ISSN 2069-0037 ISSNL 2069-0037

EDITURA BALNEARA

CONFERINA NAIONAL DE BALNEOLOGIE

SUBEGIDA

MinisteruluiSntiiAutoritiiNaionalepentruCercetaretiinific

ORGANIZATORI:InstitutulNaionaldeRecuperare,MedicinFiziciBalneoclimatologie

AsociaiaRomndeBalneologie

PresedinteleConferintei:HoriaLazarescuPresedintedeonoare:Prof.ZekiKaragulle

COMITETSTIINTIFICDeliaCinteza

MagdaElenaDragosloveanuMihaiHoteteuIonIonescuIaroslavKissOvidiuMera

LucianMirescuGildaMologhianu

ConstantinMunteanuAdrianaSarahNicaDanielaPoenaruIuriSimionca

SuzanaPretorian

RodicaGabrielaScarletCOMITETDEORGANIZAREConf.Dr.DeliaCintezaConstantinMunteanuSebastianDiaconescu

AugustinDimaVictoritaMarcuDanDumitrascuAlexandruCristeaIrinaPetruscaLilianaCiocAlinaSandu

ReneePopoviciAdrianaLoghin

SECRETARIATMioaraBanica

GeorgianaGalca

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A X-A CONFERINTA NATIONALA DE BALNEOLOGIE (cu participare internationala)

SOVATA, 10-12.05.2012 - AGENDA 10.05.2012 08.30 10.30 SEDINTA / SESSION I 08.30 09.00 Deschidere oficial a lucrarilor celei de a X-a Conferinte Nationala de Balneologie Opening Ceremony of the 10th National Conference of Balneology 09.00 10.30 Balneologia: prezent si viitor RAPOARTE / Balneology: now and then -LECTURES 10.30 11.00 Pauza/Pause 11.00 12.00 Simpozion AstraZeneca /AstraZeneca Symposum: Vimovo - Eficienta in ameliorarea durerii cu protectie gastrica inclusa / Vimovo- Effeciency in pain relief with gastric protection included12.00 14.00 SEDINTA AII-A/SESSION II Activitatea medical i de cercetare balnear n Staiunea Sovata COMUNICARI Medical activity and scientific research in Sovata resort ORAL PAPERS 14.00 15.30 Pauza de pranz/Lunch 15.30 16.00 Simpozion Astellas /Astellas Sympozium: Noi orizonturi in managementul durerii neuropate/Neuropatic pain - new perspectives of treatement 16.30 18.30 SEDINTA A III-A/SESSION III Cercetarea fundamentala in domeniul factorilor naturali terapeutici COMUNICARI The scientific research of the natural therapeutic factors ORAL PAPERS 19.30. Cina/Dinner (Danubius Hotel) 11.05.2012 9.00 11.00 SEDINTA A IV-A/SESSION IV Factorii naturali terapeutici in managementul diverselor boli (I) - RAPOARTE Natural therapeutic factors and different diseases management (I) - LECTURES 10.30 11.00 Simpozion MEDA / MEDA Sympozium Tratamentul durerii articulare - locul Keithon si avantajele sale / Treatment of joint pain - Keithon place and its advantages11,00 11.30 Simpozion EVER / EVER Sympozium Eficiena medicaiei multimodale (Factorii neurotrofici) n tratamentul AVCI i TCC / Multimodal therapy for ischemic stroke and traumatic brain injury 12.00 14.00 SEDINTA A V-A / SESSION V Factorii naturali terapeutici in managementul diverselor boli (I) - RAPOARTE Natural therapeutic factors and different diseases management (I) / - LECTURES 13.00 13.30 Simpozion Servier /Servier Sympozium: Protectia superioara impotriva fracturilor osteoporotice/A higher protection against the osteoporosis fractures 13.30 14.00 - Simpozion de electroterapie / Electrotherapy sympozium Actualitati de electroterapie n medicina fizica si recuperare / Up-to-date in electrotherapy 14.00 15.00 Pauza de pranz/ Lunch 15.00 16.30 SEDINTA A VI-A/SESSION VI Speleoterapia in Romania - RAPOARTE SI COMUNICARI /Speleotherapy in Romania - LECTURES AND ORAL PAPERS 16.30 19.00 Vizita n Salina Praid/Praid Salt Mine visit 19.30 Cina/Dinner (Praid Salt Mine) 12.05.2012 9.00 11.00 SEDINTA A VII-A / SESSION VII Medicina fizica si recuperare medicala - RAPOARTE SI COMUNICARI Physical Medicine and Rehabilitation Oral papers 11.00 11.30 Pauza / Pause 11.30 Vizita la Salina Turda/Turda Salt Mine visit 14.00 Pauza de pranz/Lunch 15.30 18.00 Vizita la Salina Turda/Turda Salt Mine visit 18.00 Inchiderea lucrarilor conferintei/ Closing Ceremony (Aamfiteatrul din MinaRudolf) 19.00 Cina/Dinner (Hotel Centrum, Turda)

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CUPRINS / CONTENTS

ROLUL VITAMINEI K IN PROFILAXIA SI TRATAMENTUL OSTEOPOROZEI Laurentia Andronache .................................................................................................................................. 10 TOXINA BOTULINICA IN TRATAMENTUL SPASTICITATII LA COPILUL CU PARALIZIE CEREBRALA - Avram Carmen, Cioara Felicia , Ramona Suciu, Liviu Lazr............................. 11 THE USE OF BOTULINUM TOXIN A IN CHILDREN WITH CEREBRAL PLASY - Avram Carmen, Cioara Felicia, Ramona Suciu, Liviu Lazr................................................................................ 12 INDICATII ALE TRATAMENTULUI BALNEAR IN HEMOFILII - Daniela Avramescu, Valentina Oprea, Elena Mihaela Dicu, Gabriela State, Adriana Loghin ..................................... 13 ISTORICUL STATIUNII SOVATA - FACTORI NATURALI DE CURA - ACTIVITATEA MEDICALA (GENERIC) - Andras Bartha, Janos Fulop-Nagy ....................................... 13 SOVATA RESORT: HYSTORY, NATURAL THERAPEUTIC FACTORS AND MEDICAL ACTIVITY - Andras Bartha, Janos Fulop-Nagy........................................................................ 14 PARTICULARITATI ALE HIDROKINETOTERAPIEI PE CATEGORII POPULATIONALE SI DE PATOLOGIE - Consuela Brailescu, Rodica Scarlet, Horia Lazarescu................ 15 ASPECTE BIOCLIMATICE I DE GEOGRAFIE MEDICAL N JUDEUL MURE - Bunescu Iulia, Enache Liviu .......................................................................................................................... 16 BIOCLIMATE AND MEDICAL GEOGRAPHY ASPECTS IN MURE COUNTY - . Bunescu Iulia, Enache Liviu .......................................................................................................................... 16 RECUPERAREA TULBURARILOR DE MERS LA VARSTNICII CU AFECTIUNI POSTTRAUMATICE ALE MEMBRULUI PELVIN - Gheorghe Chiriti, Dana-Maria Dimulescu ............ 17 REHABILITATION OF THE GAIT DISTURBANCES IN OLD PATIENTS WITH POST-TRAUMA INJURIES ON SUPPORTING JOINTS - Gheorghe Chirii Dana-Maria Dimulescu .............. 18 TRATAMENTUL BALNEAR AL BONAVULUI CARDIAC IN ROMANIA Delia Cinteza, Daniela Poenaru, Sebastian Diaconescu, Horia Lazarescu............................................................... 18 BALNEARY TREATMENT FOR CARDIAC DISEASES IN ROMANIA Delia Cinteza, Daniela Poenaru, Sebastian Diaconescu....................................................................................... 19 POSTERIOR TIBIAL NERVE STIMULATION FOR PATIENTS WITH VOIDING DYSFUNCTION AFTER SPINAL CORD INJURY - Delia Cinteza, Daniela Poenaru, Sebastian Diaconescu, Victorita Marcu, Dan Dumitrascu ....................................... 19 AEROBIC TRAINING IN MULTIPLE SCLEROSIS REMISSIVE FORM REHABILITATION - Delia Cinteza, Daniela Poenaru, Sebastian Diaconescu, Victorita Marcu, Liliana Cioc, Irina Petrusca......................... 20 SULPHUROUS MINERAL WATER FOR LOWER LIMB OSTHEOARTHRITIES THERAPY IN ELDERLY SHORT AND LONG TERM OUTCOME - Delia Cinteza, Augustin Dima, Alexandru Cristea, Daniela Poenaru, Irina Petrusca................................................. 20 MANAGEMENTUL RECUPERARII IN ARTROPLASTIILE COXOFEMURALE - Felicia Cioara, Lucia Vicas, Carmen Avram, Ramona Suciu, Marius Rus .............................................................. 21

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RECOVERY MANAGEMENT IN TOTAL HIP ARTHROPLASTY - Felicia Cioara, Vicas Lucia, Carmen Avram, Ramona Suciu, Marius Rus .............................................................. 22 BENEFICIILE BALNEOTERAPIEI IN DUREREA LOMBARA JOASA DE CAUZA DEGENERATIVA - Felicia Cioara, Ramona Suciu, Marius Rus, Liviu Lazar.................................................. 22 BALNEOTHERAPY BENEFITS IN THE CASE DEGENERATIVE LOW BACK PAIN - Felicia Cioara, Ramona Suciu, Marius Rus, Liviu Lazar ..................................................................................... 23 METODOLOGII DE TRATAMENT BALNEAR IN BOLILE CEREBROVASCULARE - Liliana Cioc................................................................................................................................................ 23 BALNEARY TREATMENT METHODOLOGIES IN CEREBROVASCULAR DISEASES - Liliana Cioc ......................................................................................................................... 24 REHABILITATION INTERVENTIONS FOR A COMPLEX REGIONAL PAIN SYNDROME AFTER TIBIAL FRACTURE IN A HEMOPHILIC PATIENT CASE REPORT - Liliana Cioc, Alina Sandu, Irina Petrusca, Renee Popovici, Alexandru Cristea, Adriana Loghin, Delia Cinteza ............ 25 THE IMPORTANCE OF ELECTRONEUROGRAFIC EXAM FOR RECOVERY ASSESSMENT OF PATIENTS WITH CARPAL TUNNEL SYNDROME - Clin Corciov, Dan Zaharia, Daniela Matei..................................................................................................... 26 METODOLOGIA TRATAMENTULUI BALNEAR IN AFECTIUNILE REUMATISMALE ARTICULARE DEGENERATIVE - Alexandru Cristea ....................................... 27 METODOLOGY OF BALNEARY TREATMENT IN DEGENERATIVE RHEUMATIC DISEASE - Alexandu Cristea..................................................................................................................... 28 EFFICIENCY OF THE PHYSICAL-KINETIC AND BALNEAR TREATMENT FOR KNEE OSTEOARTHRITIS A REVIEW OF THE RECENT LITERATURE Dana-Maria Dimulescu, Gheorghe Chirii, Ion Ionescu....................................................................................... 29 EFICIENTA TRATAMENTULUI FIZICAL-KINETIC SI BALNEAR IN GONARTROZA ANALIZA DATELOR DIN LITERATURA RECENTA - Dana-Maria Dimulescu, G. Chiriti, Ion Ionescu................................................................................................. 29 CURA BALNEARA LA VARSTNICI - Roxana Dragomir, Larisa Incrosnatu, Andreia Murgu .................... 30 SPA TREATMENT IN ELDERLY - Roxana Dragomir, Larisa Incrosnatu, Andreia Murgu .......................... 31 APE TERMALE N RECUPERAREA DE FAZ III PENTRU AFECIUNILE POST-TRAUMATICE, N STAIUNILE BALNEARE DIN ROMNIA - Dan Dumitracu ........................ 31 THERMAL WATERS IN PHASE III REHABILITATION FOR POST-TRAUMATIC CONDITIONS, IN ROMANIAN BALNEARY RESORTS - Dan Dumitracu .................................... 32 TRATAMENTUL AFECTIUNILOR RESPIRATORII (STATIUNEA SOVATA) Emese Fazakas, Janos Fulop-Nagy ................................................................................................................. 32 TREATMENT OF RHEUMATHOLOGICAL DISEASES (SOVATA RESORT) Emese Fazakas, Janos Fulop-Nagy ................................................................................................................. 33

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CHALLENGES OF ETHICAL PROBLEMS IN REHABILITATION MEDICINE Dorina Maria Frca, Delia Cintez,................................................................................................................ 34 PROVOCRI ALE ASPECTELOR ETICE N RECUPERAREA MEDICAL Dorina Maria Frca, Delia Cintez ................................................................................................................ 34 CONTRIBUTIA MICROALGELOR SI A SPECIILOR DE CLADOPHORA IN ECONOMIA PROCESULUI DE PELOIDOGENEZA DIN LACUL TECHIRGHIOL Liana Gheorghievici, Madalina Cosmoiu, Iulia Pompei, G.Gheorghievici, I.Tanase, Margareta Mustata ..................... 35 THE CONTRIBUTION OF MICROALGAE AND CLADOPHORA SPECIES TO THE ECONOMY OF PELOIDOGENESIS PROCESS FROM TECHIRGHIOL LAKE, Liana Gheorghievici, Madalina Cosmoiu, Iulia Pompei, G.Gheorghievici, I.Tanase, Margareta Mustata ..................... 36 OCNA SIBIULUI, FACTORI NATURALI DE CURA - Dan Giurca .................................................. 37 THE NATURAL HEALING' S FACTORS FROM OCNA SIBIULUI - Dan Giurca ......................... 37 TRATAMENTUL AFECTIUNILOR REUMATOLOGICE (STATIUNEA SOVATA) Cornel Harsan, Janos Fulop-Nagy................................................................................................................... 38 TREATMENT OF RHEUMATHOLOGICAL DISEASES (SOVATA RESORT) Cornel Harsan, Janos Fulop-Nagy .................................................................................................................. 39 POSSIBILITIES FOR INTERNAL USE OF BICARBONATE-RICH MINERAL WATERS IN PREVENTIVE ALKALIZING THERAPY - M.Haysak, O.Holubka, V.Kudyk................. 40 INFLUENTA MICROCLIMATULUI DIN SALINELE OCNA DEJ SI CACICA ASUPRA SOBOLANILOR ALBI LINIA WISTAR - M. Hoteteu, Iuri Simionca, C. Munteanu, L. Enache.................. 41 DEJ AND CACICA SALT MINES MICROCLIMATE INFLUENCE ON WISTAR WHITE RATS - M. Hoteteu, Iuri Simionca, C. Munteanu, L. Enache .............................................................. 41 ROLUL FACTORILOR BALNEARI IN PROFILAXIA BOLILOR CARDIO-VASCULARE - Ana-Maria Ifrim, Delia Cinteza, Irina Tacu, Alina Sandu, Liliana Cioc, Simona Neagoe, Gabriela Nagy, Dan Dumitrascu..................................................................................................................... 42 The role of balneary factors in the cardiovascular diseases prevention - Ana-Maria Ifrim, Delia Cinteza, Irina Tacu, Alina Sandu, Liliana Cioc, Simona Neagoe, Gabriela Nagy, Dan Dumitrascu ............................. 43 CURA BALNEARA IN AFECTIUNILE NEUROLOGICE - Larisa Incrosnatu, Roxana Dragomir, Andreia Murgu ........................................................................................ 43 BALNEARY TREATMENT IN NEUROLOGICAL DISEASES - Larisa Incrosnatu, Roxana Dragomir, Andreia Murgu ........................................................................................ 44 CURELE PROFILACTICE DIN STAIUNILE BALNEO-CLIMATICE N CONCEPTUL MODERN AL REFORMEI SISTEMULUI SANITAR DIN ROMNIA - Ion Ionescu. .................... 44 TERAPIA PRIN CONTRAST TERMIC; MODALITATE DE DIVERSIFICARE A PROGRAMELOR PROFILACTICE IN STATIUNILE BALNEARE - Iaroslav KISS ....................... 46 Alkalizing and buffering influence of natural mineral waters - I.Lemko, M.Haysak ............................... 48 Calcium and bicarbonate-rich mineral waters in the prevention of calcium-deficit conditions - I.Lemko, S.Shubert, L.Dychka, V.Malynovska ................................................................................................. 49

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IMPACTUL STRESULUI ASUPRA SANATATII (PROGRAMUL ANTISTRES SOVATA) - Csaba Lukacs, Janos Fulop-Nagy............................................................................................. 49 STRESS AND HEALTH (SOVATA) Csaba Lukacs, Janos Fulop-Nagy ................................................... 50 PELOIDOTHERAPY IN OSTEOARTHRITIS-MODULATION OF OXIDATIVE STRESS - Viorica Marin, Olga Surdu, Daniela Profir, Sibel Demirgian ............................................................. 51 TURDA POTENTIAL BALNEAR SI PERSPECTIVE PENTRU SPELEOTERAPIA EUROPEANA - Dan Tiberiu Mera, Ovidiu Mera, Iuri Simionca, Constantin Muntaeanu, Oana Cristina Mera, Liana Gheorghievici, Gh. Gheorghievici ................................................................................................. 52 TURDA BALNEAL POTENTIAL AND PERSPECTIVES FOR EUROPEAN SPELEOTHERAPY - Dan Tiberiu Mera, Mera Ovidiu, Iuri Simionca, Constantin Munteanu, Oana Cristina Mera, Liana Gheorghievici, Gh. Gheorghievici ................................................................................................. 53 STUDIU PRIVIND EFICIENTA UNUI PROGRAM DE KINETOTERAPIE IN AMELIORAREA CALITATII VIETII PACIENTELOR CU OSTEOPOROZA POSTMENOPAUZA SI CU DEPRESIE REACTIVA - Gilda Mologhianu, Adriana Sarah Nica, Andreia Murgu, Consuela Brailescu, Dana Dimulescu, Alina Frunza, Sebastian Schwarcz ....................................... 54 CERCETAREA TIINIFICA A APELOR MINERALE I NMOLURILOR TERAPEUTICE - Constantin Munteanu, Delia Cintez, Mihai Hoteteu, Diana Munteanu, Horia Lzrescu, Iuri Simionca...................... 55 SCIENTIFIC RESEARCH OF THERAPEUTIC MINERAL WATER AND MUD Constantin Munteanu, Delia Cintez, Mihai Hoteteu, Diana Munteanu, Lazarescu Horia, Iuri Simionca..................................... 56 ARGUMENTE TIINIFICE PENTRU SPELEOTERAPIE - Constantin Munteanu, Delia Cintez, Mihai Hoteteu, Diana Munteanu, Lazarescu Horia, Iuri Simionca...................... 57 SCIENTIFIC ARGUMENTS FOR SPELEOTHERAPY - Constantin Munteanu, Delia Cintez, Mihai Hoteteu, Diana Munteanu, Lazarescu Horia, Iuri Simionca...................... 58 ACTUALITATI IN TRAUMATISMELE VERTEBRO-MEDULARE - Andreia Murgu, Roxana Dragomir, Larisa Incrosnatu ........................................................................................ 59 Sovata - istorie si practica balneara - Roxana Miclaus, Adriana Nica .......................................................... 60 Studiu epidemiologic privind adresabilitatea si complexitatea cazurilor dirijate pentru nisa balneara Pucioasa - Lili Miron, Adriana Nica.............................................................................................. 60 SPINAL CORD INJURY STATE OF THE ART - Andreia Murgu, Roxana Dragomir, Larisa Incrosnatu ........................................................................................ 61 Dinamica sindromului dureros reno-urinar la pacientii cu litiaza si infectie urinara sub actiunea crenoterapiei de diureza cu ape minerale Calimanesti-Caciulata" - Adriana Nica ................... 62 Actualitati de terapie in durerea cronica somatica Adriana Sarah Nica ................................................. 62 METODOLOGIA APLICARII TRATAMENTULUI BALNEAR IN BOLILE DE TESUTURI MOI - Gabriela Nagy, ............................................................................................................ 63 CONCEPTUL MEDICALL WELLNESS. CONCLUZII SI PERSPECTIVE DE VIITOR (STATIUNEA SOVATA) - Robert Fulop-Nagy, Suzana Pretorian .............................................................. 63

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CONCEPTUL MEDICALL WELLNESS. CONCLUZII SI PERSPECTIVE DE VIITOR (STATIUNEA SOVATA) - Robert Fulop-Nagy, Suzana Pretorian .............................................................. 64 TRATAMENTUL COMPLEX BALNEAR AL GONARTROZEI - Valentina Oprea, Daniela Avramescu, Elena Mihaela Dicu, Adriana Loghin, Gabriela State, Daniela Poenaru ................................................ 65 BALNEAR MANAGEMENT OF KNEE OSTEOARTHRITIS - Valentina Oprea, Daniela Avramescu, Elena Mihaela Dicu, Adriana Loghin, Gabriela State, Daniela Poenaru ................................................ 66 METODOLOGIA TRATAMENTULUI BALNEAR IN AFECTIUNILE RENALE - Irina Petrusca .............................................................................................................................................. 66 BALNEOTHERAPY METHODOLOGY IN KIDNEY DISEASES - Irina Petrusca........................... 67 APELE MINERALE IN U.E. SI ROMANIA. STUDIU COMPARATIV SI POZITIONAREA ROMANIEI IN IERARHIA TERMALISMULUI EUROPEAN - Adrian Popa.......................................................................................................................................................... 67 MINERAL WATERS IN E.U. AND ROMANIA. A COMPARATIVE STUDY AND POSITIONING ROMANIA IN THE EUROPEAN THERMALISM HIERARCHY Adrian Popa................................................................................................................................................ 68 CRENOTERAPIA CU APE MINERALE SULFUROASE LA OLANESTI, IN GASTRITELE CRONICE. STUDIU COMPARATIV CU STATIUNILE DE PROFIL DIN FRANTA SI ITALIA - Adrian Popa ........................................................................................................ 69 CRENOTHERAPY WITH SULPHUROUS MINERAL WATERS FROM OLANESTI IN CHRONIC GASTRITIS. A COMPARATIVE STUDY WITH THE CORRESPONDING RESORTS FROM FRANCE AND ITALY - Adrian Popa..................................................................... 69 METODOLOGIA TRATAMENTULUI BALNEAR IN AFECTIUNILE DIGESTIVE Renee Aurora Ioana Popovici ........................................................................................................................ 70 THE METHODOLOGY OF THE BALNEARY TREATMENT IN DIGESTIVE DISEASES - Rene Aurora Ioana Popovici.................................................................................................. 71 TRATAMENTUL AFECTIUNILOR GINECOLOGICE (STATIUNEA SOVATA) - Suzana Pretorian, Janos Fulop-Nagy ............................................................................................................... 73 TREATMENT OF GYNAECHOLOGICAL DISEASES (SOVATA RESORT) - Suzana Pretorian, Janos Fulop-Nagy ............................................................................................................... 73 COMBINED HALOAEROZOLTERAPY AS A METHOD OF REHABILITATION OXIDATIVE HOMEOSTASIS PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE - D.Reshetar, O.Lemko, M.Gabor ..................................................................... 74 RECUPERAREA RESTANTULUI FUNCTIONAL FOLOSIND TEHNICI KINETOTERAPEUTICE SI COMPUTATIONALE Mariana Rotariu, Ilea Mihai, Marius Turnea............. 75 TERAPIA BALNEARA IN STATIUNI CU PROFIL CARDIO-VASCULAR. CURA BALNEARA DE RECUPERARE - Elena-Alina Sandu, Irina Tacu, Dan Dumitrascu, Ioana-Simona Neagoie, Liliana Cioc, Gabriela Naghy ........................................................................................................... 76

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BALNEOTHERAPY IN CARDIOVASCULAR PROFILE RESORTS - REHABILITATION BALNEARY COURSE - Elena-Alina Sandu, Irina Tacu, Dan Dumitrascu, Ioana-Simona Neagoie,Liliana Cioc, Gabriela Naghy......................................................................................... 77 EFECTELE APELOR BAILOR TERMOMINERALE SULFUROASE DIN SONDA 2641 BANEASA STUDIU CLINICO-TERAPEUTIC - Rodica Gabriela Scarlet, Nicolae Teleki, Consuela Brailescu ...................................................................................................................................... 77 ACTUALITIES OF SCIENTIFIC RESEARCH ON THE SPELEOTHERPY FIELD IN ROMANIA (REPORT) - Iuri Simionca .................................................................................................. 78 ACTUALITATI IN CERCETAREA STIINTIFICA DIN DOMENIUL SPELEOTERAPIEI IN ROMANIA (REFERAT) - Iuri. Simionca. .......................................................................................... 78 Possibilities for the complex use of sulfide-containing mineral water in the rehabilitation treatment of patients with rheumatoid arthritis - M.V.Shvardak, T.V.Chajkovska, S.I.Horitska, L.O.Hajnas.................................................................................. 80 TECHIRGHIOL MUD - PRESENT AND FUTURE - Demirgian Sibel, Marin Viorica , Profir Daniela, Surdu Olga, Stanciu Liliana......................................................... 81 PHYSIOLOGICAL FEATURES OF AGING PROCESS AND MODULATION OF THERMAL PARAMETERS REQUIRED BY APPLICATION OF BALNEAL FACTORS IN ELDERLY - O. Surdu, V. Marin, T. V. Surdu, S. Demirgian, D. Profir........................................................ 82 SINDROMUL DE ENTRAPMENT SI TRATAMENTUL BALNEAR - Gabriela State, Elena Mihaela Dicu, Valentina Oprea, Daniela Avramescu, Adriana Loghin, Andreea Mirita, Daniela Poenaru .................... 83 ENTRAPMENT SYNDROME AND BALNEARY TREATMENT - State Gabriela Elena Mihaela Dicu, Valentina Oprea, Daniela Avramescu, Adriana Loghin, Andreea Mirita.......................................... 83 TRATAMENTUL BALNEAR IN AFECTIUNILE REUMATISMALE INFLAMATORII - Irina Tacu, Alina Sandu, Simona Neagoie ........................................................................................................ 84 BALNEO-THERAPY IN INFLAMMATORY RHEUMATIC DISEASE - Irina Tacu, Alina Sandu, Simona Neagoie................................................................................................................................ 84 MODELAREA MATEMATICA A EXCITATIEI TERMICE IN HIDROKINETOTERAPIE - Mihaela Turnea, Mariana Rotariu, Marius Turnea............................................. 85 Bicarbonate-rich and Siliceous mineral water in the complex detoxification therapy K.Vagerich, N.Yakovenko, O.Holubka, O.Lyahova, N.Popadinets ....................................................................... 86 ASPECTE ALE RECUPERRII OBEZITII - Lucia Vica, Felicia Cioar ......................................... 87 ASPECTS OF OBESITY REHABILITATION - Lucia Vicas, Felicia CIOARA ...................................... 88 IMPLANTURI CERAMICE NANOCOMPOZITE PENTRU PROTEZE DE SOLD Rogojan Rodica, Iliescu Irina, Hoteteu Mihai, Simionca Iuri .......................................................88

EFECTUL TERAPEUTIC AL AEROIONIZARII NEGATIVE Ioana- Simona Neagoie, Irina Tacu, Alina Sandu...89

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ROLUL VITAMINEI K IN PROFILAXIA SI TRATAMENTUL OSTEOPOROZEI Dr Laurentia Andronache, INRMFB

Vitamina K este un termen generic care desemneaza un grup de substante care contin un nucleu 2 metil-1-4 naftochinona, care poseda o capacitate hemostatica. A fost descoperita in 1920, ca factor important in procesul de coagulare.Se gaseste in plante , sub forma " filochinonei "(vitamina K1) si , la animale, sub forma vitaminei K2; acest din urma termen este destinat unui grup de compusi, numiti "menachinone". Vitamina K 2 este un compus produs la om in tractul gastrointestinal, de anumite bacterii probiotice.Ea se gaseste si in produse animale, ca :galbenusul de ou,ficatul de vita,unt , anumite branzeturi,precum si in produsul fermentat de soia , numit "natto". Vitamina K este cofactor la carboxilarea posttranslationala a reziduurilor de acid glutamic,pe care le transforma in carboxiglutamat, fapt care permite legarea calciului de hidroxiapatita,eveniment crucial in procesele de osteosinteza. OBIECTIVELE STUDIULUI:stabilirea unor corelatii intre nivelul lipidelor sanguine, care exprima direct nivelul vitaminei K, si valorile osteodensitometriei, la pacientele cu osteoporoza MATERIAL SI METODA Au fost selectionati ca material biologic 30 sobolani albi, linia Wistar ,repartizati in 3 loturi omogene: -lotul 1: a primit hrana normala, dar fara lapte , cu vitamina K -lotul 2:a primit hrana normala si lapte -lotul 3: a primit hrana normala, far lapte STUDIUL CLINIC A fost efectuat pe 21 paciente, selectionate dupa instalerea menopauzei, care au fost investigate clinic si paraclinic in vederea stabilirii diagnosticului de osteoporoza. A fost efectuat pentru evidentiarea unor corelatii intre valorile DXA si valorile fosfatazei alcaline, ale trigliceridelor, HDL si LDL sanguine. CONCLUZII -exista o corelatie semnificativa intre osteoporoza si valorile LDL -nu exista o metoda curenta de determinare a nivelului plasmatic al vitaminei K -conceptuil "alimente functionale " este important in profilaxia osteoporozei - se remarca necesitatea unor studii viitoare pe aceasta tema" TOXINA BOTULINIC IN TRATAMENTUL SPASTICITATII LA COPILUL CU PARALIZIE CEREBRALA - Avram Carmen1, Cioara Felicia2 , Ramona Suciu2, Liviu Lazr2 1Spital Clinic de Recuperare Bile Felix, Secia Recuperare, Medicin Fizic i Balneologie Copii 1Mai 2Universitatea din Oradea, Facultatea de Medicina si Farmacie Paraliziile cerebrale (PC) reprezint un grup de tulburri neurologice neprogresive, caracterizate printr-un control neadecvat al motilitii i posturii, datorate unor leziuni ale sistemului nervos central produse n perioada pre-, intra- sau postnatal (pn la vrsta de 3 ani). PC sunt considerate afeciuni neprogresive, dar n continu dinamic, fiind influenate de procesul de cretere i dezvoltare, astfel c manifestrile clinice se pot modifica n timp. Afectarea motorie este un criteriu obligatoriu i definitoriu al PC, aceasta fiind aproape ntotdeauna nsoit de alte manifestri secundare afectrii SNC. Spasticitatea este o tulburare a sistemului senzitivo-motor, caracterizata de o crestere a

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tonusului muscular cu reflexe tendinoase exagerate, rezultate din hiperexcitabilitatea reflexului de intindere, reduce motilitatea poate duce la disabilitate. Toate formele de tratament ale hiperactivitatii musculare au dou obiective principale diferite de atins: imbunatatirea functiei active si reeducarea mersului, autoservirii, autonomiei pacientului spastic. Terapia farmacologica sistemica poate fi indicata, cnd hiperactivitatea musculara este difuza. Medicamentele antispastice actioneaza n SNC, fie prin supresia excitatiei (glutamat), cresterea inhibitiei (GABA, glicina) sau prin combinatia celor doua. Terapia intratecala este o metoda invaziva care presupune implantarea unui dispozitiv. Chemodenervarea locala cu toxina botulinica este o metoda eficienta, pentru reducerea spasticitatii focale, fara efecte adverse semnificative. Toxina botulinica (TB) este utilizata din 1989 in terapia spasticitatii membrului superior si inferior, prezent n terapie ca alternativ n tratamentul de recuperare la copilul cu PC. Toxina botulinic este o neurotoxin care, administrat parenteral, nu depete bariera hematoencefalic, dar se fixeaz pe receptorii sinaptici ai plcii neuromotorii din musculatura scheletic. Paralizia tranzitorie creat de toxina botulinic, permite aplicarea recuperrii la nivelul segmentului afectat, prelungind momentul interveniei chirurgicale. THE USE OF BOTULINUM TOXIN A IN CHILDREN WITH CEREBRAL PLASY - Avram Carmen1, Cioara Felicia2 , Ramona Suciu2, Liviu Lazr2 1Spital Clinic de Recuperare Bile Felix, Secia Recuperare, Medicin Fizic i Balneologie Copii 1Mai 2Universitatea din Oradea, Facultatea de Medicina si Farmacie Cerebral palsy (CP) has been described as an insult of the developing brain that produces a disorder of movement and posture that is permanent but not unchanging. It is the most frequent cause of motor disability amongst children in Children with CP may present with a variety of motor problems, changing with growth and development. Primary problems are directly related to the lesion in the central nervous system, influencing muscle tone, balance, strength and selectivity, whereas static muscle contractures and bone deformities (secondary problems) develop slowly over time in response to the primary problems. The treatment of spasticity is central in the clinical management of children with CP. Spasticity can be reduced with oral medication, phenol, selective dorsal rhizotomy and intrathecal baclofen. In the past two decades, botulinum toxin serotype A (BTX-A) has been introduced as a selective treatment option for spasticity in children with CP. BTX-A, when injected into the muscles, will reduce muscle tone. BTX-A blocks the release of acetylcholine at the motor end plate, causing a temporary muscular denervation and, in an indirect way, a reduced spasticity. However in these younger children, delaying surgery is crucial because the results of early surgical interventions are less predictable and have a higher risk of failure and relapse. It became clear that the use of BTX-A was a major advance in the treatment of CP and it is now widely accepted in the management of paediatric posture and movement disorders.

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INDICATII ALE TRATAMENTULUI BALNEAR IN HEMOFILII - Daniela Avramescu, Valentina Oprea, Elena Mihaela Dicu, Gabriela State, Adriana Loghin, INRMFB Hemofilia este o diatez hemoragic congenital insotita de artropatii, ca urmare a sngerrilor intraarticulare recurente. Manifestarea articulara acuta a hemofiliei este hemoragia intraarticulara (hemartroza). In formele severe de boala ea apare la varsta la care copilul incepe sa mearga, fiind frecventa la genunchi, coate si glezne. Suferinta articulara se agraveaza cu varsta si se extinde la mai multe articulatii. O sangerare intraarticulara izolata este lipsita de semnificatie patologica majora, dar prin caracterul repetitiv antreneaza leziuni ireversibile ale structurilor articulare. Astfel, sangerarile articulare repetate antreneaza leziuni ale sinovialei, intial acute, apoi cronice cu efecte degenerative asupra cartilajului articular si distructive asupra tesutului osos subcondral. Exista o forma activa in care predomina leziunile inflamatorii si hemoragice si o forma inactiva in care predomina procesele de fibroza. Sinovita cronica are capacitati distructive articulare: la copiii in curs de crestere poate determina hipertrofie osoasa, cu discordante in lungimea oaselor, deformari angulare, alterari ale conturului scheletal. Ea provoaca degradarea progresiva a cartilajului articular, putand determina condroliza, apoi osteoartrita progresiva, efectul distructiv articular depinzand de gravitatea hemofiliei si de particularitatile individuale. Leziunile acestea au consecinte nefaste functionale: instabilitate crescuta, mobilitate redusa pana la anchiloza totala. Artropatia cronica in formele severe de boala afecteaza 30-90% dintre pacientii hemofilici. Tratamentul balnear al pacientilor cu artropatie hemofilica cuprinde partea de profilaxie si partea curative si de recuperare. Profilactic, in statiunea balneara se obtine preventia instalarii retracturilor si a deficitelor de mobilitate. Obiectivele tratamentului de recuperare sunt ameliorarea statusului articular, al simptomatolgiei algice, al performanelor locomotorii si cresterea capacitatii la efort. Se utilizeaza proceduri clasice de fizioterapie. Balneoterapia in cura externa cuprinde hidroterapie cu efect de ansamblu benefic pentru tulburrile locomotorii. Se folosesc bai cu ape minerale carbogazoase, hipotone, atermale, ape minerale sulfuroase, bai cu apa sarata, talazoterapie. ISTORICUL STATIUNII SOVATA. FACTORI NATURALI DE CURA. ACTIVITATEA MEDICALA (GENERIC) - Dr. Andras Bartha, medic primar Recuperare, medicina fizica, balneologie, Dl. Janos Fulop-Nagy, director general SC Balneoclimaterica Sovata SA Statiunea Sovata, situata in Podisul Transilvaniei, la poalele Muntilor Gurghiu, era cunoscuta inca de pe vremea romanilor pentru exploatarile miniere de sare. In 1578 asezarea a fost atestata documentar sub numele Sovata. Solul bogat in sare a permis formarea unor lacuri sarate, care au constituit baza activitatii balneare, initial sub forma empirica, apoi stiintifica. Primul document care aminteste de Sovata ca loc de cura prin efectele terapeutice ale apei sarate dateaza din anul 1597. In anul 1884 Sovata este declarata oficial statiune balneara.

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Unicitatea fenomenului de heliotermie specific Lacului Ursu, microclimatul favorabil si vegetatia abundenta, au creat premisele dezvoltarii unei statiuni balneoclimaterice de clasa internaionala. Fiind o zona de confluenta interetnica si culturala, Sovata a constituit locul de intalnire al unor personalitati politice si culturale. De statiunea Sovata se leaga inceputurile medicinii balneare romanesti cu fundamentare stiintifica, profesorul Marius Sturdza, medicul sef al statiunii Sovata (1920-1930), a intemeiat prima catedra de Balneologie si Fizioterapie din Romania, la Cluj (1931). Din anul 1900, cand s-au deschis oficial baile din Sovata de Sus si pana in prezent, dezvoltarea statiunii a fost marcata de dou momente hotaratoare: construirea unui grup hotelier langa Lacul Ursu (1975-1983), respectiv privatizarea in anul 2001 a trei dintre aceste hoteluri (Sovata, Bradet, Faget) si integrarea lor in lantul hotelier european Danubius, cu reprezentare in Ungaria, Cehia, Slovacia, Romania si Anglia. Pana in anul 1850 apele sarate erau folosite empiric de catre localnici in scop terapeutic pentru afectiunile reumatice, dupa care s-a trecut la valorificarea organizata a bailor. La inceputul secolului XX incep cercetarile asupra fenomenului de heliotermie a Lacului Ursu, iar in 1929 este introdus tratamentul balneo-fizioterapeutic sub supraveghere medicala. Turismul balnear propriu-zis, ca fenomen de masa, se dezvolta in paralel cu construirea hotelurilor si activitatea hoteliera, dupa anul 1973. Rezultatele deosebite si de durata obtinute prin tratament si preventie cu ajutorul factorilor de cura sus-mentionati, mentin viu interesul pentru activitatea de cercetare a mecanismelor de actiune, in colaborare si cu sprijinul unor institutii de prestigiu medicale si hidrogeologice. SOVATA RESORT: HYSTORY, NATURAL THERAPEUTIC FACTORS AND MEDICAL ACTIVITY - Dr. Andras Bartha, MD, Rehabilitation, physical medicine and balneology, Mr Janos Fulop-Nagy, general manager SC Balneoclimaterica Sovata SA Sovata resort, located in the Transylvanian plateau, at the foot of the Gurghiu Mountains, was known from the period of the Romans because of the salt mines exploitation. In 1578, the settlement was documentary certified under the name Zowata. The soil, rich in salt, has made possible the development of some small salt lakes, which represented the base of (firstly empirical, and than scientifical) balneary treatments. The first document which mentioned Sovata for the healthy effects of salt water treatments was dated in 1597. In 1884 Sovata was officially recognized as health resort. The unicity of the heliothermal effect of the Bear Lake, the sedative climate and the abundant vegetation, have made possible the development of an international level health resort. Sovata is the place of several ethnical and cultural confluence, so the resort has become the meeting place of some political and cultural personalities. Sovata is linked with the beginnings of the Romanian scientifically documented balneology, professor Marius Sturdza, the head doctor of Sovata resort (1920-1930), has founded the first Balneology and Physiotherapy department in Romania, at Cluj (1930-1931). From 1900, when the baths of Upper Sovata was opened officially, and till now, the development of the resort was marked by two significant events: between 1975 and 1983 there was built a group of hotels near Bear Lake; the second event was in 2001, when three of these hotels (Sovata, Bradet, Faget) have become private and they linked with the European hotel group named Danubius, represented in Hungary, Slovackia, Czeck Republic, Romania and England.

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The touristic activity of the resort includes from its beginning two types of activities: loisir (recreation-leisure-bussiness meetings) and balneary treatments. Till 1850 the salt water was used empirically by the natives to treat the rheumathological diseases; than, the salt water was used in organized treatments. At he beginning of the XXth century has started the research on the heliothermic effect of Bear Lake. In 1929 there was introduced the medically supervised balneary treatment. The balneary tourism itself, as mass phenomenon, has evolved in parallel with the building of the hotels and the activity at these hotels, after 1973. The efficient and the longlasting results obtained by treatment and prevention using the natural factors of cure mentioned above, keep alive the interest for research concerning their mechanisms of action, in relationship and helped by some renowned medical and hydrogeological associations. PARTICULARITATI ALE HIDROKINETOTERAPIEI PE CATEGORII POPULATIONALE SI DE PATOLOGIE - Consuela Brailescu, Rodica Scarlet, Horia Lzrescu ,,Apa reprezinta viata si evolutie (M Emoto, 2007); Hipocrate a fost primul care i-a descoperit valorile terapeutice asupra balantei umorale, respiratiei si locomotiei la bolnavii care faceau bai si practicau exercitii in apa sarata a marii. Astazi, beneficiile hidrokinetoterapiei sunt demonstrate si apreciate deopotriva de medici si de pacienti, fiind una din conceptele de baza ale recuperarii medicale functionale pentru o categorie foarte larga de afectiuni, fie profilactic, fie curativ. Material: Autorii isi propun ca aceasta lucrare sa fie un ,,peer-review al conceptelor generale legate de mediul acvatic si al influentei acestor parametrii fizico-chimici (presiunea hidrostatica, rezistenta, vascozitatea, temperatura, compozitia fizico-chimica a apei) asupra corpului uman, cu beneficiile sale generale si particulare (pe diverse aparate si sisteme), din care deriva gama larga de indicatii si extrem de putinele contraindicatii. Deasemeni, se trec in revista metodologiile de aplicare atat in scop profilactic si ca gimnastica de intretinere (scop recreativ), dar mai ales aplicatiile hidrokinetoterapiei ca metoda asociata programului traditional de Recuperare Medicala la o diversitate de pacienti: post-operatori si post-traumatici sechelari, neurologici periferici sau centrali, reumatologici degenerativi sau inflamatori cronici, respiratori, cardiovasculari, etc. Programul de hidrokinetoterapie este strict individualizat, se tine cont nu numai de suferinta principala, ci si de co-morbiditatile pacientului si de categoria de varsta din care face parte. Dealtfel, indicatiile in scop profilactic si terapeutic capata particularitati la copii, varstnici, femei in timpul sarcinii, sportivi de performanta si se ajusteaza pe parcursul progresiei statusului clinico-functional al pacientului. Concluzii: Beneficiile exercitiului acvatic (imbunatatirea flexibilitatii articulare si fortei musculare in conditiile descarcarii de greutate a segmentului respectiv, scaderea durerii prin relaxare musculara, imbunatatirea rezistentei cardiovasculare si antrenamentul aerob de efort, imbunatatirea stabilitatii segmentelor si a coordonarii, reluarea mersului precoce si in conditii de siguranta, efect psihologic benefic, etc) impun adaugarea hidrokinetoterapiei (alaturi de programul clasic la sala de kineto) intr-o serie larga de afectiuni (sfera pediatrica, neurologica, ortopedica, reumatologica) atat ca profilaxie, cat si ca parte a procesului terapeutic de recuperare, cu conditia particularizarii programului pe categorii populationale si de patologie.

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ASPECTE BIOCLIMATICE I DE GEOGRAFIE MEDICAL N JUDEUL MURE Asist. Cercet. Bunescu Iulia, conf. dr. Enache Liviu, INRMFB Un aspect important pentru o regiune dat, dar i pentru o ntreag ar, o reprezint cunoaterea condiiilor specifice regiunii i a strii de sntate i a populaiei respective. Condiiile bioclimatice descriu mediul de via al populaiei respective, n timp ce, o serie de parametri statistici medicali contribuie la aprecierea factorilor de risc privind incidena sau frecvena unor boli din cadrul geografic analizat. Judeul Mure este unul cu un bogat potenial balneoclimatic care include ape, nmol, dar i aerul din zon. Dovad sunt i staiunile balneoclimatice existente, unele de interes general Sovata, altele de interes local Sngeorgiu de Mure, Ideciu de Jos, Bile Srmel, la care se adaug i localiti cu factori balneari Jabenia i factori terapeutici - Stnceni, Lunca Bradului Slard. Lucrarea i propune s reliefeze att condiiile climatice i bioclimatice din judeul Mure, ct i unele aspecte de geografie medical (incidena unor boli: tuberculoz, hepatit viral) privite comparativ cu alte judee, dar i cu alte ri europene. Aprecierile bioclimatice indic faptul c acesta este difereniat, n funcie de zona geografic analizat (de la relaxant, cu nuane de stimulare n zona Podiului Transilvaniei, pn la tonic-stimulent n zona muntoas). Sub aspect medical, datele statistice arat c, spre deosebire de alte regiuni ale rii, judeul Mure (iar n unele cazuri, chiar Romnia) ocup locuri nedorite n clasamentele unor afeciuni patologice. Cauzele sunt multiple i complexe (un nivel de via mai sczut, cheltuieli de sntate mai mici, legislaie incoerent, un climat psihologic nefavorabil grija zilei de mine, omajul i altele), care, toate pot contribui la deteriorarea strii de sntate a populaiei. De exemplu, n timp ce n unele ri din Europa, din Produsul Intern Brut, se aloc pentru sntate sume cuprinse ntre 4,1% n Grecia (ar cu probleme financiare serioase) i peste 10% n Elveia, Austria, Germania i Belgia, n Romnia s-a alocat doar 3,2 - 3,5% (2009). Pentru evidenierea principalelor probleme cu care se confrunt populaia judeului Mure, n ceea ce privete starea de sntate i bunstare, a fost analizat perioada 1989 2009 i s-au avut n vedere date din Anuarul de statistic sanitar pe anul 2010. BIOCLIMATE AND MEDICAL GEOGRAPHY ASPECTS IN MURE COUNTY - Asist. Cercet.Bunescu Iulia, conf. dr. Enache Liviu, INRMFB An important aspect for a given region, but for an entire country, is the knowledge of specific conditions and health state of the population. Bioclimatic conditions describe the living environment of the population, while a number of parameters contribute to medical statistics assessement of risk factors on the incidence or frequency of diseases within geographycally analysed. Mure County have a rich balneoclimatic potential, including water, mud, but also, air in the area. As proof are the existing balneoclimatic resorts, some of general interest Sovata, other of local interest - Sngeorgiu de Mure, Ideciu de Jos, Bile Srmel, plus added locations with balneary factors Jabenia and therapeutical factors - Stnceni, Lunca Bradului Slard. The paper aims to highligh both the climatic and bioclimatic Mure County and some

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aspects of medical geography (the incidence of diseases: tuberculosis, viral hepatitis) seen compared to other counties, but also with other European countries. The bioclimatic assessments indicate that it is differentiated according to geographical area analysed (from relaxing with shade of stimulus in the Transylvanian Plateau, to the tonic and stimulant in the mountains). In the terms of medical, statistical data show that, unlike other regions, Mure County (and in some cases, even Romania) takes places in the rankings of unwanted pathological conditions. The causes are multiple and complex (lower living standards, lower health costs, inconsistent legislation, a negative psychological climate worrying about tomorrow, unemploymemt etc.), which can all contribute to the deterioration of public health. For example, while in some european coutries, the G.D.P. is allocated for the health amounts ranging from 4,1 % in Greece (a country with serious financial problems) and over 10 5 % in Switzerland, Austria, Germany and Belgium, Romania has allocated only 3,2 to 3,5 % (2009). To highlight the main issues facing the Mure County population, in terms of health and welfare, was analysed between 1989 2009 and have considered data from the Health Statistics Yearbook 2010. RECUPERAREA TULBURARILOR DE MERS LA VARSTNICII CU AFECTIUNI POSTTRAUMATICE ALE MEMBRULUI PELVIN Dr. Gheorghe Chiriti, Dr. Dana-Maria Dimulescu, U.M.F.Carol Davila, Bucuresti; Institutul National de Recuperare, Medicina Fizica si Balneoclimatologie

Obiective: Realizarea unui studiu prospectiv randomizat privind eficienta programului de recuperare fizical-kinetic la 2 loturi de varstnici cu afectiuni post-traumatice ale articulatiilor portante (sold, genunchi, glezna), cu si fara afectarea compliantei cognitive, asupra parametrilor clinico-functionali ai mersului. Material si metoda: Studiul realizat la INRMFB a inclus 2 loturi (1-de studiu si 2-martor), cu cate 50 pacienti fiecare, de ambe sexe, varstnici, cu afectiuni post-traumatice ale articulatiilor portante (sold, genunchi, glezna); distinctia intre cele 2 loturi s-a bazat pe testul Folstein, dupa un screening: in lotul martor au fost inclusi pacientii cu scor de peste 15 puncte, in lotul de studiu fiind inclusi cei cu scorul de sub 15 puncte. Parametrii clinico-functionali urmriti au fost: durerea, disfunctiile fizice si cognitive, dizabilitatile, calitatea vietii pacientilor; s-au utilizat scalele: VAS, MMSE, GDS, Scala de Anxietate Zigmond-Snaith, Scala Tinetti de Mers, Scala Tinetti de Echilibru, ADL24. Rezultate si concluzii: In urma programului de recuperare fizical-kinetic, scorurile parametrilor clinico-functionali s-au ameliorat: durerea cu 35,7% (lotul 1) si 39,3% (lotul 2); disfunctiile fizice cu 21,7% (lotul 1) si 28,7% (lotul 2); disfunctiile cognitive cu 35% (lotul 1) si 48% (lotul 2); dizabilitatile (tulburarile de mers) cu 30,7% - lotul 1 i 37,4% - lotul 2. Calitatea vietii pacientilor s-a ameliorat cu 31,6% - lotul 1 si 37,7% - lotul 2. Concluzii: Concluzia acestui studiu demonstreaza eficienta programului de recuperare la varstnicii cu afectiuni post-traumatice ale membrului pelvin si tulburari de mers, precum si influenta negativa exercitata de disfunctiile cognitive, depresie si anxietate asupra rezultatelor acestui program.

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REHABILITATION OF THE GAIT DISTURBANCES IN OLD PATIENTS WITH POST-TRAUMA INJURIES ON SUPPORTING JOINTS - Gheorghe Chirii MD, PhD, Dana-Maria Dimulescu MD, PhD UMF Carol Davila Bucharest; National Institute of Rehabilitation, Physical Medicine and Balneoclimatology Objective: To perform a prospective, randomized study concerning efficiency of the physical and kinetic rehabilitation program in two groups of older patients with post-trauma injuries on supporting joints (hip, knee, ankle), with and without affecting physical or cognitive compliance according to a clinical and functional assessement of the gait. Material and method: The study was performed to NIRPMB, in two groups (group1- a study group and group 2 the control group), either of 50 patients, males and women, elderly, with posttraumatic injuries of the supporting joints (hip, knee, ankle); distinction between the two groups was mode based on the Folstein test, after a screening: in the control group (group 2) included patients with a greater score than 15 points, in the study group (group 1) included patients with a lower score than 15 points. The clinical and functional parameters assessed: pain, physical and cognitive dysfunctiones, disabilities, quality of life. We used also the following scales: VAS, MMSE, GDS, Zigmond-Snaith Anxiety Scale, Tinetti Gait Scale, Tinetti Balance Scale, ADL 24. Results and conclusions: After physical and kinetic rehabilitation program, the scores of the clinical and functional parameters improved as follows: the pain with 35,7% (group 1) and 39,3% (group 2); physical dysfunctions with 21,7% (group 1) and 28,7% (group 2); cognitive dysfunctions with 35% - group 1 and 48% - group 2; disabilities (gait disturbances) with 30,7% - group 1 and 37,4% - group 2; quality of life improved with 31,6% - group 1 and 37,7% - group 2. Conclusion: Conclusion of this study certify the efficiency of rehabilitation program for the older patients with posttraumatic injuries and gait disturbances and the fact that the cognitive dysfunctions, depression and anxiety of the olders with fractures of the lower extremities exert a negative influence on the outcomes of this rehabilitation program. TRATAMENTUL BALNEAR AL BONAVULUI CARDIAC IN ROMANIA Delia Cinteza, Daniela Poenaru, Sebastian Diaconescu, Horia Lzrescu - INRMFB Introducere: Cura balneara reprezinta un complex terapeutic cumuland actiunea tuturor factorilor naturali terapeutici (FNT) prezenti intr-o statiune. Acestia au o actiune directa locala (variabila de la un factor la altul), precum si o actiune generala nespecifica (conditionata de reactivitatea individuala si de capacitatea de adaptare a fiecaruia). Scop: Prezentarea sintetizeaza experienta acumulata din practica medicala si din studiile clinice din ultimii 50 de ani, in scopul armonizarii informatiilor si conceptiilor, care opun, adesea, boala cardiaca,indiferent de tipul ei, aplicarii factorilor terapeutici naturali. Material si metoda: Factorii naturali terapeutici utilizati in managementul terapeutic al pacientilor cardiaci cuprind: gazele terapeutice mofeta, apele minerale carbogazoase in cura externa, apele minerale sulfuroase in cura externa, complexul de factori ai litoralului (talasoterapia), precum si climatul si microclimatul

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In general, curele balneare utilizate pentru pacientii cardiaci sunt: cura in scop profilactic (profilaxia primara si profilaxia secundara ) si cura de recuperare. Curele profilacice se adreseaza factorilor de risc aterosclerotic si coronarian Cura de recuperare are urmatoarele obiective si avantaje: prevenirea recidivelor si a posibilelor decompensari / reactivari, ameliorarea tolerantei fizice si psihice fata de boala, cu mentinerea stilului de viata adecvat fiecarei afectiuni si strict individualizat , mentinerea si cresterea restantului functional, readaptare si reeducare a pacientului la viata personala/profesionala/socio-familiala in concordanta cu restantele functionale datorate bolii Concluzii: o buna cunoastere a mecanismelor de actiune ale factorilor naturali terapeutici asupra organismului uman permite indicarea corecta a curelor balneare pentru pacientii cardiaci. BALNEARY TREATMENT FOR CARDIAC DISEASES IN ROMANIA Delia Cinteza, Daniela Poenaru, Sebastian Diaconescu, INRMFB Background: Balneary cure means a complex therapy, using the action of a bunch of natural factors from a resort. These factors action individually, influencing the functioning of a system or an organ, but there is a global unspecific action too, determined by the human body reactivity and adaptation capacity). Purpose: the presentation aims to synthesize the results of over 50 years of medical practice and medical studies, in order to prescribe the best treatment for the right patient. Material and methods: The natural factors used for the cardiac patients are: therapeutic gases, carbogaseous and sulphurous waters, the complex factors from the seaside and the climacteric factors. The balneary cures for cardiac diseases can be only for preventive and for rehabilitation purposes. Conclusion: The adequate knowledge concerning the mechanisms of action for these variable natural therapeutic factors allows the correctness of our prescription and avoid mistakes. POSTERIOR TIBIAL NERVE STIMULATION FOR PATIENTS WITH VOIDING DYSFUNCTION AFTER SPINAL CORD INJURY Delia Cinteza, Daniela Poenaru, Sebastian Diaconescu, Victorita Marcu, Dan Dumitrascu National Institute of Rehabilitation Physical Medicine and Balneology Bucharest, Romania Introduction: Posterior tibial nerve stimulation (PTNS) is a technique of electrical neuromodulation for treating the voiding dysfunction caused by neurogenic bladder in patients who have failed other therapies. Voiding dysfunction includes urinary frequency, urgency, incontinence and nonobstructive retention. Spinal cord injury (SCI) is a common causes of voiding dysfunction. Purpose: to determine the effects of noninvasive PTNS on post SCI patients with neurogenic bladder and intermitent catheterisation, in order to improve their quality of life. Material and method: 25 patients (2 women and 23 men), 20 to 38 years, with paraplegia after thoracic SCI accepted to enter this study. They used intermitent catheterisation for at least 6 months (5-6 voiding sessions per day) before the beginning of the study. All of them have had urinary incontinence between catheterisation sessions. We used 24-h

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bladder diaries and QoL questionnaires (SF-36, and incontinence-specific QoL) to be completed at baseline and after 3 weeks PTNS applications. Results: There was a significant correlation (P

of 325 women and 245 men, 65 to 87 years of age, acceped for tratment according with well-establish criteria. 36% of them needed surgical treatement, but they refused that for different reasons. 10% from the group with knee localization had inflamatory exacerbation at the baseline. More than three quarters refused to walk with a cane, despite the pain and the poor gait pattern. We used QOL questionnaires and a clinical evaluation report (WOMAC scale, VAS, clinical items of gait analysis etc) to be completed at baseline, after 18 days of treatement and after 1 year. Adverse effects were also noted. For the third evaluation, the number of exarcerbation and/or hospitalizations for lower limb ostheoarthritis were recorded. Results: All the patients received sulphurous mineral applications as general bath during 18 treatment days, using a standardized methodology; cardiac function was daily evaluated.The treatment also included education and adapted physical exercises. Clinical complaints were significantly reduced comparing with the baseline level, even for those with inflamatory exacerbation. Qol and patient satisfaction also had a significant improvment. After one year, 102 patients had more than one clinical exacerbation of the pain; 35 patients suffered a surgical procedure (26 hip replacement and 9 knee replacement); radiologic evaluation for the others showed no further joint deterioration. More than half of the patients were using a cane and followed the medical advices concerning physical exercises and joint protection. Conclusions: Balnear therapy with sulphurous mineral water determined a significant and consistent improvement of clinical aspects and quality of life for knee and/or hip ostheoarthritis patients in our study. The health education under continous medical supervision during the 18 days cure helped the patients compliance for medical advices and joint protection. Keywords: sulphurous mineral water, knee ostheoarthritis, hip ostheoarthritis MANAGEMENTUL RECUPERARII IN ARTROPLASTIILE COXOFEMURALE - Felicia Cioara, Lucia Vicas, Carmen Avram, Ramona Suciu, Marius Rus Universitatea din Oradea, Facultatea de Medicin i Farmacie Numrul artroplastiilor de old a crescut n ultimii 10 ani cu 50% in Statele Unite; realizndu-se anual peste 170000 de artroplastii totale, dintre acestea 20% fiind reprezentate de artroplastiile de revizie. Scopul tratamentului de recuperare al artroplastiilor totale de old este redobndirea independenei bolnavului n activitile de zi cu zi. n acest sens, se fac eforturi constante pentru creterea eficienei recuperrii acestei afeciuni i a complianei pacienilor la programele de recuperare. Material i metod: Am luat n studiu un numr de 55 de pacieni cu artroplastii coxofemurale, care au urmat tratament de recuperare n Spitalul Clinic de Recuperare Medical Bile Felix. Obiectivele tratamentului recuperator au fost: combaterea durerii, meninerea i consolidarea stabilitii oldului, meninerea i creterea mobilitii n articulaie. Rezultate: Durerea s-a ameliorat semnificativ statistic. Scorul durerii a sczut de la 7,46 la 5,22 (procentul de ameliorare fiind de 30.02%); Ameliorarea disfunciilor fizice cu 14,99% (determinat mai ales de evoluia tulburrilor de static la nivelul membrului portant). Ameliorarea dizabilitilor cu 24,22% determinat de ameliorarea celor 2

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parametri - ADL i capacitatea de deplasare; ameliorarea scorului general mediu cu 24,12%, creterea stabilitii articulare, apreciat obiectiv prin testing muscular, creterea mobilitii articulare, apreciat obiectiv prin testing articular. Concluzii: Rezultatele noastre demonstreaz c un program riguros de hidrokinetoterapie i kinetoterapie individual, care a inclus tehnici specifice de cretere a forei i rezistenei musculare, reeducarea mersului i antrenament cardiovascular, poate fi o modalitate eficace de ameliorare a strii funcionale la pacienii cu artroplastii coxofemurale. RECOVERY MANAGEMENT IN TOTAL HIP ARTHROPLASTY Felicia Cioara, Vicas Lucia, Carmen Avram, Ramona Suciu, Marius Rus University of Oradea, Faculty of Medicine and Pharmacy

Number of hip arthroplasty in the last 10 years increased by 50% in the U.S., realizing annual total arthroplasty over 170,000, of which 20% are represented by revision arthroplasty. The goal of treatment for recovery of total hip arthroplasty patient is regaining independence in daily activities. In this respect, are constantly striving to increase the recovery efficiency of the disease and patient compliance to rehabilitation programs. Methods: We studied a total of 55 patients with the hip arthroplasty, recovery following treatment in Medical Rehabilitation Hospital Felix. Recovery treatment goals were: control pain, maintain and strengthen the hip stability, maintain and increase joint mobility. Results: Pain improved significantly. Pain score decreased from 7.46 to 5.22 (percentage of improvement being 30.02%) 14.99% improvement with physical disorders (disorders caused mainly by the development of static load-bearing limb). Improving disability to 24.22% due to improvement of two parameters - ADL and ability to travel, improving the overall average score of 24.12%, increase joint stability, judged objectively by muscle testing, increase joint mobility, assessed objectively by joint testing. Conclusions: Our results demonstrate that a rigorous program of physical therapy hydrokinetotherapy and individual, which included techniques to increase strength and muscle strength, gait rehabilitation and cardiovascular workout, can be an effective way to improve functional status in patients with the hip arthroplasty. BENEFICIILE BALNEOTERAPIEI IN DUREREA LOMBARA JOASA DE CAUZA DEGENERATIVA - Felicia Cioara, Ramona Suciu, Marius Rus, Liviu Lazar Universitatea din Oradea, Facultatea de Medicin i Farmacie Durerea lombar joas este unul dintre cele mai frecvente motive pentru prezentarea la consultaii de medicin primar. n majoritatea cazurilor, aceti pacieni sufer de boala degenerativ a coloanei vertebrale: spondilartroz, discartroz, artroza articulaiilor interapofizare, stenoza de canal spinal. Material si metoda: Am efectuat un studiu de tip prospectiv care a cuprins un numr de 50 de pacieni (35 femei si 15 barbati) cu suferin degenerativ a coloanei lombare - stabilit prin evaluare clinic i paraclinic n cadrul Spitalului Clinic de Recuperare Medicala Baile Felix. Metodele de evaluare au inclus: examen clinic, examen obiectiv,

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evaluarea biologic, evaluarea radiologic i imagistic, chestionarele autoadministrate care ncearc s reflecte consecinele de ordin funcional i social ale suferinei de coloan lombar, Scala analog vizual pentru durere, Scala Oswestry, Scala de evaluare a calitii vieii. Toti pacientii au urmat un tratament balneofizio-kinetic timp de 14 zile. Rezultate: Evoluia scorului durerii dup primele 14 zile de tratament, arat o scdere semnificativ statistic. n paralel cu scderea durerii pacienii au semnalat o ameliorare a somnului i a bunei dispoziii. Concluzii: Repausul asociat cu tratamentul balneofizio-kinetic, a dus la ameliorarea sindromului algic i disfuncional. Pe termen lung, pacienii lotului de studiu au nregistrat o ameliorare net a calitii vieii cu preponderen n domeniul bunei dispoziii a somnului i a muncii. Coloratura psiho-afectiv cu tendin la anxietate i depresie a ngreunat aderena pacienilor la programul recuperator, la acetia rezultatele tratamentului fiind mai limitate. BALNEOTHERAPY BENEFITS IN THE CASE DEGENERATIVE LOW BACK PAIN Felicia Cioara, Ramona Suciu, Marius Rus, Liviu Lazar University of Oradea, Faculty of Medicine and Pharmacy Low back pain is one of the most common reasons for presentation to primary medical consultations. In most cases, these patients suffering from degenerative spine disease: spondylarthrosis, facet joint arthrosis, spinal canal stenosis. Material and methods: We performed a prospective study that consisted of 50 patients (35 women and 15 men) with degenerative lumbar spine pain - established by clinical assessment and paraclinical the Medical Rehabilitation Hospital Felix. Evaluation methods included clinical examination, physical examination, assessment of biological, radiological and imaging evaluation, self-administered questionnaires that try to reflect the functional nature and social consequences of suffering the lumbar spine, visual analogue scale for pain, Oswestry Scale, Rating Scale quality of life. All patients were followed balneofiziokinetotherapy treatment for 14 days. Results: Change in pain score after the first 14 days of treatment, show a statistically significant decrease. In parallel with decreased pain patients reported improved sleep and mood. Conclusions: Sleep associated with balneofiziokinetotherapy treatment resulted in improvement of painful and dysfunctional syndrome. Long-term study group patients showed a net improvement in quality of life mainly in the provision of good sleep and work. Psycho-emotional coloring tendency to anxiety and depression recovery program difficult patient adherence to their treatment outcomes are more limited. METODOLOGII DE TRATAMENT BALNEAR IN BOLILE CEREBROVASCULARE Dr.Liliana Cioc, INRMFB Accidentele vasculare cerebrale reprezinta a-3-a cauza de morbiditate si mortalitate in Europa si SUA( dupa boala cardiac ischemica si cancer) ,iar in Romania conform statisticilor O.M.S se situeaza pe primul loc,atat in ceea ce priveste mortalitatea ,cat si invaliditatea majora. Indicatiile de cura balneara in cazul bolnavilor cu AVC trebuie bine cantarite si trebuie limitate la acele cazuri care au realizat in prealabil progrese in recuperarea unor functii

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motorii de baza in serviciile de recuperare de specialitate din spitale,care nu prezinta aspecte de decompensare sau evolutive .Cura balneara se adreseaza formelor stabilizate de AVC dupa minimum 6 luni de la producere si hemiparezelor sechelare vechi cu deficit motor minor. Obiectivele curelor balneare sunt in primul rand de recuperare medicala si de profilaxie secundara daca ne referim la afectiunea de baza care a determinat leziunile neurologice. Metodologia curelor balneare si modul de actiune al factorilor terapeutici naturali in afectiunile neurologice central se bazeaza in principal pe kinetoterapie,kinetoterapie care se aplica individual in salile de gimnastica medicala sau in bazine cu apa simpla sau cu apa mineral.Alaturi de kinetoterpie se folosesc metode fizicale ca aplicatii locale de caldura,masajul,metodele de electroterapie decontracturanta si vasculo-trofica cu curenti de joasa si medie frecventa, aplicatii de ultrasunet, curent galvanic . Factorii terapeutici naturali au rol adjuvant in recuperarea acestor bolnavi ,ei aducand contributii valoroase fie prin efectele lor vasculo-trofice asupra tesuturilor,fie prin efectele lor terapeutice asupra bolii de baza.Factorii terapeutici naturali utili in recuperarea si tratamentul afectiunilor indicate sunt :apele minerale termale oligominerale care permit aplicarea hidrokinetoterapiei in bazine ,adaugand efecte vasculo-trofice,apele minerale sarate de concentratie mica si medie, apele carbogazoase prin efectele lor vasodilatatoare periferice cu solicitare moderata cardio-circulatorie sistemica ,cu efecte vasodilatatoarecerebrale produse de bioxidul de carbon,apele sulfuroase cu efecte vasodilatatoare si trofice periferice, aplicatiile de namol sub forma cataplasmelor si impachetarilor partiale.Elementele climatului fie sedative ,fie tonizante,pot fi utile in reechilibrarea neurovegetativa si neuropsihica a acestor categorii de bolnavi care prezinta frecvent asemenea tulburari. BALNEARY TREATMENT METHODOLOGIES IN CEREBROVASCULAR DISEASES - Dr.Liliana Cioc, INRMFB Stroke is the 3rd cause of morbidity and mortality in Europe and U.S. (after ischemic heart disease and cancer) and also in Romania according to WHO statistics ranks first both in terms of mortality and major disability. Indications of balneary cure for patients with stroke should be well weighed and be limited to those cases which have previously made progress in recovery of basic motor function into the rehabilitation services of specialized hospitals, that do not have decompensation or progressive issues. Balneary treatment addresses those stabilized forms of stroke after minimum 6 months from production and old hemiparesis with minor motor deficit. The objectives of balneary cures are primarily medical recovery and secondary prevention if we refear to the disease that caused neurological damage. The methodology of the balnear treatment and mode of action of natural therapeutic factors in central neurological condition is based mainly on physical therapy. Physical therapy is applied individually in medical gyms or pools with plain or mineral water. With kinetotherapy there are used physical methods like local application of heat, massage, decontracturant and vasclo-trophic electrotherapy methods with low and medium frequency currents, application of ultrasound, galvanic current. Natural therapeutic factors serve as an adjuvant in these patients recover, and also they are bringing valuable contributions by vascular-trophic effects on the tissues, or by their

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therapeutic effects on the primary disease. Natural therapeutic factors useful in recovery and treatment of specified diseases are: oligomineral thermal waters that allow the aplication of hydrokinethoterapy , adding vascular-trophic effects, mineral waters small and medium salt concentration, carbonated waters by peripheral vasodilatory effects with moderate systemic cardio-circulatory application, cerebral vasodilatatory effects produced by carbon dioxide, sulfurous waters with peripheral vasodilator and trophic effects, mud application .The climate sedative or tonic, can be useful in neuropsychological and neurovegetative rebalancing of these categories of patients who often have such disorders. REHABILITATION INTERVENTIONS FOR A COMPLEX REGIONAL PAIN SYNDROME AFTER TIBIAL FRACTURE IN A HEMOPHILIC PATIENT CASE REPORT - Liliana Cioc, Alina Sandu, Irina Petrusca, Renee Popovici, Alexandru Cristea, Adriana Loghin, Delia Cinteza National Institute of Physical and Rehabilitation Medicine Bucharest, Romania Introduction: Hemophilia A is an inherited disorder caused by the deficiency of plasma clotting factor VIII. Almost 50% of patients develop permanent changes of the bones and the joints. Purpose: to present the rehabilitation goals and interventions for a patient with hemophilic arthropathy, tibial fracture and complex regional pain syndrome (CRPS). Material and method: A case of a 64 year old man with type A hemophilia and severe artropathy (stage IV and V on Arnold-Hilgartner classification) is presented. He also has some co-morbidities: diabettes mellitus, hypertension, obesity and a low level of physical activity. 4 months before, he experienced a left tibial fracture; the only treatment was 3 months cast imobilisation. At admission in the rehab facility, he presented joint deformation, muscle atrophy, CRPS in left knee and ankle, left peripheral neuropathy of common peroneal nerve and difusse musculoskeletal pain. Results: Rehabilitation interventions improved the degree of independence in basic activities. The patient obtained a significantly safer gait. We still have to establish if a general therapy for osteoporosis is necessary in order to prevent other fractures. The type of CRPS remain unclear. Conclusions: Osteoporosis due to bone modifications and activity limitations have to be considered as a serious threat of hemophilia in long term survivors. Fractures occur with some uncommon localisations, after low intensity trauma and have slowly outcome. Physical and rehabilitation medicine improve the functional status of this kind of patients.

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THE IMPORTANCE OF ELECTRONEUROGRAFIC EXAM FOR RECOVERY ASSESSMENT OF PATIENTS WITH CARPAL TUNNEL SYNDROME Clin Corciov, Dan Zaharia, Daniela Matei University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania Introduction. Although modern technology is constantly developing, man needs to use his body to do different things. Thus, the upper limb consisting of three segments: arm, forearm and hand, remains the most economic, ergonomic and easiest to perform various activities, whether large and small efforts or fine and precise processes. Objectives. This paper presents the importance of hand recovery in case of carpal tunnel syndrome. The consequence of not treating this condition is a dysfunction of both motor and sensory nature, leaving the subject with a functional disorder and forcing him to quit the field of activity where he was integrated and turning him into a person with disabilities, who requires social and professional reintegration. Materials and Methods. The study was conducted on 20 patients diagnosed with carpal tunnel syndrome, which were evaluated by the following steps: measurement of anthropometric parameters, assessment of symptoms, clinical diagnostic tests. Electrophysiological exploration of the stimulo-detection system used a computerized system for electrophysiological exploration of Esaote Reporter type, consisting of a mixed block of mioelectric biosignals acquisition (with four channels) and a generator of electrical stimulation (with two channels), also having an integrated system for signal processing. All 20 patients preferred non-surgical treatment: 10 patients have turned to traditional measures: brace, anti-inflammatory treatment, cortisone infiltration; 10 patients followed physio-kinesitherapeutic program and immobilization with the brace and did not use any anti-inflammatory cortisone or drugs. After a month of treatment patients returned for a new clinical and electroneurografic evaluation. Results. Statistical analysis of acquired data used ANOVA test. Parameters resulting from the sensitive and motor examination of the median nerve are: SNAP (V) the amplitude of the sensitive nerve action potential; sNCV (m/sec) - sensitive nerve conduction velocity; CMAP (mV) - compound muscle action potential; mNCV (m/sec) - motor nerve conduction velocity, MDL (m/sec) - motor distal latency. These values were analyzed before and after treatment. At the first assessment we found abnormal electrophysiological values of the sensitive conduction velocity of the median nerve sNCV in 20 patients (100%): 48.8 in the first group vs. 47.3 in the second group, statistically insignificant difference between the two groups, but much lower than normal sNCV values adopted for the median nerve. At the second evaluation after 30 days we found that after treatment the sensitive conduction velocity increased in both groups: group I = 51.3 vs. group II = 61.4, but the most important increase in sNCV occurred in group II, with an increase from 47.3 to 61.4, with statistical significance (p = 0.001). Conclusions. The examination protocol of patients with carpal tunnel syndrome, even immediately after its detection, should include sensitive nerve conduction velocity of the median nerve in order to establish the diagnosis of sensitive polyneuropathy, combined with motor conduction velocity of the median nerve. To restore the upper limb function, the treatment should be started immediately and require medical treatment combined with kinesitherapy. Keywords: carpal tunnel syndrome, stimulo-detection, sensitive and motor conduction velocity

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METODOLOGIA TRATAMENTULUI BALNEAR IN AFECTIUNILE REUMATISMALE ARTICULARE DEGENERATIVE - Alexandru Cristea, INRMFB Tratamentul balnear in afectiunile reumatismale articulare degenerative poate fi diferentiat, in functie de obiectivele pe care le urmareste, in tratament balnear profilactic si tratament balnear terapeutic sau de recuperare medicala. Tratamentul profilactic poate fi aplicat inainte de instalarea artrozelor (adresat persoanelor care prezinta conditii ce pot favoriza aparitia artrozei) sau la bolnavii cu artroze constituite (in perioadele de compensare, fara manifestari patologice) si are ca scop corectarea/limitarea factorilor determinanti/favorizanti ai afectiunilor degenerative articulare primare sau secundare. Tratamentul terapeutic este aplicat bolnavilor cu artroze degenerative compensate cu sindroame reduse si decompensate algic si muscular fara decompensare inflamatorie si are ca scop inlaturarea/reducerea verigiilor fiziopatologice algica si inflamatorie, pentru a asigura o ameliorare clinica si pentru a creea conditiile necesare aplicarii unei terapii active de refacere a functiilor sistemului locomotor diminuat in urma evolutiei bolii. Obiectivele curei baneare sunt: corectarea/compensarea tulburarilor posturale, ameliorarea sindromului algic, tonifierea musculaturii (in principal grupele musculare de forta antigravitationala), cresterea mobilitatii articulare si a coordonarii motorii, corectarea tulburarilor circulatorii, vasomotorii si endocrino-metabolice, reducerea greutatii in cazul persoanelor supraponderale si corectarea tulburarilor neuro-psihice. Factorii naturali utilizati in cura baneara specifica afectarilor reumatismale degenerative sunt: - ape minerale - oligiminerale termale, termale sulfuroase, ape sulfuroase, ape sarate - namoluri sapropelice, minerale sau de turba - Balneotermoterapia/hidrotermoterapie - bai cu ape minerale (calde, hiperterme, intens hiperterme), impachetari cu namol la temp 40-45 grade, bai de lumina, bai de abur, sauna, impachetari cu parafina, cataplasme cu namol, bai ascendente Hauffe la extremitati, sollux - bioclima- bioclimat excitant-solicitant (aeroterapie, helioterapie), bioclimat sedativ-indiferent de crutare, bioclima tonico- stimulant ; - exercitiul fizic; - regim igieno-dietetic Efectele si mecanismele de actiune sunt: - efecte analgetice si antiinflamatorii : obtinute prin baneotermo si hidrotermoterapie - prin mecanism de hipertermie care produce vasodilatatie - efecte vasculo-trofice si metabolice: bai minerale calde prin mecanism chimic la nivel cutanat si mecanism reflex metameric la nivel profund, aplicatii de termoterapie locala cu namol si parafina prin mecanism conductiv direct - efecte tonifiante / decontracturante / miorelaxante : prin balneokinetoterapie prin efectul de descarcare a greutatii corpului - ameliorarea mobilitatii articulare si a functiei de locomotie : prin programe de exercitii fizice, inotul in bazine, lacuri si miscarea in aer liber - reechilibrare psihica, inlaturarea starii de oboseala, reglarea somnului, sau inlaturarea unor tulburari neuropsihice: prin elementele excitante stimulante sau sedative ale climatului Statiunile recomandate sunt: Sovata, Amara, Techirgiol, Pucioasa, Calimanesti - Caciulata, Vatra Dornei, Baile Felix, Geoagiu Bai, etc

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METODOLOGY OF BALNEARY TREATMENT IN DEGENERATIVE RHEUMATIC DISEASE - Alexandu Cristea, INRMFB Balneary treatment in degenerative rheumatic disease can be classified in prophylactic and therapeutic. Prophylactic treatment can be applied either before the development of arthrosis (for patients with associated risk factors for the condition) or after its development (for patients in remission phase, without acute symptoms), the aim of the treatment being to correct or limit the inducing factors. Therapeutic treatment is applied either to patients with compensated degenerative arthrosis with reduced syndromes or to patients with decompensated disease (pain or muscular involvement, but no inflammation). The purpose is to treat the pain and inflammatory pathways, aiming at clinical improvement and creating the optimal conditions for an active recovery therapy of the musculoskeletal system functions, which were affected during the course of the illness. The objectives of the balneary treatment are to correct / compensate abnormal posturing, to improve pain and tonify muscles (mainly muscle groups involved in producing antigravity forces), to increase joint motility and motor coordination, to correct vascular, endocrine and metabolic disturbances, to reduce body weight in overweight patients and to correct neuro-physical imbalances. Natural factors used in balneary treatment of degenerative rheumatic conditions are: - mineral waters thermal oligomineral, thermal sulfurous, sulfurous, salty - muds: sapropelic, mineral or peat - Balneothermotherapy / hydrothermotherapy mineral waters baths (warm, hyperthermic, intensely hyperthermic), full body mud treatment at 40-45 degrees, light baths, steam baths, sauna, mud and paraffin packs, Hauffe ascending baths for body extremities, sollux - bioclimate excitatory (airtherapy, heliotherapy), sparing; stimulant; - physical exercise; - dietary regime. Mechanisms and effects of therapy: - Analgesic and anti inflammatory effects: obtained through balneothermotherapy and hydrothermotherapy mechanism: hyperthermia and secondary vasodilatation. - Vasculotrophic and metabolic effects: warm mineral baths chemical mechanism at cutaneous level and metameric reflex effect at deep level; local thermotherapy with mud and paraffin packs direct conductive mechanism - Tonifying, spasm relief and myorelaxing effects: balneokinetotherapy reducing body weight - Improving joint motility and motor function: physical exercise routines, swimming, outdoor activities - Mental balancing, combating fatigue, sleep regulation, improving neuro-physical imbalances: excitatory and sparing climate. Some of the recommended balneary ressorts are : Sovata, Amara, Techirgiol, Pucioasa, Calimanesti - Caciulata, Vatra Dornei, Baile Felix, Geoagiu Bai.

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EFFICIENCY OF THE PHYSICAL-KINETIC AND BALNEAR TREATMENT FOR KNEE OSTEOARTHRITIS A REVIEW OF THE RECENT LITERATURE Dana-Maria Dimulescu*,** MD, PhD, Gheorghe Chirii*,** MD, PhD, Ion Ionescu** MD *)UMF Carol Davila Bucharest, **)National Institute of Rehabilitation, Physical Medicine and Balneoclimatology Background: The increase in life expectancy of the population has led to an increase in chronic diseases such osteoarthritis. Knee osteoarthritis for the high disability and psychological stress, not considered adequately, has negative impact on the quality of life. Balneotherapy is considered an important part of the overall management of knee osteoarthritis. Objectives: To sommarise the available scientific evidence on the effectiveness of physio- and balneotherapy interventions in the management of knee osteoarthritis. The objective of the study were to evaluate whether physio- and balneotherapy with mineral sulphate-bicarbonatate-calcium water could determine substantial symptomatic improvement and to detect any changes in the quality of life of patients with symptomatic knee OA. Methods: We performed a systematic review of randomized controlled trials testing efficacy of physio- and balneotherapy for treating patients with knee OA. Trials were identified by systematis searches of PubMed, Cochrane Central Register of Controlled trials and Amed. The main outcomes of interest were pain, stiffness, functional capacities and quality of life. Results: Nine randomized controlled trials satisfied the inclusion criteria. The final sample included 493 patients who provided data at the ends of the study. All interventions that were used in these trials found out an improvement in pain, functional capacity and quality of life. In two study, a three- week inpatient spa-exercise therapy and balneotherapy (with sulphate-bicarbonatate-calcium mineral water bath) was compared with weekly outpatient group physiotherapy alone- there was moderate quality evidence for effects in pain (15%), physical function (27%) and quality of life index (21%) in favour of the combined spa-exercise therapy and balneotherapy. EFICIENTA TRATAMENTULUI FIZICAL-KINETIC SI BALNEAR IN GONARTROZA ANALIZA DATELOR DIN LITERATURA RECENTA Dr. Dana-Maria Dimulescu*,**, Dr. Gheorghe Chiriti*,**, Dr. Ion Ionescu***)U.M.F.Carol Davila, Bucuresti, **)Institutul National de Recuperare, Medicina Fizica si Balneoclimatologie Introducere: Cresterea sperantei de viata a populatiei a dus la cresterea incidentei afectiunilor cronice artrozele. Gonartroza cauzatoare de dizabilitate si stress are un impact negativ asupra calitatii vietii pacientilor.Balneoterapia este considerata o parte importanta a managementului acestei afectiuni. Obiective: Insumarea dovezilor stiintifice evidente ale eficientei tratamentului fizical-kinetic si balnear (ape minerale sulfatate-bicarbonatate-calcice), in ameliorarea semnificativa a simptomelor si cresterea calitatii vietii la pacientii cu gonartroza simptomatica.

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Metoda: O sinteza a literaturii specifice din ultimii ani (Cochrane, PubMed, AMED) a inclus studii randomizate pe pacienti cu gonartroza, testand eficienta terapiei fizical-kinetice si balneare in tratamentul acestora. Rezultatele obtinute au vizat: durerea, redoarea, capacitatea functionala si calitatea vietii pacientilor. Rezultate: Noua trialuri randomizate controlate, incluzand 493 pacienti cu gonartroza au fost incluse in aceasta sinteza. S-a obtinut ameliorarea durerii, a capacitatii functionale si a calitatii vietii pacientilor. In 2 studii, pacientii internati 3 saptamani care au primit tratament fizical-kinetic (hidro-kineto-terapie) si tratament balnear (cura externa cu ape minerale sulfatate-bicarbonatate-calcice) au fost comparati cu pacientii care au primit doar tratament fizical (fara hidro-kineto-terapie, fara balneoterapie); s-au obinut rezultate superioare la pacientii la care s-a aplicat hidro-kineto-terapie si balneoterapie ameliorarea durerii (15%), a disfunctiilor fizice (27%), a calitatii vietii pacientilor (21%). Concluzii: Tratamentul combinat fizical-kinetic si balnear- are efecte pozitive in ameliorarea durerii, a disfunctiilor fizice si a calitatii vietii la pacientii cu gonartroza. CURA BALNEARA LA VARSTNICI Roxana Dragomir, Larisa Incrosnatu, Andreia Murgu, INRMFB Introducere : Fenomenul complex de imbatranire si consecintele sale determina dimensiuni clinice si disfunctionale variate si beneficiaza de cura balneara profilactica si terapeutica. Pentru statiunile balneoclimatice, varstnicul a fost intotdeauna un pacient constant, beneficiind de cure cu factori terapeutici naturali, atat prin crenoterapie cu ape minerale, cat si prin metode de cura externa cu ape minerale, namoluri, mofete, asociate cu hidroterapie, electroterapie, kinetoterapie, masaj. La populatia varstnica, patologia cea mai frecventa este cea cronica, progresiv desabilitanta, de aceea obiectivele tratamentului sunt recuperarea disfunctiilor multiple datorate patologiei cronice si mentinerea cat mai mult posibil a independentei varstnicului. Obiective : prezentarea principiilor si posibilitatilor de a pune in practica indicatia de cura balneara pentru pacientii varstnici in tara noastra. Metodologie: Modalitatile de abordare si realizare a curelor balneare pentru varstnici sunt: cure balneoclimatice cu obiective terapeutice curative si de prevenire a disfunctiilor si disabilitatilor secundare, care se adreseaza patologiei prezintata de varstnic (afectiuni ale aparatului locomotor - reumatismale, ortopedice, traumatice, neurologice periferice, afectiuni cronice ale aparatului digestiv, afectiuni respiratorii sau ORL, afectiuni vasculare periferice, afectiuni ginecologice, afectiuni dermatologice ; cure balneoclimatice cu obiective de recuperare pentru un domeniu de patologie disfunctional major (recuperarea motorie, recuperarea cardio-vasculara, recuperarea respiratorie), cure balneoclimatice cu obiective curative si de recuperare si pentru reactivarea psiho-fizica a varstnicilor (cuprinde tratamentul afectiunilor cronice ale varstnicului, recuperarea disfunctiilor aparatului locomotor si cardio-respirator, programe de socializare si de activitati fizice de grup pentru reactivarea psiho-fizica si comportamentala a varstnicului). Rezultate : metodologia de aplicare a curei balneare la varstnic s-a modificat si adaptat normelor europene, statiunile balneoclimatice cu traditie din tara noastra oferind servicii medicale pentru o paleta larga de afectiuni ale varstei a III-a. Concluzii: Ambientul balnear cu climat favorabil, nepoluat, ofera varstnicului posibilitatea ca paralel cu tratamentul curativ si recuperator sa aiba o viata sociala, cu

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activitate adecvata la capacitatea sa functionala, cu scopul de a se adapta la stresuri psihologice, biologice si sociale, pentru a preveni anxietatea si depresia. SPA TREATMENT IN ELDERLY Roxana Dragomir, Larisa Incrosnatu, Andreia Murgu, INRMFB Introduction : The complex phenomenon of aging and its consequences determine various size of clinical and dysfunctional dimensions. The balneary cure has major benefits for elderly both for prophylactic and for therapeutic purposes. For balneary resorts the elderly has always been a patient constantly where they could benefit of valuable natural factors as crenotherapy with mineral waters, external mineral waters, sludges, mofete, associated with hidrotherapy, electrotherapy, kinetotherapy, massage. Aims : the paper intends to present the principles and the opportunities to benefit from a modern balneary therapeutical cure for elderly in our countrys resorts. Methodology : the elderly may benefit from different types of balneary cure with prophilactic and therapeu