Ivet Borissova Koleva
Medical University, Bulgaria
Biography
Ivet Borissova Koleva is a Medical Doctor, specialist in
Neurology and in Physical & Rehabilitation Medicine
(PRM) with 30 years of clinical practice in the domain
of Neurorehabilitation. She has completed a PhD
thesis on Physical Prevention and Therapy of Diabetic
Polyneuropathy and a thesis for Doctor of Medical
Sciences on Neurorehabilitation in patients with socially
important neurological diseases. She received the titles of
Associate professor (2006) and Professor (2010) in PRM.
Currently, she is serving as a Professor in the Medical
University of Sofia, Bulgaria. She is also the consulting
PRM specialist of several university hospitals, including
the National Heart Hospital of Sofia (Cardiorehabilitation
Department). She is the author of scientific papers,
monographs and manuals in the fields of Physical Medicine
and Rehabilitation, occupational therapy, Grasp and Gait
rehabilitation, functional evaluation, pain management. She
is the Member of national and international associations
of PRM and President of Bulgarian Neurorehabilitation
Society and Editor-in-chief of the Bulgarian scientific journal
Neurorehabilitation (since 2006).
Abstract
Introduction: After valve replacement cardiosurgery (with extracorporeal
circulation), some patients develop cerebrovascular insufficiency in the vertebrobasilar
system with balance problems or ataxia signs. Our goal was to evaluate
the prevalence of cerebrovascular insufficiency in old patients after cardiac
surgery with extracorporeal circulation and to investigate the possible impact
of balance training in the complex cardiac rehabilitation (CR) algorithm of these
patients.
Material & Methods: We have observed 213 patients after cardiac surgery (7-10
days after aortic, mitral or tricuspid valve replacement). Patients were randomized
into three therapeutic groups (71 per group). The control was done before, during
and at the end of the CR course (of 10 treatment days), and one month after its
end-using a battery of clinical methods and functional scales. In all patients, we
applied a complex cardio-rehabilitation (CR) programme of physiotherapy and
ergotherapy including cardio training, respiratory exercises (predominantly for
external and internal intercostal muscles) and goal-oriented activities (standing
up, walking and climbing stairs). Group (gr) 1, received only this CR programme.
In gr 2, we added balance training exercises. In the next group (gr 3), we applied
additionally coordination exercises for the upper and lower extremities.
Results: The statistical analysis of the results of functional assessments
demonstrated significant improvement of circulatory parameters (response
of arterial tension and pulse to physical activity); upgrade in cardiac functional
parameters (holtercardiography; transthoracic echocardiography /ejection
fraction), enlargement in autonomy (timed up and go test; functional independence
measure–subscales of self-care, transfers and locomotion) in all patients. We
observed bigger amelioration in trunk stability, balance and gait velocity in the
second and the third groups (Tinetti test, Berg balance scale).
Conclusion: Balance training must be obligatory element of cardiorehabilitation
algorithm in patients after cardiosurgery requiring extra-corporeal circulation