Stroke is the second or the third leading cause of death and the leading producer of disability among adults in Lithuania and Western countries. Surgery is very important to treatment and prevention of ischemic cerebrovascular disease, but the selection of patients for it must be based on meticulous evaluation of surgery risk and factors influencing follow-ups. The aim of this study was to evaluate the selection criteria for cerebral revascularisation in patients with ischemic cerebrovascular diseases and factors affecting postoperative follow-ups. The innovativeness and originality of this study is the complex evaluation of neurological, neuroradiological, neurophysiological factors in patients with ischemic cerebrovascular disease before and after cerebral revascularisation. The evaluation of the influence of cerebral revascularisation to the neurological status of the patients, the possibilities of cerebral revascularisation for patients with Moyamoya disease, the factors affecting the neurological status of patients after cerebral revascularisation, the postoperative complications, death causes of patients after cerebral revascularisation and the surviving after cerebral revascularisation was done. The specification of the factors affecting outcomes after cerebral revascularisation was done too.

SUMMARY Objective of the study. To assess the need of nursing care for patients with spinal cord injury during the early in-patient rehabilitation period. Methods. During the study, thirty-two patients following an acute spinal cord injury, hospitalized in the Neurorehabilitation Unit of the Rehabilitation Division at the Kaunas University of Medicine Hospital, were inquired, examined and cared for. The contingent of studied patients consisted of paraplegic individuals with retained upper limb functions who could fill in themselves a questionnaire, which included 22 questions. Results. The obtained data have shown that 10 women participating in the study were older than 22 men (p £ 0.05): the average age of the women (in the range of 28 to 70 years) was 41 years whereas of the men (in the range of 19 to 52 years), 33.86 years. A reliable correlation according to the Kendall coefficient was determined between the patients self–assessment and the real mobility of the studied individuals. The data of the study have shown that 17 (54.5 percent) of the patients with disturbed urinary function were febrile. The fever was assessed in all 7 patients with continuously indwelled Foley catheters (p £ 0.05), whereas in 15 cases of intermittent catheterization just 5 (33.3 percent) of the patients were febrile (p £ 0.05). The employment of the Fisher criterion has shown that in cases of continuously indwelled Foley catheters for the urinary bladder drainage and the presence of fever... [to full text]

Galvos smegenų pilnavertiškam funkcionavimui turi būti palaikoma optimali galvos smegenų kraujotaka ir įsotinimas deguonimi. Darbo tikslas - nustatyti ir palyginti galvos smegenų kraujotakos pokyčius neurochirurginių operacijų metu naudojant sevofluraną ir propofolį. Mokslinio darbo tikslui pasiekti nustatyti uždaviniai: nustatyti galvos smegenų kraujotakos pokyčius transkranijiniu ultragarsiniu doplerografu matuojant vidurinės smegenų arterijos kraujo tėkmės greitį viršpadangtinių galvos smegenų navikų ir galvos smegenų arterinių aneurizmų operacijų metu bei operuojant ligonius, neturinčius galvos smegenų susirgimų (kontrolinė grupė); palyginti galvos smegenų kraujotakos pokyčius viršpadangtinių galvos smegenų navikų šalinimo operacijų metu naudojant sevofluraną ir propofolį; palyginti galvos smegenų kraujotakos pokyčius sevoflurano anestezijoje atliekant galvos smegenų navikų šalinimo, arterinių aneurizmų išjungimo operacijas ir operuojant ligonius, neturinčius galvos smegenų susirgimų (kontrolinė grupė); nustatyti ir palyginti sisteminės kraujotakos pokyčius bei įvertinti ir palyginti ligonių būklę po neurochirurginių operacijų naudojant sevofluraną ir propofolį. Klinikinio tyrimo metu ištirta 260 ligonnių. Nustatyta, kad bendrosios anestezijos palaikymui, atliekant neurochirurgines operacijas, sevofluranas gali būti naudojamas taip pat saugiai, kaip ir propofolis. Sevofluranas, naudojamas dozėmis iki 2,0 proc. tūrio iškvėpiamose dujose chirurginiam anestezijos gyliui... [toliau žr. visą tekstą] / Optimal cerebrovascular circulation and oxygen saturation must be maintained for full cerebral functioning. The aim of the study is to determine the changes of the cerebral circulation during supratentorial tumour resection or cerebral arterial aneurysm clipping surgery under sevoflurane and propofol anaesthesia. The following objectives were established: to determine and evaluate changes of the cerebral circulation by measurements of cerebral blood flow velocity in the middle cerebral artery using transcranial Doppler ultrasonography during supratentorial brain tumour resection or cerebral arterial aneurysm clipping surgery or operations for patients without cerebral pathology (control group); to compare the changes of the cerebral circulation during supratentorial brain tumour resection surgery under sevoflurane and propofol anaesthesia; to compare the changes of the cerebral circulation during supratentorial brain tumour resection, cerebral arterial aneurysm clipping or operations for patients without cerebral pathology (control group) under sevoflurane anaesthesia; to determine and compare the changes of the systemic hemodynamic during neurosurgery under sevoflurane and propofol anaesthesia; to determine and compare recovery period after sevoflurane and propofol anaesthesia.After giving written informed consent 260 eligible patients were enrolled in the study. The obtained results showed, that sevoflurane can be used as safely as propofol for maintaining general... [to full text]

The scientific problem of the study Brain concussion is the most common subtype of the post-concussion syndrome in childhood. This is a mild traumatic brain injury that accounts for 80-90℅ of all cases. Individuals who have sustained brain concussion, i.e. mild traumatic brain injury, frequently complain of various symptoms that are commonly defined as the post-concussion syndrome. Such symptoms are headache, dizziness, nausea, attention disorders, memory problems, sleep disturbances, learning problems, fatigue, emotional instability, mood changes, anxiety, fear, etc. – all of these are defined in the International Classification of Diseases. The symptoms of the post-concussion syndrome are non-specific and subjective. Some patients indicate similar symptoms even without having experienced head injury; these symptoms can occur in the presence of other health disorders, such as the fatigue syndrome, neurasthenia, hyperactivity and attention disorders, as well as in cases of anxiety, mood and emotional disorders, and depression. During the last 25 years, over 500 articles on mild traumatic brain injury have been published in psychological literature, and a similar number of publications in medical literature. The results of scientific studies are quite different, and the variety of the results is still inciting heated scientific debates. Some researchers insist that brain concussion has long-tern sequelae. On the other hand, an opinion has emerged that even if... [to full text]

Tyrimo tikslas: Veiksnių, įtakojančių kineziterapijos efektyvumą, sergantiesiems GSI, ankstyvuoju ligos laikotarpiu, nustatymas. Kontingentas. Tyrimas buvo atliktas Kauno medicinos universiteto klinikų (KMUK) neurologijos skyriuje. Tyrime dalyvavo 25 ligoniai (17 moterų ir 8 vyrai), kuriems buvo diagnozuotas išeminis galvos smegenų insultas, ūmus ligos laikotarpis. Reabilitologas buvo paskyręs kineziterapiją. Tyrimas buvo atliekamas 2007 m. spalio – 2008 kovo mėn. Pacientai vidutiniškai skyriuje praleido 14 dienų. Tiriamieji buvo suskirstyti į keletą grupių: pagal lytį – vyrai ir moterys, pagal amžių – 50-69 bei 70-87 metų, bei pagal galvos smegenų pusrutulio pažeidimo pusę – kairės ir dešinės. Tyrimo metodai. Reabilitacijos veiksmingumui vertinti pasirinkta paciento bendros funkcinės būklės ( Bartelio indeksas), motorinės funkcijos (Rivermedo judesių įvertinimo skalė), bei pažintinių funkcijų (Trumpas protinės būklės tyrimo testas) pokytis po reabilitacijos. Tyrimo rezultatai parodė, kad ankstyva sergančiųjų galvos smegenų insultu kineziterapija statistiškai reikšmingai pagerino pacientų bendrąją funkcinę būklę, motorinę funkciją bei pažintines funkcijas visose grupėse (pagal amžių, lytį ir galvos smegenų pažeidimo pusę)(p<0,05). Tačiau statistiškai reikšminga lyties, amžiaus, bei galvos smegenų pažeidimo pusės įtaka bendrai funkcinei būklei, motorinei, bei pažintinėms funkcijoms nenustatyta, kaip manoma dėl mažo tiriamųjų skaičiaus. / Aim of the research: Establishment of factors influencing the effectiveness of physiotherapy of people sick with stroke in the early period of illness. Contingent. The research was performed in the Division of Neurology of Kaunas University of Medicine Hospital. 25 patients took part in the research (17 women and 8 men) with the diagnosis of (išeminis) stroke, acute period of the illness. The rehabilitation physician had prescribed physiotherapy. The research was performed in October 2007 – March 2008. The patients spent in the Section on the average 14 days. The exploratory people were divided into several groups: according to the sex – men and women, according to the age – 50-69 and 70-87 years old, and according to the side of the hemisphere of head brains affection – left and right. Methods of the research. In order to evaluate the effectiveness of rehabilitation the alteration of patent’s general state (Barthel Index), motor functions (Rivermead Motor Assessment scale) and cognitive functions (Mini-Mental State Examination) after the rehabilitation were chosen. The results of the research have shown that the early physiotherapy of people sick with stroke statistically significantly improved patients’ general functional state, motor function and cognitive function in all groups (according to the age, sex and the side of the hemisphere of head brains affection) (p<0,05). However statistically significant influence of age, sex and the side of the hemisphere of head... [to full text]

Tikslas. Darbo tikslas yra susipažinus su „smegenų šturmo“ metodika atlikti pasirinktos „smegenų šturmo“ PĮ analizę ir pateikti pasirinkimo rekomendacijas. Tyrimo objektas. Tyrimo objektas yra 6 diegiamos „smegenų šturmo“ programos ir 4 internetinės sistemos. Egzistuojanti problema. Renkantis „smegenų šturmo“ PĮ kyla problema, kad gamintojai nepateikia pakankamai informacijos apie savo produktą, taip pat trūksta ir informacijos lietuvių kalba. Jie pateikia technines ir programines charakteristikas, tačiau nepateikia duomenų apie funkcionalumą ir našumą, nors šie aspektai taip pat svarbūs vartotojams. / The aim of bachelor's is to review the brainstorming methodology, to carry out the analysis and give recommendation of selection to users, because manufacturers provide information about systems requirements but don’t provide information about functionality of systems. These aspects are important for users. Also there is little information in Lithuanian. While applying the research of the theoretical methods, brainstorming methodologies, rules and execution are reviewed in this paper.

Tyrimo tikslas. Palyginti eisenos atsigavimą asmenims, patyrusiems trauminį galvos smegenų sužalojimą (TGSS) ar galvos smegenų infarktą (GSI), pirmajame reabilitacijos etape taikant kineziterapiją. Tyrimo uždaviniai.1) Įvertinti asmenų, patyrusių TGSS ar GSI, protinę būklę ir mobilumą prieš ir po kineziterapijos; 2) Įvertinti asmenų, patyrusių TGSS, eiseną taikant kineziterapiją pirmojo reabilitacijos etapo pradžioje ir pabaigoje; 3) Įvertinti asmenų, patyrusių GSI, eiseną taikant kineziterapiją pirmojo reabilitacijos etapo pradžioje ir pabaigoje; 4) Įvertinti asmenų, patyrusių TGSS ar GSI, proto būklės ir mobilumo atsigavimo įtaką eisenos atsigavimui, taikant kineziterapiją. Tyrimo metodai. Tyrime dalyvavo 60 asmenų: 30 asmenų, patyrusių TGSS, ir 30 asmenų, patyrusių GSI. Visiems tiriamiesiems buvo sutrikusi eisena. Vertinome tiriamųjų proto būklę pagal Trumpą Proto Būklės Tyrimo Testą, (TPBVT), mobilumą pagal Rivermead’o mobilumo indeksą (Rivermead Mobility Index) ir eiseną pagal Dinaminį Eisenos Indeksą (Dynamic Gait Index). Rezultatai skaičiuoti atliekant matematinę statistinę analizę. Visiems tiriamiesiems buvo taikoma kineziterapija siekiant eisenos atsigavimo. Tyrimo rezultatai. Tyrimo rezultatai parodė, kad taikant kineziterapiją pagerėjo proto būklė, mobilumas ir eisena abiejose tiriamųjų grupėse. Atlikus asmenų po TGSS ar GSI proto būklės, mobilumo ir eisenos palyginamąją analizę, gavome, kad kineziterapija turi teigiamą įtaką abiejų grupių proto būklės, mobilumo... [toliau žr. visą tekstą] / The aim. To compare gait recovery of individuals after Traumatic Brain Injury (TBI) or Ischemic Brain Stroke (IBS) using Physical Therapy during first rehabilitation stage. The tasks were: 1) To evaluate individuals after TBI or IBS mental state and mobility before and after Physical Therapy. 2) To evaluate individuals gait after TBI before and after Physical Therapy during first rehabilitation state. 3) To evaluate individuals gait after IBS before and after Physical Therapy during first rehabilitation state. 4) To find correlation between mental state, mobility and gait recovery of individuals after TBI or IBS using Physical Therapy. Methods and Material. In this study there were 60 persons participated: 30 after TBI and 30 after IBS. All patients had gait disorders. We evaluated mental state using Mini Mental State Examine (MMSE), mobility using Rivermead Mobility Index (RMI) and gait using Dynamic Gait Index. The results were calculated using mathematical statistical analysis. All patients received Physical Therapy to improve their gait. Results. The results showed significant mental state, mobility and gait recovery after Physical Therapy in both groups. Comparative analysis of persons after TBI or IBS mental state, mobility and gait showed that Physical Therapy has a statistically significant influence on mental state, mobility and gait recovery in both groups. We found correlation between mental state, mobility and gait recovery for patients after TBI or IBS. Gait... [to full text]

The tasks of the study were as follows: to investigate histological findings of the spinal cord two hours after a trauma; to investigate the influence of the narrowing of spinal canal on the histological changes development of the injured spinal cord; to estimate the influence of the spinal cord surgical decompression performed within twenty hours after the cervical spine trauma on its clinical signs of the changes of the injury; to determinate the relationship between the duration of the cervical spinal cord compression and its clinical signs of changes of the injury. The main results: The hemorrhages in the gray matter and within the perivascular spaces of the spinal cord and beneath it dura mater, blood stasis in the vessels of the spinal cord gray matter and the thrombosis of the superficial spinal cord vessels, ischemic neurons were established in axial sections of the spinal cord two hours after the experimental trauma. The degree of pericellular edema established in axial sections of the spinal cord stained with hematoxylin and eosin by light microscopy two hours after the experimental trauma was more severe for the laboratory animals which underwent reduction of vertical diameter of the spinal canal by 50 % followed by spinal cord compression. The cervical spinal cord decompression performed within twenty four hours after trauma provided significant neurologic recovery twelve months after surgical intervention. The decompression of the injured spinal cord manifested... [to full text]

Šio darbo metu tirta skirtingų rTMS parametrų įtaka galvos smegenų bioelektriniam aktyvumui. Atlikus EEG duomenų spektrinę analizę, pademonstruota, jog aukšto dažnio rTMS virš KPFDLŽ, skirtingai nuo žemo dažnio rTMS virš DPFDLŽ, stimuliuojant aštuoniukės formos rite, statistiškai patikimai padidina alfa bangų dažnių diapazono absoliučią galią dešiniajame pusrutulyje. Paminėtina ir tai, kad po gydymo kurso rTMS aštuoniukės formos rite Kleino protokolu, skirtingai nei klasikiniu protokolu, frontalinėje srityje alfa bangų dažnio diapazone statistiškai reikšmingai sumažėja (F7-F8)/(F7+F8) asimetrijos koeficientas. Svarbu pažymėti, jog po rTMS stimuliacijos apvalia rite, palyginus su stimuliacija aštuoniukės formos rite, registruojami labiau išplitę, sudėtingesni smegenų bioelektrinio aktyvumo pokyčiai. / Recently rTMS emerged as a new clinical tool for the treatment of major depressive disorder. rTMS is noninvasive and easily tolerated method that is able to alter bioelectrical brain activity. This phenomenon is achieved by using alternating magnetic fields to induce electric currents in cortical tissue. Nowadays it is widelly accepted that lateralized alterations in brain activity might play a role in depressive symptoms. It has been found that major depressive disorder patients exhibit greater right frontal activity in contrast to left frontal hypoactivation (it should be noted, that cortical activity is inversely related with alpha power). Therefore rTMS is a potential method that can help to re-eastablish normal brain activity. In this study we examined effects of different rTMS parameters (protocols and stimulation coils) on bioelectrical brain activity modulation in patients with the treatment resistant major depressive disorder. It was shown that 10 Hz stimulation with the figure-eight coil over the left prefrontal area increases alpha power in the right hemisphere. In addition, it was demonstrated that 1 Hz stimulation over the left prefrontal cortex changes frontal alpha asymmetry. It should be underlined, that there appears to be no significant difference in clinical efficacy between the two protocols. It was also demonstrated that changes in frontal alpha asymmetry tend to correlate with the outcome of the treatment. Furthermore, it was shown that stimulation with... [to full text]

Šiuo metu reabilitacijos įstaigose trūksta paprastų tikslių instrumentinių tyrimų GSI patyrusių pacientų raumenų jėgai matuoti. Svarbu išsiaiškinti, ar instrumentiniai tyrimai naudingi galvos smegenų insultą patyrusiųjų funkcijų atgavimo prognozei. Tyrimo objektas. Galvos smegenų insultu sergančiųjų apatinių galūnių jėgos deficitas (JD). Tyrimo tikslas buvo įvertinti dinamometrinių parametrų informatyvumą galvos smegenų insulto pažeistos motorinės funkcijos atgavimo prognozei. Tiriamųjų kontingentą sudarė 59-73 metų vyrai ir moterys (n=24) sergantys galvos smegenų insultu. Tiriamieji atrinkti naudojantis Pasaulinės Sveikatos Organizacijos pripažintu Barthel indeksu, kuris skirtas vertinti paciento savarankiškumą bei pagal mini mąstymo testą, skirtą protiniam sutrikimui nustatyti. Testavimai buvo atliekami standartinio gydymo laikotarpio reabilitacijos įstaigoje pradžioje bei pabaigoje. Tiriamieji testuoti raumenų jėgos testavimui naudojant manualinį dinamometrą bei Reese NB (2005) “Muscle and sensory testing” protokolą. Buvo registruojamas abiejų kūno pusių maksimalus blauzdos lenkiamųjų, blauzdos tiesiamųjų, pėdos lenkiamųjų ir tiesiamųjų raumenų jėgos dydis. Be šių matavimų, tiriamieji turėjo atlikti atsistojimo-atsisėdimo testą. Visų tirtųjų raumenų jėga reabilitacijos pradžioje buvo asimetriška lyginant sveikąją bei pažeistąją kūno puses. Visų tirtų apatinių galūnių raumenų jėgos dydžio vidurkis abiejose kūno pusėse reabilitacijos pabaigoje reikšmingai padidėjo lyginant... [toliau žr. visą tekstą] / There are not enough simple apparatus methods for the brain stroke suffers strength testing. It is useful to assess if apparatus methods are informative for the brain stroke suffers diaganostic. Subject of the study. Brain stroke suffers strength deficit of lower extremities. Aim. To assess the usefulness of the dynamometric parameters on the prognosis of recovering motor function after stroke. Subjects comprised males men and women aged 59-73 (n=24) with brain stroke. Subjects to be studied were selected according to the Barthel index acknowledged by the World Health Organization; this index is intended to assess patient’s self-dependence. Measurements were taken at a rehabilitation institution in the beginning and at the end of the standard treatment period. The researched people’s muscle strength was tested with a manual dynamometer on a protocol by Reese NB (2005) “Muscle and Sensory Testing”. Maximum values of knee flexors, knee extensors and foot flexor muscles (both dorsal and plantar flexion) of both sides of the body were analyzed. Besides these measurements, a stand-sit test was carried out. In the beginning of the rehabilitation, lower extremities’ muscle strength was asymmetric bilaterally in all of the recruited patients. At the end of the rehabilitation, muscle strength of both sides of the body increased significantly in comparison with the initial value (p<0.05). Muscle strength of the affected side of the body increased more markedly than that of the... [to full text]