Individualized Rehabilitation Program Research Articles

Adherence to Visits to Medical Institutions and Quality of Therapy after Acute Coronary Syndrome (according to the LIS Registry 3)

Aim. The aim of the research is to evaluate the relationship between patients' adherence to visiting polyclinics after acute coronary syndrome (ACS) and the quality of the therapy they receive.Material and methods. The study was conducted on the basis of the LIS registers (LIS and LIS-3) (Lyubertsy study of mortality) in the Lyubertsy district of the Moscow region. To clarify the vital status of all patients discharged in the first 9 months of 2014 and 2018. from Lyubertsy district hospital 2, contact was established no earlier than 1 year after discharge, and in case of death, its cause was clarified. In the course of a telephone survey, information was obtained on the therapy taken, adherence to visits to medical institutions, a record of cases of cardiovascular events and invasive treatment, hospitalizations due to worsening of the course of the underlying disease for the period after discharge from the hospital was carried out. The search for patients who did not answer the phone call was carried out by studying the archives of polyclinics, using the Megaclinic statistical database, and the data of the individual rehabilitation program for the disabled. In the course of a telephone survey, the response was 60.5%, the search for the remaining patients through statistical databases, the archive of polyclinics made it possible to increase the total response to 87.2%.Results. In the LIS-3 registry, out of 104 patients discharged in 2014, the status was determined in 90 (86.5%) patients, out of 223 patients in 2018 – in 195 (87.4%) patients. During the survey, it was found that 172 patients are observed after discharge from the hospital, 53 patients are not observed at all in the medical facility after discharge. 11 (4.9%) people did not take any groups of medications at the time of the survey. In the group of patients who are highly committed to attending a health facility, the best quality of taking essential medications after discharge from the hospital was noted according to the survey: statins (88.2%, p<0.001), beta-blockers (86.4%, p<0.001) and antiplatelets (90.9%, p=0.001). In both groups, committed and not committed to attending a medical facility, there is a negative dynamics in the quality of taking medications after discharge from the hospital, however, in the group of patients committed to attending a medical facility, it was noted that the odds of taking antiplatelet agents after discharge was 3.4 times higher (OR 3.449, p=0.002), beta-blockers – 4 times (OR 4.103, p<0.001), statins – 4.5 times (OR 4.450, p<0.001), in relation to the group of patients who are not observed in the medical facility after discharge from the hospital.Conclusion. 1-6 years after discharge from the hospital after the reference event, the quality of therapy deteriorated significantly in both groups, mostly in non-adherent patients. Significant differences in the quality of medication intake (antiplatelet agents, statins, β-blockers) were noted in the group of adherents to visiting health care facilities in comparison with those who were not committed to visiting health facilities. It is obvious that high adherence to visits to healthcare facilities after discharge from the hospital is associated with better quality of medication intake. Despite improvements in the quality of adherence to clinical recommendations, the percentage of patients who independently refuse to take drug therapy (4.9%), regardless of visits to healthcare facilities after discharge from the hospital, remains.

Assessing data in planning the provision of early assistance services to children and their families as part of the formation of interdepartmental interaction: regional experience

Introduction. One of the priority areas in the implementation of the national project “Demography” is supporting the family and strengthening the health of the younger generation. Data on the increase in the number of children who, in the early stages of development, are diagnosed with psychophysical development disorders of various severity and structure of expression, pose important tasks for regional authorities to modernize comprehensive care and create a model of interdepartmental interaction in the provision of early assistance services to children and their families in order to prevent negative scenarios for child development. The purpose of our article is to analyze the modern system for recording data on identifying and providing services to young children, and the experience of organizing early care for children and their families. Methods. Data is used on the health status of young children living in the Chelyabinsk region (Russian Federation) for 2020 – 157,459 children, 2021 – 218,249 children; 2022 – 137,978 children. A method of compiling and grouping statistical observation materials was used, which allows for an analysis of the numerical composition of young children at risk receiving early assistance services, the structure of institutions and organizations in the field of health care, education and social protection of the population of state and municipal forms of ownership on the basis of which services are provided early assistance in the region. Results. It has been established that in the region, the system for collecting, analyzing and systematizing statistical data on children classified as a target group and receiving early assistance services is based on federal statistical reporting forms. Quantitative and qualitative analysis of the data obtained allows us to say that 100% of children in the target group receive early intervention services. At the same time, conclusions were drawn about a clear underestimation of the potential capabilities of the education system (18% of children in the target group) and social protection of the population of the region (4% of children in the target group) to create conditions for the provision of early assistance services. The use of such a form of statistical method of “observation” as reporting analysis made it possible to identify a pattern that reveals a trend of annual increase in the detection of the number of children in the target group at each subsequent stage of age development (on average by more than 75%). Conclusion. Prospects for developing a model for the development of early care in the region are based on the need to: take into account data on the individual characteristics of children’s health; their inclusion in the system of habilitation and rehabilitation measures carried out within maximum walking distance for the family by specialists with the required level of professional competence; ensuring the implementation of an individual child rehabilitation program in the regional system of interdepartmental interaction.

Tasks of the state policy of formation and implementation of social protection for persons with disabilities in Ukraine

The article is devoted to the study of the tasks of the state policy of formation and implementation of social protection of persons with disabilities in Ukraine. The article analyzes international and national legislation in the researched area. In the article, the author provides the author's definition of the tasks of the state policy of the formation and implementation of social protection of persons with disabilities as a predetermined complex of decisions and actions of subjects of power, aimed at solving the problems of social protection of persons with disabilities. In addition, among the main tasks of social security of persons with disabilities recognized by the world community, namely the identification and elimination of obstacles and barriers that prevent the provision of rights and the satisfaction of needs, including access to public and civil facilities, improvement, transport infrastructure, road service (hereinafter – objects of the physical environment), transport, information and communication, as well as taking into account individual capabilities, abilities and interests – to education, work, culture, physical culture and sports; health care; social protection; ensuring the implementation of an individual rehabilitation program for persons with disabilities; provision of adapted housing; promotion of social activities. The author focuses on the fact that the inherited system of social protection of persons with disabilities is largely based on the medical model of disability. In addition, it was established that the issue of transition from the medical model of social protection is currently being updated, and currently the priority tasks of social protection of persons with disabilities are their autonomy and social inclusion; departure from the medical model of protection; the need to «transpose» the system of services for persons with disabilities, directing them to the independence and atomization of the individual.

Optimizing Rehabilitation Strategies for Sports Injuries: A Comprehensive Analysis of Evidence-Based Interventions and Rehabilitation Protocols

Athletes commonly become injured during competition, emphasizing the necessity for appropriate recovery. This research examines if standard sporting injury treatments and rehabilitation work in China. The issue Despite the high occurrence of sports injuries in China, rehabilitation therapy efficacy research is scarce. Interview-based research addresses such problems. This research examines how different therapy and rehabilitation programs help Chinese athletes recover from competition-related injuries. The researchers interviewed wounded athletes to acquire data. Structured interviews were conducted to collect qualitative data from participants regarding their rehabilitation therapies' efficacy, adherence, and results. The study revealed fresh information on the efficacy of evidence-based treatments and rehabilitation methods for Chinese sports injuries. The interviews revealed how different rehabilitation methods impacted on the athletes' recoveries and what variables influenced program adherence and positive results. Based on the findings, medical practitioners, sports trainers, and Chinese athletes should prioritize scientifically backed rehabilitation regimens. Using this data to create individualized rehabilitation programs for athletes with sports-related injuries may improve their chances of a complete and quick recovery. In conclusion, an interview-based study in China revealed the effectiveness of evidence-based sports injury treatment and rehabilitation. The study will help the Chinese sports community better rehabilitate and recover faster.

Комплексная оценка здоровья детей с хроническим аденоидитом 4–7 лет разных типов психосоматической конституции

The article presents the comprehensive assessment of the health of preschool children with chronic adenoiditis, taking into account different types of psychosomatic constitution. The main group included 196 children aged 4 to 7 years with the verified diagnosis of chronic adenoiditis; another 140 frequently ill children (with reduced resistance without chronic adenoiditis) made up the control group. It was revealed that the state of health of mothers of patients with chronic adenoiditis in many parameters had significant differences in children of extra- and introverted types of psychosomatic constitution (hereinafter referred to as extra– and introverts). Introverted children from the main group were significantly more likely to suffer from allergic rhinitis – in 47 (69.1%) cases versus 2 (2.9%), and atopic dermatitis – 50 (73.5%) versus 4 (5.9%), respectively. The type of psychosomatic constitution significantly affects the main clinical manifestations, course and development of complications of chronic adenoiditis and acute respiratory diseases in children of both groups, as well as the indicators of their neuropsychiatric development and the types of prevailing behavior. The data obtained in the study should be taken into account when developing individualized rehabilitation programs. Key words: children with reduced resistance, introverts, psychosomatic constitution, chronic adenoiditis, extroverts

Impact of Cranioplasty on Rehabilitation Course of Patients with Traumatic or Hemorrhagic Brain Injury.

Some authors have hypothesized that cranioplasty after decompressive craniectomy (DC) could positively influence functional recovery through several mechanisms. However, only a few studies with small sample sizes have investigated the effects of cranioplasty on functional recovery. Our study aims at evaluating the role of post-DC cranioplasty in influencing the functional recovery in a large cohort of patients with different etiologies of acquired brain injury (ABI). This retrospective study consecutively enrolled 253 patients with ABI, consisting of 108 adults who underwent post-DC cranioplasty and 145 adults who did not. All the subjects underwent a 6-month individual rehabilitation program. Demographic data, etiology, classification and anatomical site of brain injury, neurological and functional assessment at baseline and on discharge, and number of deaths during hospitalization were recorded. In our cohort, 145 patients (57.3%) and 108 patients (42.7%) had, respectively, a hemorrhagic stroke (HS) and a traumatic brain injury (TBI). Only in the patients with TBI cranioplasty emerged as an independent predictor of better functional outcome in terms of the Functional Independence Measure (FIM) total score at discharge (β = 0.217, p = 0.001) and of the FIM variation during rehabilitation (ΔFIM) (β = 0.315, p = 0.001). Conversely, in the case of HS, no associations were found between post-DC cranioplasty and functional recovery. Post-DC cranioplasty was associated with better functional recovery six months after TBI but not in the patients with HS. Although the pathophysiological mechanisms underlying HS are different from those of TBI and possibly play a role in the different outcomes between the two groups, further studies are needed to investigate the mechanisms underlying the observed differences.

Peculiarities of manifestation and general rehabilitative signif icance of the phenomenon paradoxical kinesia in Parkinson’s disease

The purpose of the study: is to identify the factors contributing to the occurrence of paradoxical kinesias (PK) in Parkinson’s disease (PD) and to assess their frequency and clinical manifestations (according to the results of interviews). All patients interviewed were divided into two groups. The first group (45 people) — patients without symptoms of dementia, the second group (18 people) — patients with symptoms of dementia. The MMSE assessment was conducted no more than three months before this survey to assess the frequency of PK phenomenon, before the introduction of quarantine restrictions. Patients with PD initially have virtually no idea about the phenomenon of PK, but when informed (individually and in groups) in a group of patients without clinically significant cognitive decline, understanding of the essence and possibilities of PK increases from 6.7% to 88.9% of respondents. Patients with PD, cognitively preserved, note the manifestations of PK in the form of a spontane- ous ability to perform movements faster and more dexterously in 82.2% of observations, with vital movements of posture control, walking, and balance observed in 93.3% of patients, and the per- formance of complex acts in 51.1% of observations. Factors contributing to the manifestation of PK are often (in more than 50.0% of cases) in the group of patients without significant cognitive decline is - rhythm, counting, cues (84.4%), listening to music (93.3% of answers), environment (64.4%), strong emotions (93.3%); communication with certain people (88.9 %; answers); quality of sleep (80.0 %); less frequent, but practically applicable are internal order and conscious control (48.9 %) and visualization of the motor act (40.0 %). The realization of the phenomenon of PK with the help of factors that reveal it can be used in conducting classes on motor rehabilitation, but it is necessary to preserve the cognitive poten- tial of patients. The rehabilitation potential of patients with PD is defined as medium or low level. This level of rehabilitation potential is generally sufficient for the implementation of the developed individual rehabilitation programs.

THE EFFECT OF CONNECTIVE TISSUE DYSPLASIA ON THE FORMATION OF COMORBID PATHOLOGY IN YOUNG PEOPLE

Deviations in the development of organs and connective tissue dysplasia (CTD) still remain an urgent interdisciplinary problem. The aim of this study was to study clinical and morphological changes of the maxillofacial system, skeletal deformities and blood parameters in 164 young people. Twice as much as in the control group, orthopedic pathology (68.4% and 32.9%) and manifestations of anemia were found in every fifth (21.5%) of the examined patient. The revealed multi-organ changes identified the need to select individual rehabilitation programs in patients with CTD.

PECULIARITIES OF THE QUALITY OF LIFE OF PATIENTS WITH SCHIZOPHRENIA WITH CONCOMITANT DIABETES MELLITUS

In this article studied the features of the quality of life of patients with schizophrenia with concomitant diabetes mellitus. Conducting this study on the assessment of the quality of life of patients in the compared groups, we came to the conclusion that concomitant diabetes mellitus significantly reduces the quality of life of patients with schizophrenia. The revealed stronger relationship between the subjective assessment of one's QoL and the severity of positive and negative psychopathological symptoms in patients with concomitant somatic pathology suggests that the use of questionnaires to assess the quality of life in this category of patients for the development of individual rehabilitation programs is highly informative. Keywords: quality of life of patients with schizophrenia, diabetes mellitus, positive and negative psychopathological symptoms, individual rehabilitation programs.

Delphi-Based Consensus to Determine Core Aspects of Post-Hip-Fracture Surgery Rehabilitation Based on the International Classification of Functioning, Disability, and Health.

A hip fracture is a major adverse event for older individuals that has extremely high rates of mortality and morbidity, specifically functional decline. Thus, effective post-hip fracture rehabilitation is crucial to enable patients to regain function and improve their quality of life. Most post-hip fracture rehabilitation programs focus only on physical functioning, but rehabilitation goals related to the quality of life, social participation, and environmental issues are also crucial considerations. This study aimed to develop a core set of considerations based on the International Classification of Functioning, Disability, and Health (ICF) for use as a reference in designing comprehensive rehabilitation programs for patients with hip fractures. For this purpose, we recruited 20 experts from related fields working at a university hospital to complete a three-round Delphi-based questionnaire. Before beginning this process, a literature review related to ICF category selection was conducted. Next, a 5-point Likert scale was employed to rate the importance of each proposed category, and Spearman's rank correlation coefficient and semi-interquartile range indices were analyzed to rate the consensus status. Categories for the ICF core set of considerations for post-hip-fracture rehabilitation were chosen on the basis of a high level of consensus and a mean score of ≥4.5 in the third Delphi-based questionnaire round. After selection, the ICF core set comprised 34 categories, namely 15 for bodily functions, 5 for bodily structures, 13 for activities and participation, and 1 for environmental factors. The proposed post-hip-fracture rehabilitation ICF core set can serve as a reference for developing effective rehabilitation strategies and goal setting by interdisciplinary teams. However, further feasibility evaluation is recommended for individualized rehabilitation program design.

The relationship of respiratory functions and respiratory muscle strength with trunk control, functional capacity, and functional independence in post-stroke hemiplegic patients.

Cardiorespiratory system involvement and early fatigue observed in stroke patients complicate the rehabilitation process and affect their ability to perform daily activities and functional independence. It was aimed to determine the relationship between respiratory functions and respiratory muscle strength with trunk control, functional capacity, and functional independence in hemiplegic patients after stroke. Twenty-five volunteers who were diagnosed with post-stroke hemiplegia were included in the study. Sociodemographic and physical characteristics were recorded. Pulmonary function test (PFT), respiratory muscle strength, Trunk Impairment Scale (TIS), Timed-Up and Go Test (TUG), and Barthel Index (BI) were applied. There was a moderate negative correlation between TUG scores and PFT results (r=0.413-0.502; p=0.011-0.04), except for PEF (%) and FEV1/FVC. Also, there were statistically significant correlation between TIS scores and FEV1(%) (r=0.505; p=0.012), FVC(%) (r=0.449; p=0.024). On the other hand, there was no statistically significant relationship between BI results and any parameter of the PFT (p>0.05). There was no statistically significant correlation between respiratory muscle strength and TUG, TIS, BI (p>0.05). It has been shown that respiratory functions are associated with functional capacity and trunk control. However, it was found that there was no relationship between respiratory muscle strength and functional capacity, trunk control, and functional independence. It is thought that considering these parameters in the assessment of patients will contribute to the creation of individual and effective rehabilitation programs. The respiratory system should be systematically assessed in stroke rehabilitation and considered as part of a holistic approach. NCT05290649 (retrospectively registered) (clinicaltrials.gov).

Current issues in the formation of the rehabilitation system for victims with fractures of the long bones of the limbs in martial law conditions

The problem of treating fractures of the long bones of the limbs (FLB) does not lose its relevance, since among all injuries of the locomotorsystem, they occur most often and are accompanied by various complications. According to the literature, in 38 % of patients,disability from injuries of the locomotor system is due to its functional disorders, and in most cases it can be prevented by followingthe correct rehabilitation measures. Objective. To analyze and determine the most important factors for the formation of a rehabilitationprogram for patients with FLB and to evaluate the effectiveness of these measures. Methods. A medico-social analysisof the results of treatment of 63 patients (41 men and 22 women) with FLB, including those with flammability, who received treatmentat the «Sitenko Institute of Spine and Joint Pathology NAMS of Ukraine» in 2020‒2021. Of them, 63.5 % had multiple injuries,in 2020 — 64.3 %, in 2021 — 62.8 %. The results. The clinical and functional state of the patients was analyzed, taking into accountthe nature of the injury and the location of the fractures, depending on the level of rehabilitation potential. The main organizationalprinciples of providing medical assistance and rehabilitation to victims of FLB have been defined and formulated. The rehabilitationgroups of patients are characterized, the main factors affecting the rehabilitation potential and rehabilitation prognosis are determined.The main principles that must be taken into account when drawing up an individual rehabilitation program for patients withFLB are formulated. Conclusions. The conducted studies showed that the proposed principles of creating a medical rehabilitationprogram for patients with fractures of the long bones of the limbs made it possible to more objectively substantiate the scope andterms of restorative treatment at all stages of rehabilitation and specify the structure of rehabilitation measures for every case, that,finally, made it possible to develop individual rehabilitation programs for these patients and improve the results of their treatment.

A Rehabilitation Program for Individuals With Chronic Low Back Pain: Protocol for a Randomized Clinical Trial.

Low back pain (LBP) is the leading cause of disability worldwide. Physical exercise, as a treatment, is beneficial for the improvement of quality of life in patients with LBP, and it is widely accepted. We aimed to develop a protocol for a feasibility study that is designed to compare the effectiveness of different interventions in reducing pain, functional, and psychosocial factors among patients with chronic LBP after 8 weeks of randomization. This is a study protocol for a randomized controlled trial that will consist of individuals with chronic LBP who are aged between 18 and 65 years. Participants will be allocated, through block randomization, to one of the following groups: the motor control exercises (MCEs), pain education, MCEs+pain education, and usual care groups. The primary outcome will be pain intensity, and the secondary outcomes will be the pressure pain threshold, which will be measured with a digital algometer; LBP-related disability; fears and beliefs; the fear of movement; quality of life; mood states; and levels of depression and anxiety. The trial was approved by the ethics committee for research involving human beings of the Federal University of Pelotas (reference number: 5.717.390) in September 2022, and it will be conducted until August 2023. The researchers are being trained to apply the questionnaires and carry out the interventions. Patient recruitment will begin at the end of 2022 and results are expected to be achieved by August 2023. Our trial will provide preliminary data regarding the feasibility and safety of MCEs and pain education for patients with LBP. It will also provide preliminary outcome data that can be used to identify the most efficient intervention and the level of health care that should be implemented in public health services. Brazilian Registry of Clinical Trials U1111-1221-4106; https://ensaiosclinicos.gov.br/rg/RBR-2xx2r2/. PRR1-10.2196/31345.

The role of health staff in programs rehabilitation of recipients of social services in the conditions of a psychoneurological boarding house

The article presents a rehabilitation program for the recipients of social services in a psychoneurological residential care facility (hereinafter referred to as PRCF) in various directions with the direct participation of junior and middle medical personnel. The purpose of creating the program is to implement the medical and labor rehabilitation of social service recipients (hereinafter referred to as SSR) and maintain their independence with any possible resources. Program results: the implementation of rehabilitation activities was organized in accordance with the individual rehabilitation and (or) habilitation program, the areas of work with people with disabilities for their further medical and labor rehabilitation were determined, the desire, interest and opportunity to train SSR in new labor skills were determined, and the SSR socialization was preserved. Conclusion. The result of the well-coordinated specialist team work is the complete satisfaction of the needs of a sick person. Recipients of social services feel like full-fledged members of society with all rights, responsibilities and duties.

BULLYING: PROBLEM SOLVING ALGORITHM

The article presents the algorithm of actions of pedagogical staff of a general secondary education institution in case of detection of signs or facts of bullying (harassment), namely: notification of bullying (harassment), investigation of the facts of bullying (harassment) by the head of the educational institution, establishment of a commission to consider cases of bullying (harassment) ). Subjects of response and responsibility of persons for committing bullying (harassment) are also considered. The focus is on preventive measures regarding bullying. The main ones are measures of educational influence. It was determined that the main role in solving these issues belongs to the head of the institution, who takes and ensures the necessary measures to provide social, psychological and pedagogical services to students. A practical psychologist and a social pedagogue, within the scope of their job duties, constantly work and diagnose the state of the psychological climate in the team, in which the bullying (harassment) took place; develop a plan for corrective work with the offender and witnesses, parents or their legal representatives; implement an individual rehabilitation program for the victim; develop a plan of preventive measures for the group of observers. And most importantly, they provide support for pedagogical workers who conduct the educational process in a class group where a case of bullying (harassment) has been recorded, providing psychological support for students of education. It has been established that the subjects of response in case of detection of a case of bullying in educational institutions are: the service of the educational ombudsman; services for children; social service centers for family, children and youth; local governments; managers and other employees of educational institutions; founder(s) of educational institutions or a body authorized by him/her; territorial bodies (units) of the National Police of Ukraine. It should be emphasized that the list of measures of educational influence is determined and planned by th bullying, which is created in the institution of general secondary education. It was found that the head of the institution should take and ensure the necessary measures to provide social, psychological and pedagogical services to the students of education. A significant role in this line of work is given to practical psychologists and social pedagogues. A practical psychologist and a social pedagogue, within the scope of their duties, diagnose the state of the psychological climate in the team in which the bullying took place; develop a plan for corrective work with the offender and witnesses, parents or their legal representatives; implement an individual rehabilitation program for the victim; develop a plan of preventive measures for the group of observers.

Study regarding the functional level of the upper limb after mastectomy

The complex treatment applied to breast cancer patients consists of mastectomy, chemotherapy and local radiation therapy and affects the functional level of the upper limb on the side of the mastectomy. Physical therapy plays an important role in increasing the functionality of the upper limb after treatment. The purpose of the study is to verify the effectiveness of an individualised therapeutic exercise programme aimed at increasing the range of motion of the upper limb. Five participants who had undergone mastectomy surgery 6 months earlier were included in the study and each received an individualised rehabilitation programme that was performed twice a week for 6 months. The patients were assessed using three functional tests: test 1 - bringing the hand to the back of the neck, test 2 - touching the scapula with the hand by performing flexion, adduction and internal rotation, and test 3 - touching the scapula with the hand by performing extension, adduction and external rotation. These tests are quantified on a scale of 0 to 4. Early application of an individualised kinetic programme improves the functional capacity of the upper limb on the side of the surgery and contributes to reintegration into daily and socio-professional activities. We consider it important to train patients through educational monthly sessions that address issues such as: maintaining body weight, allowed food and nutritional management for side effects during adjuvant treatment, prevention of chronic diseases.

Individualized rehabilitation strategies for patients with critical pulmonary diseases

Individualized rehabilitation for patients with critical pulmonary diseases is a comprehensive intervention system that emphasizes individualized intervention with multidisciplinary specialties with different medical background support. On the basis of ensuring patients' safety, and evaluation of the right time for intervention, combined ABCDEF bundle strategies are used to implement individualized rehabilitation programs. In the process of rehabilitation treatment, we perform dynamic evaluation of the benefit and risk of individualized rehabilitation for patients suffering critical pulmonary diseases, and formulate adverse reaction prevention and control plans, and therefore to effectively improve the physical and psychological functions of patients, reducing complication and post- ICU syndrome, and promoting recovery.

Physical Rehabilitation in the System of Remedial Treatment of Patients after COVID-19: a Review

INTRODUCTION. The global spread of the new coronavirus infection COVID-19 determines the relevance of studying the clinical features and long-term consequences of the disease in children. Respiratory tract lesions in COVID-19 are the most common symptoms in the pediatric population. At the same time, the possibility of the development of gastrointestinal, neurological and psychological disorders has now been established, which is important to consider when designing medical rehabilitation programs for such patients. RESULTS AND DISCUSSION. The article describes modern approaches to the organization of 3-stage medical rehabilitation of patients who have undergone a new coronavirus infection COVID-19. Medical rehabilitation of such patients is aimed at restoring the ventilation function of the lungs, improving bronchial patency and drainage function of the respiratory tract, normalizing the functional state of the cardiovascular system, gastrointestinal tract, muscle tone, increasing exercise tolerance and the defenses of the child’s body. The most important component of rehabilitation measures, in addition to drug therapy and physiotherapy methods carried out for such patients, is physical rehabilitation, that is, the use of physical exercises for therapeutic, preventive and rehabilitative purposes. The authors describe the main tasks, means and forms of physical therapy, motor modes and intensity of load for each stage of medical rehabilitation, the principles of a differentiated approach to the selection of basic physical rehabilitation measures taking into account the target organ, the stage of medical rehabilitation are presented. CONCLUSION. Physical rehabilitation is a mandatory component of the individual medical rehabilitation program for children who have suffered COVID-19. The differentiated application of physical rehabilitation, taking into account the target organ, the severity of the disease, the stage of medical rehabilitation, makes it possible to achieve an earlier and complete restoration of the impaired functions of various organs and systems.

Rehabilitation Measures Planning based on the Analysis of Functional Impairments and Disabilities due to Chronic Kidney Disease: a Retrospective Study

INTRODUCTION. Quality of functional impairments analysis and the degree of disability associated with chronic kidney disease is a key factor of the effectiveness of the rehabilitation measures organization for persons with disabilities with the above pathology. AIM. To assess the degree of physical dysfunction of the disabled persons due to the chronic kidney disease on the basis of the clinical and functional disorders to determine the need for rehabilitation measures. MATERIAL AND METHODS. The study was generated in the form of the Excel spreadsheet using the following methods: documentary, excerpting data in the volume of 265 units. For quantitative variables, statistical indicators were used: mean and median. To compare two independent groups, the reliability index was used, the X2 statistic and Spearman’s rank correlation coefficient were performed. The significance level for testing statistical hypotheses was assumed to be 0.05. Processing and analysis was performed in the R environment (environment for statistical data analysis. http://www-r-project.org). RESULTS AND DISCUSSION. In these patients, the largest proportion in the structure of physical dysfunctions were limitations to self-care, first-degree movement, labor activity and second-degree self-care, and third-degree labor activity. Analysis of the degree of severity of disability depending on the stage of the disease, which determines the structure of social insufficiency and reduced quality of life, can be accepted as a basis for planning rehabilitation measures. At the same time, due to the predominance of general symptomatology, analysis of clinical signs of chronic kidney disease, taking into account the stage of the disease, can be recognized only as an auxiliary mechanism. CONLUSION. Expert-rehabilitation diagnostics among persons who have undergone primary and repeated examination allows us to get an idea of the rehabilitation measures amount required for them, taking into account the stage of the process in certain subgroups. When forming an individual rehabilitation program, the use of ICF is indispensable.

Adamkiewitz syndrome in Marfan syndrome and rehabilitation outcomes-3 cases and review of the literature

Acute Spinal Cord Ischemia Syndrome (ASCIS) is rare but clinically significant. Aortic dissection (AD) is one reason for ischemia of the spinal cord. The artery of Adamkiewicz provides the major blood supply to the anterior thoracolumbar spinal cord, and injury to this artery can cause consequential neurologic damage.Three male patients applied to our rehabilitation clinic with paraplegia. All three had AD due to Marfan Syndrome and clinical findings due to Adamkiewitz artery ischemia. Although we later learned that one of the patients later died from a new ruptured aortic aneurysm, we achieved good motor gains in these rare cases with rehabilitation. Although paraplegia is rare as the initial symptom in AD, vascular etiology should not be forgotten in acute paraplegia. The prognosis of ASCIS is known to be poor, but a good and individualized rehabilitation program is required.