Marcin Miś

Background/Objectives: Fear of falling is highly prevalent after stroke and may interact with mobility limitations, neurological deficits, and reduced quality of life. However, few studies have examined these dimensions together during inpatient rehabilitation. This study aimed to assess fear of falling, balance and gait performance, and HRQoL in adults undergoing post-stroke inpatient rehabilitation, and to examine the interrelationships among psychological, functional, and clinical measures to support multidimensional assessment strategies. Methods: This cross-sectional study included 39 patients (51.28% women, 71.79% after ischemic stroke) undergoing post-stroke inpatient rehabilitation. The main assessments included the Falls Efficacy Scale-International (FES-I), the Tinetti Test (TT), and the Short Form-36 (SF-36). Results: High fear of falling was reported by 61.5% of participants, while a substantial proportion (35.9%) demonstrated moderate-to-high fall risk on the TT, despite the majority being classified as low risk. SF-36 domain scores indicated moderate HRQoL with substantial interindividual variability across dimensions. Strong correlations were found between SF-36 and FES-I (rs = 0.76, p < 0.001), TT (rs = −0.78, p < 0.001), Barthel Index (rs = −0.71, p < 0.001), and NIHSS (rs = 0.65, p < 0.001). Patients with greater neurological impairment and lower independence demonstrated worse HRQoL and higher fear of falling. Also, a statistically significant (p < 0.001) strong negative correlation (rs = −0.89) was found between the TT and the FES-I scores, indicating that higher fear of falling was associated with poorer mobility. Conclusions: Fear of falling, impaired balance, and reduced HRQoL are highly prevalent and strongly interconnected among post-stroke inpatients. These findings highlight the need for early multidimensional assessment and integrated interventions targeting both physical performance and psychological factors. Larger longitudinal studies are required to clarify causal pathways and optimize rehabilitation strategies.

Background: Discogenic low back pain (LBP) is a significant therapeutic and social problem. Discopathy is associated with neurological symptoms that severely disrupt the patient’s functional status. Regardless of the choice of neurosurgical procedure for discopathy, its effectiveness highly varies. Aims: This study aimed to assess the effectiveness of neurosurgical treatment and neurorehabilitation procedures based on a comprehensive analysis of a number of neurological symptoms and the functional status of patients with chronic discogenic LBP. Material and Methods: This study involved 110 patients (56 women and 54 men) who underwent first-ever lumbar spine surgery. Before the surgery and 3 months after the hospital discharge, all patients were subjected to neurological examination and comprehensive assessment of neurological symptoms. Results: After the procedure, improvement was shown in sensory disturbance (p < 0.0001), pain (p < 0.0001), and sexual dysfunction (p < 0.0001). The results of lower limb paresis, monoplegia, and sphincter complications remained non-significant. A reduction in scoliosis (p = 0.0040) and lumbar pain (p < 0.0001) was observed. There was a reduction in pain in the lower leg (p = 0.0136) and foot (p = 0.0122) during movements. Improvement in passive and active mobility as well as pain reduction in the lumbar spine area were demonstrated (p < 0.0001). There was significant improvement in the knee and ankle reflexes (p < 0.0001). There were no significant changes in the superficial sensation. In the functional assessment, an improvement in the toe-to-floor test of 13.3 cm was confirmed (p < 0.0001), while there was no difference in the Lasègue’s test. Conclusions: The general and neurological condition of patients with LBP significantly improved after the spine surgery. The improvement included mainly a reduction in pain and sensory disturbances, return of deep reflexes, and increased mobility of the lower limbs and spine.

BACKGROUND Aphasia is a common consequence of stroke and traumatic brain injury (TBI) that significantly impairs communication and quality of life. Transcranial direct current stimulation (tDCS) has emerged as a non-invasive technique potentially enhancing language rehabilitation. This study aimed to evaluate the efficacy of tDCS in combination with speech-language therapy (SLT) in improving language functions in patients with aphasia. MATERIAL AND METHODS A group of 90 patients diagnosed with TBI- or stroke-related aphasia were randomly assigned to 3 groups: tDCS alone (Group I), SLT alone (Group II), and tDCS combined with SLT (Group III). Treatment procedures spanned 5 months. tDCS sessions lasted 30-40 minutes each (1-1.5 mA), targeting the left dorsolateral (F3) and the right (F4) prefrontal cortex. Language function was assessed using the Frenchay Aphasia Screening Test (FAST), Aphasia Evaluation Scale (SODA), and Token Test (TT). Statistical analyses compared pre- and post-intervention outcomes within and between groups. RESULTS All groups demonstrated significant improvements in language function (p < 0.001). Group III showed the greatest gains in verbal expression, comprehension, and reading (32.6% improvement in FAST scores), significantly outperforming Group I (24.3%) and Group II (17.8%). tDCS alone was more effective than SLT alone (p = 0.04). Combining tDCS with SLT resulted in superior patient-reported improvements in daily communication and confidence in verbal expression compared to either treatment alone. CONCLUSIONS Patients who received combined tDCS and SLT had notable improvements across all measured parameters, including verbal expression, comprehension, reading, and writing, as assessed by the FAST, SODA, and TT tests.

Background/Objectives: Emotional and cognitive impairments are prevalent in patients with acute ischemic stroke (AIS) and traumatic brain injury (TBI), significantly affecting their quality of life and recovery potential. Transcranial direct current stimulation (tDCS) has emerged as a promising non-invasive method to enhance neurorehabilitation outcomes by modulating neural activity. Methods: This prospective, open-label, multicenter interventional study included 100 participants (50 AIS, 50 TBI) who underwent 10 sessions of tDCS. Emotional states, depression levels, and memory and learning outcomes were assessed pre- and post-intervention using the UWIST Mood Adjective Checklist (UMACL), Depression Measurement Questionnaire (DMQ), Benton Visual Retention Test (BVRT), and Brain Damage Diagnostic Test (BDDT). Results: Significant improvements in emotional states were observed post-tDCS. Hedonic tone increased (AIS: 2.5 to 5 stens; TBI: 1.5 to 4 stens), while tension arousal decreased (AIS: 8 to 6 stens; TBI: 8 to 6 stens; all p < 0.001). Depression levels dropped significantly, with the overall depression index decreasing from 131 to 100 points in AIS and from 126 to 104 points in TBI (both p < 0.001). Memory and learning scores improved significantly, evidenced by increased correct responses and reduced errors in BVRT and BDDT tests (all p < 0.001). Conclusions: tDCS effectively improved emotional states, reduced depression levels, and enhanced cognitive functions in AIS and TBI patients. These findings support the integration of tDCS into neurorehabilitation protocols, with further research needed to explore long-term benefits and individualized treatment strategies.

Background: The management of degenerative musculoskeletal disorders, including degeneration of the intervertebral disc (IVD) and its neurological consequences, is complex. This approach requires coordinated collaboration among specialists, especially neurosurgeons, nurses and physiotherapists.Aim of the study: The aim of the study was to perform the review of scientific reports and summary of the current state of knowledge regarding the degeneration of the IVD in the context of various treatment aspects, both in terms of conservative therapy and surgical treatment.Materials and Methods: The literature review was based on searching key medical databases such as PubMed, MEDLINE, Scopus. A search strategy was defined, including keywords, synonyms, and controlled vocabulary terms (MeSH terms). The search covered the last 20 years and focused on aspects of conservative and surgical treatment. Studies meeting the inclusion criteria underwent a full-text analysis. Data and information gathered from the literature analysis were synthesized to provide a comprehensive overview of the state of knowledge on the investigated issue.Results: Classical conservative methods include neurorehabilitation, heat treatment, proper body positioning, and pain management. The common feature of all minimally invasive methods is percutaneous access, where instruments are introduced through small puncture incisions. The effectiveness of conservative treatment for patients with degenerative lumbar spine disease fluctuates around 40%. Meanwhile, the surgical treatment of lumbalgia remains a controversial topic, with many unknowns, lacking clear algorithms and standards. Further research and the development of clinical practice are crucial for improving diagnostic, therapeutic, and preventive methods related to this exceptionally complex clinical problem.Conclusions: The process of treating IVD degeneration is complex and should be considered individually in each case. Collaboration between a neurosurgeon and a physiotherapist forms a dynamic team that addresses both diagnostic and therapeutic aspects. This synergy allows for close monitoring of the patient, combining surgical and rehabilitation aspects, resulting in comprehensive care and maximizing treatment outcomes, thereby improving the quality of life (QOL).

Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% - emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b-TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization - in 30.7%, mRS of 0-2 - in 31.4% and mRS of 6 in 22% of cases. Our results can help harmonize standards for MT in Poland according to international guidelines.