e12701 Background: Integrated rehabilitation improves quality of life in breast cancer patients, but its impact on long-term outcome of disease is unclear. The aim of our study was to find out whether early initiation of integrated rehabilitation is associated with a lower incidence of distant metastases. Methods: The subjects of our prospective study were 553 female non-metastatic invasive breast cancer patients (26-65 (mean 52) years of age), who participated in the pilot study on the individualized integrated rehabilitation of breast cancer patients in 2019-2022. The patients completed three questionnaires (EORTC QLQ - C30, B23 and NCCN): before, six and twelve months after the beginning of cancer treatment. The control group included 278 patients and the intervention group 275 patients. The control group obtained the same rehabilitation as was offered to all breast cancer patients in our hospital before the start of our study. The multidisciplinary rehabilitation team reviewed the documentation of all the patients from the intervention group before, six and twelve months after the beginning of treatment and recommended appropriate interventions according to the patient's problems. The integrated rehabilitation coordinator referred patients for additional treatments in compliance with the institute’s new clinical pathway (psychologist, general practitioner, nutritional treatment, physical rehabilitation, kinesiologist-guided online exercises, gynaecologist, analgesia, vocational rehabilitation). Data on the patients’ demographics, disease extent, cancer treatment, distant dissemination and distant disease-free survival were collected. This data were analysed using the chi-square and ANOVA test. Distant disease-free survival and disease-specific survival were estimated using the Kaplan–Meier method, and between-group differences were assessed using the Cox proportional hazards model. Adjustment for tumor subtype and type of systemic therapy was not performed. Results: There were no differences between the control and the intervention group of patients in terms of age, education, disease extent, surgical procedures, systemic cancer treatment, radiotherapy, or disease-specific survival. The follow-up period ranged from 1 to 72 (median 57) months. Distant metastases occurred in 3% of the intervention group and 7% of the control group. Distant disease-free survival was 97% in the intervention group and 94% in the control group (HR = 0.43, 95% CI 0.19-0.98; p = 0.04). Conclusions: Early integrated rehabilitation is associated with longer distant disease-free survival compared to the control group. These findings suggests that early individualised integrated rehabilitation may contribute not only to improved quality of life but also to favourable long-term oncological outcomes.

Background: Our study investigated the impact of multicomponent balance exercises (MBE) and sensorimotor mobilization with foot muscle strengthening (SMFE) on postural stability in patients with balance disorders, assessed using the Balance Error Scoring System (BESS) while standing still. Methods: Twenty postoperative patients were included in a randomized clinical study and divided into an MBE group (six women and four men with an average age of 30.2 years) and the SMFE group (six women and four men aged 34.5 years). Balance was assessed with the BESS on the third postoperative day and before discharge. The hospitalization lasted 10 days. Results: All patients in both groups showed significant clinical and statistical improvements (p < 0.05) in maintaining an upright posture after the BESS test. In the MBE group, 80% of patients achieved a minimum clinically significant change of 10 points in postural stability, whereas 100% of patients in the SMFE group did the same. The SMFE group exhibited a statistically significant improvement (p < 0.05) in specific balance tasks conducted on hard and soft surfaces. Conclusions: Our patient sample results suggest that SMFE is more effective than MBE. We recommend its use in early rehabilitation, although further research is necessary.

11007 Background: Return to work is beneficial both for breast cancer (BC) patients and for society. This study explored the impact of early integrated and vocational rehabilitation on sick leave and disability one year after the start of cancer treatment in BC patients. Methods: The subjects of our prospective study were 435 employed female BC patients (26-65 (mean 52) years of age), who participated in the pilot study on the individualized integrated rehabilitation in 2019-2022 and were followed for at least one year. There were 211 patients in the control group and 224 in the intervention group. The patients completed three questionnaires (EORTC QLQ - C30, B23, and NCCN): before, half and one year after the start of cancer treatment. The control group received the standard rehabilitation programme, offered to all BC patients before the start of the study. The multidisciplinary rehabilitation team reviewed the documentation of the patients from the intervention group before, half and one year after the start of treatment and recommended appropriate interventions according to the patient's needs in compliance with the institute’s new clinical pathway (psychologist, general practitioner, nutritional treatment, physical rehabilitation, kinesiologist-guided online exercises, gynaecologist, analgesia, vocational rehabilitation). Data on the patients’ demographics and needs reported in questionnaires, the extent of the disease and cancer treatment were collected. These data and the frequency of sick leave and disability retirement one year after the start of treatment in both groups of patients were analysed using the chi-square and ANOVA test. Results: The patients from the intervention group had 50 calendar days shorter sick leave compared to the control group (p = 0.002). Patients without metastatic disease from the intervention group had 52 calendar days shorter sick leave compared to the control group (p = 0.002). The intervention group treated with chemotherapy had 43 calendar days shorter sick leave compared to the control group (p = 0.029). The difference in sick leave of the group of patients who did not receive chemotherapy was statistically borderline significant (50 calendar days, p = 0.053). The patients in the intervention group had a better work ability (p < 0.001) and less disability (p < 0.001) than the patients in the control group one year after the start of treatment. Conclusions: One year after the beginning of cancer treatment, patients from the intervention group had shorter sick leave, better work ability, and a lower proportion of disability compared to the control group.

Background: Our study aimed to investigate the effects of vestibular rehabilitation therapy on functional gait performance in patients with balance disorders. Methods: A total of 40 post-operative patients with balance disorders were included in the study. They were divided into two groups and participated in a vestibular rehabilitation program during their hospital stay. After discharge, the intervention group performed vestibular exercises at home, while the control group did not. Balance was assessed using the Functional Gait Assessment Scale at discharge and three months after surgery. Results: The intervention group included 15 women and 5 men with an average age of 45 years, while the control group included 7 women and 13 men with an average age of 50 years. Three months after surgery, the change in Functional Gait Assessment (FGA) scores exceeded the clinically significant threshold of 5 points in 17 patients in the intervention group and 14 in the control group. There was a statistically significant difference in FGA progression between the groups (p = 0.034). After three months post-surgery, 7 patients in the intervention group experienced falls compared to 12 in the control group. Conclusion: Three months after surgery, we observed a significant improvement in the performance of balance tasks while walking and a lower risk of falls in the intervention group.

Background: Tobacco related illnesses are important public health issues worldwide. Cigarette smoking effects cancer risk and cardiovascular risk. Smoking cessation confers substantial benefits on health. Our aim was to determine whether the early introduction of integrated rehabilitation from the beginning of cancer treatment is associated with the smoking cessation in breast cancer patients. Material and Methods: The subjects of our prospective study were 467 female breast cancer patients (29-65 (mean 52) years of age), who participated in the pilot study on the individualized integrated rehabilitation of breast cancer patients in 2019-2022 and were followed for at least one year. The control group included 282 patients and the intervention group 185 patients. The patients completed three questionnaires (EORTC QLQ - C30, B23 and NCCN) before and one year after the beginning of cancer treatment. The control group obtained the same rehabilitation as was offered to all breast cancer patients in our hospital before the start of our prospective study. The multidisciplinary rehabilitation team reviewed the documentation of all the patients from the intervention group before and one year after the beginning of cancer treatment and recommended appropriate interventions according to the patient’s difficulties. The integrated rehabilitation coordinator referred patients for additional interventions in compliance with the institute’s clinical pathway (psychologist, general practitioner, clinical nutritionist, physical rehabilitation, kinesiologist-guided online exercises, gynecologist, analgesia, vocational rehabilitation). Smokers were referred to a smoking cessation workshop organized by a health promotion center within community health centres. Data on the patients’ demographics, disease extent, cancer treatment and prevalence of tobacco smoking before and one year after the beginning of cancer treatment were collected and analysed using the chi-square and ANOVA test. Results: There were no differences between the control and the intervention group of patients in terms of age, education, disease extent, surgical procedures, systemic cancer treatment, or radiotherapy. There were no differences between the groups in the prevalence of smoking before the treatment. Before the cancer treatment, smoking was present in the intervention and control group in 22% and 27% (p=0.22), respectively. However, one year after the beginning of cancer treatment, smoking was less common in the intervention group in comparison to the control group of patients (p=0.004). Smoking was present in the intervention and control group in 10% and 20%, respectively. Conclusions: Early integrated rehabilitation helps the smoking cessation in breast cancer patients. Citation Format: Nikola Besic, Zlatka Mavric, Anamarija Mozetic, Tina Zagar, Vesna Homar, Nena Kopcavar Gucek, Andreja Cirila Skufca Smrdel, Jana Knific, Simona Borstnar, Mateja Kurir Borovcic, Lorna Zadravec Zaletel, Natasa Kos, Branka Strazisar, Denis Mastnak Mlakar, Nina Kovacevic, Vedran Hadzic, Bojan Pelhan, Marko Sremec, Tina Rozman, Romi Cencelj-Arnez. Early integrated rehabilitation helps smoking cessation in 467 breast cancer patients – a comparison between the intervention and control group in a prospective study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-31.

e24062 Background: Our aim was to determine the frequency of health-related problems faced by breast cancer patients before and six months after the initiation of breast cancer treatment. Methods: This prospective study involved 600 female breast cancer patients (26-65 years, mean 52), who participated in the pilot study in the novel individualized integrated rehabilitation programme in 2019-2022 and were followed for at least six months. The patients completed three questionnaires (EORTC QLQ - C30, B23 and NCCN) before the initiation of cancer treatment and six months after. The patients received neoadjuvant chemotherapy in 22% of the cases, tumorectomy in 53%, mastectomy in 39%, breast reconstruction in 27%, sentinel node biopsy in 67%, lymphadenectomy in 23%, external beam radiotherapy in 73%, chemotherapy in 45%, anti-HER-2 therapy in 11% and hormonal therapy in 74% of the cases. Data on the patients’ demographics, disease extent, cancer treatment and problems reported in the questionnaires were collected and analysed using descriptive analysis. Results: The problems reported by patients before the initiation of cancer treatment and after six months are presented in Table. In 14 out of 22 parameters, the frequency of problems increased in the six months after the initiation of treatment: fatigue, insomnia, lymphedema, shoulder movement impairment, disturbing scars, heart problems, hot flashes/sweating, gynaecological problems, sexual problems, body image worries, inappropriate nutrition, pain in the shoulder or arm, alopecia and concerns about returning to work. On the other hand, the frequency of problems decreased six months after the initiation of cancer treatment in 6 out of 22 parameters. Our patients less often had depression or anxiety, were too little physically active, smoked, consumed alcohol or used food supplements than before. Conclusions: Six months after the initiation of breast cancer treatment patients have more problems than at the time before treatment.[Table: see text]

Introduction: The novel coronavirus disease 2019 (COVID-19) became an important and urgent threat to global health. In Slovenia, the COVID-19 struck the health system immensely. Neurosurgery experienced difficulties, not only in regular, elective surgeries, but also during emergency situations. Methods: In the article, we analyse and compare the number of elective and emergency neurosurgical procedures during the time of the pandemic (from March 2018 to February 2020) and describe our protocol in the management of neurosurgical patients in the Medical Centre in Ljubljana, Slovenia. Results: There were 2597 patients treated surgically, including 1932 emergency patients and 665 emergency patients. Overall, we recorded an 11.2% drop in all neurosurgical procedures in two years after COVID-19 was declared compared to two years before. Elective procedures decreased by 13.9%, mostly on account of spinal pathology procedures (245, 23.5%), functional neurosurgical procedures (37 cases, 24.7%), endonasal endoscopy procedures (11, 12.8%), and brain lesions (31, 4.8%). Conclusion: COVID-19 had a vast impact on the healthcare system in Slovenia, including on neurosurgery. New and improved strategies to maintain neurosurgical practice during public health emergencies are necessary for the neurosurgical service and healthcare system to run smoothly in the long term and prevent disruptions during future pandemics.

Izhodišča: Prizadetost ravnotežnega sistema se pri bolnikih med izvajanjem funkcionalne hoje kaže kot kombinacija zaznavnih, okulomotoričnih, posturalnih ter avtonomnih simptomov. Namen raziskave je bil ugotoviti učinke specifične ravnotežne rehabilitacije na izboljšanje izvedbe bolnikove hoje. Metode: Raziskava je potekala prospektivno. Vključenih je bilo 40 bolnikov, ki so imeli po operaciji procesa v zadnji lobanjski kotanji motnje statičnega in dinamičnega ravnotežja. Razdeljeni so bili v 2 skupini. Vsi so bili med hospitalizacijo vključeni v program ravnotežne rehabilitacije. Ob odpustu so bolniki v interventni vadbeni skupini izvajali specifično dinamično ravnotežno vadbo v domačem okolju, bolniki iz kontrolne skupine vaj v domačem okolju niso izvajali. Za oceno ravnotežja in primerjavo med skupinama smo uporabili Lestvico za oceno funkcionalnosti hoje (FGA). Bolnike smo ocenili ob odpustu in 3 mesece po odpustu iz bolnišnice. Rezultati: V interventni vadbeni skupini je sodelovalo 15 žensk in 5 moških s povprečno starostjo 45 let; v kontrolni skupini brez vadbe pa je sodelovalo 7 žensk in 13 moških s povprečno starostjo 50 let. Najmanjšo klinično pomembno spremembo med dvema ocenama FGA, ki je znašala 5 točk, je preseglo 17 bolnikov v interventni vadbeni skupini in 14 bolnikov v skupini, ki vadbe ni opravljala. Napredek FGA se je med skupinama tudi statistično značilno razlikoval (p=0,034). V času hospitalizacije ni prišlo do padcev. Po 3 mesecih je v vadbeni skupini padec utrpelo 7 bolnikov, v skupini brez vadbe pa 12 bolnikov. Zaključek: Tri mesece po odpustu smo pri bolnikih v interventni vadbeni skupini ugotovili statistično pomembno izboljšanje pri izvedbi ravnotežno zahtevnejših funkcionalnih nalog med hojo in zmanjšano ogroženost za padec.

BACKGROUND Cigarette smoking affects cancer risk and cardiovascular risk. Smoking cessation is very beneficial for health. This study aimed to evaluate an early individualized integrated rehabilitation program and standard rehabilitation program for smoking cessation in breast cancer patients. MATERIAL AND METHODS This prospective study included 467 breast cancer patients (29-65 (mean 52) years of age) treated at the Institute of Oncology Ljubljana from 2019 to 2021 and were followed longer than 1 year. The control group and intervention group included 282 and 185 patients, respectively. Three questionnaires were completed by patients before and 1 year after the beginning of oncological treatment. The intervention group received interventions according to the patient's needs, while the control group underwent standard rehabilitation. The data obtained from the survey were analyzed using the chi-square test and analysis of variance. RESULTS In total, 115 patients were tobacco smokers before the beginning of cancer treatment. There were no differences between the intervention and control group in the prevalence of smoking before the treatment. Before the cancer treatment, smoking was present in the intervention group in 22% and in control group in 27% (P=0.27). One year after the beginning of cancer treatment, smoking was present in the intervention group in only 10% of cases, while it was present in control group in 20% of cases. Smoking was significantly less common in the intervention group than in the control group (P=0.004). CONCLUSIONS Smoking cessation was more common after early integrated rehabilitation than after standard rehabilitation.

Worldwide, the novel coronavirus disease 2019 (COVID-19) has become a significant threat to global health. Worldwide, COVID-19 has affected the health service also in Slovenia. During this time, neurosurgery is facing difficulties in its service, both in emergency and elective surgeries. In the article, we describe the anti-COVID-19 measures taken at our neurosurgical department in a medical centre in Ljubljana, Slovenia, and analysed and compared the number of emergency and elective neurosurgical procedures during the time of the pandemic.

12074 Background: Fatigue after breast cancer treatment is a major health problem that is very difficult to treat. Our aim was to determine whether the early introduction of focused rehabilitation from the start of the cancer treatment is associated with the frequency of fatigue in breast cancer patients. Methods: The subjects of our prospective study were 600 female breast cancer patients (26-65 (mean 52) years of age), who participated in the pilot study on the individualized integrated rehabilitation of breast cancer patients in 2019-2022 and were followed for at least six months. The control group included 300 patients and the intervention group 300 patients. The patients completed three questionnaires (EORTC QLQ - C30, B23 and NCCN): before and six months after the beginning of cancer treatment. The control group obtained the same rehabilitation as was offered to all breast cancer patients in our hospital before the start of our study. The multidisciplinary rehabilitation team reviewed the documentation of all the patients from the intervention group before six months after the beginning of treatment and recommended appropriate interventions according to the patient's problems. The integrated rehabilitation coordinator referred patients for additional treatments in compliance with the institute’s new clinical pathway (psychologist, general practitioner, nutritional treatment, physical rehabilitation, kinesiologist-guided online exercises, gynaecologist, analgesia, vocational rehabilitation). Data on the patients’ demographics, disease extent, cancer treatment and complaints reported in questionnaires were collected. This data and the frequency of fatigue six months after the beginning of treatment in both groups of patients were analysed using the chi-square and ANOVA test. Results: There were no differences between the control and the intervention group of patients in terms of age, education, disease extent, surgical procedures, systemic cancer treatment, or radiotherapy. There were no differences between the groups in the prevalence of fatigue before the start of treatment. Before the cancer treatment, 50% of the patients in both groups reported fatigue, while moderate or severe fatigue was reported in the intervention and control groups in 9% and 10% (p = 0.69), respectively. Six months after the beginning of cancer treatment, fatigue was reported in the intervention and control groups in 66% and 70% (p = 0.38), respectively. However, moderate or severe fatigue were reported in the intervention and control groups in 17% and 26% (p = 0.02), respectively. Conclusions: Early integrated rehabilitation is associated with a lower prevalence of moderate or severe fatigue in breast cancer patients in comparison to the control group six months after the beginning of cancer treatment.

Background: Spasticity is characterised by an atypical increase of muscle tone, affecting normal movements and interfering with the patient quality of life. The medicines may limit the effects of the disease and selective dorsal rhizotomy (SDR) can be used for selected cases or cases refractory to medicine. We present the surgical technique and the short-term results of this newly established surgical treatment in Slovenia. Methods: A retrospective analysis was performed of all patients that underwent the SDR from 2017 to 2019. The median follow-up was of 10 months. The following data have been collected: aetiology of spasticity, age at SDR, number of sectioned lumbar rootlets L1-S2, intraoperative disappearance of the H-reflex and intraoperative preservation of the bulbocavernosus reflex. The motor functions of all children have been classified by the Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM-88). Twelve children underwent SDR, the median age at surgery was 9.6 years (min 3.9-max 16 years). Results: A mean of 57.8% of dorsal rootlets L2-S1 have been cut, while at level L1 50% of the dorsal roots have been routinely sectioned. The median amount of S2 rootlets cut was 14.3%. Postoperatively, we observed a sudden decrease in muscle tone. In all patients, there was an improvement of the muscle tone and of the gait pattern. The GMFM improved from 187.8 to 208.3 after a follow-up of 6 months. Conclusions: There was no complication in terms of wound healing, cerebrospinal fluid fistula of neurological dysfunctions. Despite the relatively short follow-up, our early results confirm the efficacy of the SDR.

Background: Rett syndrome is a rare genetic neurological syndrome that affects mostly females. The syndrome leads to severe impairments impacting all areas of the affected persons’ life, including speech, mobility, eating, and breathing impairments. The most distinct symptoms include stereotyped hand movements, ataxia, and atrophy of the lower limbs, and signs of autism. Methods: According to the principle of convenience sampling, the quantitative research included five females diagnosed with Rett syndrome subject to their personalized goal oriented neurological physiotherapy. Changes in gross motor function were assessed by the Gross Motor Function Measure 88 and Rett syndrome Gross Motor Scale. Results: It was found that the 12-month multifaceted neurological physiotherapy intervention had statistically significant improvements in both Gross Motor Function Measure 88 (p = 0.005) and Rett syndrome Gross Motor Scale (p = 0.012). Despite positive improvements, the absence of control group made it difficult for a comparative evaluation to determine what interventions had the best possible outcomes. Conclusions: The quantitative research demonstrates neuro-developmental treatment sessions, hippotherapy, hydrotherapy, physical therapy, a walking program, endurance exercises, active-assisted exercises, and coordination exercises, had a significant impact on improving gross motor function status. Current multifaceted intervention program leads to good improvement of gross motor skills above what can be expected from late motor deterioration.

Background Prehabilitation with regular exercise and nutritional care for patients undergoing surgeries for malignant disease was recently introduced to increase physiologic reserve prior to the procedure, accelerate recovery and improve outcomes. This study aimed to investigate the feasibility and safety of combined exercise training and nutritional support in patients with haematologic malignancies prior to haematopoietic stem cell transplantation (HSCT). Methods In this single-arm pilot study, 34 HSCT candidates were enrolled at least two weeks before admission for the procedure. Patients performed aerobic exercises at least 4 days per week for 20–30 min and strength exercises 3 days per week for 10–20 min. They received daily supplements of whey protein (0.3–0.4 g/kg body weight) and oral nutritional supplements if needed. The primary endpoints were feasibility (acceptability > 75%, attrition < 20%, adherence > 66%) and safety. The secondary endpoints were fat-free mass (FFM), muscle strength, physical performance and health-related quality of life (HRQoL) at HSCT. Results The rate of acceptability, attrition and adherence to aerobic exercise, strength exercise and protein supplement consumption was 82.4, 17.8, 71, 78 and 80%, respectively. No severe adverse events were reported. Twenty-eight patients participated in the study for a median of 6.0 weeks (range, 2–14). They performed aerobic exercises 4.5 days per week for 132 min per week and strength exercises 3.0 times per week. Patients consumed 20.7 g of extra protein daily. At the end of the programme, we recorded increases of 1.1 kg in FFM ( p = 0.011), 50 m in walking distance in the 6-min walking test (6MWT) ( p < 0.001), 3.3 repetitions in the 30-s chair-stand test (30sCST) score (p < 0.001) and 2.6 kg in handgrip strength ( p = 0.006). The EORTC QLQ-C30 scores improved by 8.6 ( p < 0.006) for global health status, 8.3 ( p = 0.009) for emotional functioning, and 12.1 ( p = 0.014) for social functioning. There was less fatigue, nausea and insomnia ( p < 0.05). Conclusions Our study shows that a multimodal intervention programme with partially supervised exercise training combined with nutritional support prior to HSCT is feasible and safe. Patients showed improvements in FFM, physical performance and HRQoL. Additional research is needed to assess the possible positive effects of such interventions.

Izhodišče: V akutni fazi nevrorehabilitacije imajo bolniki po nevrokirurških posegih pogosto motnje statičnega kot tudi dinamičnega ravnotežja. Lestvica za oceno funkcionalnosti hoje (angl. FGA) omogoča oceniti dinamično ravnotežje med hojo in je primerna za izvajanje specifičnih kompleksnih gibalnih spretnosti in temu primernih ravnotežnih odzivov. Namen raziskave je ugotoviti stopnjo izboljšanja dinamičnega ravnotežja pri bolnikih po odstranitvi vestibularnega tumorja z uporabo lestvice za ocenjevanje funkcionalnosti hoje, ki smo jo uporabili kot vadbeno orodje v času hospitalizacije.Metode: V prospektivno raziskavo smo vključili 10 bolnikov po kirurški odstranitvi vestibularnega tumorja, ki so bili sposobni slediti navodilom in so na Kratkem preizkusu spoznavnih sposobnosti (KPSS) dosegli več kot 25 točk od 30 možnih in dobili oceno po indeksu Barthelove več kot 8 od 20 točk. Med hospitalizacijo smo vse bolnike vključili v individualno prilagojeni program ravnotežnih spretnosti s poudarkom na različnih funkcijskih in kognitivnih nalogah, ki jih vključuje lestvica FGA, in jo uporabili kot učinkovito vadbeno orodje. Kot merilno orodje pa smo lestvico FGA uporabili za oceno dinamičnega ravnotežja ob odpustu bolnikov iz bolnišnice v domače okolje in ponovno po treh mesecih od odpusta. Bolniki so dobili tudi pisna navodila in posnetke vaj na DVD- ju za ustrezno nadaljevanje izvajanja dejavnosti v domačem okolju.Rezultati: Povprečna starost vključenih bolnikov (6 žensk, 2 moška, 2 najstnika) je bila 39,5 let (razpon 18–57 let). Hospitalizacija je povprečno trajala 10,5 dni (razpon od 7 do 14 dni). Šest bolnikov je ob odpustu iz bolnišnice po lestvici FGA dobilo oceno od 8–14/30, štirje bolniki pa vrednosti 16–20/30, kar kaže na prisotnost zmernih do hudih motenj dinamičnega ravnotežja. Tri mesece po odpustu je 7 bolnikov doseglo več kot 22 točk (od 24–28/30), kar pomeni, da so imeli blage motnje dinamičnega ravnotežja, 3 bolniki so dosegli manj kot 22 točk (od 14–18/30), kar pomeni, do so imeli med hojo zmerne do hude motnje dinamičnega ravnotežja, zato so potrebovali nadzor ali pomoč druge osebe. V naši raziskavi je minimalno izračunano zaznavno spremembo 4 točke po FGA preseglo 70 % bolnikov, kar kaže na izboljšanje dinamičnega ravnotežja.Zaključek: Lestvica za oceno funkcionalnosti hoje se je izkazala kot odlično vadbeno orodje za odkrivanje motenj in izboljšanje dinamičnega ravnotežja, ki ugodno vpliva na specifične gibalne spretnosti in tako olajša bolnikovo delovanje v domačem okolju.

BACKGROUND Patients in the acute phase of rehabilitation after vestibular tumor surgery are dysfunctional in basic daily activities. Balance, gait impairments, and falls are prevalent with vestibular loss. AIM To determine the degree of balance disorders after vestibular tumor surgery, the susceptibility to falls and to assess motor tasks using the Functional Gait Assessment (FGA) scale for functional gait, as part of the vestibular rehabilitation program during hospital stay. METHODS Patients who achieved a score higher than 25 points on the Mini-Mental State Examination and higher than 8 points on the Barthel index were included in the study. They were evaluated with the Berg Balance Scale the second day after surgery, during their hospital stay, at discharge, and three months after surgery. Throughout their hospitalization, patients took part in the vestibular rehabilitation program, focusing on multiple motor tasks included in the FGA. RESULTS All patients progressed clinically and statistically significant differences in functional activities of daily living were observed during hospitalization, before discharge to the home environment (median = 11; P = 0.0059) and three months after vestibular tumor surgery (median = 8; P = 0.0058). After discharge from hospital, four patients were at risk of falls, and two patients were at risk at three months. CONCLUSION Our study showed a positive effect of the use of FGA tasks as part of a rehabilitation program on functional activities of daily living in patients after vestibular tumor surgery. Nevertheless, we suggest further research to include a larger sample and a control group to overcome the deficiencies of our study.

Spastičnost je motorična motnja, ki jo zaznamuje porast mišičnega tonusa do take mere, da otežuje gibanje in vzdrževanje položaja telesa, kar vpliva tudi na kakovost življenja. S to patologijo se kljub pogostosti in pomembnosti ukvarja malo pediatričnih nevrokirurgov, najverjetneje zato, ker so bile možnosti za nevrokirurško zdravljenje dolgo omejene in nezanesljive. O prvi seriji dorzalnih rizotomij je leta 1979 poročal Fasano, do takrat pa so nevrokirurgi takim otrokom lahko nudili le skromno pomoč. Farmakološko zdravljenje spastičnosti se je do danes močno razvilo in obsega zdravila za peroralno, intramuskularno in intratekalno dajanje. Kirurške tehnike zdravljenja, kamor uvrščamo nevrokirurške in ortopedske posege, pa poleg delne sekcije perifernih živcev in globoke možganske stimulacije vključujejo tudi selektivno dorzalno rizotomijo (SDR). Izbira najbolj ustreznega zdravljenja je individualna in odločanje poteka interdisciplinarno. Predstavljamo primer otroka s spastičnostjo in zdravljenje z nevrokirurško tehniko SDR, ki smo jo v Sloveniji izvedli prvič.

Introduction: Work-related musculoskeletal disorders (WMSDs) represent a major problem for society, employers, and employees. These kinds of problems can cause discomfort, pain, and poor work performance. Among physiotherapists, the 1-year prevalence of WMSD ranges from 28 to 96%. Most problems occur in the lower back, with a 1-year prevalence of up to 83%. This study aimed to determine the prevalence of WMSD on a sample of physiotherapists from Slovenia and to identify associations between demographic/anthropometric variables, job satisfaction, and physical activity with WRMD aiming to contribute to the development of effective prevention and control strategies. Methods: The extended Nordic musculoskeletal questionnaire was used to obtain data from a sample of 102 physiotherapists. Data were presented with descriptive statistics and processing was performed with the Spearman’s rank correlation coefficient for non-parametric variables. The level of statistical significance was set as p ≤ 0.05. Results: The 1-year prevalence of WMSD was 92.2%. One-year prevalence of WMSD was highest for the neck (64%) and lower back (63%). Higher age and more years of practice were correlated with WMSD for shoulders and ankles/feet areas. Several patients treated by a physiotherapist were a risk factor for difficulties in the neck and multiple body areas. The level of physical activity was not correlated with WMSD in different body areas. Conclusion: The prevalence of WMSD found in our study sample was among the highest compared to other countries, despite probably having similar working conditions as elsewhere in Europe. The first WMSD of Slovenian physiotherapists mostly did not occur in the first 5 years of practice as other studies reported, which could be explained as a result of a good educational training of young physiotherapists. Possible reasons for the high prevalence of WMSD could be that our study sample represented only secondary and tertiary levels of health care; another reason could also be non-ergonomic and hard working conditions during their careers. Physiotherapists are mostly adequately physically active, however, that did not turn out to be effective WMSD prevention in our sample. The relatively high prevalence is indicating the need for better interventions and prevention of WMSD in Slovenian physiotherapists.