Treatment of patients with COVID-19, prevention of respiratory and other affected systems complications, prevention of multisystem damage and faster recovery possibilities and disease consequences overcoming is a particularly relevant topic today, when the number of people who have suffered from acute coronavirus infection is increasing. A tendency to shift the focus from acute manifestations to long-term morbidity and chronic involvement of various organs and systems is observed. In these subacute and chronic phases of illness, the application of physical modalities would be potentially effective. Traditionally, physical and rehabilitation medicine deals with patients with combined pathologies in order to reduce the duration of treatment and to speed up after-illness recovery. Deep Oscillation® therapy is a relatively new physical modality that is successfully applied to a number of diseases, including inflammatory pathologies of respiratory and musculoskeletal system, trauma, burns, fibrosis prevention, edema reduction, muscle relaxation etc. The purpose of this article is to make a review of the potential therapeutic effects of the Deep Oscillation® therapy application to patients suffering from COVID-19 and/or post-COVID-19 syndrome. Materials and methods: A review of the available literature was performed, including reports, articles, feedback letters regarding the application of Deep Oscillation® therapy. The search for scientific articles was conducted in the bibliographic database of Pub Med, Google Scholar, Elsevier. Results matching the following keywords were searched: Deep Oscillation® therapy, low-frequency and low-intensity electrostatic field, COVID-19, COVID-pneumonia, post-COVID-19 syndrome, long COVID, post-acute sequelae of SARS-CoV-2 infection, chronic COVID syndrome, diseases of the respiratory system, pneumonia, obstructive bronchitis, asthma, edema, lymphedema, musculoskeletal symptoms after COVID-19, chronic pain, myalgia, arthralgia, chronic back pain, fatigue. Results: The review made found evidence regarding the anti-inflammatory, anti-edematous, pain-reducing, and anti-fibrotic effects observed with the application of Deep Oscillation® in various diseases, including such of lungs. At this time, no research data were found regarding the application of Deep Oscillation® in patients with COVID-19 or after illness except for a brief communication in the form of a feedback letter regarding the therapy application in individual clinical cases of patients with COVID -19. Conclusion: The scientific studies carried out so far testify of established anti-inflammatory, -swelling and pain-reducing effects, fibrosis reduction possibilities, muscle spasm reduction, local microcirculation improvement and anti-lymphedematous effects of Deep Oscillation® application in various diseases, including lung diseases. These data suggest that a possible positive effect of the low-frequency electrostatic field can also be assumed in patients with COVID-19. Now, however, there are no clinical studies conducted about the Deep Oscillation® application effect in patients with COVID-19 and post COVID-19. Low-frequency electrostatic field therapy is probably an appropriate adjuvant therapy but cannot be recommended as a therapeutic modality in daily clinical practice in patients with COVID-19 due to the lack of reported therapeutic benefits in scientific reports. In the presence of convincing scientific evidence, this opinion is subject to correction. At the same time, it would be appropriate to determine the benefit of this therapy in post-COVID-19 recovery and persistent arthralgia and musculoskeletal symptoms.
Introduction: Osteoarthritis (OA) is a widespread disease among adult population and is one of the major public health problems. OA is leading cause of disability the joints of lower limbs: knee and hip. As global life expectancy increases, it predicted that OA will be the leading cause of damage resulting in permanent disability. In cases of OA a reduction in cartilage tissue is observed, which is radiographically demonstrated by narrowing of the joint space and bone changes, osteophytes and subchondral bone sclerosis. However, a significant proportion of patients with radiological evidence of gonarthritis do not report joint pain. It is important to evaluate the changes occurring in the surrounding tissues. Muscle weakness of m. quadriceps femoris may occur before pain and impaired joint function. The development and application of new non-pharmacological methods in the rehabilitation of degenerative joint diseases is particularly important.Purpose: To establish the short-term therapeutic effects of treatment with Low-frequency and Low-intensive electrostatic field, applied through Deep Oscillation® method and complex of therapeutic exercises in rehabilitation of patients with osteoarthritis of the knee.Materials and methods: We conducted a one-year observational study involving 23 patients with clinical symptoms and radiologically proven II and III stage according Kellgren-Lawrence gonarthritis, aged between 42 and 78 years, were observed. 15 of them were women average age 61.73±12.9 years vs 8 - males average age 61.75±9.6 years (p=0.997). The duration of the current pain-episode was 1.7±0.7 months. The treatment was conducted in 10 sessions and included: Low-frequency and Low-intensity electrostatic field and complex therapeutic exercises.Results: The results were evaluated before and after completion of therapeutic course by assessing pain (VAS) at rest, when walking, climbing and descending on stairs, Manual Muscle Testing, Measurment of the knee joint circumference, Test Range of Motion and WOMAC Osteoarthritis Index, V.LK 3.1. were tracked. For processing statistical data SPSS v.13 was used. There was a statistically significant reduction of pain syndrome at rest (p<0.001), walking (p<0.001), descending stairs (p<0.001), climbing (p<0.001). Reduction of knee joint circumference (p<0.001). Increasing the range of flexion before Ме (Range) from 105º (90º-120º) versus 120º (100º-125º) after therapy. Reduced deficiency at an extension from 3.48 ± 4.38 before therapy to recovery of the extension. Improved total WOMAC Index (p<0.001), Stiffness (p<0.001) and Function (p<0.001).Conclusion: The short-term effects of the application of Low-frequency and Low-intensive electrostatic field in complex with therapeutic exercises show reduction of clinical symptoms and improvement of daily functional activity in patients with knee joint osteoarthritis. Reduction of pain of rest and physical activity (walking, descending and climbing stairs) is observed, oedema is reduced, joint range of motion increases, immediately after completion of the therapeutic course. Because of the small number of patients included in the study for better objectifying of the effects of the low-frequency and low-intensity electrostatic field, the studies should continue.
Urinary Incontinence (UI) is a significant medical and social problem which affects both sexes. It can lead to a reduction in social contacts and physical activity, associated with poor self-assessment of the health status, impairment of emotional and mental well-being, reduction of sexual relations and depressive symptomatology. It is a significant reason for lower quality of life. In women, urinary incontinence is more common than in men. There are a number of reasons why urinary incontinence may occur: after surgery in small pelvis, pregnancy, vaginal delivery, hysterectomy, menopause, extreme obesity, chronic cough, constipation, some medications (muscle relaxants, sedative, antihypertensive agents, ACE inhibitors, antiacids) and others. Age factors leads to increased rate of incontinence, which has a large social and financial impact. It reflects the quality of life and it is a significant financial problem, both personal and for the health insurance system.The purpose of this review article is to investigate the therapeutic opportunities of non-surgical and physiotherapeutic treatment of patients with urinary incontinence.The treatment of urinary incontinence is strictly individual and depends on the type of incontinence, its severity and the reasons for its occurrence. It can be conservative and operative. The disease often does not progress over time and the conservative therapy is well tolerated, effective and safe. Non-surgical and physiotherapeutic treatment (behavioral therapy, the reduction of body mass, bladder training, lifestyle change, kinesitherapy for the pelvic floor muscles, biofeedback therapy, electrostimulation of skeletal pelvic floor muscles (ES), vaginal cones, mechanical devices, medication therapy, Botulinum toxin therapy) is the first choice and is preferred by most patients and it is well tolerated and effective. The application of physiotherapeutic methods of treatment requires the preparation of an individual rehabilitation program, which must be consistent with rehabilitation potential of the patient. The principles of gradual increase in the type and number of repetitions in therapeutic exercises, the continuity of kinesitherapy and the appropriate combination with electrostimulation procedures of the pelvic floor muscles are applied. It is considered, that the strengthening of the pelvic floor muscles is achieved through three levels of action: increasedg compression on the urethra, suppor of the bladder neck and improvement of the coordination of contractions of m. transversus abdominis and pelvic floor muscles. For electrostimulation, devices allowing percutaneous, intravaginal or intrarectal stimulation, usually with biphasic current, and low frequency and optimal intensity allowing painless contraction, are used.Conclusion: The urinary incontinence (UI) is highly prevalent and causes significant levels of morbidity, especially in women. The treatment for urinary incontinence is strictly individual and depends on the type of incontinence, the severity and the reasons for its occurrence. A stepwise approach treatment is recommended. The disease often does not progress over time, the conservative therapy is well tolerated, effective and safe.
Objective To explore the knowledge, perceptions of and attitudes to digital health of Bulgarian hospital professionals in the first study of digital health in this professional group. Methods A paper-based questionnaire was administered to doctors, trainee doctors, nurses, midwives, and laboratory assistants working in multiprofile or specialized hospitals. Topics included the following: state, objectives, benefits, and future of digital health; data storage, access, security, and sharing; main software used; patient-held Personal Information System (PIS); and telemedicine. A total of 1187 participants from 14 hospitals completed the survey in two phases: September 2013–April 2014 and May 2015–April 2017. Data were analyzed through descriptive statistics and multilevel logistic regression. Results Three-quarters of participants evaluated the state of development of digital health in Bulgaria as subpar (36.0% negative; 38.9% passable; 24.5% positive). 27.2% (323) endorsed patients having unconditional access to their data. In contrast, 89.5% (1062) of participants considered it appropriate to have full access to patient data recorded by colleagues. Doctors were more likely to endorse patients having access to their data than healthcare specialists (OR = 1.79 at facility, OR = 1.77 at location). Conclusion The largely negative or lukewarm attitudes toward the state of development of digital health in Bulgaria are likely to result from the high number of failed projects, unmet expectations, misunderstood benefits, and unforeseen challenges. This study provides a much-needed stimulus and baseline for researching the ways in which the digital health landscape in Bulgaria has matured—or not.
Introduction: Functional recovery of voice function in patients with laryngeal dysfunction is a slow and lengthy process that is associated with changes in social and economic living conditions. The serious functional damage can also lead to disorders in swallowing and respiratory function. It is believed that paresis passes into definitive if continues for more than 10-12 months due to irreversible changes in the tissues. According to literature data, spontaneous recovery in unilateral vocal cord paralysis is observed in 40% of cases. Low frequency currents with adjustable parameters are frequently used in the practice of electro diagnostics and electrical stimulation in damage of the neuromuscular system and in particular in laryngeal paresis and paralysis. In recent decades, an increase in the number of patients suffering from diseases associated with laryngeal dysfunction was noted by many authors. Interruption of nervous pulsation to laryngeal structures leads to sensory and motor disorders and development of subsequent paralysis of the muscles. Treatment depends on the cause, the severity of the symptoms and time of onset of the disease. It includes non-operative and operative treatment. Non-operative treatment is with good results and should precede surgery. Purpose: The purpose of this study is to objectify the therapeutic options of neuromuscular elektro-phonatory stimulation /NMEPS/ in patients with laryngeal dysfunction. Materials and methods: The study included 21 patients with unilateral dysfunction of n. laryngeus recurens after surgery of the thyroid gland. Patients with complete denervation were excluded from the study. Procedures are preceded by electro-diagnostic in direct laryngoscopy to establish the extent of damage of the nerve and to determin the coefficient of accommodation (ACC) and variable parameters for stimulus currents. Therapeutic session is implemented in two stages: (1) 'heating' with galvanic current, and (2) real NMEPS selective stimulation of the damaged muscle, leaving untreated antagonists or neighboring healthy muscles, accompanied by active and targeted implementation of Förster phonatoric exercises, coughing and breathing. Treatment is organized in courses for 10 days, 20 procedures per course. Results: The results before and after completion of therapeutic course by assessing changes in the coefficient of accommodation(ACC), voice quality, degree of hoarseness, coughing efficiency, presence of dysphagia are reported. After statistical processing of the obtained results a statistical dependence in relation to dysphonia before and after NMEPS therapy was established (p=0.0001), which is expressed in improvement of medium to mild dysphonia. In relation to dysphagia we found improvement from average-heavy to light form of dysphagia and absence of any symptoms of it after treatment, but there are patients with no change observed (44.4%) and statistical dependence (p=0.005) Patients with dysfunction regarding the effectiveness when coughing, before treatment they were: 16.7%, with severe dysfunction, 50.0% with moderate to severe and 33.3% with light. After NMEPS therapy improvement in the condition of patients with moderate-heavy to light form was observed. The non-parametric analysis proved statistical dependence (Z=3.58 ;p=0.0001). All patients were asked to assess the quality of their voice according to the Linkert five-point rating scale. In the beginning of the therapy 44.4% of the patients ranked their voice quality as poor, 50.0% as moderate and 5.6% as good. After treatment improvement in self-assessment of voice quality from moderate to very good and statistical dependence (p=0.0001) was observed. Conclusion: The results of the observational study prove that NMEPS therapy is effective for functional recovery in complex treatment of laryngeal dysfunction. Because of the small number of patients included in the study for better objectifying of the effects of the neuro muscular elektro-phonatory stimulation, the studies should continue.
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