Multidisciplinary Rehabilitation Team Research Articles

Assessing the efficacy of a graded pulmonary rehabilitation protocol in mechanically ventilated patients following brainstem hemorrhage.

The objective of this study is to assess the impact of an early-graded pulmonary rehabilitation training program on patients undergoing mechanical ventilation due to brainstem hemorrhage. Eighty patients receiving mechanical ventilation due to brainstem hemorrhage at our hospital's neurosurgery department between August 2022 and October 2023 were enrolled as participants. A sampling table was generated based on the order of admission, and 80 random sequences were generated using SPSS software. These sequences were then sorted in ascending order, with the first half designated as the control group and the second half as the intervention group, each comprising 40 cases. The control group received standard nursing care for mechanical ventilation in brainstem hemorrhage cases, while the intervention group underwent early-graded pulmonary rehabilitation training in addition to standard care. This intervention was conducted in collaboration with a multidisciplinary respiratory critical care rehabilitation team. The study compared respiratory function indices, ventilator weaning success rates, ventilator-associated pneumonia incidence, mechanical ventilation duration, and patient discharge duration between the 2 groups. The comparison between patients in the observation group and the control group regarding peak expiratory flow and maximum inspiratory pressure on days 1, 3, 5, and 7 revealed statistically significant differences (P < .05). Additionally, there was a statistically significant interaction between the main effect of intervention and the main effect of time (P < .05). The success rate of ventilator withdrawal was notably higher in the observation group (62.5%) compared to the control group (32.5%), with a statistically significant difference (P < .05). Moreover, the incidence rate of ventilator-associated pneumonia was significantly lower in the observation group (2.5%) compared to the control group (17.5%) (P < .05). Furthermore, both the duration of mechanical ventilation and hospitalization were significantly shorter in the observation group compared to the control group (P < .05). Early-graded pulmonary rehabilitation training demonstrates effectiveness in enhancing respiratory function, augmenting the ventilator withdrawal success rate, and reducing both the duration of mechanical ventilation and hospitalization in mechanically ventilated patients with brainstem hemorrhage. These findings suggest the potential value of promoting the application of this intervention in clinical practice.

Early integrated rehabilitation and vocational rehabilitation in 435 patients with breast cancer: A comparison between the intervention group and control group in a prospective study.

11007 Background: Return to work is beneficial both for breast cancer (BC) patients and for society. This study explored the impact of early integrated and vocational rehabilitation on sick leave and disability one year after the start of cancer treatment in BC patients. Methods: The subjects of our prospective study were 435 employed female BC patients (26-65 (mean 52) years of age), who participated in the pilot study on the individualized integrated rehabilitation in 2019-2022 and were followed for at least one year. There were 211 patients in the control group and 224 in the intervention group. The patients completed three questionnaires (EORTC QLQ - C30, B23, and NCCN): before, half and one year after the start of cancer treatment. The control group received the standard rehabilitation programme, offered to all BC patients before the start of the study. The multidisciplinary rehabilitation team reviewed the documentation of the patients from the intervention group before, half and one year after the start of treatment and recommended appropriate interventions according to the patient's needs in compliance with the institute’s new clinical pathway (psychologist, general practitioner, nutritional treatment, physical rehabilitation, kinesiologist-guided online exercises, gynaecologist, analgesia, vocational rehabilitation). Data on the patients’ demographics and needs reported in questionnaires, the extent of the disease and cancer treatment were collected. These data and the frequency of sick leave and disability retirement one year after the start of treatment in both groups of patients were analysed using the chi-square and ANOVA test. Results: The patients from the intervention group had 50 calendar days shorter sick leave compared to the control group (p = 0.002). Patients without metastatic disease from the intervention group had 52 calendar days shorter sick leave compared to the control group (p = 0.002). The intervention group treated with chemotherapy had 43 calendar days shorter sick leave compared to the control group (p = 0.029). The difference in sick leave of the group of patients who did not receive chemotherapy was statistically borderline significant (50 calendar days, p = 0.053). The patients in the intervention group had a better work ability (p &lt; 0.001) and less disability (p &lt; 0.001) than the patients in the control group one year after the start of treatment. Conclusions: One year after the beginning of cancer treatment, patients from the intervention group had shorter sick leave, better work ability, and a lower proportion of disability compared to the control group.

Let the records speak: an exploration of rehabilitation services offered in primary healthcare, Johannesburg metropolitan district

BackgroundPrimary healthcare in South Africa aims to transform the national health system by emphasising community-based care and preventive strategies. However, rehabilitation services, particularly for individuals with disabilities and chronic non-communicable diseases, are often overlooked in primary healthcare. This study aimed to investigate the provision of primary healthcare rehabilitation services in the Johannesburg Metropolitan District by exploring client sociodemographics and variations in services provided by rehabilitation professionals.MethodsA retrospective review of clinic rehabilitation records from 2011 to 2020 was conducted at nine provincially funded community health centres (CHCs) offering rehabilitation services. Stratified sampling facilitated record selection based on rehabilitation service type and year. A specifically designed data extraction tool captured demographics, disabilities, rehabilitation received, and referral sources. Descriptive analysis used means, standard deviations, and frequencies.ResultsThe findings show a diverse client population with a wide age range, with a significant proportion falling into the < 5 years and 30–49 years age groups. Neuromusculoskeletal and movement-related disabilities were most prevalent, affecting approximately two-thirds of clients. Referral sources were often undocumented, and inconsistent discharge information with no record of patient follow up, highlighted the need for improved documentation practices. Clinic visits were the primary service delivery mode, followed by limited home visits and outreach services. Occupational therapy and physiotherapy were the most used services. Speech and language therapy services were underused, and some CHCs lacked audiology services. There were variations in the number of individual and group sessions provided by the different rehabilitation services, and there were age- and disability-specific differences in service use.ConclusionThis study offers insights into rehabilitation service provision in the Johannesburg Metropolitan District and enhances our understanding of rehabilitation services in primary healthcare settings. It underscores the importance of a multidisciplinary rehabilitation team to address diverse rehabilitation needs, improving documentation and discharge practices, expanding service delivery models, and reducing disparities in service use. The findings inform strategies for optimising service delivery, workforce, resource allocation, and intersectoral collaboration to ultimately enhance the quality and accessibility of integrated rehabilitation services.

Exposure to Meta-Analysis During Graduate and Postgraduate Trainings Predicts the Good Knowledge and Use of Randomized Controlled Trials, Systematic Reviews, and Meta-Analyses Among Nigerian Physiotherapists.

Background Evidence-based practice (EBP) is essential for physiotherapy as an integral part of the multidisciplinary rehabilitation team. Randomized controlled trials (RCTs), systematic reviews, and meta-analyses are the gold standard in the hierarchy of evidence. However, the extent of knowledge, attitudes, and professional use of RCTs and meta-analyses among physiotherapists in Nigeria remains unclear. Therefore, this study aimed to describe and explore the predictors of Nigerian physiotherapists' knowledge, attitudes, and professional behaviors toward RCTs, systematic reviews, and meta-analyses. Methods In this observational study, an electronic version of an adapted questionnaire assessing the knowledge, attitudes, and professional use of RCTs and meta-analyses was shared across electronic platforms of Nigerian physiotherapy professional organizations. Results We found good overall knowledge (76 {80.8%}) and attitude (83 {88.3%}) towardthe use of RCTs, systematic reviews, and meta-analyses for evaluating health interventions. Exposure to meta-analysis during graduate and postgraduate training (odds ratio {OR}, 7.102; 95% CI, 1.680-30.021; p = 0.008) and the presence of a medical library at the workplace (OR, 0.264; 95% CI, 0.070-0.997; p = 0.049) were significant predictors of good knowledge of RCTs, systematic reviews, and meta-analyses. Self-rated (OR, 56.476; 95% CI, 1.356-2357.430; p = 0.034) and overall levels of knowledge (OR, 0.013; 95% CI, 0.000-0.371; p = 0.011) predicted the good use of RCTs, systematic reviews, and meta-analyses among respondents. Discussion To equip physiotherapy practitioners with the requisite skill in using RCTs, systematic reviews, and meta-analyses, graduate and postgraduate trainings should prioritize education on the use of RCTs, systematic reviews, and meta-analyses to inform clinical decisions and practice, while capable workplaces may set up medical libraries to ease access and enhance the use of RCTs, systematic reviews, and meta-analyses.

The ROCK trial—a multidisciplinary Rehabilitation intervention for sudden Out-of-hospital Cardiac arrest survivors focusing on return-to-worK: a pragmatic randomized controlled trial protocol

IntroductionMost cardiac arrest survivors are classified with mild to moderate cognitive impairment; roughly, 50% experience long-term neurocognitive impairment. Postarrest challenges complicate participation in society and are associated with social issues such as failure to resume social activities and impaired return to work. The effectiveness of rehabilitation interventions for out-of-hospital cardiac arrest survivors are sparsely described, but the body of evidence describes high probabilities of survivors not returning to work, returning to jobs with modified job descriptions, returning to part-time employment, and often in combination with extensive unmet rehabilitation needs. Hence, there is a need to develop and test a pragmatic individual targeted intervention to facilitate return to work (RTW) in survivors of OHCA. The overall aim of the ROCK trial is to evaluate the effectiveness of a comprehensive individually tailored multidisciplinary rehabilitation intervention for survivors of OHCA on RTW compared to usual care.Methods and analysisThe ROCK trial is a two-arm parallel group multicentre investigator-initiated pragmatic randomized controlled superiority trial with primary endpoint measured 12 months after the cardiac arrest. Adult survivors who were part of the labour force prior to the OCHA and had at least 2 years until they are qualified to receive retirement state pensions are eligible for inclusion. Survivors will be randomized 1:1 to usual care group or usual care plus a comprehensive tailored rehabilitation intervention focusing on supporting RTW. After comprehensive assessment of individual rehabilitation needs, the intervention is ongoingly coordinated within a multidisciplinary rehabilitation team, and the intervention can be delivered for up until 12 months. Data for the primary outcome will be obtained from the national register on social transfer payments. The primary outcome will be analysed using logistic regression assessing RTW status at 12 months adjusting for the intervention and age at OHCA, sex, marital status, and occupation prior to OHCA.DiscussionThe ROCK trial is the first RCT to investigate the effectiveness of a rehabilitation intervention focusing on return to work after cardiac arrest.Trial registrationClinicalTrials.gov NCT05173740. Registered on May 2018

Реабилитационный диагноз у недоношенных детей с перинатальной патологией нервной системы на основе Международной классификации функционирования

Aim. To determine the main categories of the International Classification of Functioning, Disability and Health that constitute a rehabilitation diagnosis in a premature infant with perinatal lesions of the nervous system. Key points. One of the urgent tasks in the formation of a unified approach to the rehabilitation and habilitation of premature babies when they are transferred from the first or second stage of rehabilitation is to assess the child's rehabilitation status and establish a rehabilitation diagnosis. For this purpose, we used the International Classification of Functioning, Disabilities and Health. Studied domains include nervous system structures; vision and related functions; hearing and vestibular functions; neuromuscular and movement-related functions; skeletal, digestive, and metabolic functions; child mobility; and environmental factors. The article describes a clinical case of a 9.5-month-old patient, born at 30 weeks' gestation, who was admitted to a rehabilitation course at a day hospital with a complaint of delayed motor development. After establishing the rehabilitation diagnosis, the infant's average rehabilitation potential was determined and a favourable rehabilitation prognosis was predicted on the basis of the rehabilitation results. The positive effect of the rehabilitation activities was associated with the emergence of new skills and improvement in the rehabilitation status of the child. Conclusion. Formulating a rehabilitation diagnosis involves assessing the patient's current situation, which makes it possible to set rehabilitation goals, form a multidisciplinary rehabilitation team, justify the use of rehabilitation methods and evaluate the outcome of rehabilitation interventions. Keywords: premature children, rehabilitation diagnosis, rehabilitation potential, International Classification of Functioning, psychological development.

Availability of rehabilitation for victims of mine-explosive injury in the conditions of territorial community.

Aim: The aim of the study was to determine the needs for long-term rehabilitation of persons with damage as a result of a mine-explosive trauma and the availability of rehabilitation for these persons in the territorial community. Materials and Methods: Research materials included domestic and foreign scientific sources and normative legal acts on the topic. Research methods included the content analysis, bibliosemantic, data summarization, medical and statistical. Results: The needs for long-term rehabilitation are determined by combined damage, among which damage to the limbs (34.78%-65.22%) [10], craniocerebral injuries (7.9%-12.7%) [11], the acoustic system (40.5%) [16], injuries of bones and soft tissues of the face (10.85%) [18]. Іn 2018, for the first time, 1.2 per 10,000 adult population of participants of the Anti-Terrorist Operation/Joint Forces Operation were recognized as persons with disabilities [7]. Permanent limitations of life activities were caused mainly by brain and limb injuries. In general, long-term rehabilitation is available to persons with injuries in the territorial community in accordance with European approaches. At the same time, the participation of the general practitioner-family doctor is limited by regulatory requirements only to refer the patient to rehabilitation specialists and other specialists. Conclusions: High needs for long-term rehabilitation of persons brain and limb injuries as a result of mine-explosive trauma have been established. There is a need to expand the participation of general practitioners-family doctor in the organization and implementation of rehabilitation as a full-fledged member of a multidisciplinary rehabilitation team, which requires making appropriate changes to regulatory acts.

Psychological support of patients with motor disorders at the second stage of medical rehabilitation

The article presents the results of a literary review on the problem of the organization of differentiated psychological support at the second stage of medical rehabilitation of patients with the consequences of motor disorders that arose as a result of stroke or developed against the background of degenerative and dystrophic diseases of large joints and spine. The psychological consequences of motor disorders, patients’ characteristics, and possible approaches to psychocorrection are analyzed. It was revealed that regardless of the nosology of motor disorders, the targets of psychocorrection at the second stage of medical rehabilitation of patients are signs of anxiety and depression in the current emotional state, while the specific targets in the case of stroke are disorders of higher mental functions, and in the case of degenerative and dystrophic diseases of large joints and spine — subjective perception of pain syndrome. As the main guidelines for the systematic work of a psychologist as part of a multidisciplinary rehabilitation team at the second stage of medical rehabilitation of the studied contingent of patients, the following are indicated: determining the basic targets of psychocorrection, selecting relevant and nosology-sensitive motor disorders correction methods, and increasing the effectiveness of psychocorrection through the use of high-tech virtual and augmented reality tools.

Актуальні тенденції в індивідуальних програмах реабілітації дітей із церебральним паралічем: важливий крок до поліпшення якості життя (огляд літератури)

Approaches to treating and rehabilitating children with cerebral palsy now focus on maximizing their environment and increasing their independence in everyday life. The study of different techniques allows us to consider the needs and goals of families when developing individualized treatment and rehabilitation programs, contributing to the optimal development of the child. Purpose - to study the criteria for developing individual rehabilitation programs, analyzing the examination of children with cerebral palsy, evaluating family-centered care, researching multidisciplinary rehabilitation teams, and analyzing the provision of medical and rehabilitation services and their impact on the quality of life of children with cerebral palsy. A comprehensive and structured search of scientific sources in scientometric databases such as PubMed, Google Scholar, Scopus, Cochrane Library, EMBASE, MEDLINE, and specialized journals in pediatrics and neurology was performed to conduct a systematic literature review. The literature search and analysis were conducted over the past 10 years (from 2012 to 2022). For the bibliometric analysis, the method of data analysis using the VOSviewer program was used. Several important aspects related to the provision of rehabilitation services to children with cerebral palsy and their relationship with classification systems and other aspects are considered and analyzed. The influence of the provision of rehabilitation services by a multidisciplinary rehabilitation team on the functional state of children with cerebral palsy according to the level of the classification system of basic motor functions is substantiated. The study also investigated how the provision of medical and rehabilitation services affects the quality of life of children with cerebral palsy. All of these aspects of the study aimed to improve the provision of services to children with cerebral palsy and their functional status and quality of life. Conclusions. The research demonstrates the need for an in-depth analysis of the examination of children with cerebral palsy and the introduction of family-oriented care. It was found that the development of multidisciplinary rehabilitation teams is effective in achieving the best results in developing children with cerebral palsy. The importance of further research to improve individual rehabilitation programs and improve the quality of life of these children is also substantiated. No conflict of interests was declared by the author.

Rehabilitation of Adult Patients with Pulmonological Manifestations of Long COVID: a Review

INTRODUCTION. The most common symptoms in patients who have had a new coronavirus infection (COVID-19) are associated with pulmonary lesions (shortness of breath, chest pain, cough) and the same complaints persist in the majority of those suffering from long COVID the occurrence and prevalence of which in the population is inextricably linked with the number recovered from COVID-19.&#x0D; AIM. To study the current state of the problem of diagnosis, treatment and rehabilitation of patients with pulmonological manifestations of long COVID at the stage of a specialized rehabilitation hospital in order to formulate basic practical recommendations for the management of this category of patients.&#x0D; MATERIALS AND METHODS. During the period from January 1, 2021 to December 1, 2022, we performed a systematic search of the MEDLINE, Cyberleninka, and eLIBRARY.RU databases on the topic of pulmonary manifestations of long COVID and methods of their rehabilitation in adult patients that gave 678 matches. After further filtering steps according to the methodology outlined in the PRIZMA guidelines, we selected 60 publications for the final analysis.&#x0D; RESULTS. Pulmonary manifestations of long COVID, including, first of all, shortness of breath, rank second after fatigue in terms of frequency of occurrence in long COVID. Diagnostic findings include radiologic pulmonary tissue changes recorded in a proportion of patients under one year, restrictive abnormalities on spirometry, and impaired pulmonary diffusion capacity. Many patients who have had COVID-19 recover quite quickly, but some of them have a long-term symptom complex of dyspnea and physical fatigue, for which rehabilitation in a specialized centers is indicated.&#x0D; The most effective treatment is possible with the involvement of a multidisciplinary rehabilitation team in the rehabilitation process and the appointment of rehabilitation programs created in accordance with the conceptual basis of respiratory rehabilitation, including, first of all, a wide range of methods of therapeutic physical culture.&#x0D; The most effective treatment is possible by involving a multidisciplinary rehabilitation team in the rehabilitation process and prescribing rehabilitation programs designed in accordance with the conceptual framework of respiratory rehabilitation, including, above all, a wide range of therapeutic physical education techniques.&#x0D; CONCLUSION. Current knowledge of the clinical picture, diagnosis, treatment and rehabilitation measures in long COVID is constantly reassessed and expanded. This literature review gives an analysis of research papers focused on the treatment and rehabilitation of pulmonary manifestations in adults, combining the etiopathogenetic and syndromic approaches characteristic of the “classical Russian therapeutic” and, closest to it, the “German” schools. The information extracted both from documents published by World Health Organization (WHO) and from local Russian and European clinical guidelines will allow a specialist engaged in the rehabilitation of adults with pulmonary manifestations of long COVID to create an effective and personalized individual rehabilitation plan for each patient.

Standardization of rehabilitation medical cards for adult patients with musculoskeletal and peripheral nervous systems dysfunction

Currently, each rehabilitation institution solves the problem of registration of rehabilitation medical records empirically, based on the existing realities of a particular institution.&#x0D; The study examined the development of a medical history template for the in- and outpatient medical rehabilitation of patients with peripheral nervous system (PNS) and musculoskeletal system (MSA) dysfunction.&#x0D; The medical history template corresponded to the currently approved forms 003/y (Medical record for inpatient care) and 025/y (Medical record for outpatient care) but supplemented with chapters, allowing entry of information in accordance with the requirements of the Ministry of Health of the Russian Federation Order for medical rehabilitation of adults (No. 788n dated July 31, 2020). Additional chapters, forms, and appendices designed to include specific information about the rehabilitation process included the physical and rehabilitation medicine doctor examination list, multidisciplinary rehabilitation team members, examination lists, rehabilitation routing scale blank, list of MDRC discussions, individual patient management forms, standard rehabilitation discharge form, and list of rehabilitation quality criteria for adult patients with MSA/PNS dysfunction. Validated scales and test forms were also included.&#x0D; The unification of rehabilitation medical records for patients with MSA/PNS impairment makes it easier for the staff of the rehabilitation departments and centers to file medical records in accordance with the current legislation.

The application of a multidisciplinary methodological approach to the training of physical therapists in the process of rehabilitation of a patient with a gunshot wound to the spinal cord

rehabilitation is one of the key areas of medicine, especially during periods of full-scale war, when militaries and civilians require long-term rehabilitation interventions. The use of a multidisciplinary approach in rehabilitation made it possible to expand the scope and opportunities of rehabilitation treatment and improve the recovery of patients. A physical therapist plays an important role in a multidisciplinary team and carries out rehabilitation measures to eliminate, stop or reduce pain, restore body functions, achieve a normal level of health, physical independence and activity, optimal physical condition and well-being. The training of qualified physical therapists is an important component of successful rehabilitation. The article presents the results of the cooperated work of specialists of the multidisciplinary team of the Military Medical Clinical Treatment and Rehabilitation Center of city Irpin, and physical therapy higher education applicants of the Department of Physical Rehabilitation and Sports Medicine of the Bogomolets National Medical University. The aim of the work was to improve the practical skills of physical therapy higher education applicants by integrating them into the work process of a multidisciplinary rehabilitation team for the rehabilitation of a patient with a gunshot wound to the spinal cord. Higher education applicants took part in the rehabilitation examination and had the opportunity to expand practical skills in this direction. The team of specialists conducted the following rehabilitation tests and obtained results - according to the ASIA scale, the degree of damage to the patient's spinal cord is complete - there is no sensitivity and motor function of the S4-S5 segments, according to the modified Rankin scale 5 points, which corresponds to severe functional disability; according to the Barthel index, 10 points, which corresponds to the patient's complete dependence on external assistance, according to manual muscle testing, the strength of the muscles of the upper shoulder girdle corresponded to 3 points - the full amplitude of movement against the force of gravity. On the basis of the obtained results, the multidisciplinary team determined the main violations according to the domains of the international classification of functioning, and in accordance with them, the higher education applicants developed the key goals of rehabilitation and methods that must be included in the rehabilitation process. Physical therapy higher education applicants conducted rehabilitation interventions aimed at improving patient mobility and self-care, prevention of bedsores, contractures, improvement of the musculoskeletal system, and increased tolerance to physical exertion. After six weeks of the rehabilitation process, repeated rehabilitation examinations were carried out, positive dynamics were admitted according to the Rankin scale, according to the Barthel index and manual muscle testing. The higher education applicants survey showed that while working in a multidisciplinary team, physical therapist higher education applicants managed to expand their knowledge, practical skills and acquire the necessary components for work and close interaction with all team members, to increase the effectiveness of rehabilitation measures for a patient with a spinal cord injury.

Barriers and facilitators in providing home-based rehabilitation for stroke survivors with severe disability in the UK: an online focus group study with multidisciplinary rehabilitation teams

ObjectivesIn the UK, over 20% of stroke survivors leave hospital with severe disability. Limited evidence-based clinical guidance is available to support the rehabilitation of these individuals. Our previous research has...

OCCUPATIONAL THERAPY AND PHYSICAL THERAPY IN INCLUSIVE EDUCATION

In the context of solving the tasks of inclusive education, the competencies of physical therapists and occupational therapists, defined by the Standard of Higher Education of the second (master's) level of higher education in the field of knowledge 22 Health care, specialty 227 Physical therapy, occupational therapy, in particular effective cooperation with all members of the multidisciplinary rehabilitation team and other health, education and social policy professionals involved in providing services to patients/clients.&#x0D; The purpose of the research is to reveal the content and tasks of physical therapy, occupational therapy in an inclusive educational space. In order to achieve the set goal, the following research tasks must be solved: to reveal the state of scientific study of the problem of using methods of physical therapy, occupational therapy in inclusive education; to analyze the task of the team of psychological and pedagogical support of a child with special educational needs; determine the types of health-preserving technologies in educational institutions with an inclusive form of education; to analyze the content, forms and methods of adaptive physical education in an inclusive educational space.&#x0D; Conclusions:&#x0D; &#x0D; The introduction of an inclusive form of education in Ukraine significantly actualized the need for the use of occupational therapy and physical therapy in corrective and developmental assistance for children with disabilities of different age and nosological groups. At the same time, the support of children with special educational needs in the implementation of the tasks of the individual development program by a multidisciplinary team of specialists in an inclusive educational space has become an important direction of ensuring their special educational needs.&#x0D; The use of various types of health-preserving technologies is an important condition for the effective functioning of inclusive education. In order to preserve, strengthen and increase the physical, mental and social health of pupils of inclusive groups of special education, such main groups of health-preserving technologies are used as: organizational-pedagogical, psychological-pedagogical and educational-educational. Organizational and pedagogical ones are used to determine the structure of the educational process, which is able to prevent overwork, hypodynamia, etc.&#x0D; Among the types of health-preserving technologies that are used in the inclusive educational space of primary schools, it is appropriate to single out: physical culture and health, medical and preventive technologies, and technologies for ensuring optimal mental and social health of preschoolers.&#x0D; The effectiveness of the introduction of AFV in the work with pupils of special educational institutions who have normative development and their peers with special needs of different nosological groups depends on ensuring an optimally favorable, barrier-free educational environment in special educational institutions. The results of AFV directly depend on taking into account and realizing the potential opportunities and needs of each child, individual characteristics, preservation and strengthening of his health. At the same time, it is necessary to take into account that regardless of the psychophysical development of preschoolers and their state of health, each of them has resource opportunities, the use of which can positively affect the quality of life.&#x0D;

Some problematic issues of rehabilitation of patients with the stroke consequences at the present stage

Background. Acute cerebrovascular disorders are one of the main causes of severe disability in modern society. Russian and foreign researchers register the emerging trend towards rejuvenation of the patients with stroke, which, in turn, significantly increases the relevance of the treatment and rehabilitation of these patients at various stages.The aim. To study the social and hygienic characteristics of the stroke patients and to determine their need for medical rehabilitation in the early recovery period.Materials and methods. We studied the social and hygienic characteristics of 109 patients who had stroke in 2020 and 2021 and underwent rehabilitation in the specialized rehabilitation department of the Southern District Medical Center of the Federal Medical and Biological Agency, and determined their need for medical rehabilitation using the analytical method, the method of expert assessments and questionnaires.Results. The average portrait of a patient with a stroke in the early recovery period is as follows: this is a man aged 61 to 70 years with a higher or secondary specialized education, unemployed, living in the city. Up to 30 % of stroke survivors were recognized as disabled; among which, the persons with more severe disability (groups I and II) predominate – up to 90 %. Implementation of rehabilitation measures in the acute period in the hospital and in the early recovery period in the outpatient clinic is carried out at a fairly low level. The percentage of patients being examined by a multidisciplinary rehabilitation team ranges from 17.4 to 10.1 %.Conclusion. The availability of medical rehabilitation measures in a specialized rehabilitation center is quite limited; more than half of the surveyed contingent (52.3 %) experienced problems in obtaining a referral to treatment, about half of the respondents (46.8 %) waited up to 6 months for a referral, which indicates the need to expand the network of such institutions at the regional level.

Pediatric Intestinal Transplantation Management and Outcomes.

Intestinal failure is the anatomic or functional loss of intestinal function below the minimum required to absorb nutrients to maintain health and growth. Parenteral nutrition is the main supportive therapy for children with intestinal failure, but if serious complications develop, intestinal transplantation may be needed to sustain life. Referral to a multidisciplinary intestinal rehabilitation team and an extensive evaluation are necessary steps before listing for transplantation. Immunosuppression is part of life-long therapy after transplantation, and children continue to have high medical needs. Serious complications include acute cellular rejection, graft-versus-host disease, infection, and post-transplant lymphoproliferative disease. However, intestinal transplantation has led to improved outcomes in recent years and is a viable life-saving option for many children with intestinal failure.

Application of the International classification of functioning, disability and health in medical rehabilitation of children with severe traumatic brain injury

BACKGROUND: The problem of rehabilitation of patients with severe traumatic brain injury has been and remains very important and relevant for both adults and children. Patients with severe traumatic brain injury often develop severe physical, mental, emotional and cognitive impairments, which are often difficult to correct and require long-term treatment, including rehabilitation, relying solely on the body's potential, which is accompanied by a heavy financial burden for the patient, his family, and society in general. The introduction of new diagnostic methods, the improvement of resuscitation measures, the use of modern methods of neurosurgical intervention and timely rehabilitation can increase the proportion of children who survived after severe traumatic brain injury and their quality of life.&#x0D; AIM: to evaluate the effectiveness of medical rehabilitation of children with severe traumatic brain injury with the participation of a multidisciplinary rehabilitation team and relatives of patients.&#x0D; MATERIALS AND METHODS: The study included 50 children with severe traumatic brain injury. Two groups were distinguished by the randomization method: the main group 25 patients (50%) and the control group, which included 25 patients (50%). The follow-up period was 1 year after the onset of severe traumatic brain injury. In the main group, an individual plan for early rehabilitation was drawn up on the 2nd day after a severe traumatic brain injury in intensive care. At the first stage of rehabilitation, which is carried out in the intensive care unit and the neurosurgery department, an individual medical rehabilitation plan was developed for the children of the main group, depending on somatic indicators and the severity of the condition, and a rehabilitation diagnosis based on the International classification of functioning, disability and health was established. In the control group, after transfer from the intensive care unit to the specialized neurosurgical department, patients received basic rehabilitation therapy: articular gymnastics, paraffin therapy, and psychological support.&#x0D; RESULTS: In the main group, more effective changes were noted in domains associated with impaired structure and function of the nervous system, which led to improved activity and participation, self-service. In patients of the control group, there were no significant changes in the state of functions, activity and participation.&#x0D; CONCLUSION: The early start of complex medical rehabilitation of children with severe traumatic brain injury reduces disability and accelerates the process of the patient's socialization, which is more clearly demonstrated by the International classification of functioning, disability and health approach. The use of International classification of functioning, disability and health for with severe traumatic brain injury in children in medical rehabilitation departments is a good tool for setting rehabilitation goals, choosing rehabilitation measures and assessing the effectiveness of rehabilitation.

Abstract P6-05-31: Early integrated rehabilitation helps smoking cessation in 467 breast cancer patients – a comparison between the intervention and control group in a prospective study

Abstract Background: Tobacco related illnesses are important public health issues worldwide. Cigarette smoking effects cancer risk and cardiovascular risk. Smoking cessation confers substantial benefits on health. Our aim was to determine whether the early introduction of integrated rehabilitation from the beginning of cancer treatment is associated with the smoking cessation in breast cancer patients. Material and Methods: The subjects of our prospective study were 467 female breast cancer patients (29-65 (mean 52) years of age), who participated in the pilot study on the individualized integrated rehabilitation of breast cancer patients in 2019-2022 and were followed for at least one year. The control group included 282 patients and the intervention group 185 patients. The patients completed three questionnaires (EORTC QLQ - C30, B23 and NCCN) before and one year after the beginning of cancer treatment. The control group obtained the same rehabilitation as was offered to all breast cancer patients in our hospital before the start of our prospective study. The multidisciplinary rehabilitation team reviewed the documentation of all the patients from the intervention group before and one year after the beginning of cancer treatment and recommended appropriate interventions according to the patient’s difficulties. The integrated rehabilitation coordinator referred patients for additional interventions in compliance with the institute’s clinical pathway (psychologist, general practitioner, clinical nutritionist, physical rehabilitation, kinesiologist-guided online exercises, gynecologist, analgesia, vocational rehabilitation). Smokers were referred to a smoking cessation workshop organized by a health promotion center within community health centres. Data on the patients’ demographics, disease extent, cancer treatment and prevalence of tobacco smoking before and one year after the beginning of cancer treatment were collected and analysed using the chi-square and ANOVA test. Results: There were no differences between the control and the intervention group of patients in terms of age, education, disease extent, surgical procedures, systemic cancer treatment, or radiotherapy. There were no differences between the groups in the prevalence of smoking before the treatment. Before the cancer treatment, smoking was present in the intervention and control group in 22% and 27% (p=0.22), respectively. However, one year after the beginning of cancer treatment, smoking was less common in the intervention group in comparison to the control group of patients (p=0.004). Smoking was present in the intervention and control group in 10% and 20%, respectively. Conclusions: Early integrated rehabilitation helps the smoking cessation in breast cancer patients. Citation Format: Nikola Besic, Zlatka Mavric, Anamarija Mozetic, Tina Zagar, Vesna Homar, Nena Kopcavar Gucek, Andreja Cirila Skufca Smrdel, Jana Knific, Simona Borstnar, Mateja Kurir Borovcic, Lorna Zadravec Zaletel, Natasa Kos, Branka Strazisar, Denis Mastnak Mlakar, Nina Kovacevic, Vedran Hadzic, Bojan Pelhan, Marko Sremec, Tina Rozman, Romi Cencelj-Arnez. Early integrated rehabilitation helps smoking cessation in 467 breast cancer patients – a comparison between the intervention and control group in a prospective study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-31.

Stakeholder views on cognitive communication assessment and intervention for a person living independently in the community with severe traumatic brain injury.

Cognitive communication disorder (CCD) following traumatic brain injury (TBI) is well documented and these communication problems impede successful re-integration into community living. While there is growing evidence for intervention to both detect and treat the impact of these deficits across the rehabilitation continuum, there are barriers to accessing services. Cognitive communication impairments may be missed because the person can talk, and this may mask the subtle but debilitating impact of a CCD. Referral to a speech and language therapist (SLT) may be overlooked or not timely, which prevents the individual accessing evidence-based interventions. Inadequate treatment provision and an under- or overestimation of communication capability can potentially undermine the effectiveness of wider team assessment and intervention. To report stakeholder views on specialist SLT input for CCD within a multidisciplinary team intervention for a community-dwelling individual with severe TBI. The investigation explored perspectives on understanding of CCD, on practice and on outcomes, in order to inform professional groups on perceived impacts of the evidence-to-practice gap. A semi-structured interview methodology was employed with 11 stakeholder participants involved in a single case. Data were evaluated using a thematic framework method. Themes were inductively derived from the stakeholder narratives. Stakeholders reported the following outcomes from specialist SLT input for CCD within a collaborative team approach: improved engagement with rehabilitation and support teams, improved health-related quality of life and well-being, and increased client participation in community activities of personal relevance. Stakeholders also reported inequities in wider service provision where limitations in professional understanding of CCD and knowledge of best practice recommendations preclude access to specialist SLT services. CCDs are under-recognised and this can have a devastating effect on people with CCD and on those around them. Stakeholder reports provide evidence for the effectiveness of SLT practice recommendations for the treatment of CCD following TBI. They also provide additional evidence of persisting barriers to accessing treatment. Future research to explore ways to close this evidence-to-practice gap is required. What is already known on this subject Cognitive communication difficulties are a well-documented consequence of TBI. There is evidence for the effectiveness of person-centred interventions for CCD across the recovery continuum. International evidence-based practice recommendations are in place for CCD assessment and management. Barriers to accessing SLT expertise for CCD have previously been reported. What this paper adds to existing knowledge This investigation explores the views of a diverse group of stakeholders involved in a single case of a community-dwelling individual with severe TBI. Stakeholders report positive real-world outcomes from SLT interventions for CCD within a coordinated multidisciplinary rehabilitation team. Stakeholder reports also indicate inequities in wider service provision and CCD knowledge gaps amongst professional groups providing rehabilitation services for people with TBI. What are the potential or actual clinical implications of this work? CCDs are under-recognised, with devastating effect for people with CCD and those around them. These findings underscore the importance of raising professional awareness of CCD and best practice recommendations, in order to improve access to SLT expertise for people with CCD following TBI.

A CLINICAL CASE OF EFFECTIVE REHABILITATION OF PATIENT WITH COMORBID VASCULAR PATHOLOGY

The problem of rehabilitation of patients with multimorbid pathology currently holds its medical and social relevance, due to the complexity of choosing an adequate treatment and predicting possible complications at the hospital stage. This is determined by the predominant monomorbid nature of clinical recommendations, as well as the difficulty of analyzing all risk factors and predicting the outcome of a comorbid disease. The article describes the case of a 60-year-old man with comorbid cerebrocardiovascular pathology, transferred from the palliative department to a rehabilitation center. The score on the Rehabilitation Routing Scale (RRS) was 5 points with a prospective regression to 6 points. As part of a multidisciplinary rehabilitation team (MDRT), the patient underwent a complex of rehabilitation measures including physical and cognitive rehabilitation, apparatus physiotherapy, speech and occupational therapy, complementary to medication. On the 21st day of rehabilitation measures, the patient's condition improved by 1.2 times in terms of RRS, 4 times according to the NIHSS stroke scale, 3 times in muscle strength according to the MRCWS, 2 times in mAS spasticity, 4 times in dysphagia, and 1,5 times in balance, Barthel Index of ADL – by 1.5 times, Rivermead Mobility Index – 3 times.