity of considering such a subject emerged as
a result of the latest developments in the physician-patient
relationship in the actual socio- economic context.
In order to elaborate this article, we used older and newer
pieces of well known bibliography as well as the shared
professional experiences of our colleagues.
Conclusions
1. The responsability of a corect medical assesment of
the patient, and evaluation of contraindication and the
therapeutical prescriptions belongs to the physician.
2. The adverse reactions and accident risks are
impredictible as a result, the patient must be aware of these
aspects before stoing the treatment.
3. An important issue is training the rest of the
rehabilitation team:
rigurous following the medical prescription
if incidents happen, they must inform the physician about
them so proper measures can be taken.
4. It is necessary that Guides of diagnosis and treatment
are elaborated; although therapeutical algoritms kill the Art of
Medicine practice they have proven their practical utility in
keeping the Medical care givers as far as possible from the
legal problems of medical malpraxis issues.

C 17
STUDIUL OBOSELII MUSCULARE LA BOLNAVII CU
POLIARTRIT REUMATOID CU AJUTORUL EMG DE
SUPRA.A

2 Petre Badea
Mihaela .lorea 1 , .lorin-Marius Romanescu
Clinica de Medicin .izic i Recuperare Medical, Spitalul
Clinic Universitar de Urgen Craiova,
2 Universitatea de Medicin i .armacie, Craiova

Obiectiv
Prin caracterul distructiv al leziunilor caracteristice i prin
caracterul cronic al evoluiei sale, poliartrita reumatoid
genereaz semnificative deteriorri funcionale, cu impact sever
asupra calitii vieii bolnavilor. Elementul muscular (exprimat
clinic prin mialgii, astenie muscular sau amiotrofii) contribuie
substanial la realizarea invaliditilor de diferite grade. Lucrarea
i propune studiul oboselii musculare (definit ca inabilitatea
de a menine fora muscular ) la bolnavi cu poliartrit
reumatoid, ca argument pentru abordarea mai consecvent a
recuperrii musculare n cadrul programului recuperator complex al acestor pacieni.
Material i metod
Am examinat un numr de 15 bolnavi cu poliartrit
reumatoid (diagnosticat conform criteriilor ACR) internai n
Clinica de Medicin .izic i Recuperare Medical i n Clinica
de Reumatologie a Spitalului Clinic Universitar de Urgene
Craiova, n perioada 2004-2005. Bolnavii aveau vrste cuprinse
ntre 29 i 73 ani, iar distribuia pe stadii de boal a fost urmtoarea: stadiul I 1 bolnav; stadiul II 7 bolnavi; stadiul III 6
bolnavi; stadiul IV 1 bolnav. La toi subiecii a fost efectuat
nregistrarea EMG de suprafa concomitent cu nregistrarea
mecanogramei n timpul unei contracii izometrice maximale
susinut pn la epuizare, la nivelul flexorilor degetelor, att la
membrul superior dominant, ct i la cel non-dominant.
Rezultate
Programul dedicat analizei EMG, elaborat i aplicat de
Catedra de .iziologie .acultii de Medicin din Craiova, a
permis analiza unor parametri de timp i de frecven, pentru
care s-au calculat dreptele de regresie, iar pentru dreptele de
regresie ale fiecrui parametru s-au extras valorile interceptului
i pantei (slope). S-a procedat la compararea datelor obinute
cu valorile parametrilor determinai pentru lotul martor compus
din persoane sntoase neantrenate cu distribuie pe grupe de
vrst comparabil cu a bolnavilor cu poliartrit reumatoid
cuprini n studiu.
Concluzii
Parametrii studiai au permis evidenierea unor aspecte
interesante legate de precocitatea i importana afectrii
musculare n poliartrita reumatoid, ceea ce poate atrage atenia asupra necesitii instituirii programului recuperator n paralel
cu terapia medicamentoas, amplu dezvoltat n ultimii ani.
Propunem EMG de suprafa ca metod de evaluare i
monitorizare a deficitului funcional n poliartrita reumatoid.
STUDY O. MUSCULAR .ATIGABILITY IN PATIENTS WITH
RHEUMATOID ARTHRITIS USING SUR.ACE
ELECTROMYOGRAPHY
Aim
The distructive features of the characteristic lesions and
the cronic evolution of rheumatoid arthritis are able to determine
significant functional disabilities with important impact on
patients quality of life. The involvement of skeletal muscle
(clinicaly expressed as muscle pain, muscle asthenia or muscle
atrophy) has an important contribution to the achievement of
different degrees of invalidity. Throughout this study we intended
to examine the muscular fatigue (defined as inability to maintain
the muscular strenght ) in patients with rheumatoid arthritis, in
order to obtain an argument for the appropriate approach of the

38

II. COMUNICRI
muscular rehabilitation as part of the complex rehabilitation
program of these patients.
Material and methods
We have examined 15 patients with rheumatoid arthritis
(confirmed according to ACR criteria) that was hospitalised in
the Clinic of Physical Medicine and Medical Rehabilitation and
in the Rheumatology Clinic of the University Hospital of Craiova
during 2004 and 2005. The patients was between 29 and 73
years old and the distribution according to the illness stage was
the following: stage I 1 case; stage II 7 cases; stage III 6
cases; stage IV 1 case. In all patients we proceed to the surface
EMG examination as well as to the mecanoghram registration
during an isometric contraction (prolonged until exhaustion) of the
fingers flexors both in dominant and non-dominant upper-limb.
Results
The computed program dedicated to EMG analyse,
created and applied by the Physiology Department of the Medical
University in Craiova, offered us the opportunity to examine some
significant parameters of time and frequency for which we have
determined the regression curve s values for intercept and slope.
We have also compared these results with the values of the
same parameters determined for a number of healthy untrained
people that were of similar ages as the patients with rheumatoid
arthritis we included in our study.
Conclusions
The parameters we studied allowed us to notice interesting
aspects about the precocity and the significance of the muscular
involvement in the rheumatoid arthritis, so that we concluded about
the necesity of an early rehabilitation program that must
accompany the drug therapy, so much developed during the last
years. We suggest that surface EMG could be an efficient method
of evaluation of the functional damage in rheumatoid arthritis.

especially at a big carbon number. The different wavelength of

the Ar+ laser light produced a different answer of the samples.
Data processing, simulations and characterization of the external
incident and emergent signals from the samples were performed
with computer help.

C 19
IN.LUENCE O. WORK CONDITIONS ON SOME
SUBSTANCES .ROM THE BIOLOGICAL MEMBRANE
Mihaela Ghelmez (Dumitru) 1 , Cristian Toma 1 , Andreea Rodica
Sterian 1 , Bogdan Dumitru 2
Mihai Berteanu 3
1 Politehnica University of Bucharest, Physics Department,
2 SC Kvaerner IMGB SA, Bucharest
3 Clinical Hospital Elias , Bucharest

C 18
LASER WAVELENGTH ACTION ON SOME
UNSATURATED .ATTY ACIDS
Mihaela Ghelmez (Dumitru) 1 , P.E. Sterian 1 , R.I. Trascu
Elena Slavnicu 1 , C.V.Georgescu 3
1 Politehnica University of Bucharest, Physics Department
2 Clinical Hospital Caritas , Bucharest
3 Clinical Hospital Giurgiu
In this paper, we present experimental and computer
studies of systems of fatty acids and mixtures of fatty acids and
different substances, with a mesomorphic behaviour, useful for
modeling a simple biological membrane. Many works proved
that, in some conditions, the biological membrane turns in a
cooperative manner from a close-packed , gel-type structure,
to a liquid crystal phase, responsible for many membrane
mechanisms.
Typical sandwich cells containing thin films of unsaturated
fatty acids, components or forerunners of the biological membrane: elaidic acid (18:1), linolenic acid (18:3); arachidonic acid
(20:4), (5,8,11,14) were built in our laboratory and showed
different liquid crystal textures during their evolution between
some temperature values, characteristic for every of them. The
electric conduction and molecular arrangement of these systems
depend on their chemical composition and present memory
effects and other modifications under some stimuli from the
environment, like electric and magnetic fields, temperature,
optical integral and coherent light, thermal neutron irradiation
etc. As a result of this last treatment, an essential change in the
texture and electric state was observed. Relatively low
undistructive laser powers are useful for emphasizing the
changes of the structure and properties of the irradiated samples,
by their nonlinear interaction with these substances, easy to
obtain in the liquid crystal state.
By analyzing the experimental results, one can state that
almost all the samples present a nonlinear optical dependence
of the output versus input laser power, and an optical hysteresis,
which evidenced the changes occurred in irradiated samples,

The biological membrane structure and functions are not

enough known and continuously studied. The role of the
mesomorphic state of this system was established for a long
time. As it is known, the fatty acids play an important role in
membrane, and this is the reason we realized simple systems
of fatty acids and mixtures with cholesterol, and studied their
behavior while in the liquid crystal state. Nonlinear dielectric
and optic properties were emphasized.
In this paper, we present the influence of the working
conditions (vibrations, random fluctuations etc) on our samples
answer to different physical perturbations. Experimental results
and computer processing concerning laser signal interaction with
highly nonlinear optical samples are presented.
These measurements are in all cases affected by
fluctuations. Theoretically, the optical signal received by the
photodetector generates an electronic signal. By integrating this
electronic signal over a certain time interval, we obtain the mean
value of the received signal, the influence of fluctuations being
also decreased in a significant manner. Yet such a signal
processing structure is very sensitive at random variations of
the integration period (generated by the switching phenomena
at the end of the integration), and so a multiplication of the
received signal with a test-function is recommended. In this paper
we presented some invariance properties of differential
equations, which can be used for generating a practical testfunction on this time interval.
Numerical simulations were using Runge-Kutta equations
of order 4-5 in MATLAB. TableCurve 3D program was used to fit
the experimental dependencies of the output signals on different
input physical amounts. A good agreement between the
experiment and computer results was found. We must also take
care to the fact that the spatial distribution of the laser beam is
represented by a Gaussian function multiplied by Hermite
functions corresponding to the mode TEM
. This equation has
03
been also simulated in MATLAB, and the results have shown
that vibrations drastically affect the shape of function f.

C 20
ACTUALITI N MODELAREA STRUCTURILOR
BIOLOGICE
Ilona Ilinca
Universitatea din Craiova, .acultatea de Educaie .izica si
Sport
Modelarea computaional n medicin a aprut ca o tehnic non invaziv bazat pe folosirea modelelor biomecanice.
La baza acestei tehnici st o reproducere schematic a unui
sistem complex, sub forma unui sistem similar sau analog
simplificat, efectuat n scopul studierii comportamentului sistemului originar n anumite condiii i n cazul modificrilor acestora. .recvent, sistemul iniial este modelat pornind de la o
unitate de baz repetitiv. Prin model biomecanic se nelege

II. COMUNICRI
un sistem ce reprezint cuantumul proprietilor reprezentative
ale unui sistem mai complex cu care prezint analogii structurale
sau funcionale, realizat n vederea simplificrii studierii acestuia. Acest model este construit pe baza unor seciuni anatomice
prin structurile respective i poate fi supus unor ncrcri diverse pe calculator cu urmrirea modificrilor structurale ce apar.
Se realizeaz astfel un experiment numeric modalitate
asemntoare experimentului de laborator n care se pornete
de la un model numeric, cruia i se impun diferite condiii iniiale
i de limit, obinndu-se variaii ale parametrilor investigai. n
esen, experimentul numeric ncearc s modeleze evoluia
unui proces fizic, pornind att de la sistemul material studiat,
ct i de la modelul sau analitic, transfigurat ntr-o form
accesibil implementrii pe calculator. Impunnd apoi diferite
condiii iniiale i de limit modelului numeric, se obin variaii
ale parametrilor investigai, aa cum s-ar obine serii de date
experimentale n laborator, cu observaia c modelarea
numeric permite cercetarea unor fenomene greu de reprodus
la nivel de laborator.
ACTUALITIES IN MODELLING BIOLOGICAL
STRUCTURES
Ilona Ilinca
University of Craiova, .aculty of Physical Education and
Sports
Computational modeling in medicine was developed as
a non-invasive technique based on the use of biomechanical
models. At the basis of this technique lays a schematic
representation of a complex system, in a simplified or
analogue form, realized with the purpose of studying the
behavior of initial system in imposed conditions and changing
conditions. Often the initial system is modeled starting from
a basic repeatable unit. By biomechanical model is
understood a system that represents the quantum of specific
properties of a more complex system with which it presents
structural or functional analogies. The model is created by
anatomical sections through specific structures and can be
submitted to different computer loads or stresses with
visualization of structural alterations that might appear. In this
way is realized an numeric experiment an approach close
to a laboratory experiment but in which we start from a
numerical model imposed with different initial and limit
conditions, with variations for the observed parameters. In
essence the numeric experiment tries to modelate the
evolution of a physical process, starting both from the material
studied system and from its analytical model, transformed in
a form accessible to computer implementation. Imposing
different initial and limitative conditions we can obtain
variables of investigated parameters, similar to data series
in laboratory, with the observation that numerical modeling
permits research of phenomena difficult to reproduce on
laboratory level.

C 21
STRUCTURA COMUNITILOR MICROALGALE DIN
LACURI TERAPEUTICE CU SALINITI DI.ERITE DIN
ROMNIA
Drd. biol. Liana Ionescu, drd. cercet. st III Mdlina Ciocan
Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie, Bucureti
Lacurile cu ape mineralizate din Romnia reprezint valoroi
factori naturali de tratament; din aceast categorie, importana
terapeutic cea mai mare revine, incontestabil, lacurilor cu ap
srat (cu un coninut n sruri minerale > 1 g l -1 ), n care se formeaz
depozite nsemnate de nmol (peloid) terapeutic.
Lacurile i bazinele srate din Romnia prezint o mare

variabilitate a gradului de mineralizare i, implicit, a structurii

comunitilor algale prezente aici, astfel:
n Lacu Srat Brila, care face parte din categoria
-1 (111,05 g l
- 1 n
lacurilor srate, avnd o mineralizare > 100 g l
2004), diversitatea specifica a comunitilor algale este redus.
Dominante n fitoplancton sunt elementele halofile alge
albastre-verzi, alge verzi, diatomee n concordan cu valorile
nregistrate ale salinitii apei; structura biocenozei se va regsi
n caracterul nmolului de slic mineralizat, cu substane organice.
Bazna, jud. Sibiu dispune, ca factori de tratament, de
mai multe izvoare srate-iodurate-bromurate ce sunt colectate
n patru bazine, pe fundul crora se produce un nmol cu
caracter de slic, dar cu coninut mai bogat n substane organice.
Aceast caracteristic a nmolului este determinat de creterea diversitii specifice a biocenozei, n general, i a
comunitilor algale, n special; astfel, fitoplanctonul este dominat
de specii eutrofe i cele care prefer un pH circumneutru sau
uor alcalin: Oscillatoria planctonica, Euglena viridis, Navicula
cryptocephala, Nitzschia hungarica.
Rodbav, jud. Braov are izvoare cu ape minerale
clorurosodice, iodurate, bromurate ce se regsesc n cele dou
-1 (2003)
bazine, cu ap a crei mineralizare variaz ntre 11,9 g l
i 14,34 g l -1 (2004). Apa de tip salmastru permite existena unui
numr mare de alge cosmopolite, larg rspndite n diverse
ecosisteme acvatice: specii ale genurilor Pinnularia, Navicula,
Gyrosigma, Suriella.
Cuvinte cheie: microalge, halofile, plancton, mineralizare,
peloid, terapeutic.
MICROALGAE COMMUNITY STRUCTURE IN
THERAPEUTICALLY LAKES WITH VARIABLE SALINITY
.ROM ROMANIA
Drd. biol. Liana Ionescu, drd. cercet. st III Madalina Ciocan
National Institute of Rehabilitation, Physical Medicine and
Balneoclimatology, Bucharest
The lakes with mineralized water from Romania represent
important natural treatment factors; from this category, the highest
therapeutically importance belongs incontestably to the lakes
- 1 ), in
with salted water (with a high content in mineral salts> 1g l
which they form large quantities of therapeutically peloid.
The lakes and the salted reservoirs from Romania present
a large variability of the mineralization grade and implicitly of the
microalgae community structure presented here; for example:
in Salted Lake Spa, Braila, which belongs to the salted
-1 (111,05
lakes category, with a mineralization higher than 100g l
g l-1 in 2004), the specific diversity of the algae communities is
reduced. Dominating in the phytoplankton are the halophilic
elements (blue-green algae, green algae, diatoms) according
to recorded values of the water salinity; the structure of the
biocenosis will be found in the character of the peloid of
mineralized slic, with organic substance;
Bazna Spa, jud. Sibiu disposes as treatment factor of
many salted springs, iodized and bromine, which are collected
in four reservoirs, at bottom of which a peloid is produced which
has a slic character, but with a higher content of organic
substance. This characteristic of the peloid is determined by
the boom of the specific diversity of the biocenosis and implicitly
of the algae communities; in this way the phytoplankton is
dominated by eutrophic species and the ones that prefer a
neutral or easily alkaline pH: Oscillatoria planctonica, Euglena
viridis, Navicula cryptocephala, Nitzschia hungarica.
Rodbav Spa, jud. Brasov contains springs with iodized,
bromine, chlorosodium mineral waters which are collected in
the two reservoirs with water that has a mineralization that varies
between 11,9 g l -1 (2003) and 14,34 g l - 1 (2004). The salmastre
water allows the existence of a large number of cosmopolite algae
which are widespread in diverse aquatic ecosystems: species of
the Pinnularia, Navicula, Gyrosigma, Suriella genera.
Key words: microalgae, halophiles, phytoplankton,
mineralisation, peloids, therapeutic

39

40

II. COMUNICRI
C 22
AQUAPLANT-LINE PRODUSE DE UZ BALNEAR
Dr. ing. cercet. st. 1 Elena Ionescu; Ing. cercet. st. 3
Lcrmioara Perta; Dr. ing. cercet. st. 1 Carmen-Elena
Tebrencu; medic, cercet. st. Vlad Ionescu
S.C. Centrul de Cercetare i Prelucrare Plante medicinale
Plantavorel S.A., str. Cuza Vod nr. 46-610019, Piatra
Neam, tel/fax: 0233.210.308; www.plantavorel.ro
Lucrarea i propune s aduc n atenia specialitilor rezultatele cercetrii tiinifice i aplicative a specialitilor din cadrul
PLANTAVOREL Piatra Neam n elaborarea unor preparate de
uz balnear din plante medicinale si aromatice. Aceste produse
urmresc obinerea unui efect sistemic, care s conduc la
ameliorarea unor afeciuni cronice i la tonifierea general a
organismului. Elaborarea fiecrui preparat a avut n vedere
asocierea unui fitocomplex activ, cu eficacitate selectiv pentru
afeciunea avut n vedere, cu un agent de potenare ulei
volatil. Eficacitatea fitocomplexului are la baz sinergismul de
aciune a principiilor active care l compun, agentul de potenare
intervenind prin cumularea aciunii sale specifice, ct i prin
favorizarea penetraiei prin piele a principiilor active.
AQUAPLANT-line se adreseaz terapiei adjuvante a
bolilor reumatismale (ALGIN), n tulburrile nervoase senzoriale
i cerebrale (SEDIN), n afeciuni ale aparatului genital i strile
specifice menopauzei (.EMINA), n prevenirea tulburrilor
circulatorii (VENOL), n reducerea factorilor iritativi de la nivelul
tractului urinar inferior i remineralizarea organismului (RENAL).

C 23
RECUPERARE, SPIRITUALITATE, CREDIN
Dr. L. Irsay, Dr. L. Pop, Dr. Monica Pop, Dr. Rodica Ungur,
Dr. I. Onac,
U.M... Iuliu Haieganu , Spitalul Clinic de Recuperare, Cluj
Existena uman este strns legat de existena
spiritualitii.
Rolul spiritualitii i al rugciunii n recuperare sunt
domenii prea puin studiate. Pe de o parte sunt noiuni puin
palpabile, pe de alt parte se pune problema dac din punct de
vedere etic medicul poate aborda aceste teme n cursul
consultaiei. Dificultatea cuantificrii acestor aspecte,
heterogenitatea bolnavilor n ceea ce privete apartenena
spiritual, gsirea unui lot martor sunt doar cteva dintre problemele care se ridic n cursul unui studiu pe aceast tem.
Un studiu efectuat de autori arat c 48,78% dintre pacieni
doresc ca personalul medical s se roage mpreun cu ei, un
procent foarte ridicat (50%) consider credina ca pe o for
vindectoare. Acestea sunt doar cteva date care arat c
spiritualitatea, credina pacientului pot fi surse de energie interioar care pot influena benefic demersul recuperrii.

C 24
ROLUL KINETOTERAPIEI N MANAGEMENTUL
SINDROMULUI METABOLIC
Mihaela Macovei-Moraru 1 ,Luminia Marinescu
1 UM. Craiova,
2 .E.S,Universitatea Craiova

Obiectiv
Sindromul metabolic tinde s devin o problem de
sntate public i n Romnia, date recente enunnd o
prevalen a acestuia de 41% din populaia rii(20-60 ani).
n studiul efectuat am urmrit influena kinetoterapiei ca
i component de baz a schimbrii stilului de via asupra
parametrilor considerai criterii de diagnostic de ctre NCEP-

ATPIII (circumferina taliei, valoarea TA, glicemia, trigliceridemia,

nivelul HDL-C).
Material i metod
Studiul a inclus 36 pacieni (22 femei, 14 brbai), cu vrste
cuprinse ntre 40-67 ani, diagnosticai cu sindrom metabolic
conform criteriilor NCEP-ATPIII. n perioada noiembrie 2004
iunie 2005, subiecii au fost evaluai clinic, paraclinic i funcional,
fiind grupai n dou loturi a cte 18 pacieni.
Programul de recuperare (educaional, igieno-dietetic,
medicamentos) a inclus pentru un singur lot i kinetoterapie
(exerciiu aerobic, antrenament de rezisten, cicloergometru,
antrenament de relaxare autogen). Evaluarea pacienilor s-a
fcut iniial (t1), la 4 sptmni (t2) i la 12 sptmni (t3).
Prelucrarea rezultatelor a fost analizat statistic, realiznd diverse corelaii cu ajutorul testului ANOVA.
Rezultate
Schimbarea stilului de via (diet, ntreruperea fumatului,
combaterea stresului) a avut o influen favorabil asupra ambelor loturi, dar rezultate semnificative statistic (p<0.05) s-au
obinut n cadrul lotului ce a beneficiat de exerciiu fizic
standardizat. A sczut rezistena la insulin, glicemia,
circumferina taliei la 78% din pacieni, hipertrigliceridemia s-a
diminuat la 80% din pacieni, TA a sczut sub 130/80 mm Hg la
88,8% din pacieni i HDL-C a crescut la 63,8% din pacieni.
Concluzii
Kinetoterapia corect prescris i nsuit de pacienii cu
sindrom metabolic, practicat consecvent, de minim 3 ori pe
sptmn, reprezint o component obligatorie a programului
recuperator, o constant a stilului de via pe care pacienii trebuie s i-l nsueasc, cu implicaii benefice pe termen lung
prin scderea riscului cardiovascular.
Cuvinte cheie: kinetoterapie, sindrom metabolic, schimbarea stilului de via.
THE ROLE O. KINETOTHERAPY IN THE MANAGEMENT
O. THE METABOLIC SYNDROME
Mihaela Macovei-Moraru 1 , Luminia Marinescu
1 UM. Craiova,
2 .E.S, University of Craiova

Objectives
The metabolic syndrome became a matter of public health
in Romania too, last data showing a 55% prevalence (between
20 and 60 years). We studied the influences of kinetotherapy
as a basic step in therapeutic lifestyle changing over the
parameters which are the diagnosis criteria (NCEP-ATP III), such
as abdominal perimeter, blood pressure, glycemia, serum
triglycerides and HDL-C.
Material and methods
The study has included 36 patients (22 women, 14 men)
aged between 40 and 67 years, which are diagnosed with
metabolic syndrome. During November 2004-june 2005 the
patients were evaluated from clinical, functional and para clinical
point of view and were separated in 2 groups with 18 patients
each of them. The rehabilitation program (educational, hygienodietethical, pharmacological) was applied daily in 12 sessions
initially and then three times a week. .or one of the groups the
program has included kinetotherapy (aerobic exercises,
endurances training, cycloergometer). The patients were
evaluated in 3 steps: t1 in the beginning, t2 after 4 weeks, t3
after 12 weeks. Statistical analysis and correlation between
data were performed with ANOVA test.
Results
Therapeutic lifestyle changing (diet, stop smocking,
avoiding the stress) had a good influence over the patients from
the both groups, but statistically significant results (p<0.05) had
the group who benefited of specific kinetotherapy. The results
were represented by the decrease of: insulin resistance,
abdominal perimeter, blood glucose level to 78% of patients,
triglicerides blood level to 80% of patients, blood pressure to
88% of patients and growth of HDL-C to 63,8%.

41

II. COMUNICRI
Conclusions
The programs of kinetotherapy which are correctly
prescribed and performed by the patients with metabolic
syndrome three days a week are useful in the management of
metabolic syndrome, determining the decrease of the
cardiovascular risk and the growth of life hope.
Key words : kinetotherapy, metabolic syndrome, lifestyle
change

C 25
ROLUL RECUPERRII MEDICALE NTR-UN CAZ DE
SINDROM ANTI.OS.OLIPIDIC PRIMAR CU
DETERMINRI PRIMAR CEREBRALE - TETRAPAREZ
ATAXIC POSTATAC ISCHEMIC VERTEBROBAZILAR
Dr. Mologhianu Gilda, Dr. Brilescu Consuela, KT Ivacu
Marius
Clinica Universitar III Recuperare Medical INRM.
Bucureti
Sindromul antifosfolipidic este unul din cele mai frecvente
afeciuni autoimune din lume, caracterizat prin asocierea trombozelor
multiple la orice nivel vascular (att arterial, ct i venos), a avorturilor
spontane recurente i prezena anticorpilor antifosfolipidici (tip
anticardiolipin , anticoagulantul lupic, anti beta2 glicoproteina I) .
Poate evolua cu manifestri clinice i paraclinice ca boal
unic (sd. primar) sau asociat unor boli autoimune sau condiii
patologice (sd. secundar).
Prezentm cazul unui pacient de 26 ani, diagnosticat n urm
cu 9 luni cu sindrom antifosfolipidic primar cu determinri primar
cerebrale, aflat n evidena Clinicii Universitare Recuperare III de
aproximativ 7 luni. Pacientul prezenta la internarea iniial
tetraparez ataxic cu spasticitate sever (predominent hemicorp
drept), cu afectarea sever a capacitii de mers (dificil, cu sprijin
bilateral i cu supraveghere atent), a capacitii de autongrijire
(necesita asisten permanent) i de comunicare (afazie motorie).
A fost iniiat i continuat permanent un program complex
de recuperare medical, medicamentos i fizical-kinetic, avnd
ca obiective finale: prezervarea funciilor vitale; ameliorarea
deficitului funcional n vederea relurii mersului ct mai fiziologic
posibil i a capacitii de utilizare a membrelor superioare la
activitile uzuale zilnice); prevenirea recurenelor datorate bolii
de baz i a complicaiilor induse de tratamentul continuu
(anticoagulant, cortizonic, antispastic central); creterea
capacitilor de comunicare i reinserie socio-profesional.
Intensitatea i complexitatea programului de recuperare
au fost permanent ajustate n funcie de rezultatul reevalurii
funcionale lunare a pacientului .
Concluzie
Dup 7 luni de tratament complex de recuperare medical,
pacientul i-a mbuntit semnificativ statusul funcional, capacitatea de locomoie, de autongrijire, de comunicare, cu
creterea calitii vieii i a posibilitilor de reintegrare sociofamilial.
Cuvinte cheie: sd. antifosfolipidic, atac ischemic vertebrobazilar, recuperare medical.
THE ROLE O. REHABILITATION MEDICINE IN AN
ANTIPHOS.OLIPID SYNDROM CASE WITH
VERTEBROBASILAR ISCHEMIC STROKE
Dr. Mologhianu Gilda, Dr. Brilescu Consuela, KT Ivacu
Marius
Clinica Universitar III Recuperare Medical INRM.
Bucureti
Antiphosfolipid syndrome is one of the most frequent
autoimmune diseases, characterised by the association of multiple venous or arterial thrombosis, spontan abortions and the
presence of specific antiphosfolipid antibodies.
It may evoluate as an unique disease (primary syndrome)

or associated with other autoimmune or pathological situations

(secondary syndrome).
We present a 26 years-old male patient case, who was
diagnosed with antiphosfolipidic syndrome 9 months ago, after
an ataxic tetraparesis caused by an ischemic vertebrobasilar
stroke.
The pacient has been treated in our clinic for 7 months;
the rehabilitation program has been very complex (drugs and
physio-kinetic therapy) and adjusted by the monthly functional
reevaluation.
The objectives of the recovery treatment were: vital function
preservation; functional improvement for lower extremities (gait)
and for upper extremities (ADL performance); prevention of
disease or treatment possiple complications; improving
communication and socio-professional reintegration.
Conclusions
After 7 months of recovery, the improvement of quality of
life, self-care possibilities, gate control, ADL performing and
communication were significant.
Key-words: antiphosfolipid syndrome, vertebrobasilar
ischemic stroke, medical recovery.

C 26
POTENIALUL TERAPEUTIC AL APELOR MINERALE
LITINI.ERE MARIA DE LA MALNA-BI
Constantin Munteanu 1 , Diana Munteanu 1 , Gabriela
Zamfirescu 1 , Otilia Zrnescu 2
1 Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie
2 Universitatea din Bucureti, .acultatea de Biologie
Litiul exist n esuturile biologice, n alimente i n apa
potabil. Apele naturale conin concentraii mari de sruri de
litiu i de ioni ai altor metale. Srurile de litiu au fost utilizate
prima dat n terapeutic n 1850, n ameliorarea
simptomelorgutei, reumatismului, litiazei renale. n 1949, Cade
are meritul de a fi descoperit efectul sedativ al srurilor de litiu
n starea de agitaie maniacal, dar terapia este nsoit de frecvente cazuri de intoxicaie. n 1967, se reuete determinarea
valorii terapeutice a litemiei (0,2 - 1,5 mEq/l). n Romnia exist
cteva surse de ap mineral cu un coninut ntre 3-8 mg Li
ncadrate n grupa apelor minerale litinifere. Un izvor terapeutic
de ap mineral litinifer este Maria de la Malna-Bi, care
conine 8.03 mg litiu la litru. Malnaul este situat n extremitatea
nordic a judeului Covasna, aflndu-se n cavitatea depresiunii
de la Bixad, avnd nlimi ntre 570 i 650m. n partea vestic
se ntinde grupul nordic al munilor Bodocului, cu nlimi de
1200m.
Scopul acestui studiu este de a observa dac apele minerale bogate n litiu au acelai efect ca i srurile de litiu.
Obiectivul studiului este de a investiga influena apelor minerale litinifere asupra mecanismelor reglatorii ale diferenierii i
proliferrii celulare. Litiul este cel mai simplu agent terapeutic
utilizat n tratamentul tulburrilor bipolare de peste 100 de ani i
nc nu a fost stabilit un mecanism definitiv care s explice efectele sale. Multe studii au fost fcute asupra neuronilor i ele
au artat c litiul are multe influene asupra sistemelor de
neurotransmitere, sistemelor de mesageri secundari i asupra
nivelului polarizrii membranare. Celulele gliale creaz un mediu
celular specific pentru neuroni i exist efecte asupra lor, de
asemenea. Am ncercat s descoperim modul n care morfologia
i viabilitate celulelor gliale se schimb prin tratamentul in vitro
cu ape minerale litinifere.
Litiul utilizeaz, pentru intrarea n celul, proteine
transportoare implicate n transportul sodiului i potasiului,
nlocuindu-i pe acetia. Principalele ci de intrare a litiului n
celule sunt: canalele de sodiu i schimbtorul de Na/H. Canalele
de sodiu au rol n transportul sodiului de la exteriorul la interiorul
celulei, n sensul gradientului de concentraie. Datorit
permeabilitii aproximativ egale a acestor canale pentru sodiu
i litiu, ionul de litiu le poate utiliza pentru a ptrunde n celul

/l,

42

II. COMUNICRI
fr consum energetic. Concentraia litiului crete de 5-10 ori la
nivelul dendritelor n urma unei salve de stimuli, aceasta
explicndu-se prin deschiderea unui numr mare de canale de
sodiu n timpul potenialului de aciune (Lenox i al., 1998).
Detaliile privind mecanismul molecular i regiunea int ce
justific aciunea de stabilizare a psihozei maniaco-depresive de
ctre srurile de litiu nu sunt pe deplin elucidate. S-a sugerat
totui c sistemele generatoare de mesageri secundari care implic adenilat ciclaza i fosfoinozitolii sunt poteniale situsuri int
(Jakobsen i colab., 1998). n sngele uman, ionii de litiu pot
interfera cu aproape orice proces care implic ioni de sodiu,
potasiu, calciu, magneziu, calmodulin, diferii mesageri
secundari, hormoni i muli din neurotransmitorii cunoscui
(Klemfuss i colab., 1991). Aciunea terapeutic a srurilor de
litiu n bolile bipolare pare a fi rezultatul unui cumul de evenimente
care modific activitatea neuronal la nivele multiple.
THERAPEUTIC POTENTIAL O. MARIA LITHIUM MINERAL
WATERS .ROM MALNAS-BAI
Constantin Munteanu 1 , Diana Munteanu 1 , Gabriela
Zamfirescu 1 , Otilia Zarnescu 2
1 National Institute of Rehabilitation, Physical Medicine and
Balneoclimatology
2 Bucharest University, .aculty of Biology
Lithium exists in the biological tissues, aliments and
running water. Spring waters contain great concentrations of
lithium salts and other metal ions. Lithium salts have been first
used with therapeutic purpose in 1850 for treating gout
symptoms, rheumatism and renal lithia. In 1949, Cade has the
merit to discover the sedative effects of lithium salts on manic
phase of affective disorders, but the therapy is accompanied
with frequent cases of intoxication. In 1967, was possible the
determination of therapeutic values of lithemia (0,2 - 1,5 mEq/l).
In Romania are existing the sparking waters sources which have
a high level of lithium salts in the content, being so-called Lithium
content sparkling waters , the concentration of lithium being
between 3 and 8 mg Li per litre. One of these sources is Maria
spring from Malnas-Bai, which has a lithium concentration of
8,03mg lithium per litre Malnas is located in the Nordic extremity
of Covasna district, in the Bixad depression , with highs between
570 and 650m. In the West part there is the Nordic Group of
Bodoc Mountains, with highs of 1200m.
The aim of this study is to investigate the influence of lithium
mineral waters upon the regulatory differentiation and
proliferation of glial cells. Lithium is the simplest therapeutic agent
available for the treatment of bipolar disorder for over 100 years
and no definitive mechanism for its effect has been established.
Many studies have been done on neurons and they pointed out
that lithium has many influences on the neurotransmitter
systems, second messenger systems and the level of membrane depolarization. Glial cells create a specific cellular
environment for neurons and there are effects on them too. We
tried to find out how glial cells viability and morphology are
changed during treatment in vitro with lithium mineral waters.
Lithium is using for entrance into the cell the transporting
proteins involved in Natrium and Potasium transportation. The
main entrance ways of lithium are sodium channels and Na/H
exchangers. Sodium channels are implicated in Na transport
from exterior to the cell interior, in the concentration gradient
sense. Because of equal permeability of these channels to
sodium and lithium, lithium ions can use them for entering to
the cell without energy consumption. Lithium concentration
grows by 5-10 folds at the level of dendrites after a stimuli salve, this been explicated by opening of numerous sodium
channels during action potential (Lenox et al., 1998).
Details regarding the molecular mechanism and target
region that justify the stabilizing action of lithium salts on manicdepressive psychosis are not fully elucidated. Has been
suggested that second messengers generating systems, which
imply adenylate cyclase and phosphoinositols, are potential

target sites (Jakobsen and all., 1998). In human blood, lithium

ions can interfere with almost any process that implies sodium,
potassium, calcium, magnesium, calmoduline, other second
messenger, hormones and many from known neurotransmitters
(Klemfuss et all., 1991). Therapeutic action of lithium salts in
bipolar disorders seems to be the result of many events that
modify the neuronal activity at multiple levels.

C 27
ACCIDENTELE DE MUNC CE IMPLIC MNA
EVALUARE .UNCIONAL I RECUPERARE MEDICAL
POSTCHIRURGIE PLASTIC
Andreia Murgu, Diana Popescu, Mihaela .iru, Adriana Sarah
Nica
Clinica de Recuperare Medical III .ilantropia
Introducere
Mna este cel mai complicat segment de membru din
organism, ca urmare a adaptrii structurale i funcionale la
complexitatea activitii umane. Traumatismele severe ale
minii, cu incidena n cretere, creeaz un handicap major. n
aceste condiii, recuperarea, dei dificil i ndelungat, este
absolut necesar att preoperator, ct i postoperator.
Scopul lucrrii
Prezentul studiu propune analizarea beneficiilor i eficiena
programelor de recuperare n refacerea funcional a pacienilor
care au suferit un accident de munc soldat cu un traumatism
complex al minii.
Material i metod
n cadrul clinicii de Recuperare Medical .ilantropia, n
perioada ianuarie octombrie 2005 au fost internai i evaluai
clinico-funcional 10 pacieni 6 brbai i 4 femei cu vrste
cuprinse ntre 25 i 59 ani, cu status algofuncional post
traumatism complex de mn (accident de munc) operat.
Pacienii au fost evaluai la internare i la externare, o parte
dintre ei putnd fi urmrii n dinamic pe parcursul mai multor
cure succesive de recuperare. Pentru evaluare s-au utilizat scale
funcionale i scoruri ce analizeaz amplitudinea unghiurilor
articulare la nivelul articulaiilor mici ale minii afectate.
Rezultate i discuii
Din datele obinute prin studierea foilor de observaie ale
celor 10 bolnavi internai n clinica noastr n anul 2005, reiese
o evident ameliorare a statusului funcional al minii
traumatizate, cu att mai important cu ct compliana bolnavului
la programul de recuperare a fost mai mare.
Concluzii
Evoluia este mult mai bun la cei cu multiple cure de recuperare, ceea ce subliniaz faptul c o singur internare nu
este suficient n majoritatea cazurilor. Refacerea funcional a
minii postraumatism complex operat poate fi spectaculoas
dac refacerea structurilor anatomice a inclus teno i neurorafia
i duce la creterea calitii vieii bolnavului.
Cuvinte cheie: traumatism complex de mn, chirurgie
plastic, evaluare clinico-funcional, recuperare medical.

C 28
BOALA CHARCOT-MARIE-TOOTH
Aspecte teoretice i practice de Recuperare Medical
Andreia Murgu, Gilda Mologhianu, Oana Vasilescu, Diana
Popescu, Adriana Sarah Nica
Clinica de Recuperare Medical III .ilantropia
Introducere
Boala Charcot-Marie-Tooth (CMT) sau neuropatia
senzitiv motorie ereditar (HMSN) reprezint un grup heterogen
de afeciuni ereditare. Debutul este insidios la orice vrst, cel
mai adesea ntre 5-15 ani, dar se poate produce foarte precoce
(nou-nscut, sugar) sau dup 50 de ani. Semnele revelatoare

43

II. COMUNICRI
sunt deformarea progresiv a picioarelor, avnd drept consecin piciorul scobit bilateral ( pes cavus ) i tulburrile de mers.
Scopul lucrrii
Prezentarea teoretic a principiilor de recuperare medical
a deficitelor funcionale ale pacienilor cu boala Charcot-MarieTooth, la care patognomonic este neuropatia periferic
senzitivo-motorie a membrelor care se manifest printr-o atrofie
progresiv a muchilor gambei, n special a muchilor peronieri.
Material i metod
Am luat n discuie dou cazuri de pacieni cu CMT, aflai
n tratament n Clinica de Recuperare Medical III .ilantropia,
unul urmrit n dinamic de aproximativ 3 ani, cu boala
diagnosticat la vrsta de 11 ani i alt caz la prima internare.
Pacienii au suferit mai multe intervenii chirurgicale corectoare
la membrele superioare i inferioare. Lucrarea prezint teoretic
i practic principiile programului de Recuperare Medical
necesar unui pacient diagnosticat cu CMT, obiectivele i mijloacele terapeutice recomandate de literatura modern de specialitate, pe care le-am aplicat n clinica noastr.
Concluzii
Programul de Recuperare recomandat unui pacient
suferind de CMT trebuie s aib n vedere c aceti pacieni
sufer de o boal incurabil, sunt pacieni cu deficite funcionale importante i multiple, a cror calitate a vieii poate fi crescut.
Cuvinte cheie: boala Charcot-Marie Tooth, program de
Recuperare Medical, principii teoretice i practice, calitatea vieii.

C 29
MANAGEMENTUL ARTROPATIEI HEMO.ILICE
Dan Neme 1 , 3 , 5 , Dan V Poenaru 1 , 2 , Ion Branea 1 ,2 , Dan One 4 ,
Alina Totorean 1 , 5 , 6 , Andreea Ni 1 , 5 , Armand Gogulescu 1 , 3 ,
Elena Amrici 1, 3 , Merima Jurici 1 , 3 , Iosif Ilia 3 , Atef Hammad 3 ,
Angelica Ponoran 3 , Carmen Haifer 3 , Corina Petru 3 , Camelia
Ptruescu 3 , Loredana Mihil 3 , Dan Naicu 3 , Mihaela
Udrescu 3
1 Universitatea de Medicin i .armacie Victor Babe
Timioara, 2 Spitalul Clinic Judeean de Urgen Timioara
3 Spitalul Clinic
Secia clinic ortopedie-traumatologie II,
Judeean de Urgen Timioara Secia clinic ortopedietraumatologie II Compartimentul de recuperare medical,
4 Spitalul Clinic Judeean de Urgen Timioara
Secia
5 SC Excentric
clinic de radiologie i imagistic medical,
Company SRL Centru medical de recuperare medical
Timioara, 6 Spitalul Clinic Municipal Timioara Secia clinic
de balneofizioterapie, Romnia
Hemartrozele repetate sunt caracteristice hemofiliei
(hemofilia de tip A caracterizat prin afectarea producerii . VIII)
i implic cel mai frecvent genunchiul, cotul, oldul i glezna.
De regul, este afectat aceeai articulaie. n timp, se ajunge
la lezarea esutului sinovial, cu distrucia articulaiei i
deformarea ei n flexie, constituindu-se astfel artropatia
hemofilic.
n cazurile n care artropatia duce la fixarea n flexie a
articulaiei, cu limitarea micrilor, i innd cont i de rezultatul
investigaiilor imagistice (radiologice, RMN), tratamentul recomandat este intervenia chirurgical, i anume artroplastia
articulaiei afectate.
Indispensabil pentru susinerea rezultatului actului operator
(mobilitatea articular), dar i pentru meninerea mobilitii
articulare i a forei musculare a tuturor celorlalte articulaii, este
tratamentul de recuperare medical att pre-, ct i postoperator.
Acest tratament recuperator se va aplica toat viaa cu o serie
de caracteristici specifice bolii, avndu-se n vedere faptul c
hemofilia nu este deocamdat o boal tratabil i care, neglijat,
are un caracter invalidant marcat.
Se impune abordarea multidisciplinar ( comprehensive
care ) a hemofilicului.
Cuvinte cheie: artropatie hemofilic, deformare n flexie,
substituie de .VIII, artroplastie, electro-terapie, kinetoterapie,
abordarea multidisciplinar

HEMOPHILIC ARTROPATHY MANAGEMENT

Dan Neme 1 , 3 , 5 , Dan V Poenaru 1 , 2 , Ion Branea 1, 2 , Dan One 4 ,
1,3 ,
Alina Totorean 1 , 5 , 6 , Andreea Ni 1 , 5 , Armand Gogulescu
Elena Amrici 1, 3 , Merima Jurici 1 , 3 , Iosif Ilia 3 , Atef Hammad 3 ,
Angelica Ponoran 3 , Carmen Haifer 3 , Corina Petru 3 , Camelia
Ptruescu 3 , Loredana Mihil 3 , Dan Naicu 3 , Mihaela
Udrescu 3
1 Victor Babes University of Medicine and Pharmacology
Timisoara, 2 Timis County Universitary Hospital Orthopedic
3 Timis County Universitary
and Traumatology department,
Hospital Orthopedic and Traumatology department
4 Timis County Universitary
Rehabilitation department,
5 Excentric Company Ltd
Hospital Radiology department,
6 Timisoara Medical
Timisoara Medical Rehabilitation Unit,
Rehabilitation Universitary Hospital, Romania)
Repeated hemarthrosis are a rule in hemophylia (A type
hemophylia due to lack of VIII antihemophylic factor), especially
in knee, hip, elbow and ankle. Usually is involved the same joint.
In time, the synovial tissue is also implied, with joint destruction
and flexum position, so turning up in hemophilic artropathy.
In case of flexum position of the joint, with poor range of
motion and regarding, also, the imagistic findings (X ray, MRI),
elective therapy is surgical, meaning joint arthroplasty.
Indispensable for sustainig the surgical treatment result
(increase in range of motion), but also for for muscle tonifyieing
is the rehabilitation program, pre and post op. This is a life time
therapy because hemophylia is, regarding it s particular features,
an untrateable disease and neglacting it becomes handicaping.
Comprehensive care of the hemophilic patient is
necessary.
Key words: hemophilic artropathy, arthroplasty,
electrotherapy, kinetotherapy, comprehensive care

C 30
MANAGEMENTUL RECUPERATOR AL ATROPLASTIEI DE
OLD I GENUNCHI LA PACIENII VRSTNICI CARDIOVASCULARI I CALITATEA VIEII ACESTORA
Dan Neme 1 , 3 , 5 , Dan V Poenaru 1 , 2 , Mihai Drgoi 1 , 5 , 6 , Dan
One4 , Alina Totorean 1, 5, 6 , Andreea Ni 1 , 5 , Armand
Gogulescu 1 , 3 , Elena Amrici 1 , 3 , Merima Jurici 1, 3 , Cristian
Milicin1, 3 , Iosif Ilia 3 , Atef Hammad 3 , Angelica Ponoran 3 ,
Carmen Haifer 3 , Corina Petru 3 , Camelia Ptruescu 3 ,
Loredana Mihil 3 , Adalbert Schiller 1 , 7 , Dan Naicu 3 , Mihaela
Udrescu 3 , Rzvan Drgoi 1 , Camelia Nemes 8
1 Universitatea de Medicin i .armacie Victor Babe
Timioara, 2 Spitalul Clinic Judeean de Urgen Timioara
3 Spitalul Clinic
Secia clinic ortopedie-traumatologie II,
Judeean de Urgen Timioara Secia clinic ortopedietraumatologie II Compartimentul de recuperare medical,
4 Spitalul Clinic Judeean de Urgen Timioara
Secia
5 SC Excentric
clinic de radiologie i imagistic medical,
Company SRL Centru medical de recuperare medical
Timioara, 6 Spitalul Clinic Municipal Timioara Secia clinic
7 Spitalul Clinic Judeean de Urgen
de balneofizioterapie,
8 Spitalul Clinic
Timioara Secia clinic nefrologic,
Municipal Timioara Laboratorul clinic, Romnia
Profilul acestui tip de pacient este caracteristic: vrsta > 65
ani, coxartroz sau gonartroz avansat deformant, boal
cardiovascular asociat alt patologie, deficit funcional marcat.
Impactul atrozei severe asupra pacientului vrstnic i
cardiac determin activarea unui cerc vicios: anxietate, durereinfirmitate/fractur-handicap-disabilitate
Impactul economic, care se refer la costurile necesare
ngrijirii medicale a vrstnicului, este n direct corelare cu creterea numeric a acestui segment populaional. Aceast realitate
demografic a zilelor noastre, cu impact n mai multe sfere de
interes naional, genereaz politici sociale i de sntate n
domeniul persoanei vrstnice.

44

II. COMUNICRI
Ateptrile pacienilor sunt legate de: independen, via activ, aspect sntos, oase rezistente, confort psihologic. Domeniile
cheie n aprecierea calitii vieii acestor pacieni sunt n segmentul:
psihologic: lipsa plcerii, anxietate/ depresie, lipsa de
adaptare la situaie
social (modificri n): relaiile interpersonale, relaiile
sexuale, participare la activiti sociale i de divertisment
ocupaional (modificri n): dorina de a munci i capacitatea de munc, activitatea domestic
fizic: durere, handicap funcional
Metodologia terapiei este stadializat:
n Preoperator
1. Stabilizarea afeciunii cardiovasculare altei patologii
2. Pregtirea segmentului vizat pentru:
w reducerea perioadei de imobilizare postoperatorie;
w instituirea preoce a terapiei recuperatorii;
w scurtarea duratei de spitalizare.
n Postoperator
1. Meninerea parametrilor afeciunii cardiovasculare
altei patologii n limite care s permit introducerea programului de recuperare medical;
2. Recuperare precoce imediat la pat pentru realizarea mersului ortezat;
3. Recuperare precoce n unitatea spitaliceasc pentru
reeducarea ortostatismului, echilibrului i mersului.
Cuvinte cheie: profil caracteristic, cerc vicios, domenii
cheie, metodologie stadializat
MEDICAL REHABILITATION MANAGEMENT O. ELDERLY
CARDIOVASCULAR PATIENTS WITH HIP AND KNEE
ARTHROPLASTY AND THEIR QUALITY O. LI.E
Dan Neme 1 , 3 , 5 , Dan V Poenaru 1 , 2 , Mihai Drgoi 1 , 5, 6 , Dan
One 4 , Alina Totorean 1, 5 , 6 , Andreea Ni 1, 5 , Armand
Gogulescu 1 , 3 , Elena Amrici 1 , 3 , Merima Jurici 1 , 3 , Cristian
Milicin1, 3 , Iosif Ilia 3 , Atef Hammad 3 , Angelica Ponoran 3 ,
Carmen Haifer 3 , Corina Petru 3 , Camelia Ptruescu 3 ,
Loredana Mihil 3 , Adalbert Schiller 1 , 7 , Dan Naicu 3 , Mihaela
Udrescu 3 , Razvan Drgoi 1 , Camelia Nemes 8
1 Victor Babes University of Medicine and Pharmacology
Timisoara, 2 Timis County Universitary Hospital Orthopaedic
3 Timis County Universitary
and Traumatology department,
Hospital Orthopaedic and Traumatology department
Rehabilitation department,
4 Timis County Universitary
5 Excentric Company Ltd
Hospital Radiology department,
6 Timisoara Medical
Timisoara Medical Rehabilitation Unit,
7 Timis County
Rehabilitation Universitary Hospital,
Universitary Hospital Nephrology department,
8 Timisoara
Universitary Hospital Medical Lab, Romania
This patien has a characteristic profile: age > 65 ani,
advanced and deforming hip or knee arthrosis, associated
cardiovascular disease other pathological conditions, high
functional loss.
Severe arthrosis impact on elderly and cardiovascular
patient generares a vicious circle: anxiety, pain-impairment/
fracture-handicap-disability
Economic costs for elderly medicale are related with
demographic growth of this population. This reality of our days,
with national spheres impact, generates social and helth politics
foe elderly.
Patients expectations are: independence, active life,
healthy appearance, lasting bones, psichologic comfort. The key
domaines in life quality assessment are:
psichologic: absence of pleasure, anxiety, depression,
absence of situation adaptation
social (changes in): persons intercourses, sexual
relations, taking part in social and entertainment activities
ocupational (changes in): desire and capacity of work
, home activities
phisic: pain, functional handicap
Therapy management is a standardised one

n Preop
1. Cardiovascular disease other pathological
conditions
2. Preparation of targeted segment for
w shortenning postop imobilisation period;
w precocious appliance of medical rehabilitation therapy;
w shortenning the hospitalisation period.
n Postop
1. Mentaining cardiovascular disease other
pathological conditions parameters in such terms that allows us
to start medical rehabilitation program;
2. At patient bad precocious madical rehabilitation in
order to obtain sustained walking;
3. Precocious medical rehabilitation in medical unit to
reeducate standing, balance and walk.
Key words: characteristic profile, vicious circle, key
domaines, standardised therpy management

C 31
METODE I PRINCIPII DE RECUPERARE N MEDICINA
PALEATIV
Dan Neme 1 , 3, 4 , Mihai Drgoi 1, 4, 5 , Dan One 2 , Alina Totorean 1 ,
4, 5 , Andreea Ni 1, 4 , Armand Gogulescu
1 , 3 , Elena Amrici
1, 3 ,
Merima Jurici 1 , 3 , Iosif Ilia 3 , Atef Hammad 3 , Angelica Ponoran 3 ,
Carmen Haifer 3 , Corina Petru 3 , Camelia Ptruescu 3 ,
Loredana Mihil 3 , Dan Naicu 3 , Mihaela Udrescu 3 , Adalbert
Schiller 6 , Camelia Nemes 7
1 Universitatea de Medicin i .armacie Victor Babe
Timioara, 2 Spitalul Clinic Judeean de Urgen Timioara
3 Spitalul
Secia clinic de radiologie i imagistic medical,
Clinic Judeean de Urgen Timioara Secia clinic
ortopedie-traumatologie II Compartimentul de recuperare
medical, 4 SC Excentric Company SRL Centru medical de
5 Spitalul Clinic Municipal
recuperare medical Timioara,
6 Spitalul
Timioara Secia clinic de balneofizioterapie,
Clinic Judeean de Urgen Timioara Secia clinic
nefrologic, 7 Spitalul Clinic Municipal Timioara Laboratorul
clinic, Romnia
Problema recuperrii n medicina paleativ cuprinde variate aspecte fizice, psihice, sexuale i socio-profesionale; ea
poate fi abordat cel mai bine de o echip de specialiti diveri
(medici, fiziokinetoterapeui, psihologi asistent social, preoi) care
s poat rspunde cerinelor specifice fiecrui bolnav.
Readaptarea este un concept nou, care difer de medicina clasic n sensul c bolnavul este abordat cu ntregul complex de probleme pe care o boal le poate genera pe plan fizic,
psihic si social. Ea ar putea fi definit ca o dezvoltare maxim a
potenialului fizic, psihologic, social i profesional al bolnavului
n concordan cu limitele fiziologice pe care i le impune boala
i condiiile sale de via. n acest cadru, care depete simpla
aplicare a tratamentului cu scopul unei vindecri somatice, calitatea vieii are un rol esenial i trebuie s primeze n ansamblul msurilor de ngrijire a bolnavului, ea reflectnd valorile
spirituale de care acesta este ataat.
Calitatea vieii este important pentru bolnavii cu anse
reale de vindecare, dar este cel puin la fel de important i
pentru bolnavii ale cror perspective de supravieuire sunt minime. Bolnavul trebuie s aib dreptul i s poat opta ntre un
tratament fr anse de vindecare, dar care i ofer condiii
acceptabile de via i un tratament cu anse ipotetice, dar care
cu siguran i va impune suferine deloc neglijabile.
Recuperarea include diferite tipuri de intervenii:
fizioterapie, terapie ocupaional, managementul stomelor,
logoterapie, terapia muzicii, terapia artei (arte creative i
literatura). Scopurile recuperrii paleative includ controlul durerii,
prevenirea contraciilor i a punctelor dureroase de presiune,
prevenirea deteriorrii inutile, datorat inactivitii, i sprijin
psihologic pentru pacient i membrii familiei. Readaptarea fizic,
psihic i reintegrarea socio-profesional se realizeaz prin

45

II. COMUNICRI
modaliti fizice (crioterapie, terapie prin cldur, electroterapieterapia TENS, acupunctur, terapie laser), kinetoterapie, masaj,
terapie ocupaional.
Cuvinte cheie: abordare complex, calitatea vieii, diferite tipuri de intervenii, readaptarea
REHABILITATION PRINCIPLES AND METHODS IN
PALLIATIVE MEDICINE
Dan Neme 1 , 3, 4 , Mihai Drgoi 1, 4, 5 , Dan One 2 , Alina Totorean 1 ,
4, 5 , Andreea Ni 1, 4 , Armand Gogulescu
1 , 3 , Elena Amrici
1, 3 ,
Merima Jurici 1 , 3 , Iosif Ilia 3 , Atef Hammad 3 , Angelica Ponoran 3 ,
Carmen Haifer 3 , Corina Petru 3 , Camelia Ptruescu 3 ,
Loredana Mihil 3 , Dan Naicu 3 , Mihaela Udrescu 3 , Adalbert
Schiller 6 , Camelia Nemes 7
1 Victor Babes University of Medicine and Pharmacology
Timisoara, 2 Timis County Universitary Hospital Orthopedic
3 Timis County Universitary
and Traumatology department,
Hospital Orthopedic and Traumatology department
4 Excentric Company Ltd
Rehabilitation department,
Timisoara Medical Rehabilitation Unit,
6 Timis County
7 Timisoara
Universitary Hospital Nephrology department,
Universitary Hospital Medical Lab, Romania
Medical rehabilitation in palliative care problems embrase
various physical, psihycal, sexual, social and labour apects and
these can be better tackled by a team of diverse specialists
(doctors, physiotherapists, psihologists, social workers, priests),
who can carry out the specific needs of every patient.
Readaptation is a new and different concept from clasical
medicine, by approaching the patient as a whole with all
physical, psihycal and social problems generated by the
disease. It can be definited as a maximal development of
physical, psihycal and social potential, regarding disease and
life conditions limits. So, readaptation is not a simple therapy
appliance , quality of life beein the essential part and it has to
be the first concept in the therapy management, reflectind the
spiritual values of the patient.
Quality of life is essential to the patient with real healing
changes, but also for patient with minimal survival expectations.
The patient must have the right to chose between a treatment
without healing chances but with acceptable life conditions and
one with hipotetical chances and real suffer.
Rehabilitation includes different types of theraputical
means: physiotherapy, ocupational therapy, stoma management, speach therapy, music therapy, arts therapy (creative arts,
literature). The goals of paleative rehabilitation are the pain
controll, prevention of muscle contracture and the pressure
acheing pints, prevention of body useless degradation due to
lack of activity, psihologic support for the patient and family
members. Physical, psihycal, sexual, social and labour
readaptation is realise thru physical means (cold therapy, heat
therapy, electrotherapy-SNET, acupuncture, laser therapy),
medical gym, massage, ocupational therapy.
Key words: complex approach, quality of life, various
interventional types, readaptation

C 32
STUDIU PRIVIND E.ICACITATEA METODEI TAIJIQUAN IN
MBUNTIREA CALITII VIEII
Adriana Sarah Nica, Gilda Mologhianu, Mihaela Mihescu
Introducere
OMS consider mbuntirea calitii vieii unul din
scopurile majore ale medicinei moderne. Datorit creterii duratei medii de via a crescut i incidena unor boli netransmisibile
cu caracter degenerativ (bolile cardiovasculare, cancer, BPOC,
osteoporoz), boli cauzatoare de scderea calitii vieii prin
efectele secundare, i anume tulburrile de echilibru.

Tulburrile de echilibru reprezint cea mai important cauz de cderi cauzatoare de fracturi, motiv de discomfort pentru
populaia de vrsta a treia. Alturi de durere reprezint principalele cauze ale scderii calitii vieii.
Reeducarea echilibrului i coordonrii reprezint un
obiectiv important n creterea calitii vieii, prin scderea riscului
de cderi generatoare de fracturi.
Scopul studiului
Prin lucrarea de fa am urmrit:
w Realizarea unui studiu privind eficiena terapeutic a
unui program alternativ de kinetoterapie n recuperarea
tulburrilor de echilibru i coordonare.
w Recunoaterea de ctre paciente a eficienei programului alternativ TaiJiQuan n mbuntirea calitii vieii
w Utilizarea unor metode de evaluare ct mai specifice
care s permit cuantificarea prin scale adecvate ale
parametrilor caracteristici cu calcularea de scoruri individuale
i medii (pe loturi) ale parametrilor respectivi.
w Evaluarea comparativ a rezultatelor obinute n lotul
de studiu n urma programului de TaiJiQuan versus lotul martor.
Material i metod
Progamul de exerciii TaiJiQuan a fost adaptat astfel nct
s respecte regulile standard ale unui program kinetoterapeutic
(intensitate progresiv, pauz de o zi ntre edinele de exerciii,
intensitatea i durata exerciiilor adaptate la deficitul funcional
i la patologia specific a pacientelor), dar n acelai timp
pstrnd tehnica i caracteristicile gimnasticii TaiJiQuan.
Meritele sanogene ale TaiJiQuan au nceput s fie recunoscute i de forurile medicale occidentale. OMS a declarat n
1988 TaiJiQuan ca fiind cel mai bun exerciiu terapeutic
cunoscut.
Pentru evaluarea subiectiv a calitii vieii s-a folosit
chestionarul QUALE..O 41. S-u folosit i teste obiective de evaluare
a echilibrului: Tinetti, Up & Go , tandem standing , chair rising .
Rezultate i concluzii
Un proverb chinez spune c orict ar fi de abrupt i de
lung, orice drum ncepe cu primul pas . Introducerea metodei
TaiJiQuan n medicina de recuperare din Romnia este o
noutate. Dei nu atinge amploarea din rile vestice, unde acest
program are deja o tradiie, prin studiul de fa am reuit s
demonstrm obiectivele propuse:
w Prin participarea i cooperarea pacientelor programul ia dovedit accesibilitatea n rndul persoanelor de vrsta a treia
w Pacientele au prezentat o vizibil cretere a ncrederii
n forele proprii, privin mai optimist boala i evoluia ei
w Trebuie menionat i rolul psihologic al ntlnirilor. Activitatea desfurndu-se n grup, vrsta pacientelor fiind relativ
apropiat (65-80 ani) a constituit un prilej bine venit de socializare
w Pentru controlul obiectiv s-au folosit testele funcionale
de evaluare a echillibrului i coordonrii, rezultatele artnd o
mbuntire semnificativ a parametrilor urmrii
Iniial programat pe durata a ase luni, programul de
TaiJiQuan a continuat timp de aproape un an, la cererea
pacientelor. Aflate n permanen sub supraveghere medical,
acestea au insistat n menionarea efectelor benefice vizibile
asupra strii generale.

C 33
ASPECTE PRIVIND CONTRIBUIA BIO.EEDBACK-ULUI
EMG N CADRUL PROGRAMELOR DE RECUPERARE ALE
BOLNAVILOR CU AVC
(Experiena Spitalului Clinic de Recuperare Cluj Napoca)
I. Onac, L. Pop, Rodica Ungur, L. Irsay, Monica Pop, Roxana
Repta, Dana Russu, Delia Stemate
U.M... Iuliu Haieganu , Spitalul Clinic De Recuperare - Cluj
Biofeedback-ul EMG reprezint metoda prin care pacientul
i modific voluntar tonusul sau fora de contracie muscular,
pornind de la informaii vizuale sau auditive cu o mrime direct

46

II. COMUNICRI
proporional cu activitatea electric muscular.
Ipoteza
Biofeedback-ul mioelectric (EMG) poate ameliora fora de
contracie muscular pe grupele deficitare la pacienii
hemiparetici n stadiu sechelar dup AVC ischemic.
Material i metod
A fost luat n studiu un grup de 30 pacieni cu hemiparez
sechelar dup AVC ischemic, internai n Clinica Neurologie a
Spitalului de Recuperare Cluj-Napoca.
Pacienii au fost selectionai dup criterii prestabilite i au
urmat un program de tonizare a tibialului anterior, principalul
muchi implicat n flexia dorsal a piciorului. Programul de
antrenament prin biofeedback mioelectric a fost urmat timp de
12 edine (5/sptmn).
S-a urmrit n dinamic valoarea potenialelor electrice
musculare convertite n semnal luminos, recoltate de la nivelul
muchiului tibial anterior i de la nivelul antagonitilor spastici.
Rezultate i discuii
.ora de contracie muscular a tibialului anterior a avut o
mbuntire statistic semnificativ la ntregul lot de pacieni.
Nu s-a nregistrat ns o progresie continu, o parte din
pacieni prezentnd i momente de regresie pe parcursul
terapiei, pentru ca mai apoi s revin la evoluia de tip ascendent.
Spasticitatea muchilor flexori plantari nu s-a modificat
semnificativ.
Concluzii
1. Biofeedback-ul mioelectric este o metod eficient de
cretere a forei musculare pe grupele deficitare, la pacientul
hemiparetic n faza sechelar dup AVC.
2. Spasticitatea grupelor musculare antagonice celor
antrenate nu este influenat n cadrul programelor de scurt
durat.
3. edinele efectuate zilnic implic un grad de oboseal
cu scderea de moment a performanelor contractile musculare.

C 34
E.ECTELE IMOBILIZARII PRELUNGITE
ASUPRA METABOLISMULUI OSOS LA SECHELARII
DUPA AVC
Daniela Poenaru Nadine Liculescu
INRM.B
Obiective generale
Lucrarea de fata isi propune evidentierea consecintelor
imobilizarii prelungite,cu precadere asupra sistemului
osos.Aceste modificari,care nu se regasesc numai la nivelul unui
singur aparat sau sistem, au fost grupate in ceea ce se numeste
sindrom de deconditionare , entitate nosologica separata fata
de afectiunea initiala, care a dus la limitarea activitatii fizice
normale.
Obiective speciale
a) primare
w influenta tipului si intensitatii activitatii fizice din antecedente asupra calitatii osului,exprimata prin densitatea minerala
osoasa
w influenta statusului functional al pacientului cu deficit
motor al unui hemicorp asupra evolutiei densitatii minerale
osoase si metabolismului calciului
b) secundare
w aprecierea nivelului si tipurilor de activitate fizica din
antecedentele pacientilor supravietuitori ai unui AVC;
w determinarea tipului de activitate fizica cu impact
asupra calitatii osului;
w aprecierea influenteistatusului functionalasupra
calitatii osului la pacientii neurologici;
w aprecierea influentei statusului functional asupra
parametrilor metabolismului osos.
Material si metoda:
Lucrarea este un studiu clinico-statistic si epidemiologic,

prospectiv, randomizat controlat. A cuprins 55 pacienti sechelari

dupa un AVC recent. Criteriile pentru alcatuirea lotului au impus
excluderea pacientilor cu antecedente personale patologice ale
aparatului locomotor si cu alte afectiuni care au limitat nivelul
de activitate fizica.
Evaluarea pacientilor a cuprins:
w variabile demografice:varsta, sex, mediu de
provenienta a pacientilor;
w variabile clinice:tipul AVC, vechimea AVC, localizarea
deficitului motor;
w variabile neurologice: tipul deficitului motor,
spasticitatea;
w variabile privind nivelul de activitate fizica: chesionarul
Dunbar, Phisycal Activity History, Baecke;
w variabile functionale: .unctional Independence
Measure (.IM), indexul Barthel;
w variabile biofizice: densitatea minerala osoasa (DMO)
- scorul T;
w variabile bio-chimice: calcemia totala, calcemia ionica,
calciuria, hidroxiprolinuria, fosfataza alcalina, fosforemia, 25hidroxi-vitamina D serica, hormonul paratiroidian seric.
Rezultate si concluzii
Acest studiul confirma si aprofundeaza alte studii referitoare la evolutia metabolismului osos la o categorie speciala de
pacienti: sechelarii dupa AVC:
w pacientii cu deficit motor al unui hemicorp dezvolta
secundar osteoporoza;
w osteoporoza acestor pacienti se datoreaza in principal
imobilizarii;
w modificarile endocrine (25-hidroxi-vitamina Dsi
hormonul paratiroidian), cel putin in faza subacuta, sunt
secundare alterarii metabolismului calciului;
Datele obtinute prin corelarea scorului T cu scoruri partiale
obtinute la chestionarele utilizate arata ca DMO este direct
proportionala cu nivelul de activitate fizica din viata de adult, considerata dupa 18 ani. Dintre toate solicitarile fizice din viata adulta,
mersul pe jos in ritm rapid si foarte rapid, practicat cu regularitate,
este cel mai important factor care influenteaza mineralizarea osului.
A.TER STROKE PACIENTS BONE METABOLISM
E..ECTS GENERRATED BY PROLONGED
IMMOBILIZATION
Daniela Poenaru, Nadine Liculescu
INRM.B
General objectives
This paper highlights the negative effects as a result of
prolonged immobilization, mainly focused on the bone
metabolism.
Specific objectives
a) mainly
w the influence of type and force of general physical
activity on the bone quality, revelled by mineral density of bones;
w the impact of motional status at after stroke patients,
related to mineral density of the bones and calcium metabolism.
b) secondly
w estimating the kind and level of previous physical
activity at surviving stroke patients;
w significance of physical activity and motion capacity
at neurological patients and their effects on the bone quality.
Method
This paper is a result of an epidemiological, prospective,
randomised research, which includes 55 stroke patients. It is important to be known, that all patients have not any locomotory
illness records.
The research considered: age, sex, environment, stroke
type, neurological effects, physical activity level, functional,
biophysical and biochemical fluctuations.
Outcome and conclusions
After stroke patients with:

47

II. COMUNICRI
w hemiparesis - develops osteoporosis, caused by
prolonged immobilization;
w hormonal disturbances - mainly caused by the calcium
metabolism altering.
As a main remark of this paperwork, the osteoporosis is
one of the most important negative effect caused, at these
patients, by long immobilization.
Therefore, prevention and recovering after stroke are close
related to constant physical activity, especially walking (before
a stroke may occur) in a fast rhythm, appears to be one of the
most important factor for bone mineralization.

C 35
PELOIDOTERAPIA MECANISME BIOLOGICE DE
VALIDARE A E.ECTELOR TERAPEUTICE
Monica Pop, L. Pop, Dr. L. Irsay, Rodica Ungur, I. Onac,
Georgios Nikolaidis*
U.M... Iuliu Haieganu Cluj, Spitalul Clinic de Recuperare
Cluj
*Spitalul Bodosakion Ptolemaida - Grecia
Utilizat nc din epoca antic, peloidoterapia a adus
beneficii incontestabile n tratamentul a numeroase afeciuni.
Indicaia acestui tip de tratament se fcea pe baze empirice, fr
a fi cunoscute mecanismele biologice prin care acioneaz.
n ultimii ani, o dat cu implementarea medicinii bazate
pe dovezi, s-au efectuat numeroase studii n scopul identificrii
unor modificri induse de ctre terapia cu nmoluri la nivel
serologic, tisular i chiar celular, care ar putea explica efectele
terapeutice.
Astfel, s-au pus n eviden variaii semnificative ale nivelului seric de citokine (IL1, TN.a, receptori specifici de TN.a,
IG.1), prostaglandine (PGE2) i leucotriene (LTB4), b endorfine
i hormoni de stress (ACTH, cortisol), markeri ai stressului
oxidativ (NO, MPO, GSH peroxidaza). De asemenea au fost
efetuate studii care se supun criteriilor medicinii bazate pe dovezi
pentru demonstrarea efectelor clinice ale peloidoterapiei.

C 36
CORELAII NTRE PREZENA STATUSULUI
DISMETABOLIC I PATOLOGIA DEGENERATIV A
COLOANEI VERTEBRALE DORSO-LOMBARE
Roxana Popescu

, Mihaela Macovei-Moraru
Marinescu 2
1 UM. Craiova,
2 .E.S, Universitatea Craiova
1

, Luminia

Obiectiv
Pornind de la observaia c o mare parte dintre pacienii
care ni s-au adresat pentru sindrom algic de tip mecanic cu
localizare dorso-lombar i impoten funcional la acest nivel
prezint un status dismetabolic (dislipidemie, hiperuricemie,
gut, sindrom metabolic, diabet zaharat) am analizat corelaia
dintre afectarea degenerativ a coloanei vertebrale dorso-lombare i prezena tulburrilor de metabolism.
Material i metod
n perioada ianuarie 2005 iulie 2005 am evaluat 53
pacieni (33 femei i 20 brbai), avnd vrsta medie de 51,5
ani, cu afectare metabolic pe diverse linii (glucidic, proteinic,
lipidic). Pacienii au beneficiat de evaluare clinic, imagistic,
de laborator i funcional iniial i dup patru sptmni de
tratament (igieno-dietetic, medicamentos i fizical-kinetic).
Investigaiile imagistice ale segmentului dorso-lombar al coloanei
vertebrale (Rx, TC, RMN) au evideniat preponderant modificri de tip degenerative la 78% dintre pacieni. n majoritatea
cazurilor s-au evideniat modificri de spondilodiscartroz dorso-lombar, cu 5 cazuri de retrolistezis degenerativ (la nivel L4

i L5). La 37,7% dintre pacieni s-au depistat modificri

radiologice tipice pentru sindromul .orrestier, acetia prezentnd
scorul scalei .IM mult influenat.
Rezultate i discuii
Dintre parametrii urmrii (durere cuantificat cu ajutorul
scalei VAS, mobilitate evideniat de indicii Schober, Ott,
degete sol, i calitatea vieii evaluat prin scorul scalei .IM)
s-au corelat cel mai bine cu gradul i tipul de afectare metabolic
ultimii doi (p< 0,05). Tulburrile metabolice asociate mai frecvent
cu afectarea degenerativ a coloanei vertebrale dorso-lombare
au fost: hiperuricemia, dsilipidemia i sindromul metabolic.
Rmne de studiat n ce msur statusul proinflamator al acestor
pacieni (proteina C reactiv, fibrinogen crescute), ntlnit mai
ales n sindromul dismetabolic, se constituie ntr-un precursor
al leziunilor discovertebrale degenerative.
Concluzie
Afeciunile dismetabolice determin prin mecanisme
fiziopatologice multiple (inflamaie ischemie) modificri disco-vertebrale cu aspect degenerativ, care se coreleaz cu
gradul de dezechilibru metabolic.
Cuvinte cheie: sindrom metabolic, boala .orrestier,
hiperuricemie
CORRELATIONS BETWEEN DISMETABOLIC STATUS
AND DEGENERATIVE PATHOLOGY O. THORACIC AND
LUMBAR SPINE
Roxana Popescu

, Mihaela Macovei-Moraru
Marinescu 2
1 UM. Craiova,
2 .E.S, University of Craiova
1

, Luminia

Objective
In our study we tried to establish the correlations between
dismetabolic diseases and degenerative pathology of spine.
Methods
During January 2005 July 2005 were evaluated 53
patients, with medium age around 51,5 years and different
metabolic diseases. Patients have been evaluated clinical,
imagistic and laboratory and functional perspective in the
beginning and after 4 weeks of treatment. Imagistic investigations
(Rx, CT, RMN) showed degenerative disorders to 78% of
patients, in most of the cases being osteoarthritis of the thoracic
and lumbar spine. .orrestier syndrome was discovered in
37,7% of patients.
Results
.rom the followed parameters the range of motion and
quality of life were best correlated with the degree or type of
metabolic injury (p< 0,05). Hyperuricemia, dyslipidemia and
metabolic syndrome were most frequently associated with
degenerative diseases of spine.
Conclusions
Dismetabolic disorders determine, through multiple physiopathological pathways (inflammation, ischemia), disco-vertebral
injuries with degenerative appearance, correlated with the
degree of metabolic unbalance.
Key words: hyperuricemia, .orrestier disease, metabolic
syndrome

C 37
APORTUL BIO.EEDBACKULUI VIZUAL N
CONTIENTIZAREA I CORECIA POSTURAL LA
ADOLESCENII I TINERII CU CI.OSCOLIOZE
Roxana Popescu, Luminia Marinescu,
Mihaela Macovei Moraru
Obiective
Cercetrile actuale n sfera tulburrilor de static
vertebral, pun accent pe contientizarea schemei corporale i

48

II. COMUNICRI
a imaginii de sine, care trebuie integrate actului recuperator.
.alsele percepii ale schemei corporale, la pacienii tineri cu
deviaii ale rahisului, pot fi nlturate prin metododele
biofeedbackului vizual. Acesta este i scopul studiului actual,
care folosete metoda de captare video SIMI MOTION, cu
markeri de suprafa i analiz computerizat, pentru creterea contientizrii i ameliorarea coreciei posturale.
Material i metod
Am selectat n studiu 38 de pacieni cu cifoscolioz, cu
vrste cuprinse ntre 12- 29 ani, cu o valoare medie a unghiului
Cobb de 24,5 grade i a deviaiei sagitale de 58 grade.Toi
pacienii au fost evaluai iniial clinico- funcional i imagistic, iar
prin metoda videografic Simi Motion s-au nregistrat unghiul
tragus- C7- vertical( din profil) i unghiurile humerus bilateralL5- vertical( din spate), n poziia ortostatic. Pacienii au urmat
un program kinetic standard cu 2 edine/ sptmn, lotul de
studiu (18 pacieni) beneficiind n plus de contientizarea imaginii
video i a graficelor variaiilor unghiulare n static(naintea i la
finalul edinelor de kinetoterapie) i n timpul mersului. S-au
nregistrat valorile variaiei unghiulare iniial i dup o lun de
program recuperator.
Rezultate
La ambele loturi s-au nregistrat iniial valori apropiate ale
unghiului tragus- C7- vertical, respectiv 16,2 grade lotul martor
i 16,5 grade lotul de studiu, care atest proiecia anterioar a
capului prin dezechilibrul sagital cifotic.Evoluia la o lun prezint rezultate ncurajatoare pentru lotul de studiu, la care se
nregistreaz o scdere cu o valoare medie de 10,5 grade, spre
deosebire de lotul martor 2 ,8 grade. Valorile unghiulare pentru echilibrul frontal au nregistrat o scdere medie de 5,7 grade
pentru lotul de studiu i de 3 grade pentru lotul martor.
Concluzii
Biofeedbackul vizual prin metoda videografic
computerizat Simi Motion are un aport semnificativ n mbuntirea contientizrii i meninerea coreciei posturale, la
pacienii adolesceni i tineri cu cifoscolioze, n special
pentru echilibrul sagital, dar i pentru cel frontal.
Cuvinte cheie:biofeedback,cifoscolioz, metoda Simi
Motion
CONTRIBUTION O. VISUAL BIO.EEDBACK IN THE
CONSCIOUSNESS AND POSITIONAL CORRECTION TO
TEENAGERS AND YOUNGH WITH KYPHO-SCOLIOSIS
Roxana Popescu,Luminita Marinescu,
Mihaela Macovei- Moraru
Objective
The present researches in the field of static vertebral disorders
out pointing to the consciousness of the corporeal plan and self
image, which most incorporate in the rehabilitation program. The
wrong perception of the corporeal plan to the young patients with
static disorders of the spine can be eliminate trough visual
biofeedback method .Our study use the method of video capture
Simi Motion with surfaces markers and computer analysis.
Methods
We study 38 patients with kypho-scoliosis, aged between
12-29 years, with medium value of Cobb angle by 24,5 and
anteroposterior deviation around 58.All patients have been
evaluated initially from clinical, imagistic and functional
perspective. The patients followed a standard kinetic program,
with 2 sessions on week, the study lot (18 patients),have been
benefit by method Simi Motion.
Results
Evolution after one month showed good results for the study
group(angle values for frontal equilibrium decrease with 5,7).
Conclusions
The visual biofeedback with Simi Motion method have a
significant contribution to maintain positional correction to the
teenagers and young patients with kypho-scoliosis, especially
for anteroposterior equilibrium.
Key words: biofeedback, kypho-scoliosis, Simi Motion
method.

C 38
STUDIU COMPARATIV AL REEDUCRII .UNCIONALE A
GENUNCHIULUI DUP LIGAMENTOPLASTIE

Ligia Rusu 1, 2 , Mirela Lucia Clina 1, 2 , Elvira Pun

Universitatea din Craiova, .acultatea de Educaie .izic i
Sport
2 Policlinica pentru Sportivi Craiova
3 Spitalul Clinic de Neuro-Psihiatrie Craiova

Scopul acestei lucrri este de a evalua eficiena unui program de reeducare funcional a genunchiului, efectuat
ambulatoriu dup reconstrucia chirurgical a liligamentului
ncruciat anterior (LIA).
Pentru aceasta au fost comparate rezultatele a dou grupuri
de pacieni operai; primul grup a beneficiat de un program de
recuperare exclusiv ambulatorie, iar cel de-al II-lea grup a fost
reeducat iniial ntr-un serviciu de Medicin .izic i Recuperare,
n regim de spitalizare complet timp de 3 sptmni.
Material i metod
Studiul a fost efectuat n perioada iunie 2003 iulie 2005,
pe un numr de 24 pacieni, 16 de sex masculin i 8 de sex
feminin, cu vrsta medie de 24 ani, crora li s-a efectuat
reconstrucia chirurgical a LIA.
La externarea din serviciul de Ortopedie, pacienii au fost
repartizai n mod aleatoriu n dou grupuri, n funcie de
reeducarea efectuat pe parcursul primei luni postoperator:
grupul A (12 pacieni), cu reeducare exclusiv ambulatorie, efectuat de ctre un kinetoterapeut ales de ctre pacient, 3 edine
pe sptmn, timp de 6 sptmni i grupul B (12 pacieni),
cu reeducare ntr-un serviciu de Medicin .izic i Recuperare,
2 ore pe zi, 5 zile pe sptmn, timp de 3 sptmni i apoi n
ambulatoriu ca i grupul A.
Recoltarea datelor i evaluarea pacienilor s-au fcut conform protocolului stabilit la 3, 6 sptmni, 4, 6 luni i un an
postoperator.
Rezultate
Evaluarea pacienilor nu a pus n eviden diferene semnificative ntre cele dou grupuri la nici unul dintre parametrii
luai n studiu: prezena epanamentului lichidian [ecografic:
cotaia 0-3: 0 = fr ; 1 = minim (lam); 2 = mediu; 3 = important], amplitudinea micrilor de flexie i extensie ale
genunchiului (goniometric), starea ligamentelor genunchiului
(test Lachman-Trillat: 0 = absen sertar; +/- sertar minim; + =
sertar moderat; ++ = sertar important) i scorul funcional
Lysholm (cotaie 0-100: 0-64 = slab; 65-83 = mediu; 84-100 =
bun/excelent).
Concluzie
Reeducarea funcional dup plastia chirurgical a LIA
se poate efectua ambulatoriu, nc de la externarea pacientului
din serviciul de Ortopedie.
O supraveghere medical sptmnal n timpul primei
faze de reeducare este de dorit deoarece poate ameliora rezultatele, permind respectarea mai riguroas a programului kinetic
i ajustarea sa n funcie de fiecare pacient, precum i depistarea
precoce a eventualelor complicaii.
O bun cooperare pacient kinetoterapeut medic a
permis obinerea unor rezultate comparabile ntre reeducarea
funcional ambulatorie i cea din serviciul de Medicin .izic
i Recuperare, dup reconstrucia chirurgical a LIA.
COMPARATIVE STUDY O. KNEE .UNCTIONAL
REHABILITATION A.TER ANTERIOR CROSSED
LIGAMENT RECONSTRUCTION
Ligia Rusu 1, 2 , Mirela Lucia Clina 1, 2 , Elvira Pun
Departement of Phisical Education and Sport, University of
Craiova
2 Sports Policlinic, Craiova
3 Departement of Phisiotherapy, Neuro-Psychiatry Hospital,
Craiova

49

II. COMUNICRI
Objectiv
The aim of this study is to evaluate the rehabilitation of
knee after anterior crossed ligament (ACL) reconstruction. We
compared two groups of subjects: group A go to rehabilitation
in ambulatory services and group B go to rehabilitation in a
rehabilitation hospital services, during 3 weeks.
Material and method
We made the study between june 2003-july 2005. We
studied 24 patients (16 males and 8 females), mean age 24
years, all have surgical ACL reconstruction.
After ACL reconstruction we made 2 lots: group A (12
subjects) with ambulatory rehabilitation by kinetic programme, 3
/ week, 6 weeks and group B (12 patients) with rehabilitation in a
rehabilitation hospital services, 2 hours / day, 5 days, 3 weeks
and after that, they go to ambulatory rehabilitation like lot A.
Results
After evaluation we didn t observed diffrents results regards
rehabilitation parameters like: intrajoint pressure (echografic
evaluation from 0-3: 0 = without, 1 = minimum pressure, 2 =
medium, 3 = important), joint mobility (gonyometric evaluation),
Lachman test (0 = absence, + / - = minimum, + = moderate, ++ =
important false move of joint), functional score Lysholm (0-100:
0-64 = minimum, 65-83 = medium, 84-100 = good).
Conclusions
.unctional rehabilitation of knee after ACL reconstruction
can be made in ambulatory rehabilitation services, if exist a good
evaluation of patients, if the kinetic programme begain at soon
as possible after surgical intervention and if dosent exist
complications.A good colaboration between physician, patient
and physical therapyst can go to good results even if the patients
go to ambulatory rehabilitation services.

C 39
ROLUL KINETOTERAPIEI N TRATAMENTUL
PLEXOPATIEI BRAHIALE (THORACIC OUTLET
SYNDROME-TOS)
Ligia Rusu 1 , 2 , Mirela Clina 1 , 2 , Elvira Pun
1 Universitatatea din Craiova,
2 Policlinica pentru Sportivi Craiova
3 Spitalul Clinic Neuropsihiatrie Craiova

Obiective Lucrarea i propune urmrirea eficienei aplicrii unui program kinetic n tratamentul pacienilor cu sindrom
TOS. Am plecat de la o selecie corect i obiectiv a pacienilor,
care au fost diagnosticai cu TOS supui unui program fizicalkinetic complex care s corespund obiectivelor recuperrii i
s conduc la o reluare a activitii sportive ct mai rapid,.
Materiale i metode Studiul s-a desfurat la Serviciul de
Recuperare al Policlinicii pentru Sportivi din Craiova n perioada
martie 2004-martie 2005, pe 10 pacienti, sportivi, care prezentaser
diverse microtraumatisme, de tipul elongaiei,compresiunii, n
regiunea supraclavicular. Pacienii au fost distrbuii n trei grupe
(intervenie kinetic pasiv, activ, grup de control) i clinic au
manifestat poziie vicioas a umrului care este cobort,
anteproiectat, reducerea unghiului umr gt, manifestri vasculare,
neurologice, predominana durerii, contracturii musculare.
Acetia au fost evaluai clinic, funcional, utiliznd teste
specifice pentru apreciere a mobilitii, durerii, contracturii,
fenomenelor neurovasculare, precum i scale de evaluare a
durerii cum este chestionarul durerii McGill dar i scala VAS.
Evaluarea pacienilor s-a realizat nainte i dup aplicarea programului kinetic care a avut ca obiective combaterea durerii, refacerea mobilitii, forei musculare i stabilitii la nivelul umrului.
Rezultate Aprecierea eficienei programului n urma
folosirii mijloacelor combinate fizical kinetice -a constatat dup
opt sptmni o evoluie favorabil funcional i clinic,o
rentoarcere integral la activitatea sportiv. Menionm c
tratamentul fizical kinetic a fost asociat cu o ortezare corespunztoare care a continuat i pe perioada ce a urmat tratamentului

n scop protector. Metodelor statistice s-au aplicat n cazul scalei

VAS i a parametrilor fizici, observnd mbuntirea
parametrului mobilitate crete cu 20 puncte; parametrului for,
curs ascendent cu 35 de puncte; parametrul abilitate coordonare ascensiune de 10 de puncte. Testele specifice nregistreaz o evoluie favorabil. Astfel iniial Adson (drop test) a
fost pozitiv la 80% din pacieni, dup tratament pozitiv la 20%
din pacieni. Testul Spurling a fost pozitiv la 90% din pacieni
nainte i la 20% din pacieni dup tratament. Hawkin test a
fost pozitiv la 60% din pacieni i apoi la 20% din pacieni.
Concluzii Acest studiu a investigat formele kinetoterapiei
active/pasive de intervenie, la indivizi cu sindromul TOS.Ambele
intevenii au demonstrat o semnificativ mbuntire n ameliorarea durerii i funcionalitii. Studiile sunt necesare s
investigheze legtura dintre elementele specifice i nespecifice
i pentru a adapta intervenia specific n raport cu evaluarea
pacienilor. Kinetoterapia i-a adus aportul n ameliorarea semnificativ a parametrilor funcionalitii unui membru superior lezat
cu diagnosticul deTOS. Aceasta s-a reflectat n ameliorarea
durerii, a sensibilitii, coordonrii, mobilitii , tonusului muscular.
ROLE O. KINETIC PROGRAMME IN REHABILITATION O.
BRACHIAL PLEXOPATHY (HORACIC OUTLET
SYNDROME)
Ligia Rusu

, Mirela Clina 1 , 2 , Elvira Pun

University of Craiova,
2 Clinic of Sport Medicine Department
3 Neuropsychiatry Hospital Craiova
1,2

Objectives The aim of this study is to present the role of

kinetic rehabilitation programme at patients with thoracic outlet
syndrome (TOS), after we made a correct and objective selection
of patients. Our subjects go to rehabilitation programme that
include physical and kinetic methods because they must to return
to sport activity at soon at possibile.
Material and method
We made this study at Sport Medicine Department of
Clinical Hospital from Craiova, between march2005-march2005,
on 10 athlets, that present some microthrauma during sport
activity like elongation or compression of brachial plex. Our
subjects have been distributed in 3 groups (passive kinetic, active
kinetic methods and control group). All of the present down
shoulder and anteproiection of shoulder, reduce of angle
between shoulder and neck, neurovascular signs, pain, muscle
contracture. We evaluated our patients using clinical, functional
and specific tests for evaluation mobility, pain, contractures and
also we used scale for evaluation pain like McGill scale and
also VAS. The evaluation has been made before and after kinetic
treatment. The objectives of rehabilitation were increase the pain,
restore the mobility, muscle force and shoulder stability.
Results
Efficiency of kinetic and physical rehabilitation programme
has been observed after 8weeks because exist a good evolution
regards clinico-functional parameters. Also we must to say that
our programme including orthesis therapy that has been used
also after programme. Statistic evaluation for VAS and pshysical
parameters showed us an increase of mobility 20 points, force
increase with 35 points, ability and coordination increase 10
points. Specific tests showed a good evolution for Adson test
from 80% to 20% (positive test means bad prognostic). Also
Spurling test has a good evolution from 90% to 20% and Hawkin
test from 60% to 20%.
Conclusions
This study present the role of active and passive kinetic
programme in TOS. This therapy showed to us that we can obtain
an improvement of clinic and functional parameters like disappear
of pain and also is important to make a good evaluation before we
begin the rehabilitation programme. We observed that kinetic
rehabilitation protocol give to us an increase of upper limb functionality
in TOS, that means to obtain a good evolution of sensibility,
coordination, mobility, muscle force and muscle tonus.

50

II. COMUNICRI
C 40
PARTICULARITI ALE RINICHIULUI LA VRSTNICI I
TERAPIILE DE RECUPERARE I CU AINS
Adalbert Schiller 1 , 2 , Dan Neme 1, 3, 4
Universitatea de Medicin i .armacie Victor Babe
Timioara
2 Spitalul Clinic Judeean de Urgen Timioara
Secia
clinic nefrologic
3 Spitalul Clinic Judeean de Urgen Timioara
Secia
clinic ortopedie- traumatologie II Compartimentul de
recuperare medical,
SC Excentric Company SRL Centru medical de recuperare
medical Timioara, Romania

In such conditions, rehabilitation techniques for

osteoarthritis may represent an ideal therapy option, without,
as much as possible, NSAID s treatment
Key words: elderly, chronic kidney disease, NSAID s,
rehabilitation, ideal therapy option

Tratamentul cronic cu antalgice i AINS este considerat

factor de risc pentru dezvoltarea bolii cronice de rinichi (K/DOQI
2002). NHANES III apreciaz c 5,2% din populaia SUA consum zilnic i aproximativ 30% din populaie consum anual
AINS. Riscul tratamentului cu AINS i analgetice este crescut
la vrstnici, datorit particularitilor anatomice i funcionale
ale rinichiului la vrst naintat. Aceste modificri sunt
reprezentate de reducerea populaiei de nefroni i reducerea,
astfel, a rezervei filtrante a rinichiului, reducerea diametrului
vaselor renale independent de HTA, reorientarea circulaiei
intrarenale spre glomerulii medulari, fibroza interstiial
extensiv, atrofii tubulare.
Efectele renale negative ale AINS la vrstnici pot mbrca
mai multe forme: nefrita tubulointerstiial imun alergic acut
(mai mult sau mai puin nsoit de proteinurie), precum i
reducerea perfuziei glomerulare prin vasoconstricie de arteriol
aferent (efect hemodinamic). O mare parte din vrstnici prezint patologie asociat semnificativ (boli cardiovasculare, boli
hepatic cronice etc.), care se nsoesc de hipoperfuzie renal
cronic. Riscul renal al terapiei cu AINS la aceti bolnavi este
amplificat, cu att mai mult cu ct o parte se gsesc i sub
tratament cu inhibitori ai enzimei de conversie. Terapiile cu
inhibitori COX 2 selectivi dezvolt efecte secundare renale similare cu AINS neselective.
n acest context, terapia recuperatorie pentru bolile cronice
degenerative osteoarticulare la vrstnici, n msura posibilului
fr tratament cu AINS, rmne opiunea ideal.
Cuvinte cheie: vrstnici, boal cronic de rinichi, AINS,
recuperare, opiune ideal
THE KIDNEY IN ELDERLY PATIENTS, REHABILITATION
THERAPIES AND TREATMENT WITH NSAID
Adalbert Schiller 1 , 2 , Dan Nemes 1, 3, 4
Victor Babes University of Medicine and Pharmacology
Timisoara
2 Timis County Universitary Hospital
Nephrology department
3 Timis County Universitary Hospital
Orthopaedic and
Traumatology Department Rehabilitation Department
4 Excentric Company Ltd Timisoara
Medical Rehabilitation
Unit, Romania
1

NSAID treatment is considered risk factor for the

development of chronic kidney disease (K/DOQI 2002).
According to NHANES III 5.2% of Americans are treated on
daily base and 30% are occasional consumers of NSAID s.
Treatment risks with analgesic drugs and with NSAID s is enhanced
in elderly patients due to age related kidney alterations (reduction
of G.R by decreasing number of nephrons, reduction of kidney
perfusion, interstitial fibrosis, tubular atrophies and so on).
The negative renal effects of NSAID therapies may be
expressed mainly by immune interstitial nephritis, by glomerular
hypo perfusion due to afferent arteriole constriction. In the mean
time many of the elderly patients present cardiovascular diseases,
chronic liver diseases (and so on) which are generating chronic
renal hypo perfusion and frequently they are treated with CEI. In
these patients reduction of glomerular perfusion by NSAID s may
induce acute renal failure. Unfortunately COX 2 inhibitors did not
reduce significantly renal complications in elderly patients.

C 41
E.ECTELE TRATAMENTULUI DE .OND CU IN.LIXIMAB
ASUPRA EVOLUTIVITII CLINICE I RADIOLOGICE A
PACIENILOR CU POLIARTRIT REUMATOID
Prof.dr.Sidenco E.L. 1 , dr.Pavelescu R.I. 2
Universitatea Spiru Haret Catedra de Kinetoterapie n
colaborare cu Serviciile Ambulatorii Poli-Med i BioTerra Med
2 Serviciul Radiologie - Spital ELIAS-Bucureti
1

Obiective
Studiile controlate realizate n mai multe centre au dovedit
c tratamentul cu ageni anti-TN. este eficient n evoluia artritei
reumatoide (AR). Am urmrit evaluarea efectelor clinice i asupra
progresivitii radiologice a afeciunii, la pacienii cu AR, n urma
tratamentului pe termen lung (peste 18 luni) cu Infliximab.
Metod
Am studiat 34 pacieni cu AR, activ chiar sub tratament
specific, pe parcursul a 18 luni de tratament cu Infliximab,
administrat n perfuzii (conform schemei, 3mg/kg/perfuzie), la
fiecare 6-8 sptmni. Eficiena clinic a fost evaluat prin scorul
DAS44. radiografiile de mini i picioare au fost evaluate pe
baza metodei Sharp/van der Heijde modificat, urmrindu-se
eroziunea, ngustarea spaiilor articulare i scorul final. S-au
urmrit modificrile fa de rezultatele iniiale i s-a estimat o
rat de progresivitate, pentru fiecare pacient.
Rezultate
Din grupul de studiu, 27 pacieni (peste 79%) i 32 (peste
94%) au rspuns la a 6-a, respectiv a 12-a perfuzie. La aceeai
pacieni evoluia bolii s-a mbuntit progresiv, fr s fie necesar modificarea dozei iniiale. Am gsit scderi semnificative ale valorilor medii DAS44 pentru ntregul lot (de la 5,27 la
4,54, nainte de a 12-a perfuzie, p<0,002). Evaluarea radiologic
final s-a realizat dup o evoluie medie de 3,7 ani a bolii, i
dup 18 luni de tratament cu Infliximab. Modificrile radiologice
fa de nivelul iniial s-au ncadrat n medie n scorul total 8,6.
Se constat c dup tratament rata de distrucie, ngustarea
spaiului articular i scorul total se nbuntesc.
Concluzii
n urma acestui studiu iniial, s-a constatat eficiena acestui
tratament anti-TN. asociat, asupra evolutivitii clinice i
radiologice a bolii.
E..ECTS ON CLINICAL AND RADIOGRAPHIC
PROGRESSION O. LONG TERM TREATMENT WITH
IN.LIXIMAB .OR RHEUMATIC ARTHRITIS
Prof.dr.Sidenco E.L. 1 , dr.Pavelescu R.I. 2 ,
University Spiru Haret Chair of Kinetics in coop. with
Ambulatory Poli-Med i BioTerra Med
2 Department of Radiology - ELIAS Hospital-Bucharest

Objective
Several controlled trials have shown that treatment with antitumour necrosis factor (anti-TN.) agents is effective in rheumatoid
arthritis. We intended to assess the effect of long term (> 18
months) Infliximab treatment on clinical and radiographic
progression in patients with rheumatic arthritis (RA).
Methods
We studed 34 patients with active RA despite treatment
with disease modifying antirheumatic drugs, during 18 months
of Infliximab infusions. Infliximab (3 mg/kg/infusion) was given
every 8 or 6 week. Clinical efficacy was assessed by the Disease
Activity Score (DAS) index (44 joints). Radiographs of hands
and feet were assessed according to the modified Sharp / van
der Heijde scoring method, for erosion, joint space narrowing,
and total score. Changes from baseline were assessed, and a
predicted progression rate estimated for each patient.

51

II. COMUNICRI
Results
.rom the group of study, 27 (over 79%) and 32 (over 94%)
were responders on the 6
th and 12
t h Infliximab infusion,
respectively. In the same patients, disease activity gradually
improved without modifications in the initial dosing. We found a
significant decrease in the mean DAS score in this group (from
5,27 to 4,54 before the 12 th infusion, p<0,002). The mean diseas
duration was 3.7 years and the mean Infliximab treatment duration
18 months until the final x ray examination. The mean change
from baseline in total score was 8.6. After treatment, the rate of
destruction, joint space narrowing, and total score improved.
Conclusions
In this initial observational study of patients with RA treated
with recommended doses of Infliximab, this associated treatment
maintained adequate disease control and reduced the rate of
radiographic damage.

C 42
ASPECTE RADIOLOGICE PRIVIND RELAIA DINTRE
ARTRITA REUMATOID I OSTEOPOROZA
POSTMENOPAUZ N ACCELERAREA DISTRUCIEI
ARTICULARE
Prof.dr.Sidenco E.L.

, dr.Pavelescu R.I. 2 , ef lucr.dr. Grigorie

D.3 , dr. Popiel M. 4
1 Universitatea Spiru Haret
Catedra de Kinetoterapie n
colaborare cu Serviciile Ambulatorii Poli-Med i BioTerra Med
2 Serviciul Radiologie - Spital ELIAS-Bucureti
3 Institutul de Endocrinologie C.Parhon
4 Centrul de Diagnostic i tratament V. Babe -Bucureti
1

Obiectiv
Am ncercat evaluarea determinanilor distruciei articulare
i a scderii densitii minerale osoase (BMD) la femeile cu artrit
reumatorid activ (RA) aflate la menopauz i dac exist
markeri comuni ai celor dou procese.
Metod
BMD s-a msurat prin osteodensitometrie DEXA, iar
deteriorarea articular s-a examinat radiografic folosind scorul
Larsen. S-au examinat 48 de paciente.
Rezultate
Scderea BMD i creterea distruciei articulare s-au
asociat: la antebra i colul femural osteoporoz asociat cu
scor Larsen ridicat, la vrstnice slabe; la oldul n ntregime
osteoporoz asociat cu greutate mic, scor Larsen ridicat i
tratamente intermitente cu corticoizi (p<0,001). Creterea
scorului Larsen s-a mai asociat evoluiilor lungi i creterilor de
protein C reactiv (CRP) (p<0,001).
Concluzii
Osteoporoza este caracteristic pacientelor cu RA
postmenopauz. Se constat c greutatea mic i scorul Larsen
mare au fost puternic asociate cu scderea semnificativ a BMD.
Creterea CRP i evoluia lung a bolii au fost determinani n
accelerarea eroziunilor la pacientele cu RA posmenopauz.
Asemeni altor date din literatur, rezultatele par a indica
mecanisme comune pentru pierderea osoas local i
generalizat n RA.
RADIOGRAPHIC ASPECTS CONCERNING
ACCELERATED JOINT DESTRUCTION IN RHEUMATOID
ARTHRITIS ASSOCIATED WITH POSTMENOPAUSAL
OSTEOPOROSIS
Prof.dr.Sidenco E.L. 1 , dr.Pavelescu R.I. 2 ,
ef lucr.dr. Grigorie D. 3 , dr. Popiel M. 4
1 University Spiru Haret
Chair of Kinetics in coop. with
Ambulatory Poli-Med i BioTerra Med
2 Department of Radiology - ELIAS Hospital-Bucharest
3 Institute of Endocrinology C.Parhon
4 Center of Diagnosis and Treatment V. Babe -Bucharest
Objective
We investigated determinants of joint destruction and
reduced bone mineral density (BMD) in postmenopausal women

with active rheumatoid arthritis (RA) and to evaluate if there are

common markers.
Methods
BMD was measured using dual x ray absorptiometry
(DEXA) and joint damage was examined by x ray examination
according to the Larsen method in 48 patients with RA.
Results
Reduced BMD and increased joint destruction were
associated: at the forearm and femoral neck, osteoporosis
associated with high Larson score, low weight and old age
(p<0,001); at the total hip, osteoporosis associated with low
weight, high Larsen score and doses of glucocorticosteroids
(p<0,001). Larsen score was associated with long disease
duration and increased C reactive protein (CRP) (p<0,001).
Conclusions
Osteoporosis is common in postmenopausal patients with
RA. Low weight and high Larsen score were strongly associated
with BMD reduction. Increased CRP and long disease duration
were determinants of erosive disease in postmenopausal women
with RA. There observations indicate common mechanisms of
local and generalised bone loss in RA.

C 43
INDICAIA PENTRU NCLMINTEA DE ALERGARE
O SARCIN DEOSEBIT PENTRU MEDICUL SPORTIV
SAU RECUPERAIONIST
Prof.dr. Elena-Luminia Sidenco, kt. S. Didilescu, kt. Aura
Vlsceanu, prof. M.Radu, kt. .lorena arpe, kt. Laura-Neli
Stoica
*Universitatea Spiru Haret - Catedra de Kinetoterapie
**Institutul Naional de Cercetare pentru Sport
***Ortopedica-Bucureti
Leziunile legate de alergare au devenit aproape cea mai
frecvent cauz de consultaie la cabinetul de medicin sportiv
sau/i de recuperare.
Este posibil ca, pe baza noiunilor fundamentale de anatomie funcional a piciorului i a tipurilor acestuia, a modelelor
de mers i a datelor de design pentru pantofii-sport de alergare,
s se poat monitorza corespunztor aceast activitate i s
se diminue semnificativ leziunile datorate acestei activiti.
Lucrarea analizeaz corelaii ntre datele de anatomie clinico-funcional specifice i aplicaiile practice n jogging.
THE RUNNING SHOE PRESCRIPTION A TASK .OR THE
SPORTMEDICINE AND REHABILITATION
1 , S.Didilescu
1 , Aura
Professor Elena-Luminita Sidenco MD
2 , M. Radu 3 , .lorena
Vlceanu 2 , Professor Gratiela Vjial
arpe 3 , Laura-Nely Soica 3
1 University Spiru Haret - Chair of Kinetics
2 National Institute of Research in Sport
3 Ortopedica-Bucureti

Running-related injuries are among the most frequently

reasons for primary care visits at the sportmedicine or
rehabilitation specialists.
Armed with information on the basics of foot types, gait
patterns and running shoe design, healthcare provides can perform
a simple, office-based assessment that gives the best possible
proper foot gear may well have fewer running-related injuries.

C 44
STUDIU DE MEDIU SUBTERAN N VEDEREA UTILIZRII
ULTERIOARE A .ACTORILOR POTENIAL TERAPEUTICI
PREZENTI N CAVITILE MINEI SALINE UNIREA
SLANIC PRAHOVA PENTRU REALIZAREA UNOR
PERSPECTIVE DE DEZVOLTARE A SPELEOTERAPIEI N
ROMNIA.
CPII Dr.b., Ph.D. Simionca, Iuri (Gheorghe)
Enache Liviu 1 , Biochim. Hoteteu Mihail

1 , Conf. Dr.fiz.
, Ing. Grudnicki

52

II. COMUNICRI
Nicolae 1 , Dr.med. Kiss Jaroslav 1 , Chim. Rogojan Rodica 1 ,
Geol. Matei Mihaela 2 , Dr.chim. Petec Clin Gheorghe
1 , CPIII
Ing.Geol. Mirescu Lucian 1 .
1 Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie, Bucureti;
2 Societatea Naional a Srii SALROM S.A., Bucureti
Lucrarea reprezint o parte din studiul dedicat elaborrii
soluiei noi i metodologiei de utilizare a factorilor terapeutici de
mediu al unei mine saline pentru corecia unor modificri ale
statusului imun la bolnavii cu astm bronic.
Obiectivele lucrrii
1. Studii i testri fizico-chimice i microbiologice de
mediu subteran n vederea evaluarii salinei, care dispune de
posibili componeni ai factorilor curativi, de un posibil mecanism
de autoepurare, i care pot fi utilizai pentru a obine efectul
curativ i de corecie a statusului imun (sau a unor modificri
ale reactivitii imunologice) la bolnavii cu astm bronic.
2. Studii i testri n vederea evalurii stabilitii factorilor
de mediu subteran dup activitatea antropogenic.
Materiale i metode
Pentru evaluarea parametrilor de mediu subteran au fost
efectuate urmtoarele investigaii n lipsa pacienilor sau turitilor
i dup o activitate antropogenic a acestora n cavitile din
mina salin :
w temperatura in mediul subteran salin;
w presiunea atmosferic i diferena fa de exterior;
w umiditatea aerului subteran i viteza curenilor de aer;
w concentraia de aeroioni pozitivi i negativi;
w concentraia i mrimea particulelor de aerosol salin;
w concentraia de microorganisme, inclusiv patogene,
condiionat-patogene i saprofite n aerul, solul salin i pe pereii
de sare n slile destinate speleoterapiei;
w radioactivitatea n spaiul subteran (tipul, valoarea),
prezena i concentraia de radon;
w concentraia de oxigen i bioxid de carbon, prezena
i concentraia de ozon;
w prezena i concentraia de gaze poluante (NO
, SO ,
2
2
hidrocarburi i derivate de ozon.).
Rezultate i concluzii
Rezultatele au permis desemnarea salinei deintoare de
proprieti potenial terapeutice pentru posibila realizare a
efectului de corecie a unor modificri imunologice la bolnavii
cu astm bronic o nou perspectiv de dezvoltare a
speleoterapiei n Romnia. Analiza datelor, de asemenea, a
determinat elaborarea unui complex de investigaii, necesare
pentru studii de mediu subteran salin, n scopul utilizrii ulterioare
medicale ale diferitor saline i evalurii mecanismului
speleoterapeutic respectiv.
ENVIRONMENT STUDY IN ORDER TO A.TER THE EVENT
USE O. POTENTIAL THERAPEUTIC .ACTORS EXISTING
IN THE CAVITY O. SLANIC PRAHOVA UNIREA SALT
MINE .OR THE ACHIEVEMENT O. SOME
PERSPECTIVES O. SPELEOTHERAPY DEVELOPMENT
IN ROMANIA
Dr.b., Ph.D. Simionca Iu. (Ghe.) 1 , Dr. Phys. Enache L. 1 ,
Biochem. Hoteteu M. 1 , Ing. Grudnicki N. 1 , Dr.med. Kiss Ja. 1 ,
Chem. Rogojan Rodica 1 , Dr.chem., Geol. Matei Mihaela 2 ,
Petec Calin Ghe. 1 , Ing.Geol. Mirescu L 1 .
1 National Institute of Rehabilitation,Physical Medicine and
Balneoclimatology, Bucharest..
2 National Salt Society SALROM S.A., Bucharest, Romania.
This paper represents a part of the research dedicated to
the elaboration of the new solution and of the methodology of
use of the therapeutical environment factors of the salt mine for
the correction of the modifications of the immune status at the
patients with bronchial asthma.
The objectives of the paper
1. Research and physical-chemical tests as well as
microbiological tests of underground environment in order to
evaluate the salt mine which comprises components of curative
factors, a possible self-purifying mechanism and which can be
used in order to obtain the curative effect and the one of the
correction of the immune status (or of modifications of

immunological reactivity) at the patients with bronchial asthma.

2. Research and tests regarding the evaluation of the
stability of the underground environment factors after the
anthropogenic activity.
Materials and methods
In order to evaluate the parameters of underground
environment the following investigations were performed in the
absence of the patients and tourists and after their intense
anthropogenic activity in the cavities of the salt mine:
w temperature in salt mine underground environment;
w atmospheric pressure and the difference compared
to the exterior;
w relative humidity of air and speed of air currents;
w concentration of positive and negative air ions;
w concentration and size of the salt aerosol particles;
w concentration of microorganisms, including
pathogenic ones, conditioned-pathogenic and saprophytes in
the air, salt soil and on the salt walls of the rooms destined to
speleotherapy;
w radioactivity in the underground space (type, value),
presence and concentration of radon;
w concentration of oxygen and carbon dioxide, presence
and concentration of ozone;
w presence and concentration of polluting gases (NO
SO , hydrocarbons and ozone derivatives.)
2
Results and conclusions
The results allowed us to designate the salt mine which
comprises potentially therapeutical properties for the possible
performance of the correction effect of immunological
modifications at the patients with bronchial asthma - a new
perspective of the speleotherapy development in Romania. The
analysis of the data, in addition, determined the elaboration of a
concurrence of investigations, necessary for the underground
salt environment research, with the purpose of different salt
mines subsequent medical use and of the evaluation of
respectively speleotherapeutical mechanism.

C 45
PREVALENCE O. LOW BACK PAIN IN ADULT
POPULATION O. THE DISCTRICT RODALIVOS (NORTH
O. GREECE).
Dr. Stergyos .rastanlys
This epidemiologic study was done on a group of 300 adullt
subjects (over 20 years olds) from 4 different towns from Macedonia Greece (Rodolivos, Protis, Amphypolis and Kornistas),
with total adult population of 10782 peoples. The study was
randomized, from the point of view of the sex, age group,
profession and residency.
The prevalence of LBP was very high: 46,3% of total group
suffered in their life of :
1-radiculopathies L5 or S1 (43%);
2-sequellae folowing laminectomy and discectomy (12,9%);
3-lumbar spinal stenosis (5,7%);
4-LBP (without sciatica)-(38,1%);
Some special observations:
- The frequency was a little higher . -(48,3%) in
comparison with M- (44,2%) for the old people (over 60 years
olds), especialy for .- (48,6%), in comparison with M (41,4%);
- The prevalence of radiculopathies was lower in M
(38,4%), LBP (without sciatica) at . (36,4%), and of the cases
operated was .;
The prevalence of LBP was very large between the people
who are working in agriculture, the main activity in this region
(40% of activ population).

C46
STUDIU HISTOLOGIC COMPARATIV AL ACTIUNII
NAMOLULUI SAPROPELIC DE TEGHIRGHIOL ASUPRA
TEGUMENTULUI.
Olga Surdu
medic primar rmfb, drd, Sanatoriul Balnear si de Recuperare
Techirghiol

,
2

53

II. COMUNICRI
Obiectiv
Evidentierea modificarilor citometrice ale componentelor
tegumentare sub actiunea aplicatiilor terapeutice cu namol
sapropelic de Techirghiol.
Material si metoda
Au fost alcatuite 4 loturi de studiu din cate 10 pacienti,
dupa cum urmeaza:
1. lotul martor care nu a efectuat aplicatie de namol;
2. lotul pacientilor ce au efectuat aplicatia rece, dupa
metoda antica egipteana;
3. lotul pacientilor care au efectuat impachetare generala
de namol;
4. lotul pacientilor care au efectuat baia generala de namol.
Tuturor acestor pacienti le-au fost prelevate fragmente
tegumentare din regiunea deltoidiana la sfarsitul curei balneare. .ragmentele au fost fixate cu formol 10%, incluse la parafina
si dupa sectionarea lor cu microtomul au fost colorate dupa
metodele conventionale de lucru din histologie. Citirea a fost
facuta la microscopul optic si datele au fost interpretate statistic.
Cuvinte cheie: peloidoterapie, tegument/structura

C 47
STUDIUL VARIATIEI IN TIMP A COMPOZITIEI CHIMICE A
NAMOLULUI SAPROPELIC DE TECHIRGHIOL DE LA
EXTRACTIE PANA LA .INALUL APLICATIEI
TERAPEUTICE.
Olga Surdu

, Carmen Tebrencu 2 , Vorica Marin 1 , Daniela

Profir 1
1 Medic primar rmfb, drd, Sanatoriul Balnear si de Recuperare
Techirghiol
2 C.P.I Dr. ing., SC Centrul de Cercetare si Prelucrare Plante
Medicinale Plantavorel SA, Piatra Neamt.
1

Obiectiv
Analiza chimica globala si sistemica a peloidului extras
din zacamantul subacvatic in scop terapeutic in conditiile
0 C), sub actiunea aerului, (pe o
expunerii la temperatura (55
durata de timp determinata) si in cursul aplicatiei terapeutice.
Material si metoda
Echipamentele de lucru au fost: spectrofotometru de
absorbtie atomica SHIMADZU AA-620, cuptor de calcinare,
balanta analitica Precisa, termobalanta Sartorius, baie de apa
electrica Precisterm, agitator magnetic. Ca reactivi pentru
mineralizarea probelor s-au folosit: acid clorhidric, d=1,18: acid
azotic d=1,40; azotat de magneziu 10%; perhidrol 30%.
Materialele de referinta sunt solutii cu concentratii cunoscute
ale elementului care se dozeaza in stabilirea curbei de etalonare.
Analiza namolului a cuprins:
1. caracterizarea fizico-chimica globala (pH, densitate,
granulometrie,determinarea apei, a substantelor volatile, a
substantelor minerale);
2. analiza chimica sistemica a cuprins:
w analiza substantelor organice (substante humice, azot
organic total, celuloza, substante grase, bitumine, pectine);
w analiza continutului mineral (silicatii, hidrogenul
sulfurat total si legat, bazele schimbabile);
Concluzii
Studiul a scos in evidenta stabilitatea componentelor
chimice cu rol terapeutic: substantele humice, bituminele,
substantele minerale. Scaderea valorii concentratiei unor
compusi (grasimi, proteine, compusi cu sulf, carbon organic)
nu influienteaza potentialul terapeutic al namolului. La momentul redactarii rezumatului nu este finalizata analiza statistica a
variatiei compozitiei chimice dupa aplicatia terapeutica.
Cuvinte cheie: peloidoterapie, namol/compozitie chimica

C 48
ANALIZA NMOLULUI SAPROPELIC DE TECHIRGHIOL N
SCOPUL OBINERII UNUI BIOCOMPLEX INJECTABIL CU
ACIUNE TERAPEUTIC

Olga Surdu 1 , Gabriela Stanciu 2 , Simona Lupor

Medic primar rmbft, drd, Sanatoriu Balnear i de recuperare
Techirghiol

Confereniar dr., farnacist, Departamentul de Chimie,

Universitatea Ovidius Constana
3 Preparator universitar drd., Departamentul de Chimie,
Universitatea Ovidius Constana
2

Ultimile studii riguroase despre mecanismele de aciune

i efectele nmolului au fost efectuate n anii 60- 70 ai secolului trecut i au evideniat efectele fiziologice de reglare neurovegetativ i metabolic. Atunci a fost descris metodologia de
efectuare a curei balneare n scop preventiv, terapeutic i
recuperator. Nu exist n momentul actual pe piaa farmacologic
nici un preparat injectabil extras din nmol.
Prin studiile ntreprinse s-a urmrit realizarea unui produs
natural din nmolul sapropelic de Techirghiol pentru administrare parenteral, produs care n momentul actual nu se gsete
n uzul terapeutic din ar sau din strintate.
Nmolul este un sistem fizico-chimic eterogen alctuit
dintr-o faz lichid reprezentat de ap i sruri minerale, o
faz solid ce conine dou structuri distincte: una cristalin i
una coloidal i o faz gazoas care conine hidrogenul sulfurat.
Compoziia chimic a nmolurilor difer dup originea i modul
lor de formare, existnd diferene mari n ceea ce privete
coninutul lor n substane lipo- i hidrosolubile. O orientare
global asupra chimismului nmolurilor reiese din calculul n
procente al coninutului sau n ap, n substane minerale i n
substane organice.
Substanele minerale dozabile se gsesc att n faz
lichid ct i n faz solid.
A fost efectuat o analiz fizico-chimic a nmolului din
Lacul Techirghiol utiliznd metode moderne de investigaie.
Metalele grele au fost determinate prin absorie atomic utiliznd
spectrofotometrul GBC-AVANTA (aer / flacra de acetilen).
Prezena metalelor n nmoluri dar i n apa lacurilor de
provenien i n extractul de nmol deschide i o alt
perspectiv terapeutic tiut fiind faptul c metalul intr n
componena enzimelor (metal-enzimele) sau sunt o prezen
indinspensabil pentru desfurarea unor activiti enzimatice
(catalizatori).
Extractele obinute la rece i la cald, n diferii solveni (eter
etilic, cloroform, metanol) au fost analizate n vederea identificrii
i determinrii cantitative a compuilor organici.
Substanele organice, avnd structur coloidal, provin
din fito- i zooplanctonul bazinului acvatic, din resturile vegetale i animale descompuse. Complexul organic din nmoluri este
reprezentat de: hidrai de carbon (celuloz), lignin
(hemiceluloz), componente humice (acizi humici i humai),
componente bituminoase (ceruri i rini), componente lipidice
i proteice, aminoacizi. Cantitatea n care se gsesc aceste
substane n nmoluri variaz de la un zcmnt la altul.
Acizii humici, alturi de sruri minerale i mpreun cu
H S au efecte terapeutice acionnd prin intermediul pielii.
2

C 49
BENE.ICIUL EXERCIIULUI .IZIC N RECUPERAREA
GONARTROZEI SECUNDARE
Rodica Tristaru, Roxana Popescu, V.N.Prvulescu
UM., Craiova
Scop
Dei reprezint un stres fiziologic care acioneaz asupra
organismului, efortul fizic are un efect benefic dovedit.
n studiul prospectiv efectuat am urmrit rezultatele programului de recuperare, fundamentat pe kinetoterapie, la
pacienii cu gonartroz bilatearal secundar.
Material i metod
Lotul studiat a cuprins 74 pacieni (48 femei, 26 brbai)
cu limitele de vrst ntre 34 - 68 ani. Subiecii au fost evaluai
clinico-funcional, imagistic (radiologic i echografic) i
oscilometric (membre inferioare). S-au folosit scalele VAS pentru durere i scor WOMAC pentru statusul funcional. S-a aplicat

54

II. COMUNICRI
un program de recuperare (educaional, igieno-dietetic,
medicamentos, fizical-kinetic) zilnic, 14 edine.
Rezultate
Monitorizarea clinico-funcional s-a realizat n 3 timpi (T1iniial, T2-dup terminarea programului recuperator i T3 la 8
sptmni de la evaluarea iniial). Parametri urmrii au avut
evoluie favorabil (predominant n T2). Evoluie net favorabil,
cu semnificaie statistic, au avut pacienii care au derulat anterior, n cursul vieii, exerciii fizice uoare i moderate.
Concluzii
Rezultatele studiului confirm datele din literatura de specialitate cu privire la efectul favorabil complex (clinic, funcional,
paraclinic) al exerciiului fizic terapeutic uor i moderat, derulat
constant de ctre pacienii cu gonartroz secundar, fr a exista
riscul declanrii sau favorizrii procesului de osteoartrit.
Ameliorarea parametrului durere concord cu aspectele
ecografice, fiind dovedit efectul negativ al durerii asupra
contraciei musculare voluntare i a rezistenei musculare n
timpul contraciilor submaximale.
Programul kinetic efectuat cu regularitate, corelat cu o diet
corespunztoare determin modificri n bine ale stilului de via
la pacientul cu gonartroz secundar compensat.
Cuvinte cheie: exerciiu fizic, gonartroz secundar, recuperare
THE PHYSICAL EXERCISE BENE.ITS IN SECONDARY
KNEE OSTEOARTHRITIS REHABILITATION
Rodica Tristaru, Roxana Popescu, V.N.Prvulescu
UM., Craiova
Aim
Although physical effort represents a physiological stress
into whole body, it was proven its benefic effects. In our
prospective study, we mentioned the results of rehabilitation
program, based on the kinetic aspects, in the patients diagnosed
with bilateral secondary knee osteoarthritis.
Material and methods
We studied seventy-four patients (48 women, 26 men),
aged between 34 - 68 years. All patients were clinical, functional,
imagistic (X rays and sonography) and oscilometric point of
view (lower limbs). We used VAS scale for pain and WOMAC
index for functional status. It performed a complex rehabilitation
program (educational, dietetic, pharmacological , physical kinetic), 5 days / week, 2 weeks.
Results
Patients were evaluated at baseline (T1) and at 2 (T2)
and 8 (T3) weeks. The studied parameters had a good
evolution, especially in T2 moment. Patients that presented a
previous regular exercise for lower limb (submaximal exercise)
showed a statistic significantly improvement for the studied
parameters.
Conclusions
The results of our study confirm the data into medical
literature about the favorable complex effect (clinical, functional
and sonographic) of regular and therapeutic submaximal
exercise performed in the patients with secondary knee
osteoarthritis. At these patients is no risk of accelerating knee
arthritis.
The pain improvement is correlated with sonographic
aspects. It is known that pain reduces maximal voluntary
contraction and endurance time during submaximal contractions.
These aspects have morphological consequences.
The regular kinetic program correlated with correct diets
determines beneficial changes of the life style in the patients
with secondary knee osteoarthritis.
Key words: physical exercise, secondary knee
osteoarthritis, rehabilitation

C 50
ROLUL KINETOTERAPIEI N RECUPERAREA COMPLEX
A PACIENILOR VIRSTNICI
Viorica Viorica Lefter, medic primar B.T Lacu Srat
Oana Andreea Cibu, medic stagiar Spitalul Judeean Brila
Literatura de specialitate, legat de patologia locomotorie
a vrstnicului, (generatoare de disfuncii ale aparatului
locomotor, ce creeaz dificulti n activitile zilnice), consider c un program kinetic, adaptat dizabilitilor constatate i
suferinelor asociate, riguros aplicat poate constitui o ipotez n
obinerea unui ADL (Activities of Daily Living) normal i ar reduce dependena funcional a persoanelor vrstnice.O.M.S.,
mparte vrstele, ncepnd de la 45 de ani, n: vrsta medie
45-59 de ani, vrstnici: 60-74 de ani; btrni: 75-89 de ani,
longevivi:90 de ani i peste.
Scopul lucrrii de fa este: de a institui un tratament
prevenional i recuperator pentru obinerea i meninerea
independenei totale la pacientul vrstnic i realizarea unor
programe kinetice complexe ce pot fi efectuate la domiciliu.
Materialul i metoda
Acest studiu a fost efectuat prin evaluarea si urmrirea
direct a 120 de cazuri luate n studiu n perioada mai 2004
aprilie 2005 n staiunea Lacul Srat . Dintre cei 120 de pacieni,
72 au fost de sex masculin reprezentnd 60%, i 48 de sex
feminin, reprezentnd 40%: pacienii provin din zone limitrofe ale
staiunii Lacul Srat : Galai, Vrancea, Tulcea, Brila, Bucureti:
66 din mediul rural 55% i 54 din mediul urban 45%, fiind toi
pensionari care au muncit n diferite medii.Lotul de studiu a
cuprins: 30 pacieni cu artroza minii 25%, 31 pacieni cu
gonartroz 25,%, 32 cu coxartroz 25,7%, 18 pacieni cu
spondiloz, 15%, 12 cu lombosciatic, 5% prin spondiloz
lombar 10%, la care se adaug afeciunile asociate: HTA
22,5%, obezitate gr.ll i lll 35%, CIC 15,7%,ASC 10,3%,
afeciuni vasculare periferice 17,5%. Pentru pacienii cu dizabiliti
generate de coxartroz programul a cuprins exerciii avnd ca
obiectiv: mbuntirea mersului, a urcatului i cobortului scrilor,
creterea mobilitii, creterea rezistenei la efort minimal i mediu.
La pacienii cu artroza minii, programul a cuprins exerciii
complexe de creterea mobilitii n vederea prehensiunii,
exerciii efectuate pe placa canadian, scri, manivel, terapie ocupaional n vederea autoservirii.Ca metod de cercetare
am efectuat un test iniial pentru evaluarea durerii i
funcionalitaii tip: Indexului .uncional WOMAC (Westen Ontario MacMaster University) care cuprinde 6 ntrebri i Indexul
.uncional Dreisser care cuprinde 10 ntrebri , testul HARRIS,
testingul muscular i articular.Testarea final a scos n eviden
o mbuntire semnificativ a mersului i abilitii, lotul de studiu
neavnd nici un pacient dependent total. La externare, programul kinetic a fost tiprit i nmnat pacienilor pentru fiecare
categorie de patologie, program pe care urmau s-l efectueze
la domiciliu de cel puin 2 ori/ sptmn.
Concluzii i propuneri
n urma prelucrrii i interpretrii datelor iniiale i finale,
se confirm ipoteza c tratamentul kinetic amelioreaz evident
deficitul funcional att pe aparatul locomotor ct i pe afeciunile
aparatelor asociate (cardio-vascular, respirator, metabolic i
nervos). Beneficiul funcional pentru artroza minii a avut valori
cuprinse ntre 14-23% cu o medie de 18,5%; pentru cozartroz
18-54% cu o medin de 36%; pentru gonartroz ntre 17-56% cu
o medie de 36,5%. Studiul nostru concluzioneaz faptul c
pacientul vrstnic trebuie integrat ntr-un program de recuperare complex funcie de handicapul constatat pentru durata ntregii
viei.Programul kinetic, n decursul unei internri de 18 zile este
doar iniiatorul recuperrii pacientului vrstnic. Medicul
recuperator mpreun cu medicul geriatru, vor ntocmi fie ADL
pentru fiecare bolnav n parte i fiecare dizabilitate constatat,
ce vor fi trimise ca scrisoare medical medicului de familie pentru continuarea tratamentului la domiciliu.

III.

P1
CALITATEA VIEII LA SECHELARII POST AVC INCLUI
N PROGRAME DE RECUPERARE MEDICAL PRECOCE
Bogdan Anatole, Sebastian Diaconescu, Carmen Logoftu,
Gina Glbeaz, Simona Onofrei, Gabriela Udvuleanu,
Cristian Bodescu, Iolanda Hanna, Delia Cintez
INRM.B
Premise
Nivelul de activitate fizic i de fitness influeneaz
sntatea, calitatea vieii i longevitatea, afirmaie valabil nu
doar pentru cei sntoi, ci i pentru sechelarii postAVC. Pentru acetia din urm, prognosticul funcional i calitatea vieii
sunt direct influenate de rapiditatea cu care revin la un stil de
via activ, contracarnd astfel efectele imobilizrii prelungite,
cu toate efctele secundare ale acesteia.
Obiectiv
Determinarea influenei programelor de recuperare medical precoce asupra calitii vieii la supravieuitorii post AVC
Determinarea influenei nivelului iniial de infirmitate i
disfuncie asupra calitii vieii.
Material i metod
Studiul prospectiv, controlat, randomizat a cuprins 57 de
pacieni internai n clinica de Recuperare Medical III ntr-un
interval de1 an; n funcie de vechimea accidentului vascular
cerebral, subiecii au fost mprii ntr-un grup A, de 30 de
pacieni, cu o vechime de cel mult 5 sptmni a afeciunii i
un grup martor (B), cu o vechime mai mare de 3 luni i mai mic
de 6 luni. Parametrii urmrii au fost cei de infirmitate neurologic,
disabilitate i calitate a vieii i au fost msurai la internare, la 4
sptmni i la 6 luni.
Rezultate i discuii
Cele dou loturi au fost omogene n ceea ce privete
variabilele demografice i tipul de AVC. Lotul B a cuprins pacieni
cu scoruri mai mari pentru spasticitate, n schimb lotul A a prezentat deficit de for muscular semnificativ mai important.
Indicatorii funcionali au prezentat valori initiale superioare pentru
lotul B, chiar dac la limita semnificaiei statistice, pentru ca la 4
sptmni lotul A s prezinte indicatori funcionali mai buni. La
6 luni, indicatorii funcionali i indicatorii de calitate a vieii au
prezentat o bun corelaie i au avut valori semnificativ statistic
mai bune, comparativ cu lotul martor.
Concluzii
Iniierea precoce a programelor de recuperare medical
post AVC se asociaz cu scoruri funcionale superioare
programelor ncepute tardiv (dup 3 luni). Calitatea vieii acestor
pacieni se coreleaz cu nivelul iniial de infirmitate neurologic,
respectiv de disabilitate i este puternic influenat de iniierea
precoce a recuperrii.
LI.E QUALITY O. THE PATIENTS WITH SEQUELAS
POST STROKE INCLUDED IN PRECOCIOUS
REHABILITATION PROGRAMS
Bogdan Anatole, Sebastian Diaconescu, Carmen Logoftu,
Gina Glbeaz, Simona Onofrei, Gabriela Udvuleanu,
Cristian Bodescu, Iolanda Hanna, Delia Cinteza
INRM.B
Premises
The level of physical and fitness activity influence health,
life quality and longevity, this is a valid affirmation not only for
health people also for patients with sequelas post stroke. .or
these patients functional prognostic and life quality are directly
influenced of the fast returning to an active life style, thus
counteract the effects of sustained immobilization.

55

POSTERE

Objective
To determine the influence of precocious medical
rehabilitation programs towards life quality of the stroke
survivors.
To determine the influence of the initial level of invalidity
and disfunction towards life quality.
Method and material
The study involved 57 patients hospitalized in Medical
Rehabilitation Clinic the III ,during 1 year depending on the
oldness of the stroke, the subjects were divided in an A group,
with 30 patients whose affection was of 5 week old and group
witness B with oldness more then 3 months and less then 6
months. The parameters pursued were the neurological infirmity,
disability and life quality and were measured at hospitalization ,
to 4 weeks and 6 month.
Results and disscutions
All 2 groups were unitary regarding the demographic
variables and stroke type. Group B involved patients with great
spastic scores in exchange group A had important muscular
force deficit. .unctional indicators describe superior initial values
for the B group even if on the statistic limit, therefore at 4 weeks
group A describe better functional indicators. At 6 month,
functional indicators and life quality indicators describe a good
correlation and had significant good statistic values, comparative with witness group.
Conclusions
Precocious initiation of medical rehabilitation programs
post stroke is associated with functional superior scores for
tardy start programs (after 3 month). The life quality of these
patients is correlated with initial neurological infirmity level, respective of disability and is strong influenced of precocious
initiation of rehabilitation.

P2
ASPECTE PRIVIND ETIOPATOGENIA SINDROMULUI DE
IMPINGEMENT LA SPORTIVII DE PER.ORMAN
Bogdana Anton
2

, Mihai Berteanu 2 , Alexandru Buzescu

1 ANE.S, Bucuresti
UM. Carol Davila , Bucureti
1

Sindromul de impingement ( impingement syndrom ) este

una dintre cele mai frecvente forme de PSH, ocupnd un loc
important n cadrul patologiei de suprasolicitare a sportivilor de
performan.
Scop
Lucrarea de fa reprezint un studiu constatativ-aplicativ
n scopul stabilirii incidenei acestei afeciuni localizate n cadrul
lotului de subieci studiat i evidenierii factorilor cauzali i/sau
favorizani ai acestei patologii, n vederea elaborrii unei strategii
preventive optimizate de ctre antrenor preparator fizic medic
kinetoterapeut psiholog.
Material si metode
n cadrul studiului iniiat, am analizat 590 de fie medicale
ale sportivilor de performan, componeni ai echipelor
divizionare A sau ai loturilor reprezentative de seniori, tineret i
juniori ale Romniei, de handbal, volei, nataie i gimnastic
sportiv, ramuri sportive n care trenul superior este solicitat cu
precdere n special articulaia umrului.
Rezultate i discuii
Din cei 590 de subieci analizai, 180 (30,5%) au prezentat afeciuni de suprasolicitare la nivelul umrului. Solicitarea
maxim necesar perfomanei duce la apariia unui numr mare
de forme anatomo-clinice de natur hiperfuncional n articulaia
umrului sportivului de performn, (8 n studiul iniiat) n

56

III. POSTERE
concordan cu caracteristicile biomecanice ale sportului
practicat.
.ormele anatomo-clinice cele mai frecvente raportate la
ntreg lotul studiat au fost: tendinita 33,98%; entezita 31,55%;
sindromul de impingement 8,74%, ceea ce corespunde datelor
din literatura de specialitate conform crora cele mai multe leziuni
ntlnite n patologia sportiv se produc la nivelul tendoanelor,
datorit aprovizionrii vasculare precare, suprasolicitrii, forelor
repetate de frecare i traciune plasate asupra lor. Repartiia pe
sexe a cazurilor inregistrate cu sindrom de impingement al
umarului a fost: 11,3% in cadrul lotului feminin (pe locul trei in
cadrul patologiei de suprasolicitare a umarului) si de 5,4% in
cadrul lotului masculin (locul 5).
Raportat la ramura sportiva practicata, incidenta
sindromului de impingement al umarului a fost: pe primul loc sa situat voleiul cu 11,42 % din numrul de cazuri nregistrate;
pe locul doi s-a situat handbalul cu 11,39%; pe locul trei natatia
cu 6,06% din numrul total de cazuri nregistrate, pe locul patru
gimnastica sportiv cu 3,84%.
Cocluzii
Suprasolicitrile impuse de marea performan,
dezechilibrele dintre solicitrile biomecanice ale efortului sportiv
i rezistena funcional a esuturilor, determin o inciden
crescut a sindromului de impingement al umrului la sportivi.
Cauzele i mecanismele de producere sunt att comune,
ct i specifice fiecrei discipline n parte.
Valoarea sczut a forei musculare a centurii scapulare
favorizeaz apariia sindromului de impingement la toi sportivii
care practic activiti repetitive n articulaia umrului.
Sindromul de impingement al umrului necesit, prin natura simptomatologiei, de multe ori un numr crescut de zile de
repaus; de aceea repausul general trebuie acordat numai n
cazuri excepionale, cel mai frecvent fiind recomandat repausul
segmentar.

oxygen consumption favor the appearance of impingement

syndrome which was proven by calculation and regression.

P3
TENDINOPATIA DE SUPRASPINOS LA SPORTIVII DE
PER.ORMAN
Bogdana Anton

, Mariana Cordun 1 , Mihai Berteanu

ANE.S, Bucuresti
2 UM. Carol Davila , Bucureti

, Mihai Berteanu 2 , Alexandru Buzescu

1 ANE.S, Bucharest
UM. Carol Davila , Bucharest
1

Shoulder impingement syndrome involves the

compression of a shoulder muscle tendon, the shoulder bursa
(a lubricating sac that helps with the sliding of tendons), and the
long head of the biceps tendon, all of which are located under
the top part of the shoulder blade called the acromion arch.
Impingement (pinching) most often occurs in repetitive overhead
activities such as swimming, skiing, serving a tennis ball, spiking
a volleyball, throwing a ball, or jobs involving overhead reaching.
Purpose.
- to establish the incidence of this pathology within the
group of subjects under study
- to determine the causal and/or favoring factors.
Material and methods
The study was performed on 590 Romanian top athletes,
part of handball, volleyball swimming and gymnastics teams,
between 1999-2003. .or each subject we analyzed the following
parameters: the muscular tonus, the muscular force of the
scapula, the heart rate, the aerobic and anaerobic power.
Results and discussions
Out of the 590 subjects, 8,74 % presented impingement
syndrome. Sex distribution of this pathology was: 11.3% in
female group and 5.4% in male group
Conclusion
The analysis of morbidity proves the incidence by
impingement syndrome was 8.74%.
As for sports branch, the incidence was: volleyball on the
first place, 11.42%, handball on the second, 11.30%, swimming
on the third place 6.06% and gymnastics on the last place
3.84%.
The low values of the scapula force and of the maximum

SHOULDER IMPINGEMENT SYNDROMES IN ATHLETES

ETIOPATHOGENIC ASPECTS
Bogdana Anton

Introducere
Leziunile degenerative ale tendoanelor de la nivelul
umrului sunt extrem de frecvente, cel mai afectat fiind tendonul
supraspinosului. Este cauzat de suprasarcini excesive i
repetitive, cu aparitia microtraumatismelor la nivelul tendonului
muchiului supraspinos. Aceast form este ntlnit mai ales
la sportivii (nottori, halterofili, handbaliti, aruncatori, tenismeni)
care execut micri repetate ale braelor deasupra planului
orizontal (90 fa de trunchi), suferina aprnd pe partea cea
mai solicitat.
Scop
Prezentul studiu are ca scop stabilirea incidenei acestei
afeciuni n cadrul lotului de subieci studiat i evidenierea
factorilor cauzali i/sau favorizani ai acestei patologii.
Material si metod
Studiul a fost efectuat pe un eantion de 590 sportivi de
performan, componeni ai echipelor divizionare A sau ai
loturilor reprezentative de seniori, tineret i juniori ale Romniei, de handbal, volei, nataie i gimnastic sportiv, ramuri sportive n care trenul superior este solicitat cu precdere n
articulaia umrului.
Rezultate i discuii
Tendinita a fost ntlnit n procent ridicat de 33,98%, ceea
ce corespunde datelor din literatura de specialitate conform
crora cele mai multe leziuni ntlnite n patologia sportiv se
produc la nivelul tendoanelor, datorit aprovizionrii vasculare
precare, suprasolicitrii, forelor repetate de frecare i traciune
plasate asupra lor. Repartiia pe sexe a cazurilor nregistrate a
fost: 33,3% n cadrul lotului feminin i de 66,6% n cadrul lotului
masculin.
Raportat la ramura sportiv practicat, incidena a fost:
pe primul loc s-a situat gimnastica sportiv; pe locul doi s-a
situat handbalul, pe locul trei nataia, pe locul patru voleiul.
Concluzii
Suprasolicitrile impuse de marea performan,
dezechilibrele dintre solicitrile biomecanice ale efortului sportiv
i rezistena funcional a esuturilor, determin o inciden
crescut a tendinopatiei de supraspinos la sportivi.
Cauzele i mecanismele de producere sunt att comune,
ct i specifice fiecrei discipline n parte.
Valoarea sczut a forei musculare a centurii scapulare
favorizeaz apariia acestei patologii la sportivii care practic
activiti repetitive n articulaia umrului.
SUPRASPINATUS TENDINOPATHY IN PER.ORMANCE
ATHLETES
Bogdana Anton

, Mariana Cordun 1 , Mihai Berteanu

ANE.S, Bucharest
2 UM. Carol Davila , Bucharest
1

Introduction
Supraspinatus tendinopathy is a common cause of
shoulder pain in athletes whose sports involve throwing and
overhead motions.
Purpose
This research aims at determining this pathology incidence
within the group of subjects under study and its emphasizing
causal and/ or favoring factors.
Materials and methods
The study was performed on 590 Romanian top athletes,

57

III. POSTERE
part of handball, volleyball, swimming, and gymnastics teams,
under the supervision of the National Institute of Sports Medicine, between 1997 and 2003.
Results and discussions
The pathology registered a high percent 33.98%, this
corresponding to the data in specialty literature, according to
which the most sports injuries occur at tendon level. Sex
distribution was: 33.3% in female group and 66.6% in male
group. As for the sports branch, the incidence was: gymnastics
on the first place, handball on the second place and swimming
and volley-ball on the third place.
Conclusions
The overuse imposed by top performance, the unbalance
between biomechanical exertions of sports effort and tissue
functional resistance, determine a high incidence of
supraspinatus tendinopathy in athletes.
Their causes and producing mechanisms are both
common and specific to each sports discipline. The low value of
shoulder girdle muscular strength favor this pathology in athletes
practising repetitive movements in shoulder joint.

P4
UMRUL DUREROS AL INOTTORULUI DE
PER.ORMAN
Bogdana Anton

, Mihai Berteanu 2 , Anca Ionescu

ANE.S, Bucuresti
UM. Carol Davila , Bucuresti
1

Introducere
Umrul dureros (UD) sindrom provocat de lezarea
esuturilor subacromiale, este cea mai comun leziune musculoscheletal de suprasolicitare n not, att n rndul adolescenilor,
care pot avea programe de antrenament riguroase i au scheletul
imatur dezvoltat, ct i n rndul nottorilor de performan. Ea
este prezent ntr-o proporie cuprins ntre 9% i 35% la
nottorii de elit, iar 38%-75% dintre acetia au antecedente
legate de durerea in umr.
Umrul nottorului este un sindrom care apare n special la cei care practic stilul de not liber sau fluture.
Suprasolicitarea muchilor inelului rotatorilor, disfuncia
scapular i laxitatea umrului contribuie la apariia patologiei,
sportivul acuznd o durere la nivelul umrului anterior n timpul
notului sau dup antrenament. Ea poate interfera cu micarea
braului sau poate fi asociat cu o anumit faz a micrii, n
funcie de stilul folosit de nottor, distana pe care acesta noat
de obicei i intensitatea antrenamentului
Obiectiv
Prezentul studiu are ca scop stabilirea gradului de corelatie
si/sau asociere intre incidenta acestei patologii in cadrul lotului
de subiecti studiat si valorile unor indicatori fiziologici si
functionali caracteristici efortului specific.
Material si metoda
Studiul a fost efectuat pe un esantion de 125 de subiecti
componenti ai cluburilor si loturilor reprezentative ale Romaniei.
Sportivii au fost investigati in Laboratorul de Traumatologie
Sportiva din cadrul Institutului National de Medicina Sportiva
Bucuresti, pe o perioada cuprinsa intre anii 1999-2003.
Pentru fiecare subiect apartinand lotului ce a prezentat
patologia de suprasolicitare am analizat valorile unor parametrii functionali: tonus muscular, forta musculara a centurii
scapulare, consum maxim de O
, frecventa cardiaca de repaus/
2
post efort, STT/watt/kg.
Rezultate si discutii
Din cei 125 de subiecti analizati, 51,10% au prezentat
afectiuni de suprasolicitare in articulatia umarului. S-au inregistrat
66 de cazuri, din care 35,39% la sexul masculin si 64,61% la
sexul feminin. Repartitia formelor anatomo-clinice in functie de
partea lezata a fost: pe partea dreapta (36,36%); pe partea stanga (16,66%); bilateral (46,98%).
Dintre diagnostice mentionam: tendinita (39,39%), entezita

(28,78%), miozita (10,6%), mioentezita (4,54%), sindrom de

impingement (6,06%), bursite (10,63%).
Concluzii
Suprasolicitarile impuse de marea performanta,
dezechilibrele dintre solicitarile biomecanice ale efortului sportiv
determina o incidenta crescuta a leziunilor de suprasolicitare in
articulatia umarului la inotatorii de performanta. Valori scazute
ale consumului maxim de oxigen, fortei musculaturii centurii
scapulare, tonusului muscular al muschiului biceps drept/stang
in contractie si crescute in relaxare, in cadrul evaluarilor efectuate anterior momentului diagnosticarii, favorizeaza aparitia
leziunilor de suprasolicitare in articulatia umarului.
SWIMMER S PER.ORMANCE SHOULDER
Bogdana Anton

, Mihai Berteanu 2 , Anca Ionescu

ANE.S, Bucharest
2 UM. Carol Davila , Bucharest
1

Introduction
Swimmer s shoulder is one of the most common injuries.
This condition a chronic irritation of the shoulder s joints and/
or soft tissues is thought to affect 35 percent of swimmers.
Objective
The paper, based on findings and applications, aims at
emphasizing the causal and/or favoring factors of this pathology
within the group of subjects under study and the value of certain
physiological and functional parameters characteristic to specific
effort.
Subjects and method
The study was made on a sample of 125 subjects,
members of the Romanian representative clubs and teams. The
athletes were investigated at the Traumatology Lab within the
Bucharest National Institute of Sports Medicine between 1999
and 2003.
.or each subject, we also analysed the values of some
functional parameters: muscular tonus, muscular strength of the
shoulder girdle, maximum oxygen consumption, heart rate at
rest and after an effort, STT/watt/kg.
Results and discussions
Out of the 125 subjects investigated, 51.10% presented
overuse injuries of the shoulder joint. We registered 66 cases,
out of which 35.39% in males and 64,61% in females. The
distribution of the anatomical-clinical forms, depending on the
injured side was: 24 on the right side (36.36%); 11 on the left
side (16.66%); 31 bilateral (46.98%).
Among the diagnoses, we mention: tendinitis (39.39%),
enthesitis (28.78%), myositis (10.6%), myoenthesitis (4.54%),
impingement syndrome (6.06%), bursitis (10.63%).
Conclusions
The exertions imposed by the great performance, the lacks
of balance among the biomechanical strains of the sports effort
determine a high incidence of the overuse injuries of the shoulder
joint in performance swimmers. Low values of the maximum
oxygen consumption, of the shoulder girdle muscular strength,
of the muscular tonus of the right/ left biceps muscle under
contraction and relaxation conditions, within the evaluations
made before the diagnosis moment favor the producing of this
pathology type.

P5
LEZIUNEA DE NERV PERONIER PRIN SINDROM
COMPARTIMENTAL POST TRAUMATIC
Ruxandra Badea, Mihai Berteanu, Luminia Dumitru, Eduard
Neagu, Mirela Boian, Gina Comnescu
Spitalul Universitar de Urgen Elias, Clinica de Recuperare
Medical
Prezentare de caz
Prezentm cazul unui pacient de 36 ani, implicat ntr-un
accident rutier (august 2004) soldat cu fractur cominutiv cu

58

III. POSTERE
nfundare de hemiplantou tibial extern drept, operat cu
osteosintez, fractur peroneu drept, parez nerv peronier drept
prin contuzie direct, sau postoperator conform afirmaiei
pacientului, entors gr.II glezn dreapta.
Acesta a fost internat n Clinica de Recuperare Medical
a Spitalului Universitar de Urgen Elias n noiembrie i decembrie 2004 pentru durere paralizie de nerv peronier i recuperarea mobilitii n articulaiile genunchiului i gleznei drepte.
Examenul obiectiv a evideniat la nivelul genunchiului drept
imposibilitatea micrii de flexie, edem important al gambei,
imposibilitatea micrii de flexie dorsal a piciorului drept.
Pacientul se deplasa cu sprijin n cadru, fr ncrcarea la nivelul membrului inferior drept.
Pareza de nerv peronier a fost obiectivat prin examenul
EMG (absena oricrei activiti electrice, inclusiv semne de
denervare). S-a suspicionat clinic un sindrom compartimental
la nivelul gambei drepte confirmat n urma unei ecografii de
esut moale.
Programul de recuperare a avut ca scop reeducarea
mersului, diminuarea edemului i a simptomatologiei algice la
nivelul gambei i a constat n electrostimularea musculaturii
dorsiflexoare a piciorului, kinetoterapie, hidrokinetoterapie,
crioterapie, masaj de drenaj. n completare a beneficiat i de
medicaie AINS, antialgic, neurotrofic i psihoterapie.
Evoluia a fost favorabil cu remiterea edemului gambier,
ameliorarea flexiei n articulaia genunchiului, refacerea nervului
peronier confirmat electromiografic i obiectivat prin iniierea
flexiei dorsale a piciorului, pacientul trecnd progresiv la mersul
cu sprijin ntr-o crj.
Particularitatea cazului o reprezint sindromul
compartimental aprut sub aparat gipsat ce s-a suprapus peste
leziunea focal a nervului peronier la nivelul capului osului
peronier. Sindromul compartimental a fost suspicionat clinic,
diagnosticat EMG, confirmat ecografic.
Cuvinte cheie: sindrom compartimental, leziune nerv
periferic, recuperare
THE LESION O. LATERAL POPLITEAL NERVE (LPN)
CAUSED BY POSTRAUMTATIC COMPARTMENTHAL
SYNDROME
Ruxandra Badea, Mihai Berteanu, Luminia Dumitru, Eduard
Neagu, Mirela Boian, Gina Comnescu
Spitalul Universitar de Urgen Elias, Clinica de Recuperare
Medical
Case report
We are presenting the case of a 36 years old patient,
involved in a car accident, with next consequences: facture of
proximal end of a right tibia, fracture of head of right fibula,
paresis of LPN by bruise or after surgical intervention and strain
of right foot.
The patient was hospitalized in our clinic in November and
December last year for pain, paresis of LPN, rehabilitation of
motion in right knee and foot. Objective, we established:
impossibility knee s flexion, significant oedema of shank, paresis
of LPN. The patient walked with support.
Paresis of LPN was confirmed by EMG. We suspected
compartmental syndrome by clinicalexamination who was
confirmed by echography.
We proposed walk s rehabilitation, diminution of oedema
and pain/ the patient benefited of kinetotherapy,
hydrokinetotherapy, cryotherapy, draining massage, pain
medication and psychotherapy.
The evolution was good, with recovery of LPN, confirmed
EMG and by partial extension of foot.
The specific feature of this case was neglect
compartmental syndrome and paresis of LPN, diagnosed and
EMG and conformed echo.

P6
EVALUAREA RISCULUI DE CDERE LA PACIENII
OSTEOPOROTICI VRSTNICI I CORELAREA CU
CLEARENCE-UL CREATININEI
Ruxandra Badea, Mihai Berteanu, Luminia Dumitru,
Gina Comnescu
Spitalul Universitar de Urgen Elias, Clinica de Recuperare
Medical
Osteoporoza este o afeciune caracterizat prin scderea
densitii minerale osoase (DMO) i deteriorarea microarhitecturii osului ceea ce duce la creterea riscului de fractur. n
ultimi ani, osteoporoza a devenit o cauz de morbiditate,
disabilitate, o adevrat problem de sntate public.
Obiectiv
Studiul i propune s obiectiveze corelaia ntre valoarea
sczut a clearence-ului creatininei (CrCl) i riscul de cdere i
fractur la pacienii vrstnici cu osteoporoz, corelaie
menionat n literatura de specialitate nc din 2004.
Material i metod
Studiul a cuprins 20 de pacieni (18 femei i 2 brbai) cu
vrste peste 65 ani, diagnosticai cu osteoporoz. S-au avut n
vedere urmtoarele date referitoare la pacient:
metoda de diagnosticare a osteoporozei examen
radiologic/US/DEXA
numrul i tipul cderilor (sincopale/nesincopale) din
ultimul an
fracturile cauzate de osteoporoz n ultimul an: numr,
localizare, precedate sau nu de cderi
tratament antiosteoporotic
patologie musculo-scheletal asociat.
S-au efectuat trei tipuri de teste:
1. Chair rising text CRT (testul ridicatului de pe scaun)
2. Up and go test UGT
3. Tandem standing test TST (statul n tandem)
S-a determinat CrCl conform formulei Cockroft-Gault. CrCl
< 65ml/min crete riscul de cdere.
Rezultate
Din cei 20 de pacieni aflai n studiu, la 55% s-a obinut
un CrCl<65ml/min.
Dintre cei cu CrCl sczut 81,8% au efectuat CRT n >10
secunde, 18,2% nu au putut efectua CRT, 45,4% au efectuat
UGT n >20 secunde, 36,3% nu au putut efectua TST.
Concluzii
Se observ o corelaie important ntre nivelul sczut al
CrCl i creterea riscului cdere, obiectivat prin scderea activitii musculare de ansamblu (funcionalitate, for, coordonare). Patologia musculo-scheletal asociat (n special deficitele
motorii de tip hemiparetic) crete de asemenea riscul de cdere.
Concluzia final este c tratamentul osteoporotic ar trebui s
se adreseze n egal msur att sistemului osos ct i celui
muscular urmrind mbuntirea funcionrii sale prin exerciii
terapeutice i medicaie.
Cuvinte cheie: osteoporoz, risc de cdere, clearence-ul
creatininei
THE RISK O. .ALL AT AGED PATIENTS WITH
OSTEOPOROSIS
Ruxandra Badea, Mihai Berteanu, Luminia Dumitru,
Gina Comnescu
Spitalul Universitar de Urgen Elias, Clinica de Recuperare
Medical
Osteoporosis is a disorder characterized by a low bone
density, microarhitectural damage in bone tissue and a
consequent increase in risk fracture. It is a major cause of
morbidity, disability and public health.
Objective
By this study we are proposed to confirm correlation
between low creatinine clearence (CrCl) and falls and fractures
of aged patients with osteoporosis.

III. POSTERE
Material and method
We included in our study 20 patients (18 females and 2
means) aged 65 older, suffering from osteoporosis. We totaled
the next information:
- the method from diagnosis x-ray/densiometry/
ultrasound
- number and type of falls (syncopal/nonsyncopal)
within last year
- fractures caused by osteoporosis within last year
number localiyation, preceding or not by falls
- osteoporosis therapy
- musculo-skeletical diseases
We effected three kind of tests:
1. Chair rising test (CRT)
2. Up and go test (UGT)
3. Tandem standing test (TST)
We determinate the CrCl according to Cockcroft Gault formula. CrCl<65ml/min increase risk of fall.
Results
.rom 20 patients, at 55% we obtained CrCl<65ml/min. from
those with CrCl<65ml/min:
- 81,8% performed CRT over 10 seconds
- 18,2% not performed CRT
- 45,4% performed UGT over 20 seconds
- 36,3% not performed TST
Conclusions
We observed a major correlation between the low CrCl
and increase risk of fall, materialized by decrease of muscle
function (force, power and coordination). In conclusion, we
should treat muscle and bone as well by therapeutical exercise
and medication.

P7
ACHIZITII RECENTE PRIVIND STATEGIA DE RECUPERARE IN SPONDILITA ANCHILOPOIETICA
Banciu Mioara, Betereu Oana, Cord Claudia, Girban Delia,
Tomulescu Otilia, Bocioc Alina
SA necesita un diagnostic precoce si un program
terapeutic complex in care fiziokinetoterapia si balneoterapia
constituie o parte insemnata a tratamentului pentru mentinerea
unui potential maxim de miscare si prevenirea deformarilor
posturale.
Material si metoda
S-a studiat un numar de 126 pacienti, analizati in finctie
de stadiul, forma bolii, varsta, sex, mediu si profesie. Diagnosticul
clinic s-a stabilit conform criteriilor ACR modificate de van der
Linden si in care examenul radiologic si RMN au avut un rol
decisiv.
Inainte si dupa instituirea tratamentului s-au efectuat
evaluari ale:
1. functiei coloanei prin determinarea indicilor BAS.I si D.I.
2. durerii, inclusiv cea nocturna, prin VAS sau BASDAI.
3. mobilitatii coloanei (test Schoeber, distanta occiputperete, bilant articular) si a articulatiilor afectate (sold, genunchi,
articulatii periferice).
4. aprecierii globale de catre pacient (VAS la o saptamana)
5. reactantilor de faza acuta: VSH, PCR.
In functie de stadiul bolii s-a instituit medicatie AINS,
asociata cu scheme de tratament fizical: electroterapie de joasa
si medie frecventa, curenti electromegnetici, kinetoterapie
precedata de termoterapie prin unde scurte, impachetari cu
parafina sau fototerapie (Solux) si hidroterapie mai ales in bazine
cu apa termominerala clorurosodica, feruginoasa bromiodata,
calcica, magneziana.
Rezultate
Pacientii au fost clasificat in functie de stadiu: stadiul I

35.5%, stadiul II 32.2%, stadiul III 25.5%, stadiul IV 6.6% precum si dupa forma bolii: Bechterew 38.5%, Marie-StrumpellLied 10.3%, rizomelica 25.66%, periferica 10.62%, combinatie
centrala si rizomelica 14.15%.
Pacientii din stadiul I si II au prezentat o crestere a
mobilitatii coloanei vertebrale (Schoeber crescut cu 1-2 cm),
scadere a durerii (VAS mai mic cu 2-3 unitati) si ameliorarea
functionalitatii coloanei vertebrale (BAS.I mai mic cu 5 puncte).
Concluzii
Diagnosticul precoce in SA cu stabilirea unei scheme
adecvate si individualizate de tratament, cat si o buna cooperare medic-pacient duc la succese terapeutice de durata, intarziind
evolutia nefavorabila a bolii spre anchiloza.
Ameliorarea starii de sanatate a acestor bolnavi suferinzi
prin modificarea stilului de viata, a conditiilor familiale, aplicarea
posturilor nocturne, dinamice, ocupationale, efectuarea unor
activitati sportive recreationale are drept consecinta
imbunatatirea calitatii vietii.
RECENT ACHIEVEMENTS IN THE REHABILITATION
STRATEGY O. ANKYLOPOIETIC SPONDYLITIS
Banciu Mioara, Betereu Oana, Cord Claudia, Girban Delia,
Tomulescu Otilia, Bocioc Alina
AS demands an early diagnostic and a complex
therapeutic program in which physiokinetotherapy and
balneotherapy play an important role in order to maintain a
maximal level of spinal mobility and to prevent postural
deformities.
Material and method
We studied a group of 126 patients concerning the stage,
the type of the disease, age, gender, provenience and
profession. The clinical diagnostic was established minding the
ACR criteria (modified by van der Linden); radiology and MRI
played a major role in the diagnostic decision. Before and after
the diagnostic was established we evaluated:
1. Spinal function determining BAS.I and D.I.
2. Pain including nocturnal pain assessed by visual
analogue scale (VAS) or BASDAI (disease activity index).
3. Spinal mobility (joint motion range, Schoeber test) and
that of the other affected joints (hip, knee, peripheral joints).
4. Global assessment by the patient (VAS after one week
of treatment).
5. Acute phase reactants: ESR, CRP.
Minding the stage of the disease we introduced drug
therapy (NSAID) and physical therapy: kinetotherapy, low,
medium frequency electrotherapy, electromagnetic currents,
short wave thermotherapy, phototherapy, paraffin packing, hydro
thermotherapy in pools with thermo mineral waters containing
NaCl, .e, Br, I, Ca, Mg.
Results
Concerning the stage of the disease, there were 35.5 %
in stage I, 32.2% in stage II, 25.5 % in stage II and 6.6 % in
stage IV. Classified by form we found that 38.5 % of the patients
had the Bechterew form, 10.3 % the Marie-Strumpell-Lied form,
25.6 % the risomelic form, 10.62 % the peripheral form and 14.14
% the mixed form of AS.
In the patients with stage I, II the spinal mobility improved
(Schoeber test up 1-2 cm), the pain decreased (VAS down 2-3
units) and the spinal function enhanced (BAS.I down 5 points).
Conclusions
Early diagnostic in AS and a adequate individualized
therapeutic program, as well as a good cooperation between
the patient and his physician lead to long-term therapeutic
success and delay the negative evolution of the disease towards
ankylosis. Improvement in the quality of life for these patients
also depends on a changed lifestyle, of family conditions, on
applying nocturnal, dynamic and occupational postures and on
carrying out recreational exercise.

59

60

III. POSTERE
P8
RECUPERAREA .UNCIONAL LA PACIENII CU AVC
ISCHEMIC AMELIORAT DE ADMINISTRAREA DE
)
DERIVAT PEPTIDIC (CEREBROLYSINE
Mihai Berteanu, Dumitru Luminia, Liviu Dumitrescu,
Ruxandra Badea, Kt.Eduard Neagu, .kt. Alina Iliescu,
Gina Comanescu
Clinica de Recuperare Medical a S.U.U. Elias
Introducere
Cerebrolysine este un complex de peptide neuro biologic
active care depesc bariera hemato-encefalic i sunt captate
de neuronii n care i manifest aciunea metabolic,
neurotrofic, neuroprotectoare i neuromodulatoare.
Obiective
Studierea eficacitii tratamentului adjuvant neuroprotector
cu Cerebrolisyne n recuperarea pacienilor post AVC ischemic
Material i metod
Au fost studiai 25 de pacieni cu vrste cuprinse ntre 4281 ani (15 femei i 10 brbai) cu AVC ischemic cu o vechime
variind ntre 3 sptmni i 6 luni. Dintre acetia 10 pacieni au
urmat tratament fizical-kinetic (Lotul A), ceilali 15 beneficiind
(Lotul B)
de asocierea tratamentului cu Cerebrolysine
S-au administrat 3 serii de cte 15 injecii a 10ml
Cerebrolysine (perfuzie endovenoas n ser fiziologic) separate de pauze de 15 zile. Pacienii au fost evaluai la iniierea
tratamentului i dup 3 luni de tratament n formula menionat,
utiliznd ca parametrii indexul Barthel, CNS (Canadian
Neurological Scale seciunea pentru funcia motorie), .AC
(.unctional Ambulation Categories).
Rezultate
Indexul Barthel s-a modificat de la valoarea medie de 44,8
la 68,2 (Lotul A) respectiv 80,4 (Lotul B).
CNS de la 2,6 la 3,8(Lotul A), respectiv 4,5 (Lotul B)
.AC de la 1,2 la 1,7 (Lotul A), respectiv 3,8 (Lotul B)
Concluzii
crete eficiena
Asocierea tratamentului cu Cerebrolysine
recuperrii la pacienii cu AVC ischemic.
Cuvinte cheie: cerebrolysine, neuropeptide, AVC
ischemic
Abrevieri: AVC accident vascular cerebral
.UNCTIONAL RECOVERY O. PATIENTS WITH STROKE
IMPROVED BY PEPTIDIC DERIVATE (CEREBROLYSINE)
Mihai Berteanu, Dumitru Luminia, Liviu Dumitrescu,
Ruxandra Badea, Kt.Eduard Neagu, .kt. Alina Iliescu,
Gina Comanescu
Clinica de Recuperare Medical a S.U.U. Elias
Introduction
Cerebrolysine is a complex of neuro-biological active
peptides that cross the blood-brain barrier and is captured by
neurons in which it develops its metabolic, neurotrophic,
neuroprotective and neuromodulating action
Objectives
The study of the efficacy of the associated neuroprotective
treatment with
Cerebrolysine in the recoyery of the patients with stroke.
Material and method
We have studied 25 patients with stroke, aged between
42-81 years
(15 women, 10 men), at 3 weeks-6 months after the onset.
10 of these patients were treated using physical-kinetic
methods(group A), the other 15 using an associated treatment
with Cerebrolysine and physical-kinetic methods (group B).
We ve used 3 series of 15 daily endovenous injections with 10
ml. Cerebrolysine separated by similar treatment-free periods.
The patients have been evaluated before and 3 months
after the end of the treatment, using the Barthel Index (BI), the
Canadian Neurological Scale(CNS) the motor function section
and the .unctional Ambulation Categories(.AC).

Results: improvement of the BI mean score from 44,8 to

68,2 (group A) and 80,4 (group B);
CNS-motor function section mean score from 2,6 to 3,8
(group A) and 4,5 (group B);
.AC mean score from 1,2 to 1,7 (group A) and 3,8 (group
B).
Conclusions
Cerebrolysine is an useful treatment to improve recovery
of the patients with stroke.
Keywords: cerebrolysine, strocke, neuropeptides

P9
STUDIU PRIVIND EVALUAREA SUBIECTIVITII
PACIENILOR CU ARTRIT REUMATOID N
APRECIEREA MODULUI N CARE BOALA LE
IN.LUENEAZ STILUL DE VIA
A. C. Bighea 1 , Daniela Matei 2 , Rahela Marcu 1 , Simona Ptru
1 Clinica de Medicin .izic i Recuperare, UM. Craiova;
2 Clinica de Medicin .izic i Recuperare,
Spitalul Clinic de Urgen Craiova

Obiectiv
Studiul i propune s evidenieze nivelul de corelare ntre gradul de activitate al bolii evaluat prin DAS28 i gradarea
durerii, a fatigabilitii i evaluarea global a activitii bolii
apreciate subiectiv prin SVA de ctre pacieni cu artrita
reumatoid definit.
Metod
Studiul de tip in acute s-a desfurat n Clinica de
Medicin .izic i Recuperare a Spitalului Clinic de Urgena
din Craiova pe un lot de 18 pacieni diagnosticai cu artrit
reumatoid (criteriile ACR). Pacienii cu o medie de vrst de
62,5 ani, cu raport ntre sexe ./B=8/1, au prezentat o vechime
a bolii ntre 3-15 ani (medie de 7,11 ani) i au fost ncadrai n
clasa funcional Steinbrocker II i III. .iecare pacient i-a gradat,
utiliznd SVA de 10 cm, durerea, fatigabilitatea i evaluarea
global a activitii bolii, iar n paralel s-a evaluat gradul de activitate al bolii prin DAS28. Rezultatele au fost analizate prin
programul de statistic SPSS.
Rezultate
O corelaie semnificativ a fost evideniat pentru VAS
2 = 0,854)
global fa VAS durere (sig = 0,000, R = 0,924, R
precum i ntre VAS global fa de DAS28 (sig = 0,003, R =
0,854, R 2 = 0,730) i VAS durere fa de DAS28 (sig = 0,027, R
= 0,725, R 2 = 0,526).O corelaie slab s-a dovedit a exista ntre
VAS oboseal fa de VAS durere. Absena oricrei corelaii
ntre parametri precum VAS oboseal i DAS28 (R = 0,032)
sau ntre VAS global fa de clasa funcional (R = 0,0054)
susine faptul c modul de percepie al bolii de ctre pacieni nu
este influenat de gradul de activitate stabilit clinico-biologic.
Concluzii
Corelaiile evideniate ntre diferiii parametri analizai n
studiul nostru susin necesitatea acordrii unei atenii sporite
modului de apreciere de ctre pacieni a influenei globale a
bolii dat fiind semnificativa corelaie cu gradul de activitate al
bolii, n ideea unei corecte monitorizri a evoluiei artritei
reumatoide.
A STUDY .OR ESTIMATING THE SUBJECTIVITY O. THE
PACIENTS WITH RHEUMATOID ARTHRITIS IN ORDER TO
DETERMINE THE WAY THE ILLNESS IN.LUENCES THE
LI.E STYLE
A. C. Bighea 1 , Daniela Matei 2 , Rahela Marcu 1 , Simona Ptru
1 Physical and Rehabilitation Clinic, UM. Craiova;
1 Physical and Rehabilitation Clinic,
Urgency Clinical Hospital of Craiova
Aim
The objective of the study is to analyze the correlation
between the activity level of the illness evaluated with DAS28

61

III. POSTERE
(Disease Activity Score including a 28 joint count) and the
patient s global assessment of disease activity (VAS 0-10 cm),
patient s assessment of pain (VAS 0-10 cm), patient s
assessment of fatigue (VAS 0-10 cm).
Method
The in acute study took place in the Physical Medicine
and Rehabilitation Clinic of the Hospital no1Craiova on a group
of 18 patients diagnosed with rheumatoid arthritis (ACR criteria).
The patients aged 62,5 with a sex proportion of ./M = 8/1
presented a period of the illness between 3-15 years (an average
of 7,11 years). They were entered in the functional class
Steinbrocker II and III. Using the 10 cm VAS, each patient leveled
his pain, fatigability and global evaluation of the activity of the
illness. Simultaneously the level activity of the illness was
evaluated with DAS28. The results were analyzed with the
statistics program SPSS.
Results
An important correlation became evident between global
2 = 0,854), between
VAS and VAS pain (sig = 0,000, R = 0,924, R
2 = 0,730) and
global VAS and DAS28 (sig = 0,003, R = 0,854, R
also between VAS pain and DAS28 (sig = 0,027, R = 0,725, R
= 0,526). A weak correlation proved to exist between VAS fatigue
and VAS pain. The absence of any correlation between
parameters such a VAS fatigue and DAS28 (R = 0,032) or
between global VAS and the functional class (R = 0,0054)
indicates the fact that the way the patients perceive the illness
is not influenced by the level of activity established clinicallybiologically.
Conclusions
The emphasized correlation between different parameters
analyzed in our study underline the attention that should be paid
to the way the patients estimate the global influence of the illness
when a significant correlation with the activity level of the illness
is given. The aim is to correctly watch the evolution of the
rheumatoid arthritis.

P 10
IN.LUENA DIABETULUI ZAHARAT ASUPRA EVOLUIEI
.UNCIONALE A SECHELARILOR POST ACCIDENT
VASCULAR CEREBRAL
Cristian Bodescu, Sebastian Diaconescu, Carmen Logoftu,
Gina Glbeaz, Bogdan Anatole, Gabriela Udvuleanu,
Simona Onofrei, Delia Cintez
INRM.B
Premise
Diabetul zaharat este adesea prezent la pacienii cu boal
cerebrovascular, fiind incriminat att ca factor de risc pentru
aceasta, ct i ca factor de risc pentru recidiva accidentului
vascular cerebral (AVC), respectiv pentru mortalitatea precoce
sau tardiv post AVC. Studiile n domeniu sugereaz i o
asociere a DZ cu o evoluie funcional mai proast.
Obiectiv
Determinarea influenei diabetului zaharat asupra evoluiei
funcionale la sechelarul postAVC
Material i metod
87 pacieni supravieuitori dup un AVC nu mai vechi de
3 luni, diabetici (lotul A de studiu), au fost comparai cu 53 de
sechelari post AVC fr diabet (lotul martor) din punctul de vedere al evoluiei funcionale. Ambele grupuri ndeplineau condiiile de includere n programe de recuperare medical, fiind
omogene ca vechime a AVC, varst, repartiie pe sexe. Au fost
urmrite variabile demografice, neurologice, funcionale (.IM,
Barthel, EuroQOL) i variabile de caracterizare a DZ. Msurarea
parametrilor s-a fcut la intrarea n studiu, dup 3 sptmni, la
6 luni i la 1 an. Pacienii au fost inclui n program de recuperare standard, cu precauiile impuse de prezena DZ pentru cei
din lotul A. Datele obinute au fost supuse analizei statistice.
Rezultate i discuii
n lotul A, valorile .IM i Barthel la 6 luni i la 1 an au avut
valori semnificativ mai sczute fa de lotul martor. Pacienii din

acest lot au avut i scoruri .IM cognitiv i .IM global la intrarea

n studiu. 3/4 dintre pacienii din ambele loturi prezentau i
dislipidemie, dar aceasta nu a influenat prognosticul nici ca
variabil singur, nici n asociere cu DZ. Prezena DZ s-a asociat
mai frecvent cu unele complicaii: infecii urinare, escare, durere,
sindrom mn- umr, care au contribuit la diminuarea calitii
vieii.
Concluzii
Prezena diabetului zaharat asociaz scoruri funcionale
mai proaste pe termen mediu i lung la pacienii cu sechele
post AVC inclui n programe de recuperare medical de faz 1
i 2, influena sa fiind explicat multifactorial.
.UNCTIONAL PROGNOSIS IN DIABETICS POSTSTROKE
SURVIVORS
Cristian Bodescu, Sebastian Diaconescu, Carmen Logofatu,
Gina Galbeaza, Bogdan Anatole, Gabriela Udvuleanu,
Simona Onofrei, Delia Cinteza
INRM.B
2

Background
DZ is often present in patients with cerebrovascular
disease; this medical condition is a risk factor for stroke, but for
recidiva and for after stroke mortality too. Some studies clam
that DZ is also a negative predictor for functional prognosis in
post stroke survivors.
Objectiv
To determine how diabetes mellitus influence the functional
evolution in post stroke survivors
Material and method
We compared the medium and long term functional
evolution of two groups of patients with post stroke sequels,
accepted in medical rehabilitation program: group A with 87
diabetic patients and group B with 53 non-diabetics. We
measured demographyc, medical and functional parameters
(.IM, Barthel index, EuroQOL) at the admittance, at six months
and after one year. All the patients were included in standard
rehabilitation program; diabetes mellitus imposed some
precautions in group A.
Results
.IM and Barthel index had signifiquant lower values at six
and twelve months at the patients in group A; they had lower
initial cognitive and global .IM scores, too. 3/4 of all the patients
also had dislipidemia, but functional prognosis wasn t influenced
by that for group A, neither for group B. By the other hand, DZ
was signifiquantly associated with pain, shoulder-hand
syndrome, urinary infection, skin wounds and, consequently,
with poorer life quality.
Conclusion
Diabetes mellitus had a bad influence on both medium
and long term functional evolution in post stroke pacients
included in rehabilitation programs; this kind of evolution could
have had have multiple causes.

P 11
ROLUL TRATAMENTULUI IMUNOSUPRESOR LA
BOLNAVELE CU POLIARTRIT REUMATOID
Bumbea Ana Maria, Rodica Tristaru, Adrian Bighea
Obiective
Autorii i propun s evidenieze rolul tratamentului
imunosupresor la bolnavele cu poliartit reumatoid.
Material i metod
Au fost luate n studiu un numr de 86 de bolnave cu
vrsta cuprins ntre 35 i 78 de ani, pe o perioad de 3 ani.
Studiul s-a desfurat la seciile de recuperare din Spitalul
.ilantropia i Spitalul Clinic de Urgen Craiova i seciile
medicale I i II din Spitalul Clinic de Urgen Craiova.
Bolnavele au fost mprite n 3 loturi: un lot martor care nu a
beneficiat de tratament imunosupresor, urmnd doar

62

III. POSTERE
tratament cu antiinflamatorii nesteroidiene, un lot care a urmat
tratament imunosupresor nespecific, respectiv cu methotrexat
n doze sptmnale de 7,5 sau 15 mg, i un ultim lot urmnd
tratament imunosupresor specific, constnd n administrarea
de10 mg leflunomid, doz zilnic. De precizat c n acest studiu
nu au fost incluse cazurile care au urmat tratament de tip
cortizonic, dozele administrate fiind mici i pe perioade scurte.
Bolnavele au fost urmrite clinic, funcional, paraclinic i
imagistic la debutul studiului i apoi anual. Parametrii clinici
urmrii au constat n evaluarea durerii prin scala vizual
analog, gradul de redoare matinal. Parametrii funcionali
urmrii au constat n monitorizarea funciei articulare i
musculare. Bolnavele au fost controlate paraclinic pentru
sindromul inflamator: VSH, fibrinogen, Protein C reactiv si
imunologic: C3, CIC, AAN. Parametrii imagistici au constat n
urmrirea radiologic a progresiei leziunilor.
Rezultate
Lotul de bolnave care a urmat tratament imunosupresor a
avut o evoluie mult mai bun att clinico-funcional i paraclinic,
respectiv sindromul inflamator i imunologic, ct i imagistic prin
stoparea proceselor evolutive.
Concluzii
Dintre loturile de bolnave care au urmat tratament
imunosupresor, i-a dovedit superioritatea tratamentul
imunosupresor specific.
THE ROLE O. THE IMUNOSSUPRESOR TREATMENT
TO PATIENTS WITH RHEUMATOID ARTHRITIS
Bumbea Ana Maria, Rodica Tristaru, Adrian Bighea
Objectives
The authors propose to emphasize the role of the
imunosupresor treatment at reumatoid arthritis patients.
Material and methode
We have studied a number of 86 patients with ages
between 35 and 78 years, for a period of 3 years. The study
took place at the rehabilitation medical services I and II from the
Clinical Hospital of Emergency Craiova. The patients were
divided in two groups: a witness group that did not benefit of the
imunosupresor treatment specific that was composed of the
administration of 10 mg leflunomid, daily dose. To specify the
fact that in this study were not included the cases hat have
followed corticoid-therapy, the administration doses are low and
on short periods. The patients have been followed clinically,
functionally, paraclinical and radiology at the debut of the study
and then every year. The clinical followed parameters were made
of the pain evaluation through the VAS, the degree of matinal
stiff. The functional followed parameters were made of the
following of the joint and muscular functions. The patients were
paraclinical controlled for the inflammatory syndrome: VSH,
fibrinogen, PCR and imunological: C3, CIC, AAN. The
radiological parameters were made of the radiological following
of the injure evolution.
Results
The group of patients that followed the imunosupresor
treatment had a much better evolution in clinical-functional,
paraclinical, inflammatory syndrome and imunological but by
radiology evolution too, by stopping evolution processes.
Conclusions
Between the two groups of patients, the group with the
best results was the one that followed the specific imunosupresor
treatment.

P 12
ROLUL TRATAMENTULUI CU LE.LUNOMID LA UN CAZ
DE POLIARTRIT REUMATOID CARE ASOCIAZA UN
SINDROM ANEMIC DE TIP BIERMERIAN
Bumbea Ana Maria, Rodica Tristaru, Adrian Bighea

Obiective
Prezentarea unei bolnave cu poliartrit reumatoid
diagnosticat de 15 ani, care a asociat la 10 ani de la debut o
anemie Biermer, la care s-a iniiat tratament imunosupresor
specific dup corectare prealabil a sindromului anemic.
Material i metod
Bolnav n vrst de 75 de ani diagnosticat de 15 ani cu
poliartrit reumatoid, a urmat tratament de fond cu sruri de
aur doza maxim permis, evoluia a fost lent, progresiv. La
10 ani de la debut declaneaz un sindrom anemic, care, n
urma investigaiilor, se dovedete a fi anemie Biermer. Bolnava
este tratat cu Vitamina B 12 1000 gamma, doz care
corecteaz n decurs de 12 luni deficitul de hemoglobin. n
acest interval, bolnava a urmat doar tratament cu antiinflamatorii nesterioidiene, simptomatologia articular agravndu-se. Se
iniiaz tratament cu leflunomid 10 mg pe zi, fr doz de ncrcare. Bolnava este monitorizat clinic, funcional i paraclinic
timp de 6 luni. Parametrii clinici urmrii au constat n evaluarea
durerii prin scala vizual analog, gradul de redoare matinal.
Parametrii funcionali urmrii au constat n monitorizarea funciei
articulare i musculare. Bolnava a fost controlat paraclinic pentru sindromul inflamator: VSH, fibrinogen, Protein C reactiv
i imunologic: C3, CIC, AAN. Parametrii imagistici au constat n
urmrirea radiologic a progresiei leziunilor.
A fost urmrit i funcia hematologic prin determinarea
hemoleucogramei, VEM, CHEM. De asemenea, a fost luat n
observaie i gradul de afectare gastric, bolnava fiind
endoscopiat la 3 luni.
Rezultate
Evoluia bolnavei a fost favorabil, cu remiterea
simptomelor articulare i a sindromului inflamator.
Concluzii
Tratamentul imunosupresor specific nu a agravat
sindromul anemic al bolnavei, pstrndu-se n acest interval
tratamentul cu ciancobalamin., n dozele stabilite.
THE ROLE O. TREATMENT WITH LE.LUNOMIDE TO A
PATIENT WITH REUMATOID ARTHRITIS AND BIERMER
ANEMIA
Bumbea Ana Maria, Rodica Tristaru, Adrian Bighea
Objectives
The presentation of a patient with rheumatoid arthritis with
arthritis from 15 years, that associated a Biermer anemia at 10
years from the debut. The patient is treated with B 12 Vitamin
1000 gamma, dose that corrects in 12 months time the
hemoglobin deficit. In this time the patient followed only the
treatment with nonsteroidian anti-inflammatory, the joint
symptoms getting worse. Then a treatment with leflunomid 10
mg a day is been initiated, without maximal doses. The patient
has been clinical, functional and paraclinical followed for 6
months. The clinical followed parameters were made of pain
evaluation VAS and matinal stiff. The functional followed
parameters were joints and muscular function monitorization.
The patient has been paraclinical controlled for inflammatory
syndrome: VSH, fibrinogen, reactive C Protein and imunological:
C3, CIC, AAN. The radiological parameters were made of
radiological following of the injures evolution. The hematological
function has been followed by determine the HLG, VEM, CHEM.
There has also been taken into observation the degree of gastric
injury, the patient had been gastric endoscopes once at 3
months.
Results
The evolution of the patient was favorable, with the
decrease of the joints symptoms and inflammatory syndrome.
Conclusions
The specific imunosupresor treatment did not worsen the
anemic syndrome of the patient, keeping the B 12 Vitamin
treatment in these period.

63

III. POSTERE
P 13
ROLUL BASTONULUI N BALANSUL POSTURAL LA
PACIENII HEMIPARETICI
Chirii Gheorghe, Dimulescu Dana
U.M... Carol Davila
Obiective
Evaluarea cantitativ a efectelor de susinere a corpului,
cu ajutorul bastonului, asupra balansului postural la pacienii
hemiparetici.
Material i metod
Studiul a inclus 35 de pacieni cu stroke i 35 de persoane n vrst, sntoase. .iecare subiect a stat n picioare n
poziia Romberg, n dou situaii: fr susinere i cu baston.
Rezultate i concluzii
La ambele grupuri, zona cea mai mare de balans a
centrului de greutate s-a produs cnd subiecii au stat n picioare,
fr susinere. Aria balansului centrului de greutate al pacienilor
cu stroke a fost mai mare dect a btrnilor sntoi. La pacienii
cu stroke, procentul a sczut n poziia n picioare, cu baston
58% la brbai i 54% la femei, n contrast cu 68% la brbai i
68,5% la femei, n grupul celor btrni, sntoi.
Efectul susinerii greutii cu un baston asupra balansului
postural la pacienii cu stroke a fost mult mai eficient dect la
btrnii sntoi.
POSTURAL SWAY DURING CANE USE BY PATIENTS
WITH HEMIPARESIS
Objectives
To evaluate the effect of body support with a cane on
postural sway, in patients with hemiparesis.
Methods
This study included 35 patients with stroke and 35 healthy
elderly people. Each subjects stayed in the Romberg position,
in two conditions: without support and with a cane.
Result and conclusions
In both groups, the largest area of gravity center sway
occurred when the subject stayed without support. In the patients
with stroke, the area of gravity center sway was bigger than
that of the healthy elderly. In the patients with stroke, the
percentage decrease in the standing position with the cane was
58% in the men, 54% in the women, as opposed to 68% men
and 68,5% in the women, in the group of healthy elderly.
The effect of body support with cane on postural sway of
patients with hemiparesis, was more effective than that of
healthy elderly.

P 14
MODI.ICRI ALE PARAMETRILOR DE MERS LA
PACIENII CU GONARTROZ
Chirii Gheorghe, Dimulescu Dana
U.M... Carol Davila
Obiective
Investigarea tipurilor de mers i a forelor de reacie la sol
n plan sagital, pentru diferite grupuri de vrst i la pacieni cu
gonartroz
Material i metod
Studiul a inclus 55 de subieci (femei), capabili de micare,
divizai n 3 grupuri: grupul mai tnr (de control), grupul celor
n vrst i grupul pacientelor cu gonartroz. Parametrii de mers:
viteza de mers, cadena, timpul sprijinului unipodal i al dublului
sprijin, forele de reacie la sol n plan sagital, au fost obinui pe
durata unei viteze de mers confortabile, utiliznd Scala Tinetti
de Mers, Scala de Evaluare a Mersului.
Rezultate i concluzii
Grupul pacientelor cu gonartroz a avut o vitez de mers
mai mic i o caden joas, prin comparaie cu celelalte dou

grupuri (p< 0,05). .ora de reacie la sol: primul pic pentru durat,
exprimat n procente din ciclul de mers, a fost cu mult mai mare
la grupul cu gonartroz (16,4), comparativ cu grupul celor n
vrst (15,5) i al celor tinere (15,1). .ora pe durata mijlocului
perioadei statice a fost mai mare la grupul cu gonartroz (85,4),
comparativ cu celelalte dou grupuri (p<0,05). Al doilea pic de
for a fost mai mic la grupul cu gonartroz, comparativ cu grupul
tnr de control (p<0,01).
Parametrii mersului la btrni i la pacienii cu gonartroz
sunt caracterizai de o vitez mai mic de mers, o caden joas,
o lungime a pasului mai mic i un timp mai lung pe perioada
dublului sprijin; scurtarea timpului de atac cu talonul i o for
de solicitare mai mare n zona median a piciorului, la mijlocul
perioadei statice, s-au constatat la ambele grupuri.
MODI.ICATION O. GAIT PARAMETERS IN PATIENTS
WITH KNEE OSTEOARTHRITIS
Objectives
To investigate the gait patterns and the sagittal ground
reaction forces different age groups and in people with knee
osteoarthritis.
Methods
This study included 55 female subjects capable of gait,
subjects divided into three groups: the control group (young),
the elderly group and the osteoarthritis knee group. Gait
parameters walking velocity, cadence, step length, stride time,
single and double support time, sagittal ground reaction
forces were obtained during confortable walking speed used:
the Tinetti Gait Scale, the Evaluation Gait Scale.
Results and conclusions
The osteoarthritis knee group had slower walking velocity,
lower cadence, and longer stride time as compares with the
elderly and young control group (p<0,05). Gait parameters in
the elderly and osteoarthritis knee patients were characterised
by slower walking velocity, lower cadence, shorter step length,
longer stride time and longer double support time. Less heel
contact and more loading force into the midfoot region during
midstance, were noticed in these two groups.

P 15
IMPORTANA METODELOR .IZICALE DE TRATAMENT N
RECUPERAREA .UNCIONAL A UMRULUI DUREROS
SIMPLU
Camelia Ciobotaru, L. Crciun, Mdlina Iliescu,
Adriana Clipa
.acultatea de Medicin Constana
Obiective
Scopul studiului a fost s evidenieze importana metodelor
fizicale de tratament n recuperarea funcional a umrului
dureros simplu.
Pacieni i metod
Grupul de studiu a cuprins 58 de pacieni cu periartrit
scapulo-humeral, forma clinic de umr dureros simplu, de
vrst 35 60 ani. La acest lot de pacieni s-a aplicat un
tratament care a constat n metode fizicale (cureni diadinamici,
2 ), masaj cervicounde scurte doze medii, ultrasunet 0,6 W/cm
dorsal i umr, kinetoterapie.
Rezultate
Durerea a fost apreciat pe o scal analog vizual, de la
scor 1 (fr durere) la 10 (durere sever la mobilizare). n plan
obiectiv, pacienii au fost evaluai att nainte de tratament, ct
i dup, prin bilan articular. Scorul severitii durerii a sczut
semnificativ statistic (p < 0,001) dup tratament. De asemenea,
dup tratament a crescut amplitudinea de micare pentru rotaia
intern i extern (p < 0,05).
Concluzii
n cazul umrului dureros simplu, fizioterapia i
kinetoterapia sunt eficiente, fr a aduga la tratament medicamente antiinflamatoare non-steroidiene.

64

III. POSTERE
P 16
ASPECTE MODERNE DE EVALUARE I RECUPERARE N
COXARTROZA SECUNDAR
Ciobotaru Camelia, Iliescu Mdlina, Clipa Adriana,
Crciun Liviu
.acultatea de Medicin Constana
Artrozele coxofemurale domin patologia oldului att prin
frecvena lor mare (reprezentnd peste 90% din artropatiile
coxofemurale), ct i prin potenialul lor invalidant.
Aproape 40% din coxartrozele secundare apar la bolnavi
cu malformaii congenitale subluxante ale oldului. Printre alte
cauze se citeaz: traumatismele (contuziile, fractura colului
femural, luxaiile coxo-femurale), protruzia acetabular,
osteocondrita disecant, boala lui Paget, disgenezia epifizar
din mixedemul infantil etc.
Cea mai mare parte a coxartrozelor sunt predispuse unei
agravri lente, inevitabile i ireversibile, dar viteza unei astfel
de evoluii este variabil, aici intervenind recuperatorul, prin
iniierea ct mai precoce a unui program terapeutic adecvat.
Scopul comun al tuturor formelor de tratament, n special
cel de recuperare, este ntreruperea lanului evolutiv patogenic
al artrozei, pentru crearea condiiilor de regenerare articular.
Metodele de recuperare fiziokinetoterapice i
balneoterapia i au importana lor att preoperator, ct i n
reeducarea postoperatorie a coxartrozei secundare.
n acest sens, lucrarea de fa i propune s stabileasc
locul fiziokinetoterapiei n cadrul tratamentului coxartrozei
secundare i rolul acesteia n combaterea durerii, contracturii
musculare, a hipotoniei i a hipertrofiei musculare.
Studiul nostru a fost efectuat pe un lot de 20 de bolnavi cu
coxartroz secundar decompensat algic i funcional,
prezentai n ambulatorul Spitalului Clinic de Urgen Constana. Pacienii au fost supui unui tratament complex:
electroterapie, masoterapie, hidrotermoterapie, kinetoterapie.
Rezultatele obinute permit susinerea faptului c
profilaxia, tratamentul i, mai ales, recuperarea funcional reprezint una dintre cele mai dificile probleme ale practicii medicale.

P 17
APLICATIA DE LASER N DISTRO.IA SIMPATIC
RE.LEX (.ORMA SINDROMULUI UMR MN )
.lorentina Ciubotariu, Mariana Cojocaru, Daniela Radu,
Simona Opri, Dana Toader, Liliana Bucur,
Ramona Plopeanu, Delia Cintez
Clinica Recuperare Medical III, INRM.B
Introducere
Algoneurodistrofia este un sindrom dureros complex
regional (CRPS), descris probabil pentru prima dat de Ambroise
Pare n secolul al XVI-lea. n decursul timpului, sindromul a
cptat numeroase explicaii, definiii i denumiri. Cercetrile n
domeniu s-au datorat ncercrii de a diagnostica precoce
sindromul i de a-l trata eficient, date fiind durata suferinei i
sechelele funcionale pe care le determin.
Obiective
1. determinarea efectului aplicaiilor de laser n distrofia
simpatic reflex
2. determinarea eficienei aplicaiilor de laser n funcie
de stadiul suferinei
3. implicaia sindromului umr-mn asupra
prognosticului funcional al pacienilor hemiplegici.
Material i metod
Au fost urmrii 33 de pacieni sechelari post AVC cu
sindrom umr-mn, aflai n diferite stadii, care au primit, pe
lng tratamentul medicamentos standard, aplicaii de laser;
comparaia s-a fcut cu un lot martor de 25 de pacieni similari
din punct de vedere demografic i clinic, la care s-au prescris

doar aplicaii de electroterapie de joas frecven. Au fost

urmrite caracteristici clinice (durerea, necesarul de analgetice,
gradul de tumefacie etc) i funcionale (gradul de mobilitate
articular etc). Datele obinute au fost supuse analizei statistice:
deviaia standard, testul t , testul U , testul chi ptrat.
Rezultate
Pacienii din lotul de studiu au prezentat o ameliorare semnificativ mai mare i mai rapid comparativ cu lotul martor
(p<0.05); rezultatele au fost similare pentru necesarul de antiinflamatorii i analgezice. Evoluia cea mai bun au prezentat-o
pacienii cu CRPS stadiu I (p<0.01). Concomitent, i indicii
funcionali au cunoscut imbuntire semnificativ.
Concluzii
Tratamentul cu laser diminu semnificativ durerea din
CRPS forma sindromului umr-mn la pacientul hemiplegic,
mai ales n stadii precoce, comparativ cu tratamentul standard
cu forme de electroterapie analgezic, permind o evoluie
funional mai bun i complian mai mare a pacienilor la programele de recuperare medical.
LASER APPLICATIONS IN RE.LEX SYMPATHETIC
DYSTROPHY (HAND- SHOULDER SYNDROME)
.lorentina Ciubotariu, Mariana Cojocaru, Daniela Radu,
Simona Opri, Dana Toader, Liliana Bucur,
Ramona Plopeanu, Delia Cintez
Clinica Recuperare Medical III, INRM.B
Ambroise Pare first described reflex sympathetic dystrophy
in XIVth century and during the time, several researchers tried
to establish diagnostic and therapeutic protocols, in order to
avoid functional sequels.
Objective
1. determine the effects of laser applications in reflex
sympathetic dystrophy
2. determine the effects of laser applications in different
stages of illness
3. the impact of hand-shoulder syndrome on functional
prognosis of patients with hemiplegia
Material and method
In this study were included 33 patients with hand-shoulder
syndrome, in different stages of illness; they received besides
standard therapy laser applications; 25 patients received low
frequency electrical applications representing a match group.
Several clinical (pain, analgesics requirements, local edema)
and functional (joint mobility) data were recorded.
Results
Patients who received laser applications had a better and
faster recovery, the results were similar for anti-inflammatory
and analgesics needs. The best evolution was recorded for
CRPS stage I patients.
Conclusions
Laser applications diminish the pain in patients with
hemiplegia and hand shoulder syndrome, especially in early
stages, compared to standard therapy with analgesic
electrotherapy; they had a better functional evolution and a better
compliance with rehabilitation programs.

P 18
APORTUL TERAPEUTIC AL ASISTENTELOR MEDICALE
IN RECUPERAREA PACIENTULUI HEMIPLEGIC
Asistent medical principal: Comanoiu Mariana, Tescan Ioana,
Dedu Adriana, Antalut Camelia
INRM.B
Echipa de recuperare presupune i impune existena
specialistului de recuperare medicul care stabilete prin bilanul
specific clinico-funcional obiectivele programlui de recuperare
la pacientul hemiplegic, dar i modalitatea de efectuare la nivel
de spital.

65

III. POSTERE
ngrijirea acestui pacient complex presupune, n condiii
de parial mobilizare i deficit de comunicare att cu pacientul,
ct i cu familia, o atitudine extrem de minuioas, avnd n
vedere complicaiile ce pot aprea: escare, diabet zaharat, risc
crescut la infectii etc.
n acest context, asistentelor medicale le revine o sarcin
extrem de complex i divers de activiti prin care s realizeze
deziderate eseniale pentru pacient: s nu fac ru, s creeze
un climat favorabil, s monitorizeze 24 din 24 h pacienii, care
n seciile de recuperare sunt bolnavi cu polipatologii cu risc de
decompensare (diabet zaharat, cardiopatie ischemic, hipertensiune arterial) suficiente argumente pentru a analiza
aportul efectiv i eficace al asistentelor medicale n profilul de
recuperare.
Lucrarea analizeaz cele mai importante aspecte de
monitorizare pentru hemiplegicul adult i mai ales cel vrstnic
disfuncionalitile somatice, viscerale i psihologice.

P 19
ROLUL ASISTENTEI MEDICALE N REINTEGRAREA
PACIENILOR N SOCIETATE N CADRUL PROGRAMULUI DE RECUPERARE
Comnoiu Mariana, Tescan Ioana, Dedu Adriana, Nisipeanu
Cristina
INRM.B
Asistentele medicale au rol foarte important n asigurarea
calitii ngrijirii pacienilor i ofer un suport psihologic bolnavului
i familiei acestuia.
Rolul cadrelor medii ncepe din momentul internrii
pacientului n clinica de recuperare, avnd misiunea de a
diminua impactul psihologic cu privire la nceperea programului
de recuperare ce presupune de cele mai multe ori timp
ndelungat, perseveren, voin.
Supravegherea i evaluarea problemelor de nutriie,
tulburri de somn, sechele pe termen lung sau scurt ale
tratamentului constituie un punct important n procesul de recuperare.
Problemele psihologice precum teama, anxietatea,
depresia, nesigurana pacienilor au devenit subiecte importante abordate n procesul de educare, cercetare, perfecionare a
asistentelor medicale.
Boala aduce cu sine numeroase schimbri importante n
modul n care individul se percepe pe sine i lumea din jur, respectiv au loc schimbri n viaa profesional, n relaiile cu familia
i prietenii.
Asistenta medical este implicat n programul de recuperare, n etapele tratamentului i, mai ales, n susinerea psihologic i consilierea pacientului i a familiei acestuia.
Lucrarea evideniaz necesitatea perfecionrii asistenilor
medicali care lucreaz n secii de recuperare privind importana
consilierii psihologice centrat pe reintegrarea pacientului n
societate.

Modul de abordare este prezentarea celor trei cazuri i

analiza lor comparativ din punct de vedere al antecedentelor
heredocolaterale i personale, statusului clinic, paraclinic,
funcional, al momentului diagnosticrii, al tipului de boal i al
introducerii programului de recuperare. Diagnosticarea precoce a bolii, tipul IA, lipsa complicaiilor cardiace i a factorilor de
risc se asociaz cu un pronostic bun. Consilierea precoce i
sfatul genetic au un rol esenial. .racturile multiple, trstur
comun a pacienilor cu osteogenez imperfect, modific
prognosticul funcional al pacientului n dublu sens, n msura
n care sunt abordate printr-o conlucrare ortoped-medic
recuperator. De asemenea, un program de recuperare adecvat
i susinut pe termen lung crete calitatea vieii i ntrzie
instalarea complicaiilor bolii.
n concluzie, incidena sczut i prognosticul rezervat
al bolii ne oblig spre o mai bun colaborare ntre medicul de
familie, medicul ortoped i medicul de recuperare pentru a diagnostica precoce i a trata corespunztor aceti pacieni.
Cuvinte cheie: osteogeneza imperfect, diagnostic precoce, prognostic, recuperare medical.
PREDICTIVE .ACTORS IN THE ANALYSE O.
OSTEOGENESIS IMPER.ECTA DIAGNOSED CASES
PROGNOSIS
Cristina Daia, Gilda Mologhianu, Mihaela .iru, Andreea
Murgu, Alexandru Putaru, Manuel Colichi, Ana-Maria Drosu,
Mugur Pirvu, Brilescu Consuela, Alina Stroe, Gabriel Tatua
INRM.B
The purpose of this article is to present three cases all
hospitalized in the .ilantropia University Clinic of Rehabilitation
and diagnosted with osteogenesis imperfecta ( The Lobstein
desease or Blue sclerae disease , a rare heritable disorder
that involves the conjunctive tissue).
The method we used is the comparation of the cases
regarding heredocollateral and pathological antecedents, clinical
status, the type and the diagnosis time, the moment of starting
rehabilitation.
.avorable predictive factors are: early diagnosisand
genetic advise, Type I A, lack of cardiac complication or other
risk factors.
Multiple fractures (a common complication in this disease)
modify the functional prognosis and need multidisciplinary
abordation (medical and orthopaedic treatment).
Conclusion
The complex rehabilitation program improves the quality
of lifffe and prolonged the time until the complications occure;
it s very important to conlucrate and work in a medical team
between orthpaedic, rehabilitation and primary care doctors for
en early diagnosis and treatement of these patients.
Key-words: osteogenesis imperfecta, early diagnosis,
predictive factors, medical rehabilitation.

P 21
P 20
.ACTORI PREDICTIVI N ANALIZA PROGNOSTICULUI
PACIENILOR DIAGNOSTICAI CU OSTEOGENEZ
IMPER.ECT
Cristina Daia, Gilda Mologhianu, Mihaela .iru, Andreea
Murgu, Alexandru Putaru, Manuel Colichi, Ana-Maria Drosu,
Mugur Pirvu, Brilescu Consuela, Alina Stroe, Gabriel Ttu
INRM.B
Lucrarea de fa i propune prezentarea a trei cazuri
cazuri internate n Clinica Universitar III .ilantropia i diagnosticate cu osteogenez imperfect (maladia Lobstein sau boala
sclerelor albastre, afeciune ereditar rar ce afecteaz esutul
conjuctiv).

STUDIU ASUPRA APORTULUI RECUPERRII MEDICALE

LA PACIENII CU TRAUMATISME CRANIOCEREBRALE
Cristina Daia, Alexandru Putaru, Manuel Colichi,
Ana-Maria Grosu, Mugur Prvu, Alina Stroe, Gabriel Ttu,
Gilda Mologhianu
INRM.B
Introducere
n condiiile dezvoltrii performanelor tehnice ale
mijloacelor rutiere, specific progresului societii actuale,
traumatismele craniocerebrale devin o patologie care ne reine
atenia prin incidena n cretere, complexitate i oportunitatea
oferit de programul de recuperare n reabilitarea pacienilor.
Obiectivul studiului
Prin studiul de fa urmrim s evalum, prin cercetare

66

III. POSTERE
retrospectiv, beneficiul programului de recuperare medical
aplicat pacienilor diagnosticai cu traumatism craniocerebral.
Material i metod
Studiul include 17 pacieni internai n Clinica Universitar
de Recuperare III .ilantropia, n perioada ian 2003 sept 2005,
diagnosticai cu TCC.
S-au folosit urmtoarele criterii de evaluare:
date antropometrice (vrst, sex, mediul de provenien)
natura TCC (modaliate de producere, gravitate clinic,
tipologie)
numrul de reinternri
gradul de recuperare al deficitului motor
terapia neurochirurgical abordat
Rezultate i discuii
Majoritatea pacienilor internai n clinica noastr cu
diagnosticul de TCC au fost brbai (70,59%), tineri (64,7%),
provenii din mediul urban (64,7%)
Modalitatea de producere a TCC a fost n 76,48% din
cazuri prin accident rutier
Peste jumtate din pacienii internai au fost diagnosticai
cu TCC grav (GSC 3-8) (58,9%)
Unul din patru pacieni cu TCC grav a recuperat complet deficitul motor instalat posttraumatic, iar 40% dintre pacieni
au recuperat independena la mers
n cazul TCC mediu II, 40% dintre pacieni au recuperat
complet deficitul motor, iar la 60% s-a oinut autonomie la mers.
Costurile terapiei au fost mai mari la pacienii cu TCC
grav, tip I, la acetia reinternrile fiind regul, spre deosebire de
cei cu TCC tip II la care au fost necesare reinternri doar n
60% din cazuri.
Concluzii
1) Adresabilitatea pacienilor cu traumatisme
craniocerebrale este mult mai mic comparativ cu incidena
acestora
2) Beneficiul programului de recuperare se coreleaz
n mod direct cu gravitatea TCC
3) Ctigul funcional a fost mult mai mare n cadrul unui
program de recuperare intensiv, susinut, etapizat la pacienii
cu multiple internri n serviciul nostru
4) Din studiu se desprinde necesitatea colaborrii
interdisciplinare: neurochirurg medic neurolog medic de recuperare medic de familie, pornind din stadiile iniiale pn la
obinerea unei independene funcionale i unui nivel de
reinserie socio-profesional adecvat.
STUDY ON THE CONTRIBUTION O. THE MEDICAL
RECUPERATION .OR THE PATIENTS WITH CRANIOCEREBRAL TRAUMAS
Cristina Daia, Alexandru Putaru, Manuel Colichi, Ana-Maria
Grosu, Mugur Parvu, Alina Stroe, Gabriel Tatuta,
Gilda Mologhianu
INRM.B
Introduction
As a result of the technical performance progress of the
means of transport, which are natural in a continually growing
society, the cranio-cerebral traumas become a reality that cannot
be avoided. Their pathology draws our attention through their
exponential growth, complexity and also the opportunity we have
in the rehabilitation of the patients.
Study objective
The objective of the present study is to evaluate, by means
of retrospective research, the benefits of the rehabilitation related
to the patients that suffer from cranio-cerebral traumas.
Subjects and method
The study includes 17 subjects, all hospitalized in the .ilantropia University Clinic of Recuperation III , between January
2003 and September 2005, diagnosed with CCT.
The following evaluation criteria have been used:
anthropomorphic data (age, gender, background)
nature of the CCT (origin, clinical seriousness, typology)
number of hospital re-admissions

recuperation level of the motor deficit

the neuro-surgical therapy that has been used
Results and comments
Most of the patients admitted in our Clinic on the
diagnosis on CCT were young (64,7%) men (70,59%), coming
from the urban area (64,7%).
The origin of the CCT lay mostly in a road accident, in
76,48% of the cases.
Over half of the patients were diagnosed with severe
CCT (GSC 3-8) (58,9%).
One in four patients with severe CCT completely
removed the post-trauma motor deficit and 40% of the patients
regained the ambulatory independence.
.or the CCT medium II, 40% in the patients completely
removed the motor deficit and 60% of them regained the
ambulatory independence.
The therapy costs were higher for the severe CCT, type
I, where the re-admissions formed the standard, whereas for
the CCT type II the re-admissions were required by only 60% of
the cases.
Conclusions
1) Treatment possibility for the patients with craniocerebral traumas is much less compared to their frequency.
2) The benefits of the rehabilitation program are
correlated to the severity of the CCT.
3) The functional progress was much higher in the case
of the patients who benefited from intensive, sustained, gradual
recuperation during their re-admissions in our clinic.
4) There is a high necessity of inter-discipline dialogue
among the neuro-surgeon, the neurologist, the recuperation
doctor, the family doctor, dialogue that should start in the initial
stages of the trauma up to the stage of the functional freedom
and further on to the appropriate social reintegration.

P 22
CONTRIBUIA PROGRAMULUI DE RECUPERARE IN
EVOLUIA UNEI PACIENTE CU ARAHNOIDIT CHISTIC
Cristina Daia, Alexandru Putaru, Manuel Colichi, Ana-Maria
Drosu, Mugur Prvu, Alina Stroe, Gabriel Ttu,
Gilda Mologhianu
INRM.B
Prezentare de caz
Lucrarea de fa are ca obiect prezentarea cazului
pacientei AA, care ne reine atenia prin patologia neurologic
complex, evoluia, dar, mai ales, prin oportunitatea oferit de
programul de recuperare abordat vis a vis de prognosticul
pacientei.
Pacienta AA, n vrst de 47 de ani, se prezint pentru
prima oar n clinica noastr n ianuarie 2003, pentru recuperarea deficitului motor de tip paraparetic, parestestezii la nivelul
trunchiului i membrelor, precum i tulburri sfincteriene.
Substratul etiologic al manifestrilor este dat de hemoragia
subarahnoidian recent suferit i de un chist subarahnoidian
premedular, determinnd un sindrom de compresie medular
cu leziune neurologic incomplet la nivel T5 operat (Spitalul
Bagdasar, ian 2003); la internarea n Clinica Universitar de
Recuperare III .ilantropia, pacienta prezint paraparez spastic
rezidual, scor ASIA pe MI 34/50. Din acest moment, pacienta
este inclus ntr-un program de recuperare adecvat.
Raritatea patologiei, precum i scorul ASIA de pornire
sunt dou dintre argumentele care ne-au determinat s alegem
acest caz.
Evoluia neurologic ulterioar este un argument n plus:
recidive multiple ale chistului subarahnoidian, urmate de
intervenii neurochirurgicale (septembrie 2003, noiembrie 2003),
apariia complicaiilor: fistula LCR- intervenie pentru practicare
unt chisto-pleural drept (Israel, martie 2005), intervenie de
repoziionare unt deplasat posttraumatic (aprilie 2005).
Rezultatele favorabile obinute n urma programului de
recuperare susinut n Clinica Universitar de Recuperare III

67

III. POSTERE
.ilantropia, se structureaz, de asemenea, ca argument major
pentru prezentarea acestui caz: mbuntirea strii generale i
ctigul funcional sunt evidente, la ultima internare (septembrie 2005) pacienta avnd un scor motor ASIA pe MI 47/50. n
plus, permit fixarea, ca obiectiv urmtor al planului de recuperare, autonomia funcional a pacientei, pentru ca aceasta s
se poat reinsera activ n mediul familial i, nu n ultimul rnd,
ntr-un mediu socio-profesional adecvat.
n concluzie, lucrarea de fa evideniaz c un program
de recuperare eficient, axat pe cele cinci principii de baz ale
recuperrii moderne este esenial pentru ca un pacient
neurologic s ajung pe drumul sigur spre o via activ i
independent.
CONTRIBUTION O. THE REHABILITATION PROGRAM IN
THE EVOLUTION O. A PATIENT DIAGNOSED WITH
CYSTIC ARACHNOIDITIS
Cristina Daia, Alexandru Putaru, Manuel Colichi, Ana-Maria
Drosu, Mugur Pirvu, Alina Stroe, Gabriel Tatuta,
Gilda Mologhianu
INRM.B
Case Presentation
This present study deals with the presentation of the patient
AA case that drew our attention by its complex neurological
pathology, evolution and particularly by the opportunity we have
in the rehabilitation program of the patient above mentioned.
The patient AA, 47 years old, comes to our clinic in January
2003 for the first time, with the purpose of rehabilitation of the
motor deficit, the paraparesis type, paraesthesias at the trunk
and members level and also sphincter disorders. The etiological
reason of the manifestations is her recent sub-arachnoidian
haemorrhage and a sub-arachnoidian cyst that lead to a
syndrome of medullary compression with neurological incomplete lesion at the T5 operated level (Bagdasar Hospital, January
2003); at the admission time into the .ilantropia University Clinic
of Recuperation III, the patient displays residual spastic
paraparesis, score ASIA on MI 34/50. Right after her admission,
she has been part of an appropriate recuperation program.
The rarity of the pathology and the initial ASIA score are
two of the main reasons for our case choice.
The ulterior neurological evolution is an extra motive:
multiple relapse of the sub-arachnoidian cyst followed by neurosurgical interventions (September 2003, November 2003),
complications occurrence: LCR fistula- intervention of the right
pleural cyst shunt (Israel, March 2005), intervention of the
misplaced post-trauma re-positioning shunt (April 2005).
The satisfying results that followed the sustained
rehabilitation program in our clinic are another major rationale
in choosing this case: improvement of her general physical state and the functional progress are very much obvious at the readmission in September 2005. The patient has a score ASIA
on MI 47/50. A suggestion for the recuperation program would
be the functional autonomy of the patient, so that she will be
able to actively reintegrate into the family and last but not least
into an appropriate social environment.
As a conclusion, we can point out that an efficient
rehabilitation program, centered on the five basic principles of
the modern rehabilitation, is quite essential for a neurological
patient who aims to an active and independent life.

P 23
ROLUL HIDROKINETOTERAPIEI N LOMBALGIA
SUBACUT MUSCULOLIGAMENTAR
Lorena David, Daniela Ionescu, Mihaela Patru, Dan Curelea
Ambulatoriul de Recuperare Medical III INRM.B
Obiectiv
Determinarea efectului hidrokinetoterapiei comparativ cu
cel al repausului la pat asupra evoluiei durerii lombare i a

disfunciei locomotorii la pacieni cu lombalgie musculoligamentara.

Material i metod
S-a efectuat un studiu prospectiv asupra a 32 de pacieni
( 337 ani) cu lombalgie musculoligamentara (diagnostic clinic),
tratati in ambulatoriul INRM.B, la care la tratamentul standard
s-a adugat programul de hidrokinetoterapie din ziua a treia de
la debut. Lotul martor a cuprins 23 de pacieni (comparativ ca
vrst i sex), care au meninut repausul la pat peste 7 zile. S-au
notat: intensitatea durerii n ziua a7-a i a 14-a durata totala a
durerii, evoluia semnelor clinice obiective,mobilitatea lombar
n ziua a 7-a i a 14-a, numrul de zile de incapacitate de munc.
Rezultate
Lotul de studiu a nregistrat o evoluie net favorabil a
tuturor parametrilor studiai, cu ameliorare semnificativ mai
rapid fa de lotul martor; rspunsul cel mai bun la mobilizarea
precoce l-au avut pacienii sub 45 de ani.
Concluzii
Mobilizarea precoce, utiliyand hidrokinetoterapia, a
pacienilor cu lombalgie subacut musculoligamentar pare a fi
mai benefic din punct de vedere funcional dect repausul total
prelungit la pat, mai ales pentru pacienii tineri.
AQUATIC THERAPY IN LOW BACK PAIN
Lorena David, Daniela Ionescu, Mihaela Patru, Dan Curelea
Ambulatoriul de Recuperare Medical III INRM.B
Objective
To determine the effect of aquatic therapy over prolonged
rest on low back pain.
Material and method
We studied 32 low back pain out-patients (337 years),
treated with standard methods and aquatic exercices from the
third day. Another 23 patients (age and sex matched) maintained
the total rest over 7 days. We measured the pain (the 7-th and
the 14-th day), the lumbar mobility, the number of days with
pain, the days of work invalidity.
Results
The study group had a significant better evolution,
especially for the patients younger than 45 years.
Conclusion
The earlier mobilization, by using aquatic therapy, in low
back pain seems to be more favorable than prolonged rest for
functional outcome of the young patients.

P 33 BIS
STUDIILE MEDICO-BIOLOGICE EXPERIMENTALE I
CLINICE N VEDEREA EVALURII E.ECTULUI
ANTIMICROBIAN AL ESTURII CU .IBRE AMICRON
Onose G., Simionca Iu. (Ghe), Hoteteu M., Rogojan Rodica,
Ruse Irina, Nstase Iulia, Chirii Gh., Alexandru R.,
Dinulescu Diana
INRM.B, Bucureti
Studiul prezent i propune testarea, n dou etape, la nivel
experimental preclinic i clinic, a efectelor potenial benefice
complexe (antiinfecioase, antialergice, absorbante i respectiv
de ameliorare a gradului de confort i calitii vieii) ale
materialului textil cu fibre AMICOR asupra organismului .
Materiale i metode
Etapa I:
1. Studiu experimental in vitro al posibilului efect
antimicrobian asupra culturii de
Staphylococcus aureus.
2. Studiu experimental in vivo al efectului asupra procesului infecios-inflamator cutanat indus la animalele de laborator
(30 obolani albi), care include: inducerea procesului
experimental infecios-inflamator cutanat, msurarea suprafeei rnii infectate i inflamate, determinarea concentraiei de
microorganisme, unele investigaii hematologice, investigarea

68

III. POSTERE
activitii procesului de fagocitoz al neutrofilelor PMN, testul
nitrozo-blau-tetrazoliu intracecular n neutrofilele PMN,
investigarea activitii catalazei i superoxidismutazei n snge
precum i a activitii citochromoxidazei n omogenatul stratului
cutanat cu rana infectat i inflamat, testul de transformare a
limfocitelor T n blati sub aciunea mitogenuluifitohemaglutininei i a supernatantului omogenatului de material
textil cu fibre AMICOR.
Etapa II:
1. Studiu al posibilului efect potenial terapeutic al
materialului textil cu fibre
AMICOR asupra procesului infecios-inflamator cutanat la
subiecii umani (lot 30 pacieni).
Investigaiile experimentale preclinice i clinice asupra
animalelor de laborator i subiecilor umani (conform protocolului gril de urmrire a unui set de parametri clinici standartizai)
au fost planificate s fie efectuate pn la aplicarea materialului
textil cu fibre AMICOR, la 48 ore i la 7 zile de la aplicarea
acestuia.
Rezultate i discuii.
Rezultatele studiilor experimentale permit a presupune
efectul benefic al materialului textil cu fibre AMICOR asupra
organismului uman, inclusiv antiinfecios i de protecie
antialergic. Prezint interes evaluarea efectului multifuncional benefic al materialelor textile cu fibre AMICOR asupra diferitor
pacieni n dependen de factorul etiologic, localizarea procesului infecios inflamator i alergic.

P 24
PARTICULARITI EVOLUTIVE ALE A.ECTRII
VERTEBRO-MEDULARE DE DI.ERITE ETIOLOGII
Diaconescu Sebastian, Anatole Bogdan, Bodescu Cristian,
Glbeaz Gina, Logoftu Carmen, Udvuleanu Gabriela,
Onofrei Simona, Hanna Iolanda, Delia Cinteza
Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie
Afectarea vertebro-medular este frecvent n Romnia,
cu predominanta etiologic a traumei, dar i a celei vasculare
sau inflamatorii; adresabilitatea precoce (din pcate redus
numeric din cauza lipsei informaiei) ajut procesul de recuperare i previne instalarea complicaiilor cauzate de imobilizarea
prelungit.
Obiectiv
Determinarea particularitiilor evolutive ale pacienilor, n
funcie de cauz.
Material
4 pacieni internai n perioada noiembrie 2004 - august
2005,diagnosticai cu:
a) traumatism vertebro-medular toraco-lombar
b) mielit transvers
c) ischemie medular; de menionat precocitatea
prezentrii n serviciul de recuperare.
Metoda
Programul de recuperare aplicat a urmrit:
- meninerea tonusului trenului inferior
- prevenirea redorilor articulare
- creterea forei trenului superior pentru pregatirea
mersului
- refacerea controlului sfincterian
- prevenirea complicaiilor imobilizrii prelungite ! escare/
tromboflebit/ infecii pulmonare i urinare/ osteoporoza de
inactivitate/ imobilizare.
S-au monitorizat:
parametrii vitali (TA, AV, frecvena respiratorie)
numrul de miciuni
parametrii specifici fora muscular, unghiurile de mobilitate articular, tulburrile de sensibilitate
complicaiile
Rezultate
Analizate statistic

Concluzii
Programul de recuperare precoce a indus evoluie
favorabil, mpiedicnd apariia complicaiilor imobilizrii
prelungite.
EVOLUTIVE PARTICULARITIES O. VERTEBROMEDULAR CONDITIONS HAVING DI..ERENT
III.
ETIOLOGIES

POSTERE

Diaconescu Sebastian, Anatole Bogdan, Bodescu Cristian,

Glbeaz Gina, Logoftu Carmen, Udvuleanu Gabriela,
Onofrei Simona, Hanna Iolanda, Delia Cinteza
National Institute of Rehabilitation, Physical Medicine and
Balneoclimatology
Background
The vertebro-medular involvement is frequent in Romania, with the etiological predominance of trauma, lent also of
the vascular or inflamatory ones; the early addresability
(unfortunately reduced in number due to the lack of information)
facilitates the recovery process and the installation of the
complications caused by prolonged immobilization.
Objectives
To establish the evolutive particularities of the patiens,
according to the cause.
Material
4 patientes hospitalized in our clinic during November 2004
August 2005, diagnosed with:
a) thoraco-lombar vertebro-medular trauma
b) transverse myelitis
c) medular ischemia; it is worthing to note the precocity
of the attendance in the recovery service.
Method
- maintenance of the lower train tonus
- prevention of the joint stiffness
- increasing of the upper train force for preparing the
consumption to walk
- prevention of the complications of the prolonged
immobilization ! bed sores/ trombophlebitus / lung and urinary
infections /osteoporosis of inactivity /deconditioning.
- orthesis of lower limb
There were monitorized:
vital parameters (BP, HR, respiratory rate)
urination number
specific parameters: muscular force, joint mobility angels,
sensitivity disorders and also the complications.
Results
Statistically analized
Conclusions
The early recovery program induced favorable evolution,
intercepting the complications.

P 25
E.ECTUL AJUTTOARELOR DE MERS ASUPRA
ECHILIBRULUI LA PACIENII CU STROKE
Dimulescu Dana, Chirii Gheorghe
U.M... Carol Davila
Obiective
Examinarea efectelor bastonului standard i tetrapod
asupra balansului postural i a modelelor de susinere a greutii
la pacienii cu hemiparez.
Material i metod
Studiul a inclus 30 de subieci hemiparetici, cu vrst
medie de 70,8 ani, i 25 subieci sntoi, cu media de vrst
de 71,2 ani.
Balansul postural i procentajul greutii corporale
susinute de fiecare extremitate au fost msurate n 3 poziii:
1) poziia aliniat; 2) cu extremitatea inferioar afectat
plasat nainte; 3) cu extremitatea inferioar neafectat
plasat nainte.

69
Toi pacienii au fost testai n fiecare poziie: fr baston,
cu baston standard i cu baston tetrapod.
Rezultate i concluzii
La poziia aliniat (1) i cu extremitatea inferioar
neafectat plasat anterior (3), balansul postural a fost redus
doar cu bastonul tetrapod. Ambele tipuri de bastoane au redus
balansul postural n poziia cu extremitatea inferioar afectat
plasat anterior (2), bastonul tetrapod avnd un efect mai mare.
Distribuia asimetric a greutii ntre extremitile inferioare nu
a nregistrat modificri la pacienii plasai n poziiile (2) i (3),
chiar cu ajuttoare de mers.
Bastonul tetrapod este utilizat cu rezultate mai bune dect
bastonul standard n micorarea balansului postural la pacienii
hemiparetici, n timpul perioadei statice.
THE E..ECT O. WALKING AIDS ON BALANCE O.
PATIENTS WITH HEMIPARESIS
Objectives
To examine the effects of standard and quad cane on
postural sway in patients with hemiparesis.
Methods
This study included 30 subjects with hemiparesis and 25
subjects without hemiparesis. Postural sway and percentage of
body weight borne by each extremity were measured in 3
positions: 1) aligned position; 2) affected extremity placed anterior; 3) unaffected extremity placed anterior.
All subjects were tested in each position: with no cane, a
standard cane, a quad cane.
Results and conclusions
In both the aligned (1) and normal extremity placed anterior (3), postural sway was reduced with the quad cane. Postural
sway in position with affected extremity placed anterior (2), was
reduced with the both types of cane, the quad cane had a major
effect. An asymmetrical weight distribution between the lover
extremity did not modified in the patients placed in (2) and (3)
positions, even with walking aids.
The quad cane has a greater effect then the standard cane,
in reduced postural sway, in patients with hemiparesis.

P 26
.ACTORI DE PREDICIE AI NIVELULUI COGNITIV I
DEPRESIEI, LA PACIENII CU STROKE
Dimulescu Dana, Chirii Gheorghe
U.M... Carol Davila
Obiective
Evaluarea factorilor de predicie socio-demografici i clinici ai nivelului cognitiv i depresiei, la subieci cu diferite leziuni
de lateralitate.
Material i metod
Am inclus n studiu 75 de pacieni, cu stroke pe dreapta
(43) i pe stnga (32), n primul an de boal, utiliznd: Scala de
Depresie Hamilton, Scala de Anxietate Hamilton, Indexul
Barthell, Testul MMSE.
Au fost msurate variabilele socio-demografice. 25 pacieni
(33%) au suferit de depresie major, iar 16 pacieni (21%) au
suferit de depresie minor.
Rezultate i concluzii
Scorurile MMSE au fost diferite la grupurile de pacieni cu
stroke pe dreapta i pe stnga cu: depresie major, depresie
minor i fr depresie.
Pacienii cu stroke pe stnga, cu depresie major, au prezentat insuficien cognitiv mai mare dect celelalte grupuri.
Acest rezultat a fost valid dup controlul efectului localizrii
leziunii asupra diferenei de nivel cognitiv dintre grupuri.
Severitatea depresiei a fost un factor de predicie pentru nivelul

cognitiv la pacienii cu stroke pe stnga.

Ali factori de predicie ai nivelului cognitiv au fost starea
de anxietate la pacienii cu stroke n emisfera stng, precum
i nivelul educaional la pacienii cu stroke n emisfera dreapt.
.actorii de predicie pentru nivelul cognitiv i severitatea
depresiei sunt diferii la subiecii cu lateralitate diferit a leziunii;
depresia major este asociat cu insuficiena cognitiv la
pacienii cu stroke n emisfera stng.
PREDICTORS O. COGNITIVE LEVEL AND DEPRESSION,
IN PATIENTS WITH STROKE
Obijectives
To evaluate predictors of cognitive level in depression in
subjects with stroke.
Methods
This study included 75 patients with stroke on right side
(43) and on left side (32), using: the Hamilton Depression Scale, the Hamilton Anxiety Scale, the Barthell Index, the Mini Mental
State Examination (MMSE). 25 (33%) patients suffered from
major depression and 16 (21%) patients suffered from minor
depression.
Results and conclusions
MMSE scores were different in the groups of left and
right stroke patients: with major depression, minor depression
and without depression. The patients with stroke on left side,
with major depression, were more cognitively impaired than
the other groups. The depression severity was a predictor of
cognitive level, in the patients with stroke on the left. The others
predictors of cognitive level was the anxiety, in the patients
with stroke on the left, and educational level in the patients
with stroke on the right.
The predictors of cognitive level and depression severity
are different in patients with different laterality of lesion; major
depression is associated with cognitive impairement in left
stroke patients.

P 27
CONSIDERAII PRIVIND EVALUAREA RECUPERRII
GENUNCHIULUI ARTROZIC DUP OSTEOTOMIA TIBIAL
DE CORECIE
Magda Dragosloveanu
INRM.B, Bucureti
Studiul urmrete s cuantifice gradul de recuperare a
genunchiului operat i evoluia sa n timp. A fost urmrit un lot
de 168 de bolnavi, operai n ultimii cinci ani pentru gonartroz
secundar pe model de varum. S-au practicat, n toate cazurile,
osteotomii de corecie tibial.
Pentru evaluare s-a folosit Scorul Societii de chirurgie a
genunchiului (KSS=Knee Society Score) calculat nainte de
intervenia chirurgical, la trei luni postoperator, la un an, doi
ani i cinci ani de la operaie.
Tratamentul de recuperare s-a nceput imediat
postoperator, prin mobilizare pasiv (KINETEC) i activ, dublat
de exerciii de tonifiere a cvadricepsului. Reluarea mersului cu
sprijin parial s-a nceput la trei luni postoperator. 53 de bolnavi
din acest lot au fcut un tratament de recuperare periodic, condus ntr-o unitate specializat.
Rezultatele scorului KSS au fost superpozabile, n ambele loturi, n primele ase luni postoperator, cu diferene nete, n
timp, n favoarea celui de-al doilea lot.
n timp, scorul genunchiului s-a ameliorat progresiv, n
primii trei ani, dup care s-a nregistrat o pant lent descendent.
n concluzie, considerm c este un real avantaj pentru
bolnav combinarea tratamentului chirurgical cu tratamentul de
recuperare, acesta avnd indubitabil rolul de a consolida i
ameliora n timp efectele osteotomiei.

70

III. POSTERE

CONSIDERATIONS REGARDING THE EVALUATION O.

THE ARTHROSIC KNEE REHABILITATION A.TER TIBIAL
OSTEOTOMIA
Magda Dragosloveanu
INRM.B, Bucharest
The purpose of this study is to quantify the level of
rehabilitation of the operated knee and its evolution in time. There
has been registered a lot of 168 patients who got operated in
the past five years for secondary varus ghonarthritis. In all of
the cases, it was performed a high tibial osteotomia.
.or evaluation, there has been used the KSS (Knee
Society Score), calculated before the surgical intervention, three
months after and then, one, two and five years after the surgery.
The rehabilitation treatment started immediately after the
surgery consisting in passive (KINETEC) and active mobilization,
adding exercises for the quadriceps s tonus. Starting the walking
with partial support began three months after the surgery. 53
patients of this lot have had a periodically rehabilitation treatment
in a specialized center.
The results of the KSS have been identical for both of the
lots during the first six months after the surgery,with obvious
differences for the second lot, in time.
In time, KSS has progressively improved in the first three
years after which there has been registered a slow decrease.
In conclusion, we consider that the combination between
surgery and the rehabilitation treatment proves to be a real
advantage for the patient, as the last one has surely the role of
strengthening and reducing in time the effects of osteotomia.

P 28

REHABILITATION THERAPY IN SPONDILOEPIPHYZAR

DISPLASYA

ELEMENTE DE RECUPERARE N DISPLAZIA

SPONDILOEPI.IZAR
Mihai Drgoi
, Dan Neme
, Adriana Bitang ,
Oana Bereteu 2 , Alina Totorean 1 , 2 , Cristian Milicin 1 , 2 ,
Elena Amarici 1 , 3 , Rzvan Drgoi 1 , Camelia Neme 4
1 Universitatea de Medicin i .armacie Victor Babe
Timioara,
2 Spitalul Clinic Municipal Timioara
Clinica de Recuperare
Medical i Balneofizioterapie,
3 Spitalul Clinic Judeean de Urgen Timioara
Secia
clinic ortopedie- traumatologie II Compartimentul de
recuperare medical,
4 Spitalul Clinic Municipal Timioara
Laboratorul clinic,
Romania
1,2

1, 3

paraclinice radiologice cu modificri caracteristice n contextul

unor examene de laborator normale orienteaz spre diagnosticul
de displazie spondiloepifizar, diagnostic confirmat i de
consulturile interdisciplinare.
Tratamentul de recuperare s-a efectuat pe fiecare segment implicat, avnd ca obiective creterea mobilitii la nivelul
articulaiilor implicate.
1. Obiectivele urmrite la nivelul coloanei au fost:
poziionare n rectitudine, asuplizare cu mobilizri segmentare
i globale, gimnastic respiratorie, posturri relaxante i
facilitatoare ale respiraiei, corectarea curburilor patologice ale
gtului, poziiei capului, coloanei dorsale, lombare, tonifierea
diafragmului i a musculaturii respiratorii propriu-zise, tonifiere
general muscular, corectarea scoliozei.
2. Obiectivele urmrite n recuperarea oldului drept
operat: creterea forei musculare, meninerea mobilitii
postoperatorii, evitarea instalrii unor atitudini vicioase, rotaiei
externe i adduciei.
3. n cazul oldului stng, preoperator s-a urmrit:
nvarea contraciilor cvadricepsului, fesierului mare, mijlociu
(izometrice), exerciii cu rezisten pentru m. cvadriceps, fesier
mare, fesier mijlociu, triceps sural i latissimus dorsi.
4. La nivelul articulaiilor coatelor/genunchilor s-a urmrit:
poziionare pentru evitarea flexumului, tonifiere musculatur
general i pe grupe flexori-extensori, mecanoterapie, biciclet
ergometric
5. La nivelul minilor, respectiv a picioarelor obiectivele
urmrite au fost: meninerea manualitii prin pstrarea forei
de prehensiune i a anatomiei piciorului pentru meninerea
mersului
Cuvinte cheie: displazie spondiloepifizar, terapie
chirurgical multipl, tratament complex de recuperare medical

Pacienta D.C., n vrst de 21 ani, student, se interneaz

cu poliartralgii cronice, predominent la nivelul oldurilor i
coloanei vertebrale, deviaii axiale multiple, perturbri majore
n performarea activitilor vieii zilnice. n anul 1997, la vrsta
de 3,5 ani este diagnosticat cu coxa vara congenital i sufer
prima intervenie chirurgical de osteotomie de abducie cu plac
cu urub. n anul 1994 se instaleaz modificri la nivelul minilor
bilateral, cu mrirea n volum a articulaiilor interfalangiene
proximale i distale. ntre 1993-1995 se reintervine chirurgical
la nivelul oldurilor bilateral i se efectueaz osteotomii repetate.
n 1996, este diagnosticat cu artrit reumatoid juvenil form
poliarticular seronegativ, evolutiv invalidant, iar din anul 1997
urmeaz tratament medicamentos de fond fr rezultate pozitive.
n 1998, se efectueaz tenotomia adductorilor membrului inferior
drept i osteotomie de bazin Chiari old drept, iar n 2004 se
efectueaz artroplastia oldului drept cu endoprotez total
necimentat de tip Striker, recomandndu-se i protezarea
oldului stng.
La examenul aparatului locomotor se deceleaz deformri
articulare, cu mrirea n volum a articulaiilor implicate (genunchi,
interfalangian distal i proximal) cu deviaii axiale, mobilitate
redus la nivelul articulaiilor. Nu se deceleaz semne
caracteristice ale unui proces inflamator activ. Investigaiile

Mihai Dragoi 1 , 2 , Dan Nemes 1, 3 , Adriana Bitang 2 ,

Oana Bereteu 2 , Alina Totorean 1 , 2 , Cristian Milicin 1 , 2 ,
Elena Amaricai 1, 3 , Razvan Dragoi 1 , Camelia Nemes 4
1 Victor Babes University of Medicine and Pharmacology
Timisoara,
2 Timisoara Medical Rehabilitation Universitary Hospital
3 Timis County Universitary Hospital
Orthopaedic and
Traumatology department- Rehabilitation Department,
4 Timisoara Universitary Hospital
Medical Lab, Romania
Pacient D.C., female, 21 years old, student, applied to our
service for cronic polyaltralgies, predominat in the hips area and
in the spine area, multiple axial deviations and major
disturbarciens in performing daily activities.
.rom the disease investigation comes out that the
disease started in early childhood with bilateral coxalgies and
swinging gait. In year 1997, at 3,5 years age, she is beeing
diagnosed with congenital coxa vara and has the first surgical
intervention of abduction osteotomy with screw plate. In year
1994, are instaled modifications at the hand level, billateral,
with volume expansions of proximal and distal interfalangian
articulations. In the period 1993-1995 she underwent other
surgical procedures, such as repeated osteotomies and
reductions under anesthesy. In 1996 she is diagnosed with
juvenile rheumatoid arthritis, polyarthicular seronegative form,
evolutive and invalidant, and started 1997 she is under
medicamentos treatment but without results. In 29.01.1998 a
tenothomy of the adductors of the right inferior member and a
Chiari pelvic osteotomy of right hip, and in december 2004
arthroplasty of the right hip with Striker uncimentated total
endoprotesis of right hip.
At the locomotor system examination we take notice of
articular deformation with the growth in volume of the
articulations involved (knee, interfalangial, distal and proximal)
with axial deviations and reduced articular mobility. We could
not find any caracteristic signs of an active inflamatory process.
The paraclinic radiological investigations, associated with

71

III. POSTERE
normal lab exams orient us to the diagnos of spondiloepiphyzar
displasya, diagnosis confirmed by intredisciplinary consults.
The rehabilitation treatment focused on each segment
involved, with the objectives to increass mobility in the damaged
joints. The objectives followed at spine: a straight position,
segmental and global mobilization, respiratory exercises,
relaxant positions to facilitate bhreeding, corections of
pathological positions of the neck and head, the dorsal spine,
tonification of the diaphragm and of the respirathory muscle,
general muscular tonification and the correction of scoliosis.
Key words: spondiloepiphyzar displasya, multiple surgical
procedures, complex medical rehabilitatipn program.

P 29
ULTRASONOTERAPIA N A.ECIUNI ALE UMRULUI
Dumitrescu Liviu, Georgescu Claudiu, Ciobanu Ileana,
Marin Andreea, Boian Mirela
Clinica de Recuperare Medical a S.U.U. Elias
Recuperarea funcional a micrilor umrului comport
recuperarea integral a unui complex de cinci articulaii strns
legate ntre ele dpdv biomecanic. .uncionarea integrat i
armonioas a tuturor acestor articulaii este necesar pentru
mobilitatea normal i complet a umrului, ceea ce va permite
i realizarea activitilor zilnice, dar i desfurarea activitilor
profesionale i recreaionale.
Durerea i inflamaia local sunt elemente prezente
constant n toate fazele de evoluie a traumatismului umrului,
reducerea pn la dispariia acestor fenomene fiind o preocupare
constant a fizioterapeutului.
Clasificare Tipuri Tratament
Afeciunile umrului pot fi de natur:
a) reumatismal:
periartrit scapulo humeral;
artrit acut/cronic;
sindromul Reiter
reumatism articular acut;
b) degenerativ: artroza umrului (omartroz);
c) metabolic: disfuncii hipofizare i tiroidiene;
d) vascular:
anevrism de arter axilar subclavicular
infarct miocardic
angin pectoral;
e) pleural:
pneumonia, tuberculoza, infarctul pulmonar;
pleurita din bolile de collagen;
f) nervoas:
hemiplegia, Parkinson;
nevralgia cervico-brahial
radiculopatie cervical
amiotrofie nevralgic;
g) distrofic: sindrom umr mn;
h) traumatic:
osteonecroza capului humeral;
osteomielit;
fracturi, luxaii;
disjuncia acromio-clavicular.
n patologia umrului, ca manifestri clinice ntlnim urmtoarele tipuri:
1. umr dureros simplu: degenerare tendinoas i
inflamaie, cu durere moderat la mobilizare;
2. umr dureros acut: dureri brute, violente, exacerbarea
durerii la mobilizare ca urmare a contracturii musculare;
3. umr blocat: micrile articulaiei sunt mult reduse
(blocaj mecanic);
4. umr pseudoparalitic: impotena funcional a braului
prin ruptura rotatorilor.
Astfel, tratamentul aplicat poate fi:
a) medicamentos:
antiinflamator local i general (aspirin, ibuprofen,
diclofenac, piroxicam, fenilbutazon); corticoterapia (prednison,

cortizon, hidrocortizon);
analgezic (piafen, izopirin, codein, morfin);
decontracturant, miorelaxant (benzodiazepine,
neuriplege, midocalm).
b) fiziokinetoterapeutic:
aplicaii de ageni fizici (ultrasonoterapie, cureni
analgezici de joas frecven, cureni miorelaxani de frecven
medie, unde scurte, crioterapie);
masaj i mobilizri pasive, dar i active ale articulaiei.
c) chirurgical:
sinovectomia, acromioplastia;
rezecia extremitii superioare a humerusului;
sutura chirurgical a tendonului (n cazul rupturii
traumatice a coifului rotatorilor).
Aplicaia de ultrasonoterapie
Prin efectele sale:
analgezice, prin aciunea asupra terminatiilor nervoase;
antispastice, prin scderea cronaxiei neuromusculare;
de stimulare a SNV, efect simpaticolitic/
simpaticomimetic, n funcie de zona tratat i de intensitatea
undelor ultrasonice;
de vasodilataie local, stimulnd metabolismul local cu
resorbia inflamaiilor i a depozitelor mineralizate.
Ultrasonoterapia reprezint o procedur fizioterapeutic
de baz n tratamentul formelor subacute i cronice ale
afeciunilor umrului, rezultatele obinute fiind bune i foarte
bune.
Experiena personal:
n Clinica de Recuperare Medical a S.U.U. Elias tratm
des afeciuni ale umrului, de obicei n combinaie cu alte
proceduri de electroterapie: termoterapie, hidroterapie,
kinetoterapie i masaj cu rezultate terapeutice bune.
Ultrasunetele au fost aplicate pe esuturile conjunctive moi
situate periarticular, cu accent pe punctele trigger (tender).
Experiena noastr clinic demonstreaz eficiena
aplicaiilor de ultrasunet n formele subacute i cronice ale
afeciunilor umrului. Se poate constata n urma tratamentului
complex aplicat mbuntirea troficitii zonei afectate, cu creterea mobilitii articulare, dar i a forei musculare a membrului
superior afectat.
ULTRASONOTHERAPY IN SHOULDER PAIN
Dumitrescu Liviu, Georgescu Claudiu, Ciobanu Ileana,
Marin Andreea, Boian Mirela
Clinica de Recuperare Medicala - S.U.U. Elias
The functional recovery of shoulder movements involves
the full recovery of a complex made by five joints very deep
connected biomechanically.
The harmoniously and integrated work of all those joints
is necessary for a normal and complete mobility of the shoulder
which will allow not only our daily living activities, but also a full
professional and recreational performance.
Local pain and inflammation are constantly present
elements in all shoulder trauma phases, the physiotherapist
constant concerning means to obtain reduction until
disappearance of all those painful phenomena.
Classification Types Treatment
Shoulder pain may appear from many reasons, as:
a) rheumatismal:
PSH
acute / chronical arthritis
Reiter Syndrome
RAA
b) degenerative: shoulder arthrosis
c) metabolical: hypophysis and thyroid dysfunction
d) vascular:
myocardial infarct
angina pectoris
subclavian axillary arteries aneurysm;
e) pleural:
pneumonia, tuberculosis, pulmonary infarct

72

III. POSTERE
collagen diseases pleuritis
f) nervous:
hemiplegia, Parkinson
cervical radiculitis
amyotrophic neuralgia;
g) dystrophy: shoulder hand Syndrome
h) traumatical:
humeral head osteonecrosis
osteomyelitis
fracture, luxation.
In shoulder s pathology, we meet many clinical types:
1) simple painful shoulder: tendinous degeneration and
inflammation, with temperate pain ;
2) acute painful shoulder: sudden and violent pains, mostly
during the night, pain exacerbation at joint mobilization because
of muscle contracture;
3) frozen shoulder: joint movements are reduced a lot
(mechanical blocking);
4) pseudoparalytic shoulder: functional impotence of the
arm by rotators cuff breaking.
So, treatment applied is:
a) medication:
local and general anti-inflammatory ( aspirin, ibuprofen,
dicofenac, piroxicam); corticotherapy (cortisone, hydrocortisone,
prednisone);
analgesic( piafen, izopirina, codeine, morphine)
muscle spasm relaxation (neuriplege, midocalm,
benzodiazepine)
b) physiokinetotherapy:
physical agents applications (ultrasonotherapy, low
frequency analgesic currents, medium frequency miorelaxational
currents, short waves, cryotherapy);
massage and passive but also active joint mobilization.
c) surgical:
acromioplastia, synovectomy,
humerus superior extremity resection
surgical suture of the tendon ( rotators cuff breaking off).
The utilization of ultrasounds in physiotherapy, through
its effects:
analgesic, acting over nervous terminations;
antispastic, by subtraction of the neuromuscular
chronaxy;
stimulating for the Sympathetic Nervous System, effect
sympatheticolitic/sympatheticomimetic, varying with treated zone
and the ultrasonical waves intensity;
local vasodilatation, stimulating local metabolism with
inflammation and mineralized deposits resorption;
represents a basically physiotherapy procedure in all
subacute and chronic diseases of the shoulder , therapeutic
results obtained being good and very good.
Personal Experience:
In The Medical Rehabilitation Clinic of the Elias U.E.H.,
we treat very often shoulder affections, usually in combination
with other electrotherapy procedures of thermotherapy,
hydrotherapy, kinetotherapy and massage.
The ultrasounds were applied on the soft conjunctive
tissue, located all around the joint, with accent on the trigger
(tender) points.
Our clinical experience demonstrate ultrasonotherapy s
efficiency in subacute/chronic shoulder pathology. .ollowing the
complex treatment results we can find them very good, so we
can observe: trophic improvement in the affected area,
improvement in the muscle force and the joint mobility of the
affected arm.

P 30
ACTUALITI N CRIOTERAPIE
Dumitrescu Liviu, Ciobanu Ileana*, Georgescu Claudiu*,
Marin Andreea*, Bogzoiu Catalin*, Boian Mirela*
*Asisteni fizioterapie, Clinica de Recuperare Medical,
Spitalul Universitar de Urgen Elias

Scurt istoric
nc din epoca de ghea, omenirea a folosit agentul termic
rece n avantajul propriu. Egiptenii foloseau frigul pentru a trata
rni i inflamaii nc din anii 2500 i.Chr.
Mecanism de aciune
Durerea, inflamaia i spasmul muscular sunt rspunsuri
obinuite ale esuturilor la suprasolicitare.
- frigul aplicat pe o astfel de zon, n faza acut, scade
fluxul fluidului aprut n esuturi, reduce metabolismul local
efect antiinflamator.
- efectul analgetic al aplicaiei de ghea rezult din
scderea vitezei de conducere a impulsurilor prin fibrele
nervoase ale sensibilitii dureroase.
- rcirea esuturilor profunde reduce spasmul muscular
prin reducerea capacitii muchiului de a menine o contracie
(contractilitatea).
Efecte
reducerea durerilor,
reducerea inflamaiilor, edemelor i a sngerarilor interne,
relaxare .
Excesul de frig poate avea efecte negative:
hipopigmentaia, hiperpigmentaia, atrofia local a pielii
stimularea fibrelor nervoase termoreceptoare
nemielinizate C conduce la disfuncii simpatice nervoase regionale.
nervii adiaceni intaci pot fi i ei afectai, conducnd la
apariia unei noi surse de durere.
crioterapia prelungit i repetitiv poate determina
afectarea definitiv a nervilor mielinizai,
Dac nc de la nceput crioterapia agraveaz durerea
neuropatic preexistent se recomand ntreruperea
tratamentului.
Indicatii
n marea chirurgie pentru reducerea funciilor vitale, n
interveniile de lung durat pe cord i pe rinichi;
n oncologie pentru distrugerea tumorilor,
n chirurgia oftalmologic, pentru a trata afeciuni
retiniene,
n dermatologie se trateaz psoriazisul, cheratoza
actinic, negii;
n fizioterapie:
n tratarea durerilor pre i post operatorii (profilaxia
edemelor i analgezie),
n tratarea bolilor inflamatorii i degenerative ale
articulaiilor (tendinite, bursite),
pentru efect analgezic i antiinflamator n probleme
posttraumatice acute (contuzii, dislocaii, rupturi musculare),
tratarea durerilor i spasticitii musculare neurogene,
Contraindicaii:
Crioterapia nu trebuie aplicat:
persoanelor care prezint probleme circulatorii (sindrom
Raynaud, arteriopatii);
persoanelor cu tulburri de sensibilitate (post AVC,
neuropatii periferice datorate diabetului sau leprei)
celor alergici la frig (unele persoane dezvolt urticarie
sau eczeme la rece);
persoanelor cu care nu se poate comunica,
persoanelor ce prezint acroscleroz, scleroderm;
copiilor mici.
Modalitati de aplicare
Ca proceduri de fizioterapie cu aplicaii de rece moderat
avem:
masajul cu ghea;
aplicarea de pungi cu ghea,
crioterapia cu aparatur special.
Experienta personal:
n clinica de Recuperare Medical a S.U.U. Elias, folosim
aparatul de crioterapie Kryotur 600, produs de TUR
Elektromedizin, un aparat ce servete la obinerea de energie
frigorific cu ajutorul unor module termoelectrice (elemente
Peltier), uor de deplasat i cu care se face crioterapie dozat
i controlat.

73

III. POSTERE
Aparatul prezint doi aplicatori:
capul frigorific pentru crioterapie cu temperaturi joase
(aplicaii mobile de durat scurt cu temperaturi de pn la -10
grade C.) se folosete pentru crioterapie simpl sau
electrocrioterapie,
maneta frigorific, cu rcire treptat pn la temperatura de minim +12 grade C.(aplicaii fixe n regim continuu sau
ntrerupt).
Crioterapia se aplic n fizioterapie ca procedur unic
sau n combinaie cu alte proceduri de electroterapie,
hidroterapie i kinetoterapie, aducndu-i beneficiile n cadrul
procesului complex de recuperare al pacienilor cu afeciuni
reumatice, traumatice, neurologice.
PRESENT-DAY CRYOTHERAPY
Dumitrescu Liviu, Ciobanu Ileana, Georgescu Claudiu, Marin
Andreea, Bogzoiu Catalin, Boian Mirela
Short history
Since ice age, humankind used cold in their advantage.
The Egyptians were using cold for to treat injuries and
inflammations in the 2500 b. Christ.
How does cold act
Pain, inflammation and muscle spasm are usual answers
of the tissues when injury comes from overdosed effort.
Cold applied on such an area, in an acute phase, slows
the flow of the fluid new appeared in the tissues, slows the local
metabolism it reduces inflammation.
The analgesic effect of ice application results from a
decreased nerve conduction velocity along pain fibers.
Cooling the deep tissues reduces muscle spasm by
reducing the muscle s ability to maintain a contraction (
contractility).
Effects
Reducing pain,
Reducing inflammations, edema and internal bleeding,
Relaxation.
Too much cold may have negative effects:
Hipopigmentation,hiperpigmentation, local skin atrophy,
The stimulation of unmyelinated C-thermo receptor
nerves leads to regional sympathetic nerve dysfunction,
The adjacent intact nerves are susceptible to be injured,
resulting in a new source of pain,
Prolonged and repetitive cryotherapy can result in a
permanent damage to myelinated nerves.
If, from the beginning, cryotherapy aggravates the
preexisting neuropathic pain, it should be discontinued.
Therapeutical indications
In surgery, for to reduce vital functions, in long time kidney
and heart interventions:
In oncology for to destroy tumors:
In ophtalmologic surgery, for to treat retinal injuries.
In dermatology they treat psoriasis, actinic keratosis,
warts:
In physiotherapy:
In treating pre and postoperatory pain ( in oedema and
pain prevention)
In treating inflammatory and degenerative joint diseases
(tendonitis, bursitis),
.or analgesic, effect, in post trauma acute injuries (
contusions, dislocations, muscle injuries),
In treating neurogenic pain and muscle spasm.
Not indicated in
Cryotherapy may not be used in:
Individuals with circulatory disturbances (Raynaud s
Syndrome, artheriopathy);
Individuals with sensibility disorders (after a stroke,
peripheral neuropathy due to diabetes or leprosy)

To those allergic to cold (some may develop a urticaria

or blisters when cold applied);
To individuals we cannot communicate with;
Individuals with acrosclerosis, scleroderma;
Little children.
How we applie cold
In physiotherapy we apply moderate cold using:
Ice massage;
Ice packs;
Cryotherapy with special devices.
Personal experience
In The Medical Rehabilitation Clinic of the U.E. Elias
Hospital, we use Kryotur 600 cryotherapy device produced by
TUR Elektromedizin, device using thermoelectrical modules
(Peltier elements) to produce frigorifique energy. Easy to move
where necessary, this device is used to apply controlled and
dosed cryotherapy.
The device uses two applicators:
The frigorific head for low temperature cryotherapy
(mobile, short applications with temperatures to -10C) used to
simple or electro cryotherapy.
The frigorific cuff, temperature being reduced down to a
minimum of +12C.(in a fixed position, in continuous or
discontinuous mode).
Cryotherapy is used in physiotherapy alone or in
combination with other electrotherapy, hydrotherapy or
kinetoherapy applications, altogether bringing their benefits in
the complex process of rehabilitation of the pacients suffering
of rheumatical,traumatical, neurological diseases.

P 31
PRIVIRE GENERAL ASUPRA MICROCLIMATULUI DIN
UNELE SALINE CU DESTINAIE TERAPEUTIC DIN
ROMNIA
L. Enache 1, 2 , 3 , C. .ilipescu 4 , Iulia Bunescu 1
Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie, Bucureti,
2 Universitatea de tiine Agronomice i Medicin Veterinar,
Bucureti
3 Comisia Romn de Speleoterapie, Bucureti
4 Institutul Naional de Cercetare-Dezvoltare n Domeniul
Patologiei i tiinelor Biomedicale Victor Babe , Bucureti
1

n general, mediul ambiant se caracterizeaz prin mai muli

parametri fizici care contribuie la definirea trsturilor
caracteristice specifice ale diverselor locuri. Toi aceti factori
(de exemplu, temperatura i umiditatea aerului, viteza vntului,
presiunea atmosferic i alii) se afl ntr-o strns
interdependen i pot ndeplini i exercita, n anumite condiii
definite, roluri i influene pozitive, cu potenial bioterapeutic sau,
dimpotriv, nefavorabile. Orice modificare cantitativ i calitativ a caracteristicilor mediului, peste anumite limite, se face
resimit la nivelul unui organism viu sub diferite forme.
Spaiile subterane (mine de sare, peteri) se disting, la
rndul lor, pritr-o serie de proprieti particulare care, nu numai
c le deosebesc fa de condiiile existente la suprafa, ci i
ntre ele. Unele dintre aceste trsturi pot exercita influene
asupra organismelor vii i, astfel, s poat fi valorificate n scopuri
terapeutice n tratarea unor afeciuni specifice unul din
scopurile principale ale speleoterapiei.
Articolul face o trecere n revist cteva dintre caracteristicile microclimatice pentru cteva dintre cele mai importante
saline din Romnia i anume: Tg. Ocna, Slnic Prahova, Praid,
Cacica i Turda.
Lucrarea prezint particularitile principalilor parametri
microclimatici (temperatura i umiditatea aerului, viteza curenilor
de aer, diferena de presiune atmosferica n raport cu intrarea)

74

III. POSTERE
ale acestor locaii subterane, n cadrul unor scurte caracterizri
ale caracteristicilor climatice a localitilor unde sunt situate
aceste spaii subterane.
Cuvinte cheie: microclimat, saline, speleoterapie.
GENERAL SIGHT O. THE MICROCLIMATE .ROM SOME
ROMANIAN SALT MINES WITH THERAPEUTIC
DESTINATION
L. Enache 1 , 2 , 3 , C. .ilipescu 4 , Iulia Bunescu 1
National Institute of Rehabilitation, Physical Medicine and
Balneoclimatology, Bucharest
University of Agronomical Sciences and Veterinary Medicine,
Bucharest
3 Romanian Permanent Commision of Speleotherapy,
Bucharest
4 Victor Babe National Institute of Research and Development in Pathology and Biomedical Sciences, Bucharest,
Romania.
1

As a rule, the surrounding environment characterizes by

many physical parameters that contribute to defining of the
specific properties of different places. All these factors (for
instance, air temperature and humidity, wind speed,
atmospheric preasure and others) there are in a closed
interdependence and can carry out and exert, in some defined
conditions, pozitive roles and influences, with therapeutic
potential, or, on the contrary, unfavourable. Any quantitative
and qualitative modification of the environmental
characteristics, over some limits, suffers from the level of a
living organism under different forms.
At their turn, underground spaces (salt mines, caves)
distinguish by some particular properties that, not only differ in
comparison with the existing surface conditions, but also among
they. Some of these features can exert influences on living
organisms and, so, can be turn account in therapeutical purposes
for treatment of some specific diseases one of the principal
goals of the speleotherapy.
The article passes in the review some of the microclimate
characteristics for some of the most important salt mines from
Romania, namely: Tg. Ocna, Slnic Prahova, Praid, Cacica and
Turda.
The work presents the characteristic features of the
principal microclimate parameters (air temperature and humidity,
air draught velocity, atmospheric pressure difference in
comparison with the entrance) of these underground locations,
in the frame of some short characterizations of the climatic
features of the localities where are situated these underground
spaces.
Key words: microclimate, salt mines, speleotherapy.

P 32
ASPECTE ALE RECUPERRII LA PACIENTUL VRSTNIC
CU PROTEZ DE OLD
Glbeaz Gina, Logoftu Carmen, Diaconescu Sebastian,
Anatole Bogdan, Udvuleanu Gabriela, Onofrei Simona,
Hanna Iolanda, Bodescu Cristian, Delia Cintez
Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie
Pacientul vrstnic necesit protez de old din trei motive: coxartroz avansat invalidant, fractura de col femural (d.o.
favorizat de osteoporoz) i mult mai rar necroza aseptic
de cap femural. Pentru coxartroza avansat se folosesc proteze
totale cimentate iar pentru fractura de col femural cu cotil integru,
se folosesc proteze Moore.
Obiectivul lucrrii a fost studierea evoluiei postoperatorii
precoce i tardive la 4 paciente cu vrsta peste 80 ani i introducerea unor programe terapeutice n vederea recuperrii

optime a deficitelor instalate asfel nct s se obin o integrare

familial i social i o cantitate ct mai bun a mersului.
Metoda i materialul
Metoda: am folosit tehnici de kinetoterapie activ (pentru
creterea de for i tonifiere muscular, ameliorarea
coordonrii, exerciii de mers, exerciii pentru creterea capacitii aerobe, tehnici de combatere a decondiionrii i masaj
(sudativ i decontracturant).
Materialul: cercetarea a fost efectuat asupra unui grup
de 4 paciente cu vrste cuprinse ntre 80 i 94 de ani. Parametrii urmrii: au fost clinici generali: TA, AV, frecvena respiratorie, specifici mobilitatea la nivelul oldului, parametrii de mers,
teste globale pentru mers i echilibru (Cooper, Tinetti).
Rezultate
Toate cele 4 paciente au fost reintegrate social i familial
i s-a obinut o ameliorare a mersului (creterea perimetrului de
mers i a nivelului de independenenden motorie) cu rezultate
variabile n funcie de vrst i afeciunile asociate.
Concluziile lucrrii
Pacientul vrstnic are de obicei afeciuni asociate multiple care determin mai frecvent i mai rapid instalarea sdr. de
decondiionare i care limiteaz utilizarea unui program de recuperare standard.
Pentru o reintegrare social i familiala i o recuperare
optim a mersului este necesar un program de recuperare
adaptat bazat n special pe tehnici de KT activ.
ASPECTS O. REHABILITATION IN ELDERY WITH HIP
PROSTETICS
Galbeaza Gina, Logofatu Carmen, Diaconescu Sebastian,
Anatole Bogdan, Udvuleanu Gabriela, Onofrei Simona,
Hanna Iolanda, Bodescu Cristian, Delia Cinteza
National Institute of Rehabilitation, Physical Medicine and
Balneoclimatology
An elderly needs hip prostetic for 3 reasons: an invalid hip
arthritis, a fracture of femur neck (ussually due of osteoporosis)
and much more rare an necrosis of femure head.
.or advanced hip arthritis are in use cimentate total
prostetics and for neck femur fracture they are in use Moore
prostetics.
The objective was the study of precocious and tardily
postoperative evolution of four patients over 80 years old and
drawing of therapeutics programs for optimum rehabilitation of
installed deficiencies thus to obtaine a social and family
reintegration and better quality of gate.
The method
We used technics of active kinetotherapy (for strenght,
improve coordination, gate exercise, exercise for growing of
aerob capacity, tehnics against deconditioned).
The study was accomplished on a group of four patients
over eighty years old.
The parameters we had in view were:
- clinics generals: TA, AV, respiratory frequency
- specifics: the mobility of hip, the parameters of gate:
speed, perimeter of gate, total tests for gate and balance(
Cooper, Tinetti)
Results
All patients were familial and social reintegrated and we
obtained an improvement of gate (growing of gate perimeter
and of level of motor independence) with variable results
depending on associate affections.
Conclusions
The elderly ussually have multiple associate affections
which cause frecquently and quickly(rapidly) installation of
deconditioned syndrome and which limits the use of standard
rehabilitation program.
.or a social and familial reintegration and an optimum
rehabilitation of gate it is necessary an adapted rehabilitation
program based specially on active Kinetotherapy techinics.

75

III. POSTERE
P 33

The rehabilitation in the elderly needs a special care

because of multipathology, diminished effect tolerance and the
great frequency of accidents.

ASPECTE PRIVIND REABILITAREA LA VRSTNICI DUP

AVC
Ghiorghe Simona 1 , Khayat Mihaela 2 , Popescu Georgeta
Strinu Marinela 3 , Sadica Isabela 2
1 INGG Ana Aslan Bucureti
2 INRM.B Bucharest
3 Clinica de Recuperare
Spital Municipal Hunedoara

Accidentul vascular cerebral este una din cele mai frecvente cauze de mortalitate a vrstnicului i care, prin sechelele
sale, poate s determine o important dizabilitate a pacientului
dac acesta supravieuieste momentului acut.
Scopul lucrrii
Lucrarea de fa i propune analiza unor aspecte privind
reabilitarea pacientului sechelar dup AVC, cu afectare substanial neurologic; scopul reabilitrii nu este de a vindeca, ci
mai degrab de adaptare la handicapul funcional, maximizarea
funcionalitii n perspectiva mbuntirii calitii vieii.
Material i metod
Au fost luai n studiu 67 pacieni internai n I.N.G.G. Ana
Aslan , cu vrste cuprinse ntre 68-75 ani, 38 brbai i 29 femei,
care au fost evaluai din punct de vedere clinic, biologic,
funcional, psihologic.
Reabilitarea pacientului sechelar dup AVC este
nendoielnic pluridisciplinar, incluznd medici geriatri, echipa
de recuperare, nurse.
Rezultate i discuii
Posibilitile de recuperare i limitele sale sunt dependente
de tipul i severitatea deficitului neurologic, prezena i gradul
deficitului cognitiv, suportul familial, momentul nceperii
tratamentului recuperator i continuitatea acestuia.
Concluzii
Vrsta naintat nu este un impediment pentru recuperare, aceasta poate i trebuie fcut, precocitatea instituirii programului recuperator favoriznd prognosticul funcional.
Recuperarea la vrsta a III-a necesit grij special, datorit confruntrii permanente cu o semiologie bogat, cu diminuarea capacitii de efort i cu frecvena crescut a recidivelor.

Ioana Giurgiu, Nora Cucu, L. Irsay, L. Pop, I. Onac,

Mrza Dorina, Rodica Ungur, Luminia Pop, Monica Pop,
Ivona Comnescu, Alexandrina Nicu
Spitalul Clinic de Recuperare Cluj
Centrul Medical Universitar Cluj
Premize
Asocierea spondilitei anchilozante cu osteoporoza este
binecunoscut i crete semnificativ gradul de disabilitate,
deteriornd prognosticul.
Obiective
Evaluarea prevalenei osteoporozei la pacienii cu
spondilit anchilozant internai pe secia noastr, precum i
evaluarea calitii vieii prin metoda chestionarelor.
Material i metod
Am efectuat un studiu de urmrire, nc n derulare, la
pacienii cu spondilit anchilozant internai pe secia noastr
din septembrie 2004 i pn n prezent, la care s-a determinat
DMO folosind tehnica DEXA.
Rezultate
Studiul fiind nc n derulare, putem afirma c pn la ora
actual au fost investigai 27 de pacieni cu spondilit, dintre
care la 29% am obinut ostoporoz, iar la 30% osteopenie.
Concluzii
Asocierea nefast dintre cele dou maladii este frecvent
i n populaia autohton. Dup finalizarea studiului vom ncerca
s gsim rspunsuri i la alte probleme importante: tipul
osteoporozei, avnd n vedere vrsta relativ tnr, modificrile calitii vieii fa de ali pacieni care nu prezint asocierea
celor dou boli, urmrirea acestor pacieni pe mai muli ani cu
monitorizarea concomitent a celor dou boli.

REHABILITATION O. THE ELDERLY A.TER AN AVC

Ghiorghe Simona 1 , Khayat Mihaela 2 , Popescu Georgeta
Strinu Marinela 3 , Sadica Isabela 2
1 INGG Ana Aslan Bucharest
2 INRM.B Bucharest
3 Clinic of Recuperation - Hunedoara Municipal Hospital
Stroke is one of the most common cause of death in the
elderly which as a consequence can determine a significant
disability if the patient survives the acute phase of the stroke.
Purpose of the paper
The present paper analyses some aspects regarding the
rehabilitation of the elderly after a stroke with substantial
neurological impairment; the goal of rehabilitation is not cure
but rather adaptation to the functional handicap, to maximise
functionality for enhancing the quality of life.
Method
Our study was made on 67 patients hospitalised in INGG
Ana Aslan , aged between 68 and 75 years, 38 men and 29
women, evaluated from clinical, biological, functional and
psychological point of view. The rehabilitation of the patient after
a stroke is a multidisciplinary action, including geriatricians,
recuperation doctors and nurses.
Results and discussions
The rehabilitation possibilities and its limits are depending
on the type and severity of the neurological deficit, the presence
and degree of cognitive impairment, family support, the time at
which the rehabilitation treatment starts and its continuation.
Conclusions
The old age is not a barrier for rehabilitation; it is possible
and must be done, as early as possible to be successful.

P 34
PREVALENA OSTEOPOROZEI LA PACIENII CU
SPONDILIT ANCHILOZANT LA SPITALUL DE RECUPERARE CLUJ
- REZULTATE PRELIMINARE -

P 35
CERVICALGIA CRITERIU ADIIONAL DE DIAGNOSTIC
DI.ERENIAL NTRE SPONDILOZA CERVICAL I
SINDROMUL MIO.ASCIAL
Irina Gordon, Silvia Sandu, Mihaela Mihail, Mdlina Sideri
Clinica de Recuperare Medical, Spital Clinic Colentina
Cervicalgia este un simptom comun al unui numr mare
de afeciuni musculoscheletale.
n secia Recuperare Medical a Spitalului Clinic Colentina
s-au prezentat n ultimii 2 ani un numr mare de pacieni cu
sindroame algice i disfuncionale la nivelul coloanei cervicale,
ale cror cauze s-au dovedit a fi spondiloza cervical sau
sindromul miofascial.
Ne-am propus, n aceast lucrare, s studiem intensitatea
durerii cervicale la mobilizarea coloanei pe diferite axe de
micare.
Am luat n studiu un numr de 120 pacieni, dintre care 70
diagnosticai cu spondiloz cervical i 50 diagnosticai cu
sindrom miofascial.
Durerea a fost evaluat, dup scala vizual analog, de
la 1 la 10, n timpul mobilizrii coloanei cervicale pe: flexie,
extensie, inflexiuni laterale i rotaii.
Diferenele semnificative n cadrul celor dou grupuri au
fost constatate la evaluarea intensitii durerii la micrile de
flexie i extensie.
Concluzii
micarea de extensie determin o durere mai intens

76

III. POSTERE
dect cea de flexie, la 90% din pacienii cu spondiloz cervical;
micarea de flexie determin o durere mai intens dect
cea de extensie, la 86% din pacienii cu sindrom miofascial.
Putem spune c intensitatea durerii ce nsoete micrile
coloanei cervicale n plan sagital (flexie i extensie) poate fi
considerat un criteriu adiional de diagnostic diferenial ntre
spondiloza cervical i sindromul miofascial.

P 36
METODE .IZICALE N RECUPERAREA PATOLOGIEI DE
ESUT MOALE ASOCIAT UMRULUI HEMIPLEGIC
.KT Alina Iliescu, Eduard Neagu, Boain Mirela,
Luminia Dumitru, Mihai Berteanu
Clinica de Recuperare Medical, Spitalul Universitar de
Urgen Elias
Scopul lucrrii
Prezentarea modificrilor funcionale i de biomecanic
la umrul hemiplegic, evaluarea n vederea detectrii afectrilor
esutului moale i propunerea unui program complex fizicalkinetic de reabilitare.
Material i metod
S-a efectuat un studiu pe un lot de 40 de pacieni cu
hemiplegie post AVC n diferite stadii evolutive. S-au urmrit ca
parametrii: durerea, intervalul de mobilitate i modificrile
aliniamentului centurii scapulare.
Rezultate
S-a constatat o ameliorare semnificativ a parametrilor
urmrii la pacienii la care programul fizical-kinetic s-a instituit
precoce.
Concluzii
Modificrile funcionale sunt o prezen constant la
pacientul postAVC. Kinetoterapia susinut de fizioterapie pare
a fi o modalitate terapeutic eficient n reabilitarea membrului
superior.
PHYSICAL METHODS IN REABILITATION O.
PATHOLOGY O. SO.T TISSUE IN HEMIPARETHIC
SHOULDER
.KT Alina Iliescu, Eduard Neagu, Boain Mirela,
Luminia Dumitru, Mihai Berteanu
Clinica de Recuperare Medical, Spitalul Universitar de
Urgen Elias
Objective
To present functional an biomecanical changes of
hemiparetic shoulder, to evaluate the injuries of soft tissue and
to propose a complex physiotherapeutical treatment.
Material and methods
Our study included 40 patients with stroke in different
stages of recovery. We followed parameters like:pain, range of
motion and disaligniamet of shoulder girgle.
Results
We observe an important improvement of followed
parameters, especially when treatment begun in early stages.
Conclusions
.unctional changes are common in stroke and
kinetotherapy in addition with after physical agents seems to be
a proper modality for rehabilitation of shoulder in stroke.

P 37
PARTICULARITI ALE EXERCIIULUI .IZIC N SARCINA
NECOMPLICAT
.KT Alina Iliescu, Mariana Negoi, Lavinia Nanu,
Mihai Berteanu
Clinica de Recuperare Medical,
Spitalul Universitar de Urgen Elias
Scopul lucrrii
Prezentarea modificrilor anatomice, mecanice i

fiziologice care impun anumite particulariti exerciiului fizic,

precum i a posibilelor modificri patologice induse de sarcia.
Material i metod
Studiul a cuprins un lot de 20 de paciente aflate n trimestre diferite de sarcin, la care s-au apeciat ca parametrii prezena durerii lombare inferioare, modificrile de static, prezena venelor varicoase i a edemelor membrelor inferioare i prezena diastazei muchilor drepi abdominali.
Rezultate
Ca rezultate ale programului de exerciii terapeutice, s-a
constatat ameliorarea parametrilor urmrii, avnd n vedere i
absena unui tratament medicamentos i de electroterapie. De
asemenea, s-a observat o cretere a anduranei generale n
vederea pregtirii mamei pentru activitile de ngrijire a copilului.
Concluzii
Dei aflat n stare de sntate, femeia nsrcinat prezint modificri fiziologice care reclam programe precoce de
kinetoprofilaxie, dar i programe de kinetoterapie n cazul
apariiei modificrilor patologice.
PARTICULAR ASPECTS O. THERAPEUTIC EXERCISES
IN PREGNANCY
.KT Alina Iliescu, Mariana Negoi, Lavinia Nanu,
Mihai Berteanu
Clinica de Recuperare Medical,
Spitalul Universitar de Urgen Elias
Objective
To present anatomic, physiologic, mechanical changes
and pregnancy-induced pathology, which claim specific
programs of therapeutic exercises.
Material and methods
This study followed 20 women in different trimester of
pregnancy. We assessed as parameters the presence of low
back pain, the changes in posture, the presence of varicose
vein, lower extremity edema and diastasis recti.
Results
The parameters were improved, although we didn2 t use
any medications or electrotherapy. In addition, this program of
therapeutic exercises increase or maintain cardiovascular
fitness and prepare the mothers for postpartum period and infant
care.
Conclusions
Although is in a condition of wellness, the pregnant woman
presents physiologic changes which require programs of
kinetoprophylaxis and kinetotherapy when pathological changes
appear.

P 38
RECUPERAEA ARTICULAIILOR MEMBRULUI PELVIN N
HEMO.ILIE
.KT Alina Iliescu, Mariana Negoi, Lavinia Nanu,
Mihai Berteanu
Clinica de Recuperare Medical,
Spitalul Universitar de Urgen Elias
Scopul lucrrii este acela de a prezenta un program
eficient de terapie fizic la pacienii cu manifestri articulare ale
hemofiliei, avnd n vedere posibilitile reduse de tratament
medicamentos.
Material i metod
Lotul luat n studiu a cuprins 8 pacieni, evaluai i tratai
ambulator n perioada noiembrie 1999 iunie 2000 n Clinica
de Medicin .izic i Recuperare a S.U.U.B, alturi de medicii
de la Institutul de Hematologie. Eficiena programului fizicalkinetic a fost obiectivat prin determinarea unor parametrii ca:
durerea, intervalul de mobilitate, scderea de for muscular
pe musculatura stabilizatoare i instabilitatea articular la nceputul i la sfritul celor 3 sptmni de tratament.
Rezultate
Datele obinute au evideniat c parametrii monitorizai au

77

III. POSTERE
nregistrat ameliorri semnificative, exceptnd instabilitatea
articular, care s-a meninut la sfritul tratamentului din cauza
duratei prea scurte a acestuia.
Concluzii
Tratamentul de fizio-kinetoterapie nceput la primele
afectri articulare este hotrtor pentru meninerea unui interval
de mobilitate care s permit desfurarea activitilor zilnice,
evitarea instalrii deformrilor articulare i evitarea atrofiei
musculare.
REHABILITATION O. JOINTS O. LOWER LIMB IN
HAEMO.ILIA
.KT Alina Iliescu, Mariana Negoi, Lavinia Nanu,
Mihai Berteanu
Clinica de Recuperare Medical,
Spitalul Universitar de Urgen Elias
Objective:
To present an effective program of physical therapy for
patients with joint injuries in haemofilia, all the more as
medication is very poor in haemofilia.
Material and methods
Our group of study included 8 patients, evaluated and
treated in November 1999- july 2000 in the Department of
Rehabilitation and Physical Therapy of Universitary Hospital, in
cooperation with Institut of Haemathology. The effectiveness of
treatment was established by measurement of clinical
parameters like: pain, range of motion, decrease in muscular
strength and joint instability before and after 3 weeks of
treatment.
Results
Our data suggest that parameters were significant
improved, exept joint instability, because of very short period of
treatment.
Conclusions
Physical therapy begun in early stages of haemofilic
arthropaty is essential for maintain the functional range of motion
and muscular strength for perform activities of daily living.

P 39
HIDROKINETOTERAPIA N RECUPERAREA
SCOLIOZELOR IDIOPATICE LA COPIL
Mdlina Iliescu 1 , D. Iliescu 2 , Ioana Ureche 3 , S. Ureche
1 medic rezident recuperare, medicin fizic i baneologie,
prep. univ., .acultatea de Medicin,
Universitatea Ovidius Constana
2 medic specialist medicin sportiv, ef de lucrri anatomie,
.acultatea de Medicin, Universitatea Ovidius Constana
3 medic primar recuperare, medicin fizic i baneologie,
ambulatoriul de specialitate al Spitalului Clinic Judeean de
Urgen Constana
4 medic rezident ortopedie, Spitalul Clinic de Urgen
Bagdasar

Obiective
n lucrarea de fa am realizat un studiu clinico-evolutiv
pe un grup de 32 de copii diagnosticai i luai n eviden cu
scolioz idiopatic, n ambulatoriul de specialitate al Spitalului
Clinic Judeean de Urgen Constana ntre aprilie 2003 i aprilie
2005.
Material i metod
Subiecii au fost mprii n trei loturi, n funcie de
tratamentul aplicat: lotul tratat numai prin hidrokinetoterapie, lotul
tratat prin hidrokinetoterapie i C.M i lotul tratat numai prin
C.M. Evaluarea s-a efectuat la includerea n lot i la un interval
de 6 luni de la nceperea tratamentului, att din punct de vedere clinic, ct i radiologic.
Rezultate
Datele obinute dup prelucrare au fost semnificative i
au artat importana instituirii unui plan terapeutic adecvat

pentru aceti copii i, de asemenea, precocitatea aplicrii lui.

Concluzii
Terapia acvatic, prin utilizarea principiului legii lui
Arhimede, beneficiaz de reducerea considerabil a influenei
greutii corporale i realizeaz combaterea dezechilibrelor
musculo-ligamentare i dezvoltarea grupelor musculare
necesare meninerii coreciei obinute.
HIDROKINETOTERAPY- REEDUCATION O. IDIOPATIC
SCOLIOSIS IN CHILDREN
Mdlina Iliescu 1 , D. Iliescu 2 , DR. Ioana Ureche 3 , S. Ureche
1 medic rezident recuperare, medicin fizic i baneologie,
prep. univ., .acultatea de Medicin, Universitatea Ovidius
Constana
2 medic specialist medicin sportiv, ef de lucrri anatomie,
.acultatea de Medicin, Universitatea Ovidius Constana
3 medic primar recuperare, medicin fizic i baneologie,
ambulatoriul de specialitate al Spitalului Clinic Judeean de
Urgen Constana
4 medic rezident ortopedie, Spitalul Clinic de Urgen
Bagdasar
Objectives
The aim of the study was a clinical and evolutional
assessment on 32 children diagnosed with idiopathic scoliosis,
in evidence at the ambulatory of the Emergency County Clinical
Hospital of Constana between April 2003 and April 2005.
Material and Method
The subjects we study have been separated in three
different groups, based on the applied treatment: the first group
was treated only with hydrokinetotherapy, the second group was
with hydrokinetotherapy and kinetic exercise, and the last one
benefited only of kinetic exercise. We made a clinical and
radiological evaluation at the beginning as well as at after six
months of treatment.
Results
The final data illustrates the significance of an adequate
therapeutic plan for this kind of disease in children, as well as
the need for an early treatment.
Conclusions
Aquatic therapy, using Archimedes s principle, be2nefits
of a significant diminish of the influence of body weight,
equilibrates the disturbed musculo-ligamentar balance and also
develops the main muscular groups needed for the postural
maintenance.

P 40
ANALIZA BIOMECANICA A MEMBRULUI SUPERIOR N
VOLEI PRIN SIMI MOTION
Ilona Ilinca, Elena-Tania Avramescu, Mihaela Zvleanu
Universitatea din Craiova, .acultatea de Educaie .izic i
Sport
Obiective
Lucrarea prezent ofer o abordare dinamic a
biosistemelor implicate n micare. Scopul principal este acela
de a realiza o analiz comparativ ntre forele dezvoltate la
nivelul articulaiilor membrului superior pentru 2 voleibaliti cu
vechime diferit n performan.
Material i metod
Studiul a nregistrat i analizat micrile specifice serviciului n volei pentru doi sportivi de vrst apropiat (13 i 11
ani), dar cu vechime diferit n practicarea sportului. Subiectul
numrul 1, n vrst de 13 ani, practic voleiul cu bune rezultate de 5 ani, n timp ce subiectul 2, n vrst de 11 ani, practic
voleiul de 2 ani. Metoda utilizat a fost cea a achiziiei de imagine
i analiza de micare cu ajutorul sistemului SIMI Motion.
Rezultate
Rezultatele experimentale, obinute cu ajutorul sistemului
de analiz de micare SIMI Motion, sunt extrem de concludente

78

III. POSTERE
i prezint un nivel de acuratee ridicat. Rezultatele redate comparativ pentru cei doi sportivi indic o acuratee mai mare a
micrii pentru sportivul cu vechime mai mare.
Concluzii
Asemenea abordri se pot constitui, pentru kinetoterapeut
sau pentru antrenor, n adevrate instrumente de investigare,
eliminndu-se sau minimiznd dotrile implicate de determinarea experimental a acelorai mrimi. Pornind de la rezultatele
cercetrii prezente este posibil elaborarea unor metode de
realizare a modelelor biomecanice experimentale, lund n considerare structura anatomic a lanurilor cinematice ale
membrelor superioare i analiza acestora cu ajutorul sistemului
de analiz de imagine SIMI Motion. Lucrarea prezent ncearc s ofere un sistem organizat care opereaz cu indicatori
obiectivi, aplicnd metode i algoritmi bine structurai care se
pot constitui n adevrate instrumente pentru analiza tehnicilor
de antrenament sau/i de recuperare. n extensie, se poate
meniona posibilitatea lrgirii studiului cu utilizarea modelului
pentru analiza micrii la pacienii ortezai. Considerm c
lucrarea prezent permite obinerea unor informaii obiective
privind factorii limitativi ai micrii n performan sau recuperare prin metode non-invazive de ultima or. Interpretarea
corelativ a informaiilor obinute va permite obiectivizarea procesului de antrenament prin recomandarea celor mai eficiente
exerciii kinetice, facilitnd optimizarea performanei.
BIOMECHANICAL ANALYSE O. THE UPPER LIMBIN
VOLLEYBALL BY SIMI MOTION
Ilona Ilinca, Elena-Tania Avramescu, Mihaela Zavaleanu
University of Craiova, .aculty of Physical Education and
Sport
Abstract
The present study offers a dynamic approach of the bio
systems involved in human movement. The main goal is to
realize a comparative analyze between forces induced in the
upper limb joints for two volleyball players with different years
of practice.
Material and method
The study registered and analyzed the specific movements
in the volleyball service for 2 players aged 13 and 11 years with
different sport experience. Subject number 1, aged 13 years,
practice volleyball with good results for 5 years; subject number
2, aged 11 years, practice volleyball for 2 years. The method
used was acquisition and analyze of image by SIMI Motion
System
Results
Experimental results obtained are concluding and of
most accuracy. The results are presented comparative for the
2 players, showing a better precision for the subject with a greater
experience.
Conclusions
These approaches can constitute for the trainer or
kinesitherapist real investigation instruments. Starting from the
results of present research is possible to elaborate new methods
for realizing biomechanical experimental models, taking into
consideration the anatomical structure of kinetic chains for the
upper limb and the analyze by SIMI Motion System. The present
paper is trying to offer an organized system that operates with
quantified indicators, by using methods and algorithms well
structured that can develop in real instruments for analyzing the
training or recovery techniques. In extension we must mention
the possibility of enlarging the study for handicapped persons, as
the model could be used for movement description or for the
influence that different orthesis can have on the studied segment,
practical approaches in rehabilitation programmes or training.
We consider that the present paper opens new possibilities
permitting to obtain accurate information about limitation factors
in movement in performance or recovery by non-invasive
methods of last generation. Correlative interpretation of obtained
information will permit improvement of the training process by
using the best kinetic exercises and facilitating performance.

P 41
INCIDENA I RECUPERAREA
MICROTRAUMATISMELOR LA SPORTIVI
Ilona Ilinca, Elena-Tania Avramescu, Mihaela Zvleanu
Universitatea din Craiova, .acultatea de Educaie .izic i
Sport
Obiective
Traumatologia sportiv, spre deosebire de traumatologia
general, include i unele cazuri n care, n mod paradoxal,
lipsete nsui traumatismul. Este clasa afeciunilor
hiperfuncionale, capitol din patologie specific numai sportivului,
n care aceste afeciuni manifestate la nivelul aparatului
locomotor reprezint forme localizate de suprasolicitare, innd
mai mult de fiziopatologia efortului sportiv dect de traumatologia
sportiv. n acest sens, lucrarea prezent ncearc, n primul
rnd, o individualizare a factorilor ce pot interveni n geneza
microtraumatismelor i afeciunilor hiperfinctionale i, n al doilea
rnd, stabilirea unui ghid terapeutic de recuperare a acestor
afeciuni.
Materiale i metode
Subiecii au fost alei dintre sportivii de performan
nregistrai n cadrul Policlinicii pentru Sportivi Craiova, care au
prezentat afeciuni microtraumatice ce pot fi tratate prin exerciiu
fizic. Sporturile interesate au fost baschet, handbal, volei, tenis
de cmp, alergri de fond; totaliznd un numr de 68 de subieci
analizai din cadrul crora s-au selectat 23 de subieci cu
afeciuni microtraumatice, hiperfunctionale sau cronice, sechele
ale microtraumatismelor. Pentru toi subiecii examinai s-a realizat incidena traumatismelor pe o perioad de 2 ani. Pentru
traumatismele nregistrate s-au iniiat i realizat programe de
recuperare kinetoterapice.
Rezultate
n cadrul microtraumatismelor nregistrate, majoritatea sa ncadrat n grupa microtraumatismelor prin suprasolicitare i
a afeciunilor cronice, sechele ale microtraumatismelor. S-au
ntlnit:
ligamentite acute; tendinite acute. Cele mai frecvente
localizri au fost la nivelul ligamentelor genunchiului, a tendonului
bicepsului brahial, al coifului rotatorilor (volei), tendonului
achilian.
afeciuni cronice i dismetabolice, sechele ale microtraumatismelor (11.3%). Dintre aceste afeciuni mai frecvent
ntlnite au fost periartrita scapulo-humeral, spondiloza,
lombalgiile de efort.
Concluzii
n cadrul microtraumatismelor nregistrate majoritatea s-a
ncadrat n grupa microtraumatismelor prin suprasolicitare i a
afeciunilor cronice, sechele ale microtraumatismelor. Am
apreciat c aceste afeciuni au aprut ca rezultat al unui deficit
de refacere local. Cauzele predispozante sunt reprezentate
de vascularizaia anatomic redus a acestor formaiuni i de
diferena de elasticitate a acestora fa de celelalte formaiuni
anatomice ce alctuiesc acelai lan biomecanic. Schimbarea
biomecanicii sau ntreruperea efortului n cazul unui exerciiu
nou duce la cedarea fenomenelor.
INCIDENCE AND RECOVERY O. MICROTRAUMA IN
ATHLETS
Ilona Ilinca, Elena-Tania Avramescu, Mihaela Zavaleanu
University of Craiova, .aculty of Physical Education and
Sport
Objectives
Sports traumatology, differently from general traumatology
, includes some cases in which the trauma is missing. This is
the group of hyperfunctional pathologies, specific only for the
sportive, in which these diseases located on locomotory level
are forms of local over solicitation, being more related with the
physiopathology of sportive effort instead of sport traumatology.
In this idea, the present paper tries first to individualize the factors

79

III. POSTERE
that can generate microtrauma and hyperfunctional pathologies
in sportives and secondly to establish a therapeutical and
recovery guide for these pathologies.
Material and methods
The subjects were selected from registered top level
sportives in the Sport Policlinic Craiova, that presented
microtrauma that can be treated by physical exercise. The
interested sports were: basketball, volleyball, tennis, long
distance running. We studied a number of 68 subjects from which
we selected 23 with microtraumatic lesions and hyperfunctional
pathologies, developed after microtrauma. .or all the subjects
we realized the trauma incidence for a period of 2 years. .or
identified pathologies we initiated and followed kinetic
programmes.
Results
Most of the microtrauma registered were from the overuse
and chronic group, developed after previous microtrauma. We
found:
acute ligamentitis; acute tendinitis, mostly localized at
knee ligaments, tendon og brachial biceps, tendon of rotator
(volleyball), achilian tendon.
chronic and dismetabolic pathologies (11.3%), most
frequently periartritis scapulo-humeralis, spondilosis, effort
lombalgies.
Conclusions
Most of registered microtrauma were from the overuse and
chronic group, developed after previous microtrauma. We
appreciate that these pathologie were developed as a result of
a local lack of recovery. The added factors were represented by
low vascularisation of these structures and low elasticity
compared with other structures in the kinetic chain. Changes in
biomechanics of movement or stopping the effort can lead to
improvement of symptoms.

P 42
KINETOTERAPIA DUP PROTEZARE TOTAL A
GENUNCHIULUI LA VRSTNICI
Marius Ivascu, Beatrice Gherman, Melania Drumea,
Cristian Papa, Cristian Paraschivescu
Clinica de Recuperare III INRM.B
Introducere
n timp ce proteza total de old este o prezen ubicuitar
n unitile de recuperare, artroplastia total a genunchiului a
nceput s fie realizat mai des, cel puin la noi n ar, mult mai
trziu. Ultimii ani au adus un numr progresiv cresctor de astfel de pacieni. Majoritatea acestora sunt vrstnici la care
tratamentul de recuperare presupune unele particulariti.
Obiective
1 .Stabilirea efectului tratamentului de recuperare asupra
mersului la vrstnicii cu protez de genunchi.
2. Identificarea factorilor de prognostic negativ ai
recuperrii mersului la aceti pacieni.
Material i metod
Am urmarit 15 pacieni cu protez total de genunchi
recent (sub 3 luni), aflai la prima internare pentru recuperare,
cu vrst medie de 70 de ani. Lotul martor a cuprins 12 pacieni
cu vrste ntre 30 i 50 de ani, cu intervenii chirurgicale (altele
dect protezare) la nivelul genunchilor. S-au utilizat scalele
GARS (Gait assessment rating scale) i Tinetti (scala combinat
pentru mers i echilibru), pornindu-se de la valori cuprinse ntre
45 i 50 puncte pentru scala GARS, respectiv ntre 10 i 15
puncte pentru scala Tinetti. S-au msurat fora muscular a
cvadricepsului i fesierilor (scala 0-5) i gradul de mobilitate al
articulaiilor membrului inferior.
Rezultate
n lotul de studiu, msurtorile la externare i la 3 luni au
artat valori semnificativ mai mici fa de grupul martor pentru
valorile scalelor GARS, Tinetti i pentru forele muchilor testai.

Dinamica recuperrii mobilitii articulare a fost similar la cele

dou grupuri. Rezultatele nu au fost influenate de importana
modificrilor artrozice anterioare protezrii; factorii de prognostic
funcional mai prost par s fie: gradul de modificare de static
anterioar operaiei, prezena tulburrilor cronice de circulaie
venoas, tromboflebita profund postoperator, gradul de
funcionalitate al articulaiilor nvecinate
Concluzii
1. Refacerea mersului la pacienii vrstnici cu protez
de old beneficiaz de tratamentul de recuperare medical, dar
este mai lent.
2. .actorii de prognostic funcional prost in de modificrile articulare i musculare caracteristice vrstei i de patologia venoas concomitent.
KINETOTHERAPY IN ELDERLY REHABILITATION A.TER
TOTAL KNEE ARTHROPLASTY
Marius Ivascu, Beatrice Gherman, Melania Drumea,
Cristian Papa, Cristian Paraschivescu
Clinica de Recuperare III INRM.B
Background
Since now, total knee arthroplasty was a lesser used
interventions in knee pathology in our country. There are few
years since more and more aged patients with total knee
arthroplasty come in the rehabilitation units. We have to know
the best rehabilitation standards methods and the reaction
particularities of these patients.
Objectives
1. To establish the effect of the rehabilitation methodology on the gait of the aged pacients with total knee
arthroplasthy
2. To identifie the functional prognostic factors in these
patients.
Methods
We studied 15 pacients over 65 ears old with recently total
knee arthroplasty and a younger group with 12 patients with
recent knee surgery. We utilized Gait Assessment Rating Scale
(GARS) and Tinetti scale for gait evaluation; we also measured
the strength of quadriceps and gluteus muscles and the range
of motion (ROM) in hip, knee and ankle.
Results
The values of gait scales were significantly lessen in the
study group after 3 weeks of reabilitation treatment and also
after 3 months; either for te muscles strenght. The negative
functional prognostic factors seem to be: the statical modifications
of the knee, the chronic venous insuficiency, the deep venous
thrombophlebitis, the affected ROM in the others joint of the lower
extremity.
Conclusions
1. The gait recovery in elderly pacients after total knee
arthroplasty with rehabilitation programs is good, but slower than
in younger pacients.
2. The degree of the ostheoarthritis, the venous insuficiency
and the age-determined muscles modifications are the negative
functional prognostic.

P 43
KINETOTERAPIA O NOU OPIUNE N TRATAMENTUL
SPONDILOZEI LOMBARE MANI.ESTAT CLINIC PRIN
LOMBALGIE, LUMBAGO I LOMBOSCIATIC
Viorica Lefter 1 , Oana Andreea Cibu
1 medic primar B.T Lacu Srat
2 medic stagiar Spitalul Judeean Brila

Motivaia abordrii temei prezentului studiu const n

expunerea unor observaii privind problematica terapeutic a
spondilozei, n general, i a lombosciaticii, n special. Literatura
de specialitate evideniaz faptul c aproximativ 80% din

80

III. POSTERE
populaie prezint cel puin un episod dureros n decursul vieii,
iar kinetoterapia reprezint 90% din terapia fazelor acute
hiperalgice, prin posturare analgetic, decontracturant i de
reducere a conflictului discoradicular specific herniilor de disc.
n condiiile sus menionate, kinetoterapia riguros aplicat,
pe baz de programe seriate dup un orar strict i fazele clinice
de evoluie a afeciunilor CDL, reprezint o ipotez n rezolvarea fazelor acute ale herniei de disc, prevenirea recidivelor i
recuperarea sechelelor spondilogene prin posturri adecvate
tip Ketonal i programe Williams.
Scopul lucrrii este de a verifica ipoteza de la care se
pornete n realizarea lucrrii i, n plus, lucrarea i propune s
fie un ghid de kinetoprofilaxie, kinetoterapie i kineto de recuperare n afeciunile spondilogene CDL n general i a
lombosciaticii n special.
Material i metod
Studiul bazat pe observaie clinic a fost realizat n serviciul de B.T i Recuperare din staiunea Lacu Srat pe un lot
format din 226 de pacieni, cu limite de vrst cuprinse ntre 3060 de ani, suferinzi de spondiloz i hernie de disc lombar cu
radiculopatie, n diverse stadii clinice evolutive. Structura lotului
luat n studiu a cuprins: 56 pacieni de sex feminin (reprezentnd 25%) i 170 de sex masculin (reprezentnd 75%), 181
pacieni din mediul urban (reprezentnd 80%) i 45 din mediul
rural (reprezentnd 20%); 79 pacieni au fost cu vrste cuprinse
ntre 30-40 ani (reprezentnd 35%), 68 pacieni cu vrste ntre
40-50 ani (reprezentnd 30%) i 79 pacieni cu vrste ntre 5060 ani (reprezentnd 35%); din punct de vedere al afeciunii
predominante au fost: 124 cazuri de lombosciatic (reprezentnd 55%); 56 cazuri de lumbago (reprezentnd 25%) i 46
cazuri de lombalgie (reprezentnd 20%). n urma evalurii clinice
iniiale s-au urmrit parametrii durerii (intensitate, localizare,
durat, iradiere) i tulburrile funcionale n cadrul spondilozei
CDL la care se adaug sindroamele specifice lombosciaticii.
Lotul luat n studiu a beneficiat de balneoterapie, fizioterapie i
kinetoterapie aplicat prin programe kinetice specifice fiecrei
faze, astfel: pentru pacienii acui am efectuat posturri conform KETONAL, pacienii din fazele subacute au beneficiat de
exerciii WILLIAMS, stadiile cronice au beneficiat de exerciii
pentru tonifierea musculaturii abdominale i paravertebrale. La
externare, n funcie de testarea final, pacienii au primit un
plan kinetic pe care urmau s-l efectueze la domiciliu de cel
puin 2 ori/sptmn.
Prin prelucrarea datelor obinute s-au estimat urmtoarele rezultate: coeficientul global iniial pentru spondiloz are valori cuprinse ntre 84-90%, iar cel final valori cuprinse ntre 98100%, cu un ctig funcional cuprins ntre 9-15 i o medie de
12%; pentru lombosciatic s-a obinut un coeficient global iniial
cuprins ntre 80-89% i un coeficient global final cuprins ntre
94-97%, iar beneficiul funcional a variat ntre 11-15 cu o medie
de 13%
Rezultate i discuii
n urma analizei rezultatelor studiului se desprind urmtoarele concluzii: n fazele acute, posturarea kinetic conform
graficelor prezentate reprezint 70-90% din eficiena terapiei;
n fazele subacute, kinetoterapia amelioreaz funcionalitatea
n proporie de 25-30%; programul Williams, urmrit pas cu pas,
poate aduce ameliorri semnificative ale mobilitii coloanei dup
consumarea procesului acut; menionez c tratamentul
kinetoterapeutic a fost asociat tratamentului balnear i fizical,
iar studiul nostru ntrete ideea menionat n literatura de specialitate c tratamentul kinetic sub toate formele lui este oportun n acest context i utilizarea lui ca form unic de tratament
ar fi hazardat, n special n fazele acute i subacute; calitatea
i durata remisiunilor n cazurile de lombalgie, lumbago i
lombosciatic depind de fermitatea cu care kinetoterapeutul
contientizeaz pacientul s utilizeze posturrile n fazele acute i poziiile adecvate n activitile cotidiene care previn
recidivele: poziia la locul de munc; poziia la mas; poziia n
timpul somnului; poziia n mijloacele de transport; poziia n
mers, ortostatism prelungit; poziia cnd ridic greuti.

KINETICS-THERAPY A NEW OPTION IN THE

TREATMENT O. LUMBAR SPONDYLOSIS CLINICALLY
SHOWN BY LUMBALGY, LUMBAGO AND
LUMBOSCIATICA
Viorica Lefter 1 , Oana Andreea Cibu 2
primary medicine B.T Lacu Sarat ,
2 student medicine in The County Hospital Braila
1

The reason of studying this issue consists of exposing

some overall remarks concerning the therapy problem of
spondylosis and particularly the lumbosciatica. The special
literature outlines the fact the around 80% people feels pain at
least once in a lifetime and kinetics therapy represents 90%
of the acute hyperalgic phases therapy, by analgesic posturing,
relaxation and disk hernia specific radicular conflict mitigation.
Under the above mentioned circumstances, thoroughly
implemented kinetics-therapy based on programs categorized
by a strict schedule and pain progress clinical phases, represent
a hypothesis in solving acute phases of disk hernia, prevention
of relapse casualties and recovery of spondylosis remainings
by adequate Ketonal posturing and Williams programs.
Work target is to check the hypothesis representing the
study basis and besides, the study intends to be a prophylactic,
kinetics therapy guide for recovery in spondylogenic diseases
generally speaking and particularly, for lumbosciatica.
Material and method
The paper based on clinical observation was drawn up in
the B.T and Recovery Department in Lacu Sarat resort, on a
group made of 226 patients 30-60 years old, suffering from
spondylosis and lumbar disk hernia with radiculopathy in different
phases of progress.
The structure of the studied group included: 56 female
patients (25%) and 170 male patients (75%); 181 patients living
in the urban area (80%) and 45 in the rural area (20%); 79
patients were 30-40 years old (35%), 68 patients were 40-50
years old (30%) and 79 patients were 50-60 years old (35%),
from the viewpoint of the dominant pain there were: 124
casualties lumbosciatica (55%); 56 casualties lumbago (25%)
and 46 casualties of lumbalgy (20%).
.ollowing the original clinical assessment, pain indicators
have been monitored (intensity, location, duration, irradiation)
and functional trouble within spondylosis adding specific
syndromes for lumbosciatica.
The group studied benefited from aqua therapy, physiotherapy and kinetics therapy implemented through kinetics
programs specific for every phase as such: for acute patients
we carried out posturing according to KETONAL, patients in
sub-acute phases benefited from WILLIAMS training, chronic
phases benefited from training for abdominal and para-vertebral
muscles tonus. On the moment of leaving the hospital,
depending on the final test, patients received a kinetic program
that they were going to perform at home at least twice a week.
By processing the information collected the following
results have been obtained: overall basic coefficient for
spondylosis ranges between 84-90% and the final one ranges
between 98-100% with a functional gain of 9-15 and average
12%; for lumbosciatica, it was obtained an overall basic
coefficient ranging between 80-89% and a final one ranging
between 94-97% and the functional benefit varied between 1115 and an average of 13%.
Results and talks
.ollowing the study results assessment, the conclusions
are: in the acute phases, kinetic posturing according to submitted
graphs represents 70-90% of the therapy efficiency; in the subacute phases, kinetics-therapy improves functionality to 25-30%;
the Williams program carried out exactly by every phase can
produce significant improvements of the spine mobility upon
completion of the acute process. I have to mention that the
kinetics-therapeutic treatment has been associated to the aquatic
and physical treatment and our study strengthens the idea
mentioned in the special literature that the kinetics-therapeutic

81

III. POSTERE
treatment under all its shapes is appropriate in this context. Using
it as the sole method would be hazardous particularly in the
acute and sub-acute phases; healing quality and duration in
lumbalgy, lumbago and lumbosciatica casualties depends on
the strength the specialist medicine gets the patient aware of
using posturing method in acute phases and appropriate
positions during daily activities preventing relapse: position at
the workplace, when eating, sleeping, in the transport means,
walking, prolonged standing; position when rising and carrying
heavy weights.

P 44
ORTEZAREA MEMBRULUI SUPERIOR N A.ECIUNILE
NEUROLOGICE CENTRALE I PERI.ERICE
Carmen Logoftu, Gina Glbeaz, Gabriela Udvuleanu,
Sebastian Diaconescu, Cristian Bodescu, Simona Onofrei,
Bogdan Anatole, Delia Cintez
INRM.B
Indicaiile general valabile ale ortezelor in cont de cele
trei funcii principale ale acestora: suport, protecie i refacerea
aliniamentului i schemelor de micare. Prescripia medical
pleac de la o bun cunoatere a funciilor membrului superior,
n particular a segmentului ce urmeaz a fi ortezat.
n afeciunile neurologice periferice ortezele sunt prescrise
postoperator, pentru prevenirea contracturilor-retracturilor
musculare, a redorilor articulare, a instalrii unor scheme de
micare substitutive, pentru imbuntirea funcionalitii minii.
O prescripie corect impune evaluarea corect a deficitului
motor i senzitiv, identificarea deficitelor cauzate indirect de
leziune, cunoaterea schemelor de micare compensatorii i
cunoaterea armamentariumului de ortezare. Este necesar
adaptarea prescripiei la particularitile pacientului, particulariti ce in de nivelul i gravitatea leziunii, etiologia suferinei,
tipul i gradul de deficit, prezena durerii i, nu n ultimul rnd,
de statutul socioeconomic al pacientului i de nivelul su de
instrurire.
n spasticitatea membrului superior, ortezele pot avea unul
sau mai multe dintre urmtoarele utilizri: limitarea sau abolirea
unei posturi anormale, prevenirea unor scheme anormale de
micare, promovarea aliniamentului i a micrii normale,
prevenirea contracturilor i meninerea mobilitii articulare,
nvarea motorie intit. O meniune aparte trebuie fcut n
ceea ce privete ortezarea umrului hemiplegic prin care se
urmrete reducerea subluxaiei acestuia i controlul durerii.
Ortezele utilizate pentru leziuni medulare nalte, soldate
cu tetraplegii, sunt orteze complexe, care au rolul de a promova
scheme de micare sau, mai ales, de a substitui/ asista muchii
cu funcie afectat. n afar de acestea mai sunt utilizate orteze
de repaus, cu rol de prevenire i imobilizare i orteze dinamice
electrice.

P 45
A.I.N.S. N TRATAMENTUL ARTROZEI
C. Mandica
Spitalul Municipal Ploieti
n jurul anilor 70, antiinflamatoriile nonsteroidiene au intrat
n practica reumatologic ca o speran, nscndu-se n plin
insucces de tolerabilitate a acidului salicilic i dup ce preparatele cortizonice ncepuser s-i fac prezent agresivitatea att
sistemic, ct i local.
Laboratoarele din ntreaga lume au nceput cercetri pentru gsirea unei molecule care s ofere efecte antiinflamatoare
crescute, asemntoare cortizonicelor, dar cu efecte secundare
minime, n special n sfera digestiv i lipsite de inducerea
dependenei. n decursul anilor, piaa farmaceutic a oferit

numeroase produse, dar a cror eficacitate terapeutic se

dovedea oarecum invers proporional cu efectele de
agresivitate, n special asupra tractului digestiv.
n ultimii ani, suntem martorii apariiei unei noi generaii
de medicamente, oarecum selective, substane cu efect de
inhibare a ciclooxigenazei 2, blocnd un anumit loc din lanul
procesului inflamator, dar lsnd liber ciclooxigenaza 1
responsabil de protecia mucoasei gastrice, i nu numai.
Procesul artrozic trebuie privit, pn la o anumit limit,
ca un proces normal n evoluia structurilor biologice, o
mbtrnire, o modificare a structurii moleculare a celulelor prin
ncetinirea metabolismului celular, prin diminuarea reaciilor
chimice din interiorul organitelor celulare.
Referindu-ne la procesul artrozic, degradarea se produce
att la nivelul condrocitului, ct i al substanei fundamentale.
Dac asupra condrocitului nu avem nc mijloace de a-l proteja
sau de a-i stimula refacerea metebolismul intern, asupra
substanei fundamentale putem interveni prin modularea
factorului de vscozitate, a gradului de polimerizare, n raport
cu deletarea mecanic la care este supus. Condroprotecia realizat de oxicami prin blocarea metaloproteazelor, a crei activitate se exercit prin conversia radicalului toxic superoxid, n
oxigen i peroxid de hidrogen cu suprimarea radicalului hidroxil
(OH-).
Durerea, simptomul principal n procesul artrozic, nc din
primul moment al instalrii acesteia, se explic prin denudarea
cartilagiului n anumite zone (zone de maxim presiune
dinamic), punnd n contact direct zonele subcondrale, bogate
n algoreceptori, cu factorul presiune. Ipoteza biotribosistemului,
argumentat matematic, dovedete importana factorului
mecanic i rolul protector al lichidului sinovial. Ameliorarea durerii
dup administrarea de AINS se poate considera ca o posibilitate, dar nu o soluie, n tratamentul artrozelor.
n concluzie, substanele AINS sunt folosite cu succes n
tratamentul artrozelor, avnd un efect important asupra calmrii
durerii, prin scderea inflamaiei secundare din evoluia acestora, dar care nu protejeaz cartilajul articular, cu excepia celor selective i a oxicamilor.
O atenie deosebit trebuie acordat factorului mecanic
de presiune, a consistenei lichidului sinovial prin concentraie
suficient de acid hialuronic i a meninerii gradului de
polimerizare a substanei fundamentale. nlturarea fragmentelor
de erozine cartilaginoase din cavitatea articular prin lavage
este, de asemenea, o modalitate ce nu trebuie neglijat.

P 46
ATLAS TEHNICI DE IN.ILTRAII N REUMATOLOGIE
C. Mandica
Ploiesti
Practica tratamentelor locale n suferinele reumatismale,
n special n cele din categoria reumatismelor inflamatorii, n
stadiile exudative impune cunoaterea cu precizie a tehnicii i
metodologiei unei astfel de manevre.
Lucrarea de fa, ncercnd s umple un gol al literaturii
de specialitate n ara noastr pune la dispoziie noiuni utile n
efectuarea de infiltraii intra-articulare cu scopul administrrii de
medicamente cu efect local sau n scop explorator.
Cunoaterea unor repere anatomice este deosebit de util
pentru a practica aceste menevre, evitnd astfel posibilitatea
lezrii unor structuri anatomice aflate n vecintatea locurilor de
abord.
Autorul dezvluie practicienilor, cu aceast ocazie, o experien de peste 30 de ani n domeniul practicii reumatologice,
la care se adaug i o experien dobndit ca asistent
universitar n catedra de anatomie.
Iconografia ce ilustreaz planele ghid sunt n majoritate
originale, ceea ce face ca nsuirea tehnicii de infiltraie s devin
facil att studenilor n medicin, medicilor practicieni de alte
specialiti, ct i medicilor de familie, confruntai adesea cu

82

III. POSTERE
solicitri din partea cazurilor ce li se ncredineaz i la care o
puncie articular poate rezolva rapid solicitarea.
Sunt inserate 28 plane color, fiecare nsoit de scheme
de anatomie descriptiv, cu evidenierea reperelor ce trebuiesc
cutate prin palpare pe tegument.

P 47
ROLUL .AMILIEI N READAPTAREA .UNCIONAL LA
SECHELARII POSTAVC INCLUI N PROGRAME DE
RECUPERARE MEDICAL PRECOCE
Gina Marinas, Doina Murariu, Viorel Crisan, Cristina Doina
Ionescu, Sabina Constantin, Dana Toader, Mihaela .iru
Clinica de Recuperare Medical III INRM.B
Introducere
n recuperarea funcional a supravieuitorilor post AVC
familia joac un rol hotrtor. O persoan cu deficiene nu poate depi situaia fr motivaie, ori pentru aceasta familia reprezint sprijinul cel mai important.
Obiectiv
Determinarea rolului familiei n motivarea sechelariloi
postAVC inclui n programe de recuperare medical precoce
Material i metod
Am urmrit evoluia funcional a 20 de pacieni cu sechele
dup AVC, similari din punct de vedere ai gradului de
dependen, vrstei i suferinelor asociate; dintre acetia, 8 au
beneficiat de sprijin total al familiei pe tot parcursul studiului (3
luni), 5 de sprijin moderat, iar 7 au fost practic ignorai de familie.
Aprecierea intensitii implicrii familiei a fost fcut de investigatori. Evaluarea a cuprins determinarea lunar a indicilor
Barthel i .IM (.unctional Independence Measure).
Analiza statistic
Deviaia standard, testul t, testul U, analiza .isher.
Rezultate i concluzii
S-a observat o mai mare complian la tratamentul de recuperare a pacienilor ce au primit sprijinul familiei; de asemenea complicaiile precum depresia, escarele, tulburrile de
nutriie i somn, sindromul mn-umr au fost semnificativ mai
rare, iar evaluarea final a gsit scoruri funcionale semnificativ
mai bune.
.AMILY SUPPORT IN .UNCTIONAL RECOVERY .OR
STROKE PATIENTS ENROLLED IN EARLY
REHABILITATION PROGRAMS
Gina Marinas, Doina Murariu, Viorel Crisan, Cristina Doina
Ionescu, Sabina Constantin, Dana Toader, Mihaela .iru
Clinica de Recuperare Medical III INRM.B
.amily support is essential for functional recovery of stroke
patients. A disabled patient cannot overcome the difficulties of
stroke sequels without a strong motivation.
Objective
Determining family impact on stroke patient motivation
enrolled in an early rehabilitation program.
Material and method
In this study were enrolled 20 patients with similar
characteristics (dependency, age, co morbidities); eight patients
had a strong family support, five patients had moderate family
support, and other seven patients were ignored by their families.
They were monthly assessed for functional scores (Barthel i
.IM).
Statistical analysis
Standard deviation, t test, u test, .isher analysis
Results and conclusions
Patients who had strong family support had a better
compliance with rehabilitation program; they had fewer
complications such as depression, escares, nutritional and sleep
disturbances, hand-shoulder syndrome; functional scores were
significantly better in patients with family support.

P 48
REEDUCAREA .UNCIONAL PRIN EXERCIII CU
MINGEA LA ADOLESCENII I TINERII CU CI.OLORDOZE
Luminia Marinescu 1 , Mihaela Macovei 2 ,
Denisa Enescu- Bieru 1
1 Universitatea din Craiova
.acultatea de Educaie .izic i
Sport
2 Universitatea de Medicin i .armacie Craiova
Obiective
Reeducarea funcional a tulburrilor sagitale ale rahisului
la adolesceni i tineri, cu ajutorul exerciiilor cu mingea (metoda
Vogelbach), are drept scop obinerea unor reacii motorii economice, specifice, la perturbrile echilibrului, cu integrarerea lor
n comportamentul motor cotidian.
Material i metod
Studiul a cuprins dou loturi de pacieni diagnosticai clinico-funcional i radiologic cu cifo-lordoze, mprii pe categorii de vrste astfel: 11-18 ani (lot 1, adolesceni), 19-30 ani (lot
2, tineri). Valorile cifozei au fost 52,8 (lot 1), 49,5 (lot 2), iar
ale lordozei de 40,2 (lot1), 43 (lot 2). Ambele loturi au urmat
pe o perioad de 3 luni (3 edine sptmnal) kinetoterapie,
cu exerciii specifice cu mingea, pentru micrile de flexieextensie, flexie lateral, rotaii i stabilizare. Scopul acestor
exerciii este de a obine prin automatism o poziie corectat a
rahisului n ortostatism i de a educa micrile analitice ale
coloanei prin reacii automate de redresare a echilibrului, cu
integrarea lor n schemele funcionale ale mersului i activitilor cotidiene. Evaluarea a monitorizat sgeile sagitale, cervical
i lombar i mobilitatea segmentar prin msurarea indicilor
Ott i degete-sol.
Rezultate i discuii
La ambele loturi s-a nregistrat mbuntirea valorilor funcionale, respectiv scderea valorilor medii ale sgeilor cervicale
cu 21 mm (lot 1), 15mm (lot 2), care atest redresarea cifozei,
i ale sgeilor lombare cu 28 mm (lot1), 18 mm (lot 2). De asemenea, indicele Ott crete cu 1,5 cm (lot 1), 0,7 cm (lot 2), iar
indicele degete-sol crete cu 18,5 cm (lot 1) i 8,2 cm (lot 2). Se
observ o evident cretere calitativ a echilibrului sagital i a
mobilitii pentru lotul 1.
Concluzii
Exerciiile cu mingea reprezint o metod kinetic
accesibil i agreabil n reeducarea funcional a pacienilor
cu cifo-lordoze, cu un impact superior la vrsta adolescenei,
conform cu mai marea suplee a coloanei la aceast vrst.
THE .UNCTIONAL RE-EDUCATION WITH THE HELP O.
BALL EXERCISES AT TEEN-AGERS AND YOUNG
PEOPLE WITH CI.OLORDOSIS.
Luminia Marinescu 1 , Mihaela Macovei 2 ,
Denisa Enescu-Bieru 1
1 Universitatea din Craiova- .acultatea de Educaie .izic i
Sport
2 Universitatea de Medicin i .armacie Craiova
Objects
The functional re-education of rachis sagittal alterations
at teen-agers and young people with the help of ball exercises
(Vogelbach method) has as purpose the obtaining of some economic motor responses, which are specific to equilibrium
perturbations, with their integration in daily motor behaviour.
Material and method
The study included two lots (groups) of patients with
cifolordosis which were diagnosed clinical, functional and
radiological; they were divided on age categories, like this: 1118 years (lot 1, teen-agers), 19-30 years (lot 2, young people).
Both lots followed on a period of 3 months (3 sessions a
week) kinetotherapy with specific ball exercises, for flexionextension, lateral flexion, rotations and stabilization movements.

83

III. POSTERE
The purpose of the exercises is to obtain through
automatism a correct position of the rachis analytic movements
as automatic responses for equilibrium straightening, with their
integration in the functional schemes of walking and daily
activities.
The estimate controlled the sagittal cervical and lumbar
arrows and the segmentary mobility with the help of Ott and
fingers-ground indices measurement.
Results and discussions
At both lots was registered an improvement of functional
values, that is the decrease of medium values of cervical arrows
with 21 mm (lot 1), 15 mm (lot 2), which attests the straightening
of the cifosis, and of lumbar arrows with 28 mm (lot 1), 18 mm
(lot 2).
Also, the Ott index increases with 1,5 cm (lot 1); 0,7 cm
(lot 2), and the fingers-ground index increases with 18,5 cm (lot
1) and 8,2 cm (lot 2).
It is noticed an obvious qualitative increase of sagittal
equilibrium and mobility for lot 1.
Conclusions
The ball exercises represents an accessible and pleasant
kinetic method for functional re-education of the patients with
cifolordosis, which has a bigger efficiency for teen-agers,
because these one have a more flexible spine.

P 49
APORTUL ASISTENTELOR DE .IZIOTERAPIE N
SINDROMUL UMRULUI DUREROS
1

3 Mariana Popescu
Mariana Moise, 2 Constana .lorescu,
1 Asistent balneofizioterapie UM. Carol Davila
2 Asistent principal balneofizioterapie INRM.B
3 Asistent principal balneofizioterapie INRM.B

Asistentele de fizioterapie, parte component i activ a

echipei de recuperare, preiau pacientul cu sindrom de umr
dureros, pe care n prima etap l bilaneaz clinico-funcional
notnd nivelul durerii, posibila reacie inflamatorie i alte modificri locale (tumefacie). Apoi l analizeaz din punct de vedere
funcional (articular i muscular), urmresc reciile cutanate i
de pri moi de vecintate, nainte de aplicarea terapiei fizicale.
Aplicarea metodelor de fizioterapie impune un bilan al
tegumentului, prilor moi i al eventualelor puncte dureroase,
al reaciei pacientului la mobilizare pasiv, activ i cu rezisten . Se urmrete reacia la aplicarea procedurilor fizicale.
Aceste elemente se monitorizeaz de-a lungul ntregii perioade
de tratament (cca 10 zile) prin terapie combinat electroterapie,
termoterapie, masaj , asistenta de fizioterapie urmrind realizarea unui microclimat psihologic i comportamental pacientului
i fiind interfaa dintre pacient i medicul de recuperare,
semnalnd totodat diferite reacii obiective sau subiective ale
pacientului, prin toate acestea dovedind poziia activ i eficace
n echipa de recuperare.

P 50
STUDIU PRIVIND E.ECTELE UNUI PROGRAM TAI CHI
CHUAN N OSTEOPOROZ
Gilda Mologhianu, Adriana Sarah Nica, Mihaela Mihescu,
Andreia Murgu
Universitatea de Medicin i .armacie Carol Davila
Osteoporoza, cea mai frecvent boal metabolic a osului,
definit ca fiind o boal scheletic, caracterizat prin scderea
rezistenei osoase i creterea susceptibilitii producerii de
fracturi , a suscitat i interesul colectivului nostru.
Scopul studiului a fost evidenierea mbuntirii
echilibrului i coordonrii unui grup de paciente diagnosticate
cu osteoporoz, aplicnd un program de gimnastic tradiional chinez Tai Chi, n vederea reducerii riscului de cdere

generatoare de fracturi.
Studiul a fost efectuat pe un grup de 28 de femei cu
osteoporoz (diagnosticat DXA, cu scor T < -2,5 DS +/ fracturi
n APP), selecionate dintre 62 de paciente cu osteoporoz comun de tip I sau II ce s-au adresat Clinicii Universitare III de
Recuperare din cadrul INRM.B, n perioada septembrie
noiembrie 2004. Evaluarea s-a fcut prin intermediul testului
Tinetti.
Concluzii
Programul de exerciii Tai Chi Chuan, efectuat pe scar
din ce n ce mai mare nu numai n Extremul Orient ci i n ntreaga lume, poate fi utilizat cu succes n recuperarea
osteoporozei pentru mbuntirea echilibrului i prevenirea
cderilor generatoare de fracturi.
Efectele trebuie urmrite pe o perioad mai mare de
timp, cel puin un an, timp n care trebuie s ne asigurm c
pacientele i continu programul acas.
Desigur, aceste exerciii trebuie s fac parte integrant
dintr-un program mai amplu de kinetoterapie specific pentru
osteporoz i pacientele trebuie s primeasc i tratament
medicamentos antiosteoporotic, n vederea mbuntirii efective
a calitii osului i, deci, a rezistenei osoase.
E..ECTS O. A TAI CHI CHUAN PROGRAM IN
OSTEOPOROSIS REHABILITATION PROGRAM
Gilda Mologhianu, Adriana Sarah Nica, Andreia Murgu,
Mihaela Mihaescu
University of Medicine and Pharmacy Carol Davila
Bucharest, Romania
Osteoporosis, the most common metabolic bone disease,
known to produce a bone resistance decrease and an increasing
risk of bone fractures, has a special attention in our Universitary
Clinique of Rehabilitation Medicine, .ilantropia Hospital in
Bucharest. The study intends to reveal the improvement of
balance and coordination in a group of 14 female patients
diagnosed with osteoporosis (by DXA, T score < -2.5 DS +/
history of fractures). The Tai Chi Chuan program has to be part
of a complex rehabilitation treatment plan, including
kinetotherapy and oral antiosteoporotic drugs, in order to
effectively enhance bone quality and resistance.
Key words: osteoporosis, Tai Chi Chuan program,
rehabilitation treatment

P 51
STUDIU PRIVIND MODI.ICAREA UNORI MARKERI DE
REMODELARE OSOAS SUB IN.LUENA UNUI PROGRAM DE KINETOTERAPIE
Gilda Mologhianu, Adriana Sarah Nica, Andreia Murgu
Clinica Universitar III de Recuperare, INRM.B
Osteocalcina este o protein ce intr n structura matricei
osoase, necolagen, produs de osteoblaste n timpul fazei de
mineralizare, reflectnd activitatea acestora. Dozat prin tehnici
radioimunologice, este un bun marker al sintezei osoase. Poate fi crescut la subiecii cu osteoporoz cu turnover ridicat,
dozarea sa permind i o evaluare a efectului terapeutic al unor
medicamente.
Obiectivul urmrit n studiul nostru a fost modificarea
markerilor osoi, n spe a osteocalcinei serice, sub influena
exerciiului fizic controlat. Studiul a fost efectuat pe un numr
de 29 de paciente cu osteoporoz diagnosticat prin DXA, pe o
perioad de 6 luni, 1iunie 2004- 30 noiembrie 2004, n cadrul
Clinicii Universitare III de Recuperare.
Pacientele au fost mprite n dou loturi astfel: lotul I
cu exerciiu fizic, fr medicaie antirezorbtiv, lotul II cu
exerciiu fizic i medicaie antirezorbtiv (fosamax). S-a
determinat osteocalcina seric nainte de instituirea programului kinetic; s-a instituit un program de exerciii fizice specific

84

III. POSTERE
osteoporozei, efectuat n clinic de 3 ori/sptmn cte 50 de
minute, cu recomandarea continurii la domicliu; s-a determinat
osteocalcina la 6 luni. S-au urmrit: vrsta medie, factorii de
risc: stilul de via, comorbiditi; evoluia osteocalcinei iniial,
nainte de nceperea programului kinetic i final.
Rezultate
S-au nregistrat scderi ale valorilor osteocalcinei la
pacientele celor dou loturi dup 6 luni de program de exerciii
fizice, controlat. La pacientele lotului care erau n tratament cu
fosamax, scderile au fost mai accentuate, dar fr semnificaie
statistic.
Concluzii
osteocalcina, n studiul nostru, pare a fi fost influenat
de efortul fizic (evaluarea s-a fcut la un interval suficient de
mare ase luni pentru a putea fi nregistrate modificri)
osteocalcina, marker important de formare osoas, poate
fi influenat de administrarea unor medicamente antirezorbtive,
precum fosamaxul care scade turnoverul osos
exerciiul fizic efectuat constant poate influena activitatea metabolic a osului n sensul reechilibrrii balanei rezorbieformare i poate fi un adjuvant important al tratamentului
medicamentos al osteoporozei
se desprinde necesitatea extinderii studiilor privind influena exerciiului fizic controlat asupra remodelrii osoase, n
vederea dovedirii efectelor acestui mijloc terapeutic la
pacienetele cu osteoporoz.
STUDY REGARDING THE MODI.ICATION O. BONE
REMODELING MARKERS UNDER THE IN.LUENCE O. O.
KINETOTHERAPY PROGRAM
Gilda Mologhianu, Adriana Sarah Nica, Andreia Murgu
The Third Rehabilitation University Clinic in Bucharest.
Osteocalcin is a non-colagen protein contained in the
structure of the bone matrix, produced by the osteoblasts during
the mineralization phase and thus reflecting their activity. It is a
good marker for bone syntesis, quantified using
radioimmunological techniques. It is found in greater quantity in
osteoporotic patients with high turnover. It can also be used ti
assess the therapeutic efficiency of some drugs.
Our object of study was the modification of bone markers,
especially osteocalcin, under the influence of physical exercise.
The study was performed on a number of 32 patients with
osteoporosis diagnosed using DXA, over a period of 6 months
between June1 2004 and November 30 2004 at the third
Rehabilitation University Clinic in Bucharest.
The patients were divided into two groups: the first group
was given physical exercise and no anti-resorptive medication,
and the second group was given physical exercise and also
anti-resorptive medication (.osamax). Seric osteocalcin was
determined for every patient before starting the exercise program. The exercise program, consisting of exercises usually
prescribed for osteoporosis, was conducted at the clinic, three
times a week for 50 minutes and with the recommendation for
exercising at home. Several factors were monitored such as
middle age and risk factors such as life style and associated
disease; the evolution of osteocalcin values from the initial level
to before entering the physical program and at the end of it.
Results
Osteocalcin levels dropped in patients of both groups after
6 months of controlled physical exercise. the patients in the
.osamax group has slighltly lower osteocalcin values, but the
difference lacked statistical value.
Conclusions
Osteocalcin is influenced by physical effort (the study
was conducted over a big enough time to register the variations);
Osteocalcin, an important bone formation marker, can
be influenced by the administration of antiresorptive drugs such
as .osamax that reduce bone turnover;
Physical exercise, if performed constantly, may influence
the bone s metabolic activity by improving the resorbtion

formation balance and may be an important aid for the drug

therapy in osteoporosis;
.urther studies regarding the influence of controlled
physical exercise on bone remodellig are mandatory, in order
to prove the effects of this therapeutic method on osteoporosis
patients.

P 52
ACIUNEA .ARMACODINAMIC A APEI MINERALE DE
LA VLCELE
Ana Munteanu, Iulia Pompei,
biol. cercet. st. III Paraschiva Ciupitu
Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie Bucureti
Pe modele experimentale a fost studiat aciunea apei
minerale de cur intern de la Vlcele.
Am urmrit aciunea apei minerale asupra secreiei
gastrice i enzimelor digestive, a hepatocitului i colerezei, a
diurezei.
Dup cura de optsprezece zile, am constatat c apa
mineral Vlcele reduce aciditatea gastric, stimuleaz enzimele
digestive, influeneaz funcia coleretic prin creterea cantitii
de bil excretat; stimuleaz funcia metabolic enzimatic a
hepatocitului; crete uor diureza i eliminrile de acid uric i
azot ureic.
PHARMACODYNAMICS O. VALCELE MINERAL WATERS
Ana Munteanu, Iulia Pompei,
biol. cercet. III Paraschiva Ciupitu
National Institute of Physical Medicine, Rehabilitation and
Balneoclimatology, Bucharest
The Vlcele mineral water, destined for internal
treatment, was tested through various experimental technics.
We studied the water s action on gastric secretions, and digestive enyzmes, on the liver, choleresis and diuresis. After
an 18-day treatment, we observed that the Vlcele mineral
water reduces gastric acidity, stimulates digestive enyzmes,
influences the choleretic function through increasing the
quantity of secreted bile, stimulates the enzymatic action of
the liver. It also slightly increases the diuresis and the
elimination of uric acid and nitric acid.

P 53
PRINCIPII DE RECUPERARE A SINDROMULUI DUREROS
COMPLEX REGIONAL DE TIP I LA PACIENTII
HEMIPLEGICI
Andreia Murgu, Adriana Sarah Nica, M. Ivacu
UM. Carol Davila Bucureti Clinica de Recuperare III
.ilantropia
Introducere
Clinica de Recuperare Medical III .ilantropia cuprinde
75 de paturi, iar peste jumtate din pacienii internai n clinic
sunt diagnosticai cu hemiplegii/hemipareze de diverse etiologii,
nivele de gravitate i stadii de evoluie. Sindrom dureros complex regional de tip I reprezint o complicaie a evoluiei acestor
pacieni i necesit un program de recuperare specific.
Scopul studiului
Studiul realizat intenioneaz s analizeze din punct de
vedere clinico-funcional evoluia diferitelor grupuri de pacieni
hemiplegici/hemiparetici postaccident vascular cerebral (AVC)
cu sindrom dureros complex regional de tip I care au urmat un
program complex de recuperare individualizat pentru fiecare
pacient.
Material i metod
Studiul cuprinde 327 de pacieni internai n clinic n

85

III. POSTERE
perioada ianuarie 2003 octombrie 2004, pacieni hemiplegici
cu rspuns neurovegetativ periferic anormal. Au fost selectai
pentru studiu pacienii cu localizri ale sindromului amintit la
membrul superior sau inferior, pacieni echilibrai hemodinamic,
fr afectare a funciilor hepatice sau renale. Am utilizat Indexul
Barthel i Scala Rankin modificat pentru evaluarea clinico-funcional a pacienilor.
Rezultate
Datele obinute prin evaluare clinico-funcional date
privind distribuia pe vrste i sex, cauzele hemiplegiei/
hemiparezei, localizarea sindromului dureros complex regional
de tip I, factori de risc ai evenimentului neurologic cauzator al
hemiplegiei/hemiparezei, localizarea antomic a AVC, stadiul
sindromului dureros complex regional de tip I, cele patru evaluri
clinico-funcionale, la internare, la externare, la 3 i 6 luni de la
prima evaluare, perioada medie de spitalizare au fost analizate
statistic.
Concluzii
Sindromul dureros complex regional de tip I reprezint o
complicaie a evoluiei pacienilor hemiplegici/hemiparetici post
accident vascular cerebral care necesit diagnostic precoce i
iniierea rapid a tratamentului de recuperare ntr-o form
individualizat, avnd n vedere istoricul medical, cauza
hemiplegiei/hemiparezei, localizarea AVC, rspunsul i
compliana la tratament.
Cuvinte cheie: Sindromul dureros complex regional de
tip I, pacient hemiplegic/hemiparetic, program complex de recuperare.
REHABILITATION IN POSTSTROKE CRPS I PATIENTS
Andreia Murgu, Adriana Sarah Nica, M. Ivacu
UM. Carol Davila Bucharest
Introduction
More than half of the patients admitted in the Universitary
Rehabilitation Clinique (Medical Complex .ilantropia) in
Bucharest with 75 beds are diagnosed with haemiplegia of
various etiologies stroke, brain tumor or trauma.
Aim of the study
This study intends to analize the clinical-functional dynamic
of different groups of patients with haemiplegia and CRPS Type
I following a complex rehabilitation program designed for each
person taking into account age, sex, haemiplegia etiology and
personal medical historic.
Method
327 patients admitted in our clinique between january 2003
and october 2004 were selected for this study, patients with
haemiplegia and peripheral overreacting neurovegetative
response. .or the Evaluation of patients with stroke: we used
the Barthel Index and Modified Rankin Scale to examine from
clinical and functional point of view our patients.
Results
.or statistical analyze of data obtained from the clinicalevaluation of the group of patients we considered information
concerning age and sex distribution, haemiplegia cause
anatomic injury caracteristic, Complex Regional Pain Syndrome
Type I localisation, risk factors for stroke, initial and second,
the third and the fourth clinical evaluation, period of
hospitalisation, stage of CRPS type I.
Conclusions
CRPS type I secondary to poststroke status is a
complication and impose an early diagnoses for a promptly start
of the proper treatment. Complex Regional Pain Syndrome Type
I complicates the evolution of the haemiplegic patient and the
rehabilitation team has to conceive a different complex
rehabilitation program for each patient, depending on the
pathological background, cause of haemiplegia, stage of CRPS
Type I, evolution, response and compliation to the program in
order to prevent complications and promote rapid and, if possible,
complete recovery.
Key words: Complex Regional Pain Syndrome Type I
(CRPS), Haemiplegic Patients, Rehabilitation program.

P 54
MODI.ICRI ADAPTATIVE IMEDIATE LA SCU.UNDAREA
CORPULUI N AP
Aspecte ale modificrilor fiziologice utilizate n Recuperarea Medical
Andreia Murgu, Valeria Blan*, Gilda Mologhianu
Universitatea de Medicin Carol Davila
*Academia Naional de Educaie .izic i Sport (ANE.S)
Introducere
Adaptarea la modificrile mediului nconjurtor poate fi
imediat (apare la toi indivizii, sportiv sau nesportivi) i tardiv
(produs n urma unui efort practicat timp ndelungat).
Scop
Prezentarea unor date teoretice privind adaptrile
fiziologice imediate i tardive la imersia corpului uman n ap i
exemplificri ale aplicaiilor practice din medicina sportiv.
Metod
Adaptarea imediat a organismului la schimbarea mediului nconjurtor se poate produce imediat ce corpul este introdus n ap. Aceste modificri adaptative au loc la nivelul
aparatului cardiovascular, aparatului respirator, sistemului osos
i muscular, aparatului renal i la nivelul glandelor endocrine.
Scufundarea corpului n ap determin perturbarea
homeostaziei, care este nsoit de reacii reglatorii la nivelul
funciilor vitale i metabolice. Reaciile reglatorii depind de
disponibilitile de funcionare ale organismului, de temperatura apei i de nivelul pn la care se face imersia.
Concluzii
Bine cunoscute i utilizate, modificrile adaptative ce apar
n corpul uman la imersia n ap pot facilita sau scdea
performana sportiv i pot fi indicate ca terapie n grbirea
recuperrii traumatismelor sportive.
Cuvinte cheie: mediu acvatic, adaptare, modificri
fiziologice, performan sportiv, recuperarea traumatismelor
sportive.

P 55
NECROZ ASEPTIC DE CAP .EMURAL I
OSTEOPOROZ SEVER LA O PACIENT TNR
Andreia Murgu, Oana Vasilescu, Mihaela .iru, Adriana Nica
Introducere
Necroza aseptic de cap femural nu este facil de
diagnosticat i presupune un program intens de recuperare
postoperator. De asemenea, osteoporoza sever la o pacient
tnr necesit multiple investigaii diagnostice i pune probleme de diagnostic diferenial. Asocierea celor dou afeciuni la o
pacient tnr pune clinicianul specialist n recuperare
medical n situaia de a confrunta pacienta cu un program complex, intensiv i de lung durat de recuperare.
Scopul lucrrii
Este de a sublinia dificultile de tratament pe care le presupune asocierea celor dou afeciuni i realizarea unui program de recuperare care s creasc calitatea vieii unei paciente
tinere cu handicap.
Material i metod
Prezentm cazul unei paciente n vrst de 32 de ani, din
mediu urban, cu un istoric medical complex, cu multiple internri
anterioare n diverse clinici de medicin intern, endocrinologie,
reumatologie, ortopedie, care se interneaz n Clinica de Recuperare III .ilantropia n mai 2005 pentru coxalgii bilaterale.
Algortimul de diagnostic diferenial este complicat i a presupus
numeroase investigaii imagistice i de laborator n clinicile
amintite. Prezentm n detaliu bilanul clinico-funcional care
evidentiaz handicapul pacientei i care a contribuit la stabilirea diagnosticului pozitiv de mai sus. Pacienta prezint multiple
fracturi spontane i mici traumatisme (pacienta nu tie cnd a
fcut fracturile de ram ischio-pubian bilateral sau fracturile de

86

III. POSTERE
metatarsiene) care caracterizeaz tabloul bolii. Obiectivele i
principiile terapeutice ale programului de recuperare au n vedere tratamentul de fond al osteoporozei, combaterea durerilor,
ameliorarea i/sau meninerea mobilitii articulare existente,
creterea forei musculare, combaterea i prevenirea
deformrilor la nivelul coloanei vertebrale, tratament ortopedico- chirurgical, psihoterapie, educarea pacientei.
Rezultate i discuii
Evoluia cazului pe parcursul internrii a fost favorabil:
s-a constatat ameliorarea mobilitii la nivelul articulaiei coxofemurale i coloanei lombare, diminuarea intensitii coxalgiilor.
Pe termen lung anticipm o evoluie lent, cu degradarea
progresiv a articulaiei coxofemurale i necesitatea protezrii.
Agravarea cifoscoliozei este inevitabil, dac nu respect
regulile de igien i postur, precum i continuarea programului de gimnastic la domiciliu, avnd n vedere c pacienta a
sczut n nlime 7cm. Pot apare noi fracturi spontane sau la
traumatisme minore.
Concluzii
Am luat n discuie cazul unei paciente tinere de 32 ani cu
necroz aseptic de cap femural i osteoporoz sever (scor T
3,46). Asocierea celor dou boli invalidante ridic mari semne
de ntrebare privind decizia medical i raspunsul la ntrebarea
pacientei: pot avea un copil?
Cuvinte cheie: necroz aseptic de cap femural,
osteoporoz sever, recuperare medical

P 56
OBSERVAII PRIVIND OPORTUNITATEA
TRATAMENTULUI CU AINS SELECTIVE-COXIBI N
LIMITAREA E.ECTELOR NOCICEPTIVE ALE TERAPIEI
.IZICALE CU ULTRASUNETE N ALGIILE REUMATICE
CRONICE, TRENANTE LA PACIENII CU RISC CRESCUT
DE HTAE, N SERVICIUL AMBULATOR
Iulia Nstase
Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie
Introducere
Afeciunile reumatice cronice, trenante ce asociaz
cvasiconstant un sindrom psihic indus de sindrom algic
persistent, refractar la tratamentele anterioare, au o mare
adresabilitate n Serviciul Ambulator de Recuperare fiind prezente predominant la pacienii vrstei a III a.
Pacienii cu risc crescut de HTAE reprezint un procent
important din totalul pacienilor hipertensivi prezeni la
consultaie, cu patologie complex, multidisciplinar. Acetia
au o opiune terapeutic medicamentoas cu antiinflamatorii
uzuale, limitat datorit efectului de retenie hidrosalin, frecvent
aceasta fiind abandonat n favoarea monoterapiei fizicale.
Aplicaiile de ultrasunete fac parte din protocolul uzual al
terapiei fizicale al afeciunilor reumatice cronice degenerative
artrozice i abarticulare, cu efecte benefice antiinflamatorii i
miorelaxante.
Unul din efectele adverse ale terapiei cu US l constituie
stimularea receptorilor nociceptivi locali, fr expresie
fiziopatologic la debutul aplicrii (primele zile) terapiei fizicale
ce declaneaz accentuarea temporar i reversibil a
simptomatologiei algice locale cu exagerarea sindromului psihic
preexistent.
Material i metod
Studiu observaional format din 2 loturi 10 pacieni
diagnosticai cu algii reumatice cronice, trenante de peste 2 luni.
S-a urmrit evoluia parametrilor simptomatici la debutul
terapiei fizicale:
durere scala VAS
Terapia aplicat:
Lotul A US + ET antialgic
Lotul B US + ET antialgic + 200mg celecoxib zilnic
timp de 5 zile.
Rezultate i discuii

Se observ:
Lotul A
accentuarea durerii locale
exagerarea sindromului psihic preexistent
creterea TA pn la valori moderate / severe
Lotul B
scderea simptomatologiei algice
sindrom psihic atenuat
TA n limite normale
n cazul aplicrii monoterapiei fizicale se observ
accentuarea simptomatologiei algice locale cu exacerbarea
sindromului psihic preexistent, datorat n principal percepiei
eronate a creterii durerii, ca i rspuns nefavorabil la tratamentul
fizical, cu scderea speranei de vindecare i a calitii vieii.
Concluzii
Aplicaiile de US la pacienii cu risc crescut cardiovascular
pot accentua simptomatologia algic local cu exagerarea
sindromului psihic preexistent, putnd precipita un puseu HTAE
prin mecanism reflex simpatic, chiar n condiiile unui tratament
cronic antihipertensiv riguros, n primele zile ale terapiei fizicale.
Administrarea de AINS selective-celeoxib la pacienii cu
risc crescut HTAE pare a fi soluia n prevenirea acestor
fenomene.

P 57
ABORDAREA COMPLEX A MAL.ORMAIEI
ARNOLD-CHIARI
Dan Neme 1, 3 , 5 , Dan V Poenaru 1, 2 , Ion Branea 1 , 2 ,
Mihai Drgoi 1 , 5 , 6 , Dan One 4 , Alina Totorean 1, 5 , 6 ,
Andreea Ni 1, 5 , Armand Gogulescu 1 , 3 , Elena Amrici 1 , 3 ,
Merima Jurici 1 , 3 , Iosif Ilia 3 , Atef Hammad 3 , Angelica Ponoran 3 ,
Carmen Haifer 3 , Corina Petru 3 , Camelia Ptruescu 3 ,
Loredana Mihil 3 , Dan Naicu 3 , Mihaela Udrescu 3
1 Universitatea de Medicin i .armacie Victor Babe
Timioara,
2 Spitalul Clinic Judeean de Urgen Timioara
Secia
clinic ortopedie- traumatologie II,
3 Spitalul Clinic Judeean de Urgen Timioara
Secia
clinic ortopedie- traumatologie II Compartimentul de
recuperare medical,
4 Spitalul Clinic Judeean de Urgen Timioara
Secia
clinic de radiologie i imagistic medical,
5 SC Excentric Company SRL
Centru medical de recuperare
medical Timioara,
6 Spitalul Clinic Municipal Timioara
Secia clinic de
balneofizioterapie, Romania
Malformaia Arnold-Chiari este o afeciune cu o etiologie
dificil de stabilit i o simptomatologie mozaicat, necaracteristic,
reprezentat de cefalee i cervicalgii, tulburri de deglutiie i
respiratorii, nistagmus, diplopie, afectarea auzului, mirosului,
crize de vertij, parestezii ale membrelor.
Morfopatologic, se caracterizeaz prin coborrea real sau
secundar aparent a trunchiului cerebral i a unor formaiuni
cerebeloase normale prin foramen magnum n canalul rahidian.
Aparent rar, n realitate malformaia Arnold-Chiari e mult
mai frecvent dect numrul cazurilor diagnosticate i aceasta
deoarece formele uoare nu dau manifestri sau exist o
simptomatologie tears i nespecific. Cazurile avansate sunt i
ele diagnosticate tardiv din cauza tabloului clinic variat,
necaracteristic i derutant. Diagnosticul de certitudine este imagistic.
Tratamentul este att medical, ct i nemedical. Cel
chirurgical are drept scop decompresiunea fosei cevicale i rezolvarea eventualelor defecte asociate. Rezultatele in de oportunitatea i precocitatea interveniei, fiind mai slabe n
interveniile efectuate la distan de la momentul debutului clinic.
Tratamentul de recuperare medical se va efectua att
pre, ct i postoperator, avnd drept obiective ameliorarea
simptomatologiei, corectarea tulburrilor asociate, iar n final,
crearea unui grad ct mai mare de independen i astfel mbuntirea calitii vieii. Se va ncepe cu elemente din cadrul

87

III. POSTERE
electroterapiei i masajului, continundu-se cu o kinetoterapie
lent, progresiv i cu o supraveghere permanent a pacientului.
n concluzie, intervenia chirurgical completat obligatoriu de un tratament recuperator specializat i foarte atent
coordonat au rezultate apreciabile, avnd n vedere capacitatea pacientului de a efectua activiti ale vieii zilnice. Aceste
rezultate vor fi cu att mai spectaculoase cu ct pacientul se
bucur de un solid i constant suport social i familial.
Cuvinte cheie: simptomatologie nespecific, abordare
complex, tratament de recuperare medical pre i postoperator,
suport social i familial.
COMPLEX APPROACH O. ARNOLD-CHIARI
MAL.ORMATIVE DISEASE
Dan Nemes 1 , 3 , 5 , Dan V Poenaru 1 , 2 , Ion Branea 1 , 2 ,
Mihai Dragoi 1 , 5 , 6 , Dan Onet 4 , Alina Totorean 1, 5 , 6 ,
Andreea Nita 1, 5 , Armand Gogulescu 1 , 3 , Elena Amaricai 1 , 3 ,
Merima Jurici 1 , 3 , Iosif Ilia 3 , Atef Hammad 3 , Angelica Ponoran 3 ,
Carmen Haifer 3 , Corina Petru 3 , Camelia Patrutescu 3 ,
Loredana Mihail 3 , Dan Naicu 3 , Mihaela Udrescu 3
1 Victor Babes University of Medicine and Pharmacology
Timisoara
2 Timis County Universitary Hospital
Orthopaedic and
Traumatology Department
3 Timis County Universitary Hospital
Orthopaedic and
Traumatology Department- Rehabilitation Department,
4 Timis County Universitary Hospital
Radiology Department
5 Excentric Company Ltd Timisoara
Medical Rehabilitation
Unit
6 Timisoara Medical Rehabilitation Universitary Hospital,
Romania
Arnold-Chiari malformation is a disease with a dificullt to
establish ethiology, intricate and uncharacteristic signs such
as head ache, necck pain, digestive and respiratory
disturbances, nystagmus, diplopya, hearing and smelling
perturbances, vertigo attack, limbs paresthesias.
Morphopathologically is characterized by really or aparent
descending, thru foramen magnum into the rahidian chanel, of
the cerebral trunk or some parts of normal cerebelous.
Apparently rare, Arnold-Chiari malformation is far more
frequent as those dianosed, because the easy forms have or no
signs or some light and uncharacteristic symptoms. Advanced
forms have also a late diagnosis because of varius, fade and
uncharacteristic symptoms. Certain diagnosis is radiologically one.
Complex approach is medical and surgical. Surgical
therapy has to decompress the cervical fossete and to solve
the associated symptoms. It s results depand on precocious and
timely moment of surgery, poor results beeing seen at a late
moment of therapy.
Medical rehabilitation therapy is pre and postop, in order
to improve symptoms and associated signs and, finally, to obtain
independence and a real quality of life. It starts with
electrotherapy and massage, followed by a slow and progressive kinetotherapy, under a permanent supervision of the patient.
So, surgical teherapy, compulsory followed by a
specialised medical rehabilitation therapy, very carefully
coordinated, have remarcable results regarding patients ability
of performing activities of daily living. These results will be more
spectacular if the patient has a ferm social nad family support.
Key words: uncharacteristic signs, complex approach pre
and post op, medical rehabilitation, social and family support

P 58
TRATAMENTUL COMPLEX AL PACIENTULUI
POLITRAUMATIZAT
Dan Neme 1, 3, 5 , Dan V Poenaru 1, 2 , Mihai Drgoi 1, 5, 6 ,
Dan One 4 , Alina Totorean 1 , 5 , 6 , Andreea Ni 1 , 5 ,
Armand Gogulescu 1, 3 , Elena Amrici 1 , 3 , Merima Jurici 1, 3 ,
Cristian Milicin 1 , 3 , Iosif Ilia 3 , Atef Hammad 3 ,

Angelica Ponoran 3 , Carmen Haifer 3 , Corina Petru 3 ,

Camelia Ptruescu 3 , Loredana Mihil 3 , Adalbert Schiller
Dan Naicu 3 , Mihaela Udrescu 3 , Camelia Nemes 8
1 Universitatea de Medicin i .armacie Victor Babe
Timioara
2 Spitalul Clinic Judeean de Urgen Timioara
Secia
clinic ortopedie-traumatologie II
3 Spitalul Clinic Judeean de Urgen Timioara
Secia
clinic ortopedie-traumatologie II Compartimentul de
recuperare medical
4 Spitalul Clinic Judeean de Urgen Timioara
Secia
clinic de radiologie i imagistic medical
5 SC Excentric Company SRL
Centru medical de recuperare
medical Timioara
6 Spitalul Clinic Municipal Timioara
Secia clinic de
balneofizioterapie
7 Spitalul Clinic Judeean de Urgen Timioara
Secia
clinic nefrologic
8 Spitalul Clinic Municipal Timioara
Laboratorul clinic,
Romnia

1,7

Politraumatismele sunt leziuni asociate sau combinate,

care necesit atitudine terapeutic de urgen i supraveghere
de specialitate (chirurgical i/sau ortopedic, neurochirurgical,
chirurgie toracic i/sauabdominal), sau de intervenii
chirurgicale seriate practicate de 2 sau mai muli specialiti, atitudine fr de care fie viaa pacientului, fie calitatea ei sunt n
pericol. Ele reprezint cauza principal de deces la adulii sub
44 ani. Accidentele rutiere sunt cele mai frecvente.
Dup acordarea msurilor de prim ajutor, tratamentul este
multidisciplinar (ATI, ortopedo-traumatologic, neurochirurgical,
de chirurgie toracic/abdominal, recuperare medical, terapie
ocupaional, psihologic/psihiatric).
Evaluarea pacientului politraumatizat se realizeaz prin
multiple scale specifice (AIS, ISS, TRISS, PTS, GCS, RTS).
Recuperarea medical complex ncepe de la patul bolnavului,
inclusiv din secia ATI i, uneori, se continu toat viaa.
Evoluia imediat i pe termen mediu, n prezena unei
terapii chirurgicale specifice, a unui tratament recuperator
adecvat, este, n general, favorabil cu absena durerii, refacerea integritii i funcionalitii structurilor, permiand n consecin reluarea treptat a activitilor vieii cotidiene. Se impune
o supraveghere prelungit (clinic i imagistic) pentru a depista
eventualele complicaii tardive.
Cuvinte cheie: politraumatism, evaluare specific,
abordare precoce, tratament multidisciplinar, supraveghere
COMPLEX THERAPY O. POLITRAUMA PATIENT
Dan Neme 1 , 3, 5 , Dan V Poenaru 1 , 2 , Mihai Drgoi 1 , 5, 6 ,
Dan One 4 , Alina Totorean 1 , 5 , 6 , Andreea Ni 1 , 5 ,
Armand Gogulescu 1, 3 , Elena Amrici 1, 3 , Merima Jurici 1 , 3 ,
Cristian Milicin 1 , 3 , Iosif Ilia 3 , Atef Hammad 3 ,
Angelica Ponoran 3 , Carmen Haifer 3 , Corina Petru 3 ,
Camelia Ptruescu 3 , Loredana Mihil 3 , Adalbert Schiller 1 , 7 ,
Dan Naicu 3 , Mihaela Udrescu 3 , Camelia Nemes 8
1 Victor Babes University of Medicine and Pharmacology
Timisoara
2 Timis County Universitary Hospital
Orthopaedic and
Traumatology department
3 Timis County Universitary Hospital
Orthopaedic and
Traumatology department Rehabilitation department
4 Timis County Universitary Hospital
Radiology department
5 Excentric Company Ltd Timisoara
Medical Rehabilitation
Unit
6 Timisoara Medical Rehabilitation Universitary Hospital
7 Timis County Universitary Hospital
Nephrology department
8 Timisoara Universitary Hospital
Medical Lab, Romania
Politraumas are complex and associated lessions, who
impose emergency therapy and speciality supervision (surgical
and /or orthopaedical, neurosurgery, abdominal and/or thoracic
surgery), or successive multidisciplinary surgical procedures,

88

III. POSTERE
without whom either patient life either his quality of life are in
danger. Politraumas are the maine death cause for adults under
44 years. Car accidents are the most frequent.
After emergency care the therapy is multidisciplinary (intensive care, orthopaedical and traumatological treatment,
neurosurgery, abdominal and/or thoracic surgery, medical
rehabilitation, occupational therapy, psychiatric therapy and
psychological support).
Politrauma patient assessment involves a lot of speciffic
scales (AIS, ISS, TRISS, PTS, GCS, RTS). Complex medical
rehabilitation starts early, in intensive care unit and, sometimes
is life long.
Evolution on short and medium term, in presence of a
specific surgcal and an adequate medical therapy, is, generally,
favourable, with pain absence, recovery of structures integrity
and functionality, allowing progressive resumption of daily living
activities.
It is necessary a permanent clinical and radiological
supervision, in order to detect eventual late complications.
Key words: politrauma, specific assessment, precocious
approach, multidisciplinary therapy, supervision

P 59
ASPECTE DE ETIOPATOGENIE, BIOMECANIC I
.IZIOPATOLOGIE N SCOLIOZA IDIOPATIC

.lorina Ojoga 1 , Victoria Suciu 2 , Dima Augustin

Asistent universitar UM. Carol Davila Clinica de
Recuperare Medical III
Medic rezident Clinica de Recuperare Medical III

Lucrarea i propune s sublinieze unele aspecte de

etiopatogenie, biomecanic i fiziopatologie n scolioza
idiopatic.
Scolioza idiopatic are probabil o etiologie multipl i
plurifactorial, dar se pare c explicaia cea mai verosimil ar fi
o tulburare tranzitorie a sistemului nervos central, mai precis a
sistemului echilibrului postural care integreaz informaiile
vizuale, proprioceptive i vestibulare.
Din punct de vedere mecanic, scolioza nu este o simpl
deviere lateral a coloanei vertebrale. n realitate, exist o tripl
deformare: o curbur lateral n plan frontal; o rotaie vertebral
n plan orizontal i o lordoz n plan sagital.
Chiar dac cunoatem perfect toate riscurile evolutive ale
unei curburi, este dificil s trasm profilul evolutiv al unei scolioze
n urma unui singur examen. Oricum, o evaluare global a
pacientului, un studiu cronologic al tuturor parametrilor de cretere, asociat unor msurtori radiologice obiective, vor constitui
ansamblul de argumente care va conduce la luarea unei decizii
terapeutice.

.lorina Ojoga 1 , Victorita Suciu 2 , Dima Augustin

Asistent universitar UM. Carol Davila Clinica de
Recuperare Medical III
Medic rezident Clinica de Recuperare Medical III

P 60
AVC HEMORAGIC SECHELAR (HEMIPAREZ DREAPT
SPASTIC PREDOMINANT BRAHIAL) LA O PACIENT
CU AMPUTAIE DE MEMBRU IN.ERIOR DREPT
PREZENTARE DE CAZ
.lorina Ojoga, Victoria Suciu, Dima A.
Obiective
Prezentm cazul unei paciente de 38 de ani, cu sechele
post AVC hemoragic (angiom cerebral operat cu drenaj
ventriculo-vezical) cu deficit motor de intensitate plegic la nivelul membrului superior drept i paretic la nivelul membrului
inferior drept, cu afazie mixt predominant motorie, cu disfuncie
sever de locomoie i de autongrijire, amputaie de membru
inferior drept (ischemie acut periferic), care a necesitat o
abordare terapeutic de recuperare complex.
Material i metod
Programul de recuperare a fost iniiat dup evaluarea funcional a pacientei i a avut ca obiective: refacerea controlului
motor proximal i distal, creterea mobilitii articulare,
prevenirea i combaterea retracturilor i contracturilor
musculare, meninerea i creterea forei musculare, refacerea
abilitilor funcionale ale membrului superior drept, refacerea
coordonrii, antrenarea echilibrului pentru centuri n decubit, n
poziie eznd i n ortostatism, reeducarea mersului
(pregtirea funcional a bontului, pregtirea trenului superior,
realizarea corect a transferurilor, realizarea ortostatismului cu
protez i ctigarea echilibrului, iar n ultima faz reluarea
mersului iniial cu dou crje, ulterior cu o crj, pentru ca n
final s se poat deplasa fr ajutor), reeducarea vorbirii prin
logopedie i reantrenamentul la efort.
Rezultate
Programul complex de recuperare a avut ca rezultat mbuntirea parametrilor funcionali, de adaptare a bontului
restant la protez, de reluare a ortostatismului i mersului.
Concluzii
1. Tratamentul complex fizical-kinetic, n cazul pacientei
noastre, a fcut posibil o net mbuntire a strii clinicofunctionale, a gradului de independen i a calitii vieii.
2. Pentru realizarea acestor obiective a fost necesar o
munc susinut i n echip, din care trebuie s fac parte:
medicul de recuperare, kinetoterapeutul, fizioterapeutul,
ergoterapeutul, logopedul, psihologul, personalul mediu specializat.
SEQUELAES O. HEMORRHAGIC STROKE (SPASTIC
RIGHT HEMIPARESIS PREDOMINANT BRACHIAL) .OR A
PATIENT WITH IN.ERIOR RIGHT LIMB AMPUTATION

IDIOPATHIC SCOLIOSIS ASPECTS O. ETIOLOGY,

BIOMECHANICS AND PATHOPHYSIOLOGY

chronological study of all growth parameters associated to an

objective radiological measurement, will constitute entirety
arguments which will lead to a therapeutic decision.

This analysis emphasizes some aspects of etiology,

biomechanics and pathophysiology in idiopathic scoliosis.
The etiology of idiopathic scoliosis is not yet fully
elucidated, but it seems that the real explanation it could be a
transitory disorder of central nervous system, more accurate is
balance posture system which integrates visual, proprioception
and vestibular information.
Biomechanics speaking, it is triple deformity: a curve of
the spine in the frontal plane, a rotation of the vertebra in the
horizontal plane and a lordosis in a sagittal plane.
Even we know all the evolutional risks of one curve it is
difficult to indicate the evolutional profile of scoliosis after one
examination. Anyway, a patient s global evolution, a

.lorina Ojoga, Victorita Suciu, Dima A.

The presentation of a clinic case
Objectives
We present the case of a patient 38 years old with
sequelaes after hemorrhagic stroke with plegic motor loss at
the level of superior right limb and paresis at the level of inferior
right limb, with mixed aphasia predominant expressive, inferior
right limb amputation, with severe locomotion disfunction and
self-careing disfunction., and which required a complex
therapeutically rehabilitation approach.
Material and method
The rehabilitation program was initiated after patient s
functional evaluation and it had as objectives: regaining motor
control, maintaing mobility, minimalizing contracture, maintaing
and growing muscular strength, coordination exercices,
equilibrium training, gait re-education (functional preparation of
the blunt, superior terrain preparation, the correct training of the

89

III. POSTERE
transfers, the achievement of the orthostatic position with
prosthesis and finally take again the gait initial with two crutch,
then with only one crutch that she will be able to walk without
any help), speech-therapy.
Results
The complex rehabilitation program had god results in the
functional parameters and adapting the blunt to prosthesis to
take again the orthostatic position and gait.
Conclusions
1. The special rehabilitation therapy in our patient case
offers not only improvement of motor loss, but also more
independence and an improvement of quality of life .
2. To master these objectives it was necessary a sustaind
team-work on multiple disciplines: rehabilitation medicine,
physiotherapy, occupational therapy, psychology, logopedy.

P 61
STRETCHING VERSUS IN.ILTRAII PARAVERTEBRALE
CU ANTIIN.LAMATORII STEROIDIENE N EVOLUIA
DURERII LOMBARE CRONICE
Simona Onofrei, Cristian Bodescu, Sebastian Diaconescu,
Carmen Logofatu, Gina Galbeaza, Bogdan Anatole,
Gabriela Udvuleanu
Clinica de Recuperare Medical III INRM.B
Obiectiv
Determinarea eficienei programului de stretching comparativ cu infiltraiile paravertebrale n controlul evoluiei
pacienilor cu durere lombar cronic
Premise
1. Durerea lombar cronic (LBP) este cauz major
de incapacitate de munc. Adesea are determinism plurifactorial.
2. Deficitele specifice de mobilitate lombar intereseaz mai ales nivelurile joase.
3. Asistarea pacienilor n sensul refacerii mobilitii
naintea unui program de antrenare a forei musculare este cheia
principal a recuperrii funcionale (conform principiilor medicinii
de recuperare).
4. Injeciile paravertebrale sunt utilizate frecvent n
tratamentul durerii lombare cronice subacute sau cronice care
nu poate fi controlat prin alte mijloace.
Material i metod
Au fost studiai 73 pacieni cu durere lombar cronic ce
respectau criterii de includere stabilite a priori. Pentru acetia
au fost urmrite cteva caraceristici clinice, demografice i sociale. Evaluarea gradului de mobilitate i a durerii s-a fcut la
intrarea n studiu, la 4 sptmni i la 8 spmni. 36 pacieni
(lot A) au urmat un program de de recuperare complex (care a
cuprins i un program de stretching) sub supraveghere medical,
ceilali 37 pacieni (lot B) fiind inclui ntr-un protocol de tratament
ce a constat din injecii paravertebrale (anestezic local i
cortizon) n primele 2 sptmni i un program de refacere a
mobilitii lombare nesupraveheat ( efectuat la domiciliu).
Instrumente de evaluare: mobilitatea lombar scala
analog pentru durere, scala Dallas analog pentru disabilitate;
analiza statistic: deviaia standard, t test, analiza ANOVA
Rezultate i discuii
1. Media scorurilor de mobilitate a artat ameliorarea
semnificativ la 4 sptmni pentru ambele loturi. La 8 sptmni se menine i chiar crete mobilitatea obinut pentru lotul
A; n schimb, pentru lotul B se constat abandonul programului
de exerciii i reapariia deficitului de mobilitate lombar.
Compliana pacienilor a fost mult mai bun pentru programul
supravegheat
2. Autoestimarea durerii i disabilitii a fost extrem de
nerealist. Barierele psihosociale cele mai importante n calea
recuperrii au fost: pragul sczut la durere, dependena de
analgetice, preferarea metodelor pasive de tratament.
Concluzii
1. Durerea lombar cronic are o evoluie net favorabil
sub tratament de recuperare susinut i supravegheat, bazat

pe exerciii de stretching
2. Ameliorarea durerii i mobilitii lombare prin acest
tratament este de mai lung durat dect prin tratament cu
infiltraii paravertebrale.
3. Pentru lotul B nu se poate spune sigur care component, infiltraia sau exerciiul, determin efectul benefic pe
termen scurt (4 sptmni)

P 62
EVALUAREA CALITII VIEII LA UN PACIENT CU
ARTERIOPATIE PERI.ERIC OBSTRUCTIV
Simona Ptru, Roxana Popescu, Adrian Bighea,
Iulia Rahela Marcu
UM. Craiova
Se prezint cazul unui pacient n vrst de 68 de ani,
diagnosticat n clinica noastr cu Arteriopatie periferic
obstructiv la nivelul membrelor inferioare gradul II .ontaine,
Hipertensiune arterial primar gradul 3, Tahicardie sinusal,
Dislipidemie mixt. Pacientul, vechi hipertensiv, n tratament
intermitent cu betablocante i inhibitori ai enzimei de conversie,
se interneaz pentru durere la nivelul gambelor i coapselor,
ameliorat de repaus, accentuat la mers i senzaie de
oboseal nejustificat la nivelul membrelor inferioare, la mers,
cu debut de aproximativ un an, simptomatologia accentunduse n ultima lun. Se instituie un tratament complex,
medicamentos (vasodilatatoare periferice, betablocante,
hipolipemiante) i fizical-kinetic (ionogalvanizare cu clorur de
calciu, masaj, gimnastic Buerger, mers codificat), pacientul
continund tratamentul medicamentos i programul de
kinetoterapie nvat i la domiciliu. Este evaluat clinicofuncional la internare i la patru sptmni folosind: semnele
vitale, examenul obiectiv, examene paraclinice, EKG,
oscilometria, ultrasonografia vascular, iar pentru evaluarea
calitii vieii s-a recurs la dou chestionare standardizate:
Walking Impairment Questionnaire (WIQ) i The MOS 36-Item
Short-.orm Health Survey (S.-36). Reevaluarea de la patru
sptmni a artat normalizarea TA i AV, modificri nesemnificative ale lipidogramei i ultrasonografiei vasculare, spre deosebire de scorurile obinute la chestionare: mbuntire semnificativ a distanei de mers, ceva mai mic a vitezei de mers i
a gradului de dificultate la urcatul scrilor, iar pentru S.-36 o
cretere a scorurilor n special pentru scalele Capacitate funcional, Durere, Vitalitate i mai redus pentru celelalte scale:
Rol funcional, Rol emoional, Sntate general, .uncia
social, Sntate mental.
EVALUATING QUALITY O. LI.E TO A PATIENT WITH
PERIPHERAL ARTERIAL DISEASE
Simona Ptru, Roxana Popescu, Adrian Bighea,
Iulia Rahela Marcu
The authors present the case of 68 years old male patient
diagnosed in our clinic with Obliterative arterial disease of the
lower limbs (stage 2 .ontaine), High blood pressure,
Dyslipidemia, Sinus Tachycardia. The patient, with history of
HBP, in discontinuous treatment with beta-blockers and ACE
inhibitors, was hospitalized for pain in calves and thighs, calmed
down to rest, increased by walking, muscular fatigue in both
legs. Symptoms started one year ago and increased over the
past 4 weeks. We applied a complex therapy including
medication (peripheral vasodilators, betablocants,
hypolipemiants drugs), physical therapy, kinesitherapy, the
pacient following this treatment at his home too. At baseline
and after 4 weeks patient underwent evaluations including: vital
signs, physical examination, laboratory testing, ECG,
Plethysmography, Doppler ultrasound and for quality-of-life and
functional assessments, two standardized questionnaires
Walking Impairment Questionnaire (WIQ) and The MOS 36-Item
Short-.orm Health Survey (S.-36). The reevaluation after 4

90

III. POSTERE
weeks indicated a normal blood pressure and heart rate,
insignificant changes on serum lipids and on Doppler ultrasound,
unlike the scores resulted from questionnaires: greater
improvement of walking distance, a significantly improvement
in the walking speed and the degree of difficulty for stair climbing,
and for S.-36, enhanced scores for Physical .unctioning, Bodily
Pain and Vitality, and for Role Physical, Role Emotional, General Health, Social .unctioning, Mental Health the increase of
scores was not so significant.

P 63
CALITATEA VIEII LA PACIENII CU ARTERIOPATIE
PERI.ERIC OBSTRUCTIV
Simona Ptru, Adrian Bighea, Roxana Popescu,
Iulia-Rahela Marcu
UM. Craiova
Scop
Acest studiu clinic i propune s evalueze impactul
terapeutic asupra pacienilor cu arteriopatie periferic
obstructiv, fr indicaie chirurgical, utiliznd metode relativ
noi: chestionarul general MOS 36-Item Short-.orm Health
Survey (S.-36) i cel specific Walking Impairment Questionnaire
(WIQ).
Material i metod
Studiul a fost realizat pe 13 pacieni cu arteriopatie
periferic obstructiv, 8 n stadiul .ontaine IIA i 5 n IIB, 10
brbai i 3 femei, cu vrsta medie de 60 ani, avnd asociai
urmtorii factori de risc: diabet zaharat 30,7%, HTA 38,4%,
fumat 69,23%. Au fost inclui ntr-un program de recuperare
ce a constat n tratament medicamentos i fizical-kinetic, timp
de dou sptmni n spital, continund la domiciliu programul
de kinetoterapie nvat. S-au calculat scorurile totale i pe
domenii, nainte de nceperea tratamentului i la patru sptmni, i distribuia scorurilor n funcie de vrst, sex, factori de
risc, stadiul i istoricul bolii.
Rezultate
Dei studiul s-a realizat pe un numr mic de pacieni, am
obinut rezultate similare cu cele din alte studii clinice: scoruri
sczute pe toate domeniile nainte de tratament i o cretere
uoar a acestora la numai 4 sptmni de recuperare. Scorurile
se menin sczute la vrstnici i la fumtori.
Concluzii
Pacienii nu au avut probleme n completarea
chestionarelor, timpul mediu de completare fiind 12 minute. Dei
aspectul calitii vieii este mai rar luat n considerare,
chestionarele pentru calitatea vieii sunt mijloace specifice, utile i ieftine pentru evaluarea diferitelor forme de tratament.
QUALITY O. LI.E IN PATIENTS WITH PERIPHERAL
ARTERIAL DISEASE (PAD)
Simona Patru, Adrian Bighea, Roxana Popescu,
Iulia-Rahela Marcu
UM. Craiova
Purpose
This study want to assess the therapeutical impact over
nonsurgical patients with PAD using somehow new tools like:
MOS 36-Item Short-.orm Health Survey (S.-36), a generic
questionnaire and Walking Impairment Questionnaire (WIQ)
specific for PAD.
Material and methods
The study was made on 13 patients with PAD, 8 staged
.ontaine IIA, and 5- IIB, 10 men and 3 women, with mean age
60 years and the risk factors included: diabetes mellitus (30,7%),
High blood pressure (38,4%), Smoking (69,2%). They underwent
a rehabilitation program including medication and physicalkinetics, for 2 weeks in hospital, then home training with learned
exercises. We calculated the total score and the scores by
domains, before starting the rehabilitation, after 4 weeks, and

the distribution of scores depending on: age, gender, risk factors,

stage and history of disease.
Results
Although the study was realized on a small number of
patients, we obtained similar results with other clinical studies:
a decrease in all scores by domains before treatment, an
increase of these after only 4 weeks, maintained low scores in
older patients and smokers.
Conclusions
The patients answered without problems to questionnaires,
the mean completing time was 12 minutes. Although the quality
of life rarely was considered, these questionnaires are specific,
useful and inexpensive tools for quantifying the results of various
treatments.

P 64
IN.LUENA TULBURRILOR DE ECHILIBRU ASUPRA
PARAMETRILOR MERSULUI LA PACIENII CU
SCLEROZ MULTIPL
Bogdan Ptru 2 , Delia Cintez 1 , Daniela Poenaru
Simona Popescu 3 , Marius Ivacu 1
1 INRM.B, UM. Carol Davila
2 Student UM. Carol Davila
3 CMDTA N. Kretzulescu

Premise
Exerciiul fizic face parte din managementul terapeutic al
sclerozei multiple. Efectele sunt benefice att la nivelul unora
dintre infirmitile neurologice, ct i pentru disabilitate
Obiective
Determinarea incidenei tulburrilor de echilibru la pacienii
cu SM testai pe platforma computerizat
Determinarea corelaiei dintre parametrii echilibrului i ai
mersului la aceti pacieni
Evoluia tulburrilor de echilibru la pacienii cu SM inclui
n programe specifice de recuperare.
Material i metod
Studiu prezentat este clinico-statistic, prospectiv controlat
i a cuprins dou loturi de pacieni (lot A = 20 pacieni cu
afectarea parametrilor de echilibru i stabilitate, lot M martor =
15 pacieni) diagnosticai cu scleroz multipl, cu o vrst medie de 40 9 ani, cu o vechime a bolii mai mic de 10 ani; toi
subiecii erau n prioad de remisiune a bolii. Loturile au foast
omogene ca vrst, distribuie pe sexe, grad de spasticitate.
Parametrii urmrii au fost demografici simpli, de deficit
neurologic (fora muscular, coeficienii de echilibru,
spasticitatea), de deficit secundar (mobilitatea articular) i parametri ai deficitului funcional (scala Kurtzke, indicele .IM, testul
Cooper). Determinarea lor s-a fcut la intrarea n studiu i la 3
sptmni.
Rezultate i discuii
Coeficienii de echilibru i stabilitate determinai cu ajutorul
platformei computerizate au permis mprirea pacienilor n cele
dou loturi, lotul A cuprinznd subieci cu modificri semnificative ale acestora. Asociat, acesta prezenta valori semnificativ
mai slabe ale variabilelor funcionale. Dup includerea ntr-un
program standard, la care, pentru lotul A s-a adugat programul special de antrenament prin biofeedback vizual pentru
echilibru i stabilitate, s-au obinut, pentru ambele loturi modificri semnificative ale parametrilor de independen funcional msurai global cu scalele .IM i EDSS, fa de nivelul de
baz. Ameliorarea a fost semnificativ mai mare la pacienii din
lotul martor. Pacienii din lotul de studiu au prezentat mbuntirea net a parametrilor de echilibru.
Concluzii
Incidena tulburrilor de echilibru la pacienii cu scleroz
multipl n lotul studiat a fost de aproximativ 70%. Acestea
influeneaz net ambulaia i rspunsul la tratamentul de recuperare. Parametrii msurabili ai echilibrului se coreleaz cu
evoluia funcional pe termen scurt.

91

III. POSTERE
IN.LUENCE O. BALANCE DISORDERS ON GAIT
PARAMETERS IN MULTIPLE SCLEROSIS PATIENTS
Bogdan Ptru 2 , Delia Cintez 1 , Daniela Poenaru
Simona Popescu 3 , Marius Ivacu 1
1 INRM.B, UM. Carol Davila
2 Student UM. Carol Davila
3 CMDTA N. Kretzulescu

Premises
Physical exercise is a component of multiple sclerosis
therapy. The effects are beneficial for patients regarding
disabilities and neurological deficits.
Objectives
Balance disorders incidence in patients with multiple
sclerosis, tested on balance platform. Measurement of relation
between balance parameters and gait parameters and balance
improvement in multiple sclerosis patients enrolled in
rehabilitation programs.
Material and method
This is a prospective, controlled, clinical and statistical
study composed of two groups of patients (group A= 20 patients
with balance and stability problems and group B=15 patients)
with multiple sclerosis, with medium age 40+- 9 years, with less
of ten years of illness; all patients were in clinical remission.
They were homogenous regarding age, sex distribution, and
spasticity level. We recorded demographic parameters,
neurologic deficit parameters (muscular strength, balance
parameters, spasticity), secondary deficit parameters (articular
mobility) and functional deficit parameters (Kurtzke, .IM index,
and Cooper test). They were determined at the beginning of the
study and after 3 weeks.
Results and discussions
Patients were divided in two groups on the basis of balance
measurements on computerized platform, group A being
composed of patients with balance problems. They were
included in a standard program and in addition they had a special training with visual biofeedback for balance and stability.
The improvement was significant greater for group B. Group A
presented an improvement of balance parameters.
Conclusions
Balance problems incidence in patients with multiple
sclerosis in group A (about 70%) has a definite impact on gait
and rehabilitation results. Balance parameters are correlated
with short-term functional evolution.

P 65
STILUL DE VIA I OBEZITATEA
Simona Pop, Mihaela Popoviciu, Monica .arago
Universitatea din Oradea
Stilul de via este considerat a fi totalitatea deciziilor i
comportamentelor individuale care afecteaz starea de sntate.
Nerespectarea principiilor unui stil de via sntos (alimentaie
nesntoas, sedentarism, consum de toxice), determin
apariia obezitii, care se asociaz cu un numr mare de boli i
stri comorbide. Am luat n studiu un lot de 50 subieci, cu vrste
cuprinse ntre 28-74 ani, internai n Spitalul Clinic Judeean
Oradea, n perioada februarie-martie 2005. S-a determinat o
corelaie ntre stilul de via i obezitate. Astfel, stilul de via
nesntos se ntlnete la 20,0% din subiecii normoponderali,
la 52,9% din cei supraponderali i la 75,0% dintre obezi.
Cuvinte cheie: stil de via, obezitate
Life style is considered to be the ensemble of decisions
and individual behaviours that affect our health state. Not
respecting the principles of a healthy life style (healthy
alimentation, sedentarism, toxic consumption) we determined
the appearance of obesity, that associates with a large number
of disorders and comorbidity states. We studied 50 subjects,
between 28-74 years old, hospitalized in Clinical District Hospital

Oradea, between .ebruary- March 2005. It was determined a

correlation between life style and obesity. Therefore, the
unhealthy life style it is found for 20,0% of normoponeral subjects,
for 52,9% of overponderal subjects and 75,0% of obese subjects.
Key words: life style, obesity.

P 66
INCIDENA .ORMELOR CLINICE DE ARTRIT
PSORIAZIC I MODALITI DE ABORDARE
TERAPEUTIC N CADRUL UNUI LOT STUDIAT
Roxana Popescu 1 , Iulia-Rahela Marcu 1 , A. Bighea
Simona Ptru 1 , Daniela Matei 2
1 Clinica de Medicin .izic i Recuperare, UM. Craiova
2 Clinica de Medicin .izic i Recuperare, Spitalul Clinic de
Urgen Craiova

Obiective
Evaluarea distribuiei diferitelor forme de artrit psoriazic
n cadrul unui lot de studiu i compararea incidenei acestora
cu datele din literatura de specialitate, precum i analiza
opiunilor terapeutice adoptate n cazul pacienilor inclui n
studiu.
Pacieni i metod
Studiul a inclus 16 pacieni cu artrit psoriazic (6 femei i
10 brbai), internai n clinicile de Reumatologie, Dermatologie,
Medicin .izic i Recuperare ale Spitalului Clinic Judeean de
Urgen Craiova n perioada noiembrie 2003 iunie 2005. Vrsta
medie a pacienilor inclui n studiu a fost de 49,625 ani (deviaia
standard SD = 8,539). Vechimea manifestrilor cutanate ale
psoriazisului a fost n medie de 19,583 ani (SD = 12,763), pe
cnd vechimea medie a artritei psoriazice a fost de 10,416 ani
(SD = 12,581). Au fost identificate clinic i radiologic toate cele
cinci tipuri de artrit psoriazic incluse n clasificarea lui Moll i
Wright.
Rezultate
Distribuia subtipurilor artritei psoriazice n cadrul lotului
studiat a fost urmtoarea: 8 cazuri de oligoartrit asimetric
(50%), 2 cazuri de artrit interfalangian distal (12,5%), 1 caz
(6,25%) de artrit mutilant, 3 cazuri (18,75%) de poliartrit
simetric; spondilita psoriazic a fost identificat ca form izolat
n 2 cazuri (12,5%), la 6 pacieni (37,5%) afectarea axial fiind
asociat unei alte forme de artrit psoriazic. A existat un singur
caz (1/16-6,25%) la care debutul manifestrilor articulare a fost
anterior manifestrilor cutanate de psoriazis. Opiunile
terapeutice de care au beneficiat pacienii cu artrit psoriazic
au fost urmtoarele: 9 pacieni (56,25%) au primit tratament cu
Metotrexat, 4 pacieni (25%) primeau tratament numai cu AINS,
iar 3 (18,75%) cu retinoizi- Neotigason.
Concluzie
Incidena formelor clinice de artrit psoriazic n cadrul
lotului studiat corespunde datelor comunicate n literatura de
specialitate. Cei mai muli pacieni au primit tratament cu
Metotrexat n doze de 7,5- 25 mg/sptmn, dat fiind evoluia favorabil cunoscut att a manifestrilor cutanate, ct i a
celor articulare, la pacienii cu artrit psoriazic ce beneficiaz
de aceast abordare terapeutic.
THE INCIDENCE O. CLINICAL SUBGROUPS O.
PSORIATIC ARTHRITIS AND THERAPEUTIC APPROACH
IN A STUDIED LOT
Objectives
To establish the incidence of clinical subgroups of
psoriatic arthritis in a studied lot and to compare them to those
published in literature; to evaluate therapeutic approach for the
patients included in this study.
Patients and methods
This study included 16 patients (10 men, 6 women) with
psoriatic arthritis, hospitalized at the clinics of Rheumatology,
Dermatology and Physical and Rehabilitation Medicine of the
Emergency Hospital Craiova between November 2003 June

92

III. POSTERE
frecven n regim continuu la pacienii hipertensivi poate
prezenta o terapie eficient adjuvant tratamentului
medicamentos, n special la pacienii cu HTA de tip sistolic.

2005. Mean age for the patients included in the study was 49,625
yers (standard deviation SD = 8,539). Mean duration of
psoriasis was 19,583 years (SD = 12,763) and of psoriatic arthritis
was 10,416 years (SD = 12,581). All five clinical subgroups of
psoriatic arthritis proposed by Moll and Wright were identified
clinically and by using radiographs.
Results
8 of the 16 patients (50%) had asymmetrical pauciarticular
arthritis, 2 patients (12,5%) had arthritis of distal interphalangeal
joints, 1 patient (6,25%) had arthritis mutilans, 3 patients (18,75%)
had symmetrical arthritis; 2 patients (12,5%) had exclusively
ankylosing spondylitis and 6 patients (37,5%) had ankylosing
spondilitis with peripheral arthritis. Therapeutic options for the
patients with psoriatic arthritis in the studied lot were: 9 patients
(56,25%) received Methothrexate, 4 patients (25%) were treated
only with NSAID s and 3 patients (18,75%) with retinoidesNeotigason.
Conclusion
The incidence of clinical subgroups of psoriatic arthritis in
the studied lot was similar to data communicated in other clinical
studies. Most patients were treated with Methotrexate (7,5-25
mg/week pulse-therapy), the benefits of this therapeutic approach
both on cutaneous and articular manifestations beeing
demonstrated.

THE IN.LUENCE O. LOW .REQUENCY MAGNETIC

.IELD APPLICATIONS OVER HIGH BLOOD PRESSURE
Roxana Popescu 1 , A. C. Bighea 1 , Daniela D. Caimac
Daniela Matei 2 , Rahela Marcu 1 , Ana Maria Bumbea
1 Physical and Rehabilitation Clinic, UM. Craiova;
2 Physical and Rehabilitation Clinic, Urgency Clinical Hospital
of Craiova

P 67
STUDIU PRIVIND IN.LUENA APLICRII DE CMP
MAGNETIC DE JOAS .RECVEN N REGIM CONTINUU
LA PACIENI HIPERTENSIVI
Roxana Popescu 1 , A.C. Bighea 1 , D. Caimac 1 , Daniela Matei
Rahela Marcu 1 , Ana Maria Bumbea 1
1 Clinica de Medicin .izic i Recuperare, UM. Craiova
2 Clinica de Medicin .izic i Recuperare, Spitalul Clinic de
Urgen Craiova
Obiective
Studiul nostru i propune s evidenieze efectele aplicrii
cmpului magnetic de joas frecven (MD.) n regim continuu,
asociat terapiei medicamentoase, asupra valorilor tensiunii
arteriale la pacieni hipertensivi.
Material i metod
Au fost urmrii pe o perioad de 7 zile un numr de 19
pacieni, internai n Clinica de Medicin .izic i Recuperare a
Spitalului Clinic de Urgen Craiova, crora li s-a aplicat MD. n
regim continuu cu urmtorii parametri: bobine cervical i lombar,
50Hz 4 min i 100Hz 8 min, zilnic; valorile tensionale au fost
determinate n condiii standard nainte, imediat dup aplicaie
i la 2 ore.
Rezultate
Vrsta medie a lotului a fost de 51 ani, majoritatea lotului
ncadrndu-se n decada a 5-a de via. Pacienii au fost
diagnosticai anterior includerii n studiu cu diferite grade de HTA
primar: 11 cu HTA grad 1, 6 cu HTA grad 2 i 2 pacieni cu
HTA grad 3; dintre acetia, la nceputul studiului, un numr de
12 au avut valori tensionale crescute (TAs medie 153 mmHg i
TAd medie 97 mmHg). 70% din bolnavi erau n tratament permanent cu antihipertensive din diferite clase.
Valorile TAs imediat dup aplicarea MD. s-au redus n
medie cu 32 mmHg, iar TAd cu 16 mmHg. La 2 ore de la aplicarea
procedurii, 89% din pacieni mai prezentau valori reduse ale TA
att sistolice, ct i diastolice comparativ cu valorile anterioare
iniierii MD. din ziua respectiv. Urmrind valorile TA din prima
zi nainte de aplicarea MD. i din ultima zi la 2 ore de la efectuarea procedurii, am observat c reducerea TAs a fost n medie cu 22 mmHg i TAd cu 12 mmHg.
Concluzii
n studiul de fa am observat o reducere semnificativ a
valorilor TA, aceasta fiind mai important imediat dup aplicarea
MD. comparativ cu cele obinute la 2 ore dup. Din acest motiv,
considerm c aplicarea de cmpuri magnetice de joas

Aim
The objective of this study is to analyze the effects of
continuous low frequency magnetic field (MD.) applications over
the values of systolic and diastolic blood pressure to different
patients with high blood pressure.
Material and methods
We watched 19 patients with high blood pressure, aged
between 37-74 years, hospitalized in Physical Medicine and
Rehabilitation Clinics of Hospital No 1 Craiova, during 7 days.
We applied continuous MD. (cervical and lumbar self, 50Hz 4
min and 100Hz 8 min) performed daily, following systolic blood
pressure and diastolic blood pressure right before and after the
MD. applications and latter (2 hours after applications).
Results
The average age of the group was 51 and all the patients
were diagnosed with primary high blood pressure: 11 stage I of
hypertension, 6 stage II and 2 patients stage III; 12 patients had
high blood pressure at the beginning of the study (mean systolic
BP 153 mmHg and mean diastolic BP 97 mmHg). The values of
systolic and diastolic BP immediately after MD. application were
on the average 32 mmHg respectively 16 mmHg and 89% from
patients had low values of blood pressure after 2 hours from
application. .ollowing the BP values from the beginning until
the final day of the study we noticed that the decrease of systolic
BP was on the average 22 mmHg and 12 mmHg for diastolic
BP.
Conclusions
We observed a significant decrease of BP values after
MD. application, especially for systolic BP and we tried to
demonstrate the MD. applications to patients with high blood
pressure can be considered useful if it is associated with
antihypertensive medication.

P 68
E.ICIENA TEHNICII CONSTRAINT-INDUCED
MOVEMENT LA PACIENII HEMIPLEGICI INCLUI N
PROGRAME DE RECUPERARE DE .AZA A-II-A
Simona Popescu*, Delia Cintez, Daniela Poenaru,
Gina Glbeaz, Ioana Brhal, Beatrice Drumea,
Cristian Papa
INRM.B
*CMDTA. N. Kretzulescu
Premise:
Incidena crescut i la vrste progresiv mai tinere
a acccidentelor vasculare.
Disfuncionalitile sechelare (hemiplegia) dup
accident vascular cerebral (AVC), cu important impact familial,
socio-economic i medical.
Dovedirea eficienei programelor de recuperare
medical pentru sechelele dup AVC
Ameliorarea calitii vieii pacienilor ca principiu
fundamental al recuperrii medicale.
Obiectiv
Determinarea eficienei tehnicii constraint induced
movement (CIM) n recuperarea funcional a membrului
superior paralizat la sechelarii post AVC admii n programe de
recuperare de faza a-II-a

1
1

93

III. POSTERE
Material i metod
Studiul clinico-statistic i epidemiologic, prospectiv,
randomizat, controlat a cuprins 45 de pacienti cu sechele dupa
AVC, inclui n programul de recuperare medical de faza a-IIa n Clinica de Recuperare Medical III n perioada octombrie
2004 - februarie 2005. Lotul a fost constitui prin aplicarea unor
criterii de includere. Pe lng tratamentul standard, la 25 de
pacieni (lotul A) s-a aplicat tehnica CIM pentru membru superior
cu imobilizarea membrului superior sntos ntr-o mnu far
degete timp de 4 ore zilnic. Au fost urmrite variabile
demografice, neurologice i funcionale, nregistrate la intrarea
n studiu, la 2 sptmni i la 6 luni. Rezultatele au fost supuse
analizei statistice.
Rezultate i discuii
Loturile au fost similare d.p.d.v. al vrstei, sexului, tipului
de AVC, spasticitii, nivelului de dizabilitate la intrarea n studiu
(loturi omogene. La externare diferena de scor al dizabilitii a
fost semnificativ statistic n favoarea lotului A. Dup 6 luni sau meninut diferenele chiar dac nesemnificative statistic pentru indicatorii .IM i Brunnstrom n favoarea lotului A. La 6 luni
indicatorul de calitate a vieii a fost statistic semnificativ mai
bun la pacienii din lotul A. De menionat c pacienii din lotul A
au continuat acas aplicarea tehnicii CIM pentru membru
superior.
Concluzii
1.Evoluia funcionalitii membrului superior paretic la
pacienii hemiplegici este semnificativ mai bun i mai rapid la
pacienii din lotul A de studiu, la care s-a aplicat tehnica CIM.
Rezultatul s-a meninut pe termen mediu (la 6 luni).
3. Aplicarea tehnicii CIM necesit scoruri funcionale
cognitive bune.
4. Nu este clar n ce msur aplicarea tehnicii CIM ar influena o evoluie nedorit a spasticitii membrului superior.
CONSTRAINT INDUCED MOVEMENT TECHNIQUE IN
STROKE PATIENTS INCLUDED IN REHABILITATION
PROGRAMS (STAGE II)
Simona Popescu*, Delia Cintez, Daniela Poenaru,
Gina Glbeaz, Ioana Brhal, Beatrice Drumea,
Cristian Papa
INRM.B
*CMDTA N. Kretzulescu
Premises
o Increased incidence and decreased age for stroke
appearance
o disabilities after stroke, with strong familial, medical,
social and economic impact
o Proving the efficiency of rehabilitation programs on
sequels of stroke
o Improving quality of patient s lives as a basic principle
of rehabilitation programs
Objective
Quantification of constraint induced movement technique
efficiency in functional rehabilitation of paralyzed hand in stroke
patients admitted in rehabilitation programs (stage II)
Material and methods
Clinical, prospective randomized and controlled study, also
statistical and epidemiological which included 45 stroke patients
enrolled in a rehabilitation program (stage II) in Medical
Rehabilitation Clinic (III), October 2004 - .ebruary 2005. Stroke
patients were divided in two groups, some of them, group A (25
patients), in addition to standard therapy, had their affected hand
restricted by the use of a glove without fingers for four hours
every day. Demographically, neurological and functional data
were recorded at the beginning of the study, at two weeks and
six month, and the data were statistical analyzed.
Results and discussions
The groups were relatively homogenous regarding age,
sex, stroke type, spasticity, and disability in the beginning of the
study. At the end of the study the difference of disability scores
was in favor of group A. After six month, the difference, although

statistical insignificant, was still in favor of group A for .IM and

Brunnstrom, and even for quality of life measure. The patients
icluded in group A continued CIM therapy after hospital release.
Conclusions
1. .unctional recovery of paralyzed hand in patients with
stroke is faster and better in patients from group A, patients
with CIM therapy, results were recorded on a period of six month
2. The condition for CIM therapy in the presence of a
good cognitive score
3. The impact of CIM on spasticity is not very clear

P 69
STIMULAREA ELECTRIC NERVOAS TRANSCUTAN
MODALITI TERAPEUTICE I INDICAII
Mariana Popescu, Constana .lorescu, .lorentina Ciubotariu,
Doina Murariu, Daniela Radu, Gina Marinas
INRM.B
Teoria porii, publicat n 1965 de Melzack i Wall, a avut
drept consecin apariia de noi modaliti de terapie a durerii,
printre care i stimularea electric nervoas transcutan (TENS).
Tens utilizeaz cureni de joas frecven, cu impulsuri
rectangulare, de durat variind ntre 50 i 200 msec; aplicarea
electrozilor se face pe tegument, n vecintatea zonei afectate,
la nivelul dermatoamelor corespunztoare sau pe punctele de
acupunctur.
Indicaiile se refer la durerea acut musculoligamentar,
postoperatorie (n chirurgia abdominal i n chirurgia
ortopedic), durerea neuropat; de asemea, n literatura de
specialitate se gsesc referiri la utilizarea TENS n durerea
lombar joas din timpul sarcinii, n timpul trevaliului i n durerea
migrenos.
n afar de terapia durerii, aplicaiile de TENS i-au mai
gsit utilizarea n tratamentul spasticitii membrelor i n
tratamentul tulburrilor micionale din vezica neurogen.
Adiional faptului c este o alternativ terapeutic simpl,
uor de aplicat, TENS are foarte puine contraindicaii i este
practic lipsit de reacii adverse; poate fi utilizat n cazurile n
care metodele clasice nu ofer rezultate sau sunt contraindicate.

P 70
CAZ PARTICULAR DE EVOLUIE A UNEI PACIENTE CU
ARTRIT CRONIC JUVENIL
Roxana Popescu 1 , Daniela Matei 2 , Iulia-Rahela Marcu
A. C. Bighea 1 , Rodica Tristaru 1
1 Clinica de Medicin .izic i Recuperare, UM. Craiova
2 Clinica de Medicin .izic i Recuperare, Spitalul Clinic de
Urgen Craiova
Scopul lucrrii
Caz de artrit reumatoid cu debut n copilrie i evoluie
agresiv, cu trei artroplastii.
Prezentarea cazului
Pacient de 50 ani, prezint dureri cu caracter inflamator
i mecanic la nivelul oldurilor, genunchiului stng, dureri cu
caracter inflamator la nivelul coatelor, umerilor, redoare matinal
60 minute i impoten funcional la mobilizare, mers i
tansferuri. Din antecedentele personale patologice reinem:
reumatism articular acut (RAA) la 10 ani, artrit cronic juvenil
(ACJ) la 11 ani, amigdalectomie la 19 ani. Bolnava afirm debutul
simptomatologiei algo-funcionale de tip inflamator la nivelul
genunchiului drept la 10 ani, cnd este diagnosticat cu RAA.
La scurt timp, simptomatologia devine poliarticular, stabilinduse diagnosticul de ACJ, cu instituirea terapiei cu corticoizi i
hidroxiclorochin. La 19 ani se practic tenotomia de adductori
olduri bilateral i se initiaz programul de recuperare. La 29
ani se realizeaz protezarea coxofemural bilateral (protez
partial) i se instituie terapia de fond cu Tauredon, ntrerupt

94

III. POSTERE
dup 2 ani (fotosensibilitate). La 38 ani se schimb proteza old
stng cu protez total cimentat (PTC); dup 2 ani se protezeaz
genunchiul drept, fiind necesar schimbarea protezei dup 4 ani.
La o distan de 15 ani de la artroplastia oldului drept se decide
schimbarea protezei (PTC). Pentru 18 ani nu se instituie terapie
de fond. Din 2003, pacienta afirm asocierea durerilor cu caracter
inflamator cu cele de tip mecanic la nivelul oldului stng; n 2004
se decide o nou schimbare a protezei old stng, care nu s-a
realizat pn n prezent. n 2003 se instituie tratament cu
Metotrexat, sistat dup 2 luni datorit alterrii testelor hepatice.
Actual s-a iniiat tratamentul cu Arava 10 mg/zi.
Discuii
Particularitatea cazului const n diagnosticul iniial de
RAA, ulterior fiind confirmat ACJ, pentru care nu s-a instituit
tratament de recuperare de la debutul bolii, iar tratamentul de
fond a fost inconstant. S-a remarcat caracterul distructiv i rapid evolutiv al leziunilor de la nivelul articulaiilor mari (olduri,
genunchi bilateral), impunnd protezarea precoce. Dup vrsta de 30 ani nu au mai fost evidente semnele clinice de
inflamaie, dei simptomatologia algic a persistat. Au existat
dificulti n nlocuirea protezelor articulare datorit osteoporozei
mixte (glucocorticoid- indus i legat de boal), limitnd astfel
posibilitile de recuperare.

Disease Activity Index), BAS.I (Bath Ankylosing Spondylitis

.unctional Index) i a chestionarului HAQ adaptat (Health
Assessement Questionnaire) pentru evaluarea statusului clinico-funcional i a calitii vieii la pacienii cu spondilit
anchilozant.
Pacieni i metod
Studiul a inclus 32 de pacieni cu spondilit anchilozant
stadiile II (6 pacieni 18,7%), III (16 pacieni 50%) i IV (10
pacieni 31,3%), cu vrsta medie de 41,78 ani (deviaia
standard SD = 13,457) i o durat medie a bolii de 9,93 ani
(SD = 9,595). Toi pacienii au completat chestionarele sub
ndrumarea unui medic; nu au existat dificulti n ceea ce privete rspunsul la ntrebri. Durerea lombosacrat a fost
evaluat pe o scal vizual analog, lundu-se n considerare
dou aspecte: durerea lombosacrat nocturn (VAS 1) i
durerea lombosacrat total (VAS 2). Mobilitatea coloanei
vertebrale i expansiunea toracic au fost evaluate cu ajutorul
indicilor menton-stern (IMS) pentru flexie, cirtometric i Schber.
Rezultate
BASDAI s-a corelat cu activitatea bolii msurat prin durata redorii matinale (indice de corelaie Pearson- r =0,535) i
prin durerea lombosacrat total VAS 2 (r = 0,373). BAS.I sa corelat semnificativ cu intensitatea durerii lombosacrate att
nocturn VAS 1 (r = 0,741; indice de predictivitate r
=0,549),
s
ct i global VAS 2 (r = 0,727; r
= 0,529). Au existat de
s
asemenea corelaii ale HAQ cu VAS 2 (r = 0,716) i indicele
Schber (r = 0,513). Am obinut corelaii ale BAS.I cu BASDAI
(r = 0,484) i mai semnificativ cu HAQ (r = 0,770; r
= 0,539).
s
n ceea ce privete indicii de mobilitate determinai, s-au
evideniat corelaii ntre IMS i stadiul bolii (r = 0,563), precum
i ntre indicele Schber i vechimea bolii (r = 0,496).
Concluzii
Chestionarele BASDAI, BAS.I i HAQ s-au dovedit instrumente utile pentru aprecierea statusului clinico- funcional al
pacientului spondilitic. Statusul funcional exprimat prin BAS.I
s-a corelat cu activitatea bolii (BASDAI), dar mai ales cu calitatea vieii acestor pacieni (HAQ).

PARTICULAR CASE O. EVOLUTION IN A PATIENT WITH

JUVENILE CHRONIC ARTHRITIS
Aim
A case of rheumatoid arthritis with onset in childhood and
aggressive evolution, with three arthroplasties.
Case presentation
50 years old patient, hospitalized for hips and left knee
inflammatory and mechanic pain, elbows and shoulders
inflammatory pain, 60 minutes morning stiffness and functional
impairment. The patient was first diagnosed with acute articular
rheumatism at the age of 10 and with ACJ at the age of 11. The
inflammatory symptomatology began when she was 10 years old
at the right knee; shortly it became poliarticular , the final diagnosis
of ACJ is established and the treatment with glucocorticoids and
HQ is instituted. At the age of 19, the rehabilitation program was
initiated and 10 years later bilateral partial hip arthroplasty was
realized. The therapy with Tauredon is initiated and interrupted
after 2 years. The hip prostheses are replaced with cemented
total prostheses and is implanted a right knee prosthesis, which
is replaced after 4 years. .or 18 years, the patient did not receive
remissive therapy; for 2 months (2003) she was treated with
Methotrexate. Now she is on Arava 10 mg daily.
Conclusions
The patient was diagnosed at first with RAA, the final
diagnosis of ACJ being established after a year. The
rehabilitation program was late initiated and the remissive
therapy was inconstant. We remarked the destructive and rapidly
evolving character of the hips and knees lesions, which led to
precocious arthroplasty. After the age of 30 there were no
inflammatory clinical signs, though pain persisted. There were
difficulties in the articular prostheses replacement due to mixed
ostheoporosis (glucocorticoid induced and disease related), with
consecutive limitation of the rehabilitation possibilities.

EVALUATION O. CLINICAL AND .UNCTIONAL STATUS

IN PATIENTS WITH ANKYLOSING SPONDILITIS

P 71
EVALUAREA STATUSULUI CLINICO-.UNCIONAL LA
PACIENII CU SPONDILIT ANCHILOZANT
Roxana Popescu 1 , Iulia-Rahela Marcu 1 , Rodica Tristaru
A. Bighea 1 , Simona Ptru 1 , Daniela Matei 2

1 Clinica de Medicin .izic i Recuperare, UM. Craiova

Clinica de Medicin .izic i Recuperare, Spitalul Clinic de
Urgen Craiova

Obiectiv
Utlizarea indicilor BASDAI (Bath Ankylosing Spondylitis

Aim
To evaluate the clinical and functional status and the quality
of life in patients with ankylosing spondilitis using the
questionnaires BASDAI (Bath Ankylosing Spondylitis Disease
Activity Index), BAS.I (Bath Ankylosing Spondylitis .unctional
Index) and HAQ (Health Assessement Questionnaire).
Patients and method
The study included 32 patients (29 men and 3 women)
with ankylosing spondilitis stages II (6 patients 18,7%), III (16
patients 50%) and IV (10 patients 31,3%). The stage and
disease duration (meanSD) in the group were 41,48 13,45
years, 9,93 9,59 years, respectivelly. All patients filled in the
questionnaires under medical supervision; none of the patients
had difficilties in answering any of the questions. Lumbosacral
pain was evaluated on a visual analogue scale. Spinal mobility
and chest expansion were evaluated by using menton- stern
distance (IMS), Schber s test and cirtometric index.
Results
BASDAI was correlated with disease activity measured
by duration of morning stiffness (r = 0,535) and by global spinal
pain VAS 2 (r = 0,373). BAS.I was correlated with spinal pain,
both nocturnal VAS1 (r = 0,741; r
= 0,549) and global VAS
s
2 (r = 0,727; r = 0,529). HAQ was correlated with VAS 2 (r =
s
0,716) and with Schber s test (r = 0,513). We obtained
correlations of BAS.I with BASDAI (r = 0,484) and especially
with HAQ (r = 0,77; r
= 0,539). There were also correlations
s
among IMS and the stage of the disease (r = 0,563) and among
Schber s test and the disease duration (r = 0,496).
Conclusions
BASDAI, BAS.I and HAQ questionnaires proved to be
useful tools for evaluting the clinical and functional status in
patients with ankylosing spondilytis. .unctional status exprimed

95

III. POSTERE
by BAS.I was correlated with disease activity (BASDAI) and
especially with the quality of life (HAQ).

P 72
ASPECTE PRIVIND STUDIUL E.ECTELOR UNOR
.ACTORI DE MEDIU AEROSPAIAL SIMULAI
(HIPERGRAVITAIEI I MICROGRAVITAIEI) ASUPRA
SISTEMULUI IMUNITAR, METABOLISMULUI
HIDROELECTROLITIC I SISTEMULUI DE PROTECIE
ANTIOXIDANT AL ORGANISMULUI ANIMAL
CPII Dr.b., Ph.D. Simionca Iu. (Ghe.), Bioch. sp. Hoteteu M.,
CPII Dr.chim. Petec Clin Ghe., Chim.sp. Rogojan Rodica,
Conf. Dr.fiz. Enache L.
INRM.B, Bucureti.
Obiective
Rezumatul actual urmrete prezentarea unor posibile
efecte ale factorilor de mediu aerospaial precum hipergravitaia
i microgravitaia, simulate n experiment, asupra organismului
animalelor de laborator elemente ale obiectivelor proiectului
Evaluarea efectului unor factori simulai de mediu aerospaial
i risc microbiologic asupra sistemului imunitar n concordan
cu procese i mecanisme fiziologice moleculare de adaptare
ale organismului animal i uman; soluii de corecie ale
modificrilor fiziopatologice , finanat n cadrul Programului
Naional AEROSPAIAL.
Materiale i metode
Studiului hipergravitaiei, prin centrifugare (1G-10G) i la
condiii de microgravitaie simulat, prin imersia n ap (Water
Immersion) au fost supui 48 obolani albi linia Wistar, repartizai
n diferite loturi experimentale i loturi martor.
n vederea evalurii posibilelor efecte gravitaionale asupra
sistemului imunitar au fost investigate procesul de fagocitoz a
granulocitelor polimorfonucleare (PMN), funcia bactericid
oxigen dependent a granulocitelor PMN n testul cu nitrozoblau-tetrazoliu, populaia de limfocite T (n testul E-CL.R) i
unele subpopulaii limfocitare T (E-CL.R 29 C i E-CL.R 45
C). Elementele echilibrului hidroelectrolitic au fost studiate prin
evaluarea capacitii de concentrare renal a electroliilor,
volumului apei eliminate din organism, precum i a rspunsului
mineralocorticoid al organismului animalelor din experiment.
Pentru caracterizarea sistemului de protecie antioxidant al
organismului a fost evaluat activitatea catalazei i superoxiddismutazei n snge.
Rezultate
n etapa actual a studiului a fost realizat modelul
experimental i metodologia de simulare a hipergravitaiei i
microgravitaiei, precum i au fost obinute date preliminare
referitor la aciunea acestora asupra unor sisteme i procese
fiziologice din organismul animal.

P 73
MICROCLIMATUL CU AEROSOL SALIN I REGIMUL
IONIZRII AERULUI (SALINE, LITORALUL MRII NEGRE)
.ACTORI DE SANOGENEZ A CILOR RESPIRATORII
CPII Dr.b., Ph.D. Simionca Iu. (Ghe.),
Conf. Dr. fiz. Enache L., Biol. Guu Emilia,
Dr.climat. Teodoreanu Elena, Dr. Anitei Lidia.
Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie, Bucureti.
Lucrarea trateaz problema formrii microclimatului
antibacterian cu aerosol salin i aspectele privind ionizarea aerului din subteran (mine saline) i pe litoralul Mrii Negre din
Romnia, precum i a posibilei influene a acestora asupra
microorganismelor poluatoare n sezonul estival.
n baza unor studii complexe, efectuate n ar (salinele

Cacica, Slnic Prahova, Tg. Ocna, Praid; staiunile balneoclimatice Eforie Nord, Techirghiol) i strintate (salinele SolotvinoSlatina, Maramureul Istoric din dreapta Tisei, Ucraina; salina
Wieliczka, Polonia) se argumenteaz prezena unei concentraii
minime de microoorganisme n aerosolul salin menionat.
Se fac cunoscute mecanismul care st la baza generrii
aerosolului salin, precum i cel antibacterian al complexului de
factori microclimatici subterani din cavitile unor saline i se argumenteaz prezena acestuia n aerul litoralului Mrii Negre.
Microclimatul specific al litoralului Mrii Negre, existena
unui aerosol salin fin, dei instabil n dependena de sezon i
clim, precum i regimul ionizrii naturale a aerului, prezint
elemente de regenerare i astfel, asemenea celui din saline,
poate poseda efectul de sanogenez asupra cilor respiratorii
(bolnavi cu boli pulmonare obstructive cronice) i tegumentului
(infecii cronice i alergii cutanate).
Problema prezint deosebit interes interdisciplinar att n
cercetarea fundamental fizic i biologic, ct i n utilizarea
eficient a microclimatului litoralului Mrii Negre n scopuri
balneoterapeutice.
THE MICROCLIMATE WITH SALT AEROSOL AND AIR
IONIZATION REGIME (SALT MINES, BLEACK SEA
SEASIDE) SANOGENESIS .ACTORS O.
RESPIRATORY WAYS
Dr.b., Ph.D. Simionca Iu. (Ghe.), Dr. fiz. Enache L.,
Biol. Guu Emilia, Dr.climat. Teodoreanu Elena,
Dr. Anitei Lidia.
National Institute of Rehabilitation, Physical Medicine and
Balneoclimatology, Bucharest
The work treats the problem of antibacterial microclimate
generation with salt aerosol and aspects regarding the air
ionization in underground spaces (salt mines) and on Black Sea
seaside in Romania, as well as their possible influence on
pollutant microorganisms in the aestival season.
On the basis of some complex studies, made in the country
(salt mines Cacica, Slanic Prahova, Targu Ocna, Praid; the
balneoclimatic health resorts Eforie Nord, Techirghiol) and
foreign countries (salt mines Solotvino-Slatina, Historical
Maramures situated on the right side of the river Tisa, Ukraine;
salt mine Wieliczka, Poland) argue the presence of a minimum
microorganisms concentration in the mentioned salt aerosol.
It is mentioned the basic mechanism for the salt aerosol
generation, as well as for its antibacterial character of the
underground microclimatic factors from cavities of salt mines
and argue its presence in the air of the Black Sea seaside.
The specific microclimate of the Black Sea seaside, the
existence of a fine salt aerosol, although unstable, depending
on the season and clime, as well as the natural air ionization
regime, present elements for self-regeneration, and so, such
the salt mines microclimate, may have a antimicrobial effect on
the respiratory ways (patients with chronical obstructively lung
diseases) and tegument (chronical infection and skin allergies).
The problem presents a special interdisciplinary interest
both on the fundamental physical and biological research and
in the efficient use of the Black Sea seaside microclimate in the
balneotherapeutical purposes.

P 74
SCHIMBAREA CLIMEI SI IMPACTUL ASUPRA
ORGANISMULUI UMAN
Diana-Lidia Tache-Codreanu
Medic primar secia Recuperare Spitalul Clinic Colentina
Clima constituie unul din factorii de mediu cu impact
foarte mare asupra omenirii. De aceea, studiul climei i a
posibilelor schimbri viitoare prezint o importan practic
deosebit i constituie una din temele de mare actualitate pe
plan internaional.

96

III. POSTERE
Ca urmare a schimbrilor evidente observate n climatul
global din ultimele decenii, se pune problema major de a evalua
schimbrile climatice n deceniile viitoare.
La schimbarea climei contribuie att factori interni (modificrile care apar n interiorul sistemului climatic i datorit
interaciunilor dintre componentele sale), ct i externi naturali
(variaia energiei emis de soare, erupii vulcanice, variaia
parametrilor orbitali ai Pmntului) sau externi antropogeni
rezultai din activitile umane (schimbarea compoziiei
atmosferei ca urmare a concentraiei gazelor cu efect de sera).
Asemenea factori acioneaz simultan, iar separarea lor e foarte dificil i constituie o adevrata provocare tiinific.
Lucrarea prezint n continuare principalele schimbri climatice nregistrate la nivel global (creterea temperaturii medii
globale, creterea nivelului mrii mediu global, descreterea
grosimii i extinderii spaiale a gheii din zona arctic, retragerea ghearilor din zonele nepolare, creterea precipitaiilor,
turbulena atmosferic crescut .a.) i cteva specificaii cu
caracter regional, precum i impactul acestora asupra diferitelor ecosisteme (speciile de plante i animale par s rspund la
schimbare). Pe baza schimbrilor climatice observate n secolul
XX, au fost descrise de experi o serie de scenarii climatice
pentru secolul XXI.
Modificrile aduse de nclzirea global, de variaia
precipitaiilor, de schimbrile n circulaia atmosferic ce, la rndul
ei, conduce la schimbri n frecvena unor evenimente extreme
de vreme, toate acestea conduc la efecte asupra sntii; astfel, vrstele extreme (copii i persoanele vrstnice) i persoanele
tarate sau cele cu meteorosensibilitate vor fi cele mai vulnerabile
la stresul produs de extremele meteorologice. Valurile de cldur,
vara, nsoite de creterea umiditii produc fenomene acute de
deshidratare, afeciuni cardiovasculare, mrirea susceptibilitii
la infecii, iar creterea polurii atmosferice accentueaz
fenomenele de astm i alte tulburri respiratorii.

P 75
E.ICIENA PREVENIEI SECUNDARE I A RECUPERRII
DUP IN.ARCUL MIOCARDIC ACUT
Georgiana Ozana Tache, Oana Istrtescu
Spitalul Clinic de Urgen .loreasca, Bucureti
Eficiena preveniei secundare i a recuperrii dup
infarctul miocardic acut (IMA) se pot aprecia prin ameliorarea
funciei cardiace i a disfunciei endoteliale.
Scopurile prezentului studiu sunt urmtoarele:
ameliorarea toleranei la efort a pacienilor dup IMA
(apreciat prin calculul METS, creterea VO2Mx i reducerea
MVO2 pentru un anumit nivel al VO2),
reducerea riscului dup IMA, utilizand teste de evaluare
neinvaziv (testul de efort, ecocardiografie i supraveghere prin
Holter ECG),
influenarea aterosclerozei coronariene (ameliorarea
disfunciei endoteliale),
diminuarea pe termen lung a costurilor ngrijirilor medicale la pacienii inclusi n programul de recuperare.
Material i metod
Au fost luai n studiu (prospectiv) 43 de pacieni cu
diagnosticul de IMA. Acetia au fost bilanai clinico-paraclinic
(tensiune arteriala, puls, test de efort, ecocardiografie, Holter
ECG, aprecierea funciei endoteliale) n momentul externrii,
dup o saptmn, apoi dup 2 luni, 6 i respectiv 12 luni de la
episodul acut.
Studiul s-a desfurat n cadrul Clinicii de Cardiologie, ct
i n cadrul Departamentului de Recuperare Medical al
Spitalului Clinic de Urgen .loreasca Bucureti.
edinele de recuperare medical s-au desfurat cu o
frecven de 3/spt. n primele 2 luni, apoi cu o frecven de 2/
spt. pn la 6 luni i o 1/spt, pn la un an.
Rezultate
Ca urmare a aplicrii programului de recuperare medical,

se constat (la pacienii inclusi n studiu) creterea semnificativ a toleranei la efort, scderea riscului dup IMA, este
ameliorat funcia endotelial i scad semnificativ costurile pe
termen lung a ngrijirilor medicale.
Concluzii
Se recomand implementarea unui program de recuperare medical urmat cu contiinciozitate, pentru a se dovedi
eficiena real a preveniei secundare i a recuperrii la pacienii
dup infarctul miocardic acut.
SECONDARY PREVENTION AND CARDIAC
REHABILITATION E..ICIENCY A.TER ACUTE
MYOCARDIAL IN.ARCTION
Georgiana Ozana Tache, Oana Istrtescu
Spitalul Clinic de Urgen .loreasca Bucureti
The secondary prevention and the medical rehabilitation
after acute miocardial infarction (AMI) can be done throught the
cardiac functioning and by the endotelial disfunctionality
improvement.
Objectives
The study objectives are, as follows:
the patients effort tolerance improvement, post miocardial
infarction (appreciated by METS calculation, by VO2Max
augmentation and by MVO2 reduction for a certain level of VO2),
the risc reduction after miocardial infarction, using noninvasive test evaluation (such as effort test, ecocardiography
and Holter EKG survey),
coronary aterosclerosis modulation (improvement of the
endotelial disfunctionality),
the long therm reduction of medical care costs on patients
included in the rehabilitation programe.
Material and methods
43 patients with the acute miocardial infarction diagnosis
have been considered in a prospective study. They were clinical
evaluated and they were investigated (blood presional levels,
cardiac frequency, effort test, ecocardiography, Holter EKG
survey, appreciation of the endotelial function), on the release
day, a week after, then 2 months, 6 and 12 months after the
acute phase.
The study was performed in the Clinic of Cardiology and
in the Medical Rehabilitation Department of the Clinical
Emergency Hospital of Bucuresti.
Medical rehabilitation programe sessions had a frequency
of 3 per week for the first 2 months, then the frequency was of 2
sessions per week, until 6 months and of a frequency of one
session per werk for the entire first year after acute miocardial
infarction.
Results
.ollowing this medical rehabitation applied programe,
result the rising of the effort tolerance, the post AMI risk reduction,
the improvement of endotelial function and the decrease of the
long therm medical care costs.
Conclusions
We recomend that all patients after AMI should follow the
medical rehabilitation programe, in order to prove the real
efficiency of the secondary prevention and of the rehabilitation
on patients after AMI.

P 76
SIMPTOMATOLOGIA DUREROAS LOCALIZAT LA
NIVELUL COTULUI: ETIOLOGIE, DIAGNOSTIC,
TRATAMENT, EVOLUIE I PROGNOSTIC
Georgiana Ozana Tache, .KT Alina Lucia Tofan,
KT Valentina Afumatu, .KT Mdlina Stoica
Spitalul Clinic de Urgen .loreasca, Bucureti
Centrul de Recuperare Medical Medical Care
Durerea localizat la nivelul cotului, ct i disfuncia

97

III. POSTERE
secundar suferinei algice, se afl n legatur cu o serie de
factori etiologici, ce contureaz diagnosticul de boal,
tratamentul, prognosticul i evoluia acesteia.
Scopurile studiului de fa sunt acelea de a identifica
etiologia suferinei, schema terapeutic eficienta i aplicabil
diagnosticului stabilit, precum i de a aprecia evoluia i
prognosticul bolii.
Material i metod
Studiul a urmrit evoluia unui numr de 34 de pacieni
diagnosticai cu patologie algic i disfuncional a cotului, care
au beneficiat de tratament complex, medicamentos i nonfarmacologic, constnd n programe de fiziokinetoterapie
(electroterapie, diatermie alternnd cu crioterapie, laserterapie,
stretching, izometrie i izotonie) pe o durat de 1, 3, respectiv 6
luni.
Rezultatele obinute arat faptul c marea majoritate a
pacienilor a avut o evoluie favorabil la tratamentul aplicat dup
o durat de 1 lun, un procent semnificativ i-a ameliorat
simptomatologia algic i disfuncionalitatea dup trei luni de
terapie iar un procent sczut dintre pacieni a prezentat un
prognostic nefavorabil, fr ameliorarea scontat, evoluand ctre
6 luni de suferin.
Concluziile prezentului studiu prospectiv sunt urmtoarele:
recuperarea sindromului algic i disfuncional localizat
la nivelul cotului necesit timp ndelungat i programe complexe,
n conformitate cu etiologia suferinei prezentate,
medicul curant i terapeutul trebuie s informeze pacienii
asupra prognosticului i evoluiei ndelungate a suferinei.
ELBOW PAIN AND .UNCTIONAL DISABILITY: ETIOLOGY,
DIAGNOSIS, THERAPY, EVOLUTION AND PROGNOSIS
Georgiana Ozana Tache, .KT Alina Lucia Tofan,
KT Valentina Afumatu, .KT Mdlina Stoica
Spital Clinic de Urgen .loreasca Bucureti
Centrul de Recuperare Medical Medical Care
The elbow pain and functional disability are linked with
the etiology that leads to the diagnosis, to the treatment and to
the prognosis and evolution of the sufference.
Objectives
The study objectives are to identify the etiology of the
sufference, the efficient therapeutical schematics, applied to the
established diagnosis, as well as to appreciate the evolution
and the prognosis of the elbow complains.
Material and method
The study followed up a group of 34 patients with diagnosis
of elbow pain and functional disability, that benefit from complex pharmacological and non-pharmacological treatment,
consisting in physical medicine and medical rehabilitation
procedures (electrotherapy, diathermy versus icetherapy,
lasertherapy, stretching, isometric and isotonic exercices), for
1, 3 or 6 months duration.
Results
The obtained results show that most of the patients had a
positive evolution to applied treatment after only one month,
another important percentage improved the pain and the
disfunctional status after three month of treatment and that the
others from the studied group of patients had a prolonged six
months of sufference.
Conclusions
The conclusions of this prospective study are, as follows:
the recovery of the elbow pain syndrome and of the
disfunctional status takes prolonged time and complex therapy,
according with the etiology of the identified sufference,
the medical doctor and the therapist must inform the
patients about the prognosis and the prolonged evolution of
elbow sufference.

P 77
DIS.UNCIA DE POMP A VENTRICULULUI STNG LA
PACIENTUL HEMIPLEGIC ASPECTE PARTICULARE
ALE EVOLUIEI .UNCIONALE
Carmen Tnas 2 , Delia Cintez 1 , Daniela Poenaru
4 ,
Simona Popescu 3 , Cristina Constantinescu
Camelia Teleianu 1 , Marius Ivacu 1
1 INRM.B
2 Student UM. Carol Davila
3 CMDTA N. Kretzulescu
4 Cardiologie SUUB

Premize
La pacienii cu sechele post AVC, rezistena sczut la
exerciiul fizic crete costul energetic al micrilor i contribuie
la evoluia funcional deficitar; n plus, pacientul se adapteaz
cu dificultate sau deloc la exerciiile mai solicitante. Cu att mai
mult acest lucru se observ la cei ce asociaz o boal cardiac,
la care fie se ntrzie ori interzice iniierea recuperrii medicale,
fie se ignor efectul bolii cardiace de exacerbare a deficitului de
rezisten la efort. Dei experiena clinic a demonstrat, pe de
o parte, frecvena crescut a concomitenei bolii cardiace i a
celei cerebrovasculare la un acelai individ, iar pe de alt parte,
sunt bine cunoscute dificultile de diagnostic i tratament de
recuperare ntlnite la aceti bolnavi, exist relativ puine studii
care s ncerce stabilirea unor protocoale adecvate de evaluare
funcional i recuperare medical.
Obiectiv
Determinarea implicaiilor unei funcii ventriculare alterate asupra prognosticului funcional al sechelarilor post-AVC
inclui n programe de recuperare de faza nti.
Determinarea efectului complicaiilor precoce i tardive
asupra prognosticului funcional al pacienilor cu sechele dup
AVC i boal cardiovascular.
Determinarea efectului disfunciei ventriculului stng
asupra recuperrii precoce a pacienilor post AVC.
Material i metod
Au fost studiai 201 pacieni sechelari dup accident
vascular recent (vechime maxim 3 luni); ecografia cardiac a
permis mprirea pacienilor n dou subloturi, cu fracie de
ejecie a ventriculului stng normal (125 pacieni) i anormal
sub 50% (78 pacieni). Evaluarea clinic funcinal la internare, la externare i pe termen mediu a fost fcut cu ajutorul
indicilor funcionali. Evoluia lor a fost comparat n funcie de
prezena sau nu a unui deficit de funcie a ventriculului stng.
Rezultate
Prezena unei fracii de ejecie a ventriculului stng
anormal a ntrziat intrarea pacienilor ntr-un program de recuperare i a influenat compliana lr la tratament i evoluia
funcional pe termen scurt (o lun); n schimb, la 6 luni evoluia funcional a celor dou subloturi a fost similar.
Concluzie
Prezena unei fracii de ejecie a ventriculului stng ntre
30% i 50% nu influeneaz negativ evoluia funcional pe
termen scurt i mediu a sechelarilor post accident vascular
cerebral
LE.T VENTRICULAR DYS.UNCTION IN STROKE
PATIENT - .UNCTIONAL EVOLUTION PARTICULARITIES
Carmen Tnas 2 , Delia Cintez 1 , Daniela Poenaru
4 ,
Simona Popescu 3 , Cristina Constantinescu
Camelia Teleianu 1 , Marius Ivacu 1
1 INRM.B
2 Student UM. Carol Davila
3 CMDTA N. Kretzulescu
4 Cardiologie SUUB
Premises
Stroke patients have low resistance to physical exercise,
with highest energetic costs and deficient functional evolution;
these patients have difficulties adapting to a stressful physical

98

III. POSTERE
exercise. If these patients have a cardiac disease, this problem
is an obstacle in initiating rehabilitation, being a limitative factor
to effort tolerance. Although the concomitance of cardiac disease
and cerebrovascular disease in the same patient is encountered
relatively frequent there are few studies trying to establish
guidelines of functional assessment and clinical rehabilitation.
Objective
Determining the impact of left ventricular dysfunction on
functional prognosis of stroke patients who are enrolled in
rehabilitation programs (stage I).
Determining the impact of precocious and late
complications on functional prognosis of stroke patients who
have also cardiac disease.
Determining the impact of left ventricular dysfunction on
precocious rehabilitation after stroke.
Material and method
In this study were enrolled 201 patients with sequels after
recent stroke (less than 3 month); on echocardiography basis,
patients were divided in to groups, one (125 patients) with normal left ventricular ejection fraction ant the other group (78
patients) with an ejection fraction less than 50%. Clinical
assessment was done at admission, during hospitalization and
at release based on functional measurements. Their evolution
was analyzed in strict correlation with the presence of left
ventricular dysfunction.
Results
An abnormal left ventricular ejection fraction was
responsible for the delay in starting a rehabilitation program and
for therapy compliance and functional evolution on short term
(1 month); at six month functional assesment was about the
same.
Conclusion
.unctional prognosis of stroke patients on short and
medium term is not influnced by a low left ventricular ejection
fraction (between 30% and 50%).

P 78
E.ECTUL HIPOTENSOR AL EXERCIIULUI AEROB
Claudia Liana Toma, M. Berteanu, Luminia Dumitru,
Ruxandra Badea, S. Cristescu
Scop
Studiul a urmrit aprecierea efectelor antrenamentului
aerob asupra hipertensiunii arteriale.
Material i metod
Studiul a fost realizat n Clinica de Recuperare Medical
a Spitalului Universitar de Urgen Elias, pe un lot de 24 de
pacieni, cu vrste cuprinse ntre 45-70 ani i 5 pacieni martor,
ntre 45 i 60 de ani, pe o perioad de 4 luni. Subiecii au fost
selectai dup criterii comune de includere, respectiv excludere.
Protocolul de lucru a constat ntr-o evaluare iniial, antrenamentul propriu-zis, de 40 min, pe bicicleta ergometric Nautilus
NB/NC 3000, respectiv evaluarea final, dupa 12 edine de
antrenament, realizate pe o perioad de 3-4 sptmni.
S-a recurs la un antrenament aerob submaximal (60-80%
din ritmul cardiac maxim), cu meninerea nivelului de 13-15 pe
Scala Borg de evaluare a oboselii. Parametrii urmrii au fost:
alura ventricular, tensiunea arterial n repaus, la efort, dup
antrenament, valorile METs, Watts, precum i evoluia pe parcursul perioadei de antrenament a factorilor de risc modificabili
i medicaia.
Rezultate
Exerciiul aerob a condus la o scdere semnificativ a
valorilor TA de repaus de aproximativ 23% (TAs) i 13% (TAd),
respectiv o cretere a valorilor METs, cu limitarea creterii AV
la efort. De asemenea, s-a constatat necesitatea ajustrii
medicaiei (scderea dozelor), respectiv scderea n greutate
i o scdere a val. glicemiei la pacienii diabetici.
Concluzii
Exerciiul aerob efectuat chiar pe termen scurt, aproximativ o lun, are efecte benefice asupra scderii TA la pacienii

hipertensivi, fr efecte semnificative la cei normotensivi i crete

tolerana la efort att la hipertensivi, ct i la normotensivi.
Cuvinte cheie: antrenament aerob, hipertensiune
arterial.
RELATIONSHIP BETWEEN AEROBIC TRAINING AND
ARTERIAL HYPERTENSION
Claudia Liana Toma, M. Berteanu, Luminita Dumitru,
Anda Badea, S. Cristescu
Scope
The aim of study is to appreciate the effect of aerobic training on high arterial pressure.
Method
Study was realized in Medical Rehabilitation Clinic of
Emergency Universitary Hospital Elias on 24 patients, aged 4570 years and 5 healthy volunteers, aged 45-60 years, within a
period of 4 months. There were used common criteria of
selection. The procedure of work consisted in a former
evaluation, sub maximal aerobic training about 40 min. on ergometric bicycle Nautilus NB/NC 3000 and final evaluation, after
12 training sessions, in a period of 3-4 weeks. Aerobic training
was performed at 60 to 80% from maximal heart rate and was
maintained at a level of 13 to 15 on Borg Scale of .atigability
Evaluation. Monitoriezed parameters were: heart rate, arterial
pressure in repose, at effort, and after training, values of METs
and Watts and any modification of risk factors and medication.
Results
Aerobic exercise lead to a semnificative decrease of
systolic arterial pressure in repose, by 23 % and 13% for diastolic
pressure, an increase of METs values, with a slow up of heart
rate during effort. Also, it was necessary to reduce medication
doses and patients loosed in theirs weigh.
Conclusions
There is a relevance between aerobic exercise (even in a
short time) and reducing the level of arterial pressure at
hypertensive patients, without semnificative effect at
normotensives and rising the tolerance at effort both for
hypertensive and normotensives.
Key words: aerobic training, arterial presure.

P 79
BENE.ICIILE PROGRAMULUI RECUPERATOR LA
PACIENTUL PARKINSONIAN
Rodica Traistaru, Ana Maria Bumbea, Rahela Marcu
UM. Craiova
Scop
Parkinsonismul constituie una dintre entitile grupului de
afeciuni motorii ale ganglionilor bazali, caracterizate prin deficite
funcionale primare (simptome negative) i efecte secundare
(simptome pozitive). Prezentul studiu a pornit de la unul din principalele aspecte ale reabilitrii pacientului parkinsonian, conform cruia funcia motorie poate fi prezervat la parametrii ct
mai aproape de cei fiziologici printr-un program kinetic aplicat
precoce. Prin aceasta se asigur meninerea i mbuntirea
calitii vieii pacientului.
Material i metod
Studiul prospectiv a cuprins 34 pacieni (14 femei, 20
bbai), 10 pacieni fiind activi profesional. .iecare pacient a
fost evaluat complet (etiopatogenic, clinic i funcional) n dou
momente T1 iniial i dup un interval mediu de 3 luni, n
momentul T2. Subiecii au urmat un program kinetic integrat
asistenei complexe; programul a fost deprins n condiii de
spitalizare i continuat la domiciliu, pn n momentul T2. Am
folosit scalele Tinetti pentru echilibru static i dinamic (mersul),
Garden City pentru statusul funcional global i scala .IM pentru aprecierea consecinelor parkinsonismului asupra statusului
general al organismului.

99

III. POSTERE
Rezultate
66% dintre pacieni au fost diagnosticai cu boal
Parkinson, iar restul de 33% cu parkinsonism secundar vascular.
Scala pentru echilibru static s-a ameliorat cu 16% (valoarea
medie final 24,47, cea iniial 28,46) iar cea pentru echilibru
dinamic cu 14% (valoarea medie final 10,97, cea iniial 13,13).
Scorul mediu al scalei Garden City s-a mbuntit cu 12%.
Creterea medie a scorul final al scalei .IM a fost cu 7,2%.
Rezultatele au avut semnificaie statistic.
Concluzii
Pentru a conserva ct mai mult timp funcia motorie
convenabil la un pacient parkinsonian (cu precdere postura,
echilibrul i mersul), pe lng tratamentul medicamentos, obligatoriu, trebuie s se asocieze programe fizical kinetice.
Alegerea tehnicilor fizical kinetice este n funcie de forma
clinic i gravitatea deficitului funcional. Rolul fundamental al
programului kinetic integrat n asistena medical complex a
pacientului parkinsonian este creterea calitii vieii, prin ameliorarea modalitilor de autongrijire, cu posibilitatea derulrii
diferitelor activiti n condiii de stabilitate, echilibru, coordonare. Pacientul parkinsonian nu trebuie ajutat n derularea activitilor cotidiene - este una dintre regulile kinetice care trebuie
s fie respectat de ctre membrii familiei sale
Cuvinte cheie: kinetoterapie, sindrom parkinsonian, recuperare medical
THE BENE.ITS O. REHABILITATION PROGRAMME IN
THE PARKINSONISM PATIENTS
Rodica Traistaru, Ana Maria Bumbea, Rahela Marcu
UM. Craiova
Aim
Parkinsonim represents an entity of basal ganglia motor
disease group. This syndrome includes both primary functional
deficits (negative symptoms) and secondary effects (positive
symptoms). In this study we tried to underline the importance of
physical program in medical assistance in persons diagnosed
with parkinsonism syndrome. In this way, the patient quality of
life is preserved and improved.
Material and methods
Our prospective study included 34 patients (14 women,
20 men), 10 patients were professional active. All patients were
evaluated at entry into the study (Time 1) and after 3 months
(Time 2). All subjects performed a kinetic programme; this
programme wad included into the complex rehabilitation
assistance. We took into consideration the Tinetti scale for
balance, Garden City scale for functional status and .IM scale
for quality of life.
Results
66% of patients were diagnosed with Parkinson disease
and 33% of patients suffered by vascular secondary
parkinsonism syndrome. All scale values are improved after 3
months (in Time 2 of evaluation); so, the improvement of Tinetti
scale for static balance was 16% and for dynamic balance was
14%; the improvement of Garden City scale was 12% and only
7,2% for .IM scale. All results have statistic significance.
Conclusions
The successful treatment of parkinsonism patients is
assured by a complexe assistance. Medications and
electrotherapy methods have a significant benefit for short time.
Kinetotherapy is the best controller medication for
musculoskeletal structure. The physical and kinetic techniques
are choice in accordance with clinical forms and gravity of
functional deficit. The fundamental role of kinetic programme is
improvement of quality of life due to benefits on selfcare activities.
All patient family members have to know that the parkinsonism
patient hasn t to received any kind of help for ADL because he
can make different activities in safe motor control due to kinetic
programme.
Key words: kinetotherapy, parkinson syndrome and
rehabilitation

P 80
ROLUL TERAPIEI OCUPAIONALE N RECUPERARE
PACIENTULUI HEMIPLEGIC
Rodica Tristaru, Rahela Marcu, Ana Maria Bumbea
UM. Craiova
Scop
n studiul prospectiv derulat am urmrit beneficiile programului de terapie ocupaional (TO) adaptat, inclus asistenei
medicale complexe de recuperare, la pacientul hemiplegic
postaccident vascular cerebral (postAVC).
Material i metode
n perioada octombrie 2004 mai 2005, 22 pacieni
hemiplegici postAVC, cu vrste cuprinse ntre 50 66 ani, au
fost evaluai complet (clinic, funcional, paraclinic screening,
CT). Pentru alctuirea programului de terapie ocupaional la
fiecare pacient au fost apreciate ariile de performan, componentele senzitivo-motorii, cognitive i psihosociale precum i
contextul temporo-spaial al derulrii acestora. Adaptarea programului TO a presupus particularizarea n funcie de stadiul
hemiplegiei, de personalul de specialitate i dotrile existente.
Toi subiecii au fost evaluai iniial (T1) i dup 12 sptmni
(T2). Parametrii studiai au fost durerea (scala VAS),
spasticitatea (scala Ashworth), statusul funcional calitatea
vieii (scala .IM i scala Duke Health Profile).
Rezultate
n momentul T2 de evaluare s-a constatat o evoluie
favorabil semnificativ statistic (p < 0,05) doar pentru scorurile
scalelor VAS (de la 7,04 n T1 la 4,63 n T2), .IM (de la 55 n T1
la 63,54 n T2) i Duke Health Profile (de la 14,36 n T1 la 19,13
n T2). Spasticitatea i pattern-urile de micare funcional s-au
ameliorat dar fr semnificaie statistic.
Concluzii
Prima etap a programului de TO este evaluarea funcional minuioas a pacientului hemiplegic. Dei ar trebuie derulat
n cadru adecvat i de ctre personal specializat, programul de
TO poate fi adaptat i aplicat n serviciul de recuperare i la
domiciliu, de ctre terapeutul fizical care posed cunotine
temeinice n domeniu. Esenial este compliana pacientului i
familiei acestuia pentru continuarea elementelor deprinse.
Integrarea familial, social i chiar profesional a pacientului
hemiplegic necesit program de TO ca un compartiment obligatoriu pentru recuperarea medical.
Cuvinte cheie: hemiplegie, terapie ocupaional, recuperare
THE ROLE O. OCCUPATIONAL THERAPY IN
HEMIPLEGIC REHABILITATION
Rodica Tristaru, Rahela Marcu, Ana Maria Bumbea
UM. Craiova
Aim
In our prospective study we followed the benefits of
adapted occupational therapy program (OTP) in complex and
controversial poststroke hemiplegic persons rehabilitation.
Materials and methods
During October 2004 May 2005, we evaluated 22
hemiplegic patients (clinic, functional, screening lab, CT), age
between 50 66 years. All patients had cerebrovascular accident
(CVA) and no patients performed previous rehabilitation program or OTP. We appreciated the performance areas, performance component (sensorimotor component,
neuromusculoskeletal, motor, cognitive integration and cognitive
components, psychosocial skills) and performance contexts in
all subjects for the OTP establishing. The adaptation of the OTP
included specific aspects correlated with the hemiplegic state,
equipment and devices, spaces (hospital, kinetic or own room).
All subjects were evaluated initial (T1) and after 12 weeks
(T2). Parameters taken into consideration were pain (visual
analogue scale - VAS), spasticity (Ashworth scale), functional

100

III. POSTERE
movement patterns, functional status (.IM scale and Duke
Health Profile).
Results
The differences between mean score values (score for
pain, the .IM scale and Duke Health Profile scores) were
statistically significant (VAS from 7,04 in T1 to 4,63 in T2; .IM
scale from 55 in T1 to 63,54 in T2; Duke Health Profile from
14,36 in T1 to 19,13 in T2). Spasticity and functional movement
patterns had an improvement without statistic significance.
Conclusions
The first step in OTP is a thorough assessment of each
hemiplegic patient s problems.
Also the OTP has to performed in adequate space through
occupational therapist, it can be adapted and applied in
rehabilitation service and own place of patient, by the physical
therapist who can tested and practiced specific program of
occupational therapy.
The patient and his family compliance are essential for
the performance of the therapeutic aspects learned in the
hospital.
.amilial, social and professional integration of the
hemiplegic patient purposed an OTP. This OTP has to integrate like a based compartment into complex rehabilitation management.
Key words: hemiplegic persons, occupational therapy,
rehabilitation

P 81
ORTEZAREA PICIORULUI NEUROLOGIC
Gabriela Udvuleanu, Simona Onofrei, Gina Glbeaz,
Carmen Logoftu, Cristian Bodescu, Sebastian Diaconescu,
Bogdan Anatole, Daniela Poenaru, Delia Cintez
INRM.B
Ortezarea are un rol adjuvant pentru programul de
kinetoterapie, dar nu se poate substitui acesteia, ci o completeaz. Ortezarea membrului inferior n afeciunile neurologice
impune evaluarea atent, urmat de stabilirea obiectivelor
terapeutice, corelarea cu programul de kinetoterapie i monitorizarea permanent a starii actuale i a obiectivelor de etap.
Prescrierea unei orteze impune:
evaluare sistematic
stabilirea obiectivelor terapeutice n concordan cu programul kinetoterapeutic
monitorizare permanent
Una dintre cele mai frecvente constatri clinice, cu implicaii
pentru ortezare, este scderea forei musculare pe dorsiflexorii
piciorului. Aceasta implic o anume deficien fucnional, modificarea fazei de balans a mersului, cu imposibilitatea de a ridica antepiciorul de pe sol, aa-zisul mers cosit. Prin urmare, recuperarea i va propune un scop funcional, adic asigurarea
fazei de balans prin ridicarea antepiciorului de pe sol. Pentru
ndeplinirea acestui scop funcional avem la dispoziie mai multe opiuni biomecanice, fiecare dintre ele cu anumite consecine
neurologice. n final se alege o singur opiune, care corespunde particularitilor leziunii i pacientului, pentru care se stabilete plantul de recuperare.
Ce ateptm de la ortezele membrului inferior?
1. Protecia muchilor, ligamentelor, structurilor osoase,
esutului nervos
2. Prevenirea apariiei deformitilor, a schemelor motorii
patologice; cea mai frecvent deformare a genunchiului este
genu recurvatum
3. .acilitarea sau inhibarea anumitor grupe musculare,
in-put-uri senzitive, scheme posturale (presiuni asupra
tendoanelor cu scop inhibitor, stretchingul antagonistului pentru facilitarea agonistului)
4. Antrenament senzitiv, adic aplicarea unor stimuli
senzitivi pentru a asista schemele motorii corecte
5. Ortezele membrului inferior se vor adapta tipului
deformaiei: deformaiile flexibile vor fi corectate (piciorul plan

va beneficia de ridicarea arcului longitudinal, iar piciorul plat

fixat va necesita o pelot scafoidian cu rol acomodativ)
Ortezarea n afeciunile neurologice se afl n atenia
permanent a unei echipe multidisciplinare (neurolog,
recuperaionist, kinetoterapeut, personal calificat n ortezare
etc.), ceea ce i asigur adaptarea permanent la deficitele
funcionale actuale ale pacientului.
NEUROLOGICAL .OOT ORTHOTICS
Gabriela Udvuleanu, Simona Onofrei, Gina Galbeaza,
Carmen Logofatu, Cristian Bodescu, Sebastian Diaconescu,
Bogdan Anatole, Daniela Poenaru, Delia Cinteza
INRM.B
.oot orthosis in neurological diseases has an important
role in rehabilitation but cannot replace kinetotherapy, being
prescribed after careful clinical and functional evaluation.
Prescribing an orthosis requests:
systematic evaluation
establishing therapeutic objectives in agreement with
kinetotherapy program
careful monitoring
A relatively frequent problem, with great importance for
orthotics, is the presence of a diminished muscular strength on
dorsal foot flexors that makes difficult for the patient to raise the
foot from the ground.
A leg orthosis needs to protect muscles, ligaments, bones,
nervous tissue, to prevent structural deformations, motor
pathological patterns, to facilitate or to inhibit several muscular
groups, to ensure sensitive training for establishing accurate
motor patterns. Neurological foot orthosis should be prescribed
after a multidisciplinary assessment for an accurate adaptation
to patient s functional deficit.

P 82
STUDIU ANATOMO-CLINIC AL UMRULUI DUREROS
SIMPLU
Ioana Ureche 1 , Mdlina Iliescu 2 , D. Iliescu 3 , S. Ureche
medic primar recuperare, medicin fizic i baneologie,
ambulatoriul de specialitate al Spitalului Clinic Judeean de
Urgen Constana
2 medic rezident recuperare, medicin fizic i baneologie,
prep. univ., .acultatea de Medicin, Universitatea Ovidius
Constana
3 medic specialist medicin sportiv, ef de lucrri anatomie,
.acultatea de Medicin, Universitatea Ovidius Constana
4 medic rezident ortopedie, Spitalul Clinic de Urgen
Bagdasar
1

Obiective
Prezentul studiu a avut ca obiectiv stabilirea concordanei
ntre diagnosticul topografic algezic al afeciunilor umrului,
testele clinice i examenele paraclinice care au confirmat sau
infirmat sindroamele tendinoase sugerate, n vederea optimizrii
diagnosticului i atitudinii terapeutice.
Material i metod
Am luat n studiu un lot de 322 de pacieni, dintre care
278 de brbai i 44 de femei, diagnosticai cu umr dureros
simplu n ambulatorul de recuperare i medicin fizic al
Spitalului Clinic Judeean de Urgen Constana, n perioada
2002-2004.
Diagnosticul clinic de umr dureros simplu a fost susinut
de prezena durerii n punctele anatomice specifice tendoanelor
afectate, de prezena senzaiei de obstacol n micarea de
abducie i a unui test pozitiv de durere, ce vizeaz solicitarea
tendonului implicat.
Diagnosticul paraclinic a fost susinut de examenul
radiologic standard, examenul echografic i examenul RMN.
Rezultate i concluzii
Concordana dintre diagnosticul topografic algez2ic si

101

III. POSTERE
testele clinice i paraclinice reprezint o etap important pentru clinicieni, n ultimi ani constatndu-se o preocupare cert n
stabilirea unui paralelism ntre constatrile clinice i cele
imagistice ale afeciunilor prilor moi ale umrului (periartritelor
scapulohumerale).
ANATOMO-CLINICAL STUDY O. THE SIMPLE PAIN.UL
SHOULDER
Ioana Ureche 1 , Mdlina Iliescu 2 , D. Iliescu 3 , S. Ureche
medic primar recuperare, medicin fizic i baneologie,
ambulatoriul de specialitate al Spitalului Clinic Judeean de
Urgen Constana
2 medic rezident recuperare, medicin fizic i baneologie,
prep. univ., .acultatea de Medicin, Universitatea Ovidius
Constana
3 medic specialist medicin sportiv, ef de lucrri anatomie,
.acultatea de Medicin, Universitatea Ovidius Constana
4 medic rezident ortopedie, Spitalul Clinic de Urgen
Bagdasar
1

Objectives
The present study assessed the possible correlations
between the topographical algesic diagnosis of the shoulder
disorders, the clinical trials and the paraclinical examination that
confirms or not the suggested tendinous syndromes, for the
optimization of the diagnosis and the therapeutic attitude.
Material and method
We evaluated 322 patients, 278 males and 44 females,
with diagnosis of simple painful shoulder in the ambulatory of
the Emergency County Clinical Hospital of Constana between
2002 and 2004.
The clinical diagnosis of simple painful shoulder was
supported by the presence of pain at the specific anatomical
marks of the involved tendons, the presence of an obstacle of
the abduction movement and of the positive test of pain for the
involved tendon.
The paraclinical diagnosis was supported by the standard
radiological examination, ultrasound and MRI.
Results and conclusions
The concordance between the topographical algesic
diagnosis and clinical and paraclinical trials represents an important step for the clinician, last years showing a real concern
for the correlations between clinical and imagistical assessments
of the shoulder soft tissues (scapulohumeral periarthritis).

major n serviciile de reeducare funcional. Atelectaziile sunt

nespecifice pentru patologia medular. Pneumopatiile complic
n special sejurul n serviciile de terapie intensiv. Apneea de
somn are o inciden crescut, ns este rareori simptomatic.
Pe plan terapeutic, leziunile situate deasupra lui C4 necesit
ventilaie asistat permanent. Se impune corecia factorilor
clinici agravani. Sunt obligatorii portul unei centuri abdominale,
meninerea supleii cutii toracice, creterea forei diafragmatice,
dezvoltarea muchilor respiratori accesori, spirometria incitativ,
travaliul coordonrii respiratorii, reeducarea tusei, kinetoterapia
respiratorie, activitile sportive. Ventilaia asistat se practic
de principiu de mai mult de 10 ani n .rana i se asociaz cu
scderea numrului complicaiilor iniiale. Traheotomia este
indicat dac ventilaia sistat dureaz mai mult de 21 de zile i
d emblee la fracturile C4 C5. Complicaiile pulmonare reprezint prima cauz de deces n perioada iniial dup
traumatismul vertebro-medular i prima cauz de deces la
pacientul tetraplegic pe parcursul ntregii sale viei.
VENTILATORY IMPAIREMENT IN PATIENTS WITH
SPINAL CORD INJURY
Ventilatory mechanic, as it results from the participation
of the chest wall, aspiratory and expiratory muscles respond at
the command of medullary centre. The supraspinal control (the
voluntary control of respiration, the adjustment of ventilation
during activity) implies the limbic structures also. Decreased
sensibility of inspiratory centre to CO2 and decreased muscle
tone can lead to sleep apnea. Patients with spinal lesions need
an appropriate evaluation: clinical, radiological, monitoring
airflows and saturation in O2. Spinal cord injury produces, along
with the blunted respiratory drive, an alteration of the respiratory
function and a loss of control of the sympathetic nervous system.
An average of 80% of quadriplegic patients presents with
at least one pulmonary complication. In C4 quadriplegic patients
permanent assisted ventilation is needed. Tracheotomy is
indicated if the assisted ventilation prolongs over 21 days and
from the beginning in C4-C5 quadriplegic patients. The
respiratory complications represent the first cause of dying during
the initial period of the spinal cord injury and the first cause of
dying in quadriplegic patients during their entire life.

P 84
TULBURRILE HIPERTONICE POST TRAUMATISM
CRANIAN

P 83
IMPLICAIILE RESPIRATORII LA PACIENTUL LEZAT
VERTEBRO-MEDULAR

Ilinca Urzic 1 , Pr. Rodica Chirieac 2

medic rezident Recuperare, Medicin .izic i Balneologie,
Iai
2 eful clinicii de Reumatologie i Recuperare medical Iai

Mecanica ventilatorie, la care particip peretele toracic,

muchii respiratori, rspunde la comanda unor centri bulbari i
pontini. Controlul supratentorial (voluntar al respiraiei, ajustarea ventilaiei n timpul activitii) intervine prin modularea
centrilor bulbari implicnd i structurile limbice. Diminuarea
sensibilitii centrilor respiratori la CO2, scderea tonusului
muscular conduc la apariia tulburrilor de somn (apneea).
Pacientul lezat medular necesit o evaluare atent: clinic,
spirometric nsoit de monitorizarea bilanului gazos arterial
(O2, CO2, pH, bicarbonai), a saturaiei n O2, radiologic
(studiul parenchimului, a cursei diafragmatice). Atingerea
medular produce, alturi de afectarea brutal a muchilor respiratori, o alterare a funciei respiratorii cu scderea complianei
toraco-pulmonare, creterea complianei abdominale, ca i o
alterare legat de afectarea sistemului nervos vegetativ. Aproximativ 80% din pacieni prezint cel puin o complicaie
pulmonar. Ancombrrile bronice reprezint o complicaie

Ilinca Urzic 1 , Pr. Rodica Chirieac 2

medic rezident Recuperare, Medicin .izic i Balneologie,
Iai
2 eful clinicii de Reumatologie i Recuperare medical Iai

Traumatizaii cranian prezint deseori fenomene motorii

hipertonice speciale. Originea acestei hipertonii nu este univoc.
Consecinele asupra statusului funcional i reeducrii sunt importante. Sistemele descendente ale controlului motor pot fi
lezate i antreneaz astfel tulburri complexe i diferite ale
tonusului. Cnd aceste dezordini tonice, motorii i posturale se
prelungesc pe durata unei faze de trezire stagnante, ele sunt
sursa durerilor i retraciilor.
Sunt descrise diferite manifestri clinice: hipertonie,
spasticitate, distonie, hiperextensie, hiperflexie. Dintre acestea
unele corespund unor leziuni mai mult sau mai puin localizate
i al cror tratament va fi mai mult sau mai puin diferit dat fiind
c fiziopatologia lor este diferit. Mijloacele terapeutice de care
dispunem nu sunt specifice. Tratamentele uzuale ale spasticitii:
posturi de inhibiie, farmacoterapie antispastic cu baclofen,
dantrolen, benzodiazepine. Recurgerea la chirurgie este relativ
rar i orientat spre intervenii focalizate de tipul neurotomiei
selective.
Toxina botulinic face parte din arsenalul terapeutic propus
n cazul unei hipertonii focale. Prin extrapolarea eficacitii sale
n hipertonia spastic legat de alte etiologii (hemiplegie

102

III. POSTERE
vascular, scleroz n plci), utilizarea sa a devenit curent n
.rana la pacienii traumatizai cranian.
Toxina botulinic, prin inocuitatea, caracterul reversibil al
aciunii sale, modul de administrare simplu i efectul potenial
antalgic, reprezint o alternativ interesant cnd hipertonia n
cauz este suficient localizat i afecteaz confortul pacientului.
Integrat n programele de reeducare, injeciile de toxin
botulinic, prin diminuarea spasticitii, faciliteaz anumite activiti cotidiene, ngrijirea, ameliorarea forelor motrice i faciliteaz kinetoterapia, lupt mpotriva durerilor secundare, permit
evaluarea i mbuntirea mobilitii articulare i, cnd este
cazul, o mai bun toleran la apareiaj.

Studiile imunocitochimice au artat c diferitele concentraii

de H O (10, 25 i 50 M) induc scderea reaciei
2
2
imunocitochimice pentru ambele tipuri de proteine. Cea mai
important modificare a fost observat la 50 M H
O i s-a
2
2
concretizat prin absena reaciei pentru a-actina i o scdere a
reaciei pentru a-tropomiozina.
Numrul contraciilor a fost mai sczut dup tratamentul
cu 10 M H O i nu au fost observate contracii n urma
2
2
tratamentului cu 25 i 50 M H
O.
2
2
+ /K+ -ATPStresul oxidativ produce o scdere a activitii Na
azei direct proporional cu concentraia H
O . Aceste rezultate
2
2
+ i K + din omogenatul celular.
se coreleaz cu cantitatea de Na
n concluzie, stresul oxidativ induce modificri semnificative ale aparatului contractil al cardiomiocitelor. Aceste modificri depind de concentraia H
O .

SPASTICITY IN ADULTS WITH TRAUMATIC BRAIN

INJURY

Spasticity in patients with acquired brain injury has long

been a major concern for rehabilitation clinicians. Several clinical
aspects are described such as hypertonic or dystonic positions,
spasticity, hyperextension, hiperflexion. Patients with traumatic
brain injury frequently present with severe extensor tone in the
upper or lower limbs from the time of injury. In addition, they
may spend many hours in non-weight bearing positions because
of pronged bed rest due to coma or inability to walk, resulting in
adaptive shortening of muscles.
Localized spasticity management approaches have
typically included oral anti-spasticity medication, nerve
phenolization. Oral medication may be ineffective or
inappropriate for localized spasticity and doses may be limited
by side effects. Nerve phenolization may produce side effects
including neuropathic pain.
Botulinum toxin has been advocated as a more appropriate
tool for the management of localized spasticity, as it could
improve active and passive range of movement, improve
function, limit pain.

Studiile au fost finantate de Programul VIASAN,

contract 409/2004.
CARDIOMYOCYTES CONTRACTILITY MODULATION IN
OXIDATIVE STRESS CONDITIONS
Gabriela Zamfirescu

1 , Otilia Zarnescu
2 , Mihaela Stanescu
Constantin Munteanu 1
1 National Institute of Rehabilitation, Physical Medicine and
Balneology, Bucharest
2 University of Bucharest, .aculty of Biology

P 85

1 , Otilia Zrnescu
2 , Mihaela Stnescu
Constantin Munteanu 1
1 Institutul Naional de Recuperare, Medicin .izic i
Balneoclimatologie, Bucureti
2 .acultatea de Biologie, Universitatea din Bucureti

Infarctul miocardic este una din cauzele mortalitii i

morbiditii. n procesul de ischemie-reperfuzie s-a demonstrat
existena stresului oxidativ datorat n parte generrii speciilor
reactive ale oxigenului.
Scopul acestui studiu a fost de a observa efectele stresului
oxidativ indus de H
O asupra aparatului contractil al
2
2
cardiomiocitelor.
Pentru imunodetectia a-actinei i a-tropomiozinei s-au
utilizat anticorpi monoclonali anti- a-actina sarcomeric i antia-tropomiozina cardiac, iar contractilitatea cardiomiocitelor a
+ /K+ -ATP-azei a fost
fost determinat microscopic. Activitatea Na
determinat printr-o metod colorimetric, iar cantitatea de Na
i K+ prin flam-fotometrie.

Myocardial infarction is a common cause of mortality and

morbidity. An increased oxidative stress has been demonstrated
in ischemia-reperfusion in part due to the generation of reactive
oxygen species.
The purpose of this study is to observe the effects of
oxidative stress induced by H
O on cardiomyocytes contractile
2
2
apparatus.
a-actin and a-tropomyosin immunodetection was
performed with anti- sarcomeric a-actin and anti- cardiac atropomyosin monoclonal antibody, while cardiomyocytes
+ /K+ contraction rate was microscopically determined. The Na
+
ATPase activity was performed by colorimetric assay and Na
and K + account by flam-photometry.
Immunocytochemistry studies show that different
concentrations of H
O (10, 25 and 50 M) induce a decrease
2
2
of immunocytochemical reaction for both proteins. The most
important alteration was at 50 M H
O concretized by absent
2
2
reaction for a-actin and a low reaction for a-tropomyosin.
The contractions number was lower after 10 M H
O
2
2
treatment and no contractions was observed after 25 and 50
M H O treatment.
2
2
+ /K+ -ATPase
The oxidative stress induced decreases of Na
activity proportionelly with the concentration of H
O These
2
2 .
+ and K
+ amounts from cellular
results are correlated with Na
homogenate.
In conclusion, oxidative stress induces semnificativ
alteration of cardiomyocytes contractile apparatus. These
modifications depend on the H
O concentration.

MODULAREA CONTRACTILITATII CARDIOMIOCITELOR

IN CONDITIILE STRESSULUI OXIDATIV
Gabriela Zamfirescu

The present study was supported by VIASAN Program,

contract nr. 409/2004.