I like that this was for chronic and at a spa which most persons would have some access to. But you'll have to ask your doctor to get the protocol for the spa treatments used. That should be the responsibility of our stroke associations but we have fucking failures of stroke associations doing nothing for survivors. And once again we have researchers that don't know the purpose of stroke research,
The Efficiency of Spa Rehabilitation in Chronic Ischemic Stroke Patients—Preliminary Reports
Bogumiła Pniak 1
, Justyna Leszczak 2,* , Jadwiga Kurczab 1
, Aleksandra Krzemi ´nska 1
, Joanna Pi ˛eta 1
,
Agnieszka Plis 1
, Ewelina Czenczek-Lewandowska 2 and Agnieszka Guzik 2
Citation: Pniak, B.; Leszczak, J.;
Kurczab, J.; Krzemi ´nska, A.; Pi ˛eta, J.;
Plis, A.; Czenczek-Lewandowska, E.;
Guzik, A. The Efficiency of Spa
Rehabilitation in Chronic Ischemic
Stroke Patients—Preliminary Reports.
Brain Sci. 2021, 11, 501. https://
doi.org/10.3390/brainsci11040501
Received: 19 March 2021
Accepted: 13 April 2021
Published: 15 April 2021
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in
published maps and institutional affiliations.
Copyright: © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
1 Excelsior Health and Rehabilitation Hospital, Al. Torosiewicza 2, 38-440 Iwonicz-Zdrój, Poland;
gabipniak@vp.pl (B.P.); milak_123@wp.pl (J.K.); okrzemien159@gmail.com (A.K.);
joannapieta1@gmail.com (J.P.); a.plis8833@gmail.com (A.P.)
2
Institute of Health Sciences, Medical College, University of Rzeszów, ul. Kopisto 2a, 35-959 Rzeszów, Poland;
e.czenczek@univ.rzeszow.pl (E.C.-L.); agnieszkadepa2@wp.pl (A.G.)
* Correspondence: leszczakjustyna.ur@gmail.com; Tel.: +48-17-872-11-53
, Justyna Leszczak 2,* , Jadwiga Kurczab 1
, Aleksandra Krzemi ´nska 1
, Joanna Pi ˛eta 1
,
Agnieszka Plis 1
, Ewelina Czenczek-Lewandowska 2 and Agnieszka Guzik 2
Citation: Pniak, B.; Leszczak, J.;
Kurczab, J.; Krzemi ´nska, A.; Pi ˛eta, J.;
Plis, A.; Czenczek-Lewandowska, E.;
Guzik, A. The Efficiency of Spa
Rehabilitation in Chronic Ischemic
Stroke Patients—Preliminary Reports.
Brain Sci. 2021, 11, 501. https://
doi.org/10.3390/brainsci11040501
Received: 19 March 2021
Accepted: 13 April 2021
Published: 15 April 2021
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in
published maps and institutional affiliations.
Copyright: © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
1 Excelsior Health and Rehabilitation Hospital, Al. Torosiewicza 2, 38-440 Iwonicz-Zdrój, Poland;
gabipniak@vp.pl (B.P.); milak_123@wp.pl (J.K.); okrzemien159@gmail.com (A.K.);
joannapieta1@gmail.com (J.P.); a.plis8833@gmail.com (A.P.)
2
Institute of Health Sciences, Medical College, University of Rzeszów, ul. Kopisto 2a, 35-959 Rzeszów, Poland;
e.czenczek@univ.rzeszow.pl (E.C.-L.); agnieszkadepa2@wp.pl (A.G.)
* Correspondence: leszczakjustyna.ur@gmail.com; Tel.: +48-17-872-11-53
Abstract:
Background:
Rehabilitation-oriented therapy after a stroke must continue in various forms
as a life-long effort.
as a life-long effort.
Aim:
The study investigated the impact of spa rehabilitation on the quality of life
and functional efficiency in patients after an ischemic stroke at a chronic stage of recovery. Methods:
The assessment was carried out in a spa resort in southeastern Poland. It involved 32 patients
with strokes who participated in a three-week rehabilitation program. Three examinations were
performed: upon admission, on the day of discharge and at a two-month follow-up. The quality of
life and functional efficiency were assessed with the WHOQOL-BREF and Barthel Index.
and functional efficiency in patients after an ischemic stroke at a chronic stage of recovery. Methods:
The assessment was carried out in a spa resort in southeastern Poland. It involved 32 patients
with strokes who participated in a three-week rehabilitation program. Three examinations were
performed: upon admission, on the day of discharge and at a two-month follow-up. The quality of
life and functional efficiency were assessed with the WHOQOL-BREF and Barthel Index.
Results:
The quality of life was significantly higher in Exam II compared with Exam I (p < 0.001), and improvement was retained at the follow-up. The Barthel scores were higher in Exam II compared with Exam I(79.84 vs. 68.59), while the differences between the scores in Exams II and III were small (p = 0.039).
Conclusions:
Conclusions:
Three-week spa rehabilitation seems to favorably affect the functional efficiency and
quality of life after a stroke. The effects appear to be long-term. The gender, age and time from stroke onset do not seem to impact short-term effects. However, long-term effects are related to the time
from stroke onset.
Keywords: quality of life; stroke; spa rehabilitation; functional efficiency; spa hospital
1. Introduction
Rehabilitation-oriented therapy after a stroke should be initiated as soon as possible
and continue as a life-long effort, because in most individuals, a stroke leads to disability.
However, one should bear in mind that during the first few weeks following a stroke,
rehabilitation should not be too intensive [1]. The purpose of physiotherapy applied poststroke is to improve(WRONG,WRONG, WRONG! It's to get back to 100% recovery. This is the reason you, your mentors and senior researchers should not be in stroke.) the patient’s functional efficiency and restore their self-sufficiency and
psychophysical balance as much as possible [2,3].
Specialist rehabilitation centers, referred to as “spa facilities”, located in areas with
favorable environmental conditions and natural therapeutic resources, provide excellent
conditions for recovery. Such facilities may continue comprehensive treatments Please
carefully check the accuracy of names and affiliations. Changes will not be possible after
proofreading. specially designed for patients who have lost their functional capacities [4,5].
Furthermore, those participating in “retreat-based therapy” have an opportunity to relax,
experience a new environment and establish new social contacts, all of which may promote
their recovery in various domains [6]. Spa rehabilitation programs include a wide range of
balneotherapies, making use of natural mineral waters and administered at various temperatures. Other treatments apply peloids or gases with medicinal properties. Hydrogen
sulphides, carbonic acid, as well as iodine and bromine baths improve microcirculation,
Brain Sci. 2021, 11, 501. https://doi.org/10.3390/brainsci11040501 https://www.mdpi.com/journal/brainsciBrain Sci. 2021, 11, 501 2 of 13
stimulate the metabolism and alleviate many adverse symptoms, including spasticity. Treatments based on balneotherapy have been found to strengthen immunity and support faster
recovery [7] as well as normalize blood pressure. Carbonic acid and hydrogen sulphide
baths are helpful for reducing systolic blood pressure [8]. Physical exercise performed in a
rehabilitation pool has been found to decrease pain and reduce spasticity [9,10]. In addition
to balneotherapy, spa rehabilitation programs include a wide range of treatments based on
a variety of specialized physiotherapeutic methods and kinesitherapy (e.g., proprioceptive
neuromuscular facilitation, neurodevelopmental treatment [11] and constraint-induced
movement therapy), as well as tools applying biofeedback. Biofeedback-supported devices
have been shown to promote the recovery of lost functions in patients with neurological
problems (e.g., manifested by gait impairment) [12,13]. Beneficial effects have also been confirmed in the case of complementary physical treatments, such as tonolysis, low-frequency
variable magnetic fields, functional electrical stimulation (FES) and cryotherapy [14].
According to the definition from the World Health Organization (WHO), quality of
life is an “individual’s perception of their position in life in the context of the culture and
value systems in which they live and in relation to their goals, expectations, standards
and concerns”. The related indicators include one’s ability to play life roles, as well as
one’s adaptability, good mental condition and functioning in society [2,15]. Therapies
designed for people presenting post-stroke dysfunctions are primarily aimed at improving
the musculoskeletal system. However, efforts to improve the patient’s functioning in the
psychological and social domains are equally necessary to enable optimum recovery after
a stroke incident [16]. Quality of life after a stroke, as well as the effects of post-stroke
rehabilitation, have been extensively investigated. Indeed, the focus on neurosciences
and various types of post-stroke rehabilitation increased significantly during the so-called
Decade of the Brain. Advancements in neurobiology related to the complexity of effects
resulting from central nervous system damage, as well as brain plasticity, provided better
insight into the mechanisms of regeneration and functional recovery in patients after
strokes [17–19]. It has been established that the largest progress in the recovery of functional
capacities can be expected during the early period after a stroke, when patients frequently
present considerable improvements in neuromotor functions [20,21] due to the fact that
recovery-related changes within the ischemic penumbra adjacent to the focal lesion occur
relatively rapidly following onset, and later, the process slows down [22,23]. Given the
above, the present study was designed to focus on a population of patients at a chronic stage
of recovery (i.e., over six months from stroke onset). At this stage, patients tend to present
persistent patterns and are largely accustomed to functioning in their own environment.
Despite this, the authors hypothesized that significant improvement in quality of life and
functional efficiency may still be feasible at this stage of recovery and that changes in these
areas would be promoted by spa rehabilitation. The above hypothesis is encouraged by
research findings showing that interneuronal connections are constantly remodeled by
physical activity. If complex motor activities are performed systematically, the area of
cortical representation of such activity increases. This suggests that brain plasticity may
be enhanced as a result of various types of training [24,25]. This process has already been
investigated with regard to hospital and ambulatory post-stroke rehabilitation [26–30], but
not in relation to spa rehabilitation.
In summary, a review of the literature confirms that the entire post-stroke treatment
process, including rehabilitation, is primarily conducted in hospitals, clinics and outpatient
facilities. However, there are no studies assessing the effectiveness of treatments continued
in spa facilities, which can create favorable conditions for the recovery of full physical and
mental efficiency [2].
In view of the above, the aim of the current study was to assess the effects of a spa
rehabilitation program, reflected in the quality of life and functional efficiency in patients
after ischemic strokes at a chronic stage of recovery. The second aim of the study was to
assess the effect of spa rehabilitation relative to the age, gender and time from stroke onset.
quality of life after a stroke. The effects appear to be long-term. The gender, age and time from stroke onset do not seem to impact short-term effects. However, long-term effects are related to the time
from stroke onset.
Keywords: quality of life; stroke; spa rehabilitation; functional efficiency; spa hospital
1. Introduction
Rehabilitation-oriented therapy after a stroke should be initiated as soon as possible
and continue as a life-long effort, because in most individuals, a stroke leads to disability.
However, one should bear in mind that during the first few weeks following a stroke,
rehabilitation should not be too intensive [1]. The purpose of physiotherapy applied poststroke is to improve(WRONG,WRONG, WRONG! It's to get back to 100% recovery. This is the reason you, your mentors and senior researchers should not be in stroke.) the patient’s functional efficiency and restore their self-sufficiency and
psychophysical balance as much as possible [2,3].
Specialist rehabilitation centers, referred to as “spa facilities”, located in areas with
favorable environmental conditions and natural therapeutic resources, provide excellent
conditions for recovery. Such facilities may continue comprehensive treatments Please
carefully check the accuracy of names and affiliations. Changes will not be possible after
proofreading. specially designed for patients who have lost their functional capacities [4,5].
Furthermore, those participating in “retreat-based therapy” have an opportunity to relax,
experience a new environment and establish new social contacts, all of which may promote
their recovery in various domains [6]. Spa rehabilitation programs include a wide range of
balneotherapies, making use of natural mineral waters and administered at various temperatures. Other treatments apply peloids or gases with medicinal properties. Hydrogen
sulphides, carbonic acid, as well as iodine and bromine baths improve microcirculation,
Brain Sci. 2021, 11, 501. https://doi.org/10.3390/brainsci11040501 https://www.mdpi.com/journal/brainsciBrain Sci. 2021, 11, 501 2 of 13
stimulate the metabolism and alleviate many adverse symptoms, including spasticity. Treatments based on balneotherapy have been found to strengthen immunity and support faster
recovery [7] as well as normalize blood pressure. Carbonic acid and hydrogen sulphide
baths are helpful for reducing systolic blood pressure [8]. Physical exercise performed in a
rehabilitation pool has been found to decrease pain and reduce spasticity [9,10]. In addition
to balneotherapy, spa rehabilitation programs include a wide range of treatments based on
a variety of specialized physiotherapeutic methods and kinesitherapy (e.g., proprioceptive
neuromuscular facilitation, neurodevelopmental treatment [11] and constraint-induced
movement therapy), as well as tools applying biofeedback. Biofeedback-supported devices
have been shown to promote the recovery of lost functions in patients with neurological
problems (e.g., manifested by gait impairment) [12,13]. Beneficial effects have also been confirmed in the case of complementary physical treatments, such as tonolysis, low-frequency
variable magnetic fields, functional electrical stimulation (FES) and cryotherapy [14].
According to the definition from the World Health Organization (WHO), quality of
life is an “individual’s perception of their position in life in the context of the culture and
value systems in which they live and in relation to their goals, expectations, standards
and concerns”. The related indicators include one’s ability to play life roles, as well as
one’s adaptability, good mental condition and functioning in society [2,15]. Therapies
designed for people presenting post-stroke dysfunctions are primarily aimed at improving
the musculoskeletal system. However, efforts to improve the patient’s functioning in the
psychological and social domains are equally necessary to enable optimum recovery after
a stroke incident [16]. Quality of life after a stroke, as well as the effects of post-stroke
rehabilitation, have been extensively investigated. Indeed, the focus on neurosciences
and various types of post-stroke rehabilitation increased significantly during the so-called
Decade of the Brain. Advancements in neurobiology related to the complexity of effects
resulting from central nervous system damage, as well as brain plasticity, provided better
insight into the mechanisms of regeneration and functional recovery in patients after
strokes [17–19]. It has been established that the largest progress in the recovery of functional
capacities can be expected during the early period after a stroke, when patients frequently
present considerable improvements in neuromotor functions [20,21] due to the fact that
recovery-related changes within the ischemic penumbra adjacent to the focal lesion occur
relatively rapidly following onset, and later, the process slows down [22,23]. Given the
above, the present study was designed to focus on a population of patients at a chronic stage
of recovery (i.e., over six months from stroke onset). At this stage, patients tend to present
persistent patterns and are largely accustomed to functioning in their own environment.
Despite this, the authors hypothesized that significant improvement in quality of life and
functional efficiency may still be feasible at this stage of recovery and that changes in these
areas would be promoted by spa rehabilitation. The above hypothesis is encouraged by
research findings showing that interneuronal connections are constantly remodeled by
physical activity. If complex motor activities are performed systematically, the area of
cortical representation of such activity increases. This suggests that brain plasticity may
be enhanced as a result of various types of training [24,25]. This process has already been
investigated with regard to hospital and ambulatory post-stroke rehabilitation [26–30], but
not in relation to spa rehabilitation.
In summary, a review of the literature confirms that the entire post-stroke treatment
process, including rehabilitation, is primarily conducted in hospitals, clinics and outpatient
facilities. However, there are no studies assessing the effectiveness of treatments continued
in spa facilities, which can create favorable conditions for the recovery of full physical and
mental efficiency [2].
In view of the above, the aim of the current study was to assess the effects of a spa
rehabilitation program, reflected in the quality of life and functional efficiency in patients
after ischemic strokes at a chronic stage of recovery. The second aim of the study was to
assess the effect of spa rehabilitation relative to the age, gender and time from stroke onset.
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