Physical Rehabilitation Of Patients Research Articles

Selection of surgery type for patients with inguinal hernias

The purpose of the study: to investigate the quality of life of patients with inguinal hernias after Lichtenstein’s surgery using the implants with a tissue-gripping system and conduct a comparative assessment of this technique and the results of classical laparoscopic surgery. The prospective controlled clinical study included the results of follow-up of 99 patients with inguinal hernias. The first group included the patients who underwent LHR surgery of the inguinal canal using a composite self-fixing polypropylene mesh. In the patients of the second group, LHR was performed using a composite polypropylene mesh, which was fixed with polypropylene suture material. The third group consisted of the patients operated on using the technique of laparoscopic transabdominal preperitoneal surgery. Indicators of physical and psychological health components were studied in the patients using the SF-36 questionnaire in the preoperative period and 3, 6, and 12 months after surgery. Results: The patients with inguinal hernias in the long-term postoperative period had different periods of restoration of quality of life, which were determined by the type of surgical intervention and the type of fixation of the synthetic implant. Three months after surgery, significant signs of normalization of indicators of the physical health component were recorded only in groups of the patients after LHR using self-fixing implants and TAPP. In the patients with suture fixation of implants during LHR, the first signs of restoration of the physical component of health, comparable to self-fixing meshes, were observed 6 months after surgery. Changes in indicators of the psychological health component in the patients of the LHR and TAPP groups did not differ at all study intervals. Conclusion: The use of implants with a tissue-gripping system when performing LHR leads to optimization and reduction of physical rehabilitation in patients with inguinal hernias, which makes it possible to recommend the use of self-fixing meshes for open repair in cases of relative and absolute contraindications to TAPP.

Efficacy and Safety of Remote Physical Rehabilitation in Patients with Hip or Knee Replacement: a Prospective Randomized Comparative Study

INTRODUCTION. An urgent problem of medical rehabilitation is the loss of results that were achieved at various stages due to the interruption of the recovery process and the absence of patients' classes at home after discharge from a medical institution. In this regard, at the third stage of medical rehabilitation, the remote (telemedicine) form of rehabilitation assistance is of particular importance, which has broad prospects for development due to the emergence of new information technologies that allow for active communication between a medical professional and a patient. Nevertheless, the issues of the effectiveness and safety of remote physical rehabilitation remain insufficiently studied, and therefore it is necessary to conduct randomized comparative trials with the analysis of long-term results.
 AIM. Evaluation of the effectiveness and safety of the remote physical rehabilitation (RPR) model for a group of patients who have undergone hip (HR) or knee (KR) replacement, the study of patient adherence, as well as the selection of the most informative evaluation tools.
 MATERIALS AND METHODS. The study included 30 patients aged 30 to 75 years who underwent HR or KR. The study participants were distributed by the envelope method into groups for remote rehabilitation in addition to routine clinical practice of providing medical rehabilitation (RPR group) or conducting only routine medical rehabilitation (comparison group), including daily independent physical exercises at home, mastered during inpatient medical rehabilitation, lifestyle modification, taking nonsteroidal anti-inflammatory drugs with the development of pain syndrome. An assessment of the effectiveness and safety of rehabilitation measures was carried out, including an analysis of physical examination data, vital signs, as well as data from various scales, tests and questionnaires (the 10-point visual-analog scale (VAS), the Timed 25-Foot Walk (T25-FW), the "Timed Up and Go Test", the Berg Balance Scale (BBS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC)).
 RESULTS AND DISCUSSION. 14 patients were randomized to the remote physical rehabilitation group (49.6 ± 12.4 years) and 16 to the comparison group (57.8 ± 11.2 years). Participation in the study was completed by 10 patients from the RPR group and all 16 patients in the comparison group. Comparing the results of rehabilitation between the groups 1 month after the inclusion of participants in the study revealed a more pronounced statistically significant improvement in the functional profile of the patient on the T25-FW (p 0.0001), the "Timed Up and Go Test" (p = 0.0064), the Berg Balance Scale (p = 0.0008) and WOMAC (p 0.0001) in group of RPR. The "Timed Up and Go Test", the visual analog scale and the WOMAC were selected based on the results obtained for further practical work. The most significant predictors of premature termination of RPR were older age (χ2 16.75, p 0.0001), pensioner status (χ2 11.75, p = 0.0006) and residence in the region (χ2 11.75, p = 0.0006). The analysis of adverse events showed that 4 patients in the RPR group and 6 in the comparison group had a periodic increase in pain syndrome in the operated limb.
 CONCLUSION. The results obtained demonstrate that of patients who have undergone hip or knee replacement is safe and effective in restoring functional mobility, reducing the risk of falls and the severity of pain syndrome, and increases adherence to physical exercises. The main limitations in the practical use of remote physical rehabilitation are related to the availability of high-speed Internet and the skills of using Internet portals.

Physical rehabilitation for patients with hemophilia

Physical rehabilitation for patients with hemophilia

EFFECTIVENESS OF APPLYING ORIGINAL METHOD OF BREATHING EXERCISES, INCLUDING TECHNIQUES FOR MOBILIZING DIAPHRAGMAL BREATHING IN COMPLEX EARLY MEDICAL REHABILITATION OF PATIENTS WHO HAVE UNDERGONE CORONARY BYPASS GRAFT

Highlights In the physical rehabilitation of patients after coronary artery bypass surgery (CABG), special attention has recently been paid to respiratory rehabilitation. The article presents the results of studies demonstrating that a course of respiratory coordination training was associated with a decrease in the incidence of hydrothorax, improved blood oxygen saturation, increased exercise tolerance and muscle strength by reducing diaphragm dysfunction and increasing respiratory muscle strength in patients in the postoperative period. AbstractAim. To analyze the clinical effectiveness of a new method of breathing exercises developed for improving breathing control in complex early rehabilitation of patients who underwent CABG.Methods. The study involved 73 patients with coronary artery disease (CAD) who underwent CABG at the Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” (Kemerovo, Russia) in 2021. During the inpatient rehabilitation, patients were randomized into two groups comparable in anamnestic and baseline clinical and functional indicators: the experimental group (38 patients) had individual breathing exercises as a part of respiratory gymnastics (with different types of exercises), and the control group (35 patients) underwent conventional exercise training.Results. Initially, there were no statistically significant differences between the groups. After 14 days the number of patients in the main group with signs of hydrothorax was significantly lower compared with the control group: 7 (18.4%) vs 11 (31.4%), respectively, p = 0.001. The ultrasound examination of the pleural space revealed the same pattern - hydrothorax was less pronounced in the main group compared with the control group: 0.9 [0.5; 1.5] vs 1.7 [0.6; 2.5] mL, p = 0.049. Analysis of oxygen saturation (SpO₂,%), reflecting the functional status of the oxygen transport system, showed higher blood oxygen saturation rates in the main group compared with the control group: 98 [96; 99] vs 95.2[94; 97]%, p = 0.04, respectively. At the same time, the exercise tolerance (ET) estimated with bicycle ergometry was comparable at baseline in both groups, and at the end of the inpatient rehabilitation ET in the main group was significantly higher than in the control group with conventional exercise training: 74. 9 [50; 100] vs 55.1[25; 75] W, p = 0.005, respectively.Conclusion. Respiratory gymnastics facilitates cardiac and respiratory rehabilitation mainly by improving the coordination of respiratory muscles and preparing them for respiratory gymnastics within short period of early inpatient rehabilitation.

Physical rehabilitation of patients with degenerative diseases of the spine using the David back concept

BACKGROUND: Physical rehabilitation of patients with degenerative-dystrophic spine diseases is an important medical problem due to the significant decrease in physical activity, work capacity and quality of life of the patient.
 AIM: The aim of the study was to evaluate the effectiveness of the developed rehabilitation complex for degenerative lesions of the thoracolumbar spine using biofeedback simulators David 110, 130, 120, 150.
 MATERIALS AND METHODS: The study included 30 patients with degenerative changes in the lumbar region (mean age 43.6 years), who underwent a complex of rehabilitation measures for an average of 9.2 days, including therapeutic exercises for the back muscles, physiotherapy, and the training devices David 110 (lumbar-thoracic extension), 130 (lumbar-thoracic flexion), 120 (rotation to the right/left), 150 (lateral flexion to the right/left).
 RESULTS: The effectiveness of the rehabilitation complex was confirmed by David back concept functional tests in the form of a statistically significant increase in muscle strength and range of motion in the thoracolumbar region (p 0.05), regression of pain syndrome (p 0.05) on the VAS scale and increased patient satisfaction were noted treatment based on the results of an oral survey of patients.
 CONCLUSION: Exercises on David training machines in combination with therapeutic exercises for strengthening the back muscles and physiotherapy have a positive effect in the implementation of rehabilitation programs for patients with degenerative changes in the thoracolumbar spine.

Injection-on-Skin Granular Adhesive for Interactive Human-Machine Interface.

Realization of interactive human-machine interfaces (iHMI) is improved with development of soft tissue-like strain sensors beyond hard robotic exosuits, potentially allowing cognitive behavior therapy and physical rehabilitation for patients with brain disorders. Here, this study reports on a strain-sensitive granular adhesive inspired by the core-shell architectures of natural basil seeds for iHMI as well as human-metaverse interfacing. The granular adhesive sensor consists of easily fragmented hydropellets as a core and tissue-adhesive catecholamine layers as a shell, satisfying great on-skin injectability, ionic-electrical conductivity, and sensitive resistance changes through reversible yet robust cohesion among the hydropellets. Particularly, it is found that the ionic-electrical self-doping of the catecholamine shell on hydrosurfaces leads to a compact ion density of the materials. Based on these physical and electrical properties of the sensor, it is demonstrated that successful iHMI integration with a robot arm in both real and virtual environments enables robotic control by finger gesture and haptic feedback. This study expresses benefits of using granular hydrogel-based strain sensors for implementing on-skin writable bioelectronics and their bridging into the metaverse world.

Features of Application of the Optimized Physical Rehabilitation Program in Patients with Coronary Heart Disease

Multisymptomatic coronary heart disease (CHD) remains a leading problem in cardiology. A person’s ability to perform physical work determines their quality of life, especially in patients with existing symptoms of damage to the cardiovascular system. The most advanced approach in the physical rehabilitation of patients with CHD is the use of ergometric testing indicators.
 The aim. To study the influence of the developed method of cycling training on the indicators of cardiopulmonary exercise (CPX) in patients with CHD.
 Materials and methods. We examined 65 men with CHD, I-II functional class stable angina pectoris, mean age 44.6 ± 1.39 years (from 32 to 60 years). The diagnosis was made on the basis of clinical findings, electrocardiography and laboratory examination according to the generally accepted criteria of the European Society of Cardiology.
 Results. The treatment results were evaluated two weeks after the completion of the physical rehabilitation program. Qualitative assessment was performed by using the CPX test with the recording of cardiac bioelectric potentials from 12 leads. The criteria for discontinuation of the test were generally accepted provisions based on WHO recommendations.
 While developing a physical rehabilitation program and predicting the timing of a functional recovery, several factors have to be taken into account that significantly affect the patient’s motor activity and determine the pace and outcome of the rehabilitation process as a whole. Long-term, regular physical activity in patients with CHD with limited coronary reserve have an impact on the mechanisms of cardiac function regulation, synchronization and optimization of the activity of the muscular, cardiovascular and respiratory systems. Systematic training sessions reduce the volume of drug therapy and can improve the patients’ quality of life.
 Conclusions. The use of the proposed individualized uniform interval cycling training combined with the intake of citrulline malate leads to a significant improvement in the achieved load capacity, heart rate, duration of work, total volume of completed work, inotropic reserve index, optimization of coronary blood circulation and improvement of bioenergy metabolism in the myocardium.

Pregnancy Failure: A Sample Set of Rehabilitation Treatment And Rehabilitation

The article presents an exemplary complex of restorative, non-medicamental treatment and physical rehabilitation in patients with clinical manifestations of pregnancy failure of various etiologies, applied at the stage of outpatient and sanatorium-resort treatment. Specific features of the practical application of such methods as therapeutic physical training, fitball exercises, reflexotherapy of biologically active points (BAP) of the genital and endocrine systems on the feet, physiotherapy, aromatherapy, Kegel exercises, vumbilding, vibration and gynecological massage are presented and described.

Intermittent physical recovery has similar benefits to continuous physical recovery in patients in the acute and early sub‑acute stages following a stroke.

Stroke is one of the most important causes of death and disability worldwide. The recovery of stroke survivors represents a real challenge for healthcare services. The aim of the present pilot study was to evaluate and compare the efficiency of two different approaches of physical rehabilitation in patients in the acute and early sub-acute stages following a stroke. Two groups of patients consisting of 48 and 20 patients, respectively, underwent continuous and intermittent physical recovery, and were assessed through electromyography and clinical evaluation. After 12 weeks of rehabilitation, no significant differences were identified between the outcomes obtained from the two groups. Due to the added value of intermittent physical recovery, this method of rehabilitation could be considered an approach that needs to be further studied for the treatment of patients in the acute and early sub-acute stages following a stroke.

Оценка эффективности реабилитации после артроскопической реконструкции передней крестообразной связки

The aim of this study was to study the effectiveness of complex individual physical rehabilitation in patients after arthroscopic anterior cruciate ligament reconstruction. Material and methods. The study involved 834 patients (464 men and 370 women) aged 18-55 years with an isolated rupture of the ACL of the knee joint. The patients were divided into two groups: the main group - 304 patients (162 men and 142 women), in which rehabilitation treatment and complex rehabilitation were carried out according to an individual program, and the control group - 530 patients (302 men and 228 women), in which patients received only rehabilitation treatment after ACL reconstruction. Results. The research revealed that 1 year after ACL arthroscopic reconstruction and physical rehabilitation in patients of the main group, higher values of median efficiency according to orthopedic questionnaires were established than in the control group (p<0.0001, Mann-Whitney U-test). The use of complex physical rehabilitation after ACL arthroscopic reconstruction provides a higher recovery of physical activity and an increase in the quality of life of this category of patients.

Алгоритм выбора методов физической реабилитации у пациентов с атаксией

Введение. Для сохранения функции равновесия и управления ею центральная нервная система использует и координирует сигналы зрительной, вестибулярной и проприоцептивной систем. Неврологический осмотр позволяет выявить статодинамические нарушения, использование стабилометрии – количественно оценить и выявить ведущие двигательные стратегии в сохранении равновесия. Функциональные шкалы уточняют степень выраженности нарушений равновесия и динамику изменений под влиянием методов физической реабилитации. Методы физической реабилитации включают различные способы стимуляции сенсорной афферентации для коррекции нарушений равновесия. Цель. Разработать алгоритм выбора метода физической реабилитации у пациентов с атаксией. Материалы и методы. Обследовано 80 пациентов с жалобами на головокружение и нарушение равновесия, средний возраст составил 42±6,5 года. Производились неврологический осмотр, стабилометрия с диагностическими тестами – тестом Ромберга, тестом с поворотом головы, тестом с оптокинетической стимуляцией. Для объективной оценки атаксии использовали функциональные шкалы Берга и Тинетти. Результаты. Установленные изменения показателей статокинезиограммы в диагностических тестах позволили идентифицировать вид атаксии. Функциональные шкалы Берга и Тинетти объективизировали степень выраженности нарушений равновесия. Анализ неврологического статуса, данных функциональных шкал и показателей статокинезиограммы позволил разработать алгоритм выбора метода физической реабилитации при атаксии. Заключение. Восстановление нарушений равновесия зависит от нозологической формы заболевания и определяется видом атаксии, степенью ее выраженности. Своевременное выявление вида атаксии и выбор наиболее эффективного метода физической реабилитации повышают эффективность восстановления, расширения двигательной активности и улучшения качества жизни пациентов. Introduction. To maintain and control the balance function, the central nervous system uses and coordinates signals from the visual, vestibular, and proprioceptive systems. Neurological examination allows identifying statodynamic disorders, using of stabilometry to quantify and identify the leading motor strategies in maintaining balance. Functional scales clarify the severity of balance disorders and the dynamics of changes under the influence of physical rehabilitation methods. Methods of physical rehabilitation include various methods of stimulation of sensory afferentation to correct imbalances. Purpose. To develop an algorithm for choosing a method of physical rehabilitation for patients with ataxia. Materials and methods. 80 patients with complaints of vertigo and imbalance examined, the average age was 42±6.5 years. A neurological examination, stabilometry with diagnostic tests, the Romberg test, the head turn test, and the test with optokinetic stimulation were performed. For an objective assessment of ataxia, the functional scales of Berg and Tinnety were used. Results. The established changes in the statokinesiogram parameters in diagnostic tests made it possible to identify the type of ataxia. The functional scales of Berg’s and Tinnety’s objectified the degree of severity of imbalances. Analysis of the neurological status, functional scale data and statokinesiogram indicators allowed us to develop an algorithm for choosing the method of physical rehabilitation for ataxia. Conclusion. Restoration of imbalances depends on the nosological form of the disease and determined by the type of ataxia and its severity. Timely detection of the type of ataxia and the choice of the most effective method of physical rehabilitation increases the efficiency of recovery, expansion of motor activity and improvement of the quality of life of patients.

Expert consensus guidance on respiratory physiotherapy and rehabilitation of patients with rib fractures: An international, multidisciplinary e-Delphi study.

There is limited research supporting optimal respiratory physiotherapy or physical rehabilitation strategies for patients with rib fractures. The aim of this study was to develop key recommendations for the physiotherapy management of patients with rib fractures. A three-round modified e-Delphi survey design, using an international Delphi panel including physiotherapy clinicians, researchers and lecturers, physician associates, trauma surgeons, and intensivists, was used in this study. The draft recommendations were developed by the Steering Group, based on available research. Over three rounds, panelists rated their agreement (using a Likert scale) with regard to recommendation for physiotherapists delivering respiratory physiotherapy and physical rehabilitation to patients following rib fractures. Recommendations were retained if they achieved consensus (defined as ≥70% of panelists ≥5/7) at the end of each round. A total of 121 participants from 18 countries registered to participate in the study, with 87 (72%), 77 (64%), and 79 (65%) registrants completing the three rounds, respectively. The final guidance document included 18 respiratory physiotherapy and rehabilitation recommendations, mapped over seven clinical scenarios for patients (1) not requiring mechanical ventilation, (2) requiring mechanical ventilation, (3) with no concurrent fracture of the shoulder girdle complex, (4) with a concurrent fracture of the shoulder girdle complex, (5) with/without concurrent upper limb orthopedic injuries, (6) undergoing surgical stabilization of rib fractures, and (7) at hospital discharge. This guidance provides key recommendations for respiratory physiotherapy and physical rehabilitation of patients with rib fractures. It could also be used to inform future research priorities in the field. Therapeutic/Care Management; Level IV.

Physical rehabilitation for Parkinson’s disease: assessment and treatment preferences of physical therapists

IntroductionPatients with Parkinson’s disease are often prescribed physical therapy. Physiotherapists often assist Parkinson’s disease patients with assessment and treatment, but little is known about the assessment tools and interventions they use. Additionally, physical therapists do not consistently integrate standard outcome measures and treatment procedures into their practices. Consequently, this study was carried out to determine physical therapists’ preferences for assessment and treatment of Parkinson’s disease.MethodsFive hundred questionnaires were distributed to physiotherapists working in clinical settings. Overall, 446 physiotherapists responded to the survey and returned the questionnaires. Questionnaires with incomplete information were excluded from the survey. In total, 418 physiotherapists participated in the study, of whom 324 saw PD patients in their clinical practice.ResultsOverall, 446 physiotherapists responded to the survey and returned the questionnaires. Questionnaires with incomplete information were excluded from the survey. In total, 418 physiotherapists participated in the study, of whom 324 saw PD patients in their clinical practice. Study participants included 43.8% male PTs and 56.2% female PTs with an average age of 30.02 ± 5.38 years. The Berg balance scale for balance assessment was preferred by 220 (67.9%), the Mini Mental State Examination for cognitive assessment was preferred by 317 (97.8%), and the Unified Parkinson’s Disease Rating Scale was preferred by 168 (51.85%) PTs. Neurological PTs employed PNF (proprioceptive neuromuscular facilitation) to decrease stiffness, and exercise and task-focused training for functional training. Virtual Reality and Motor Imagery were also known by 56.6% and 62.4% of PTs, respectively, although only 4.8% and 1.85% used them.ConclusionsStudy results revealed that most physiotherapists follow routine assessment and treatment protocols and do not implement innovative technology in the physical rehabilitation of patients with Parkinson’s disease.

Based on the pathway of physical and medical integration in medical schools under the background of healthy China

In the context of healthy China, the teaching model of physical and medical integration is studied, the departments in China must vigorously promote the reform of the medical system and mechanism, and hospitals also need improve the level of medical services, putting forward higher requirements for the current medical staff. Cultivating high-end compound medical talents in the current society has become an urgent requirement of hospitals. The goal of teaching and training should be to cultivate practical, high-end and high-quality talents in the medical school of higher learning. By learning sports health care knowledge to apply it to the field of medical practice, and adding medical technology, medical diagnosis and treatment methods to do a good job in the diagnosis and treatment of diseases and physical rehabilitation of patients, so that the physical education of medical schools can improve the physical skills of medical students in an all-round way, and also make it a method of medical students who have education, achieving the goal of combining sports and medicine. This article focuses on the teaching mode of physical and medical integration as the key content of research, optimizes the design of the teaching curriculum system of medical majors, vigorously promotes the implementation of the teaching mode of physical and medical integration, and lays a solid foundation for cultivating more professional and complex medical talents.

Motor impairments in children with autism spectrum disorders: causes and possibilities for correction

To analyze current scientific data about motor disorders in ASD and their correction possibilities in children with this pathology. Analysis of publications, contained in PubMed and Google Scholar databases, which give consideration to motor disorders in children with ASD, was carried out. The search was done by keywords: motor disorders, children, autism spectrum disorder, causes, correction. Adaptive physical culture during individual training is one of the available and effective methods of physical rehabilitation in patients with ASD. Children with ASD need three levels of psychological support, each of which offers individual exercises, depending on the nature and severity of speech and cognitive impairment.

Програмне забезпечення освітньої компоненти «Фізіологія рухової активності» для здобувачів вищої освіти першого (бакалаврського) рівня вищої освіти спеціальності 227 фізична терапія, ерготерапія освітньої програми «Фізична терапія» в Національному фармацевтичному університеті

The purpose of the study was to highlight the issues of the educational program of the educational component “Physiology of Motor Activity” for the applicants for higher education in the educational program “Physical Therapy” of the National University of Pharmacy. Materials and methods. Analysis of scientific and methodical literature, on the basis of which the work program was concluded, was carried out. Results and discussion. Motor activity is an integral part of human behavior, any movement of the human body, which is carried out thanks to the work of skeletal muscles. In a sick body, it helps to reach remission faster, improve physical and emotional state, allows to reduce the pharmacological load on the body, increases its motivation for an active life. The work program of the educational component “Physiology of Motor Activity” for applicants for higher education in the specialty 227 “Physical Therapy, Ergotherapy” of the educational program “Physical Therapy” at the National University of Pharmacy is written in accordance with the requirements of the credit-modular system of organization of the educational process. The purpose of teaching the educational component is to form in higher education applicants an idea of physical rehabilitation in patients, adequate scientific understanding of the laws of physiology of motor activity and features of the structure of functional systems and organs depending on the age of the person, as well as the acquisition of knowledge about the means of effective and early return of patients and disabled people to everyday and labor processes. The working program reflects the introduction of a competency-based approach, which establishes the level of integral, general and special competencies of the future specialists in physical therapy and the acquisition of program learning outcomes. The educational component “Physiology of Motor Activity” is structured into two content modules, which contain 13 topics. The study is completed by passing the final module control and receiving a credit. Effective mastering of the educational component is ensured by the use of various teaching methods, mastering practical skills, performing individual tasks. Conclusion. The system of training highly qualified specialists in the field of physical rehabilitation involves the study of a complex of medical and biological disciplines, among which one of the leading places is occupied by subjects that reveal the essence of movement and mechanisms of motor activity. The educational component “Physiology of Motor Activity” is aimed at studying the physiological mechanisms of voluntary movements and reveals their main characteristics. This knowledge is the foundation of high methodological training of a specialist in the field of “Physical Therapy”, which is of great importance for increasing the competitiveness of graduates of the National University of Pharmacy in the labor market

Functional recovery of patients after shoulder joint replacement

Currently, shoulder arthroplasty is being actively introduced into surgical practice, indications for operations are expanding, and the number of patients operated with severe injuries and diseases of the proximal humerus and shoulder joint is growing. The decrease in the effectiveness of restoring the painless functioning of shoulder, household independence and quality of life of patients after surgery may be due not only to the severity of damage to the shoulders joint structures of the before surgery, shortcomings in surgical techniques and the development of postoperative complications, but, possibly, the imperfection of medical rehabilitation programs for these patients.
 To date, the content of the rehabilitation protocol for the early postoperative period has not been sufficiently substantiated, the need for strict immobilization of the operated joint, as well as the long-term benefits and effectiveness of early rehabilitation remains unclear.
 The article attempts to summarize the available data on the physical rehabilitation of patients after shoulder joint replacement with various types of endoprostheses in the early and late postoperative periods.

Identification of clinical and rehabilitation groups among patients with cervical tetraplegia

BACKGROUND:Spinal cord injury at the cervical level often leads to a severe neurological deficit, such as tetraplegia (International Standards for Neurological Classification of Spinal Cord Injury) and gross functional disorders. Currently, methods of differentiated rehabilitation strategy are developed, taking into account the needs of the patients.
 AIMS:This study aimed to examine the clinical heterogeneity of patients with a cervical injury and to form appropriate clinical and rehabilitation groups based on common relevant rehabilitation goals.
 MATERIALS AND METHODS:We examined 190 patients with severe cervical myelopathy C4D1level aged 1860 years in whom changes in clinical and functional status were monitored for 57 years. The rehabilitation program was standardized and based on existing national clinical guidelines for physical rehabilitation in patients with spinal cord injuries.
 RESULTS:The greatest changes were in patients with motor levels C6and C7.Patients with cervical tetraplegia, according to the criterion of functional and motor homogeneity, can be divided into four clinical and rehabilitation groups: patients with a high level of damage to C4C6(functionally dependent), patients with a low level of damage to C7D1(functionally independent), patients with complete motor damage (types A and B), and patients with incomplete motor damage (types C and D).
 CONCLUSIONS:The allocation of clinical and rehabilitation groups allows the prediction of the results and outcomes of rehabilitation. A timely rehabilitation prognosis can improve the quality of life of patients with cervical tetraplegia and their families and contribute to their timely adaptation to society.

Основні методи фізичної реабілітації хворих на ревматоїдний артрит

Rheumatoid arthritis is a common disease characterized by a high level of disability and disability due to dysfunction of the musculoskeletal system. It is important to combine the basic therapy of rheumatoid arthritis and non-drug methods of recovery and physical rehabilitation of patients. The purpose of the study was to show the main methods of physical rehabilitation of patients with rheumatoid arthritis. Materials and method. Analysis and generalization of scientific literature were used in the study. Results and discussion. The formation of functional insufficiency of the joints in patients requires improving the functioning of the musculoskeletal system and the quality of life of patients through the use of physical rehabilitation methods. The main element of the rehabilitation complex for patients with rheumatoid arthritis is therapeutic physical culture, aimed at increasing the range of motion of the limbs, muscle strength, reducing pain and improving the general physical condition. One of the important methods of rehabilitation of patients with rheumatoid arthritis is orthosis, since the progression of the disease is inevitably associated with the development of joint deformations, especially in the feet. The goals of orthoses prescription are to protect and relieve joint stress, reduce pain and inflammation by creating controlled rest, correct anatomical axes, prevent or slow down the development of contractures, deviations and deformations. Physiotherapy methods in different periods of the disease provide anti-inflammatory and analgesic effects. Restorative treatment and physical rehabilitation of patients with rheumatoid arthritis involves a combination of various methods, among which the most effective are exercise therapy, orthotics, and physical therapy. Conclusion. Rheumatoid arthritis is characterized by a significant limitation of the functions of the musculoskeletal system due to damage to the articular cartilage and bone, which requires, in addition to drug therapy, the use of methods to restore an adequate level of physical activity and physical rehabilitation. The most effective methods of complex rehabilitation of patients with rheumatoid arthritis are physical exercises of therapeutic physical culture, orthotics and physiotherapy methods that reduce the activity of the inflammatory process, progression of deformities, maintain the volume of daily household activities, the ability to self-service, professional work and improvement of quality of life

Systematic review of the application of virtual reality to improve balance, gait and motor function in patients with Parkinson's disease.

Background:Virtual reality (VR) is an advanced technique used in physical rehabilitation of neurological disorders, however the effects of VR on balance, gait, and motor function in people with Parkinson’s (PD) are still debated. Therefore, the systematic review aimed to determine the role of VR on motor function, balance and gait in PD patients.Methods:A comprehensive search to identify similar randomised controlled trials was conducted targeting 5 databases including Web of Science, PubMed, CINHAL, Cochrane Library, and Physiotherapy Evidence Database. A total of 25 studies were found eligible for this systematic review, and the methodological assessment of the quality rating of the studies was accomplished using the physiotherapy evidence database scale by 2 authors.Results:Out of the 25 included studies, 14 studies reported on balance as the primary outcome, 9 studies were conducted to assess motor function, and 12 assessed gait as the primary outcome. Most studies used the Unified Parkinson disease rating scale UPDRS (part-III) for evaluating motor function and the Berg Balance Scale as primary outcome measure for assessing balance. A total of 24 trials were conducted in clinical settings, and only 1 study was home-based VR trainings. Out of 9 studies on motor function, 6 reported equal improvement of motor function as compared to other groups. In addition, VR groups also revealed superior results in improving static balance among patient with PD.Conclusion:This systemic review found that the use of VR resulted in substantial improvements in balance, gait, and motor skills in patients with PD when compared to traditional physical therapy exercises or in combination with treatments other than physical therapy. Moreover, VR can be used as a supportive method for physical rehabilitation in patients of PD. However, the majority of published studies were of fair and good quality, suggesting a demand for high quality research in this area.