Rehabilitation Methods Research Articles

Virtual Reality for the Rehabilitation of Acquired Cognitive Disorders: A Narrative Review.

This review article explores the use of Virtual Reality (VR) technology in cognitive rehabilitation for individuals with neurological conditions, such as stroke, traumatic brain injury, and neurodegenerative diseases. The introduction highlights the challenges posed by cognitive impairments and the limitations of traditional rehabilitation methods. VR is presented as a transformative tool that immerses individuals in interactive environments, offering promising opportunities for enhancing cognitive functions and improving quality of life. This article covers the foundational principles of VR, its applications across different clinical conditions and cognitive domains, and evaluates empirical evidence supporting its efficacy. It also discusses the advantages, limitations, challenges, and ethical considerations in the use of VR for cognitive rehabilitation. This review concludes by exploring future developments, including advancements in VR technology, the integration of Augmented Reality (AR) and artificial intelligence (AI), and the importance of standardized assessment tools for the objective evaluation of rehabilitation outcomes.

Features of Neuropsychological Support of Patients with Impaired Consciousness at the Early Stage of Rehabilitation: a Narrative Review

INTRODUCTION. In the neuropsychological support of patients with impaired consciousness at an early stage of rehabilitation, methodological and practical problems arise related to the choice and procedure for using methods of neuropsychological diagnostics and neuropsychological rehabilitation. To develop methods of working with such patients, it is necessary to address the concepts of the structure of consciousness and the content of consciousness.
 RESULTS. The article presents a review of the literature devoted to the problem of the work of a neuropsychologist with patients with impaired consciousness. In the reviewed literature, attention is drawn to the insufficient development of the neuropsychological content of the concept of “consciousness”; methodological and procedural limitations that arise when a neuropsychologist works with patients with disorders of consciousness of varying degrees of severity; the possibilities of conducting and limiting psychostimulotherapy and sensory stimulation in domestic and foreign approaches are discussed.
 CONCLUSION. The analysis of publications on the topic of accompanying patients with impaired consciousness reflects the presence of a number of unresolved issues. At the present stage of development of neuropsychological work with patients with impaired consciousness, there is no single approved and detailed protocol regulating the conduct of neuropsychological diagnostics and neurorehabilitation with them. The problem is at the stage of solution and requires further research.

Effectiveness of Complex Medical Rehabilitation of Patients with Postthrombophlebitic Syndrome of Lower Extremities and Obesity: a Randomized Clinical Study

INTRODUCTION. The relevance of the development of comprehensive rehabilitation programmes for patients with postthrombophlebitic syndrome (PTPS) is due to the high frequency of disability and a significant reduction in their quality of life. Since obesity and excessive body weight are proven risk factors for the development and progression of chronic vein diseases, weight reduction is one of the important tasks of rehabilitation measures in patients with PTPS and concomitant obesity.
 AIM. Comparative study of the influence of complex methods of medical rehabilitation, including various methods of laser blood irradiation (supravascular and intravenous), pulse magnetotherapy and dry carbon baths, on the dynamics of indicators of composite body composition according to bioimpedance measurements in patients with postthrombophlebitic syndrome of the lower extremities and obesity.
 MATERIALS AND METHODS. A randomized prospective study was conducted on the basis of the Department of Medical Rehabilitation of Patients with Somatic Diseases of National Medical Research Center of Rehabilitation and Balneology of the Ministry of Health of Russia. The study included 40 patients with PTS of the lower extremities and accompanying obesity, the average age of which was 58.3 [51.5; 68.0] year), randomized to two groups. The patients of the 1st group received Intravenous laser blood irradiation (ILIB) (“Lazmik”, Russia), impulse magnetotherapy and dry carbon baths, as well as therapeutic gymnastics in the hall. The patients of the 2nd group received a complex that included supravascular laser irradiation of blood (“Azor-2K”, Russia), pulse magnetic therapy, and dry carbon baths, as well as therapeutic gymnastics in the gym. Anthropometric measurements (body mass, malleolar volume) were used for the evaluation of anti-edema and lipolytic effects after a comprehensive course of medical rehabilitation, as well as bioimpedance measurement of body composition (“MEDASS”, Russia).
 RESULTS. In patients with PTS of the lower extremities and obesity, after carrying out a course of medical rehabilitation using preformed physical factors, including various methods of laser irradiation of the blood (supravascular and intravenous), a significant decrease in body weight indicators was observed (p 0.001), a decrease in BMI (p 0.001), total and extracellular fluid (p 0.001) without significant differences between groups. A significant decrease in the index of fat mass (kg) (p = 0.007) was found in patients of the main group.
 DISCUSSION. Maintaining a healthy body weight as well as combating obesity are first-line secondary prevention measures recommended for all patients with PTS of the lower extremities. For the control of the dynamics of the composite composition of the body, an effective and sensitive method is the method of bioimpedance measurement, which allows to estimate the reduction of extracellular fluid (anti-flow effect) and fat mass of the body (lipolytic effect).
 CONCLUSION. The method of bioimpedance measurement, used for the evaluation of the composite composition of the body, showed high sensitivity and allowed to establish the greater effectiveness of the developed complex, which includes ILIB with a wavelength of low-intensity laser radiation (NILI) of 635 nm in reducing fat mass.

Injury Prevention Strategies: Improving Strength and Flexibility for the Ankle : A Literature Review

The importance of injury prevention in the world of sport, especially football, is increasingly recognized by health practitioners and coaches. This article aims to present an in-depth literature review on strategies for preventing ankle injuries in soccer athletes, with the main focus on increasing muscle strength and flexibility. The literature presented includes the latest research results, clinical guidelines, and empirical findings in an effort to increase ankle durability and stability. Literature analysis reveals that training programs aimed at strengthening the supporting muscles of the ankle, along with increasing flexibility, can reduce the risk of injury in soccer athletes. Additionally, this review explores effective post-injury rehabilitation methods to speed up the recovery process and prevent recurrence. Practical implications of this research include developing exercise programs tailored to individual needs, regular monitoring by medical staff, and educating athletes about the importance of prehabilitation treatment. The results of this literature review confirm that implementing an exercise program that focuses on increasing the strength and flexibility of the ankle supporting muscles is an effective strategy in preventing injuries and post-injury rehabilitation in soccer athletes. Conclusion Overall, muscle strengthening and increasing flexibility in the ankle is emerging as a significant approach in the prevention and management of injuries in soccer athletes, highlighting the crucial role of targeted training in improving their health and performance.

Results of evaluation of neurometabolic and rehabilitation therapy for vincristine polyneuropathy in children with acute lymphoblastic leukemia

Introduction. Vincristine-induced peripheral neuropathies (VIPN) is a current problem in the management of pediatric acute lymphoblastic leukemia (ALL). There are no effective therapeutic strategies for VIPN. The aim of the study to present the results of evaluation of neurometabolic therapy in the acute period of VIPN in children with ALL and the method of virtual rehabilitation in the recovery period. Materials and methods. The single-center prospective comparative pilot study involved 69 children with VIPN who were treated in the acute period with the following drugs: group 1 - pyridoxine, group 2 - thioktovic acid, group 3 - inosine + nicotinamide + riboflavin + succinic acid. Clinical and electrophysiological parameters before and after drug treatment were analyzed. Among 10 children with motor deficits in the lower extremities in the recovery period of VIPN, rehabilitation with immersive virtual reality was performed, and the clinical parameters before and after the course were compared. Results. A positive effect of the studied drugs on the clinical condition of patients by the 30th day of therapy was revealed. In groups 1 and 3 the total score on the NIS-LL scale correlated with mild polyneuropathy - 4 [2÷8] and 2 [2÷6] points, respectively. Neurologic impairment in each of these groups persisted for 19 [14÷25] and 19 [13÷30] days, which was less in contrast to the duration of symptoms in group 2 (p1-2 = 0.021 and p2-3 = 0.046). In the VIPN recovery period before and after virtual rehabilitation: muscle strength in the lower limbs increased (p = 0.025); the severity of polyneuropathy decreased according to the NIS-LL scale (p = 0.003); balance improved according to the Berg scale (p = 0.017); and patients’ mobility increased according to the Functional Walking Category test (p = 0.025) and walking speed according to the time-recorded walking test (p = 0.008). Discussion. Improvement of clinical parameters with neurometabolic therapy and virtual rehabilitation in children with VIPN has been shown. Conclusion. Preliminary results of the effectiveness of pyridoxine and inosine + nicotinamide + riboflavin + succinic acid in the acute period of VIPN in children with ALL and the method of virtual rehabilitation in the recovery period were obtained.

Is karate a safe and effective method of cardiac rehabilitation in patients with heart failure and reduced ejection fraction? The KAREAD trial

Is karate a safe and effective method of cardiac rehabilitation in patients with heart failure and reduced ejection fraction? The KAREAD trial

Acupuncture combined with repeated transcranial magnetic stimulation for upper limb motor function after stroke: A systematic review and meta-analysis.

Upper limb motor dysfunction after stroke is an important factor affecting patients' motor function and daily life. Acupuncture and repetitive transcranial magnetic stimulation are effective methods for stroke rehabilitation. However, a systematic and comprehensive overview of the combined efficacy of the two is lacking. Through a systematic review and meta-analysis of randomized controlled trials, this study aimed to assess the effectiveness of acupuncture combined with repetitive transcranial magnetic stimulation on upper extremity motor function in post-stroke patients. The relevant randomized controlled trials on acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of upper limb motor disorders after stroke were searched in PubMed, Embase, Cochrane Library, Web of Science CNKI, VIP, Wanfang, and CBM databases. After screening clinical trials that met the inclusion criteria, data extraction was conducted independently by two investigators. Meta-analysis was performed using RevMan 5.4 software. After the screening, 18 articles were included, with a total of 1083 subjects. The results of meta-analysis showed that combination therapy could effectively improve the patients' upper limb motor function (MD = 7.77, 95%CI [6.32, 9.22], P < 0.05), ability of daily living (MD = 8.53, 95%CI [6.28, 10.79], P < 0.05), and hemiplegic shoulder pain (MD = - 1.72, 95%CI [- 2.26, - 1.18], P < 0.05). Meanwhile, for neurophysiological indexes, combined treatment could significantly shorten the latency of motor evoked potential and central motor conduction time (MD = - 1.42, 95%CI [- 2.14, - 0.71], P < 0.05); (MD = - 0.47, 95%CI [- 0.66, - 0.29], P < 0.05), and also could increase the amplitude of motor evoked potential (SMD = 0.71, 95%CI [0.28, 1.14], P < 0.05). According to the results of the meta-analysis, we can conclude that acupuncture combined with repeated transcranial magnetic stimulation can significantly improve the upper limb motor function and daily living ability of stroke patients.

Modern methods of physical rehabilitation for the prevention of osteochondrosis in sports players

An important component in increasing the efficiency of the training process and achieving the highest possible results of athletes - players are the methods of physical rehabilitation in osteochondrosis, which are aimed at rapid recovery of the body and are an integral part in the development of training programs. Therapeutic physical culture, massage and physiotherapeutic methods used in the prevention of osteochondrosis are considered. Taking into account the methods and means of physical rehabilitation in athletes with osteochondrosis is a priority direction in the correction of loads in different periods of the annual cycle.&#x0D; The scientific novelty of the study is due to the fact that osteochondrosis of the spine in athletes is one of the most common chronic diseases. During the training and competitive process, athletes-players endure heavy loads, which provoke further exacerbation of the manifestations of osteochondrosis, where their physical and functional capabilities in motor activity are significantly limited. Therefore, it becomes obvious the need to consider modern methods and programs of physical rehabilitation as a comprehensive approach used in the prevention of osteochondrosis.&#x0D; However, in recent years, the specifics of the physical rehabilitation of osteochondrosis of the spine in athletes - highly qualified players have been caused by a number of contradictions. In particular, the issue of the impact of spinal cord pathology on the motor functions of athletes has not been investigated. The effectiveness of the use of rehabilitation programs of physical rehabilitation, which open up new possibilities for the prevention of osteochondrosis, has not been highlighted.

Use of canisterapy in the rehabilitation treatment of children

The article analyzes methods of treatment and rehabilitation using dog therapy for children evacuated from the combat zone to Bukovina. Animal therapy is one of the types of therapy that includes the use of animals as a means of treatment. The goal of such therapy is to improve the patient's social, emotional, or cognitive functions. One of the methods of positive psychosocial and physical rehabilitation influence on people who need it, through specially managed and trained dogs, is canister therapy. There are several types of canister therapy in the world. The presence of a dog reduces psychological and physiological excitement, thus the shaggy therapist has a stabilizing effect on the patient. Canister therapy is also used as an auxiliary psychotherapeutic method to solve various situations when other methods are ineffective or unsuitable. Since special norms and requirements for animal treatment have not yet been developed in Ukraine, and specialists work exclusively according to the protocol of the World Organization for Canister Therapy and cynology. In the field of rehabilitation, work’s not certified specialists, but certified ones who have passed first-level canister therapy courses, under the guidance of Polish specialists according to international EU standards, who are valid members of the International Association of the Human-Animal Interaction Organization. There is a system of training dogs, testing them and admitting them to work in addition to the training of a rehabilitator, Since the full-scale invasion, the “City of Goodness” has sheltered more than 3,000 people, currently housing 320 wards. Among them are three evacuated children's boarding schools from Odesa and Mykolaiv regions. Today it is the largest shelter in Ukraine. “City of Goodness” provides everyone with individual support, depending on their needs. The war made adjustments to the way of life for all of us - we have to live, work and take care of each other in unusual conditions.

The effects of the Pilates method in individuals after stroke: a systematic review with meta-analysis

Background: Pilates has shown significant effects in post-cerebrovascular accident (CVA) patients. Objective: To carry out a systematic review with meta-analysis, investigating the effects of the Pilates method in post-stroke individuals. Methods: An electronic search was performed using an optimized strategy in the Medline, CINAHL, SPORTDiscus, Web of Science, LILACS and PEDro databases, plus a manual search. Clinical trials that used the Pilates method in post-stroke rehabilitation, in functionality outcomes, were included. Studies were reviewed by two independent reviewers. Methodological quality was assessed using the PEDro scale. Results: Seven studies were included. The results of the meta-analyses showed that Pilates was effective in improving mobility (-3 seconds; CI 95% -4 to -1; p=0.009), assessed by the Timed Up and Go, and quality of life (SMD 1 .1; 95% CI 0.5 to 1.58; p&lt;0.001) of individuals after stroke. Regarding the descriptive results, Pilates proved to be effective in improving lower limb motor function, cardiopulmonary function, step length, and gait ability. Conclusion: This systematic review showed, through meta-analysis, that the Pilates method is effective in improving the mobility and quality of life of post-stroke individuals. In addition, descriptive results were significant for lower limb motor function, cardiopulmonary function, step length, and gait ability. However, these latter results deserve caution, as they were all based on descriptive results from only one clinical trial each.

Mediating role of physical activity in the relationship between psychological distress and intimate relationships among stroke patients.

Stroke patients often experience psychological distress, which can impact their intimate relationships with spouses, subsequently influencing their treatment and recovery. Physical activity is considered a key rehabilitation method for stroke patients. This paper aims to analyze whether psychological distress affects intimate relationship between spouses through physical activity. To explore the mediating effect of physical activity between psychological distress and intimate relationship in stroke patients. A total of 256 stroke patients who underwent treatment at the First People's Hospital of Shangqiu between July 2021 and July 2022 were enrolled in this study. The participants completed questionnaires, including the Kessler Psychological Distress Scale (K10), the Quality of Relationship Index (QRI), International Physical Activity Questionnaire, and a general information questionnaire. Data analysis were performed using SPSS 23.0. The Harman test was employed to detect common method deviations, and Spearman correlation was used for correlation analysis. The mediating effect was assessed using Process 3.4.1, with significance testing of the regression coefficients conducted using the bias-corrected percentile Bootstrap method (5000 iterations, 95% confidence interval). Statistical significance was set at P < 0.05. The results showed that patients scored an average of 21.61 ± 6.44 points on the K10, 32.40 ± 6.19 points on the QRI; the median physical activity level according to the International Physical Activity Questionnaire was 1861 (566, 2846) MET·min/w. The level of physical activity (the physical activity intensity of the patients reflected by the International Physical Activity Questionnaire-Long Form scale) negatively correlated with psychological distress and intimacy (P < 0.05), and positively correlated with each other (P < 0.05), with the correlation stronger at lower physical activity levels compared to higher ones. The mediating effect of physical activity between psychological distress and intimate relationship was calculated to be 40.23%. Bootstrap analysis further validated the results. The mediating effect of psychological distress on intimate relationships through physical activity level was -0.284, with a confidence interval of -0.409 to -0.163, excluding 0, confirming a significant mediating effect of psychological distress on intimate relationships. Physical activity significantly affects relationship between psychological distress and intimate relationships among stroke patients. Addressing the role of physical activity may have implications for improving patient outcomes and rehabilitation strategies.

Mental and behavioural disorders increase the risk of tendon rupture after flexor tendon repair in zone I and II.

The effect of mental and behavioural disorders (MBD) on the risk of tendon ruptures after flexor tendon repair is not well understood. This study aimed to analyse the association between MBD and tendon rupture after flexor tendon repair in zones I and II. Data from the Swedish National Registry for Hand Surgery (HAKIR) on patients with a complete flexor tendon repair at our department between 2012 and 2019 were followed for a minimum of 2years to assess the rate of rupture. Independent variables were collected from HAKIR and clinical records: prevalence MBD based on ICD-10 codes F0-F99, age, sex, injured tendon, number of injured fingers, day to surgery, core suture, digital nerve injury, smoking, injury mechanism, and rehabilitation method. Multiple logistic regression was used to assess the association between variables. A cohort of 593 patients with 49 ruptures (8.2%) was identified. Potential causes of rupture were non-adherence behaviour in 16 (33%), accidents in seven (14%), infections in six (12%), and no clear cause in 20 (41%) patients. Patients with MBD had an association to rupture (OR 3.6), 17.7% ruptures compared to 7.2% in patients with no diagnosed disorders. Patients >50years of age had a higher risk compared to patients <25years (OR 4.3), 15% compared to 3.9%' respectively. Men had a higher risk compared to women (OR 2.9), 10% compared to 4.3%' respectively. We identified an association between the prevalence of mental and behavioural disorders and rupture after flexor tendon repair.

Clinical application of repetitive transcranial magnetic stimulation in improving functional impairments post-stroke: review of the current evidence and potential challenges.

In recent years, the stroke incidence has been increasing year by year, and the related sequelae after stroke, such as cognitive impairment, motor dysfunction, and post-stroke depression, seriously affect the patient's rehabilitation and daily activities. Repetitive transcranial magnetic stimulation (rTMS), as a safe, non-invasive, and effective new rehabilitation method, has been widely recognized in clinical practice. This article reviews the application and research progress of rTMS in treating different functional impairments (cognitive impairment, motor dysfunction, unilateral spatial neglect, depression) after stroke in recent years, and preliminary summarized the possible mechanisms. It has been found that the key parameters that determine the effectiveness of rTMS in improving post-stroke functional impairments include pulse number, stimulated brain areas, stimulation intensity and frequency, as well as duration. Generally, high-frequency stimulation is used to excite the ipsilateral cerebral cortex, while low-frequency stimulation is used to inhibit the contralateral cerebral cortex, thus achieving a balance of excitability between the two hemispheres. However, the specific mechanisms and the optimal stimulation mode for different functional impairments have not yet reached a consistent conclusion, and more research is needed to explore and clarify the best way to use rTMS. Furthermore, we will identify the issues and challenges in the current research, explore possible mechanisms to deepen understanding of rTMS, propose future research directions, and offer insightful insights for better clinical applications.

Проектное управление в системе управления на примере реализации проекта «Клиника лица».

A new management method in the public health care system is project management. A i m . Improving the quality of medical care in a public health care institution for patients with neurological disorders of the face through organizational measures using project management. M a t e r i a l s a n d m e t h o d s . The state medical organization has implemented an original program of assistance to patients with neurological disorders in the face in several stages. Used project management. There was no restructuring of medical departments or hiring of new employees. R e s u l t s . At the Sklifosovsky Research Institute, in total for the period 2021–2022, 865 offline (over the year, the growth rate of consultations increased by 2.5) and 48 online consultations with neurologists were conducted, there were 139 MRIs, 180 electrodiagnostic procedures, surgical treatment was performed on 101 patients, and 161 botulinum therapy procedures were performed. Scientific research included the development of protocols for magnetic resonance imaging and electrodiagnostics, an algorithm for making decisions about surgical care was described, and new methods of physical rehabilitation were proposed. 28 scientific articles were published, the results were reported at scientific and practical conferences and congresses. A team of specialists has developed a postgraduate educational program. Provided patient education. The Face Clinic project is recognized as socially important. C o n c l u s i o n s . For a specific group of patients, in order to quickly achieve results, it is better to organize work through project management. It is necessary to teach doctors management tools.

Mirror therapy as a method of rehabilitation for stroke patients

Mirror therapy as a rehabilitation method for stroke patients. Stroke claims millions of lives every year worldwide. Its severity is associated with the damage to important brain structures and severe disruptions of various physiological functions in patients, making the investigation of methods to alleviate the consequences of stroke relevant. The aim of this study is to highlight the methods of mirror therapy, their effectiveness, and to examine some possible mechanisms underlying the positive effects of mirror therapy on the recovery of limb functions. Materials and Methods. A review and analysis of literature data were conducted. Literature search was carried out in Scopus and Pubmed databases. Technical implementation of mirror therapy. Various three-dimensional structures are used to implement the method of mirror therapy, allowing the patient to perceive the work of the working limb as the work of an immobilized leg or arm, which has a positive effect on the rehabilitation process. In many studies, the effectiveness of mirror therapy has been demonstrated both in the chronic and acute phases after stroke. Several hypotheses have been put forward by scientists about the mechanisms of the effectiveness of mirror therapy, suggesting the activation of motor neuron centers and zones in the brain cortex. Conclusion. According to the results of numerous studies, mirror therapy shows a sufficiently high effectiveness in the rehabilitation of stroke patients and improves their quality of life.

EEG sensor driven assistive device for elbow and finger rehabilitation using deep learning

In today's world, a large number of people suffer from motor impairment-related challenges. Rehabilitation is the main method used to overcome these difficulties. The goal of the paper is to develop a deep learning-based electroencephalogram (EEG) sensor-controlled assistive device for the rehabilitation of elbow and finger movements. We have introduced an innovative finger and elbow movement rehabilitation method using an EEG sensor. The EEG sensor's recorded EEG signals, attention values, and meditation values have been used for this purpose. This rehabilitation technique helps a person perform basic finger movement rehabilitation motions, such as finger extension and flexion. Also, basic elbow movement rehabilitation exercises, i.e., elbow extension and elbow flexion, can be performed by using this rehabilitation technique. In this research, an EEG sensor records the prefrontal lobe’s EEG signals, attention value, and meditation value of a person while the person performs motor imagery. A deep learning-based CNN-TLSTM (Convolution Neural Network-tanh Long Short-Term Memory) model with attention mechanism has been designed for decoding the EEG sensor recorded data. The trained deep learning model decides the course of action of the rehabilitation device. The designed model achieves an accuracy of 99.6%. A working prototype model of the rehabilitation device has been developed, and the overall success rate of the model is found to be 98.66%. The novelty of the paper lies in i) designing an attention-based CNN-TLSTM model for motor imagery classification and ii) developing a low-cost EEG sensor-driven rehabilitation device for finger and elbow movement rehabilitation.

Effects of transcranial magnetic stimulation on cortical structures during motor imagination performance in the brain-computer interface

The aftermath of a stroke can frequently result in impaired motor functions causing problems performing habitual limb movements. These movement disorders stem from damage to the cerebral cortex and disruptions to neuronal connections in the central pyramidal pathways [1]. Restoring motor skills following a stroke is a time-consuming and challenging process, requiring resources from both external medical sources and the patient. Despite these challenges, it is still feasible for patients to regain control over their limb movements. The common approach for stroke neurorehabilitation consists of therapeutic physical activities and kinesiotherapy. These methods rely on afferent information during motor tasks to repair connections between intact brain areas [2]. Through exercising the impacted limbs, synaptic rearrangement happens in the cortex, awakening dormant neurons and increasing cortical areas adjacent to inactive regions. Although these techniques can partially restore movement, a significant number of stroke patients still face impairments. It is crucial to acknowledge the limitations of the current interventions and explore new approaches for better outcomes. Traditional rehabilitation methods often do not fully restore movement control, prompting researchers to explore alternative approaches. Motor-imagery-based brain-computer interfaces (BCIs) have gained attention recently [3, 4]. They allow for integrating various feedback mechanisms, which can be combined with upper and lower limb exoskeletons. The level of control a subject has over a BCI system directly affects the recovery process [5]. Introducing transcranial magnetic stimulation (TMS) into motor-imagery BCIs shows promise for developing a unified and highly efficient approach to post-stroke rehabilitation. Twenty-nine healthy adult participants (21 females) with a mean age of 20.93±2.14 years were recruited for this experiment. All participants were right-handed and had no prior experience with brain-computer interfaces. Ethical approval was obtained from the local ethics committee of Lobachevsky State University of Nizhny Novgorod (ethical approval No. 2, dated 03/19/2021), and written informed consent was obtained from all participants. Subjects were randomly assigned to receive either a sham intervention (n=15) or active TMS (n=14). The experiment displayed tasks on a 24-inch LCD screen placed 2 meters away. Participants sat in a reclining chair with hands on adjustable armrests for EEG signal recording. Motor-imagery-based BCI training took place over two days with four daily tasks: motor performance, quasi-motor, and two motor imaginations of the dominant hand. EEG activity was recorded prior to and after completing the tasks. Each task comprised of 20 trials, each lasting 10 seconds. TMS was administered in between two motor imagination tasks, and a rest period of 2 minutes followed the stimulation. The researcher objectively monitored electromyography (EMG) in real-time during motor tasks. Certified NVX 52 amplifiers with 32 Cl/Ag electrodes positioned according to the international 10-10 system recorded electroencephalography (EEG) signals. The EEG was digitized at a sampling rate of 1000 Hz and filtered with a 50 Hz Notch filter. Disposable electrodes were used to record EMG data from musculus flexor digitorum superficialis on the right hand. EMG signals were digitized at 1000 Hz and filtered using a 50 Hz Notch filter. TMS was applied to the dorsolateral prefrontal cortex (dlPFC) using a figure-8 coil connected to a Neuro MS/D magnetic stimulator. Sham stimulation was performed with the same parameters, except the coil was tilted 90 degrees to simulate the sound of real stimulation. A nonparametric permutation test was conducted to assess the statistically significant dissimilarities between rest periods and periods subsequent to conducting motor imagery after TMS. Significant clusters of the highest event-related desynchronization (ERD) were observed. The analysis demonstrated a significant negative cluster in the theta rhythm (0–6 Hz) that was distinct from the magnetic stimulation site. Similar significant ERD clusters were identified during the first and second series of imaginary movements. The study examined alterations in motor cortex function following targeted rTMS. The results demonstrated that TMS using particular parameters resulted in the pre-activation of brain regions comparable to those stimulated during motor imagery. The implementation of this stimulation protocol increased activity in cortical regions related to motor imagery. The outcomes propose the probable effectiveness of TMS in elevating motor cortex activation during the rehabilitation process.

Condition and Management Strategy of Coral Ecosystem in Kedindingan Island, Bontang City

Kedindingan Island is one of the Marine Conservation areas in East Kalimantan Province with rich natural resource. This study aims to determine the extent of coral distribution and health, determine the health condition of live coral cover and to formulate management strategies in Kedindingan Island for the realization of sustainable coral management. The results of the analysis using Landsat 8 imagery showed live coral was 55.44 Ha in 2015 and 48.06 Ha in 2022. Love coral cover in stations 1,2, and 4 were in good category i.e. 52,53$, 53,6%, and 60,34%, respectively . whilst in station 3 31,34% was moderate category. There are three priority management strategies for coral ecosystem management in Kedindingan Island, the first is to create a team in each region consisting of policy makers, academics, and the community, the second is to increase the role of NGOs and local communities in monitoring and supervising coral ecosystems, and the third is to improve management and develop rehabilitation methods and monitor corals regularly in Kedindingan Island.

A comparative study of stretch-and-flow voice therapy versus Smith accent method in rehabilitation of hyperfunctional dysphonia: a randomized controlled trial

BackgroundThis work aims to compare between stretch-and-flow voice therapy and Smith accent method of voice therapy in treatment of hyperfunctional dysphonia in order to assess the benefit of using this new technique in its management. A randomized controlled trial was conducted at the Unit of Phoniatrics, Otorhinolaryngology Department, in the period from November 2020 to February 2023. A sample of 60 patients with hyperfunctional dysphonia was randomly divided into two groups; each group consisted of 30 patients: “group A” who received stretch-and-flow voice therapy (SnF) and “group B” who received Smith accent (SA) method of voice therapy. Assessment included auditory perceptual assessment (APA) using modified GRBAS scale and Arabic-voice handicap index (Arabic-VHI).ResultsThe study revealed significant improvement in grade of dysphonia, voice quality, and Arabic-VHI post-therapy for both groups. There was a significant improvement regarding voice pitch in SnF group only and in loudness of voice in SA group only.ConclusionSnF can be considered as an alternative approach for treating hyperfunctional dysphonia, offering a shorter duration, and potentially being a simpler alternative for patients who struggle with the more intricate rhythms of the Smith Aaccent voice therapy method.

Algorithm for physical rehabilitation of patients with multiple sclerosis: practical experience

BACKGROUND: Multiple sclerosis is a pressing problem of modern society and healtcare. The high risk of disability of the able-bodied population, together with the observed trend of increase in morbidity and decrease in the age of onset of the disease, create a number of economic and social difficulties. It is well known that current medical treatment of multiple sclerosis is most effective in reducing the frequency of exacerbations and disability progression, but does not affect the already established residual manifestations, indicators of disability progression objectified by magnetic resonance imaging data.&#x0D; AIM: Evaluation of the effectiveness of using the algorithm for choosing a method of physical rehabilitation, according to the selected models of patients with multiple sclerosis.&#x0D; MATERIALS AND METHODS: The medical histories of patients aged from 31 to 58.8 (average age 48.9±8.6) years who were in hospital treatment were analyzed (n=504; men — 34%, women — 66%), of which 56% had no disability, 11% had disability group I, 25% had disability group II, and 8% had disability group III.&#x0D; RESULTS: An algorithm for working with patients in this category was developed from the perspective of functioning in the categories of the International Classification of Functioning, Disability and Health, and Assessment of Impairments, which is a huge part of the medical rehabilitation protocol for patients with multiple sclerosis.&#x0D; CONCLUSION: The proposed models of patients, including pronounced disorders, make it possible to systematize and standardize the process of rehabilitation measures, improve the quality of provided medical services and provide the population with qualified rehabilitation care.