This review provides a comprehensive summary of major advances in pulmonary rehabilitation (PR) research from October 2024 to September 2025. It focuses on four key domains: implementation status, expansion of disease spectrum, conceptual innovation, and technological development. Globally, PR coverage remains suboptimal, with pronounced socioeconomic disparities, poor program quality and low adherence. Evidence suggests that simplified equipment and shorter rehabilitation courses can maintain therapeutic efficacy while substantially improving accessibility. In terms of disease spectrum, PR is no longer confined to single chronic respiratory diseases but has expanded to include respiratory comorbidities. Its application timeline has advanced from post-treatment rehabilitation to early prevention. While the rapid growth of tele-rehabilitation has enhanced service reach, yet its limitations and the unique advantages of traditional center-based programs must be acknowledged. Technologically, emerging training modalities, psychological interventions, and digital intelligent systems have continually enriched rehabilitation strategies. Overall, PR is advancing towards a more precise, continuous, and universally accessible model of integrated respiratory care.

ABSTRACT Clinical reasoning is vital yet difficult to teach in occupational therapy education. AI chatbots may support learning, but their effect on reasoning is unclear. To determine whether chatbot-assisted case-based learning enhances occupational therapy students' cognitive, affective, and psychomotor outcomes versus traditional instructional methods. In a post-test-only randomized controlled, mixed-methods trial, 25 students (age 20–23) in a neurological rehabilitation course were allocated to a chatbot (n = 11) or classic (n = 14) group. Teams analyzed a Parkinson's disease case and drafted intervention plans; the chatbot group interacted with an AI agent simulating the client, and the classic group used conventional resources. Outcomes were a six-item written exam, analyzed with ANCOVA adjusting for Grade Point Average, and qualitative analysis of chatbot queries. Groups did not differ on total or domain-specific exam scores (p > .05). Qualitative analysis showed that chatbot queries overwhelmingly sought factual clarifications and procedural guidance, indicating that students treated the AI chiefly as an information source rather than a prompt for ethical or reflective reasoning. Chatbot-assisted learning yielded performance comparable to traditional methods. While useful for factual learning, unstructured chatbot use did not foster higher-order reasoning. Structured guidance and longitudinal research are needed to support deeper engagement and examine sustained affective benefits. Clinical Trial: NCT07045077.

Relevance. Rehabilitation occupies one of the leading positions in healthcare. The special military operation (SMO) and the the subsequent partial mobilization affected many Russian families, increasing stress and tension levels, undermining fundamental human needs for safety, trust in the world, protection, and a sense of future stability. The number of post-traumatic stress disorders has increased. Medical rehabilitation and psychological support for the participants of the SMO and their family members have become a priority within the healthcare system. Intention. To present a system of outpatient psychological assistance for marital couples participating in the SMO using clinical examples. Materials and methods. The presented system of psychological assistance includes approaches, methods and means of psychological impact in medical rehabilitation provided in the Republican Hospital for War Veterans. Clinical, psychological methods and questionnaires were used in the rehabilitation of three married couples using the International Classification of Functioning. Results and discussion. Upon completion of the rehabilitation course, positive dynamics were observed in spousal relationships, including improved mutual understanding, increased communicative competence, and changes in communication patterns within the couple and in parent–child interactions from the husband’s side. The biopsychosocial model grounded in ICF domains was employed within a multidisciplinary rehabilitation team, integrating psychological techniques for working with couples. Special training of psychologists in crisis psychology, psychological support in extreme situations, and trauma-focused interventions is essential. Conclusion. The presented system of psychological work with married couples participating in the SMO has shown its effectiveness in providing psychological and correctional care to patients at the outpatient stage of medical rehabilitation in a Hospital for war veterans and can be recommended for implementation in specialized institutions.

To describe the application of water treadmill exercise for equine fitness and/or rehabilitation in a scientific and clinically reasonable manner. Horses owned by Spy Coast Farm were used for video content. A literature review was performed and compiled in this brief video to provide veterinarians with a comprehensive, evidence-based guide for implementing water treadmill exercise within fitness and rehabilitation programs. Equine water treadmill exercise is an aerobic modality that increases distal limb flexion and range of motion, with no reported adverse effects. It is associated with increased stride length and decreased stride frequency. Water treadmill exercise should not be used as a sole rehabilitation modality; instead, it is most effective when incorporated into a comprehensive rehabilitation plan. Kinematic data, clinical findings, and controlled studies offer the framework for the development of individualized water treadmill programs tailored to a horse's condition. Oversight by trained personnel or a veterinarian is essential, as program adjustments are necessary over the course of rehabilitation. In the future, multicenter prospective clinical trials using standardized protocols would be helpful to develop recommendations for specific injuries.

Abstract. Relevance of the research topic. The article presents the results of a study aimed at evaluating the effectiveness of breathing exercises and sound gymnastics as part of a physical therapy program for girls aged 10–12 years with chronic bronchitis. The relevance of the research is обусловлена by the steady increase in the prevalence of chronic bronchopulmonary diseases among school-aged children, which leads to impaired respiratory function, reduced physical capacity, and decreased adaptive reserves of the growing organism. In the context of frequent adverse effects associated with pharmacological treatment, the implementation of safe, accessible, and non-pharmacological rehabilitation methods is of particular importance. The purpose of the study was to investigate the impact of breathing exercises and sound gymnastics on the functional state of the respiratory system in girls aged 10–12 years with chronic bronchitis during the outpatient stage of rehabilitation. Material and methods. To assess the effectiveness of the developed physical therapy program, respiratory rate, vital lung capacity, vital index, Skibinski index, and the results of the Stange and Genchi breath-holding tests were analyzed.The study involved 20 girls with an average disease duration of 3,9 years. Research results and conclusions. The physical therapy program was based on a stepwise approach and included static and dynamic breathing exercises as well as sound gymnastics performed under sparing and sparing-training motor regimens, taking into account individual functional capabilities. The results demonstrated a statistically significant improvement in the main indicators of respiratory function. At the end of the rehabilitation course, a decrease in respiratory rate to physiological values was observed, along with an increase in vital lung capacity and vital index. Additionally, there was a significant improvement in the Skibinski index and breath-holding test results, indicating enhanced functional reserves of the respiratory system, increased tolerance to hypoxia, and improved adaptive potential. The findings confirm the effectiveness of breathing exercises and sound gymnastics as key components of physical therapy programs for girls aged 10–12 years with chronic bronchitis. Their systematic application contributes to the normalization of respiratory function, reduction of functional impairments, and prevention of disease exacerbations, making these methods a valuable element of comprehensive pediatric rehabilitation.

Muscle coordination pattern can be disrupted by neural disorders and perceptual disturbance, leading to abnormal gaits. However, it is still unclear how neuro-muscular control regulates walking gaits through training and exercising due to lengthy rehabilitation periods and complicated musculoskeletal redundancies. This paper proposes a gait rehabilitation monitoring method based on muscle deformation to elucidate the evolution of muscle coordination during the full-course vertigo-gait rehabilitation. The proposed method is verified by musculoskeletal dynamics simulation and experimentally validated through immediate applications to five healthy subjects and five vertigo patients. The vertigo gaits were assessed by comparing with the normal gait of healthy subjects. For the first time, this paper reports experimental results and muscle coordination analysis throughout the full course of vertigo-gait rehabilitation. The findings reveal that the vertigo patient adjusts phase difference between the rectus femoris (RF) and medial gastrocnemius (MG) at toe-off, driving the knee and ankle joints to regulate foot-to-ground angle, thereby enhancing gait stability and walking efficiency. These results indicate that muscle deformations serve as an alternative quantity besides traditionally employed kinematic features, and the proposed wearable sensing method is expected to provide an effective tool for clinical gait assessment.

Multiple sclerosis (MS) is an immune-mediated neurodegenerative disease of the central nervous system (CNS), and one of the most common CNS disorders, predominantly affecting young adults. It is believed that a robust immune response to presumed CNS antigens is driven by an interaction between environmental and genetic factors. There are four distinct forms of MS, classified based on clinical presentation: relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), primary progressive MS (PPMS), and progressive relapsing MS (PRMS). Clinically, RRMS is the most common form, initially diagnosed in approximately 85 % of patients. We examined 78 patients with MS, including 56 women (72 %) and 22 men (28 %) aged 26 to 49 years (mean age – 34.5 ± 5.2 years). The disease duration ranged from 1 to 16 years (mean – 5.2 ± 2.9 years), with an average EDSS score of 4.7 ± 0.5. Analysis of functional tests revealed a statistically significant improvement (p<0.05) in balance and coordination according to the Berg Balance Scale (by 10.4 %) in individuals who completed a full course of physical rehabilitation. Additionally, these patients showed an 8.8 % reduction (p<0.05) in the time taken to complete the “Four Square Step Test”, indicating improved speed and ability to change movement direction. Thus, regular physical exercise positively impacts neuromuscular coordination and the neurophysiological mechanisms regulating motor activity in MS patients. According to the data, the second patient group undergoing comprehensive therapy including physical rehabilitation showed a significant decrease in the scores for the pyramidal functional system (FS) — 3.2 ± 0.5 points (moderate lower limb paraparesis, possibly combined with mild upper limb paresis), and the cerebellar FS — 2.2 ± 0.5 (moderate gait ataxia and mild limb ataxia). This indicates a slowing of disease progression, reduction in activity limitations, and overall improvement in patient condition due to regular physical activity. Conversely, in the groups receiving conventional exercise programs or irregular physical therapy, no significant improvements in the evaluated indicators were observed. Patient status assessment also demonstrated a statistically significant (p<0.05) reduction in anxiety and depression, as measured by the Hospital Anxiety and Depression Scale, by 20.4 % among those who completed the full rehabilitation course. Thus, regular physical exercise improves neuromuscular coordination, leading to increased self-esteem, reduced panic feelings, and enhanced sense of well-being in MS patients. During the study, 14 patients withdrew: 4 patients (15.4 %) from group I, 2 patients (8 %) from group II, and 8 patients (29.6 %) from group III. The findings confirm that the highest level of patient compliance was observed in group II, demonstrating regular participation in the proposed physical rehabilitation program — a key factor for successful improvement in functional status. Patients who fully adhered to the rehabilitation program showed statistically significant improvements in balance, coordination, reaction speed, and psycho-emotional status. In contrast, no substantial positive changes were recorded in patients with low compliance or irregular physical activity (group III). This emphasizes the importance of motivating patients to consistently follow rehabilitation protocols and maintaining their adherence to treatment throughout the course of therapy.

INTRODUCTION. An innovative trend in magnetotherapy involves the use of devices generating strong magnetic fields with an induction of 100–700 mTl for therapeutic and rehabilitation purposes, among which is the Exotherapy device. AIM. To study the clinical effectiveness of the Exotherapy device in the complex rehabilitation of patients with coxarthrosis and concomitant spinal osteochondrosis. MATERIALS AND METHODS. A clinical prospective randomized trial was conducted at the National Medical Research Center for Rehabilitation and Balneology of the Ministry of Health of the Russian Federation. The patients in the control group (n = 30) completed a comprehensive medical rehabilitation programme consisting of laser therapy on the projection area of the hip joint, paravertebral electrotherapy on the lumbosacral region, robotic mechanotherapy, therapeutic massage, and group sessions of exercise therapy sessions. In addition to this, the patients in the main group (n = 30) received high-intensity pulsed magnetic field therapy from an Exotherapy device, according to Method No. 12. The effectiveness of the rehabilitation programme was assessed using functional research methods and scales and questionnaires on the 14th day after its commencement. RESULTS AND DISCUSSION. After the rehabilitation course, there was a more pronounced decrease in pain on the visual analog scale in patients of the main group (p = 0.00005). When analyzing the test results on the ProKin device after the rehabilitation course, a more pronounced positive trend was revealed in patients of the main group in terms of postural stability with both open and closed eyes (ellipse area, perimeter). Patients in the main group also showed statistically significant positive dynamics in the indicators of maximum extension of the lower extremities, maximum extension force, average extension force, average force in 0.20 seconds, and peak torque (p 0.05) according to isokinetic dynamometry. According to the video analysis of gait, it was found that in the main group there was a positive trend in the following indicators: the contribution (%) of the support phase increased, the contribution of the transfer phase decreased, the number of steps per minute and walking speed increased. CONCLUSIONS. Thus, the inclusion of the Exotherapy device in the medical rehabilitation program for patients with coxarthrosis and concomitant spinal osteochondrosis can significantly increase the effectiveness of standard rehabilitation programs.

INTRODUCTION. Upper limb lymphedema is a common and disabling complication following radical breast cancer treatment, with a prevalence of 20–40 %. Although volumetry remains the gold standard for diagnosing limb lymphedema, it cannot differentiate between lymphatic edema and adipose hypertrophy. Bioimpedance analysis (BIA) offers a more comprehensive approach to assessing body composition. However, the impact of complex rehabilitation programs on multi-compartment body composition in postmastectomy upper limb lymphedema has not been sufficiently studied. AIM. To investigate the effect of a comprehensive medical rehabilitation program, including laser therapy, magnetic therapy, exercise therapy, intermittent pneumatic compression, and cyclic trainer exercises, on body composition parameters assessed by BIA in patients with upper limb lymphedema, associated with radical mastectomy. MATERIALS AND METHODS. A cross-sectional study included 30 women aged 35–75 years with post-mastectomy lymphedema. Over 10 days, patients underwent comprehensive rehabilitation alongside a high-protein diet. The effectiveness assessment included anthropometry (circumferences of upper limb segments) and BIA of body composition before and after treatment. RESULTS. A statistically significant reduction was observed in the circumferences of all upper limb segments on both arms (p 0.05), except for the right elbow circumference. The most pronounced changes were noted in the proximal segments. BIA revealed a significant decrease in total (p = 0.00035), extracellular (p = 0.00008), and intracellular fluid (p = 0.000002), as well as a reduction in waist (p = 0.00004) and hip circumference (p = 0.0003). Positive changes in lean body mass (p = 0.0018) and musculoskeletal mass (p = 0.004), along with an improvement in basal metabolic rate (p = 0.026), were observed. DISCUSSION. The results demonstrate the effectiveness of the comprehensive approach in reducing lymphedema and normalizing fluid homeostasis. The pronounced effect in the proximal segments is consistent with literature data on the importance of restoring proximal lymphatic flow. The observed positive dynamics of changes in skeletal muscle mass (p = 0.004), active cell mass (p = 0.0018) and basal metabolic rate (p = 0.026) may indicate an increase in the level of metabolism in skeletal muscles due to an increase in the overall level of physical activity after the rehabilitation course. CONCLUSION. The comprehensive medical rehabilitation program is an effective means of correcting not only local manifestations of lymphedema but also systemic body composition disorders. The combined use of BIA and traditional anthropometry provides an objective multi-component assessment of rehabilitation effectiveness.

Background. The hemiplegic form of cerebral palsy (CP) is the most prognostically promising in terms of the possibilities of correction and social adaptation of disabled children. However, the main limitation of successful rehabilitation is severe limb muscle spasticity, because so reducing muscle hypertonicity is a priority task in this disease. The aim. To evaluate the effectiveness of improved method for correcting of upper limb spasticity in children with the hemiplegic form of CP. Materials and methods. An open, non-randomized, prospective, comparative study was conducted involving two groups of patients with spastic hemiplegia with predominant damage to the upper limb, compared to the case-control type. The control group of children (n = 20) was treated using standard methods – drug therapy, exercise therapy, massage, physiotherapy; the main group (n = 20) was additionally prescribed exercises on the new medical simulator "Glove". The study participants in the groups were compared by gender, age and severity of motor impairment. The course in comprehensive rehabilitation lasted 10 days. The effectiveness of the improved method for correcting upper limb spasticity was assessed by studying the dynamics of motor function indices using scales for assessing muscle tone (modified Ashworth scale) and manual skills (Frenchai and ARAT tests, V.G. Bosykh and N.T. Pavlovskaya method). Results. The additional inclusion of training using the new medical simulator for correcting upper limb spasticity "Glove" in the rehabilitation program for children with hemiplegic CP allowed achieving a significantly better treatment result with a significant decrease in muscle tonus, an increase in the volume and accuracy of movements, including in the section of small differentiated acts, with the elimination of the phenomenon of the «learned non-use» phenomenon. Conclusions. The use of a new medical simulator in the complex therapy of children with spastic hemiplegia allows increasing its effectiveness relative to standard rehabilitation methods. However, the question of the long-term effect remains open and requires an assessment of longer-term use of the simulator in the interhospital period.

Background. The development and implementation of effective long-term treatment strategies for secondary lymphedema associated with radical treatment for breast cancer remains a pressing issue in medical rehabilitation. Objective. To study the impact of a comprehensive rehabilitation program on quality of life in patients with secondary lymphedema of the upper extremities, stages I-III, who underwent radical treatment for breast cancer. Materials and methods. The study was conducted at the clinical site of the Federal State Institution National Medical Research Center for Rehabilitation and Balneology of the Ministry of Health of the Russian Federation and included 30 patients with lymphedema associated with radical treatment for breast cancer stages I-III, with an average age of 63.40 ± 10.85 years. The rehabilitation program included laser therapy, magnetic therapy, sessions with a clinical psychologist, group therapeutic exercises in the gym, occupational therapy, exercises on cycling equipment, and pneumatic compression procedures (10 sessions per course). The treatment duration was 12 days. A quality of life study was conducted using the LYMQOL ARM questionnaire. Limb circumferences were measured on the hand, lower and middle third of the forearm at symmetrical points on the affected and healthy limbs. Results. Before treatment, patients with lymphedema associated with radical treatment for breast cancer had a deterioration in the overall quality of life score to 4.63 ± 1.21 points. After the rehabilitation course, a decrease in hand circumference by 3.54% (p < 0,0001), forearm circumference by 2.32% (p < 0,0001), and middle arm circumference by 3.25% (p < 0,0001) was noted. After the rehabilitation course, improvement was noted in all quality of life indicators (LYMQOL ARM): an improvement in the hand function score (p < 0.001); an improvement in the body appearance and perception score (p < 0.001); an improvement in the lymphedema symptoms score (p < 0.001); Emotional state/mood score (p < 0.001). Overall quality of life improved by 37.36% (p < 0,001). Conclusions. The study of quality-of-life indicators in patients with lymphedema after rehabilitation using the LYMQOL ARM questionnaire in the Russian population confirmed its reliability and sensitivity in patients with lymphedema. Using this instrument to assess the effectiveness of rehabilitation increases the significance of the study, as lymphedema often impacts not only physical functioning but also significantly limits health-related psychosocial well-being in breast cancer survivors.

In the context of modern healthcare, the system of continuous medical education (CME) requires the integration of psychological aspects and the concept of the International Classification of Functioning, Disability and Health (ICF) into the training of specialists involved in the management of patients with chronic diseases. Diabetic distal polyneuropathy (DDPN) is one of the most common and disabling complications of diabetes mellitus, requiring a comprehensive multidisciplinary approach and the inclusion of psychological rehabilitation in the standard of care. The aim of the study was to assess the impact of multidisciplinary comprehensive rehabilitation (MCR), based on the principles of the ICF, on the physical and psychological status of patients with diabetic distal polyneuropathy, and to substantiate the need for integrating psychological aspects and ICF-based tools into the system of continuous medical education for training rehabilitation professionals. The study included 155 middle-aged and elderly patients with confirmed DDPN. Quality of life (QoL) was assessed using a standardized questionnaire, while mental health parameters were evaluated across five ICF domains within the categories of functions (b1301, b1528, b341) and activities and participation (d15700, d2401). Rehabilitation was carried out by a multidisciplinary team comprising an endocrinologist, neurologist, physiotherapist, physical therapy physician and instructor, nurses, and a psychologist. The assessment was conducted dynamically — before, immediately after, and 3 and 6 months following the rehabilitation course. After MCR, a significant reduction in pain intensity and improvement in all ICF domain indicators were observed. Both physical and psychological components of quality of life improved, as confirmed by the questionnaire results and SF-36 scores. The inclusion of a psychologist in the multidisciplinary team enhanced patient motivation and reduced levels of anxiety and depressive symptoms. Multidisciplinary comprehensive rehabilitation involving a psychologist is an effective tool for improving the quality of life in patients with DDPN. The application of the ICF framework allows for the objective assessment of treatment outcomes, accounting for both physiological and psychosocial limitations. The inclusion of modules based on ICF principles and health psychology into continuous postgraduate medical education programs is essential for developing competencies required for the comprehensive management of patients with chronic diseases.

To conduct a comparative analysis of the effectiveness of various outpatient rehabilitation algorithms for patients with exacerbation of LSD depending on the baseline pain severity. The study included 120 patients (ICD-10: M54.5), divided into three groups and two subgroups within each group. Patients of the first group (n=40) received comprehensive rehabilitation, including therapeutic exercise (TE) in the form of group sessions; magnetic therapy; electrophoresis with 2% euphyllin solution; classical therapeutic massage of the PCOP area, the course duration was 10 days. Patients of the second group (n=40) received physiotherapy treatment and massage according to the standard program carried out in the first group, the course duration was 10 procedures; followed by a course of therapeutic exercise in the form of online sessions with an exercise therapy instructor-methodologist, lasting 10 procedures. Patients of the third group (n=40), due to paramedical reasons, did not receive a course of physiotherapy and massage; the rehabilitation course included only TE sessions in the form of telemedicine services, lasting 10 procedures. All patients received basic drug therapy with drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) and centrally acting muscle relaxants. Each patient group was stratified by baseline pain using the visual analog scale (VAS) into subgroup A (VAS 2-3 cm, n=20) and subgroup B (VAS 4-5 cm, n=20). Assessments were made before treatment (T0), after a 10-day course (T1), and after 1 month (T2) using the VAS, Oswestry Disability Index (ODI), EQ-5D-3L, SF-36, and Hospital Anxiety and Depression Scale (HADS). Statistical analysis included ANOVA, the Mann-Whitney test, and adjustment for covariates (age, disease duration, physical activity level). As a result of the study, in patients of subgroup B, the greatest reduction in pain and improvement in functional status were recorded in group 1: VAS decreased from 4.7±0.5 to 1.2±0.4 cm (p<0.001), ODI - from 68.1 to 33.1% (p<0.001). In group 2, the changes were moderate (VAS: 2.5±0.7 cm; ODI: 47.6%), in group 3 - minimal (VAS: 4.1±0.6 cm; ODI: 59.5%). After a month, the effect in group 1 was maintained, in others - partial recurrence was observed. In patients of subgroup A (VAS 2-3 cm), the results in groups 1 and 2 were comparable and significantly better than the baseline (p<0.01), while in group 3 the improvement was less pronounced, but statistically insignificant compared to other groups (p>0.05). Quality of life (EQ-5D, SF-36) and anxiety (HADS) scores correlated with changes in pain and function. Comprehensive outpatient rehabilitation is the most effective model for patients with high baseline pain intensity (4-5 cm on the VAS scale). For patients with moderate pain (2-3 cm), telemedicine-based physical therapy demonstrates comparable efficacy to traditional group physical therapy and can be considered a rational alternative. A personalized approach to selecting a rehabilitation model based on baseline pain severity improves its clinical effectiveness, cost-effectiveness, and accessibility.

The diagnosis of cubital tunnel syndrome (CTS) is based on clinical presentation, electroneuromyography, and ultrasound examination. The restoration of lost hand functions due to CTS directly depends on timely surgical treatment performed at the earliest stages, before the development of severe motor, sensory, and trophic disorders in the hand. However, CTS is often undiagnosed for a long time. A case is presented of effective surgical treatment of a 63-year-old patient engaged in heavy physical labor, who developed compressive-ischemic ulnar neuropathy (CTS) against the background of an old elbow joint injury. For a long period, the patient was followed with a misdiagnosis of cervical radiculopathy associated with osteochondrosis, which led to progressive motor and sensory disorders with impaired hand function. After surgical treatment (microsurgical decompression of the left ulnar nerve at the level of the cubital tunnel, and neurotization of the motor branch of the left ulnar nerve with the anterior interosseous nerve at the level of the distal third of the forearm) and a course of postoperative rehabilitation, the CTS symptoms completely regressed and hand function was restored. One-year follow-up demonstrated a stable positive effect. Issues of delayed diagnosis, conservative, and surgical treatment of CTS are discussed.

Introduction: Cochlear implantation is the treatment of choice for severe hearing loss and deafness. Cholesteatomas can cause this deafness. A frequently used procedure in the course of surgical rehabilitation is a subtotal petrosectomy combined with a cochlear implant. The clinical follow-up of residual cholesteatomas is related to the blind sac closure difficult. Cholesteatoma MRI sequence-related CI magnet artefacts make follow-up challenging. Recent developments in combining cochlear implants and necessary MRI examinations enable the assessment of the internal auditory canal and cochlea. The study aimed to develop a procedure for detecting cholesteatomas in patients with cochlear implants using magnetic resonance imaging (MRI). Methods: Ex vivo MRI examinations were performed on five volunteers with fixed cochlear implants (Medel Synchrony) and swim caps. MRI examinations were performed at 1.5 T and 3 T using EPI, HASTE, and RESOLVE sequences (Siemens). The position of the implant was 12 cm distal to the external auditory canal, with anteversional head position of the volunteers in the MRI. Results: Due to artefact effects, assessment of the ipsilateral and contralateral mastoid is not possible with EPI sequences and a cochlear implant. The combination of cholesteatoma-detecting MARS sequences (HASTE, RESOLVE), a distal implant position, and a specific head position allows the assessment of the ipsilateral mastoid. Conclusions: Postoperative cholesteatoma assessment after CI implantation and subtotal petrosectomy appears to be possible under 1.5 T and 3 T, considering the MRI sequence, implant position, and head position.

Proximal femur ("hip") fractures are associated with high complication rates and challenging rehabilitation courses in the geriatric population. These patients can develop rapid sarcopenia and bone loss. Anabolic agents such as androgenic anabolic steroids (AAS) mightcounteract this catabolic state, but their efficacy remains uncertain. The purpose of this systematic review and meta-analysis was to evaluate whether postoperative AAS improves the outcomes in geriatric hip fractures. A systematic search of MEDLINE, Embase, CENTRAL, Web of Science, Google Scholar, ClinicalTrials.gov, and Wiley (inception to June 1, 2025) identified randomized controlled trials (RCTs) comparing an AAS with placebo/standard care after hip fracture. After record screening and data extraction, the data from studies evaluating AAS were analyzed using fixed-effect modeling. In addition, studies were assessed descriptively. The certainty of evidence was graded using the GRADE system. Nine RCTs (466 total participants; 214 received anabolic agents) met the inclusion criteria. AAS therapy significantly increased hip bone mineral density (BMD) z-score (d = 1.29, 95% CI 1.04-1.55; moderate certainty). The Harris Hip Score (HHS) (d = 2.85, 95% CI 2.52-3.17) and Katz Activities of Daily Living (KADL) index (d = 0.95, 95% CI 0.71-1.19) also improved with anabolic therapy. HHS and KADL index findings had very low certainty due to a high risk of bias and imprecision. No significant gain was observed in operative-leg strength versus the contralateral leg. Thirteen mild, transient adverse events (liver-enzyme elevation, sweating, hirsutism) occurred among AAS patients (13/214, 6.1%). No serious androgen-related complications were reported. Low-dose AAS after hip fracture surgery increased BMD and improved patient-reported function without significant safety concerns. Still, evidence of functional benefits is limited by small, often unblinded trials. Larger, multicenter RCTs using standardized treatment protocols and functional endpoints will help better determine the benefits of AAS after proximal femur fractures. Level I, Systematic Review and Meta-analysis.

BACKGROUND: Total knee arthroplasty is the gold standard for treating stage III–IV deforming osteoarthritis; however, in early rehabilitation, up to 20% of patients report persistent limitations in joint function, gait disturbances, and decreased quality of life. An important challenge is the integration of rehabilitation technologies that support gait recovery using augmented virtual-reality systems under conditions approximating real-life situations. AIM: To evaluate the effectiveness of the D-Wall system (DIH S.r.l., Florence, Italy) in patients in the early rehabilitation period after total knee arthroplasty using the domains of the International Classification of Functioning, Disability and Health. METHODS: A prospective, randomized, controlled trial was conducted with 60 patients (mean age 68.2 ± 6.5 years) after primary total knee arthroplasty at the second stage of medical rehabilitation. The main group (n = 30) received training on the D-Wall rehabilitation system in addition to a standard comprehensive rehabilitation program, while the control group (n = 30) followed standard comprehensive rehabilitation program. Functional status was assessed before the start of medical rehabilitation and after completion of a 10-day rehabilitation course. RESULTS: Ten days after completing rehabilitation, the main group demonstrated significant improvements compared with the control group: a 42% reduction in pain intensity measured by the Visual Analog Scale (4.1 ± 1.2 points in the main group and 6.3 ± 1.5 points in the control group, p 0.01); a 25° increase in knee flexion range of motion (115 ± 8° in the main group and 90 ± 10° in the control group, p 0.001); a 35% increase in walking speed according to C-Mill assessment (0.92 ± 0.15 m/s in the main group and 0.68 ± 0.12 m/s in the control group, p 0.01); and a 28% improvement in social and daily-living adaptation (p 0.05). CONCLUSIONS: Incorporating the D-Wall rehabilitation system with 3D video-reconstruction and biological feedback into early postoperative rehabilitation after total knee arthroplasty promotes faster recovery of motor function, gait correction, and improved quality of life.

INTRODUCTION. Cerebral palsy (CP) is the leading cause of motor impairment in childhood and calls for comprehensive rehabilitation approaches whose effectiveness must be objectively verified. Resting-state functional MRI (rs-fMRI) provides new opportunities to explore neuroplastic changes elicited by therapy. AIM . To evaluate the impact of a rehabilitation course employing a neuro-orthopedic suit on clinical outcomes and resting-state functional connectivity in children with spastic forms of CP. MATERIALS AND METHODS. Thirty children with spastic diplegia (Gross Motor Function Classification System, GMFCS levels II–III; mean age (8±3) years) were enrolled in a prospective study. All participants completed a 4-week rehabilitation program using the “Atlant” suit. Clinical assessments (GMFM-88, Modified Ashworth Scale, MACS, SATCo, goniometry) and rs-fMRI (Siemens 1.5 T) were performed before and after the course. Seed-based analysis focused on the sensorimotor network (SMN); intraand inter-network connectivity changes were examined. Statistics included paired t tests and Pearson correlation. RESULTS. After the 4-week intervention, significant improvements were observed on all principal clinical scales: total GMFM-88 scores increased, spasticity on the Modified Ashworth Scale decreased, manual ability (MACS) and trunk control (SATCo) improved, and joint range of motion increased on goniometry (all p&lt;0.05). rs-fMRI revealed strengthened functional connectivity between key SMN nodes (primary motor cortex and supplementary motor area) and a reduction of pathological hyperconnectivity between the SMN and the default mode network (DMN). Enhancement of SMN connectivity correlated with motor gains (r=0.65, p&lt;0.01). CONCLUSION . Use of the rehabilitation suit leads not only to clinical improvement but also to favorable reorganization of functional brain networks in children with CP. Resting-state network analysis is a sensitive tool for objectifying rehabilitation effects and elucidating mechanisms of neuroplasticity.

To determine a practical benefit from using this technology at the rehabilitation stage of cochlear implantation. Cases of 100 patients from 10 months to 74 years old, Δ=17±8.6 years, who underwent a rehabilitation course or the speech processor exchange at the St. Petersburg Research Institute of ENT in 2025 were prospectively studied. All patients had a MedEl cochlear implant with a straight type of electrode array: standard (n=69), flex-soft (n=31). Objectives of the study: to assess the correspondence between the standard implant telemetry and the impedance field telemetry heat maps; to identify additional information when analyzing heat maps; to determine indications for using the technology at the rehabilitation stage of cochlear implantation. : In all (100%) cases, impedance field telemetry heat maps served as a convenient graphical representation of the data, an additional opportunity appeared to evaluate each of the system contacts for all possible stimulation options. In 18 patients (18%), additional information had clinical significance and influenced the specialist's decision-making, which is illustrated by clinical examples of three patients. : Impedance field telemetry is an informative and convenient diagnostic method, both intraoperatively and at the rehabilitation stage. Heat maps do not completely replace classical telemetry, but they help to obtain additional information, which is of clinical significance in some cases. The method should be used in conjunction with implant telemetry in complex or ambiguous situations.

A Review of Forensic and Proprietary Rehabilitation Course Availability in CORE Accredited Rehabilitation Counseling Programs