Rehabilitation Method For Patients Research Articles

Hypercapnic hypoxia as a rehabilitation method for patients after ischemic stroke

ABSTRACT Introduction Experimental studies on animals have demonstrated a higher neuroprotective efficacy of hypercapnic hypoxia compared to normocapnic hypoxia. Respiratory training with hypercapnic hypoxia has shown a positive impact on the functional state of the nervous system in children with cerebral palsy (CP). It can be presumed that the combined effect of moderate hypercapnia and hypoxia will be promising for clinical application within the context of early rehabilitation after ischemic stroke. Methods A randomized triple-blind placebo-controlled study was conducted on 102 patients with ischemic stroke, aged 63.07 ± 12.1 years. All patients were diagnosed with ischemic stroke based on neuroimaging criteria and/or clinical criteria within the 48–72 hour timeframe. The experimental group (n = 50) underwent daily respiratory training with hypercapnic hypoxia (FetCO2 5–6%, FetO2 15–16%) using the ‘Carbonic’ device for 7–11 sessions of 20 minutes each day during the treatment process. The control group (placebo, n = 52) underwent training on a similar device modified for breathing atmospheric air. Neurological examinations were conducted on all patients before the study and on the day after completing the training course. Results The standard treatment demonstrated effectiveness in terms of neurological status scales in both groups. Intermittent exposure to hypercapnic hypoxia proved more effective in improving neurological function indicators in patients compared to the placebo group: NIHSS scale scores were 40% lower than in the placebo group (p < 0.001); mRS scale scores were 35% lower (p < 0.001); B-ADL-I and RMI indices were higher by 26% (p < 0.01) and 36% (p < 0.001), respectively; MoCA scale results were 13% higher (p < 0.05); HADS and BDI-II scale scores were lower by 35% (p < 0.05) and 25% (p < 0.05), respectively. The increase in MMSE scale scores in the intervention group was 54% higher (p < 0.001), and MoCA scale scores increased by 25% (p < 0.001). Conclusion Respiratory training with hypercapnic hypoxia improves the functional state of the nervous system in patients with ischemic stroke. After conducting further clarifying studies, hypercapnic hypoxia can be considered as an effective method of neurorehabilitation, which can be used as early as 48–72 hours after the onset of stroke.

Theoretical background of hypoxytherapy

The review discusses the structure and physiology of the oxygen supply functional system and its self-regulatory potential and role in maintaining the bodys optimal metabolic homeostasis level of blood gases. Up-to-date data on the functioning of peripheral (arterial) and central (medullary) chemoreceptors, molecular mechanisms of the oxygen and carbon dioxide content and pH perception, and their association with afferent nerve endings are presented. The paths and centers of the chemosensory reflex in various brain regions, effector elements, and reverse afferentation mechanisms are shown. Response patterns to exogenous and endogenous hypoxic stimuli from the various elements of the oxygen supply system are described. The role of intracellular HIF-dependent and HIF-independent pathways in adaptive reactions for maintaining an optimal intracellular metabolism is demonstrated. Cell mechanisms with adaptive roles in hypoxia/reoxygenation under the conditions of interval normobaric hypoxic therapy are discussed.&#x0D; The review of current concepts and analysis of research results on the physiology of the oxygen supply functional system, its structural and functional status, and its molecular regulation under exogenous hypoxic conditions will draw attention to the expediency of further randomized clinical trials on interval normobaric hypoxytherapy as a rehabilitation method for patients with chronic cardiovascular diseases

Effect of High-Intensity Interval Training on Fatty Infiltration After Delayed Rotator Cuff Repair in a Mouse Model.

Fatty infiltration (FI) of the rotator cuff muscles is correlated with shoulder function and retear rates after rotator cuff repair. High-intensity interval training (HIIT) induces beige adipose tissue to express more uncoupling protein 1 (UCP1) to consume lipids. The beta-3 adrenergic receptor (β3AR) is located on adipocyte membrane and induces thermogenesis. To test the role of HIIT in improving muscle quality and contractility in a delayed rotator cuff repair mouse model via β3AR. Controlled laboratory study. Three-month-old C57BL/6J mice underwent a unilateral supraspinatus (SS) tendon transection with a 6-week delayed tendon repair. Mice ran on a treadmill with the HIIT program for 6 weeks after tendon transection or after delayed repair. To study the role of β3AR, SR59230A, a selective β3AR antagonist, was administered to mice 10 minutes before each exercise through intraperitoneal injection. The SS, interscapular brown adipose tissue (iBAT), and subcutaneous inguinal white adipose tissue (ingWAT) were harvested at the end of the 12th week after tendon transection and were analyzed by histology and Western blotting. Tests were performed to assess muscle contractility of the SS. Histologic analysis of SS showed that HIIT prevented and reversed muscle atrophy and FI. The contractile tests showed higher contractility of the SS in the HIIT groups than in the no-exercise group. In the HIIT groups, SS, iBAT, and ingWAT all showed increased expression of tyrosine hydroxylase, UCP1, and upregulated β3AR thermogenesis pathway. However, SR59230A inhibited HIIT, suggesting that the effect of HIIT depends on β3AR. HIIT improved SS quality and function after delayed rotator cuff repair through a β3AR-dependent mechanism. HIIT may serve as a new rehabilitation method for patients with rotator cuff muscle atrophy and FI after rotator cuff repair to improve postoperative clinical outcomes.

Comparative evaluation of dental implants in posterior maxilla placed using unicortical and bicortical anchorage-A split-mouth prospective study.

The use of dental implants has become a very predictive method of rehabilitation for patients with partial or complete edentulism. It is more challenging to treat the posterior quadrants of the maxillary ridges using dental implants due to their anatomical and physiological characteristics. So to overcome the limitations of other techniques, short implants were introduced recently as a new approach to simplify implant placement in compromised alveolar bone and to prevent possible damage to vital structures. This study aims to compare the clinical outcomes of dental implants placed using the osteotomized sinus floor elevation (OSFE) technique side engaging the bony floor of the maxillary sinus (bicortical anchorage) on one side and the conventional technique by split mouth on the other side. This study included 15 patients. Study participants had dental implants placed on both sides of the mouth at the same time, so one side was implanted according to the test method, while the other side used the control method. Randomization determined which side would be implanted. The OSFE technique provides greater stability to the implant via bicortical anchorage than conventional techniques, which only provide unicortical anchorage.

Analysis of the effectiveness of various methods of rehabilitation of patients with subacromial impingement syndrome

Subacromial impingement syndrome is a common pathology that leads to a persistent decrease in the functioning of the affected limb and, as a consequence, a decrease in the quality of life and work ability of patients. According to various authors, the study of the effectiveness of treatment and rehabilitation of this pathology is quite widely presented in the literature: surgical, including arthroscopic operations, rehabilitation using various factors of physical therapy, manual and other practices. However, the issue of assessing the effectiveness of movement therapy, both alone and in combination with other therapeutic methods, remains relevant. To evaluate the effectiveness of therapeutic gymnastics procedures, both monotherapy and in combination with manual massage according to the therapeutic method and extracorporeal shock wave therapy (ESWT), in patients with subacromial impingement syndrome of the shoulder, in order to reduce pain and improve the function of the shoulder joint. The study included 70 patients whose age was 42.18±10.42 years. Patients were divided into two main groups: group 1 (n=34) and group 2 (n=36). All patients received a course of treatment, including 10 procedures of therapeutic exercises, with recommendations at the end of the course for continuation in the form of independent studies using the proven methodology. The duration of the course of therapeutic exercises (in the form of procedures with a physical therapy instructor and subsequent independent studies) was 30 days. Patients in group 2 were divided into three subgroups: subgroup 2A, in which PH procedures were combined with massage of the cervical-collar area and the upper limb area of the affected side; subgroup 2B, where PH gymnastics was carried out in combination with extracorporeal shock wave therapy (ESWT) procedures; subgroup 2C - a comprehensive program including LH procedures, manual massage and shock wave therapy. 3 months after the end of the course of rehabilitation measures, patients of all groups showed a significant improvement in scores on the ASES and VAS scales, but there were no reliably significant differences between the results of different groups. The study indicates that movement therapy is an effective method of rehabilitation for patients with subacromial impingement syndrome, and conducting complex programs in which PH is combined with other rehabilitation methods (massage, shock wave therapy) doesn't have statistically significant advantages over PH alone within a 3-month observation period.

Functional results and return to sports on recurrent anterior glenohumeral instability. Influence of the COVID-19 pandemic; Comparative retrospective study and short-term results.

Our objective is to compare the functional results in patients that underwent surgery for recurrent anterior shoulder instability (RAGHI) during the COVID-19 pandemic with remotely-based rehabilitation, to those who had surgery before the pandemic and had in-person rehabilitation therapy. A retrospective case series of 68 patients were included and divided into two groups: In person-group and Home-based group. Western Ontario Shoulder Instability Index (WOSI) and Subjective Shoulder Value (SSV) scores were used to evaluate objective and subjective clinical parameters. Time and level of return to sports was studied by the Subjective Patient Outcome for Return to Sports (SPORTS) score. The mean SSV score was 82% (40-100) on the In-Person group compared with 87% (65-100) for the Home-Based group. Results for WOSI score were similar, with an average of 210.42 (90%) for In-Person and 261.45 (88%) for the Home-Based group (p 0.12). Return to sports was carried out in an average of 6.6 (4-16)months for In-Person group, compared to 6.5 (5-8)months for Home-Based. Follow-up and rehabilitation methods for patients who underwent surgery for RAGHI, during COVID-19 lockdown, were not significantly (p 0.12) affected on functional and athletic return in comparison to traditional methods according to WOSI scale. IV Retrospective series of cases.

Rehabilitation Methods for Patients with Geographic Atrophy due to Age-Related Macular Degeneration and Effects of Rehabilitation on Quality of Life.

The purpose of the study is to evaluate the low vision rehabilitation methods and to investigate the effect of visual rehabilitation on quality of life in patients with low vision due to geographic atrophy from age-related macular degeneration (ARMD). The better-seeing eye of 78 patients with geographic atrophy due to ARMD were included in the study. Sociodemographic characteristics, ophthalmological examination findings, and preferred low vision aids for near and distant were recorded. Fifty-seven patients who preferred to use a low vision aid device in daily life were considered as a rehabilitation group, whereas 21 patients who did not use any device were considered as a control group. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was applied to all patients at the initial examination and at least 6 months after the initial examination. In the rehabilitation group, statistically significant increases were found in the overall composite score, and general vision, near and distance activities, social functioning, mental health, role difficulties, and dependency subscale scores of the NEI-VFQ-25 quality of life scale after low vision rehabilitation (p=0.009 for general vision, p < 0.001; for others). In the control group, there was no statistically significant change in any of the subscale scores or the overall score of the scale (p > 0.05). All patients (n = 78) were recommended to use at least one low vision aid for near vision. Hyperocular glasses were recommended for 77 patients (98.72%), magnifiers for 15 patients (19.23%), electro-optical devices for 2 patients (2.56%), and telemicroscope for one patient (1.28%). Furthermore, 17 patients (21.8%) were prescribed more than one low vision aids. However, for distance vision, only 29 patients (37.18%) received a recommendation for a low vision aid. Low vision patients with ARMD-related geographic atrophy should meet with low vision aids as soon as possible and should be included in low vision rehabilitation programs.

Choice of the method for eliminating postburn shoulder joint contractures

BACKGROUND: In the Russian Federation, over 400,000 patients with thermal injuries are registered yearly, with approximately 30% of them requiring hospitalization. Physicians pay special attention to the rehabilitation of patients with complications of deep burns. According to several authors, deep burns occur in 47% of cases. The most common complications of deep burns are contractures and limb deformities. Shoulder contractures occur in over 50% of patients. The outcomes and terms of a patients return to active social and working life depend on the timeliness and selection of an optimal surgical intervention from a wide range of reconstructive and plastic techniques.&#x0D; AIM: This study aimed to improve the functional and esthetic results of surgical treatment in patients with postburn shoulder joint contractures.&#x0D; MATERIALS AND METHODS: From 2011 to 2020, 198 patients underwent surgery, including 59% women and 41% men. Right shoulder, left shoulder, and right and left shoulder simultaneous joint contractures occurred in 54.5%, 38.5%, and 7% of cases, respectively. The patients age ranged from 18 to 72 years, and 99% of them were of working age. The scope of preoperative examination included clinical data, photographic documentation, duplex vascular scanning, and determination of the degree of contracture using a mechanical goniometer. Patients with grade I, II, and III shoulder joint lesions accounted for 29%, 60%, and 11% of the total number of cases, respectively. Early surgical rehabilitation prevents the development of secondary myogenic and arthrogenic contractures and accelerates the patients social reintegration. Local tissue plasty using the armpit adipodermal tongue-shaped flap, a nonperforated full-layer or split skin graft, a rotated flap based on perforating vessels, and the expander stretching method were used to eliminate contractures.&#x0D; RESULTS: Bacterial infection, total and marginal necrosis, hematomas, and seromas were not observed in the immediate postoperative period. Complete elimination of the shoulder joint contracture was achieved in 63% of cases, whereas joint mobility increased by over 60 in 30% of patients.&#x0D; CONCLUSIONS: The algorithm presented for choosing a method of surgical rehabilitation for patients with shoulder joint contractures leads to an increase in the efficiency of reconstructive surgery after burn injuries.

Relevance of water-related rehabilitation measures for stoma patients : Results of apilot project and review of the literature

The creation of askin stoma after exenterative pelvic surgery drastically affects the physical health of patients. Being concerned with aesthetic and functional aspects, patients tend to not participate in offers for water-related rehabilitation, especially water gymnastics and swimming. The aim of the pilot project "UROAquaFIT" was to evaluate the feasibility of water-related rehabilitation for patients after cystectomy with incontinent urinary diversion. Patients after radical cystectomy with incontinent urinary diversion were offered the possibility to participate in the water-based rehabilitation program "UROAquaFIT". Split into small groups, awater gymnastics course took place under the guidance of aphysiotherapist and astoma therapist as well as under medical supervision. Data on quality of life and apersonal assessment were collected using a questionnaire before and 6months after the course. In addition, aMEDLINE-based search for aqua gymnastics in oncology was conducted. All participants reported the course as being positive and enriching. The participants' well-being and self-esteem improved. Therefore, water gymnastics can be ahighly effective method for rehabilitation of patients with incontinent urinary diversion. In addition, it improves the physical health of those affected and thus expands the possibilities for social reintegration. This form of therapy should be standard in the rehabilitation of patients with incontinent urinary diversion.

Использование видеоанализа движений при оценке локомоторных функций после артроскопической реконструкции передней крестообразной связки

An anterior cruciate ligament tear is one of the most common injuries to the capsular ligament apparatus of the knee necessitating operative treatment. Postoperatively, patients with anterior cruciate ligament injuries develop a pathologic gait pattern. Today, innovative diagnostic and rehabilitation methods for patients with gait disturbances associated with such injuries are in high demand. Below, we present a case of using 3D motion capture analysis for the personalized assessment of gait function in a patient with the reconstructed anterior cruciate ligament two months after surgery. The analysis revealed that the patient had a slower, shorter, wider step with longer step intervals than the healthy subject; the flexion and extension amplitude in the large joints of the operated leg was smaller than in the healthy contralateral leg. Motion capture analysis can be used to assess the postoperative dynamics in patients with anterior cruciate ligament tears.

Optimized CSMRI Algorithm-Based MRI Image Analysis in the Active Rehabilitation Method for Patients with Acute Cerebral Infarction

This paper combines optimized CSMRI algorithm (CS) and magnetic resonance imaging (MRI) to shorten the scanning time of MRI image data and improve the imaging quality. At the same time, the paper applies functional magnetic resonance imaging (BOLD-fMRI) based on the principle of blood oxygen level dependence to explore the application value of the nerve function reconstruction therapy system for the rehabilitation of active and passive motor functions in patients with acute cerebral infarction. Methods. In this paper, 20 patients with acute cerebral infarction were included. The random drawing method was used to divide them into active group and passive group, each with 10 cases. Both groups were treated with conventional medication and acupuncture. The active group used the active mode of the nerve function reconstruction treatment system to guide the patients’ limb active exercise; all training in the passive group is provided by the nerve function reconstruction treatment system to passively exercise the patients’ limbs; both groups undergo BOLD-fMRI examination before treatment and after 2 weeks of treatment and observe the activated parts of the brain functional area and corresponding parts of the two groups before and after treatment. We observe the activation volume and, at the same time, the ADL score. Results. After treatment, the activation volume and ADL scores of brain functional areas in the two groups were significantly improved compared with those before treatment, and the difference was statistically significant ( P &lt; 0.05 ). Conclusion. The combination of optimized CSMRI algorithm (CS) and magnetic resonance imaging (MRI) can be used to evaluate the early rehabilitation efficacy of patients with acute cerebral infarction and has certain guiding value for clinical treatment.

Rehabilitation methods for patients with severe extragenital pathology after reconstructive plastic surgery for various types of urinary incontinence

In recent years, the frequency of operations for genital prolapse and urinary incontinence has been steadily increasing. Neurogenic disorders of urination can be the first manifestations of the disease of extragenital pathology. Neurogenic bladder is bladder dysfunction (lethargy or spasticity) caused by neurogenic damage. Any disease in which the afferent or efferent innervation of the bladder is damaged can lead to a neurogenic bladder.Purpose. To study the features of urinary disorders in women with severe extragenital diseases and to improve the methods of rehabilitation of patients after reconstructive plastic surgery for various types of urinary incontinence.Materials and methods. 153 patients aged 50-70 years (mean age 55.1 ± 6.3 years) and duration of postmenopause from 2 to 5 years (7.6 ± 4.1 years) were examined at the outpatient department of the of Moscow Regional Research Institute of Obstetrics and Gynecology, Russian Federation, who applied for various manifestations of urination disorders. All patients were offered the method of biofeedback in combination with electrical stimulation of the pelvic floor muscles as a treatment. When overactive detrusor therapy was detected, therapy was combined with medicamentous (solifenacin 5 mg [Vesicar] or myrobegron 50 mg [Betmiga] in the morning) in combination with estriol (cream or suppositories) 0.5 mg intravaginally 2 times a week. In the presence of symptoms of climacteric syndrome in the absence of contraindications, menopausal hormonal therapy was prescribed.Results. Subjectively, 150 (98.1 %) patients noted an improvement in their condition, 3 (1.9 %) patients did not notice the effect of treatment. The results showed a significant improvement in all OABSS and bladder diary scores, including frequency of urination during the day and at night, urgency and number of urge incontinence episodes, and urine volume. Analysis of the -hour pad test showed that the volume of urine lost, which averaged 16.5 g before treatment, was negative after treatment in patients who noted the effect. In 2 patients who did not notice the effect, no changes were found. Investigation of the intraurethral pressure profile in 23 (17.6 %) women before treatment revealed insufficiency of the internal sphincter of the urethra, leading to urinary incontinence during stress. After treatment, in 19 (82.6 %) patients, the insufficiency of the internal sphincter was not determined. In 3 (13.0 %) patients, intraurethral pressure remained in the range of 60 to 80 cm of water column and did not lead to urinary incontinence during stress. In 1 (4.3 %) patient, the insufficiency of the urethral closure persisted, which required repeated surgery.Conclusions. In patients with severe extragenital diseases against the background of vulvovaginal atrophy, an overactive bladder and a mixed form of urinary incontinence prevail. Extragenital pathology of various origins, especially concerning various parts of the central nervous system, obesity and diabetes significantly worsens the course of urination disorders in both conservative and surgical and combined treatment and requires additional treatment methods: pelvic floor muscle training, biofeedback therapy in combination with electrical stimulation of the pelvic floor muscles, local hormonal therapy, the use of M-anticholinergics, B-adrenomimetics.

The Experience of Using the Author’s Method of Rehabilitation in Patients with Fractures of the Proximal Femur

Fractures of the proximal femur (РF) are a common type of injury to the lower extremities. Most patients after conservative or surgical treatment are faced with the occurrence of pain and limited mobility in the area of the injured joint. The proposed rehabilitation option allows not only to relieve pain, develop motor skills and vestibular apparatus, but also contributes to the psychological support of the patient Aim. To evaluate the effectiveness of using the inventive device for pair balancing for patients with injuries of the PF. Material and methods. The study involved 72 patients. The main study group consisted of 35 patients whose rehabilitation included therapeutic gymnastics on a pair balancing device. 37 patients were in the comparison group and received a standard type of therapeutic gymnastics. Classes on the device were held from 3 to 5 weeks. The control of comparative results in the groups was carried out 1 month after the operation. As evaluation criteria, the authors focused on the severity of pain on a visual-analog scale and the angle of the hip joint on the affected limb. Results. Two patients (5.7%) from the main group had mild pain, three patients (8.6%) had contractures of biomechanical origin. In the comparison group, seven patients (18.9%) had pain, and ten patients (27.02%) had contractures. More often contractures were neurogenic and myogenic. patients spared the affected limb and were afraid to give it a full load. This phobia was present in more than half of the patients in the comparison group while in the main group there were no similar phenomena. Conclusion. This device has a complex effect in the rehabilitation of the patient after lower extremities injures. the device restores motor function and also acts verbally and prevents the development of psychosomatic complications.

The effect of hydrotherapy on the symptoms and functional characteristics of multiple sclerosis patients

Aim: A review of the literature on the effect of hydrotherapy on the symptoms of fatigue, pain, spasticity as well as on the balance and gait of people with Multiple Sclerosis (MS). Method: Search databases such as MEDLINE, Cochrane Library, Science Direct and PEDro were used to search the literature. The inclusion criteria were studies that included physiotherapy and mainly hydrotherapy as a means of rehabilitation in MS. Results: Hydrotherapy programs significantly reduced the symptoms of fatigue, pain, spasticity as well as significantly improved balance and gait in patients with MS, as reflected in the evaluation tests. Conclusions: Hydrotherapy is proposed as a safe, effective and enjoyable method of rehabilitation in patients with MS to reduce symptoms and improve balance and gait.

Кохлеарная имплантация при кохлеарной форме отосклероза

The cochlear form of otosclerosis is characterized by irreversible metabolic changes that lead to complete hearing loss. Cochlear implantation, which is a high-tech method of rehabilitation for patients with profound hearing loss and complete deafness, becomes an opportunity for hearing restoration. However, CI in patients with cochlear otosclerosis may be accompanied by a number of difficulties due to the remodeling of the cochlea of varying severity. Thus, changes in the bony labyrinth play a crucial role in the management of patients with the cochlear form of otosclerosis and sensorineural hearing loss IV.

Abstract 14927: Effects of Low Intensity Resistance Exercise Under Kaatsu Condition on Skeletal Muscle Size and Its Safety inCardiovascular Surgery Patients

Introduction: Surgery for cardiovascular disease is often accompanied by sarcopenia and physical frailty, and improvement of muscle mass, muscle strength, and ADL, is often difficult only with cardiac rehabilitation using aerobic exercise. The resistance training under moderately restricted muscle blood flow, named as KAATSU, induces muscle hypertrophy and strengthens muscle through low intensity exercise. However, it remains uninvestigated whether KAATSU resistance training using low intensity load (KAATSU-RE) increases muscle strength, and induces hypertrophy in patients early after cardiovascular surgery. Hypothesis: To investigate the effects of KAATSU-RE on skeletal muscle strength, hypertrophy and its safety in patients early after cardiovascular surgery. Methods: Nine patients early after cardiac surgery were included in this study (seven males, age 54 ± 18 years, BMI 23.0 ± 3.7 kg/m 2 , AVR 5 cases, MVP 3, Bentall operation 1). The patients performed leg extension exercise (20~30% 1RM) under KAATSU condition two times/week for three months. Training started after 200 m walking early after the operation. Skeletal muscle mass index (SMI) was evaluated using bioelectrical impedance analysis (BIA). The anterior mid-thigh thickness (MTH) was measured using B mode transverse ultrasound images. Physical functions (isometric knee extension peak torque, handgrip strength, and walking speed) were also measured at three points, i.e. baseline (before operation), ~7 days early after operation, and ~3 months after the training. Results: SMI and MTH decreased significantly from 7 ± 1.1, and 2.5 ± 0.4 cm preoperatively to 6.7 ± 1.0, and 2.2 ± 0.3 cm approximately 1 week after surgery. Approximately 3 months after the training, they increased significantly to 7.6 ± 0.8 and 3 ± 0.4 cm. During the rehabilitation period, hemodynamic deterioration and side effects including subcutaneous hemorrhage were not observed, and all the patients completely finished the study. Conclusions: These results suggest that KAATSU training safely increased muscle mass in patients in the early perioperative period of cardiovascular surgery. KAATSU training appears to be a promising and effective method for cardiac rehabilitation in patients with cardiovascular surgery.

КЛИНИЧЕСКИЙ СЛУЧАЙ ОРТОПЕДИЧЕСКОЙ СТОМАТОЛОГИЧЕСКОЙ РЕАБИЛИТАЦИИ ПАЦИЕНТА С СИНДРОМОМ КЛОУСТОНА И ВРОЖДЕННОЙ АДЕНТИЕЙ

Subject. Clouston syndrome is within the list of rare (orphan) congenital diseases. The issue of peculiarities in dental rehabilitation of patients with Clouston syndrome and congenital edentulism remains discussable. There are no approved clinical guidelines regarding this problem for dental practitioners.&#x0D; Aim ― improvement of diagnostic and treatment procedures efficacy for children with Clouston syndrome and congenital edentulism in the orthopedic dentistry and orthodontics clinic.&#x0D; Methodology. In order to demonstrate capabilities of efficacious orthopedic dental rehabilitation, a clinical case of a 14-years old patient with Clouston syndrome and congenital edentulism in an ambiguous oral cavity condition is presented, demonstrating the most justified and predictable approach to clinical management of patients.&#x0D; Results. The paper describes results of analysis of domestic and foreign literature devoted to the issue of determining distinctive diagnostic features of patients with Clouston syndrome used in the diagnostic process in the presented clinical case. Technological peculiarities and advantages of the chosen minimally invasive treatment approach – application of removable dentures – are described. The article demonstrates photographs depicting orthopaedic dental treatment results providing evidence of aesthetic, functional and social rehabilitation of the patient.&#x0D; Findings. The presented literature review of main distinctive clinical features of Clouston syndrome is an efficacious diagnostic algorithm in clinical orthopedic dentistry and orthodontics that forms a clear route for allied specialists in terms of diagnosis of this pathology in patients. The presented clinical case of minimally invasive orrthopedica dental treatment methods for rehabilitation of patients with Clouston syndrome and congenital edentulism is an option that provides for predictable satisfactory aesthetic and functional results of treatment, social adaptation of patients and a wide spectrum of further clinical decisions in short- and long-term follow-up management of patients.

P0959EFFECT ON THE DIALYSIS DOSE OF THE EXERCISE WITH VIRTUAL REALITY DURING THE FIRST VERSUS SECOND PART OF THE DIALYSIS SESSION

Abstract Background and Aims Exercise using non-immersive virtual reality (VR) is a novel rehabilitation method for patients undergoing hemodialysis treatment. This method has shown in a pilot study improved physical function and health-related quality of life. There is controversy about the effect of intradialysis exercise on the dialysis dose. Furthermore, theoretical models also indicate that intradialytic exercise at the end of session may be beneficial in postdialysis rebound. Objective: to determine effect of exercise with virtual reality during the first two hours and the last two hours of dialysis session on postdialysis rebound and dialysis dose. Method The design was a randomized clinical trial. Patients were randomized to exercise in the first (Start group) or last two hours (End group) of dialysis session. Dialysis dose was measured through the monocompartimental Kt/V, and the potassium, urea, phosphorus and creatinine rebound was calculated after both baseline and exercise sessions at 17 weeks. Intradialysis exercise consisted of a video game adapted to dialysis: Treasure hunting. It is a non-immersive VR game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise session lasted from 20 to 40 minutes. Intensity was checked through the rate of perceived exertion. An mixed ANOVA of repeated measures was used to assess the effect of the intervention. Patients exercised for 17 weeks. Results 43 patients participated, 11 dropouts, 17 in Start group and 15 in End group. Mean age 73 years, males 28. There were no significant differences in rebound urea, creatinine, potassium and phosphorus 30 minutes after finishing dialysis. The mean baseline Kt/V was 1.65 (SD 0.21) and with exercise 1.75 (SD 0.25). The mixed ANOVA analysis showed a significant time effect with an increase in Kt/V (mean 0.10, 95% CI 0.02-0.19, p 0.018) from exercise session vs baseline. No group per time significant interaction was found, so that there was no difference in the dialysis dose between Start and End group. Conclusion Intra-dialysis exercise with virtual reality can improve the dose of dialysis, no matter the timing of the exercise is performed.

SO064HEMODYNAMIC TOLERANCE OF EXERCISE WITH VIRTUAL REALITY PERFORMED DURING THE FIRST VERSUS THE SECOND PART OF THE HEMODIALYSIS SESSION

Abstract Background and Aims It is recommended intradialysis exercise implementation in the first part of the HD session to avoid hemodynamic instability or cramping, but the time restriction to exercise worsens clinical feasibility of exercise as a routine. Exercise using non-immersive virtual reality is a novel rehabilitation method for patients undergoing hemodialysis treatment. This method has shown in a pilot study improved physical function and health-related quality of life. Objective: to determine effect of exercise with virtual reality during the first two hours and the last two hours of dialysis session on hemodynamic control. Method The design was a randomized clinical trial. Patients were randomized to exercise in the first (Start group) or last two hours (End group) of dialysis session. Intradialysis exercise consisted of a video game adapted to dialysis: Treasure hunting. It is a non-immersive virtual reality game in which the patient must catch some objectives avoiding obstacles by moving the lower limbs. The exercise session lasted from 20 to 40 minutes. Intensity was checked through the rate of perceived exertion. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), episodes of hypotension and episodes of clinical instability are monitored throughout the session. The intervention has already begun and will continue for twelve months. The control analysis is performed during the three months at rest prior to starting the intervention (Rest) and then the intervention begins, every three months. Now we present the results at thirth month with exercise (Exercise) . An mixed ANOVA of repeated measures is used to assess the effect of the intervention. Results 43 patients participated, 11 dropouts, 17 in Start group and 15 in End group. Mean age 73 years, males 28. The mean baseline (SD) was Body Mass Index 26.2 (5.5) kg/m2, Overhydration 2.1 (1.3) liters, Kt/V was 1.65 (SD 0.21), Serum Albumin 3.84 (0.29) mg/dl and Hemoglobin 11.81(1.27) g/dl . Analysis by time Rest versus Exercise showed as mean (SD): HR 64 (8) vs 64 (7) bpm, SBP 143 (18) vs 141 (18) mmHg and DBP 61 (10) vs 60 (11) mmHg, no significant differences. The change in measurements at the end of dialysis showed in Rest vs Exercise were HR – 1.34 (5.7) vs -0.9 (5.9) bpm, SBP 1.2 (12) vs 2.65 (16) mmHg and DBP 2.65 (5.8) vs 1.09 (7.1) mmHg, no significant differences. Analysis by groups Start versus End showed as means (CI95%): HR 66 (62,69) vs 63 (59,67) bpm, SBP 145 (136,154) vs 136 (126,146) mmHg and DBP 63 (58,68) vs 56 (50,62) mmHg, no significant differences. The change in measurements at the end of dialysis showed in Start group vs End group neither showed significant differences. There were no differences between the groups regarding episodes of hypotension or clinical instability. Conclusion Performing intradialysis with virtual reality is well tolerated at any time during the session. This result improves the opportunities to implement exercise in hemodialysis.

Fuzzy controller for the treadmill speed adaptation system in mechatronic device for gait reeducation

Training with use of mechatronic devices is an innovative rehabilitation method for patients with various locomotor dysfunction. High efficiency of training is noted in systems that combine a treadmill or orthosis with a body weight support system. Speed control is a limitation of such rehabilitation systems. In commercially available devices, the treadmill speed is constant or set by the therapist. Even better training results should be obtained for devices in which the speed of the treadmill will be automatically adjusted to the patient walking pace. This study presents a mechatronic device for locomotor training that uses an algorithm to adjust the speed of the treadmill. This speed is controlled with use of a sensor that measures the rope inclination. The end of rope is fastened to the orthopaedic harness. Speed control is realized in such a way that ensures the smallest possible swing angle of the rope. A fuzzy controller was applied to adjust the treadmill speed. The drive system of the treadmill is equipped in a servodrive with PMSM motor and energy recovery module, which allows smooth speed control, limiting acceleration and minimizing electricity consumption. The presented solution was implemented in a real object and subjected to experimental tests.