The clinical use of impedance field telemetry heat maps at the rehabilitation stage of cochlear implantation

The objective of the present publication was to demonstrate changes in the socio-psychological status of the children with cochlear implants in the course of postoperative psycho-pedagogical rehabilitation. Another objective was to draw attention to the necessity of the acquisition of the new professional skills by the teachers of the deaf and hard of hearing subjects, speech and language pathologists. Special attention is given to the substantiation of dynamic psycho-pedagogical classification of the children with a cochlear implant that should reflect the process of professional reorientation of the aforementioned specialists in the course of rehabilitation of their patients.

INTRODUCTION. The widespread use of total hip arthroplasty (THA) places high demands on the restoration of a normal gait pattern and is one of the key goals of rehabilitation. AIM. Determination of key parameters of walking in patients after THA to assess the effectiveness of restoration of the physiological gait pattern. MATERIALS AND METHODS. In a control prospective study, the main group consisted of 23 patients (11 men, 12 women, aged from 41 to 75 years, mean age 63.9 ± 9.4 years), who in the first 8 weeks after planned THA, moved with the help of assistive devices. supports (two crutches or walkers) who underwent stage II of medical rehabilitation; control group — 27 healthy people (12 men and 15 women, aged from 42 to 73 years, average age 60.9 ± 9.9 years). Spatiotemporal and kinematic gait parameters were recorded before and after the rehabilitation course using a gait simulator with biofeedback equipped with three sensors. For each leg, spatiotemporal and kinematic biomechanical parameters were separately recorded. RESULTS. All spatiotemporal gait parameters on both limbs and pelvic mobility in the sagittal plane in patients in the early recovery period after THA before the start of the rehabilitation course are significantly different from healthy people. After a course of rehabilitation, the studied gait parameters approach physiological values. The main asymmetry is observed in the single support phase from 16 % at the beginning of the course, to 10 % at the end; sagittal pelvic mobility are 2 times higher than the physiological normal meaning at the beginning of the course, without significant changes in dynamics. DISCUSSION. Disturbances in the gait pattern are observed in the majority of patients undergoing THA. Step symmetry is one of the significant parameters of walking, according to which the primary global assessment of its quality is carried out. Asymmetry of the single support phase of the limbs is a natural development of compensatory motor reactions after endoprosthetics. CONCLUSION. The gait parameters “step frequency” and “step cycle” quickly change after a course of rehabilitation and can be used to assess the locomotor activity of patients during short courses of medical rehabilitation in the early recovery period. Indicators of stance and swing phases, their symmetry changes much more slowly, can serve as criteria for assessing the effectiveness of measures taken at the stages of rehabilitation in the dynamics of gait restoration.

Electroencephalographic and posturographic characteristics were studied in 26 patients with severe craniocerebral injury (CCI) in the course of rehabilitation. Comparison of electroencephalographic and clinical data with posturographic indices revealed the informative value of the latter for the assessment of the recovery of postural control in patients with consequences of CCI during their rehabilitation. The posturographic indices of patients differed from the relative normal values of these characteristics; their specific changes were also observed during recovery of vertical posture maintenance with and without visual control at different rehabilitation stages. It was shown that visual afferent inflow is more important for the recovery of postural control in early periods after CCI, whereas the role of proprioceptive inflow increases at later stages of rehabilitation. Coordination of changes in the EEG and postural characteristics in the course of patient rehabilitation was demonstrated. These findings suggest that the proposed approach can be useful in dynamic assessment of the state of patients with consequences of CCI.

To describe clinical observations of patients with syndromic deafness. Deaf patients with CHARGE, Crouzon, and Wildervanck syndromes were monitored at the Russian Research Clinical Center for Audiology and Hearing Rehabilitation (Moscow) in different years. All of them were diagnosed having bilateral congenital deafness. After collecting anamnesis, evaluating the results of computed tomography of the temporal bones, and audiological examination, it was decided to conduct the cochlear implantation. The only method that allows patients with bilateral congenital deafness to gain hearing is the cochlear implantation. The malformations of the tympanic cavity structures, an abnormal course of the facial nerve canal lead to technical difficulties during the surgical stage of cochlear implantation. The navigation equipment, monitoring of the facial nerve makes it easier to find anatomical structures, as well as to avoid injuries.

We present the results of qualitative research on mothers’ experiences of stages of cochlear implantation. The research covers all stages from suspicion on a hearing disorder to sustainable results of rehabilitation. On each stage, we have highlighted key features of the experience and factors hampering or facilitating the process. Factors hampering the process include improper diagnosis presentation, fears of the child’s health deteriorating as a result of surgery, lack of qualified rehabilitation supervision, and unrealistic expectations during the rehabilitation. Factors facilitating the process include proper diagnosis presentation, emotional support within the family, adequate rehabilitation, success during lengthy rehabilitation, etc. The results show that living through all the stages of cochlear implantation is a critical life situation that requires mothers to change their values and interpretations. We revealed that parents whose children go through cochlear implantation are highly traumatized, the trauma is especially related to the stages of diagnosis establishment and rehabilitation, the latter of which is linked with expectations of positive results of this gradual process.

Ischemic stroke (IS) is the leading cause of neurological inpatient care, readmission, and long-term disability. Until now, there is no single point of view on when the second stage of medical rehabilitation after an IS should be started and the amount of the rehabilitation activities.Objective: to compare the effectiveness of the course of motor rehabilitation during the first 30–90 days and 91–180 days after IS.Patients and methods. The patients were divided into two groups: group 1 included 44 patients in whom ≤3 months passed from IS onset, and group 2–39 patients in whom >3 but <6 months have passed since the IS onset. All patients included in the study received physiotherapy exercises, simulator exercises, robotic mechanotherapy, physiotherapy, massage, speech therapy, cognitive training, and secondary IS prevention.Results and discussion. In both groups patients got a positive treatment result: a significant increase in muscle strength, gait stability, quality, and speed. The number of patients who achieved independence (≤2 points on the Rankin scale) before the start of the rehabilitation course among patients of group 1 was 9.4%, after the end of the course – 40.6%. More initially independent patients were included in the group 2 – 28.6%; after a course of rehabilitation, the proportion of independent patients increased to 35.7%.Conclusion. Rehabilitation courses are effective in patients who have had IS, both in the first three months and in the period from the 4th to the 6th month. It is advisable to conduct the second stage of medical rehabilitation earlier after a stroke.

Objectives: The cochlear implant (CI) recipients and their families form an integral part of the CI team. The decision about CI is challenging for parents and their support is essential during rehabilitation. The families should have realistic expectations from the implantation, as unrealistic expectations cause frustration, negatively impacting the outcome. This study aimed to translate and validate the parental expectation questionnaire by evaluating the outcomes of their children after CI in the Saudi population. Materials and Methods: A questionnaire-based study was conducted at a tertiary hospital from June 2018 to July 2019. Altogether, 100 parents of children undergoing CI answered a questionnaire of 18 questions regarding the expectation of their child's performance and refilled it after a year of surgery. All healthy prelingual pediatric patients accepted by the CI committee for bilateral CI with at least 1 year follow-up postoperatively were included in this study. The main outcome measures were parents' awareness and expectation about CI. Results: The study showed parents having high expectations from their children with CI. The parents were more aware about the rehabilitation demands and stress after CI surgery with 16% of parents unaware of the importance of the rehabilitation process. Conclusions: Proper counseling on realistic expectations should be given at different implantation stages; pre- and post-implantation for an improved outcome and helping the child in reaching full potential.

There are a large number of publications confirming the clinical safety of the of physiotherapy application in patients with malignant neoplasms of the breast, but scientific studies on the physical factors complex use in medical rehabilitation of this group of patients in the early postoperative period have not been published yet. Aim. To determine the effectiveness of fluctuating currents in combination with pneumocompression, general magnetotherapy, local magnetotherapy, low-temperature argon plasma applied for patients after radical surgical treatment of breast cancer in the early postoperative period. Material and methods. A prospective, simple, randomized study involving 190 women diagnosed with breast cancer in the early postoperative period after radical Madden mastectomy or radical breast resection (2–4 days) was performed, the average age was 58±10.61 years. The control group consisted of patients included in the course of rehabilitation (exercise therapy, balance therapy and classes with a medical psychologist) fluctuating currents. Low-temperature argon plasma, intermittent pneumocompression, general and local magnetotherapy were added to fluctuations for patients in the main groups. Results and discussion. The analysis of the clinical and functional data showed that in the early postoperative period for breast cancer against the background of the standard drug therapy and the course of medical rehabilitation, the combination of fluctuating currents with intermittent pneumocompression, general and local magnetotherapy significantly reduced the degree of the upper limb edema and the volume of lymphorrhea. The addition of general and local magnetotherapy affects the decrease in the indicators of the shoulder girdle and forearm muscles electrical excitability. Low temperature argon plasma improves the regeneration of the postoperative suture and reduces swelling and inflammation in this area. The dynamics of the decrease in the level of anxiety and depression, pain syndrome and the general condition of cancer patients are most pronounced in the groups that additionally received magnetotherapy. The volume and quality of movements, muscle strength significantly increased in all groups without differences in results. The action of magnetic fields contributes to the increase of tissue oxygenation, due to which an anti-inflammatory and decongestant effect is realized. Fluctuation of the shoulder girdle and forearm muscles leads to normalization of the functional electrical excitability of the muscles by surgical treatment, which allows to restore the motor stereotype of the limb in a short time, and intermittent pneumocompression affecting the skin and tissue structures of the lower extremities and trunk improves the overall lymph flow, which does not lead to stagnation of lymph in the operated area. Conclusion. Thus, the combined application of physical factors against the background of the standard drug therapy and the course of medical rehabilitation significantly improves the result and recovery time after surgical treatment of the breast cancer in the early postoperative period. A comprehensive approach to medical rehabilitation at the I stage led to the preservation of results in the long-term period 1.5 and 6 months after the operation without adverse events.

To assess the quality of life and efficacy of telemedicine technologies for rehabilitation after total hip replacement.The study included 60 patients aged 40-75 years after total hip replacement. All patients were divided into two groups by simple randomization. All patients underwent a 7-day course of complex in-hospital postoperative rehabilitation. At discharge, patients of the main group received an access to telemedicine program for 3-month physical exercises (3 times a week for 30 minutes). In the control group, patients received routine recommendations for rehabilitation procedures and orthopedic recommendations.A course of rehabilitation with telemedicine technologies after total hip replacement was accompanied by significant clinical effect according to EQ5D, SF-36 and STAI questionnaires.Elemedicine technologies in postoperative rehabilitation after total hip replacement are accompanied by QoL improvement. It is an effective form of medical rehabilitation.Маршрутизация пациентов после хирургических вмешательств, особенно ортопедического профиля, предполагает проведение этапной реабилитации в послеоперационном периоде, при этом важность восстановительного лечения для этой категории пациентов не вызывает сомнений. Пребывание пациентов после тотального эндопротезирования тазобедренного сустава (ТЭТС) в раннем послеоперационном периоде в хирургическом стационаре составляет в среднем от 3 до 5 сут, после чего пациенту показано проведение второго и третьего этапов реабилитации. Однако часто в силу ряда парамедицинских аспектов не все пациенты имеют возможность пройти как раннюю реабилитацию в условиях круглосуточного реабилитационного стационара, так и третий этап амбулаторной реабилитации, предполагающий посещение специализированных реабилитационных центров. В связи с этим телемедицина как стремительно развивающееся направление в организации медицинской помощи населению, позволяющая дистанционно проводить не только консультации, но и целый ряд процедур медицинской реабилитации, в том числе двигательную терапию, может явиться хорошей альтернативой рутинному восстановительному лечению пациентов.Оценка качества жизни пациентов и эффективности телемедицинских технологий для реализации программ восстановительного лечения после ТЭТС.В исследование были включены 60 пациентов после ТЭТС в возрасте от 40 до 75 лет, которые методом простой рандомизации были разделены на две равночисленные группы (основную и контрольную). Пациенты обеих групп проходили восстановительное лечение, которое включало курс комплексной ранней послеоперационной реабилитации в условиях круглосуточного стационара продолжительностью 7 сут. На этапе выписки из стационара пациенты основной группы для продолжения реабилитации получали доступ к телемедицинской программе, включающей удаленное проведение лечебной гимнастики с инструктором ЛФК (30 мин, 3 раза в неделю, продолжительность курса 3 мес). Пациенты контрольной группы получали рутинные рекомендации по выполнению процедур двигательной реабилитации и ортопедические рекомендации в письменной форме.Проведение курса двигательной терапии на третьем этапе реабилитации в форме телемедицинских технологий у пациентов после ТЭТС сопровождалось достоверно более выраженным по сравнению с контрольной группой клиническим эффектом, оцениваемым по шкале качества жизни EQ-5D, опроснику SF-36 и тесту тревожности Спилбергера.Применение телемедицинских технологий в послеоперационной реабилитации пациентов после эндопротезирования тазобедренного сустава сопровождается положительной динамикой показателя качества жизни и является эффективной формой оказания помощи при медицинской реабилитации.

Introduction. Patients who have suffered pneumonia caused by COVID-19, after discharge from the hospital and return to normal life, face violations of the function of external respiration, limitations of physical performance, social and psycho-emotional functioning. The importance of rehabilitation during COVID-19 has been emphasized by the World Health Organization, the main purpose of which is to improve respiratory symptoms, preserve functions and reduce complications, as well as prevent disability. The aim of our study is to evaluate the effectiveness of rehabilitation measures in those patients who have undergone COVID-19. Materials and methods. A descriptive retrospective study. The case histories of patients who have passed all stages of rehabilitation after COVID-19 for one year in 3 organizations of the city of Almaty have been studied. The study included patients who had completed three full stages of rehabilitation. Of all 150 people, only 55 have passed the 3rd stage of medical rehabilitation. The recovery program after COVID-19 was developed individually. The rehabilitation plan included physical therapy, kinesiotherapy, massage, physiotherapy, mechanotherapy, psychological correction. The effectiveness of rehabilitation measures was assessed on the basis of specific scales and functional tests. Results. The indicator of the rehabilitation routing scale in patients who underwent COVID-19 after a course of rehabilitation significantly increased. According to the modified MRC dyspnea scale, an average degree of 2 points was determined in all 55 patients, after the course it turned into a mild degree of 1 point. According to the functional test of a six-minute walk, functional class II was determined in all patients before rehabilitation, after class I. Before rehabilitation, the Barthel Index was determined at an average of 75 points, after 90 points. The Saturation Index before the courses was determined at an average of 90 percent, after 97 percent. Conclusion. All indicators increased statistically significantly after, which confirms the effectiveness of passing all stages of medical rehabilitation for patients who have undergone COVID-19. Кіріспе. Ауруханадан шыққаннан кейін және қалыпты өмірге оралғаннан кейін COVID-19 туындаған пневмониямен ауыратын науқастар сыртқы тыныс алу функциясының бұзылуына, физикалық өнімділіктің, Әлеуметтік және психоэмоционалды жұмысының шектеулеріне тап болады. Дүниежүзілік денсаулық сақтау ұйымы COVID-19 кезінде оңалтудың маңыздылығын атап өтті, оның негізгі мақсаты тыныс алу белгілерін жақсарту, функцияларды сақтау және асқынуларды азайту және мүгедектіктің алдын алу болып табылады. Мақсаты. COVID-19 жұқтырған науқастарда оңалту шараларының тиімділігін бағалау. Материалдар мен әдістер. Зерттеу дизайны сипаттамалық ретроспективті зерттеу болып табылады. Алматы қаласының 3 ұйымында бір жыл ішінде COVID-19-дан кейін оңалтудың барлық кезеңдерінен өткен пациенттердің ауру тарихы талданды. Зерттеуге оңалтудың үш толық кезеңінен өткен пациенттер енгізілді. Барлық 150 адамның 55-і ғана медициналық оңалтудың 3-ші кезеңінен өтті. COVID-19 қалпына келтіру бағдарламасы жеке әзірленді. Оңалту жоспарына физиотерапия, кинезиотерапия, массаж, физиотерапия, механотерапия, психологиялық коррекция кірді. Оңалту шараларының тиімділігі арнайы шкалалар мен функционалдық тестер негізінде бағаланды. Нәтижелер. Оңалту курсынан кейін COVID-19 жұқтырған науқастарда оңалтуды бағыттау шкаласының көрсеткіші айтарлықтай өсті. Модифицирленген MRC ентігу шкаласына сәйкес, барлық 55 пациенттің орташа дәрежесі болса, курстан кейін ол жеңіл дәрежеге ауысты. 6 минуттық жаяу жүру функционалдық тестінің мәліметтері бойынша барлық пациенттерде оңалтуға дейін функционалдық II класс, кейін I функционалдық класс анықталды. Оңалтуға дейін Бартел индексі орта есеппен 75 балл, кейін 90 балл деңгейінде анықталды. Курс алдында сатурация көрсеткіші орта есеппен 90 пайыз болса, курстан кейін 97 пайыз анықталды. Қорытынды. Оңалтудан кейін барлық көрсеткіштер статистикалық тұрғыдан айтарлықтай өсті. Бұл COVID-19 жұқтырған пациенттердің медициналық оңалтудың барлық кезеңдерінен өту тиімділігін растайды.

To report residual hearing preservation outcomes in patients with low frequency hearing, after cochlear implant (CI) electrode insertion with two types of electrode arrays: one straight and other perimodiolar, when using intraoperative intracochlear electrocochleography (ECochG) during (CI) electrode insertion. Prospective, randomized study. Tertiary referral otology center. Fifteen patients ranging from 33 to 54 years old (mean 51.19). They had been diagnosed with a bilateral, profound sensorineural hearing loss and treated with a unilateral cochlear implant: eight of them with the CI532 and seven of them with the CI522 (Cochlear Ltd, Sydney, Australia). Pure-tone audiometry was performed preoperatively and at 1 and 6 months postoperatively. Interoperatively, intracochlear ECochG was performed using the apical-most electrode. The amplitude of the first harmonic was plotted and monitored in real time by the audiologist-surgeon team during their CI electrode insertion. The different ECoch patterns of the insertion track were recorded and analyzed. In 12 cases ECochG responses were successfully recorded. In three cases no ECochG responses could be recorded with no residual hearing observed postoperatively in two of them. With respect to the first harmonic amplitude changes, we found: four cases with an overall increase in amplitude measured from the beginning of insertion until completion, all of them showed residual hearing (<15 dB HL) at 6 months postoperation. Three cases with an increasing amplitude at the beginning of insertion, with a decrease in amplitude as insertion progressed to completion, in two cases dropping of residual hearing (15-30 dB HL) were observed after 6 months postoperation and, in one case, complete residual hearing was observed at 6 months postoperatively. And finally five cases presented amplitudes at the start of insertion with modifications of amplitude during the insertion dynamic, with increasing and descending in amplitude range during the whole insertion, two of them showed residual hearing at 6 months postoperation and three cases a drop of residual hearing (15-30 dB HL) was observed after 6 months postoperation. No statistical differences between CI532 and CI522 electrodes were found. Data of the ECochG responses are also presented (p value ≥ 0.05). ECochG is a useful tool to evaluate the residual hearing in CI patients with straight and perimodiolar cochlear implant. More studies are needed to fully understand the relationship between ECochG and the presence of residual hearing, cochlear trauma, and functional outcomes.

INTRODUCTION:The State Program for Health Development of the Republic of Kazakhstan (RK) “Densaulyk” for 2016–2019 initiated the modernization of primary health care with the introduction of family practice in order to ensure the availability, completeness and quality of health services on the basis of an integrated healthcare system focused on the needs of the population. The aim of this study was to determine the effectiveness of the cochlear implantation (CI) programs.METHODS:A literature search was conducted for all clinical trials, randomized controlled trials, and reviews in the PubMed, Cochrane, and Center for Reviews and Dissemination databases. Two reviewers independently evaluated all publications for selection. The analysis included the cost-effectiveness and benefit from the CI program.RESULTS:We analyzed the effectiveness of the services for CI in the RK and other countries (1). In our analysis, we identified that there is no research on Quality-adjusted Life Years (QALYs) and Cost-Utility Analysis (CUA) in RK. We found that, in general, the cost of CI and pre-surgical procedures are comparable with other countries. The length of stay in Kazakhstan was much higher (an average of 8 days) compared with other countries (3 days). Also in RK, there were significantly lower prices per hospital day and cost of various consultations. Postoperative costs of other countries consisted of one-third to two-thirds of the total costs for preoperative and implantation stages (2, 3). There was a little information on the effectiveness of rehabilitation programs in RK.CONCLUSIONS:Economic research like QALYs and CUA are new directions in the healthcare system in the RK. Lack of integration between primary care, rehabilitation and other services leads to difficulties in assessing the effectiveness of CI programs (for example, in our case, there was the restriction of assessment in only postoperative costs).

At the present stage of medical development, cochlear implantation is the optimal method of auditory and speech rehabilitation for patients with binaural deafness. Congenital cytomegalovirus infection, according to Russian and international scientific literature, is one of the two most common causes of congenital deafness. At the same time, its relevance in cochlear implantation is due not only to its high incidence among patients, but also to the influence on surgical procedure and the final results of hearing and speech rehabilitation. The surgery stage of cochlear implantation in patients with cytomegalovirus infection, due to a number of circumstances, requires individual technical procedure. The most significant thing in this context is the phenomenon of frequent preservation of natural hearing residues at low frequencies, requiring careful and accurate preservation. Moreover, due to the pathogenetic effect of an infectious agent, such patients have a high risk of intraoperative bleeding. Therefore, the most important goal is to prevent the penetration of blood cells into the lumen of the cochlear spiral canal in order to prevent damage to the cochlear sensory structures. However, to date, all the proposed methods of performing surgery in such patients have a number of limitations and do not in all cases meet all the requirements of efficacy and safety. In this regard, on the basis of the St. Petersburg Research Institute of Ear, Throat, Nose and Speech, an original surgical technique was developed for cochlear implantation in patients with cytomegalovirus infection. This technique most significantly meets the requirements of hearing-safe surgical techniques when performing cochlear implantation.

In recent decades, a lot of attention has been paid to the etiological and pathophysiological factors of hearing loss in the international scientific literature. However, most of the conducted research is devoted to fundamental issues of genetics, immunology, or biophysics. Meanwhile, the papers concerning the applied audiology are in a relatively smaller, scarce quantity. In this publication, we have tried to highlight the practical aspects of the cochlear implant speech processor fitting in patients with the most common infectious etiology of congenital deafness – cytomegalovirus infection. The study included 50 patients with this pathology who underwent the speech processor initial activation and subsequent aural rehabilitation courses at the Saint Petersburg Research Institute of Ear, Throat, Nose, and Speech from 2021 to 2023. We found out that this category of patients has its own characteristic features of not only surgical but also rehabilitation stage of cochlear implantation. We tried to reflect our experience in choosing the strategy and parameters of electrical signal stimulation and to highlight the most important details in the organization of pedagogical, speech therapy, and medical activities.

In recent years, there has been a trend toward more individualization in the fitting of cochlear implants (CI). Here, a new individualized approach to frequency band allocation was used. This approach is based on binaural perceptual pitch matching. The patient had congenital bilateral progressive sensorineural hearing loss due to Usher Syndrome. He had used hearing aids in both ears since the age of 4 years. In his mid-40s, he received a CI on his right ear and, ten months later, a second CI on the left ear. Adjustments to the frequency band allocations were made, guided by the binaural perceptual pitch matching of piano notes. For the first CI, pitch matching was performed using the contralateral ear as the reference, which had preserved low-frequency residual hearing (bimodal pitch matching). For the second CI, pitch matching was performed using the first implanted side as the reference (bilateral electrical pitch matching). The final frequency band allocation adjustments were always shifted toward lower frequencies relative to the default band allocations. The adjustments were larger in magnitude for the second CI compared to the first CI. Speech perception scores generally increased over the course of rehabilitation and were higher with the individualized fitting compared to the default fitting. The subjective sound quality was reportedly greatly improved with the individualized fitting. Individualized psychoacoustic frequency-based fitting can yield improvements in the perceived sound quality with a CI. However, this method requires significant residual hearing in at least one ear, and the patient must have relatively fine pitch discrimination abilities.