Individual Rehabilitation Plan Research Articles

Biofeedback training for the analysis of gait stereotypes in patients with gonarthrosis

BACKGROUND: The justification of the treatment techniques for patients with gonarthrosis requires the use of modern methods for assessing walking stereotypes.
 AIM: This study aimed to evaluate the biomechanical and podometric gait parameters of patients with gonarthrosis using the C-Mill multifunctional complex with biofeedback.
 MATERIALS AND METHODS: The study included 55 patients who were divided into the following groups: main group (n=35) of patients who had gait disturbances, diagnosed with stage III–IV primary gonarthrosis with varus deformation of the limb axis according to ICD-10, and underwent total knee replacement and control group (n=20) of patients diagnosed with stage I primary gonarthrosis. The average age of patients was 58.7 years in the main group and 47.5 years in the control group.
 RESULTS: In the main group, the decrease in average walking speed was accompanied by decreases in stride length and step frequency (р 0.05). In the stance phase, which is characterized by the contact of the foot of the affected and contralateral lower extremities with the platform surface, the durations of the double stance phase of both extremities in the main group were longer than those in the control group (p 0.05), indicating gait asymmetry and redistribution of excess load on the contralateral lower extremity, which is clinically manifested by lameness. In the main group, gait was characterized by a decrease in voluntary speed, step frequency, and gait pattern changes in various planes, confirming severe clinical and functional disorders in the lower limbs.
 CONCLUSION: The study of the walking stereotype in patients using the C-Mill multifunctional complex with biofeedback can be used to substantiate treatment techniques, followed by drawing up an individual medical rehabilitation plan to restore lower limb functions in the postoperative period, fully monitor treatment dynamics, prevent falls, and improve the quality of life of patients.

The Contemporary Foster Care Legislative Framework in Greece: A Review of its Assets and Weaknesses

This review comprehensively analyzes the contemporary Greek legislative foster care system according to N4538/2018, exploring all the relevant international agreements such as the United Nations Convention on the Rights of the Child and the European Union's Charter of Fundamental Rights, that influenced its enactment. It highlights the rights and protection afforded to children in foster care, detailing provisions from the Hague Convention on the Rights of the Child and European legislation. It explores thoroughly the recent legislative reforms in Greece, including the establishment of the National Council for Foster Care and Adoption. It emphasizes the development and adherence to National and Special Registers for minors in the modern Child Protection System, as well as the implementation of Individual Family Rehabilitation Plans. It reveals that the recent legislation framework has many advantages but also a few weaknesses that could be amended. The legal procedures and criteria for placing minors in fostering in Greece, and the required criteria to ensure that foster parents meet the necessary guidelines to protect the best interests of children are discussed. This paper also examines the legal and procedural steps required to link children to foster families, the arrangements for supervision of foster parents and the consequences of fostering in cases of non-compliance. It is also proven that social workers play a key role in all stages and procedures of the application of the institution of foster care since they have taken up the main responsibilities for its implementation, prior, during and after the children are placed in foster parents. The article concludes that there is an imperative need for informed policies and practices that will ensure the adequate care and protection of minors in the foster system, recommending a synergy of legal, institutional, and educational strategies to optimize the welfare of foster children and support foster parents.

The Psychological Impact of Leisure and Rehabilitation Activities in Children With Autism: A Delphi Approach

The leisure-rehabilitation programs offered to children and adolescents with autism convey feelings like emotional, social, cognitive, and physical engagement, fun, adventure and sense of novelty. Each activity however has an intrinsic power to influence the emotional pattern in different ways. To define how each type of rehabilitation program can be expected to influence the psychological response di children and adolescent affected by autism; A Delphi study was carried out involving twelve Expert therapists. The aim is to have criteria to personalize the individual rehabilitation plan choosing a mix of activities with more appropriate emotional influence. We applied the Delphi procedure during a workshop with 12 expert therapists (8 females- 4 males), with the aim of assessing the opinion of participants regarding the appropriateness of 11 types of leisure-rehabilitation activities in enhancing 7 types of psychological responses. The activities with the highest potential for each psychological response were for dramatherapy emotional and cognitive engagement, team sports for social engagement and for fun, indoor climbing for physical engagement and for sense of adventure, for outdoor visits to museums sense of novelty. The top five activities with the highest overall impact (mean overall score > 7) were in decreasing order: indoor climbing, team sports, outdoor visits to common life environments, outdoor visits to parks and gardens, and dramatherapy. We hope that this Delphi exercise will help the carers of individuals with autism to choose and adapt possible leisure activities according to the specific needs of the subject, maximizing the potential benefit of rehabilitation.

Doctors' Choice of Rehabilitation Measures for Patients Who Have Suffered Covid-19

Relevance. According to WHO, the number of patients with a new coronavirus infection amounted to more than 676 million people for the period from January 2020 to January 2023. It is obvious that the consequences of COVID-19 will prevail in medical practice in the coming years, so medical rehabilitation should be the focus of attention when providing medical care to patients with coronavirus infection.Aims. To investigate the approach to physicians' selection of rehabilitation interventions for patients who have undergone Covid-19.Materials and methods. The analysis of 1832 case histories of patients of one of the temporary covid hospitals in Moscow, who are being treated in the hospital in 2020–2022, was carried out. Statistical analysis was carried out using the StatTech v. 3.1.3 program (developed by Stattech LLC, Russia). Predictive models characterizing adherence to rehabilitation measures were developed using the logistic regression method.Results and discussions. The analysis of predictors of statistically significant regression models showed that when deciding on the appointment of rehabilitation measures or additional consultation when a patient is discharged from the hospital, doctors rely on pathologies already present in patients before COVID-19 disease, without taking into account the occurrence of possible pathology after a new coronavirus infection in any organ system. For example, the appointment of a cardiologist's consultation increases 6 times in the presence of a history of cardiovascular diseases or atherosclerosis and 10 times in the presence of cardiovascular diseases and atherosclerosis at the same time. The presence of bronchial asthma increased the probability of consulting a pulmonologist by almost 3 times, and in the absence of diabetes mellitus, the probability of getting additional advice from an endocrinologist decreased by 11 times.Conclusions. An individual rehabilitation plan should take into account the severity of the COVID-19 disease, the degree of damage to the lung tissue, heart, blood vessels and other organs. The regression models can be used for economic analysis in order to identify the need for working hours and the number of medical workers necessary to ensure the optimal volume and effectiveness of rehabilitation measures for patients who have suffered a new coronavirus infection.

Training Future Specialists in Specialty 227 “Therapy and Rehabilitation” at Volodymyr Dahl East Ukrainian National University

Physical rehabilitation during military aggression is one of the critical components of medical care for military personnel, their families, and the civilian population affected by the consequences of occupation, violence, bombings, etc. Training future physical therapists is a complex and essential process that requires specialised education, practical experience and constant updating of knowledge and skills. The practice-oriented approach, which allows students to gain real practical experience in treating patients even during their studies and helps them develop the skills and abilities necessary for successful practice, plays a crucial role in the training of physical therapists. The article reveals the peculiarities of training future physical and occupational therapists at Volodymyr Dahl East Ukrainian National University in cooperation with various institutions of the social sphere (rehabilitation institutions, various centres of psychosocial assistance). In interaction with the specified institutions, the recipients get to prepare for work in clinical, sports or other environments where their skills will be of actual use. A hands-on approach helps candidates learn to interact with different age groups and patients with different health conditions, from children to adults; contribute to the recovery of the physical and psychological condition of patients, helping them to return to an active life; by developing individual rehabilitation plans, physical therapists help restore mobility and improve patients’ quality of life, reducing the risk of disability.

MODERN TRENDS IN OCCUPATIONAL THERAPY SPECIALIST TRAINING IN UKRAINE

The article defines the goal, which is the systematization of modern trends in occupational therapy specialist training (physical rehabilitation, physical therapy combined with human health, etc.), who can independently and consciously choose priority areas of activity, realize professional responsibility for the organization and results of their work, approach creatively to predict work results and plan strategies and technologies for their achievement, acquire and consolidate skills and abilities; develop and implement an individual rehabilitation plan in cooperation with other specialists in the multidisciplinary team and the patient; describe violations of the functioning of organs and systems of the human body; independently and creatively apply acquired knowledge, and carry out scientific, administrative and advisory activities.
 These trends include: the usage of the latest technologies, such as virtual reality, artificial intelligence, TV-rehabilitation, and others, to improve rehabilitation processes and ensure more effective and individualized treatment methods (technology integration); attention to the development of individualized rehabilitation programs that take into account the unique needs and characteristics of each preson (individualization of activities); establishment of cooperation of specialists in various fields (physiotherapists, psychologists, social workers, etc.) to create comprehensive rehabilitation programs (multidisciplinarity); focus on the development of effective methods of rehabilitation and optimization of resource costs to increase the availability of services (resource matching); providing specialists with modern knowledge and skills necessary for using the latest methods and technologies (pedagogical culture in general); growing attention to the inclusion of persons with disabilities in various spheres of social life, including education, work, and entertainment (strategies of inclusion); creation of programs and initiatives aimed at prevention and early detection of problems to avoid further complications (prevention and early intervention).
 Modern specialists in human health, physical therapy, and occupational therapy are obliged to formulate modern ideas about a person as a bioenergetic being and the relationship of his health with nature and society by assimilating the worldview and methodological foundations of philosophical knowledge, based on knowledge of anatomy, physiology, valeology, using methods of vale-diagnostics and monitoring of physical development, plan professional and educational activities aimed at ensuring the physical development of the individual.

Validation of the Performance Oriented Mobility Assessment (Tinetti Test) Scale in Russia for Stroke Patients

INTRODUCTION. Balance disturbances are frequent syndromes after a cerebral stroke (CS). The availability of a validated tool for balance and walking functions comprehensive assessments is very important part of real clinical practice, for rehabilitation diagnosis and individual medical rehabilitation plan.
 AIM. To determine the psychometric properties of the Motor Activity Performance Assessment Scale (Tinetti Test, TT) for measuring balance and walking in patients with ischemic stroke (IS).
 MATERIALS AND METHODS. 200 patients were included, 100 in the early (ERP) and 100 in the late (LRP) recovery periods of IS. The average age of patients was 55 [51; 57] years. The average of IS-duration were 99.3 ± 30.9 days (ERP) and 267.7 ± 27.8 days (LRP). Clinical and demographic characteristics of patients in two groups were comparable. The median and interquartile interval of TT were 20 [14; 24] points out of 28 possible. Content validity and intra-rater reliability were assessed by 10 clinicians. The test-retesting method was used to determine the intra-rater reliability. The Berg Balance Scale (BBS), the Stand Up and Go for Time (TUG), and the 10-meter walk test (10MWT) were used for concurrent validation.
 RESULTS. Two-stage linguistic and cultural adaptation made it possible to construct a Russian-language version of TT that was tested in a pilot study of 30 patients. The subsequent study of the psychometric properties of TT demonstrated high level of content validity and internal consistency of TT (α-Kronbach: 0.74 for TT-Balance and 0.72 for TT-Gait). BBS data significantly correlated with TT-Balance scores (r = 0.73, p = 0.001), TUG showed a negative correlation with TT-Gait (r = −0.69, p = 0.02). Retest reliability ranged from 0.72 to 0.86. The Bland-Altman plot showed the loss of one data point for TT-total beyond 95 % CI.
 DISCUSSION. The Tinetti test indicates high substantive validity and internal consistency of the scales (the α-Kronbach for the balance and walking sections are 0.74 and 0.72, respectively), which is consistent with the data of foreign authors.
 CONCLUSION. The linguistic and cultural adaptation and psychometric testing of the Russian version of the Motor Activity Performance Assessment Scale demonstrated the validity and reliability of this test as a tool for balance and walking assessment in patients with IS.

Rehabilitation of Adult Patients with Pulmonological Manifestations of Long COVID: a Review

INTRODUCTION. The most common symptoms in patients who have had a new coronavirus infection (COVID-19) are associated with pulmonary lesions (shortness of breath, chest pain, cough) and the same complaints persist in the majority of those suffering from long COVID the occurrence and prevalence of which in the population is inextricably linked with the number recovered from COVID-19.
 AIM. To study the current state of the problem of diagnosis, treatment and rehabilitation of patients with pulmonological manifestations of long COVID at the stage of a specialized rehabilitation hospital in order to formulate basic practical recommendations for the management of this category of patients.
 MATERIALS AND METHODS. During the period from January 1, 2021 to December 1, 2022, we performed a systematic search of the MEDLINE, Cyberleninka, and eLIBRARY.RU databases on the topic of pulmonary manifestations of long COVID and methods of their rehabilitation in adult patients that gave 678 matches. After further filtering steps according to the methodology outlined in the PRIZMA guidelines, we selected 60 publications for the final analysis.
 RESULTS. Pulmonary manifestations of long COVID, including, first of all, shortness of breath, rank second after fatigue in terms of frequency of occurrence in long COVID. Diagnostic findings include radiologic pulmonary tissue changes recorded in a proportion of patients under one year, restrictive abnormalities on spirometry, and impaired pulmonary diffusion capacity. Many patients who have had COVID-19 recover quite quickly, but some of them have a long-term symptom complex of dyspnea and physical fatigue, for which rehabilitation in a specialized centers is indicated.
 The most effective treatment is possible with the involvement of a multidisciplinary rehabilitation team in the rehabilitation process and the appointment of rehabilitation programs created in accordance with the conceptual basis of respiratory rehabilitation, including, first of all, a wide range of methods of therapeutic physical culture.
 The most effective treatment is possible by involving a multidisciplinary rehabilitation team in the rehabilitation process and prescribing rehabilitation programs designed in accordance with the conceptual framework of respiratory rehabilitation, including, above all, a wide range of therapeutic physical education techniques.
 CONCLUSION. Current knowledge of the clinical picture, diagnosis, treatment and rehabilitation measures in long COVID is constantly reassessed and expanded. This literature review gives an analysis of research papers focused on the treatment and rehabilitation of pulmonary manifestations in adults, combining the etiopathogenetic and syndromic approaches characteristic of the “classical Russian therapeutic” and, closest to it, the “German” schools. The information extracted both from documents published by World Health Organization (WHO) and from local Russian and European clinical guidelines will allow a specialist engaged in the rehabilitation of adults with pulmonary manifestations of long COVID to create an effective and personalized individual rehabilitation plan for each patient.

Managing Lower Limb Muscle Reinjuries in Athletes: From Risk Factors to Return-to-Play Strategies.

Muscle injuries and subsequent reinjuries significantly impact athletes, especially in football. These injuries lead to time loss, performance impairment, and long-term health concerns. This review aims to provide a comprehensive overview of the current understanding of muscle reinjuries, delving into their epidemiology, risk factors, clinical management, and prevention strategies. Despite advancements in rehabilitation programs and return-to-play criteria, reinjury rates remain alarmingly high. Age and previous muscle injuries are nonmodifiable risk factors contributing to a high reinjury rate. Clinical management, which involves accurate diagnosis, individualized rehabilitation plans, and the establishment of return-to-training and return-to-play criteria, plays a pivotal role during the sports season. Eccentric exercises, optimal loading, and training load monitoring are key elements in preventing reinjuries. The potential of artificial intelligence (AI) in predicting and preventing reinjuries offers a promising avenue, emphasizing the need for a multidisciplinary approach to managing these injuries. While current strategies offer some mitigation, there is a pressing need for innovative solutions, possibly leveraging AI, to reduce the incidence of muscle reinjuries in football players. Future research should focus on this direction, aiming to enhance athletes' well-being and performance.

Ai-based next-generation sensors for enhanced rehabilitation monitoring and analysis

With advancements in technology and healthcare, the increasing aging population necessitates effective solutions to restore autonomy in elderly individuals suffering from conditions like stroke, cerebral hemorrhage, and muscle atrophy. In order to solve this problem this article is proposing AI-based next-generation sensors for enhanced rehabilitation monitoring and analysis along with other AI based automated tools. By employing precise motion recognition algorithms based on machine intelligence, these sensors accurately capture gait data from the elderly and allows the customization of individualized rehabilitation plans based on their unique needs. They offer a range of visual and auditory stimuli within virtual rehabilitative environments in order to stimulate interest and foster active engagement for enhancing the effectiveness of rehabilitation training in elderly people. Experimental results demonstrate that the rehabilitative effects achieved within virtual environments are comparable to real-world settings and exhibit successful outcomes. With the aid of this technology, adjustable lower limb exoskeleton medical equipment is designed to accommodate individual differences and rehabilitation progress. By seamlessly integrating virtual spaces and next generation smart sensors, the proposed research offer a dynamic and tangible rehabilitation solution. PGWBI score, balance ability score, gait improvement, blood pressure, heart rate and statistical metrics such as R2 score, mean value and standard deviation and confidence intervals are considered for performance evaluation of the proposed rehabilitation monitoring and analysis method. The proposed research is also addressing the challenges posed by an aging society while aligning with the goals of the information and digital era. The research findings hold significant theoretical and practical value in advancing rehabilitation practices.

Актуальные вопросы организации профессиональной переподготовки специалистов по физической реабилитации (кинезиоспециалистов) в условиях новой модели медицинской реабилитации.

The system of medical rehabilitation in Russia undergoes significant transformation which is reflected in the Federal Program «Optimal for health restoration medical rehabilitation in the Russian Federation». In such situation the issues of personnel training in the field of medical rehabilitation are becoming extremely relevant. The difficulties that arise along this path are associated with the interdisciplinarity of medical rehabilitation and the necessity to train specialists with medical education (doctors and nurses) as well as with higher non-medical education: physical therapists, ergotherapists, medical psychologists and medical speech therapists (according to the Order No. 788n of 31.07.2020). These allied health specialties are new for Russia but they are responsible for the main practical activity in the implementation of an individual medical rehabilitation plan. The difficulties in training non-medical personnel in rehabilitation largely arise from the requirement for them to have both medical and pedagogical competencies and to have the ability to work independently as well as in a rehabilitation team. This article summarizes the three-year experience of training specialists in medical rehabilitation with higher non-medical education at the National Research Nizhny Novgorod State University named after N. I. Lobachevsky. The article presents the main issues of the professional retraining program «Physical rehabilitation (physical therapy)» with a duration of 1020 hours, defines professional competencies, difficult issues of training, formation of practical skills and assessment of professional competencies in this category of students.

Effects of individualised rehabilitation for horses with equine herpesvirus myeloencephalopathy

SummaryIn 2019, a Swedish outbreak of equine herpes virus type 1 (EHV‐1) led to varying neurological symptoms also known as EHM (equine herpes myeloencephalopathy). Nineteen of the 39 exposed horses developed EHM. EHM outbreaks have become more common in recent decades and can result in large economic losses for the horse industry in addition to clear welfare implications. However, there is limited information about the estimated time to recovery from EHM and return to previous level of performance and there is limited published information regarding neurological rehabilitation in horses. Our objective was to describe and evaluate the potential benefit of implementing individual rehabilitation plans for horses recovering from EHM. Four horses with EHV‐1 and with clinical signs of neurological dysfunction were selected. All horses were initially hospitalised at an intensive care unit between 4 and 9 days and approximately 3 months after the outbreak they were considered sufficiently recovered to start a rehabilitation programme. The programs mainly focused on regaining proprioception, core stability and strength with consideration given to fatigue in the horse and risk to the handlers. A repeated neurological examination was performed six times over the first year and the rehabilitation programs were modified accordingly. The owners considered the horses ‘normal’, both mentally and physically, between 6 and 8 months after the outbreak. All horses were back to their previous level of performance after 8–11 months. A limitation of the study was a small study population with no control group. Our conclusions are that horses suffering from severe EHM may return to an acceptable athletic function given time and an individually adapted rehabilitation program. To potentially show that an individually adapted rehabilitation plan brings the horse back to acceptable function faster than nonspecific rehabilitation, a case‐control study would be required.

Post-COVID syndrome in children and adolescents of a large industrial city

Background. About 30 to 80% of children who have had a new coronavirus infection, suffer from post-COVID syndrome, the manifestations of which are diverse and persist for 12 weeks or more. Post-COVID syndrome remains an urgent problem in pediatrics, the clinical variants of which are diverse. There is no statistically significant relationship between the severity of coronavirus infection and the development of post-COVID syndrome. According to current data, the risk group for post-COVID syndrome includes children under 1 year of age, children with comorbid pathology.
 Aim. To evaluate the frequency of development, clinical variants and course of post-COVID syndrome in children and teenager of a large industrial city in order to optimize recommendations for their rehabilitation after a new coronavirus infection.
 Materials and methods. The were analyzed developmental histories of 6252 children and adolescents in Kemerovo (form 112/y) who had a new coronavirus infection.
 Results. Data on post-COVID syndrome were recorded in the developmental histories of 3066 (49.04%) children and adolescents, analyzed by medical documents. At the age of 13–15 years, the incidence of post-COVID syndrome is 55%, which is statistically significantly higher than in other age groups (p=0.005–0.0001). The following clinical variants of post-COVID syndrome were identified: asthenic, respiratory, cardiac, recurrent ears, nose, and throat, functional gastrointestinal disorders and mixed, the frequency of which varies depending on age and gender. Children with comorbid pathology (iron deficiency anemia and grade I–II pharyngeal tonsil hypertrophy) are statistically significantly more likely to suffer from post-COVID syndrome (p=0.000000001; 0.00000009; 0.00000009) than children without a history of comorbid pathology.
 Conclusion. Post-COVID syndrome occurs in half of children and adolescents who have had a new coronavirus infection. The frequency of post-COVID syndrome variants in children and adolescents differs. The presence comorbid pathology (iron deficiency anemia, pharyngeal tonsil hyperplasia of the 2 degree) increases the risk of developing post-COVID syndrome. It is necessary to examine patients in a timely manner for the purpose of differential diagnosis and drawing up an individual rehabilitation plan. Special attention should be paid to children with comorbid pathology.

Cофт-технологии в медицинской реабилитации после реконструкции передней крестообразной связки коленного сустава

The use of soft-technologies in medical rehabilitation is a highly relevant and promising direction of the remote method of restoring the health of patients. The authors have developed a program for an electronic computer «Medical rehabilitation (therapeutic gymnastics after reconstruction of the anterior cruciate ligament of the knee joint)». It is designed for patients to independently perform a set of exercises of therapeutic gymnastics at home. Based on the results of the lesson, the patient fills out a report, on the basis of which the attending physician makes adjustments to the individual medical rehabilitation plan. The analysis of the results of the approbation based on an anonymous survey indicates high patient satisfaction when using a mobile application and an increase in commitment to the implementation of recommendations

Application of the International classification of functioning, disability and health in medical rehabilitation of children with severe traumatic brain injury

BACKGROUND: The problem of rehabilitation of patients with severe traumatic brain injury has been and remains very important and relevant for both adults and children. Patients with severe traumatic brain injury often develop severe physical, mental, emotional and cognitive impairments, which are often difficult to correct and require long-term treatment, including rehabilitation, relying solely on the body's potential, which is accompanied by a heavy financial burden for the patient, his family, and society in general. The introduction of new diagnostic methods, the improvement of resuscitation measures, the use of modern methods of neurosurgical intervention and timely rehabilitation can increase the proportion of children who survived after severe traumatic brain injury and their quality of life.
 AIM: to evaluate the effectiveness of medical rehabilitation of children with severe traumatic brain injury with the participation of a multidisciplinary rehabilitation team and relatives of patients.
 MATERIALS AND METHODS: The study included 50 children with severe traumatic brain injury. Two groups were distinguished by the randomization method: the main group 25 patients (50%) and the control group, which included 25 patients (50%). The follow-up period was 1 year after the onset of severe traumatic brain injury. In the main group, an individual plan for early rehabilitation was drawn up on the 2nd day after a severe traumatic brain injury in intensive care. At the first stage of rehabilitation, which is carried out in the intensive care unit and the neurosurgery department, an individual medical rehabilitation plan was developed for the children of the main group, depending on somatic indicators and the severity of the condition, and a rehabilitation diagnosis based on the International classification of functioning, disability and health was established. In the control group, after transfer from the intensive care unit to the specialized neurosurgical department, patients received basic rehabilitation therapy: articular gymnastics, paraffin therapy, and psychological support.
 RESULTS: In the main group, more effective changes were noted in domains associated with impaired structure and function of the nervous system, which led to improved activity and participation, self-service. In patients of the control group, there were no significant changes in the state of functions, activity and participation.
 CONCLUSION: The early start of complex medical rehabilitation of children with severe traumatic brain injury reduces disability and accelerates the process of the patient's socialization, which is more clearly demonstrated by the International classification of functioning, disability and health approach. The use of International classification of functioning, disability and health for with severe traumatic brain injury in children in medical rehabilitation departments is a good tool for setting rehabilitation goals, choosing rehabilitation measures and assessing the effectiveness of rehabilitation.

Cardiac rehabilitation in the Comprehensive Cardiac Care program in the time of a COVID – 19 pandemic

Introduction and purpose: Cardiac rehabilitation in patients after myocardial infarction is an established form of therapy. Its main tasks in the context of the implementation of the KOS program are to improve quality of life, consolidate the effects of hospital treatment and ensure better functioning after a cardiovascular incident. The purpose of this paper is to analyze the current level of knowledge regarding cardiac rehabilitation of patients during the COVID-19 pandemic.
 Description of the state of knowledge: COVID-19 poses a significant threat to patients with cardiovascular disease. Physiotherapy in the Cardiac Rehabilitation Unit involves a step-by-step, individualized rehabilitation plan in accordance with the patient's condition. An important tool for clinical evaluation is capacity tests, the results of which provide key information for the rehabilitation team in selecting exercise intensity. These tests are performed on the first and last days of rehabilitation. In Polish conditions, the most common tests examining capacity are an exercise test on a treadmill or bicycle cycler or a 6-minute walk test. Due to the diversion of a significant number of specialists and health care teams to treat COVID - 19 patients, access to the possibility of implementing the various stages of the Coordinated Specialized Care program after myocardial infarction has been limited.
 Summary: Post-infection patients are often forced to live a sparing lifestyle. They show reduced exercise tolerance and easier fatigability. With these aspects in mind, improving the quality of life of patients after cardiovascular incidents in the era of the pandemic requires even greater involvement of the entire rehabilitation team.

Genetic factors of early termination of pregnancy

Pregnancy loss and premature delivery are combined by the definition Premature Termination of Pregnancy, while these conditions affect up to 5% of women of reproductive age. In some cases, genetic components are both etiologic and pathogenetic factors of premature birth, however, This challenge is further complicated by the fact that extensive population-based genetic studies and subsequent validation of the data are required, especially in multi-ethnic populations.
 Genome-wide studies will demonstrate polymorphic variants of hundreds of genes that are candidates for being associated with termination of pregnancy, including those regulating embryo implantation, pregnancy support, and immune system response. The review provides information about the genes and genetic polymorphisms that are involved in the regulation of the female reproductive system and associated with premature birth. A special role in the genetic mechanisms of miscarriage and/or preterm birth belongs to steroid hormone receptors, enzymes of the arachidonic acid metabolism, pro- and anti-inflammatory cytokines. However, the infectious factor takes the first place as a leading one, forming cause-and-effect relationships in the chain of pathogenetic links or giving modality to other factors. Most often, it is genetic polymorphisms associated with an over-activity of the immune system that underlie premature termination of pregnancy.
 Subsequent Investigation of the human genome, epigenome, and transcriptome helps to identify molecular mechanisms linked with preterm delivery and premature newborn clinical appearance in early and late neonatal life and even predict developmental outcomes. These data could be used to develop targeted interventions aimed at selecting the most effective individual treatment and rehabilitation plan. The data obtained in future studies could be used to develop for preconception care, targeted therapy and the most effective individual treatment plan.
 Keywords: genetic polymorphism; miscarriage; over-active immune responses; premature birth; premature termination of pregnancy; transcriptome.

Značaj rehabilitacije kod dekondicioniranog bolesnika nakon hospitalno lečene COVID-19 infekcije - prikaz slučaja

Introduction. The COVID-19 pandemic caused by the SARS-CoV-2 virus has led to significant public health problems, severe complications, and functional impairment in persons who have recovered from this disease. Case report. A 60-years-old male deconditioned patient was transferred from Corona 4 Center to the Center for Physical Medicine and Rehabilitation of the University Clinical Center in Kragujevac for a post-COVID rehabilitation due to pronounced muscle weakness and inability to walk. After functional testing, an individual rehabilitation plan was created and a kinesitherapy program was adjusted daily based on the patient's respiratory status. After the kinesitherapy program, Respivol was used-a volumetric medical device for breathing exercises in patients with respiratory difficulties. At the time of admission, the patient could not move independently, could not move from the lying to the sitting position on his own, and could not maintain balance in the sitting position. Hypotrophy caused by prolonged inactivity of the muscles of the whole body dominated the clinical picture. A six-week rehabilitation treatment performed on the patient showed a significant improvement in functionality (FIM test), muscle strength (manual muscle test), daily life activity (Barthel index), as well as a reduction of anxiety (GAD-7 scale). Conclusion. The goal of the rehabilitation program is to restore the patient's state of functionality before the initiation of COVID-19 treatment, so that they can perform their regular professional activities and achieve complete independence in performing activities of daily living (ADL).

A Study on the Roadmap of Performance Competence of Vocational Training Teachers of the Training Center for Persons with Developmental Disabilities (TCPDD) under the Korea Employment Agency for Persons with Disabilities: Based on the Perspective of the Lifelong Vocational Competence Development of Persons with Developmental Disabilities

The purpose of this study is to explore the roadmap of performance competency of vocational training teachers belonging to TCPDD under the Korea Employment Agency for Persons with Disabilities, focusing on PDD's perspective on lifelong vocational competency development. The research method was composed of the process of participating observation and FGI with experts in related fields, and the data collection and analysis work was carried out by synthesizing the response data through FGI and journal writing through participant observation. The contents of the study were presented in the context and level of the roadmap for the competencies of vocational training teachers working at the TCPDD under the Korea Employment Agency for Persons with Disabilities. Accordingly, the performance competency of the above vocational training teachers was presented in three major dimensions. Basic cognitive and motivational competencies, educational professional competencies, and administrative professional competencies are the results. In detail, in relation to the above three upper competencies, competencies for understanding the specificity of developmental disabilities, competencies for understanding lifelong education convergence based on individualized rehabilitation plan (IRP) or individualized-based planning (IBP), competencies for business jobs and lifelong vocational self-reliance development, generalization-based job virtual reality (VR) restructuring planning competencies, competencies for utilizing professional teacher-type vocational teaching and learning, competencies for circulation leadership between lifelong education and employment services, and competencies for establishing and operating a cooperative system between related institutions were presented. Through the results of the study, it was understood that TCPDD under the Korea Employment Agency for Persons with Disabilities has the status and identity to lead the importance and practice of vocational training at the level of the starting point for the transition of PDD to adulthood, and it was analyzed that whether the performance capabilities of vocational training teachers belonging to TCPDD are embodied in the level and context of the roadmap is the biggest task.

Causes of preterm birth: Genetic factors in preterm birth and preterm infant phenotypes.

The aim is to provide an overview of recent research on genetic factors that influence preterm birth in the context of neonatal phenotypic assessment. This is a nonsystematic review of the recent scientific literature. Maternal and fetal genetic diversity and rare genome variants are linked with crucial immune response sites. In addition, more frequent in preterm neonates, de novo variants may lead to attention deficits, hyperactivity, autism spectrum disorders, and infertility of both sexes later in life. Environmental factors may also greatly burden fetal, and consequently, neonatal development and neurodevelopment through a failure in the fetal epigenome reprogramming process and even influence the initiation of spontaneous preterm pregnancy termination. Minimally invasive analysis of the transcription factors associated with preterm birth helps elucidate labor mechanisms and predict its timing. We also provide valuable summaries of genomic and transcriptomic factors that contribute to preterm birth. Investigation of the human genome, epigenome, and transcriptome helps to identify molecular mechanisms linked with preterm delivery and premature newborn clinical appearance in early and late neonatal life and even predict developmental outcomes. Further studies are needed to fully understand the implications of genetic changes in preterm births. These data could be used to develop targeted interventions aimed at selecting the most effective individual treatment and rehabilitation plan.