Comprehensive Rehabilitation Program Research Articles

Rehabilitation of cardiological patients with post-COVID syndrome: morphofunctional data report

INTRODUCTION. Post-COVID is a common complication of COVID-19, occurring in more than a third of patients, and condition will persist for more than 3 months after infection with the SARS-CoV-2. AIM. To evaluate impact and potential effectiveness of a comprehensive physical rehabilitation program on health of cardiac patients with complications of a previously suffered new coronavirus infection SARS-CoV-2 COVID-19. MATERIALS AND METHODS. The study involved 128 cardiology patients with post-COVID syndrome. The study participants comprised three groups depending on the 12-week physical rehabilitation program. The effectiveness of rehabilitation was assessed through parameters of cardiopulmonary testing, as well as the 6-minute walk exercise test and the degree of dyspnea according to modified mMRC dyspnea questionnaire. RESULTS. The mMCR index in CPR group was 1.0 [0.0–1.0] point, compared with 2.0 [1.0–2.0] in control and comparative groups (p 0.05); exercise tolerance VO2max increased by 8.3 ± 3.8 % (p 0.05); normalization of heart rate and blood pressure in response to physical activity after 12 weeks in intervention group was 5.0 ± 2.1 % compared to comparative and control groups; 6MWT test results 688 m, in the intervention group, versus 490 m, for participants in control group (p 0.05). DISCUSSION. A comparative analysis of previously conducted studies confirmed pattern between the inclusion of combined cardiorespiratory training in the protocol for 12-week rehabilitation of post-COVID complications among cardiac patients, and a decrease in the degree of shortness of breath, as well as an increase in exercise tolerance. CONCLUSIONS. Based on experimental data obtained, it is advisable to analyze the effects of Cardiopulmonary Physical Rehabilitation program in the framework of larger randomized clinical trials. This will allow a more detailed assessment of the clinical consequences, as well as the ability to adjust mode and dose of physical activity of proposed rehabilitation program.

The effect of audit and feedback and implementation support on guideline adherence and patient outcomes in cardiac rehabilitation: a study protocol for an open-label cluster-randomized effectiveness-implementation hybrid trial

Background Providing secondary prevention through structured and comprehensive cardiac rehabilitation programmes to patients after a myocardial infarction (MI) reduces mortality and morbidity and improves health-related quality of life. Cardiac rehabilitation has the highest recommendation in current guidelines. While treatment target attainment rates at Swedish cardiac rehabilitation centres is among the highest in Europe, there are considerable differences in service delivery and variations in patient-level outcomes between centres. In this trial, we aim to study whether centre-level guideline adherence and patient-level outcomes across Swedish cardiac rehabilitation centres can be improved through a) regular audit and feedback of cardiac rehabilitation structure and processes through a national quality registry and b) supporting cardiac rehabilitation centres in implementing guidelines on secondary prevention. Furthermore, we aim to evaluate the implementation process and costs.MethodsThe study is an open-label cluster-randomized effectiveness-implementation hybrid trial including all 78 cardiac rehabilitation centres (attending to approximately 10 000 MI patients/year) that report to the SWEDEHEART registry. The centres will be randomized 1:1:1 to three clusters: 1) reporting cardiac rehabilitation structure and process variables to SWEDEHEART every six months (audit intervention) and being offered implementation support to implement guidelines on secondary prevention (implementation support intervention); 2) audit intervention only; or 3) no intervention offered. Baseline cardiac rehabilitation structure and process variables will be collected. The primary outcome is an adherence score measuring centre-level adherence to secondary prevention guidelines. Secondary outcomes include patient-level secondary prevention risk factor goal attainment at one-year after MI and major adverse coronary outcomes for up to five-years post-MI. Implementation outcomes include barriers and facilitators to guideline adherence evaluated using semi-structured focus-group interviews and relevant questionnaires, as well as costs and cost-effectiveness assessed by a comparative health economic evaluation.DiscussionOptimizing cardiac rehabilitation centres’ delivery of services to meet standards set in guidelines may lead to improvement in cardiovascular risk factors, including lifestyle factors, and ultimately a decrease in morbidity and mortality after MI.Trial registrationClinicalTrials.gov. Identifier: NCT05889416. Registered 2023-03-23.

Clinical case of complex rehabilitation for post-traumatic myelopathy using Taraskul lake sapropels

BACKGROUND. Post-traumatic myelopathy (combat injury) is a serious condition that leads to severe functional impairment requiring complex rehabilitation based on assessment of functional impairment. The use of sulfide-silt mud is used in sanatoriums of the eastern military district for the rehabilitation of patients with pathology of the musculoskeletal system according to generally accepted methods. Lake Bolshoi Taraskul in the Tyumen region is a natural reservoir of sapropels with unique biological properties. AIM. Show on the example of a clinical case the results of an integrated approach in the rehabilitation of a patient with post-traumatic myelopathy as a result of combat trauma, implemented on the basis of an individual. CASE DESCRIPTION. Patient, 32 years old, with post-traumatic myelopathy due to spinal injury. Upon admission, the indicators: rehabilitation routing scale — 5 points, Revermid mobility index — 4 points, Ashforth spasticity scale — 3 points, ASIA scale — B, FIM functional independence scale 99 points. Initially, the patient is transferred from the chair to the couch with minimal support, sits without additional support for more than 5 minutes, verticalization of the patient only using high support (high walkers). The comprehensive rehabilitation program included physiotherapy, hydrokinesotherapy and peloidotherapy with Lake Taraskul sapropels. As a result of treatment, the patient walks with a support on a walker on a flat surface with rest, walks along the wall with a support on handrails. A patient supported by canes climbs a ladder. CONCLUSION. This clinical case discloses the effectiveness of comprehensive rehabilitation of a patient with post-traumatic myelopathy (combat trauma) with the inclusion of Lake Taraskul in the rehabilitation program for hydrokinesiotherapy and peloidotherapy with sapropels.

The Clinical Management of Electrical Stimulation Therapies in the Rehabilitation of Individuals with Spinal Cord Injuries.

Background: People with spinal cord injuries (SCIs) often have trouble remaining active because of paralysis. In the past, exercise recommendations focused on the non-paralyzed muscles in the arms, which provides limited benefits. However, recent studies show that electrical stimulation can help engage the paralyzed extremities, expanding the available muscle mass for exercise. Methods: The authors provide an evidence-based approach using expertise from diverse fields, supplemented by evidence from key studies toward the management of electrical stimulation therapies in individuals with SCIs. Literature searches were performed separately using the PubMed, Medline, and Google Scholar search engines. The keywords used for the searches included functional electrical stimulation cycling, hybrid cycling, neuromuscular electrical stimulation exercise, spinal cord injury, cardiovascular health, metabolic health, muscle strength, muscle mass, bone mass, upper limb treatment, diagnostic and prognostic use of functional electrical stimulation, tetraplegic hands, and hand deformities after SCI. The authors recently presented this information in a workshop at a major rehabilitation conference. Additional information beyond what was presented at the workshop was added for the writing of this paper. Results: Functional electrical stimulation (FES) cycling can improve aerobic fitness and reduce the risk of cardiovascular and metabolic diseases. The evidence indicates that while both FES leg cycling and neuromuscular electrical stimulation (NMES) resistance training can increase muscle strength and mass, NMES resistance training has been shown to be more effective for producing muscle hypertrophy in individual muscle groups. The response to the electrical stimulation of muscles can also help in the diagnosis and prognosis of hand dysfunction after tetraplegia. Conclusions: Electrical stimulation activities are safe and effective methods for exercise and testing for motor neuron lesions in individuals with SCIs and other paralytic or paretic conditions. They should be considered part of a comprehensive rehabilitation program in diagnosing, prognosing, and treating individuals with SCIs to improve function, physical activity, and overall health.

The Clinical Outcome of Cardiac Rehabilitation in Coronary Artery Disease Patients with Regard to the Presence of Left Ventricular Systolic Dysfunction.

Background: Despite the use of advanced treatment techniques, coronary artery disease (CAD) still remains the main cause of left ventricular (LV) dysfunction and heart failure. Participation in cardiac rehabilitation (CR) programs can lead to a number of beneficial effects, but some patients do not demonstrate the expected improvement. The aim of this study is to evaluate the impact of CR on changes in exercise capacity with regard to the presence of LV dysfunction. Methods: A group of 428 patients with CAD were consecutively admitted to an outpatient comprehensive cardiac rehabilitation program comprising 24 exercise sessions of interval training on cycle ergometers, three times a week for 45 min, and a health education. The patients were compared in two subgroups, i.e., with LV systolic dysfunction (LVEF < 50%, n = 175) and LVEF ≥ 50% (n = 253). Results: In the LVEF < 50% group, the exercise capacity improved by 1 ± 0.78 MET (median 1.15 MET), and 0.86 ± 0.77 MET (median 1.08 MET) in the LVEF ≥ 50% group. Women with LVEF < 50% demonstrated a significant increase in exercise capacity by 1.2 MET, while those with LVEF ≥ 50% did not display any such increase. All men, regardless of LVEF, exhibited a similar improvement in exercise capacity greater than 1 MET. Conclusions: An outpatient eight-week cardiac rehabilitation program based on 45 min aerobic interval training sessions three times a week appears less effective for women with CAD and EF ≥ 50%. In this group, the proposed training intervention is insufficient in improving exercise capacity to an extent that could indicate a reduction in mortality risk.

A Structured Literature Review on the Research and Design of Rehabilitation Environments.

This literature review is conducted to identify knowledge gaps and shape a framework for the development of guidelines and future research on programming and design of rehabilitation environments. Patients suffering from trauma, stroke, neurological or cardiopulmonary conditions, or recovering from surgery or cancer treatment require rehabilitation services. A comprehensive rehabilitation program can support continuum of care for inpatient and outpatient groups. However, within most facilities, rehabilitation environments are found to be outdated and undersized compared to other programs or lack the correct adjacencies within the facility. Unfortunately, this deficiency is echoed by limited guidelines on programming, planning, and design of these environments. General guidelines derived from healthcare environments research is not adaptable to rehabilitation environments, because the paradigm used in most healthcare environment research does not address specific needs of rehabilitation patients in regaining confidence or relearning daily life skills. We conducted a structured literature review, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a basis for reporting the available body of work on evidence-based research in rehabilitation environments. Through analysis of the limited literature, specific mediators such as patient confidence and motivation were identified. An environment that creates a balance between privacy and social interaction can promote these mediators. Creating enriched environments through elements that engage the senses and encourage more social and physical interaction is essential for recovery. Finally, accessibility and wayfinding are of great importance in these environments due to potential limited mobility or cognitive impairments of patients.

EVALUATION OF THE EFFECTIVENESS OF A COMPREHENSIVE PROGRAM OF REHABILITATION OFFERED ACCORDING TO DIFFERENT THERAPEUTIC PROTOCOLS IN REDUCING CHRONIC FRONTAL SYNDROME IN PATIENTS 10-YEARS FOLLOWING NEUROSURGERY FOR POST-TRAUMATIC INTRACEREBRAL HEMATOMA

The aim of the study was to evaluate the effectiveness of a Comprehensive Program of Rehabilitation (CPReh) offered according to different therapeutic protocols in reducing chronic frontal syndrome in patients 10 years following neurosurgery for post-traumatic intracerebral hematoma.Out of 568 adult car accident patients who underwent neurosurgery for post-traumatic intracerebral hematoma between 2004 and 2010 at the Department of Neurosurgery and Neurotraumatology of the Jagiellonian University's Collegium Medicum in Krakow, 90 patients with OFC injury and Chronic Frontal Syndrome were selected for the study. Patients were divided into three groups A, B and C of 30 each, matched for age, gender and injury severity. The Comprehensive Rehabilitation Program (CPReh) (cf. Pąchalska 2008) was applied in all groups ten years after hospitalization and surgery for intracerebral hematoma and was conducted according to three therapeutic Protocols:- Protocol 1 administered in group A, combained cognitive training (CT) and the "Life Academy" program administered twice a week. The activities were continued as long as the patient was able and willing to continue (average 24 months 1.18).- Protocol 2 administered in group B, included CT and the "Academy of Life" program also administered twice a week but lasting for the standard period of about a year (average 12 months 1.03).- Protocol 3 administered in group C, included CT and the "Community Base Treatment" program similarly administered twice a week and also lasting about a year as standard (average 12 months 1.27).Evaluation of the effects of rehabilitation using the Frontal Behavioral Inventory (FBInv) was conducted 2 times: Study I (baseline, 10 years follow up after operation)-before the start of rehabilitation, Study II (follow up) after the end of rehabilitation according to all protocols.all or most of the positive or negative symptoms tested by FBInv, including neurological, cognitive, emotional and behavioral ones. A modified CPReh program administered with Protocol 1. in which combined cognitive training (CT) and the "Academy of Life" program is provided twice a week, but which continues as long as the patient was able and willing to continue, is more effective in reducing these symptoms, like the standard CPReh program administered with Protocol 2 or 3 administered only up to a year as a standard. It was also found that the "Academy of Life " program has also been shown to be a more effective component of CPReh than the Community Base Treatment.The improvement achieved by group A, in which a modified CPReh administered with Protocol 1. that provided the patient the opportunity to continue rehabilitation as long as the patient was able and willing to continue was more effective in the reduction of Chronic Frontal Syndrome than the standard CPReh administered with Protocols 2. and 3. for the patients in groups B and C.

Current treatment methods for hernias and protruded lumbar intervertebral discs: exercise therapy, HILT, hivamat, and SIS therapy

Abstract. This article presents a comprehensive review of literature on four current non-invasive non-drug methods of treating herniated and protruded intervertebral discs: exercise therapy, high-intensity laser therapy (HILT), deep oscillation therapy (Hivamat), and high-intensity magnetic therapy (SIS therapy). The purpose of the literature review is to evaluate the efficacy, safety, and treatment outcomes of each therapy. A review of the available literature, including clinical trials, systematic reviews, and comparative studies, was carried out. The focus is on the effectiveness of each treatment method in reducing pain and improving mobility and overall well-being of patients. The results of the literature review have shown that all four treatment methods are promising for the treatment of herniated and protruded discs. Exercise therapy is effective in the long term in reducing pain and relapse rates. HILT demonstrates rapid pain relief and reduction of inflammation. Hivamat is distinguished by its effectiveness in pain relief and tissue restoration. SIS therapy offers a minimally invasive approach with targeted pain relief. The authors conclude that modern non-invasive treatment methods, such as exercise therapy, HILT, Hivamat, and SIS therapy, are an efficient alternative to traditional methods of treating herniated and protruded intervertebral discs. The results of the analysis indicate a potential shift in clinical practice towards the need to include non-pharmacological methods in comprehensive rehabilitation programs. However, further largescale studies are recommended to better understand their long-term effectiveness and optimal use in clinical settings.

New horizons in comprehensive rehabilitation of melanoma patients: improved outcomes through an integrated approach to immunotherapy

Abstract. The article discusses the importance of a comprehensive rehabilitation approach for melanoma patients when treated with immunotherapy. By focusing on innovative treatments, the study highlights the need to integrate nutritional support, physical therapy, magnetic therapy, and psychological support to improve quality of life and enhance the effectiveness of immunotherapy regimens. Purpose of the study: to evaluate the impact of the multidisciplinary rehabilitation program on physiological functions, psycho-emotional well-being, general antitumor effect, and quality of life of patients with melanoma. Materials and methods. The study included 135 patients diagnosed with melanoma who received a course of immunotherapy. In the study group (the main group), a complex of rehabilitation techniques (magnetic therapy, therapeutic exercises, nutritional support, psychological support) was used, while in the control group, the patients did not undergo the accompanying comprehensive rehabilitation program. Treatment effectiveness was assessed in accordance with iRECIST 1.1 criteria; to assess the quality of life, the Russian version of the EORTC QLQ-C30 questionnaire was used. Results. The patients of the study group showed an improvement in their general physical condition and a decrease in the intensity of some side effects of treatment. The patients in the control group also showed changes in their health status, but they were less pronounced compared to the study group. Adverse events during treatment occurred in 55 % of the patients in the study group and in 74 % of the patients in the control group. The patients in the study group noted an improvement in quality of life by 25 %, while in the patients in the control group this indicator was 12 %. An 18 % improvement in general condition was noted by the patients in the study group, while the patients in the control group noted an 8 % improvement in general well-being. Conclusion. The implementation of the multidisciplinary rehabilitation approach, including nutritional support, therapeutic exercises, magnetic therapy, and psychological support, demonstrates significant improvements in symptom management and quality of life in melanoma patients undergoing immunotherapy.

CONCUSSION REHABILITATION INTERVENTIONS

Sports-related concussions (SRC) are a common injury among athletes. Despite our growing understanding of concussion pathophysiology, comprehensive rehabilitation programs remain a clinical challenge. The accepted view of SRC rehabilitation emphasizes physical and cognitive rest. However, some conflicting studies report rest may facilitate prolonged symptoms. In this review article, we report on alternative SRC rehabilitation strategies to address the complex symptom variations, including physical activity, neuro-visual training, vestibular training, music therapy, speech-language therapy, and hyperbaric oxygen chamber therapy. The mass of published works supports the utility of these alternative therapies to aid recovery, but more research is vital to clarifying these relationships. In this review, we explore the relationships between symptoms and therapies. As there is a growing body of evidence to support these alternative therapies, many questions remain when concerning the role these alternative methods play in the bigger picture of standardizing a thorough SRC rehabilitation program.

Effects of rehabilitation on functional independence in daily life, exercise tolerance and quality of life in patients with relapsing-remitting multiple sclerosis

Objective: to evaluate the efficacy of a comprehensive rehabilitation program on functional independence in daily life, exercise tolerance and quality of life (QoL) in patients with relapsing-remitting multiple sclerosis (RRMS) in remission.Material and methods. 38 patients with RRMS were analyzed (33 women and 5 men; age – 41.6±7.7 years; EDSS – 4.0 [3.5; 5.0] points, duration of MS – 8.0 [3.0; 21.0] years). The patients received comprehensive rehabilitation in a hospital for 2.5 weeks. The examination was carried out before and after the rehabilitation program. Independence in daily activities was assessed using the Functional Independence Scale, the Get Up and Go Test and the Berg Balance Scale. Exercise tolerance was determined using a cardiopulmonary exercise test (CPET) on a cycle ergometer. The following parameters were measured: oxygen consumption during exercise (VO2 peak oxygen uptake), percentage from the predicted VO2 peak (% pred VO2 peak) and maximal workload in metabolic units (MET). Walking speed was measured according to the Davis protocol in the SMART-D laboratory (Italy). QoL was determined using the SF-36 questionnaire, which assesses physical functioning (PF), general health (GH), vital activity (VT) and social functioning (SF). Cognitive functioning was assessed using the Montreal Cognitive Scale (MoCA) and depression using the Beck Depression Inventory (BDI). Results. After completion of the rehabilitation course, there was a significant increase in VO2 peak (from 18.8±3.8 to 20.4±4.3 ml/kg/min), % pred VO2 peak (from 59±13 to 63±14%), maximal workload (from 5.4±1.2 to 5.8±1.2 MET), maximal heart rate (from 140±14 to 147±13) and walking speed (from 0.84±0.29 to 0.97±0.28 m/s). At the same time, despite an improvement the patients did not reach the age- and gender adjusted reference values for exercise tolerance. QoL indicators also increased, reaching or exceeding the populational values obtained for the Russian population: PF – from 45 to 52.2; GH – from 51 to 52; VT – from 45 to 50; SF – from 62.5 to 75. The number of points on the BDI also decreased significantly (from 9 to 6), and the increase on the MoCA scale had tendency to significant difference (p=0.064). Conclusion. A comprehensive rehabilitation program in patients with RRMS in remission helps to increase exercise tolerance and improve functional independence and QoL.

Ocena skuteczności kompleksowej rehabilitacji osób z niepełnosprawnościami na podstawie ICF

Assessment of the effectiveness of comprehensive rehabilitation of persons with disabilities based on the ICF The pilot comprehensive rehabilitation program for persons with disabilities was implemented by PFRON in partnership with the Central Institute for Labor Protection – National Research Institute (CIOP-PIB) and ZUS in 2018-2023. During it, over 600 participants underwent several months of comprehensive rehabilitation in four centers. In the developed model, the main diagnostic tool that enabled various groups of specialists to cooperate in various areas of impact was the International Classification of Functioning, Disability and Health (ICF). Many participants achieved their intended goal – they undertook professional activity tailored to their capabilities, needs and preferences. A large number of people became active, improved their mental and physical well-being and gained knowledge that they can use in their future work. This article presents selected results of the assessment of the effectiveness of rehabilitation impacts, which is the difference between the final and initial research results in various categories of the ICF classification. Keywords: comprehensive rehabilitation, ICF

The chain of survival and rehabilitation for sepsis: concepts and proposals for healthcare trajectory optimization.

This article describes the structures and processes involved in healthcare delivery for sepsis, from the prehospital setting until rehabilitation. Quality improvement initiatives in sepsis may reduce both morbidity and mortality. Positive outcomes are more likely when the following steps are optimized: early recognition, severity assessment, prehospital emergency medical system activation when available, early therapy (antimicrobials and hemodynamic optimization), early orientation to an adequate facility (emergency room, operating theater or intensive care unit), in-hospital organ failure resuscitation associated with source control, and finally a comprehensive rehabilitation program. Such a trajectory of care dedicated to sepsis amounts to a chain of survival and rehabilitation for sepsis. Implementation of this chain of survival and rehabilitation for sepsis requires full interconnection between each link. To date, despite regular international recommendations updates, the adherence to sepsis guidelines remains low leading to a considerable burden of the disease. Developing and optimizing such an integrated network could significantly reduce sepsis related mortality and morbidity.

The Significance of Selected Myokines in Predicting the Length of Rehabilitation of Patients after COVID-19 Infection.

In the context of the global COVID-19 pandemic, understanding the intricate mechanisms of the body's response to infection and inflammation has become a priority for the medical and research communities. It has been proven that during COVID-19 infection, molecules are secreted-namely organokines, which may directly or indirectly play a role in the pathophysiology of COVID-19. The objective of this study was to scrutinize the potential correlation between the levels of selected myokines (myostatin, agrin, irisin, and myonectin) and the duration of rehabilitation in post-COVID-19 patients. Additionally, the study aimed to investigate whether there is a correlation between the levels of these myokines and the length of hospitalization during COVID-19 treatment. The study was conducted at the Rehabilitation Hospital in Szczecin (Poland). Patients in the study participated in a comprehensive rehabilitation program following COVID-19 treatment. In order to assess the effectiveness of rehabilitation, the following tests were performed: a 6 min walk test with an assessment of exercise tolerance (Borg scale), an assessment of dyspnea severity (mMRC scale), a spirometric assessment of respiratory function, a measurement of arm strength, and an assessment of fatigue using the Fatigue Assessment Scale (FAS). Myokine levels were measured using commercially available enzyme-linked immunosorbent assays (ELISA) according to the manufacturer's instructions. Statistical analysis was performed using Statistica 13.1 software. Lower concentrations of irisin and myonectin and higher concentrations of myostatin correlated with longer rehabilitation time. Baseline levels of specific myokines in post-COVID-19 patients could play a crucial role in anticipating the duration of rehabilitation. The duration of hospitalization for the infection may influence myokine levels in patients recovering from COVID-19.

Self-Stigma in Patients with Endogenous Mental Disorders: A Cross-Sectional Comparative Study

BACKGROUND: Self-stigma remains one of the most vexing issues in psychiatry. It complicates the treatment and social functioning of patients with endogenous psychiatric disorders. Identifying the specific features of self-stigma depending on the type and duration of the endogenous mental illness can help solve this problem. AIM: The aim of this study was to establish the level and specific features of self-stigma in patients with various types of chronic endogenous psychiatric disorders at different disease stages and to establish the correlation between the level of self-stigma and the attitude of the patient to his/her disease and treatment. METHODS: Clinical psychopathology assessment, psychometric scales and questionnaires: “Positive and Negative Syndrome Scale” (PANSS), “Questionnaire for Self-Stigma Assessment in Mentally Ill Patients”, and Russian versions of the “Insight Scale for Psychosis” (ISP), and “Drug Attitude Inventory” (DAI-10). The cross-sectional study included 86 patients with endogenous mental illnesses (bipolar affective disorder and schizophrenia spectrum disorders. RESULTS: The analysis of the results of the “Questionnaire for Self-Stigma Assessment in Mentally Ill Patients” showed that at the initial disease stages the highest level of self-stigma is observed in patients with bipolar affective disorder (M±σ=1.22±0.73; Me [Q1; Q3]=1.10 [0.83; 1.60]), while the lowest level was observed in patients with schizophrenia spectrum disorders (M±σ=0.86±0.53; Me [Q1; Q3]=0.77 [0.31; 1.25]). Patients with schizophrenia and schizoaffective disorder and a disease duration more than five years participating in a long-term comprehensive psychosocial rehabilitation program also demonstrated high rates of self-stigma (M±σ=1.20±0.57, Me [Q1; Q3]=1.26 [0.89; 1.47]). The study groups showed differences in terms of the structure of components of self-stigma and their severity; significant correlations were uncovered between the self-stigma parameters and the attitude of patients to their disease and therapy. CONCLUSION: The results of this study contribute to a better understanding of the specific features of self-stigma in patients with various endogenous disorders at different stages of the disease. These data can be used as part of a comprehensive psychosocial treatment program for this patient cohort, as well as for future research.

Osteopathic correction in complex rehabilitation of children who have undergone cochlear implantation

Introduction. Currently, the only way to rehabilitate patients with deafness is cochlear implantation (CI). CI includes not only surgery, but also rehabilitation carried out by a whole group of specialists. This is a multi- stage, labor-intensive, complex, long-term process of developing and maintaining speech function, so there is a constant search for new approaches and methods that could increase the effectiveness of ongoing rehabilitation measures. Previous studies have demonstrated that osteopathic correction in preschool children reduces the severity of speech disorders, contributes to the regression of speech therapy disorders, and helps in the correction of certain forms of dysarthria. Of particular interest is the work in which the authors demonstrated the existence of relationships between certain somatic disfunctions and the presence of disturbances in peripheral sound conduction and/or central sound conduction in children with sensorineural hearing loss. The question of the possibility of using osteopathic correction in the rehabilitation of children with pathologies of hearing and speech function (since, in addition to the consequences of highly invasive surgical intervention, children who have undergone CI, as a rule, have delayed speech development), seems promising for study.The aim was to study the results of the use of osteopathic correction in the rehabilitation of children who have undergone CI.Materials and methods. A randomized controlled prospective study was conducted from March 2022 to December 2022 on the basis of the Federal State Budgetary Institution RNTSCAiS FMBA of Russia, FSBI NMCIO FMBA of Russia. 36 children aged from 17 to 37 months were under observation. Depending on the treatment used, all observed patients were divided into 2 groups using a simple randomization method: main (20 people) and control (16 people). Patients in both the main and control groups received standard rehabilitation treatment. Each patient of the main group additionally underwent a single session of osteopathic correction lasting from 45 to 60 minutes. All patients were assessed for osteopathic status, time of connection and adjustment of the cochlear implant, and quality of life.Results. In children after CI, global neurodynamic disorders and regional biomechanical disorders in the regions of the head, neck, and dura mater were most often detected. After treatment, only patients in the main group showed a statistically significant (p&lt;0,05) decrease in the frequency of detection of both global neurodynamic and the above-mentioned regional biomechanical disorders. A single session of osteopathic correction contributes to a significant reduction in the time of connection and adjustment of the cochlear implant, which can be considered as a favorable factor for subsequent rehabilitation measures. Against the background of the ongoing rehabilitation, a statistically significant increase in the level of quality of life was obtained in both groups, however, in the main group this indicator was statistically significantly higher.Conclusion. For children who underwent CI, the most characteristic was the presence of a global neurodynamic disorder, as well as regional biomechanical disorders at the level of the head, neck and dura mater. A single session of osteopathic correction can significantly reduce the time of initial connection and adjustment of a cochlear implant, as well as improve the quality of life of this category of patients. This allows us to recommend the inclusion of osteopathic correction in comprehensive rehabilitation programs for children who have undergone cochlear implantation.

Approval of a comprehensive psychosocial rehabilitation program for patients with negative symptoms in schizophrenia

The aim of the work is to develop and evaluate the effectiveness of a comprehensive program of psychosocial rehabilitation of patients with negative symptoms in schizophrenia. Materials and methods. The study involved 168 patients with negative symptoms of schizophrenia: 94 patients who underwent a comprehensive psychosocial rehabilitation program (main group) and 74 patients who underwent a course of therapy according to the traditional scheme (control group). The criteria that evaluated the effectiveness of a comprehensive program of psychosocial rehabilitation in patients with negative symptoms in schizophrenia were: clinical dynamics of negative disorders, the degree of improvement/deterioration of compliance and social functioning, and the degree of restoration of basic life functions. Psychometric (Social Avoidance and Distress Scale (SADS), Personal and Social Functioning (PSP), Level of Compliance questionnaire, and the Severity of Negative Symptoms (SANS)) and statistical research methods were used to assess effectiveness. Results. The proposed scheme of a complex program of psychosocial rehabilitation is based on the principles of a complex, individually oriented and differentiated approach, and its targets are defined as clinical manifestations of negative symptoms in schizophrenia, impaired social adaptation, communication skills, decreased motivational sphere, compliance and impaired social functioning. Rehabilitation is implemented in four stages: diagnostic, therapeutic, rehabilitation and preventive. The effectiveness of the proposed scheme of psychosocial rehabilitation of patients with negative symptoms in schizophrenia was proven, which consisted in a more pronounced reduction of clinical manifestations of abulia, anhedonia, inattention, reduction of distress and social avoidance, improvement of social functioning in the main spheres of life, and improvement of social and behavioral compliance. Conclusions. The developed comprehensive program of psychosocial rehabilitation of patients with negative symptoms in schizophrenia has shown its effectiveness and can be used in psychocorrective measures aimed at treating patients with negative symptoms in schizophrenia.

Effectiveness of comprehensive rehabilitation of patients with impaired respiratory muscle strength after coronavirus pneumonia

Aim. The study aims to evaluate the effectiveness of a comprehensive rehabilitation program for patients experiencing reduced respiratory muscle strength following coronavirus pneumonia.Materials and methods. This prospective, ran-domized study enrolled 55 individuals (average age 66.1±6.4 years; 21.8% males and 78.2% females) who had recovered from COVID-19. The rehabilitation regimen included 10 sessions of respiratory exercises, 10 chest massage treatments, and 3 sessions of osteopathic adjustment. Assessments of respiratory function and respiratory muscle strength were conducted both before the initiation of rehabilitation and upon its completion.Results. Initial complaints included rapid fatigue, dyspnea under physical strain, vertigo, headaches, chest pain during respiration, and disrupted sleep patterns. Participants were categorized into two groups: males and females. Both groups demonstrated a decrease in expiratory muscle strength by a factor of 1.2 and inspiratory muscle strength by 1.6, compared to normative values. Spirometry indicated impaired lung function across all participants. Post-rehabilitation, a marked improvement in overall health and a reduction in complaint severity were observed. Rehabilitation routing scales showed a decrease in condition severity from 2-3 points to 1-2 points, alongside a statistically significant increase in respiratory muscle strength, enhanced oxygen saturation, and restored lung function.Conclusion. Our proposed comprehensive rehabilitation program, incorporating osteopathic manipulation, respiratory exercises, and massage, successfully shifts the pathological breathing pattern to a physiological one, strengthens respiratory muscles, and reinstates lung function. This leads to improved exercise, reduced anxiety and depression levels, and enhanced quality of life for post-COVID-19 pneumonia patients.

Population genetics of the critically endangered three-striped turtle, Batagur dhongoka, from the Ganga river system using mitochondrial DNA and microsatellite analysis

The three-striped roofed (Batagur dhongoka) is a semi-aquatic turtle that belongs to family Geoemydidae. Due to anthropogenic pressure, it has been facing an intense decline of over 80% in its distribution range in the past 50 years. It is considered as 'Critically Endangered' so effective conservation strategies are needed to protect the species by determining their genetic diversity and population genetic structure. This study investigates the genetic diversity, population structure and demographic pattern of B. dhongoka from two Turtle Rescue and Rehabilitation Centre established near Ganga river using mitochondrial cytochrome b (Cyt b: 1140 bp) ; control region (CR: 451 bp) and ten nuclear microsatellite loci. mtDNA results show low levels of nucleotide diversity (π = 0.0022) in B. dhongoka haplotypes and provide evidence for a low substitution rate. The demographic pattern estimated by the Bayesian skyline plot (BSP) analysis indicates historical stability followed by growth in the effective population size, with a recent reduction in population size from ~ 2 thousand years ago. The microsatellite findings show a moderate level of observed heterozygosity (Ho: 0.49). Bayesian-based clustering analysis revealed weak genetic structures in B. dhongoka and presence of admixed assignations suggesting close genetic relationships. These findings shed light on B. dhongoka's genetic status and underline the necessity of comprehensive rehabilitation and relocation programs and conservation and management techniques to ensure the species' long-term survival. In order to ensure the effective protection and conservation of B. dhongoka, the Government of India has taken a proactive measure by incorporating it into Schedule I of the Wildlife (Protection) Act, 1972, as amended in 2022.

Enhancing Women's Quality of Life: Exploring the Impact of Mastectomy with and without Breast Reconstruction among Breast Cancer Survivors in Iraq.

Mastectomy, a common intervention for breast cancer, has substantial implications for a woman's quality of life (QoL). However, the literature on QoL outcomes following mastectomy-with or without breast reconstruction (BR) is scant. This study aims to assess and compare the QoL among Iraqi women post-mastectomy, examining the impacts of undergoing BR. We conducted a comprehensive cross-sectional study across multiple centers in Iraq from April to September 2021. Our cohort consisted of 404 women who had a mastectomy for breast cancer treatment, 154 of whom also chose to have BR. Utilizing the European Organisation for Research and Treatment of Cancer's (EORTC) tools specifically, select domains from EORTC QLQ-BR23, QLQ-C30, and QLQ-BRECON23-we evaluated various facets of their QoL. The mean QoL score was 54 out of 100, with patients who did not undergo BR reporting slightly higher scores (55) compared to those who did (52). Notably, social and sexual functioning scores were statistically superior in the non-BR group. Satisfaction with surgery, sexual function, and breast aesthetics were the lowest rated aspects among BR patients, indicating a considerable gap between expectations and outcomes. Marital status and the type of mastectomy notably influenced body image and sexual function. A significant portion of patients (100 out of 250) opted out of BR due to recurrence concerns, while 26.2% (106 out of 154) pursued BR to restore their pre-mastectomy physique. Contrary to the anticipated benefits of BR, our findings suggest that women who underwent the procedure reported a lower QoL compared to those who did not. The outcomes highlight the discrepancy between expected and actual benefits of BR, suggesting a pressing need for comprehensive rehabilitation programs. These programs should aim to enhance the QoL for post-mastectomy patients and provide in-depth counseling to align expectations with the potential realities of BR.