Efficiency Of Rehabilitation In Patients Research Articles

Weather dependence of medical rehabilitation efficiency in patients with ischemic heart disease on the resort of the South Coast of Crimea

The aim of this work is to assess the influence of the climatic and weather characteristics of the South Coast of Crimea (SCC) on the effectiveness of health resort medical rehabilitation (MR) of patients with ischemic heart disease (IHD).Materials and methods. A study was carried out in a group of 276 patients with IHD. The influence of climatic and weather characteristics of the SCC were assessed using the methods developed by the «ARI n.a. I.M. Sechenov» - modified clinical index on weather pathogenicity (CIPP-M) and MR assessment according to the criteria of the» International classification of functioning, disabilities and health» (ICF).Results. Regression equations for the dynamics of the ICF b2401, b280, b4301 and b440 domains on the values of air temperature (AT-M), atmospheric pressure variability (APV), air temperature variability (ATV-M) wind speed (WS-M) and total CIPP-M have been developed, which allow to reliably form a rehabilitation prognosis for patients with IHD for all terms of health resort treatment in the SCC.Conclusions. The use of modernized clinical indices of weather pathogenicity allows one to adequately assess and predict the effect of weather dynamics and form a rehabilitation prognosis for patients with IHD.

Comorbidity Development in Patients with Severe Brain Injury Resulting in Chronic Critical Condition (Review)

Advances in intensive care have enabled patients to survive an acute critical condition, producing a growing population of patients in a chronic critical condition with long-term dependence on intensive care. These patients make up 5–10% of all patients with acute respiratory failure and require a disproportionate share of resources in the intensive care units, with an overall yearly survival rate of 40–50%. The aim of review is to identify the impact of comorbid complications on the course and outcome of patients with severe brain injury. Ninety-six sources were selected according to the data characterizing the clinical (syndromic) model of the patient with consciousness disorders after coma of different etiologies. This model takes into account the stages and phases of the syndrome as well as a number of comorbid conditions that determine the course and outcome of the disease. The list of sources includes papers addressing the issues of comorbidity in patients with brain injury and conditions such as strokes, consequences of severe brain injury and brain surgery. The sources reflecting the most significant mechanisms of consistent development of comorbidities were examined. These include metabolic disorders with subsequent protein and energy deficiency and comorbidities of the gastrointestinal tract. The role of microbiome in the development of comorbidity in patients in chronic critical condition was also identified. C onclusion. The comorbidity development starts from the moment of brain injury and extends until sustained stabilization or multi-organ failure and death. Timely detection and correction of comorbidities allows optimizing treatment and increasing efficiency of rehabilitation in patients with severe brain injury.

Orbital Floor Blow-Out Fractures: Ultrasonography, Postoperative Complications and Rehabilitation

The aim of this retrospective study was to analyze indications and the efficiency of post-operative rehabilitation in patients with orbital floor blow-out fractures. The selected patients were with orbital floor blow-out fractures and post-operative rehabilitation; eight case records were traced. The symptoms of the eyes (eye position and movements, coordimetry, ultrasonography) were noted before and after surgical correction and rehabilitation treatment. The data were statistically analyzed using a computer software package, SPSS version 16.0. A value of p < 0.05 was considered as statistically significant. All eight (100%) patients were men. The average age was 19.88 ± 8.25 years (14–34 years). The most common complaint was diplopia, it was in eight (100%) patients’ numb of affected face side was in two (28.6%), vertigo in one (12.5%), nausea in one (12.5%) patient. Post–operative complications were: diplopia – eight (100%) patients, postoperative scar – three (37.5%), eyelid swelling – four (50%), haematoma – one (12.5%) patient. After rehabilitation post-operative symptoms (postoperative scar, eyelid swelling, haematoma) decreased significantly (p < 0.05). Insignificant diplopia was left in seven (87.5%) (p > 0.05) patients, but it did not disturb their general activities. Patients were not treated surgically, neither they got correction with prismatic spectacles after rehabilitation. One (12.5%) patient was under supervision. Before rehabilitation ultrasonography was done for five (62.5%) patients. Ultrasonography was repeated only for one (12.5%) patient after rehabilitation. Coordimetry was done for all patients while they were being treated in order to find out the efficiency of rehabilitation. Rehabilitation can be recommended to patients with post-operative complications such as diplopia, swelling, post-operative scar. Treatment effect should be objectified by ultrasonography.Keywords: rehabilitation, orbital floor fracture, postoperative complications, ultrasonography.

Phenotypes of bronchial asthma during the health resort period and personalized programs of medical rehabilitation

Bronchial asthma (BA) is a relevant social and medical problem in our country and around the world. Currently, phenotypes of the disease are distinguished. One of the original decisions in phenotypes distinguishing is the use of cluster analysis. However, the concept of BA phenotypes at the health resort period of rehabilitation has not yet been formed. To determine the BA phenotypes upon admission of patients to a health resort medical rehabilitation (HRMR) using cluster analysis and to offer personalized rehabilitation programs. 518 patients with asthma who underwent HRMR on the southern coast of Crimea were examined. Each patient received clinical, functional and laboratory examination. HRMR included correction of long-term treatment according to the severity of asthma, climate therapy, respiratory therapy, educational programs, and physiotherapeutic procedures. We applied cluster analysis in order to identify BA phenotypes. Description statistics methods were used for phenotype-cluster characterization, comparative analysis - for determination of reliable phenotypic characteristics and relation of the effectiveness of HRMR and phenotypes. A model of three phenotype-clusters was developed. The first cluster included patients with BA of moderate severity, uncontrolled course, frequent exacerbations, history of atopy, a tendency to obesity, moderately reduced external respiration function, fixed airway obstruction, high adherence to long-term therapy with medium doses of inhaled glucocorticoids (ICS) combined with long-acting β-2 agonists (LABA). Cluster 2 included patients with mild asthma, controlled or partially controlled course of the disease, with rare short exacerbations, late onset, preserved external respiration function and exercise tolerance, but low adherence to long-term therapy with medium and low doses of ICS. Cluster 3 included patients with moderate to severe BA, uncontrolled course, with early onset, frequent and prolonged exacerbations, severe symptoms, significantly reduced external respiration function with fixed obstruction, decreased exercise tolerance, but low adherence to long-term therapy (4th stage) with high doses of ICS in combination with LABA and long-acting anticholinergics. A close relationship was found between phenotypes-clusters and the achieved effects: a significant increase in the control of BA and a high efficiency of rehabilitation in patients of the 1st and especially 3rd clusters and low in the 2nd cluster. The optimal rehabilitation programs for each of the selected cluster phenotypes were determined. The cluster model developed with the help of artificial intelligence has demonstrated high prognostic value in the determination of the effectiveness and change of control over the course of asthma as a result of HRMR. Personalized HRMR programs are suggested.

Psychological characteristics versus swallowing and speech rehabilitation efficiency in patients after oral cavity cancer excision

Personality traits of the patients surgically treated due to oral cancer form anxiety and depression levels associated with body deformation, as well as life quality during illness, and they are also associated with life span of the patients. It is purposeful to take personality traits into account during treatment management and rehabilitation of the patients. The aim of work is to recognize the association between personality traits and functional rehabilitation course in the patients treated due to oral cancer. 100 patients (W – 42, M – 58; 55.78 ±11.68 years) surgically treated due to oral cavity squamous carcinoma. Patients participated in the rehabilitation of oral functions. Wound healing course, postoperative facial deformity, breathing, swallowing, and speech were assessed in relation to “self-image”, “body image”, and “the level of acceptance of the disease” according to the Adjective Check List ACL-37, Body Cathexis Scale, and Illness Acceptance Scale after 2, 4, and 12 weeks post-surgically. Greater swallowing efficiency after 4 weeks post-surgically was present in patients with a stronger need for order and endurance. Patients who achieved greater speech efficiency in the 4th week post-surgically accepted their illness in a greater part. Patients in whom post-surgical deformity was greater showed lesser intensity in: achievements, domination, endurance, self-exposure, spontaneity in interpersonal contacts. These patients are characterized with lower self-reliance and greater need for counselling.

FEATURES OF INTENSIVE TREATMENT IN PATIENTS AFTER TRACHEOSTOMY

Objective: to enhance the efficiency of medical rehabilitation in patients who have undergone mechanical ventilation (MV) and tracheostomy in an intensive care unit through dynamic clinical, laboratory, endoscopic control and adequate therapy for detected pathology. A total of 120 intensive care unit patients who had undergone tracheostomy in different MV periods were examined. Subjects and methods. A total of 120 patients (76 men and 44 women) aged 15 to 78 years were examined in different MV periods. All the patients were operated on in intensive care units. The surgical techniques of tracheostomy were described; the clinical and endoscopic pattern of the laryngeal and tracheal mucosa in patients on MV was presented. The bacteria isolated from the patients on MV were typed; the cartilages of the anterior tracheal wall were pathomorphologically studied in different MV periods. Results. Microbiological examination indicated the predominance of the mixed microflora: Staphylococcus, Pseudomonas aeruginosa and Proteus. Intraoperative postmortem examination of the cartilages of the anterior tracheal wall was made in 30 patients in different MV periods who were noted to develop pathological changes in the laryngeal and tracheal mucosa and destructive and dystrophic alterations in the tracheal cartilage even if their intubation lasted as long as 3 days. Morphological examination of tracheal cartilages in patients who were on MV for 4 to 7 days revealed progressive destructive and dystrophic processes in peretracheal connective tissue, leukocyte accumulation, and focal bleeding. During intubation for more 7 days, there was partial death of the cartilage, its replacement by granulation tissue, and appearance of regions of sequestration of the dead cartilage. Endoscopic examination showed varying degrees of postintubation laryngeal and tracheal changes in all (n=120) the examinees. Conclusion. The performed treatment permitted decannulation of 111 patients; 16 patients underwent endoscopic intervention into the larynx and trachea; reconstructive operations followed by decannulaton were performed in 4 patients with postintubation laryngeal and tracheal stenosis; 5 patients with severe comorbidity remained to be chronic cannula carriers.

The rehabilitation of hemianopic dyslexia

Hemianopic dyslexia is a frequent and disabling functional impairment following brain injury. This form of dyslexia is an acquired reading disorder whereby patients with homonymous visual field defects have persistent and severe reading difficulties, despite having intact language functions. Hemianopic dyslexia has received little attention from researchers and clinicians, and this article is the first to review the rehabilitation of patients with the condition. In light of advances in our knowledge about the nature and causes of hemianopic dyslexia, I critically examine the available treatment methods for visual field disorders and evaluate their efficiency in alleviating hemianopic dyslexia. On the basis of the reviewed evidence, I suggest that compensatory therapies, which attempt to reorganize eye-movement control, are superior to restorative therapies, which aim at visual field restitution. For the rehabilitation of hemianopic dyslexia, I recommend a treatment protocol that involves the systematic and repetitive practice of specific eye movements for reading. Despite increasing evidence for the effectiveness of this treatment protocol, which has clinically relevant long-term benefits, the underlying mechanism of the therapeutic effect is still unclear. Indeed, more research is required to further improve the efficiency of rehabilitation in patients with hemianopic dyslexia.

Efficiency of specialist rehabilitation in reducing dependency and costs of continuing care for adults with complex acquired brain injuries

Objectives: To examine functional outcomes from a rehabilitation programme and to compare two methods for evaluating cost efficiency of rehabilitation in patients with severe complex disability. Subjects and setting: Two...

Geriatric assessment--description of functional deficits and follow-up assessment of elderly stroke patients

The aim of the present study was to describe the course and outcome of rehabilitation using a national recommended assessment program (AGAST). In our study 162 patients with stroke were included. Nearly all patients had improvement of activities of daily living (Barthel Index) and mobility (Tinetti Gait and Balance Score, Frenchay Arm Test). A similar trend was observed in patients with cognitive impairment and depression on admission. Of the different tests, the Barthel Index and mobility scores were shown to be important predictors of length of hospital stay. Further evaluation of the assessment instruments is needed to assess different aspects of quality of life (self-rated well-being, satisfaction). To assess the efficiency of geriatric rehabilitation in patients with stroke, it will be important to measure resource consumption and to evaluate the long-term results.