Medical convergence technology in the system of comprehensive rehabilitation of children with neurotrauma: our experience of implementation (with case report)

Abstract

BACKGROUND: The annual increase of childhood trauma with severe consequences is 2% per year (WHO, 2020/21). This motivates rehabilitation specialists to search for new technologies and effective approaches. Timely resuscitation, early specialized and comprehensive rehabilitation care largely determine the outcome of a serious injury and prevent serious consequences. In this context, medical convergent technologies used to provide effective medical care become particularly relevant. This article of scientific, methodological and applied nature is devoted to the description of medical convergent technology implemented in the system of comprehensive rehabilitation care of children with severe neurotrauma.
 AIM: The aim of the study was to substantiate and develop an effective rehabilitation technology at the level of unified (convergent) interdisciplinary managerial and clinical-diagnostic medical solutions in rehabilitation of children with severe injuries.
 MATERIALS AND METHODS: Children, aged 2–17, (n=420) with consequences after severe traumatic injuries who were admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (Moscow) for treatment and rehabilitation in 2018–2022 with diagnoses: traumatic brain injury, consequences of spinal cord injury, combined trauma, mine-explosive trauma, severe skeletal trauma, infected extensive wounds. More than 300 of these patients had neurotrauma. The researchers used: literature sources on the discussed problem, findings of objective and subjective examinations (clinical examination, neuroimaging, neurofunctional, laboratory, radiation, instrumental as well as questionnaires, surveys, scales; electronic medical histories). To develop medical convergent technology, rehabilitation diagnosis, potentials and prognostic options according to the decision-making algorithm developed by physicians/specialists as well as differentiated personified rehabilitation programs were used. While developing these programs, the researchers assessed specific features of the injury, disease course, severity and level of functional impairment, activity and participation expressed in the criteria of the International Classification of Functioning, Disability and Health.
 RESULTS: The researchers have enunciated the essence of the medical convergent technology in the rehabilitation of children after severe injuries as convergence, the alliance of interests from different fields, process of integration of traditional and new approaches which are united by a single goal of managing patients after severe traumatic injuries.
 CONCLUSION: An interdisciplinary/multidisciplinary approach with medical convergent technology component in restoring children after severe trauma allows to optimize the rehabilitation process and the patient’s routing within this process. Integrity and continuity in management and rehabilitation of injured patients as well as step-by-step approach, help physicians to choose the most effective tactics.