Multidisciplinary Rehabilitation Center Research Articles

ЭТИКА И ДЕОНТОЛОГИЯ КАК БАЗОВЫЙ ПРИНЦИП РАБОТЫ МНОГОПРОФИЛЬНОГО РЕАБИЛИТАЦИОННОГО ЦЕНТРА, ПРИМЕНЯЮЩЕГО МЕТОДЫ НАУЧНОЙ МУЗЫКОТЕРАПИИ

This article presents literary data on the history of the formation of norms and rules of medical ethics. It substantiates the position on the need to comply with them in medical and preventive institutions not only by doctors or nurses, but also by employees of other specialties, such as psychologists, music therapists, etc. The advantages of combining medicine and art, innovative technologies in scientific music therapy, and the norms of medical ethics in practical activities are shown using the example of the multidisciplinary rehabilitation center «Doctor Music from Estonia». Compliance with these principles has ensured a reputation as an advanced organization, as well as respect and trust from the population. Such experience may be useful for other medical and preventive organizations.

Which patients with chronic low back pain respond favorably to multidisciplinary rehabilitation? A secondary analysis of a randomized controlled trial.

The aim of this study was to identify prognostic variables at baseline associated with being responding favorably to multidisciplinary rehabilitation in patients with chronic low back pain (CLBP). A responder analysis was conducted based on data from a randomized controlled trial with 26-week follow-up including 165 patients with CLBP treated at a Danish multidisciplinary rehabilitation center. Patients were dichotomized into responders and non-responders based on the outcome of a minimal clinically important difference of six points on the Oswestry Disability Index. The associations between prognostic variables and responders were analyzed using logistic regression. A total of 139 patients completed the study, of which 42% were classified as responders. Sex and employment status were statistically significant, with a decreased odds ratio (OR) of being a responder found for males compared to females (OR = 0.09, 95% CI = 0.02-0.48) and for being on temporary or permanent social benefits (OR = 0.28, 95% CI = 0.10-0.75) compared to being self-supporting or receiving retirement benefits. Statistically significant interaction (OR = 8.84, 95% CI = 1.11-70.12) was found between males and being on temporary or permanent social benefits. In patients with CLBP, female patients as well as patients who were self-supporting or receiving retirement benefits were significantly more likely than male patients or patients on temporary or permanent social benefits to be a responder to multidisciplinary rehabilitation.

Rehabilitation of the disabled with osteoarthritis in a multidisciplinary rehabilitation center

BACKGROUND: Current demographic trends indicate an increase in the proportion of elderly and senile people in the general population structure. Osteoarthritis is one of the most important causes of pain and limited mobility in old age. The most effective methods of treating osteoarthritis are physical therapy and teaching.
 AIM: To analyze the possibilities of inpatient rehabilitation departments of a multidisciplinary institution of social protection of the population in the rehabilitation of people with osteoarthritis.
 MATERIALS AND METHODS: The study is continuous, single-stage, single-center, retrospective. 6578 persons with disabilities who received inpatient rehabilitation from 2021 to 2023 were examined. Demographic indicators and nosological structure have been studied. A group of disabled people with osteoarthritis has been identified and studied in depth. The composition and scope of measures for the medical rehabilitation of people with ostearthritis have been studied.
 RESULTS: It was found that people with disabilities with osteoarthritis constitute the largest group among all people who received inpatient rehabilitation (37.9%). The vast majority of people with osteoarthritis with disabilities were female (88.8%). The basis of the inpatient rehabilitation program for patients with osteoarthritis was based on methods with proven effectiveness.
 CONCLUSION: Rehabilitation social protection institutions make a significant contribution to meeting the needs of people with disabilities, as one of the most socially vulnerable categories of the population, in rehabilitation assistance.

Implementation of an Interdepartmental Model of Complex Rehabilitation in the Perm Region in a Specialized Centre

BACKGROUND: Contemporary Russian system of complex rehabilitation and habilitation of disabled people is in the process of transformation. Application of the biopsychosocial approach through the use of the International Classification of Functioning, Disability and Health as a planning methodology Implementation and evaluation of rehabilitation measures make it possible to implement the key principles of rehabilitation: earlier, comprehensiveness, continuity, individual approach.
 AIM: To substantiate the possibility of implementing a modern regional interdepartmental model of integrated rehabilitation in a specialized centre, taking into account the structure of disability and the formation of new target rehabilitation groups.
 MATERIALS AND METHODS: Analysis of the dynamics of primary disability of the adult population, description of the structural and functional model of the creation and operation of a multidisciplinary rehabilitation center in conditions of interdepartmental cooperation.
 RESULTS: The structure of primary and secondary disability in the Perm Region is characterized by the predominance of persons with disabilities of groups 1 and 2 (60%) of working age, whose disability is caused in 30% of cases by malignant neoplasms. This determines the content of individual rehabilitation and habilitation programs to be developed for persons with disabilities and should be reflected in the development of appropriate infrastructure in the region. Modernization of the whole system, involving the use of targeted rehabilitation groups, ensuring continuity of medical and social activities in the relevant organizations and creating conditions for their continuation in the place of residence, should contribute to the effectiveness of rehabilitation activities in general.
 CONCLUSION: Recommendations on improvement of the system of complex rehabilitation in the conditions of a specialized center on the basis of interdepartmental cooperation have been proposed as a result of the research.

Examining the Benefits of Multidisciplinary Rehabilitation Intervention for Stroke Patients

Background: Stroke is the second leading global cause of death and disability, affecting 80 million survivors with residual symptoms. Rehabilitation, involving an interdisciplinary team approach, plays a crucial role in enhancing functional recovery, addressing deficits in fine motor skills, cognition, and communication through customized therapies, as highlighted in a randomized controlled trial comparing integrated rehabilitation approaches to conventional physical therapy for stroke recovery. Methods: The study was a randomized controlled trial comparing integrated rehabilitation approaches with conventional rehabilitation in post-stroke patients aged 40-60 years over a four-month period. Conducted in a multidisciplinary rehabilitation center, the study included 90 participants, with 45 in each group. The experimental group received integrated rehabilitation involving tailored physical therapy to enhance balance, occupational therapy targeting fine motor skills, and speech therapy addressing swallowing and communication issues. The control group underwent conventional rehabilitation primarily focusing on physical therapy, omitting integrated approaches like occupational and speech therapy. Results: The analysis of the findings had revealed that interdisciplinary rehabilitation program yielded a significantly better results p<0.05 in improving patients’ conditions. The findings provided evidences that all outcome measures that were balance, fine motor function and swallowing and dysphagia were significantly improved p<0.05 both at within and between the group analyses after four months of integrated rehabilitation program. Conclusion: The interdisciplinary rehabilitation programme that included physical, occupational, and speech therapies producednoticeably better outcomes than the conventional rehabilitation methods. The results highlight how well the integrated strategy works to improve swallowing/dysphagia, fine motor function, and balance outcomes. Keywords: Physical Therapy, Occupational Therapy, Post-stroke Patients, Speech Therapy

Social and psychological assistance to families with children with disabilities

The article examines the essence of social and psychological assistance to families raising children with disabilities. The main problems of such families are identified. Methods and forms of work with families with children with disabilities are considered on the example of the Regional State Budgetary Institution of Social Service Multidisciplinary Rehabilitation Center «Podsolnukh (Sunflower) ". By means of diagnostic materials, socio-psychological problems of families with children with disabilities and emotional burnout of parents raising children with disabilities have been identified, and trainings for parents with children with disabilities have been conducted. The topics of the trainings were «Prevention of burnout syndrome in parents raising children with disabilities» and «Prevention of emotional stress in parents of children with disabilities».

Clinical Observations of Hearing, Speech, Language and Swallowing Abilities in Locked-in Syndrome: A Case-based Study

Background: Locked-in Syndrome (LIS) is a rare neurological condition characterized by quadriplegia, mutism, and lower cranial nerve paralysis with intact eye movements and consciousness and communication through eye blink only. The irretrievable LIS condition differs from a coma, persistent vegetative state, and akinetic mutism with preserved volitional vertical eye movements and blinking involving a lack of conscious interaction with the environment. Reports and evidence on assessment and rehabilitation with LIS are scanty. Thus, this case study aims to highlight some of the challenges faced by speech-language pathologists in the assessment and management of LIS in a multidisciplinary rehabilitation center. This study also emphasizes the assessment protocol adapted to diagnose and strategies planned for intervention. 
 Case Description: A 58 years old male followed by an ischemic brain stroke diagnosed with LIS with a tracheostomy came to the department. Detailed history noted history revealed a brainstem stroke with pons involvement and a tracheostomy with percutaneous endoscopic gastrotomy and immobile vocal folds with limited epiglottic movements with impaired swallowing ability and severe aspiration. The clinical assessment was challenging and difficult to select appropriate assessment strategies for the condition. Detailed Speech, Swallow, and Language evaluations were carried out. The detailed evaluation reported the client with anarthria with tracheostomy secondary to locked-in syndrome.
 Conclusion: The present case report summarizes the need and findings of various evaluation procedures in the field of communication disorders. The role of an SLP is essential and a proper diagnostic protocol need to be considered along with spectacular observation while assessing LIS.

The role of gastrostomy feeding during intestinal rehabilitation for children with short bowel syndrome.

Following extensive bowel resection, many children with short bowel syndrome (SBS) are routinely offered a placement of gastrostomy tube (G-tube) for feeding. This nutritional pathway is aimed to accommodate the gastric and small bowel motor disturbances related to SBS, and to promote weaning off parenteral nutrition (PN) to achieve enteral autonomy (EA). The aim of this study was to investigate the effect of gastrostomy feeding in outcomes of children with SBS. A retrospective cohort of all SBS children managed at our multidisciplinary Intestinal Rehabilitation Center as part of an Intestinal Rehabilitation Program. SBS was defined as PN dependence for more than six weeks following extensive bowel resection. Patients treated with G-tube feeding were compared with patients without G-tube in terms of PN duration, reaching EA, physical development, and surgical parameters. A total of 36 SBS patients diagnosed between 2003 and 2022 were included. The most common etiologies included congenital intestinal atresia (31%) and necrotizing enterocolitis (25%). SBS-G-tube (group A) contained 20 children, and SBS (group B) contained 16 children. A total of 21 children reached EA (58%); ten from group A (50%), and 11 from group B (69%) (p > 0.05). Within EA patients, mean PN duration was 49 ± 44months in group A, and 24 ± 33months in group B (p > 0.05). Patients who reached EA had 22% longer residual small bowel when compared with PN-dependent patients (p = 0.003). However, the outcomes were adjusted for residual small and large bowel length and percentages, a residual ileocecal valve, and a colon in continuity with no differences between the groups. Two-thirds of children from group A reported G-tube related complications (mechanical, bleeding, or infections). We did not find differences in mean height and weight percentiles between the groups (p > 0.05). We did not find significant advantage of gastrostomy feeding in reaching EA. Because there are surgical and mechanical complications related to this procedure, further prospective studies are required to determine G-tube relevance for children with SBS.

Orthodontic status of children with cerebral palsy in Arkhangelsk

Relevance. Cerebral palsy (CP) is a common disease, which causes early disability in children and affects their dental status. The absence of malocclusion prevalence situational analysis precludes good planning of orthodontic care in the comprehensive rehabilitation of children and adolescents with CP. The study aimed to assess the orthodontic status in Arkhangelsk children and adolescents with primary, mixed and permanent dentition to ground the inclusion of an orthodontist in a multidisciplinary team. Materials and methods. In 2021, the study examined 110 children and adolescents aged 11 months to 17 years with confirmed CP undergoing treatment at the Arkhangelsk Multidisciplinary Rehabilitation Center. We performed an oral examination, interviewed parents (guardians) on bad habits in children and adolescents, objectively examined and assessed the orthodontic status and functional impairment (chewing, swallowing, breathing). Results. The prevalence of malocclusion in children and adolescents with CP is 100%. Malocclusion was detected in primary, mixed and permanent dentitions. We diagnosed distal occlusion (75.4%), open bite in primary teeth (66.6%), deep overbite in permanent dentition (60.1%), severe overjet (71.8%) and unilateral crossbite (3.6%). Conclusion. The results suggest reconsidering approaches to dental pathology prevention and treatment in spastic CP. Early diagnosis of initial malocclusion and customized preventive measures are essential in comprehensive treatment and prevention programs.

III international conference on restorative medicine (rehabilitation)

The III International Conference on Restorative Medicine (Rehabilitation) was held at the Rehabilitation Center of the Medical Center of the Presidential Administration (UDP) of the Russian Federation. The conference was attended by representatives of Russia, USA, Sweden. In addition to the plenary session, 10 symposia were held on the following topics: cardiovascular diseases and rehabilitation issues; doubt; therapeutic and prophylactic nutrition and the problem of dysbacteriosis; rehabilitation treatment of diseases of the musculoskeletal system; rehabilitation in neurology, neurosurgery; functional diagnostics and physiotherapy in restorative medicine; implementation of staged rehabilitation treatment programs in a multidisciplinary rehabilitation center; topical problems of general and private rehabilitation; legal, economic, informational and educational aspects of the organization of the rehabilitation link in the system of medical care.

P-13: Postoperative Weaning Strategies from PN Used in European Multidisciplinary IF Rehabilitation Centers: A Report from the ERNICA if Working Group

P-13: Postoperative Weaning Strategies from PN Used in European Multidisciplinary IF Rehabilitation Centers: A Report from the ERNICA if Working Group

The modeling of an innovative educational institution «Multidisciplinary training and rehabilitation center»

The article deals with the modeling of an innovative educational institution Multidisciplinary and in the context of the realization of its strategic purposes. The meaning of the terms professional rehabilitation, training apartment, and sports rehabilitation has been clarified. The urgency of creating the organizational structure of the educational institution is substantiated: early intervention department, preschool department, special school, and special classes for children with special educational needs, boarding school, department, inclusive education support center, summer health center, and summer parenting school, a service center with the use of Apartment technology. Mechanisms for the adoption of the European experience of using the Apartment technology have been revealed. It will protect the rights and interests of students with disabilities to live independently and will promote, in the future, their effective involvement in the life of the local community. The technological aspect of creating an innovative educational institution Multidisciplinary Training and Rehabilitation Center is described, considering the requirements of current legislation and in the context of implementing the National Strategy for reforming the system of institutional care and education of children for 2017-2026. The experience of practical implementation of the results of the author's research on this issue is outlined.

Evaluation Of Post-Surgical Introduction Of Enteral Nutrition(EN)/Milk Feeds In Infants With Short Bowel Syndrome (SBS) In European Centres: A Report From The Ernica* Intestinal Failure (IF) Working Group

Rationale: There is a lack of evidence for the management of weaning of infants with SBS from parenteral nutrition (PN). The first ERNICA IF workshop was held in 2019; several questions were raised about weaning strategies from PN used in European multidisciplinary IF rehabilitation centres.

Long-Term Outcomes and Disease Burden of Neonatal Onset Short Bowel Syndrome

PurposeThe study aims to describe long-term outcomes and disease burden of neonatal onset short bowel syndrome (SBS). MethodsUtilizing the WHO criteria for adolescence, patients 10–19 years of age with neonatal onset SBS requiring parenteral nutrition (PN) for >90 days and followed by our multidisciplinary intestinal rehabilitation center between 2009 and 2018 were included for analysis. ResultsSeventy adolescents with SBS were studied. Median (IQR) age at last follow up in our center was 15 (11, 17) years. There was 0% mortality in the cohort, and 94% remained transplant free. Fifty-three patients (76%) achieved enteral autonomy. Three patients were weaned from PN without transplantation after six years of follow-up and another four after ten years of care at our multidisciplinary center. Disease burden remained higher in adolescents receiving PN, including inpatient hospitalizations (p < 0.01), procedures (p = 0.01), clinic visits (p < 0.01), and number of prescribed medications (p < 0.01). ConclusionSurvival for adolescents with neonatal onset SBS is excellent. Of the cohort studied, there was no mortality, and more than 75% achieved enteral autonomy. Disease burden remains high for adolescents who remain dependent on PN. However, achievement of enteral autonomy is feasible with long-term multidisciplinary rehabilitation. Type of studyPrognosis study. Level of evidenceLevel II.

Should rehabilitation goals reflect all aspects of functioning in relation to a biopsychosocial ICF perspective?

Purpose To classify short-term and long-term rehabilitation goals and analyse how they capture functioning in a biopsychosocial International Classification of Functioning, Disability and Health (ICF) perspective. Materials and methods A retrospective study was conducted at two specialised outpatient multidisciplinary rehabilitation centres for polio survivors and accident victims. Rehabilitation goals extracted from patient journals were linked to the ICF according to linking rules. Results One hundred patients were included. Four hundred and eighty-seven short-term and long-term rehabilitation goals were linked to the ICF. Fifty-seven per cent were linked to Activity and Participation, 22% to Body Functions, 1% to Body Structure, 4% to Environmental Factors, 4% to Personal Factors, whereas 11% were not defined and 1% was not covered. The identified categories covered all ICF domains. The most frequent categories for short-term goals were d450 “Walking” and d570 “Looking after one’s health.” For long-term goals, d850 “Remunerative Employment” and d920 “Recreation and Leisure” were the most frequent. Conclusion The study showed challenges in capturing all aspects of biopsychosocial functioning in rehabilitation goals, particularly Contextual Factors. This study indicates that rehabilitation goals capture capacity rather than performance. Further research could highlight if functioning is captured in the rehabilitation plan, and in this way include both capacity and performance. Implications for rehabilitation Health professionals in a post-acute or long-term rehabilitation setting should pay attention to capacity and performance when rehabilitation goals are set. The rehabilitation plan should contain goals and a description of patient’s contextual factors and both should be equally valued and combined in a description of functioning. In a post-acute or long-term rehabilitation setting short-term and long-term goals are affected by the context. A longer rehabilitation intervention lead to goals linked to activity and participation.

Pecularities of medical rehabilitation in a multidisciplinary hospital.

The experience of the Medical and Rehabilitation Clinical Center of the Ministry of Defense of the Russian Federation is highlighted. This multi-disciplinary rehabilitation hospital, due to its staffing and organizational structure, equipment and staffing with highly qualified specialists, has the opportunity to conduct comprehensive medical rehabilitation for patients of all rehabilitation profiles. It effectively works multidisciplinary teams, using all modern methods of medical rehabilitation. Evidence is presented of the high performance of medical rehabilitation measures, thus ensuring a substantial replenishment of the rehabilitation potential of the military medical service. The necessity of further improving the organization of medical rehabilitation of military personnel using the capabilities of a modern multidisciplinary rehabilitation center in the system of medical care for the wounded and sick has been shown.

Monitoring of long-term parenteral nutrition in children with intestinal failure.

Pediatric intestinal failure (IF) is a rare and complex condition associated with significant morbidity and mortality. It is defined as the reduction of gut mass or function below the minimal needed for absorption of nutrients and fluid to sustain life and growth. Since the advent of specialized multidisciplinary intestinal rehabilitation centers, IF management has considerably evolved in the last years, but serious complications of long‐term parenteral nutrition (PN) can occur. Main complications include intestinal failure‐associated liver disease, growth failure, body composition imbalance, central venous access complications, micronutrient deficiencies and toxicities, metabolic bone disease, small intestinal bacterial overgrowth, and renal disease. With improvement in survival rates of patients over the last 20 years, emphasis should be on limiting IF‐related comorbidities and improving quality of life. Close monitoring is pivotal to ensuring quality of care of these patients. The care of children with chronic IF should involve a comprehensive monitoring plan with flexibility for individualization according to specific patient needs. Monitoring of children on long‐term PN varies significantly across units and is mainly based on experience, although few guidelines exist. This narrative review summarizes the current knowledge and practices related to monitoring of children with IF. The authors also share their 20‐year experience at the Royal Children's Hospital in Melbourne Australia on this topic.

A COMPREHENSIVE APPROACH TO ESTABLISHING OF REHABILITATION CENTERS FOR INVALIDS

The paper addressed different organizational and legislative issues of the operation of rehabilitation facilities for invalids, including war crimples, in theRussian Federation. The issues include the juridical, organizational, interactional, and systemic societal relationships. Approaches to tackling the issues include general scientific, such as analytical and comparative, as well as special, such as formal juridical, comparative legislative, historical-legislative, and different ways of interpreting the law (logical, systemic, historical, functional etc.). The normative and legislative documents of federal and regional levels and the documents issued by the Ministry of Labor of the Russian Federation that relate to establishing of multidisciplinary centers for rehabilitation of invalids, including children, were examined. The documents include the drafts of standard regulations of multidisciplinary centers for comprehensive rehabilitation of invalids, of the Order of the Ministry of Labor «On determining the approximate stuff norms for the agencies that provide services related to social and professional rehabilitation of invalids, including children», of the Approximate Staff List of a Multidisciplinary Rehabilitation Center, and different proposals concerning professional standards for rehabilitation specialists. Multilevel approaches to the organization of multidisciplinary rehabilitation centers and the structure of their units and departments are considered. Amendments to the above documents are proposed. The expediency of working out of a unified approach to drawing-up of staff-lists for agencies involved in rehabilitation and restoration of invalids is substantiated. Such an approach will ensure the availability of rehabilitation services to invalids in every subject of theRussian Federation, the rational usage of resources available for the subjects and to the respective security, defense and law enforcement agencies.

Informing the development of an Internet-based chronic pain self-management program

BackgroundSelf-management can optimize health outcomes for individuals with chronic pain (CP), an increasing fiscal and social burden in Canada. However, self-management is rarely integrated into the regular care (team activities and medical treatment) patients receive. Health information technology offers an opportunity to provide regular monitoring and exchange of information between patient and care team. ObjectiveTo identify information needs and gaps in chronic pain management as well as technology features to inform the development of an Internet-based self-management program. MethodsTwo methods were used. First was a structured literature review: electronic databases were searched up to 2015 with combinations of MeSH terms and text-words such as chronic pain, self-management, self-efficacy, technology, Internet-based, patient portal, and e-health. A narrative synthesis of the characteristics and content of Internet-based pain management programs emerging from the literature review and how they relate to gaps in chronic pain management were completed. Second, four audiotaped focus group sessions were conducted with individuals with chronic pain and caregivers (n=9) and health professionals (n=7) recruited from three multidisciplinary tertiary and rehabilitation centres. A thematic analysis of the focus group transcripts was conducted. ResultsThirty-nine primary articles related to 20 patient-oriented Internet-based programs were selected. Gaps in CP management included lack of knowledge, limited access to health care, suboptimal care, and lack of self-management support. Overall, 14 themes related to information needs and gaps in care were identified by both health professionals and patients, three were exclusive to patients and five to health professionals. Common themes from the focus groups included patient education on chronic pain care, attitude-belief-culture, financial and legal issues, end-of-program crash, and motivational content. ConclusionsInternet-based programs contain automated, communication and decision support features that can address information and care gaps reported by patients and clinicians. However, focus groups identified functionalities not reported in the literature, non-medical and condition- and context-specific information, integration of personal health records, and the role of the different health professionals in chronic pain management were not identified. These gaps need to be considered in the future development of Internet-based programs. While the association between the mechanisms of Internet-based programs’ features and outcomes is not clearly established, the results of this study indicate that interactivity, personalization and tailored messages, combined with therapist contact will maximize the effectiveness of an Internet-based chronic pain program in enhancing self-management.

The Long-Term Treatment of Short Bowel Syndrome

Short bowel syndrome (SBS) is the most common cause of intestinal failure in the pediatric population. Functionally, SBS is defined as the spectrum of malabsorption features occurring after extensive surgical resection. Congenital SBS is a rare entity, with an estimated prevalence of 0.02-0.1% among all live births. The mainstay of treatment consists of parenteral nutrition and intestinal rehabilitation, comprising surgical reconstruction. The two main procedures are Longitudinal Intestinal Lengthening and Tailoring procedure (LILT) and Serial Transverse Enteroplasty Procedure (STEP). Transplantation is reserved as treatment of last resort, when intestinal rehabilitation has been unsuccessful. Short bowel syndrome is a debilitating disease, whose management stretches over the course of years. However, with the innovation of surgical techniques such as LILT and STEP, as well as advances in multidisciplinary intestinal rehabilitation centers, long-term survival rates are approaching 90%. In this review we discuss the current and future treatment options for SBS.