Medical Rehabilitation Program Research Articles

Features of the Background EEG of Alcohol Dependent Patients with Comorbid Exogenous Organic Brain Damage

Background: the range and prevalence of complicating pathologies in alcoholism indicate the need for a thorough examination of patients using modern diagnostic approaches. The aim was to study the indicators of spontaneous electrical activity of the brain in patients with alcohol dependence with comorbid exogenous organic brain damage non-alcoholic nature. Patients and methods: a study of electroencephalograms of 148 men with alcohol dependence using the classification of E.A. Zhirmunskaya (1984) was conducted. Results: based on the hystory data, 85 (57.4%) patients were found to have exogenous organic vascular brain damage (including hypertension in 57 (38.5%) cases, chronic cerebral circulation disorder — in 8 (5.4%), somatoform autonomic dysfunction — in 7 (4.7%)) and traumatic character (mild traumatic brain injury) in 13 (8.8%)) patients. The analysis using Fisher’s exact criterion revealed statistically significant differences between patients with alcohol dependence and alcoholism patients with comorbid exogenous organic brain damage in the frequency of occurrence of various types of electroencephalograms (p < 0.001). The study clearly showed that the presence of exogenous organic brain damage in patients with alcoholism leads to more pronounced functional changes in the brain. Conclusion: early detection of pathological activity on the EEG in patients with alcohol dependence will allow clinicians to carry out appropriate therapeutic and diagnostic measures in a timely manner and will provide additional information necessary for the development of personalized medical rehabilitation programs for patients taking into account their neurophysiological profile.

Experience and prospects of introducing information technologies in the program of medical rehabilitation of patients with cerebral circulation disorders

Objective. To assess the rehabilitation potential of patients with cerebrovascular disorders for prospective follow-up and effective medical rehabilitation. Materials and methods. The study group included patients with cerebrovascular diseases (n=20) and acute cerebrovascular accident (n=22). Integral assessment of the state of health was carried out using diagnostic complex “Computer dermograph for the topical diagnosis of pathology lesions of internal organs” (DgKTD-01). Following studying the baseline indicators, a comparative analysis of the study group and the control group (n=10) was carried out. The patients of the study group had their state of health corrected by means of the Computerized corrector ANKF-01 using low-intensity electromagnetic field for normalization of functional activity of the central and peripheral nervous system. The course consisted of 10 sessions weekly with preliminary functional and topical diagnostics using the DgKTD-01 complex. Results. Patients with acute cerebrovascular accident revealed a functional restructuring of autonomic regulation with a greater severity of activation of the sympathetic link, patients with cerebrovascular diseases – of the parasympathetic one. The determining factor in cerebral circulation disorder consists in the indices of basic functions F2 and F3. The study identified a model for predicting the likelihood of acute recurrent disorders of cerebral circulation, as well as additional diagnostic criteria for differential diagnosis. Purposeful change of excitatory (inhibitory) potentials in cortical-subcortical relations changes vegetative balance, stimulates microcirculation, muscle-tonic function, neurotrophic regulation. These effects stabilize and improve the condition of patients. The effectiveness of rehabilitation measures using ANKF-01 is considered to be higher in patients with acute cerebrovascular accident. Conclusion. Patients with cerebral circulation disorders have specific features of the adaptive capabilities of the body. This indicates the differentiation in the formation of the functional status of the body, taking into account the characteristics of the disease, individual resources and compensatory capabilities. Rehabilitation based on the use of ANKF-01 increases the effectiveness of measures aimed at preventing organic changes in the brain, and can significantly improve the prognosis and reduce the percentage of disability in this category of patients.

Long-term combined antiplatelet therapy for secondary prevention of noncardioembolic stroke

Introduction. The high risk of recurrent ischemic events after non-cardioembolic ischemic stroke(IS), the prevalence of which is 25% of all strokes in the Russian Federation, determines the need to search for effective and safe secondary prevention strategies.Аim. The study was to evaluate the efficacy and safety of a combination of ADP receptor inhibitors (dipyridamole) with acetylsalicylic acid in patients with ischemic stroke (IS) in the secondary prevention of noncardioembolic stroke.Materials and methods. 229 patients in the early recovery period of noncardioembolic IS (139 women, 90 men), with an average age of 59.0 ± 5.7 years were included in the study. The duration of IS was 54.4 ± 6.1 days. All patients received a multimodal medical rehabilitation (MMR) program. Long-term double antiplatelet therapy with acetylsalicylic acid (ASA) 75 mg per day and dipyridamole at a daily dose of 225 mg divided into 3 doses were prescribed to all the patients. The neurological and neuropsychological status of the patient, quality of life and hemorheological parameters were assessed initially (T0), after MMR (T1, 6 weeks) and 12 months after IS(T2).Results. Motor and coordination indicators of patients as well as the cognitive and emotional parameters were significantly (p < 0,05) improved due to MMR technology. These were confirmed by the dynamics of the corresponding scales. The prescribed double antiplatelet therapy did not cause significant adverse events and worsening of the patients’ well-being both during the MMR process and during the observation period. The combination of ASA with dipyridamole was well tolerated. At the end of the study, recurrent IS, myocardial infarctions, and fatal bleeding were not recorded. In 5.2% patients with severe risks of cardiovascular complications there was occurred TIA. The effectiveness of the dual antiplatelet therapy was confirmed by a decrease in the level of platelet aggregation (p < 0,05).Conclusions. The high effectiveness of secondary prevention of IS with a combination of ASA and dipyridamole with good tolerability and safety in patients after IS has been shown.

Pharmaco- and ozone therapy in outpatient medical rehabilitation programs for patients with chronic cerebral ischemia

Abstract. Purpose of the study. To evaluate the effectiveness of medical rehabilitation of patients with stage 1 chronic cerebral ischemia using ozone therapy in an outpatient setting. Material and methods. A randomized, prospective, single-center, open-label, controlled study was conducted on 80 patients with stage 1 chronic cerebral ischemia, who were divided into 2 groups by means of simple randomization: in the study group (SG/41 patients), the patients received rehabilitation in accordance with the federal clinical guidelines and intravenous ozone therapy; in the control group (CG/39 patients), the patients underwent only standardized treatment. The effectiveness of rehabilitation measures was monitored using validated rating scales, electroencephalography, and quality of life assessment. Results. The implementation of the medical rehabilitation program for patients with stage 1 chronic cerebral ischemia in an outpatient setting provides a significant reduction in pain (p < 0.01), correction of psycho-emotional and cognitive disorders (p < 0.01), normalization of lipid metabolism (p < 0.01), and improvement in quality of life (p < 0.01). The efficacy of the developed outpatient medical rehabilitation program for patients with stage 1 chronic cerebral ischemia was 85.4 %, and that of the standardized program — 77.0 %. Conclusion. Integrated pharmacotherapy and ozone therapy provide a significant increase in the effectiveness of medical rehabilitation of patients with chronic cerebral ischemia at the outpatient stage.

Assessment of the efficacy of comprehensive medical rehabilitation of patients with polypoid rhinosinusitis based on the international classification of functioning, disability and health

Abstract. Purpose of the study. The article discusses an algorithm for using the categories of the International Classification of Functioning, Disability and Health (ICF) for comparative assessment of the effectiveness of various medical rehabilitation programs for patients with polypoid rhinosinusitis. It is shown that the use of the ICF makes it possible to implement a systematic approach to assessing the efficacy of rehabilitation measures, taking into account the biopsychosocial model for assessing health (illness) and the category of functioning, which serves as the basis for the integration process of rehabilitation. The results of comparative monitoring of the formed categorical profile of a patient with polypoid rhinosinusitis convincingly proved the advantages of complex medical rehabilitation of patients with nasal polyposis, based on biological therapy with dupilumab in combination with a course application of an alternating magnetic field and low-intensity laser radiation.

Efficiency of the use of coordination training in the program of medical rehabilitation of patients after reverse shoulder endoprosthesis

The goal of this study. The goal is to evaluate the effectiveness of using upper limb coordination training after reverse shoulder arthroplasty.Material and methods. 30 patients were examined in Federal State Budgetary Institution «National Medical Research Center for Rehabilitation and Balneology» of the Ministry of Health of the Russian Federation. They were examined in a long-term period after reverse shoulder arthroplasty (in 3–4 months) and were divided into two groups: the main and the comparison groups. All patients were similar in terms of gender and age. Their clinical and functional parameters of the shoulder joint were also comparable. The patients in the comparison group were treated with laser therapy, electrotherapy, massage, group exercises to train the upper limb and mechanotherapy. The patients in the main group additionally underwent coordination training with biological feedback to the shoulder joint.The results of the study were evaluated according to the pain syndrome, functional activity of the shoulder joint, shoulder joint flexion angle and values of dynamic strength of the shoulder muscles. After the course of medical rehabilitation, the patients in both groups showed improvement of all clinical and functional parameters of the shoulder joint. There was a statistically significant improvement in the dynamic strength of the shoulder joint and reduction of pain syndrome in the patients in the main group.Conclusions. The inclusion of shoulder coordination training allows to improve the rehabilitation results for the patients who undergo reverse shoulder joint arthroplasty.

Development of a Device for Mirror Therapy

Previous research on the interconnections between brain activity and actions had led to the discovery of mirror neurons, neurons that have two particularly important roles: they mediate the imitation of movements based on visual information, and they underlie the understanding of actions. Mirror therapy is a relatively new, non-invasive therapy based on the use of visual feedback in recovery. Since 1996, it has been introduced in medical rehabilitation programmes, targeting conditions such as: hemiplegia after stroke, gait recovery after stroke, improvement of finger coordination in Parkinson's patients, reduction of phantom limb pain after amputations, and chronic pain from hand osteoarthritis, fibromyalgia, and complex regional pain syndrome. The device that is the subject of the present work presents a new constructive variant of the mirror box, which offers a much more efficient method of applying mirror therapy in various conditions, both at the level of the upper and lower limbs. The results of two assessments on the effectiveness of visual stimulation in recovery, carried out with the help of this device, first on the recovery of the hand functionality in subjects with hemiparesis after ischemic stroke and second assessment in the treatment of chronic pain of subjects with hand osteoarthritis will also be presented. Keywords: mirror therapy, visual feedback, neuroplasticity, kinesthetic memory, stroke, phantom limb pain

Pilot study of the dynamics of emotional state and quality of life of patients in stage 2 of medical rehabilitation after acute COVID-19

The COVID-19 pandemic has had an enormous impact on public health and many other social institutions. Although the disease continues evolving, new strains do not exhibit the previous lethality, and coronavirus limitations are being lifted, the problem is still relevant. An important aspect of the study of COVID-19 is the process of patient recovery, including inpatient rehabilitation programs. The aim of this pilot study was to examine the psychosocial characteristics and dynamics of the indicators of emotional state (anxiety, depression) and quality of life in patients undergoing a medical rehabilitation program after COVID-19 (N=36; mean age 63.72±12.78 years; 33.33% male, 66.67% female). Research methods included a structured interview to collect data on patients’ sociodemographic and psychosocial characteristics, the State-Trait Anxiety Inventory (STAI), the Beck’s Depression Inventory (BDI), and the 36-Item Short Health Survey (SF-36). The patients were found to have an objective perception of their physical condition, with a lack of awareness of both the disease and the rehabilitation; the illness and recovery situation was markedly stressful for the patients. During the in-patient rehabilitation period, there was a positive change in state anxiety, depressive symptoms and quality of life (p<0.001). The dynamics of the specified characteristics almost do not differ in groups of male and female patients, except for indicators of anxiety, in which differences before and after rehabilitation are more expressed among women. The findings can be used to assess the effectiveness of rehabilitation programs and to improve it, and also indicate the primary role of the clinical psychologist in managing this group of patients.

ОЦЕНКА ЭФФЕКТИВНОСТИ «ПАНТОГЕМАТОГЕНА-С» В КОМПЛЕКСНОЙ МЕДИКО-ПСИХОЛОГИЧЕСКОЙ РЕАБИЛИТАЦИИ ВОЕННОСЛУЖАЩИХ С АСТЕНИЧЕСКИМ СИНДРОМОМ В УСЛОВИЯХ САНАТОРИЯ

Introduction. The utilization of the dietary supplement "Pantohematogen-C" within the medical and psychological rehabilitation program for military personnel with secondary asthenic syndrome in a sanatorium-resort setting has demonstrated its positive impact on normalizing key asthenia symptoms, including physical and mental exhaustion, vegetative disorders, and sleep disturbances. Aim. This study aimed to enhance the effectiveness of comprehensive medical and psychological sanatorium-resort rehabilitation for military personnel with asthenic syndrome using the dietary supplement "Pantohematogen-C". Materials and Methods. The study involved 39 male military personnel aged 24 to 59 years (average age 39.2±4.18 years), with 20 patients in the main group and 19 in the comparison group. The patients underwent a 21-day sanatorium rehabilitation program at the Military Sanatorium "Yeltsovka" of the Ministry of Defense of the Russian Federation. The rehabilitation program included various interventions such as diet therapy, gentle-training motor regime, physical therapy methods, daily dosed walking, exercise equipment, transcranial electrical stimulation (TES), iodine-bromine baths, and psychological correction. Additionally, the main group received the dietary supplement "Pantohematogen-C" three times a day, while the comparison group underwent only the procedures of the basic complex. The effectiveness of the rehabilitation measures was evaluated using several assessment tools. Results. Following the comprehensive sanatorium rehabilitation program, including "Pantohematogen-C", a significant decrease in physical and mental components of asthenia, an increase in activity on the MFI-20 scale, normalization of vegetative status, and improved sleep quality were observed. Patients also reported enhanced well-being, mood, and activity. Moreover, the program led to a statistically significant decrease in situational anxiety. Conclusions. The study has explored the potential and suitability of using Pantohematogen-C to enhance the effectiveness of the sanatorium-resort program for medical and psychological rehabilitation of military personnel with secondary asthenic syndrome. This intervention has shown promise in normalizing vegetative and psycho-emotional status, improving sleep quality, and increasing patient activity in sanatorium-resort organizations catering to these patient categories.

Перикардит – осложнение или проявление менингококковой инфекции, вызванной Neisseria meningitidis серогруппы W, у ребенка?

Meningococcal infection is one of the most insidious and dangerous infections (due to the risk of lethal outcome up to 80% when septic shock develops). The article presents a clinical observation of patient A. 4 years old, who had a generalized form of meningococcal infection (GFMI) caused by meningococcus of serogroup W. Despite targeted adequate etiopathogenetic therapy, heart damage developed, which was diagnosed late in the course of the disease (day 26 of the disease). The world literature describes cases of development of complications of GFMI in children caused by N. meningitidis serogroup W at late stages of the disease in the presence of targeted therapy and with CSF sanitation. All of the above necessitates a complex clinical and neurophysiological examination in the periods of early and late recuperation and an individual program of medical rehabilitation. It should be emphasized that if there is a suspicion of complications in the late recovery period, the prescription of complex pathogenetic therapy, including the use of non-steroidal anti-inflammatory drugs and drugs with antioxidant, antihypoxic and cytoprotective effect, such as cytoflavin, is shown to improve the outcome of the disease. Key words: meningococcal infection, children, N. meningitidis serogroup W, meningitis, pericarditis, cytoflavin, medical rehabilitation

Audiovisual Stimulation and Cognitive Behavioral Psychotherapy Complex Application in the Rehabilitation of Patients with Long COVID: a Prospective Randomized Study

INTRODUCTION. The COVID-19 pandemic has created threats and risks not only for the physical but for the mental health of people as well. To date, there is insufficient scientific data on anxiety, depression in patients who have undergone COVID-19, and the clinical effectiveness of comprehensive medical rehabilitation programs in patients with post-COVID disorders.
 AIM. Tostudy the clinical effectiveness of the use of audiovisual stimulation and cognitive behavioral psychotherapy in the complex rehabilitation of patients with post-COVID syndrome.
 MATERIALS AND METHODS. The study included 59 patients with the long COVID disorders from 1 to 6 months after the disease, of which 41 (69.5 %) women and 18 (30.5 %) men aged between 31 and 81, with the mean age being 59.73 ± 1.59 years. All the patients were randomized into two groups. Group I (main) included 29 patients, 9 men, 20 women, the mean age 60.72 ± 2.04 years, who underwent medical rehabilitation using audiovisual stimulation and cognitive behavioral psychotherapy techniques. The II (control group) included 30 patients, including 9 men, 21 women; the mean age was 58.63 ± 2.44 years, who underwentrehabilitation consisting of a standard set of measures. To objectify emotional disturbances, the Hospital Anxiety and Depression Scale (HADS) and the author’s computer program for assessing subjective comfort, situational and personal anxiety were used. Statistical data processing was carried out using the program “Statistica-10“. The degree of differences in quantitative indicators in the groups was assessed by the Wilconson test, the significance of differences between the groups after the treatment was made by the Mann-Whitney test (p). The assessment of qualitative indicators was carried out by analyzing multifield tables using the Pearson chi-square test.
 RESULTS. The use of audiovisual stimulation and cognitive behavioral psychotherapy in the complex rehabilitation of patients with long COVID disorder syndrome contributed to the regression of emotional disorders, as evidenced by statistically significant changes in indicators on the HADS, Spielberger-Khanin, State Scale (p 0.05). No signs of anxiety and depression were observed after the treatment in 27 (93.1 %) patients. Average (reference) levels of situational and personal anxiety were observed in 28 (96.6 %) and 21 (72.4%) patients, respectively. The subjective comfort index reached a high level in 19 (65.5 %) (p 0.0001) patients.
 DISCUSSION. The study showed that patients who had suffered COVID-19 and had long COVID disorders before the treatment were under the influence of a high-intensity stressful situation, experienced high-level anxiety and experienced severe psycho-emotional stress. The use of audiovisual stimulation and cognitive behavioral psychotherapy helped to increase the number of patients without anxiety and depressive symptoms (p 0.05), reduce the high level of situational and personal anxiety on the Spielberger-Khanin scale (p 0.05), and increase tolerance to psychological stress and the ability to independently cope with stress and its consequences.
 CONCLUSION. A comprehensive rehabilitation program, including audiovisual stimulation and cognitive behavioral psychotherapy, helps to effectively relieve emotional stress and change the inappropriate behavior of patients with long COVID disorders.

Effectiveness of Transcranial Magnetic Stimulation in Patients after Ischemic Stroke: a Prospective Study

INTRODUCTION. Despite the fact that a large number of studies are focused on the rehabilitation of patients with ischemic stroke in the early recovery period, currently, much attention is paid to improving existing and developing new technologies in neurorehabilitation at the early stages of the disease. Transcranial magnetic stimulation (TMS) is a promising technology for the rehabilitation and recovery of patients with movement disorders after a stroke, which has a direct effect on the premotor cortex of the brain.
 AIM. To assess the effectiveness of TMS in relation to daily activity in a comprehensive medical rehabilitation program in patients with ischemic stroke in the early recovery period.
 MATERIALS AND METHODS. The study included 124 patients aged 55–75 years (53.2 % men and 46.8 % women). The main group included 64 people who received the TMS procedure. The comparison group included 60 patients who received an identical course of treatment, but instead of TMS, they underwent a low-intensity headband magnetic therapy. Treatment effectiveness was assessed using the Rivermead Mobility Index, Rehabilitation Routing Scales, and NIHSS. The severity of anxiety and depressive symptoms was assessed using the HADS scale. The total duration of treatment was 21 days. The dynamics of the patients’ condition was assessed before the start of treatment, 21 days after the course of rehabilitation and 3 months after the start of treatment.
 RESULTS. The main group showed a significant decrease in neurological deficit according to the NIHSS scale from 15.3 ± 3.6 to 10.1 ± 1.7 (p 0.05), Rivermead Mobility Index decreased from 5.6 ± 1.9 to 10.5 ± 2.4 (p 0.05) and Rehabilitation Routing Scale decreased from 4.3 ± 0.8 to 2.5 ± 0.5 points (p 0.05) since the start of rehabilitation and 3 months after its start. After 3 months, the neurological deficit in the main group was statistically significantly less compared to patients in the comparison group (p 0.5). A significant decrease in depressive symptoms was found in the main group (χ2 = 28.641; p 0.001), while in the control group the dynamics was not significant (χ2 = 7.140; p = 0.129); in addition, there was a regression of the anxiety component both in the main (χ2 = 47.949; p 0.001) and control (χ2 = 12.483; p = 0.015) groups.
 CONCLUSION. The use of the TMS device at the second stage of rehabilitation significantly reduces the neurological deficit, increases the mobility of patients, and reduces the severity of anxiety and depressive symptoms.

Controlled hypoxia-hyperoxytherapy as a component of a targeted approach in the rehabilitation of patients with multimorbidity: a single-center, randomized, placebo-controlled, prospective study

BACKGROUND: Multimorbidity is one of the most important public health problems, leading not only to a deterioration in the functional abilities of an individual, but also to an increase in the disability of the population, which determines the need to use effective measures in the treatment and rehabilitation of patients with multimorbid pathology.
 AIM: The aim of this study was to evaluate the effect of a two-week medical rehabilitation program including the respiratory therapy method based on short-term intermittent exposure to hypoxia and hyperoxia on the dynamics of hypoxia-inducible factor-1 (HIF-1) and C-reactive protein in patients with multiple chronic diseases. The novelty of this study is due to the peculiarities of the study group — patients with multimorbid pathology.
 MATERIALS AND METHODS: A single-center, randomized, placebo-controlled, prospective study (NCT05053672, ClinicalTrials.gov) included 42 patients aged 43 to 68 years with multimorbid pathology: generalized osteoarthritis — 61.9%, knee OA — 21.4%, hip OA — 16.7%, controlled arterial hypertension stage I–II — 90.5%, post-Covid syndrome — 100%. Patients were randomized into 2 groups by the method of numbered identical containers. According to clinical and demographic characteristics of patients, concomitant pathology, C-reactive protein and HIF-1 levels, the studied groups were comparable. The main group (27 patients) received a course (8–10 sessions) of individually dosed hypoxy-hyperoxytherapy on the basis of biofeedback (reoxytherapy) against the background of the standard complex of medical rehabilitation. The comparison group (15 patients) received sham reoxy therapy (placebo treatment) along with standard rehabilitation.
 RESULTS: The data obtained as a result of the study in multimorbid patients using reoxy-therapy clearly demonstrated reduction of clinical symptoms, improvement of general well-being according to visual analogue scale and decrease of C-reactive protein as a classical marker of inflammation against the background of stabilization of HIF-1 dynamics.
 CONCLUSION: The use of biofeedback-based short-term intermittent exposure to hypoxia and hyperoxia (reoxy therapy) in patients with different initial characteristics in terms of clinical health status and multimorbid pathology is reasonable taking into account modern personalized approaches to medical rehabilitation.

Ретроспективный анализ восстановительного лечения в условиях соматического отделения коморбидных пациентов, перенесших COVID-19

Purpose: TTo study the practice and features of rehabilitation treatment in a somatic hospital for comorbid patients who have suffered pneumonia associated with COVID-19. Effective medical rehabilitation of SARS CoV-2 survivors is critical to recovery and optimization of emergency and specialty care outcomes. The new coronavirus infection and the severe pathology associated with it are more common in people of older age groups, burdened by many concomitant diseases, and occurs with damage to many organs and systems. The consequences of the disease pose the need for practical healthcare to carry out urgent and large-scale rehabilitation and preventive measures using for these purposes, in accordance with the requirements of the procedure for the rehabilitation of adults, approved by the Ministry of Health of the Russian Federation capabilities of specialized therapeutic hospitals. Underestimation of the capabilities of this approach leads to unjustifiably delayed use and, most importantly, loss of quality of rehabilitation treatment. The COVID-19 disease itself, damage to organs and systems, and the reaction of concomitant pathology with it have not yet been fully studied (G.E. Ivanova et al., 2020) and these patients often have to go through a broad search for optimal treatment and rehabilitation regimens. Material and methods:80 case histories of patients (57 women and 23 men) who had pneumonia associated with the new coronavirus infection COVID-19 were studied. The time from the onset of the disease was 2 months, the average age of patients was 55 years. The study included patients who had mild, moderate, and severe pneumonia and in 85% of cases had one or another concomitant pathology. Each patient was assigned an individual rehabilitation program, consisting of “respiratory block” procedures, including therapeutic exercises, hyperbaric oxygenation, laser therapy, magnetic therapy, manual massage, psychotherapy, dietary nutrition and physiotherapeutic procedures, also aimed at concomitant pathology. All patients received drug treatment. Restorative treatment of patients who had pneumonia associated with COVID-19 and had a concomitant disease was carried out with a rehabilitation routing scale value of 2-3 points. Conclusions: When developing individual medical rehabilitation programs for patients who have suffered COVID-19, procedures aimed at concomitant pathology should also be taken into account and highlighted. It is advisable to observe this group of patients in the somatic department of a multidisciplinary hospital. With this approach, clear positive dynamics were noted, both in the main and concomitant pathologies.

Transcranial Magnetic Stimulation Application in Children with Severe Traumatic Brain Injury: a Randomized Prospective Study

INTRODUCTION. Today, severe traumatic brain injury (STBI) poses a serious threat to the life and health of affected children, which requires long-term expensive treatment and long-term rehabilitation. Improving the diagnosis, resuscitation and neurosurgical care for children with STBI leads to an increase in the percentage of surviving patients, which necessitates the development and implementation of individual early rehabilitation programs. One of the tasks of early rehabilitation is to reduce the spasticity of the extremities, in connection with which transcranial magnetic stimulation (TMS) is used in our hospital. The experience of using the TCMS method in the first month of STBI in children is given, due to which the dynamics of the restoration of lost functions improves.
 AIM. Evaluation of the effectiveness of the use of the method of transcranial magnetic stimulation in children in the acute period of STBI with inclusion in the program of early medical rehabilitation.
 MATERIAL AND METHODS. 40 patients with STBI who were treated at the GAUZ СRCH MH RT, Kazan were taken for curation. The main group was selected by the randomization method, which included 20 (50 %) patients who received the procedure of transcranial magnetic stimulation in the individual program of medical rehabilitation and the control group — 20 (50 %) patients who received only the standard individual program of early rehabilitation. Patients of the main group on the 10th day after receiving a severe traumatic brain injury were initiated to undergo TKMS in addition to the program of individual early rehabilitation.
 RESULTS AND DISCUSSION. As a result of the course of therapy with the inclusion of TMS in the rehabilitation measures, an increase in the motor activity of the affected limb was observed, which led to an improvement in the patient’s self-care.
 CONCLUSION. The inclusion of transcranial magnetic stimulation in the program of early rehabilitation of children with severe traumatic brain injury creates suitable conditions for the course of compensatory-regenerative processes in the brain due to the depolarization of the membrane of cortical neurons. In this group of patients, there was a clear increase in muscle strength and a decrease in spasticity.

Medical support of rehabilitation of stroke patients: the role of GABA-ergic drugs

Introduction. The relevance of neuroprotective therapy in patients with cerebral stroke (CS) is due to its high prevalence, as well as the need for the maximum possible restoration of damaged structures and functions of the central nervous system (CNS).Аim. Тo evaluate the clinical efficacy and nicotinoyl gamma-aminobutyric acid tolerance in the complex rehabilitation of patients in the late recovery and chronic periods of ischemic stroke (IS) in outpatient stage.Materials and methods. 110 patients in the late recovery period (LRP) and the residual period of IS, 57 women and 43 men, average age 58.0 ± 9.74 years, were observed. The duration of the stroke was on average 214 ± 28 days in PVP-patients and 428 ± 47 days for the residual period. All patients included in the study received a standard medical rehabilitation program. Two main groups included 30 patients in LRP and the residual period of IS, who treated with nicotinoyl gammaaminobutyric. Two control groups included 30 patients in LRP and 20 patients in the residual period of IS, who recievedonly the standard medical rehabilitation program.Results. The complex of rehabilitation with the inclusion of nicotinoyl gamma-aminobutyric acid (picamilon) significantly improved the indicators of neurodynamic (p < 0.05) and regulatory functions (p < 0.05) in the main subgroups on the MoCA scale, emotional status (p > 0.05 on the Beck scale), general well-being, activity, mood (WAM scale) and basic functional activity (the average Bartel index at the end of the study was 82.6 ± 3.5 in the main groups, p < 0.05). The clinical effect was observed after a month of the therapy and persisted until the end of the study.Conclusion. The inclusion of neuroprotective therapy in the complex rehabilitation leads to earlier neuropsychological and social adaptation of the patient, regression of fatigue, which is probably associated with an increase in neuroplastic and regulatory brain processes.

Substantiation for inclusion of psychocorrective methods in comprehensive program of medical rehabilitation of patients who have suffered COVID‑19 in conditions of sanatorium-resort organization

The new coronavirus infection COVID‑19 both by itself and restrictive measures related to the pandemic (prolonged isolation, compliance with sanitary and epidemiological restrictions, etc.) have a pronounced negative impact on the psycho-emotional state of patients. The article presents the results of a study of the initial psychological state of patients who have undergone a new coronavirus infection COVID‑19, justifies the use of various psychocorrective methods in the conditions of patients’ stay in a sanatorium-resort organization.

Medical Rehabilitation of Patients with Post-COVID-19 Syndrome-A Comparison of Aerobic Interval and Continuous Training.

Post-COVID-19 syndrome (PCS) is a multisystemic disorder marked by impaired physical performance as one lead symptom. Since it has been suggested that endurance training as part of medical rehabilitation may be effective in improving physical performance capacity in PCS, this study aimed to compare different modes of aerobic endurance training. A total of 110 PCS patients (49.3 ± 11.8 years; 38% women; time after infection = 260.2 ± 127.5 days) underwent detailed clinical screening including symptom-limited cardiopulmonary exercise testing at admission and after 4-6 weeks of inpatient medical rehabilitation. Questionnaires were used to assess disease perception. Patients performed controlled isocaloric cycle ergometer training (3-5 sessions/week; 18 min) as either continuous training (CT) at 50% of maximal workload or as interval training (IT; load = 60%, relief = 30%). Outcomes of PCS patients were compared to coronary artery disease patients (CAD; n = 96) to evaluate overall training effectiveness. Training participation was comparable between the groups, with no indication of training-specific exercise-induced fatigue. Overall, PCS patients improved significantly by a mean of 6.8 ± 12.1% for W at VT1; 3.1 ± 10.0% for VO2 at VT1; 5.5 ± 14.7% for O2 pulse at VT1; 7.5 ± 15.0% for W at VO2peak; 2.7 ± 11.0% for VO2peak and 4.6 ± 12.4% for O2 pulse at VO2peak (all p < 0.05) with no significant differences between groups (p > 0.05). Both groups showed reduced levels of fatigue, anxiety, and depression as well as improved quality of life and wellbeing (all p < 0.05). Compared to guideline-based cardiac rehabilitation, PCS patients showed a similar improvement in workload and oxygen uptake compared to CAD patients. PCS patients benefit from aerobic endurance training performed as moderate continuous or interval training as part of a medical rehabilitation program in terms of improved physical exercise capacity and disease perception. The results for PCS patients are comparable to the guideline-based rehabilitation of CAD patients.

Machine learning-based identification of determinants for rehabilitation success and future healthcare use prevention in patients with high-grade, chronic, nonspecific low back pain: an individual data 7-year follow-up analysis on 154,167 individuals.

To individually prescribe rehabilitation contents, it is of importance to know and quantify factors for rehabilitation success and the risk for a future healthcare use. The objective of our multivariable prediction model was to determine factors of rehabilitation success and the risk for a future healthcare use in patients with high-grade, chronic low back pain. We included members of the German pension fund who participated from 2012 to 2019 in multimodal medical rehabilitation with physical and psychological treatment strategies because of low back pain (ICD10:M54.5). Candidate prognostic factors for rehabilitation success and for a future healthcare use were identified using Gradient Boosting Machines and Random Forest algorithms in the R-package caret on a 70% training and a 30% test set. We analysed data from 154,167 patients; 8015 with a second medical rehabilitation measure and 5161 who retired because of low back pain within the study period. The root-mean-square errors ranged between 494 (recurrent rehabilitation) and 523 (retirement) days ( R2 = 0.183-0.229), whereas the prediction accuracy ranged between 81.9% for the prediction of the rehabilitation outcome, and 94.8% for the future healthcare use prediction model. Many modifiable prognostic factors (such as duration of the rehabilitation [inverted u-shaped], type of the rehabilitation, and aftercare measure), nonmodifiable prognostic factors (such as sex and age), and disease-specific factors (such as sick leave days before the rehabilitation [linear positive] together with the pain grades) for rehabilitation success were identified. Inpatient medical rehabilitation programmes (3 weeks) may be more effective in preventing a second rehabilitation measure and/or early retirement because of low back pain compared with outpatient rehabilitation programs. Subsequent implementation of additional exercise programmes, cognitive behavioural aftercare treatment, and following scheduled aftercare are likely to be beneficial.

Physiotherapy methods in medical rehabilitation of children with scoliosis

The article presents a review of the literature on the prevalence, relevance, and social significance of scoliosis in children. Much attention is given to the role and place of physiotherapy methods used in medical rehabilitation programs for children with scoliotic spinal deformity. Impulse currents occupy key positions among the numerous methods of physiotherapy for scoliosis (SMT, DDT, interference therapy, etc.) due to their specific effect on the neuromuscular apparatus in order to increase the tone of weakened muscles. The article presents the results of studies on the use of high-intensity impulse magnetic therapy, EHF therapy, vibrotherapy, biofeedback therapy (BFB), etc. in medical rehabilitation of scoliotic spinal deformity in children. In recent years, the role of balneotherapy and climatotherapy at the sanatorium-resort stage of the rehabilitation of such patients has increased. The methods of physiotherapy presented in the work are quite diverse, have different efficiency, and can be individually used in combination with physiotherapy exercises in numerous programs for medical rehabilitation of children with scoliosis.