Ivona Stankovic - Academia.edu (original) (raw)

Papers by Ivona Stankovic

PubMed, Feb 20, 2015

Is the treatment of hearing loss in rheumatoid arthritis effective? Dear Editor, Affection of hea... more Is the treatment of hearing loss in rheumatoid arthritis effective? Dear Editor, Affection of hearing, typically bilateral, symmetric, slowly progressive, has been documented in patients with rheumatoid arthritis (RA). Previous research resulted in controversial data on the incidence and treatment of hearing loss (HL) in RA 1,2. We hypothesized that the treatment of HL in RA using corticosteroids and methotrexate is possible and effective. Oral prednisone (60 mg/day, for 30 days) was administered to 38 patients with RA and HL, while 11 additional RA patients received intratympanic injections of methylprednisolone (0.5 ml of 40 mg/ml, at weekly intervals). Non responders to steroids were treated by methotrexate (initial dose 7.5 mg/week, increasing to 25 mg/week over 8 weeks). Oral steroid therapy resulted in hearing improvement in 60.5 %, while intratympanic application of steroids resulted in better hearing in 68.6% of the patients, but only for frequencies over 2000 Hz. Improvement was achieved for mild to moderate initial hearing loss. There were no significant changes of obtained improvement, after five months. The results of methotrexate treatment were not satisfactory, with improvement in only 11.1% of the patients. Subjective estimation of hearing improvement was lower than found on pure tone audiometry (42.9% vs 61.2%). The recovery of HL in persons with RA has not been sufficiently studied. Steroid treatment for autoimmune ear diseases produces significantly better results in cases without systemic diseases. However important side effects prevent long term treatment in chronic diseases 3. Intratympanic injections of corticosteroids is reported to achieve higher concentration for the longest duration in the perilymph, compared to oral and intravenous administration 4. Some studies concluded that methotrexate in low doses improved hearing and balance in autoimmune inner ear disease (AIED). However, a randomized, double-blind, placebo controlled trial reported that methotrexate was not effective in maintaining the hearing improvement achieved with pronisone therapy in patients with AIED 5. Since we cannot predict hearing improvement after steroid therapy, and they cannot be applied for a prolonged period, we recommend oral steroid administration for one month, for patients with RA who develop HL. The responders can be safely treated with intratympanic steroids, with or without insertion of ventilation tubes. Intratympanic steroids have been successfully used for sudden HL, but no study reported on their application in RA patients. Further studies are needed to define the improvement of hearing in RA using different treatment modalities. Optimization of dosage and protocol of intratympanic steroid injections is also mandatory. We conclude that RA patients with HL that respond well to initial oral steroid therapy can be successfully and safely treated by intratympanic application of steroids for longer period of time.

Acta Otorrinolaringologica (english Edition), Jul 1, 2013

PubMed, Nov 1, 2012

This is a retrospective review of patients with advanced malignant neoplasms of the larynx treate... more This is a retrospective review of patients with advanced malignant neoplasms of the larynx treated with total laryngectomy. 387 total laryngectomies for advanced squamous cell carcinoma of larynx performed in the period between 1995 and 2007 were analyzed. Primary total laryngectomy (PRT) was performed in 316 patients, while initial radiotherapy radiotherapy (60-70 Gy) and concomitant chemotherapy (cisplatin-5 fluorouracil) with radiotherapy were applied in totally 71 patients who later received salvage total laryngectomy (STL). All the laryngectomies were performed by four surgeons, using the same routine surgical technique. Postoperative clinical examination was made every three months during five years. We documented the occurrence of: local and general complications, survival rate, residual and recurrent disease, lymph node metastasis, and other changes. Salvage total laryngectomy after previous radiotherapy (STL-pRT) and after chemoradiotherapy (STL-pCTRT) caused more frequent local complications than primary total laryngectomy (PTL). TNM stage and localization of primary laryngeal tumor had significant influence on five year survival rate. It amounted: 61.4% for PTL, 52.6% for STL-pCTRT, and 48.5% for STL-pRT. Incomplete response to initial treatment produced low survival rate. Salvage total laryngectomy caused more frequent local complications, especially after chemoradiotherapy when compared to primary laryngectomy. Survival rate was increased when chemotherapy is added to radiotherapy. Five year survival rate depended on TNM stage and localization of primary tumor.

DOAJ (DOAJ: Directory of Open Access Journals), Nov 1, 2002

Klinika zafizikalnu medicinu i rehabilitaciju Kliničkog centra u Nišu Inzult uslovljava brojne ne... more Klinika zafizikalnu medicinu i rehabilitaciju Kliničkog centra u Nišu Inzult uslovljava brojne neurofiziološke deficite, kao što su afazija, poremecaj pažnje, motorne funkcije, motivacije i drugog. Ukazano je da kognitivni faktori mogu biti značajni za procenu uspeha rehabilitacije bolesnika sa inzultom. Cilj rada je bila analiza vrednosti primene skale ponašanja za praćenje uspeha rehabilitacije ovih bo lesnika. U radu je ispitivano 25 bolesnika sa inzultom koji su bolnički lečeni u Klinici za fizikalnu medicinu i rehabilitaciju u Nišu. Skalu je primenjivao fizijatar ocenjujući ukupno šest parametara: prac'enje prsta okom, mogucnost samostalne ishrane, mogucnost sprovođenja programa rehabilitacije, prepoznavanje doktora, procena situacije u okolini i mogućnost poziva oso je ukupan skor na početku i na kraju tretmana. Pokazalo se da je ovaj test jednostavan, rezultati se brzo procenjuju, pa ima značaj u poboljšanju procene ishoda rehabilitacije bolesnika sa inzultom.

Facta Universitatis, Series: Medicine and Biology

Chronic low back pain (CLBP) is a very complex medical, social and economic problem. Long duratio... more Chronic low back pain (CLBP) is a very complex medical, social and economic problem. Long duration and variability of symptoms can be frustrating for patients and lead to various psychological and behavioral changes, which can be expressed as an over-powering fear of movement and lead to avoidance behavior. The aim of this study was to highlight the importance of individually designed exercises (IDE) and cognitive-behavioral treatment (CBT) in the treatment of patients with CLBP who have signs of fear-avoidance behavior and kinesiophobia. One hundred and thirty patients were included in a prospective randomized study. Group 1 (G1; n = 35) had a combined IDE and CBT program. Group 2 (G2; n = 35) had IDE, without CBT. Group 3 (G3; n = 30) had standard group exercises for CLBP. Group 4 (G4; n = 30) was a control, patients did not have IDE or CBT. Waddel's Fear Avoidance Beliefs Questionnaire (FABQ) and Tampa Scale of Kinesiophobia (TSK), were used for monitoring and evaluation. Pa...

Acta Facultatis Medicae Naissensis, 2018

Congenital brachial palsy (CBP) can have long-term consequences such as deformities, contractures... more Congenital brachial palsy (CBP) can have long-term consequences such as deformities, contractures and growth imbalance of the affected arm and shoulder girdle that can lead to severe handicap. The aim of the paper was to determine the effectiveness of early habilitation in infants with CBP. This retrospective clinical study included 34 infants who were habilitated in the Physical Medicine and Rehabilitation Clinic, Clinical Center Niš, during the period from 2000 to 2017. The protocol consisted of passive and active-assisted range of motion exercises for the affected arm, neurodevelopmental treatment, warm packs and electrotherapy, starting from the 3rd week of life. At the Clinic, 20 sessions were conducted and parents were educated with handling and home exercise program. The infants were re-evaluated each month during the first year of life. The modification of the manual muscle test (MMT) was used to assess the muscle strength (grades 0- 3). At 6 and 12 months of age, the outcom...

European journal of physical and rehabilitation medicine, 2012

Dysfunctional voiding (DV) in neurologically normal children is characterized by involuntary inte... more Dysfunctional voiding (DV) in neurologically normal children is characterized by involuntary intermittent contractions of either the striated muscle in external urethral sphincter, or the pelvic floor during voiding. Urinary incontinence, pelvic holding maneuvers, voiding difficulties, urinary tract infections (UTIs), constipation and vesicoureteral reflux are highly associated with DV. To investigate the role of abdominal and pelvic floor muscle (PFM) retraining in children with DV. Prospective clinical controlled study Outpatient clinical facility Forty-three children, 5-13 years of age, with dysfunctional voiding In addition to standard urotherapy (education, timed voiding, adequate fluid intake, voiding posture and pattern, constipation management and hygiene issues), children were assigned abdominal and PFM retraining. Diaphragmatic breathing exercises were done in lying and sitting positions, for the purpose of achieving abdominal muscle relaxation. PFM retraining consisted of...

Annals of Physical and Rehabilitation Medicine, 2018

Annals of the Rheumatic Diseases, 2014

Background Total knee replacement (TKR) revolutionized management of patients with advanced knee ... more Background Total knee replacement (TKR) revolutionized management of patients with advanced knee osteoarthritis and rheumatoid arthritis, in order to help them overcome pain and functional limitation, with very good long-term results. Objectives Our aim was to estimate efficiency of the comprehensive early rehabilitation and physical therapy program following TKR, and to compare results between two categories of patients (OA and RA) related to pain, functional state and overall quality of life. Methods Prospective clinical study included 60 female patients 45-77 years old (33 with advanced knee OA and 27 with RA) assigned for TKR. All patients received cemented knee endoprostheses and were involved afterwards in 3 weeks rehabilitation program at The Rehabilitation Clinic, Nis, which included kinesy and occupational therapy, low frequency pulsed magnetic field and interferential currents. Patients were evaluated with two health-related quality of life questionnaires- The Womac (Western Ontario and Mc Master Universities Index of Osteoarthrosis) and modified SF 36 (Short-Form Health Survey) prior to surgery and 1, 3 and 6 months after. Patients' functional state was additionally estimated by measuring BMI, knee diameter, ROM, muscle strength of the quadriceps and hamstrings. SPSS software was used for the statistical analyses. Results Both questionnaires WOMAC and SF-36 showed significantly better outcome results for all the patients 6 months after the surgery considering pain, stiffness, mobility and active participation of daily living activities and self care (p=0.000001), while the covariance analyses showed significant differences between OA and RA patients for almost every score analyzed. OA patients amended more due to the physical function, vitality, active participation in daily living activities and general health postoperatively (p<0.001). Although there was no significant difference for pain presence postoperatively between two categories of patients, RA patients achieved larger improvement due to pain reduction because of the worse preoperative results (p=0.001). Better preoperative functional status guaranteed superior postoperative results. BMI was not a clinically important predictor of outcome. Conclusions Early rehabilitation and physical therapy program after TKR significantly improved pain reduction, functional state and quality of life in patients with OA and RA. All TKR patients need to be included in the physical therapy and rehabilitation program during the early postoperative period in order to achieve ROM necessary for everyday activities, functional, economic and enduring gait. References Singh JA, Lewallen DG. Better functional and similar pain outcomes in osteoarthritis compared to rheumatoid arthritis after primary total knee arthroplasty: a cohort study. Arthritis Care Res (Hoboken). 2013 Dec;65(12):1936-41. Judge A, Arden NK, Cooper C, Kassim Javaid M, Carr AJ, Field RE, Dieppe PA. Predictors of outcomes of total knee replacement surgery. Rheumatology (Oxford). 2012 Oct;51(10):1804-13. Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidaurreta I. Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoarthritis Cartilage. 2007 Mar;15(3):273-80. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4638

Facta Universitatis, Series: Medicine and Biology, Feb 9, 2017

The incidence of hearing loss in patients with rheumatoid arthritis (RA) and the treatment have b... more The incidence of hearing loss in patients with rheumatoid arthritis (RA) and the treatment have been differently reported. The aims of this study were to establish the presence and to differentiate the type of hearing loss in patients with RA, and to investigate the results of corticosteroid and methotrexate treatment on hearing loss in RA. Longitudinal, prospective study included 87 patients aged between 18 and 70 years diagnosed with RA. Disease Activity Score (DAS 28 Se) and Health Assessment Questionnaire (HAQ) were measured. 38 Patients were treated with prednisone; intratympanic appliction was used in 11 persons, and in case of weak or absent improvement after steroids methotrexate was applied for further treatment. Predominantly sensorineural hearing loss was present in 56.3% of the patients, without correlation with the duration of disease and clinical activity of RA. Corticosteroid therapy, both peroral or intratympanic contributed to hearing improvement in 60.0%. Audiometric tests are recommended in patients who suffer from RA in order to control hearing in rheumatoid arthritis and analyze the effect of proposed therapeutic procedures.

Pelvic Floor Dysfunction - Symptoms, Causes, and Treatment, 2022

Dysfunctional voiding is a functional voiding disorder characterized by an intermittent uroflow r... more Dysfunctional voiding is a functional voiding disorder characterized by an intermittent uroflow rate due to involuntary intermittent contractions of the striated muscle of the external urethral sphincter or pelvic floor muscles (PFMs) during voiding in neurologically normal children. Symptoms include voiding difficulties as well as urgency, voiding frequency and, in some instances, urinary incontinence and/or nocturnal enuresis. Recurrent urinary tract infections, chronic constipation and/or fecal incontinence and vesicoureteral reflux (VUR) contribute to this condition. Urotherapy is the mainstay of the treatment. It starts with education and demystification and simple behavioral modifications. Specific measures include PFM exercises with various forms of biofeedback concentrating at the recognition of PFM function and their relaxation. However, the PFMs are part of the abdominal capsule and they act in coordination with lower abdominal muscles. These muscles need to be relaxed dur...

Objective: Lumbar stabilization exercises aim to activate and strengthen the deep abdominal and b... more Objective: Lumbar stabilization exercises aim to activate and strengthen the deep abdominal and back muscles. Exercise program presented in this study combines activation of specific lumbar stabilizing muscles with traditional strengthening and stretching exercises. The main goal of this study was to establish the effect of stabilization exercises on pain reduction and improving functionality in patients with Chronic Low Back Pain (CLBP). Materials and Methods: This prospective randomized clinical study was conducted in the Clinical Center Nis, from January 2007 until March 2009. 160 patients with CLBP were eligible and met the inclusion criteria. The study group (S; n=100) had specific lumbar stabilization exercises, while the patients in the control group (C; n=60) performed traditional program for CLBP, based on the strengthening and stretching of the large, superficial back muscles. For monitoring the patients, the Oswestry Disability Index (ODI) and Short-form 36 (SF-36) were u...

Urology, 2020

OBJECTIVES To assess efficacy of combined pelvic floor interferential (IF) electrical stimulation... more OBJECTIVES To assess efficacy of combined pelvic floor interferential (IF) electrical stimulation and muscle exercises on bladder bowel dysfunction (BBD) in children. MATERIALS AND METHODS A total of 34 children with BBD (6 boys, 28 girls; mean age 7.4±2.2) were included in this study. Children were evaluated with kidney and bladder ultrasounds, uroflowmetry + electromyography (EMG), and a complete voiding and bowel habit diary before treatment. Exclusion criteria were neuropathic disease, anatomical defects and mental retardation. Participants were randomly allocated into two treatment groups including group A (n=17) who underwent IF electrical stimulation in addition to pelvic floor muscle (PFM) exercises and group B (n=17) who received PFM exercises alone. All children were re-evaluated by kidney and bladder ultrasounds, uroflowmetry + EMG and a voiding and bowel habit diary at the end of treatment sessions and 6 months later. RESULTS Constipation improved in 14/17(82%) and 8/17(47%) children in group A and B respectively at the end of treatment sessions (P=0.03). Daytime incontinence improved in all children in group A and 2/8(25%) children in group B after the treatment (P=0.007). Urinary tract infection improved in 8/10(80%) and 5/13(38.4%) children in group A and B respectively, 6 months after the treatment (P=0.02). No significant difference was observed in uroflowmetry measures between two groups after the treatment. CONCLUSION Combination of IF electrical stimulation and PFM exercises is an effective and safe modality for treatment of BBD in children.

Facta Universitatis, Series: Medicine and Biology, Jan 19, 2017

Stroke can have different clinical characteristics and consequences, with unequal disability and ... more Stroke can have different clinical characteristics and consequences, with unequal disability and outcome, thus demanding individual approach, specific skills and general knowledge. Treatment of stroke has significantly improved during the last twenty years, mainly because of clinical and experimental studies, adequate medicamentous therapy, and the use of new technologies as well. Use-dependent rehabilitation strategy includes repetitive training with proper adjustment of the program. Other rehabilitation practices should also be incorporated, such as self-care, recreation, and home-based activities. Motivation of the patients, improving quality of life, functional independence, activities of daily life are crucial. Holistic approach means that the patient as a whole should be considered and treated. Scientific evidence is sufficient to confirm the necessity of physical rehabilitation of patients after stroke in order to achieve the optimal results. Current evidence on the effect of physical therapy in stroke rehabilitation is presented.

Acta Medica Medianae, Mar 15, 2018

The number of candidates for total hip replacement (THR) is steadily increasing. Judging by the c... more The number of candidates for total hip replacement (THR) is steadily increasing. Judging by the clinical results and implant longevity, THR is one of the most common and most successful orthopedic interventions of all times. Material, design, surgical techniques and subsequent rehabilitation continue to evolve. Choice of the prosthesis and fixation technique depends on the patients' bone structure and joint stability and their individual characteristics, such as age, weight and level of activity. Rehabilitation after THR is as important as the surgery. Rehabilitation protocols vary with the type of endoprosthesis. There is some controversial evidence about the differences in the surgical approach, the role of the preoperative education and exercises, as well as the implementation of the most efficient rehabilitation protocol. Despite many uncertainties and dilemmas, most studies have shown that majority of patients are satisfied with their arthroplasty results.

Journal of Rehabilitation Medicine, 2020

Vojnosanitetski pregled, 2018

Journal of Psychology Research, 2011

Calculia is considered to be the ability of performing arithmetic operations, the preconditions f... more Calculia is considered to be the ability of performing arithmetic operations, the preconditions for the development of mathematical skills in the complex functioning of psychological functions represented in neuro-anatomical systems, as well in the interaction with the environment. Problems in acquiring arithmetic skills can be described as difficulties in counting as well as developmental dyscalculia. Reported prevalence rate for this problem in general population is 6%-10%. The most common difficulties in counting are: difficulties in logic, difficulties in planning, perseverance of inappropriate (responses) procedures and poor understanding of arithmetic operations. This paper aims to identify the influence of assessed arithmetic skills and to clarify to what extent the assessed cognitive skills affect each other in children with difficulties in counting. The relations between the level of working memory and acquiring of arithmetic skills, between the attention and the conceptual observation, and also between planning ability and acquiring of arithmetic skills have been assessed within the study goals. The tested sample consists of 84 third-grade pupils of general population divided into an experimental and a control group. The subjects of the experimental group were chosen according to the discrepancy between general intellectual competences, general achievement at school and success in the filed of mathematics expressed by school marks. Following tests of neuropsychological test battery were used: (1) Taylor's word list-Rey test; and (2) Trail-making-TMTa/b test. The results have been analyzed regarding qualitative test results, as well as the aspect of previous knowledge in the studies dealing with dyscalculia. The results of the studies indicate that there is statistically a significant difference in effectiveness of assessed cognitive characteristics of working memory, attention and planning abilities between experimental and control group (sample) (p < 0.01). The subjects of experimental group, i.e., those with difficulties in counting and the results given, show that there is poor effectiveness but positive connection of moderate intensity among assessed cognitive characteristics (p < 0.01).