Rehabilitation Measures In Patients Research Articles

Prenatal ultrasound diagnostics and sociopsychological support as rehabilitation measures in patients with congenital cleft palate complicated by anomalies of other organs and systems

BACKGROUND: Prenatal ultrasound diagnostics and sociopsychological support in the early rehabilitation of children with congenital cleft palate combined with malformations of other organs and systems complement the unified algorithm of dynamic monitoring and rehabilitation treatment of these patients. Thus, predicting the choice of techniques and the system of rehabilitation prescriptions became possible. AIM: To present the experience of prenatal ultrasound diagnostics and sociopsychological support during pregnancy for the early rehabilitation of a patient with cleft palate combined with malformations of other organs and systems. MATERIALS AND METHODS: The study was conducted in the Multiprofile Clinical Medical Center “Bonum” in Yekaterinburg. For 24 years, from the analysis of medical records of the organizational and rehabilitation process of 2,475 patients with congenital cleft lip and/or palate receiving comprehensive care (1998–2022), 823 (33.25%) patients who had with cleft palate and malformations of other organs and systems were enrolled in this study. The discharge epicrises of the pregnancy and the timing of intrauterine ultrasound diagnostics of the fetus were studied, and the history of childbirth and anamnesis of newborns and timing of their routing and registration in the specialized “Bonum” Center were analyzed. At the time of the initial outpatient appointment at the center, parents’ responses to a survey on the nature of emotional and psychological experiences during the prenatal ultrasound examination of the fetus, period of “bearing” pregnancy, and birth of a baby with a complex anatomical and physiological pathology were analyzed. RESULTS: Ultrasound examination of the fetus during uterine development registered 292 (35.48%) of 823 cases of a combination of congenital cleft palate and anomalies of other organs and systems. The main forms of malformations in the fetus were established in the second (n=99, 33.90%) and third (n=185, 63.36%) trimester pregnancy screening. Mothers who were told about the results of ultrasound diagnostics of the fetus showed anxiety and emotional lability. The use of psychocorrectional and socially significant measures during the diagnosis of fetal pathologies and at the time deciding whether to continue pregnancy, as well as the newborn period, which relieved the psycho-emotional tension of parents, was proposed. CONCLUSION: Early rehabilitation of patients with congenital cleft palate combined with malformations of other organs and systems should be provided as an integral part of the complex rehabilitation therapy. Sociopsychological support of the family from the period of prenatal diagnosis of the fetus who had multiple malformations is necessary at all stages of pregnancy and rehabilitation treatment of the child.

Analysis of SLC6A4 (5 ‑HTTLPR) gene polymorphism depending on clinical features and efficacy of therapeutic and rehabilitation measures in patients with psychostimulant addiction

The annual increase in the number of patients with psychostimulant addiction and the low duration of remissions as a result of treatment of such disorders prompt researchers to search for new approaches to therapy. It seems relevant to search for and introduce into practice new clinical and genetic markers that increase the effectiveness of psychostimulant addiction therapy within the framework of a personalized approach. The purpose of the study is to determine the impact of a number of clinical characteristics and SLC6A4 (5‑HTTLPR) gene polymorphism on the efficacy of treatment and rehabilitation program in patients with psychostimulant addiction. Materials and methods. The study included 325 patients diagnosed with «mental and behavioral disorders due to use of psychostimulants» (F14.2, F15.2, F19.2 according to ICD-10); men and women aged 18 to 50 years, ethnically Russian, signed informed consent to participate in the study. Methods: clinical-psychopathological, anamnestic, molecular-genetic, psychometric (Montgomery — Åsberg Depression Rating Scale (MADRS)), and statistical methods. Results. All patients were divided into groups depending on the psychoactive substances used and comorbid psychiatric pathology. It was found that SSRI monotherapy (Escitalopram) for the relief of affective disorders in the post-withdrawal period was most effective in the patients who used only psychostimulants (p<0.005). Combined psychopharmacotherapy was more efficient in other groups (p<0.001). The patients with SS and SL genotypes of the SLC6A4 (5‑HTTLPR) gene tolerated Escitalopram monotherapy worse; a statistical difference was achieved for the patients with LL and SL/SS genotypes of group 2 (p<0.036). There were more patients who passed the rehabilitation program and with the longest remissions among those with the SL and SS genotypes of the SLC6A4 (5‑HTTLPR) gene in all groups. Conclusion. After analyzing the results, the conclusions about the association between a number of clinical and genetic characteristics of patients with psychostimulant addiction and the effectiveness of treatment and rehabilitation measures were drawn.

The influence of HDBA organic complex with vitamin D and calcium on the effectiveness of medical rehabilitation of patients with osteoporosis

Objective. To study the effect of basic pathogenetic therapy of osteoporosis and nutritional support using HDBA organic complex with vitamin D and calcium on the effectiveness and duration of maintaining the effect of medical rehabilitation, bone mineral density and the incidence of falls in patients with osteoporosis. Material and methods. The study included 119 patients aged 50 to 80 years, admitted to the inpatient stage of medical rehabilitation and diagnosed with osteoporosis according to one of the three diagnostic criteria formulated in the clinical recommendations of the Russian Ministry of Health, which were randomized in 3 groups. Patients in group 1 (n=41) were prescribed pathogenetic antiresorptive therapy for osteoporosis (bisphosphonates or denosumab) for 12 months, depending on the severity and clinical features of osteoporosis, contraindications to various types of therapy and the patient’s preferences regarding the frequency and mode of administration of the drug for the treatment of osteoporosis, in combination with nutritional support of the dietary supplement Osteomed Forte, containing an organic HDBA complex with vitamin D and calcium. Patients in group 2 (n=39) were prescribed only nutritional support with the dietary supplement Osteomed Forte in the same dosage. Patients of the third group made up the comparison group (n=39), in which patients did not receive any interventions. A control examination was carried out after completion of the rehabilitation course – 20 days after inclusion in the study, as well as 6 and 12 months after the start of treatment. Results. Long-term nutritional support of patients with osteoporosis using HDBA organic complex with vitamin D and calcium helps maintain muscle strength values achieved during rehabilitation for up to 6 months, indicators of quality of life and balance for up to 12 months after completion of rehabilitation, as well as significant increase in bone mineral density after 12 months compared to the baseline: in combination with pathogenetic therapy for osteoporosis – by 4.2% in the spine, by 3.0% in the femoral neck and by 2.7% in the proximal femur, without antiresorptive therapy – by 1.8% in the spine. Conclusion. Nutritional support in the form of correction of dietary calcium deficiency and vitamin D deficiency and the prescription of pathogenetic therapy for osteoporosis should be a mandatory part of complex rehabilitation measures in patients with osteoporosis to increase bone mineral density, improve efficiency and long-term maintenance of the results of medical rehabilitation.

Efficiency of Remote Monitoring of Rehabilitation of Patients after Myocardial Infarction

INTRODUCTION. Rehabilitation of cardiac patients is based on a set of measures of a rehabilitation nature (medical, physical, social, psychological and pedagogical). The purpose of this type of activity is aimed at restoring health as much as possible in a particular case, as well as psychological status. Despite widespread urbanization, the share of rural residents still remains significant and amounts to 25.1 %. They face limited access to health care more often than urban populations. This is especially true for the population of remote areas.
 AIM. Evaluation of the effectiveness of the use of remote technologies during rehabilitation measures in patients who have suffered an acute myocardial infarction.
 MATERIALS AND METHODS. The study included 200 patients who had suffered acute myocardial infarction, receiving outpatient rehabilitation at the City Clinic No. 17, living in the city of Tyumen. The patients were divided into two equal groups of 100 people. The average duration of treatment in both groups was 21 days. The rehabilitation program included a therapeutic and physical training complex, which took place in a face-to-face group as part of joint classes, and in a remote group — at home using video instructions, previously sent by email.
 RESULTS AND DISCUSSION. Rehabilitation with the use of remote technologies showed a result comparable to the full-time program. In both groups, there is a statistically significant improvement in the indicators of the Rankin, and rehabilitation routing scales. However, according to the Aronov scale, positive changes are present only in the remote group.
 CONCLUSION. Based on the results of the study, a conclusion was made about the comparable effectiveness of cardiac rehabilitation in full-time and remote groups. This suggests that biomedical technologies can be used in the implementation of cardiac rehabilitation programs in areas remote from large settlements.

Современные подходы к психотерапевтической реабилитации пациентов с хроническими сердечно-сосудистыми заболеваниями

The review is devoted to the topical problem of rehabilitation of patients with cardiovascular diseases, which remain the leading cause of morbidity, disability and mortality in Russia and worldwide. A number of works demonstrating a close relationship between the course and prognosis of cardiovascular diseases and the psycho-emotional sphere of patients were analyzed. International and Russian experts emphasized the importance of timely identification and correction of psychosocial risk factors, in particular, depression, anxiety disorders, psychosocial stressors and others. The question of the need for a multidisciplinary approach to the patient in cardiac rehabilitation programs is raised. Emphasis is placed on the expediency of combining psychocorrection, psychotherapy and psychopharmacotherapy to increase the effectiveness of rehabilitation measures. The leading goals of these interventions are to change the internal picture of the disease, to achieve psychosocial adaptation and to improve the quality of life of patients with chronic cardiac diseases. This approach contributes to the prevention of exacerbations, complications and chronicization of somatic pathology, which improves labor prognosis, reduces the risk of disability and early mortality. Thus, the conducted analysis allows forming a holistic view of the importance of specialized psychological and psychotherapeutic care, the existing methods of correction and pharmacotherapy within the framework of rehabilitation measures in patients with cardiac diseases.

Dynamics of movement amplitude indicators in joints of patients with rheumatoid arthritis

The purpose of the paper is to evaluate the effectiveness of the technology of rehabilitation measures in patients with rheumatoid arthritis according to the dynamics of the amplitude of movements indicators. Theoretical (analysis and generalization of literary and Internet data), survey, collection of anamnesis, objective examination, anthropometric (goniometry) methods of mathematical statistics. 188 patients with rheumatoid arthritis were examined, of which 156 (83%) were women, 32 (17%) were men, and their average age was 44.9±7.6 years old. The analysis of the goniometric indicators of the joints of hands affected by rheumatoid arthritis after six months of conducted rehabilitation measures showed a significant improvement in the mobility of the radiocarpal joint and hand fingers in the examined patients. In particular, active flexion in the radiocarpal joint significantly increased in patients of the experimental group and was 72.5±6.0º, while in the patients of the control group this indicator was 5.3º less (67.2±5.0º) (р<0.05). A significant result was achieved in restoring flexion of the hand fingers in patients of the experi­mental group: mobility of the fingers in the metacarpal phalangeal joints was 83.2±3.6º, and in the control group it was 73.4±5.0º, in the proximal interphalangeal joints in patients of the experimental group it was 84.1±3.3º, and in the control group – 67.8±4.8º (р<0.05). Positive dynamics of active movements in the foot and finger joints was also observed in pa­tients of both groups at the end of the study. In the patients of the experimental group, the active dorsiflexion in the ankle joint was 27.7±1.4º, the plantar flexion was 41.3±1.8º, which was significantly better than in patients of the control group in which the observed dorsiflexion was 23.4±1.7º, and plantar flexion – 41.3±1.8º (р<0.05). Accordingly, there was a significant increase in the motor function indicators in the metatarsal phalangeal joints of patients in the expe­rimental group: flexion was up to 37.1±1.4º, extension – up to 39.2±1.0º, compared with the indicators in the control group: flexion – up to 33.5±1.2º, extension – up to 36.2±1.1º (р<0.05). The effectiveness of the developed technology is con­firmed by improvement of the results of goniometric indicators in patients of the experimental group compared with the control group.

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

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

ВОЗМОЖНОСТИ САНАТОРНО-КУРОРТНЫХ МЕТОДИК В РЕАБИЛИТАЦИИ ПАЦИЕНТОК С РАННИМИ ГЕСТАЦИОННЫМИ ПОТЕРЯМИ

Introduction. Early pregnancy loss is still an unresolved problem in obstetric and gynecology. The pathogenesis is based on the comorbidity of pathological factors such as subclinical hormonal, immune, psychoneurotic disorders and endometrial pathology. It requires complex rehabilitation pregnancy planning programs for such patients. Aim. Aim of research is to optimize treatment and rehabilitation measures in patients with the history of early pregnancy lost using the Belokurikha’s spa and resort clusters. Material and methods. 79 patients with early reproductive lost history underwent a course of medical and rehabilitation treatment in the «Altai Castle» spa and resort (Belokurikha, Altai Region). Complex spa treatment included climatotherapy and combination of various methods: balneo-, peloid-, physiotherapy and a prolonged course of herbal medicine. Results and discussion. Women with a history of early pregnancy loss had significant improvement in physical and mental health, ultrasound chronic endometritis markers were decreased. The first year onset pregnancy occurred in 70.9% after rehabilitation and most of them (92.8%) delivered at term. Proposed rehabilitation program is highly efficient due to the multidirectional potentiating action of natural factors that have powerful immunomodulatory, anti-inflammatory and regenerating effects. Conclusion. A complex rehabilitation program for patients with a history of early pregnancy lost in Belokurikha’s spa and resort with a prolonged course of herbal medicine helps to make rapid psychosomatic and reproductive health recovery.

Association of HTR2A and HTR2C gene polymorphisms and the efficacy of rehabilitation measures in narcology patients

In recent years, there has been an increase in the number of patients with combined addiction to several psychoactive substances, as well as with addiction to psychostimulants. Meanwhile, there are no methods of rehabilitation of these patients based on clinical characteristics and the state of patients’ genetic biomarkers within the personalized approach. It seems relevant to study the influence of some pathogenetic biomarkers on the efficacy of rehabilitation measures in patients with combined addiction to several psychoactive substances and psychostimulant addiction in order to improve the quality of medical care for these patients. The aim of the study was to determine the association of HTR2A and HTR2C gene polymorphisms and the effectiveness of rehabilitation measures in patients with combined addiction to several psychoactive substances and psychostimulant addiction. Materials and methods. The study included 325 patients with combined addiction to several psychoactive substances and psychostimulant addiction. Methods: clinical and psychopathological, anamnestic, catamnestic, molecular genetics, and statistical methods. The effectiveness of rehabilitation work was assessed by the number of patients who chose treatment in the conditions of inpatient or outpatient rehabilitation due to primary motivational work with them and by the duration of remission as a result of the program. The results of the study. The patients were divided into 3 groups: patients with only psychostimulant addiction, patients with combined addiction to several psychoactive substances, and those with psychostimulant addiction and comorbid psychiatric pathology. The association of polymorphism of genes controlling the work of the serotonin system of the brain (HTR2A and HTR2C) and the efficacy of motivational work aimed at undergoing a rehabilitation program and the duration of remissions was revealed. Conclusion. Based on the analysis of the obtained results, the association of some clinical characteristics and HTR2A and HTR2C gene polymorphisms with the effectiveness of rehabilitation measures in patients with combined addiction to several psychoactive substances, psychostimulant addiction, and with comorbid psychiatric pathology was established.

Quality of Life Changes Evaluation on the Basis of the International Classification of Functioning at the Third Stage of Rehabilitation: a Retrospective Cohort Study of 40 Women with Breast Cancer

INTRODUCTION. The article reflects long-term and distant consequences of antitumor therapy, from three to six months from the beginning of treatment, in patients with breast cancer. Analysis of the identified effects allowed to determine the structure of the rehabilitation diagnosis based on the International Classification of Functioning. AIM. To designate the main International Classification of Functioning codes for breast cancer patients corresponding to the third stage of rehabilitation, to evaluate the effectiveness of rehabilitation measures at this stage of rehabilitation in breast cancer patients who received different methods of treatment for this disease. MATERIAL AND METODS. The study was conducted on the basis Federal Research and Clinical Center of Radiology and Oncology of the Federal Medical and Biological Agency of Russia for the period October-January 2021-2022, including the data analysis of 40 patients (all women) with breast cancer stages I-IV, being at the third stage of rehabilitation 3-6 months after the complex antitumor treatment with the persistence of adverse events due to the therapy, the mean age of patients is 58 .6 ± 1.2 years. RESULTS AND DISCUSSION. The need for rehabilitation measures in patients with breast cancer persisted and increased after the end of antitumor treatment. A brief set of International Classification of Functioning was formed on the basis of complaints and evaluation of patients admitted to the third stage of medical rehabilitation from the standpoint of a biopsychosocial approach. Rehabilitation diagnosis distinctive features were identified and, accordingly, the rehabilitation program was developed at the third stage of medical rehabilitation of patients with breast cancer. CONCLUSION. The results of the study confirm the long-term effects of antitumor treatment, which suggests the need for rehabilitation measures to prevent the development and progression of complications and to improve the quality of life of breast cancer patients.

The choice of tactics of rehabilitation measures in patients with chronic paraproctitis, depending on the volume of surgical intervention based on quality of life indicators

BACKGROUND: The development of medical technologies puts forward requirements for the improvement and optimization of treatment and rehabilitation algorithms for providing surgical care to proctological patients and, in particular, patients with chronic paraproctitis. The criteria for the effectiveness of therapy are the period of wound healing, the frequency of recurrence of the disease and the preservation of the function of the anal sphincter. The development of minimally invasive surgical technologies is a new promising area of outpatient coloproctology.
 AIMS: was to evaluate the effectiveness of the use of physiotherapy programs for postoperative rehabilitation according to the SF-36 quality of life assessment scale in groups of patients operated on by various methods of surgical interventions and to develop an Algorithm for surgical treatment and postoperative rehabilitation of patients with chronic paraproctitis.
 MATERIAL AND METHODS: The study included observation and control in the pre- and early postoperative period for 270 operated patients with extra- and transsphincter pararectal fistulas with various options for surgical treatment and rehabilitation programs used in the early postoperative period. As a criterion of effectiveness, an assessment of the quality of life b according to the SF-36 questionnaire was used. The surgical-physiotherapeutic Algorithm of surgical treatment and rehabilitation of patients with chronic paraproctitis is proposed for wide introduction into clinical practice.
 RESULTS: As a result of the analysis of the data obtained, it was found that the quality of life depends on the type of operation: the advantage of using minimally invasive surgical interventions and the rehabilitation program used has been proven: the advantage of using an extended 4-component rehabilitation program has been proven.
 CONCLUSION: The data obtained made it possible to determine the tactics of rehabilitation measures in patients with chronic paraproctitis depending on the volume of surgical intervention and display it in a visual, schematic form ― Algorithm for surgical treatment and rehabilitation of patients with chronic paraproctitis.

Experience of using hypoxic-hyperoxic treatment in patients with Covid-19 associated pneumonia

Aim of the study. To study the safety and efficacy of hypoxic-hyperoxic treatment in the complex of rehabilitation measures in patients after COVID-19 associated pneumonia. Materials and methods. The study included 20 patients aged 49 to 75 years after viral pneumonia caused by the novel coronavirus infection (ICD-10 U07.1 and U07.2). The patients were divided into two groups according to the rehabilitation treatment received. In the first group (n = 10), the rehabilitation treatment was carried out in the scope of therapeutic exercises, massage and physiotherapy procedures. In the second group (n = 10), procedures for hypoxic-hyperoxic treatment were added to the complex of basic measures. Results. Our experience in conducting a rehabilitation course and including hypoxic-hyperoxic treatment in complex rehabilitation programs for patients in the early recovery period after viral pneumonia associated with the novel coronavirus infection revealed positive dynamics in terms of increasing Conclusions. exercise tolerance, reducing anxiety and depression, and improving the quality of patients’ lives. The use of hypoxic-hyperoxic treatment as part of a general rehabilitation course has shown its safety and efficacy for patients who had pneumonia associated with the novel coronavirus infection.

Whole-Body Adaptive Functional Electrical Stimulation Kinesitherapy Can Promote the Restoring of Physiological Muscle Synergies for Neurological Patients.

Background: Neurological diseases and traumas are major factors that may reduce motor functionality. Functional electrical stimulation is a technique that helps regain motor function, assisting patients in daily life activities and in rehabilitation practices. In this study, we evaluated the efficacy of a treatment based on whole-body Adaptive Functional Electrical Stimulation Kinesitherapy (AFESK™) with the use of muscle synergies, a well-established method for evaluation of motor coordination. The evaluation is performed on retrospectively gathered data of neurological patients executing whole-body movements before and after AFESK-based treatments. Methods: Twenty-four chronic neurologic patients and 9 healthy subjects were recruited in this study. The patient group was further subdivided in 3 subgroups: hemiplegic, tetraplegic and paraplegic. All patients underwent two acquisition sessions: before treatment and after a FES based rehabilitation treatment at the VIKTOR Physio Lab. Patients followed whole-body exercise protocols tailored to their needs. The control group of healthy subjects performed all movements in a single session and provided reference data for evaluating patients’ performance. sEMG was recorded on relevant muscles and muscle synergies were extracted for each patient’s EMG data and then compared to the ones extracted from the healthy volunteers. To evaluate the effect of the treatment, the motricity index was measured and patients’ extracted synergies were compared to the control group before and after treatment. Results: After the treatment, patients’ motricity index increased for many of the screened body segments. Muscle synergies were more similar to those of healthy people. Globally, the normalized synergy similarity in respect to the control group was 0.50 before the treatment and 0.60 after (p < 0.001), with improvements for each subgroup of patients. Conclusions: AFESK treatment induced favorable changes in muscle activation patterns in chronic neurologic patients, partially restoring muscular patterns similar to healthy people. The evaluation of the synergic relationships of muscle activity when performing test exercises allows to assess the results of rehabilitation measures in patients with impaired locomotor functions.

Effectiveness of rehabilitation measures in patients with posttraumatic complications based on the SF-36 questionnaire

<h3></h3> Одним из важнейших аспектов реабилитации является ее эффективность в решении проблемы поддержания работоспособности населения. Оценка эффективности реабилитационных мероприятий строится на подборе методов, достоверно отражающих наиболее важные аспекты человеческой деятельности и их динамику в процессе реабилитации. Опросник SF-36 (the Short Form (36) Health Survey) позволяет дать количественную характеристику физического, эмоционального и социального компонентов качества жизни и придать целенаправленность реабилитационному лечению. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценить влияние реабилитационных мероприятий на качество жизни пациентов с посттравматическими осложнениями. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> На базе ФБУН ЕМНЦ ПОЗРПП Роспотребнадзора проведен анализ показателей качества жизни пациентов, получавших реабилитационное лечение по поводу посттравматических осложнений верхней и нижней конечностей. Объектом исследования стали 79 работников различных сфер деятельности: врачи, юристы, педагоги, инженеры, менеджеры, медицинские сестры, рабочие различных специальностей, средний возраст которых составил 50,69±1,09 года. Все участники получили для заполнения опросник SF36 до и после реабилитации. <h3>РЕЗУЛЬТАТЫ</h3> Представлены результаты по каждому показателю опросника SF-36. Выявлены основные аспекты снижения качества жизни в отношении физического и психического здоровья, а также социального функционирования. Доказана необходимость реабилитационного лечения, направленного на конкретные области жизненного неблагополучия, такие как физическое и психическое состояние здоровья, ролевое и социальное функционирование и др. <h3>ЗАКЛЮЧЕНИЕ</h3> Для выявления неблагополучия в различных сферах качества жизни у трудоспособного населения, нуждающегося в реабилитации после посттравматических осложнений, можно использовать опросник SF-36. Он позволяет получить количественную характеристику физического, эмоционального и социального компонентов качества жизни, соответственно направить осуществляемое мультидисциплинарной командой реабилитационное лечение на наиболее уязвимую сферу.

ВОКАЛ КАК ФОРМА ПРОДУКТИВНОЙ ДЕЯТЕЛЬНОСТИ В ОТЕЧЕСТВЕННОЙ ЛОГОПЕДИИ

The authors use the terms "vocal", "productive vocal activity", "voice therapy", "vocal therapy", "vocal means" as synonyms in scientific research, which is a relevant technological technique in speech therapy, as an advanced pedagogical experience supplementing speech therapy science and practice. The article describes the therapeutic potential of vocal activity and the long-term experience of the leading Russian speech therapists in the practical application of elements of productive vocal activity for correctional and speech therapy work. The evolutionary-historical relationship between colloquial speech and singing and the high corrective potential of vocals laid the foundation for the diffusion of vocal elements into speech therapy practice as early as the middle of the XXth century. Successful long-term experience of application of vocal elements, primarily in the field of medical speech therapy, outlines a tangible resource for practical and scientific-theoretical research in this direction. The use of the components of vocal-pedagogical practice in the implementation of rehabilitation measures in patients with speech pathologies makes it possible to enhance noticeably the correctional speech therapy impact. It is also very important that vocals, in one form or another, can be successfully used to develop and automate the correct formation of complex supersegmental speech properties, acting as extra components in relation to the main pronunciation of words and sounds, that is, in other words, speech prosodic.

Clinical efficacy of rehabilitation measures in patients with melanoma of the skin undergoing immunotherapy

Currently one of the urgent problems of oncology is he choice of tactics of rehabilitation measure. Despite the long list of known possible side effects from antitumor therapy, most patients do not receive follow-up and preventive interventions necessary to correct clinically significant consequences. Analysis of clinical effectiveness of complex rehabilitation programs in patients with melanoma of skin receiving immunotherapy. The study included 109 patients with metastatic melanoma, aged 26 to 88 years, who received immunotherapy in the period from 2019 to 2022. The study group (n=54) included patients who received a comprehensive rehabilitation program: physical therapy, nutritional support, general magnetotherapy, psychotherapy sessions without concomitant medications. Patients who did not use rehabilitation programs made up the control group (n=55). The effectiveness of therapy was evaluated in accordance with iRECIST 1.1 criteria. Immuno-mediated toxity of treatment was evaluated according to CTCAE criteria (version 5.0, 2017). To assess the quality of life (QoL), the EORTC QLQ-C30 questionnaire was used. The median follow-up of patients was 20 weeks in the study group, 19 weeks in the control group. Stabilization of the disease was achieved in 21 (38.9%) patients of the study group and 23 (41.8%) patients of the control group; disease progression in both groups was comparable: 10 (18.5%) - in the study group, 12 (21.8%) - in the control group. Adverse events of therapy were detected in 39 (72.2%) patients of the study group, 46 (83.6%) patients of the control group. All registered adverse events according to CTCAE 5.0 criteria were of grade I-II. No serious adverse events of the IV degree were detected during the study period. The introduction of comprehensive rehabilitation programs in the treatment of patients with melanoma shows its effectiveness and reduced toxicity of immunotherapy, however, there are a number of important issues that require further resolution.

PECULIARITIES OF INSTITUTIONAL STAGE OF INPATIENT REHABILITATION AFTER CARDIO-SURGICAL INTERVENTIONS

Cardiovascular diseases are still ranking the leading position among the commonest disabling diseases and the causes of mortality. The increase in the number of cardiac surgical operations performed requires the development of effective rehabilitation measures. Due to the patient’s individual characteristics, there is a need to develop and test rehabilitation programs for patients who have undergone coronary artery bypass grafting (CABG), or valve prosthetics. The aim of the study is to determine the principal features of cardiac rehabilitation for patients after cardiac surgery and to evaluate the effectiveness of multicomponent individualized cardiac rehabilitation programs. The study was conducted at the recently opened Department of Rehabilitation and Planned Cardiology of the Poltava Regional Clinical Medical Cardiovascular Center. The study involved patients, who underwent coronary artery bypass grafting and valve prosthetics. Effective rehabilitation for patients after cardiac surgery requires determining the level of their rehabilitation potential that enables to choose the optimal pace and scope of rehabilitation measures, based on individual indicators of patients. The implementation of multicomponent cardiac rehabilitation programs with an individualized approach based on rehabilitation potential in patients after cardiac surgery significantly reduces the length of hospital staying, promotes the widening in the range of motor modes; as well as contributes to improvement of the quality of life compared to the patients after cardiac surgery who received standard rehabilitation program. Early start of rehabilitation measures in patients after surgical operations also enhances better recovery of lost functions. The 6-minute walk test at the beginning and the end of the inpatient stage treatment enables to estimate the efficiency of rehabilitation measures.

The effect of brain neurotrophic factor gene polymorphism on the effectiveness of therapeutic and rehabilitation measures in patients with psychostimulant dependence

Justification. Along with the rising consumption of psychostimulants, the number of patients with dependence on psychostimulants is increasing all over the world and in Russia in particular. At the same time, the number of patients with dependence on drug combinations is increasing, most of which are psychostimulants.&#x0D; Aim. The aim of the work is to develop a personalized approach to the therapy of patients with dependence on psychostimulants, taking into account the polymorphism of the neurotrophic factor gene of the brain.&#x0D; Material and methods. 305 patients with dependence on psychostimulants, men and women from 18 to 50 years old, were studied. Depending on the drug used and their combinations, as well as the presence of comorbid psychiatric pathology, all patients were divided into 6 groups. Research methods: molecular-genetic, clinical-psychopathological, catamnestic, statistical (parametric and nonparametric methods using Statistica 10.0 programs of STAT Soft Inc., USA). The effect of polymorphism of the neurotrophic factor gene of the brain on the effectiveness of therapeutic and rehabilitation measures in patients in different groups was evaluated.&#x0D; Results. It was found that patients who use only psychostimulants and psychostimulants with cannabinoids, having a homozygous (GG) genotype of the neurotrophic factor gene of the brain, are longer in the rehabilitation program and have the longest remissions.&#x0D; Conclusion. Polymorphism of the neurotrophic factor gene of the brain affects the effectiveness of therapeutic and rehabilitation measures in patients with dependence on psychostimulants.

The role of the International classification of functioning in the complex rehabilitation of cardiac patients

BACKGROUND: A new format for assessing impaired functions, disabilities and health in accordance with the international classification (ICF), which is necessary at all stages of rehabilitation, is considered of great importance in the practice of an interdisciplinary rehabilitation team. However, in practice, the use of the ICF is very limited due to a number of organizational reasons.&#x0D; AIM: To raise awareness among specialists of different fields involved in the rehabilitation of a disabled person, about the main provisions of the ICF; discuss the gradation of rehabilitation potential developed by the authors in cardiac patients.&#x0D; MATERIALS AND METHODS: An analysis of referrals to the medical and social expertise bureau (form 088 / U) of patients with cardiovascular diseases has been carried out with the allocation of groups of low and high rehabilitation potential.&#x0D; RESULTS: An analysis of the main provisions of the ICF regulating the section of cardiovascular diseases is presented. This classification is the gold standard for assessing the quality of life and medical services provided, substantiating the need, volume and composition of individual rehabilitation measures for a disabled person. The ways of using the principles laid down by the ICF in clinical practice for evaluating the results of complex rehabilitation of patients with cardiac pathology are discussed. The main provisions of the ICF, influencing the quality of rehabilitation measures in patients with cardiological profile, are highlighted. A list of diseases / conditions has been developed and proposed for use, which involves various levels of rehabilitation.&#x0D; CONCLUSIONS: The authors have developed and proposed for discussion the gradation of the rehabilitation potential of patients with cardiovascular diseases, as well as discussed the general provisions of the international classification of functioning, simplifying and facilitating the use of ICF in practical work, taking into account the standards of examination, treatment and rehabilitation for cardiac patients in accordance with the standards of examination, treatment and rehabilitation of cardiac patients approved in the Russian Federation.

Effects of Cerebellar Dysfunction Acquired as a Result of Tumor Therapy on the Functioning of the Saccadic System in Children

The cerebellum plays an important role in controlling saccadic eye movements and fixing gaze. Cerebellar lesions produce a variety of impairments to oculomotor behavior and associated psychophysiological processes. Such impairments have significant influences on the effectiveness of rehabilitation measures in patients treated for cerebellar tumors. The aims of the present work were to identify and objectively evaluate the effects of cerebellar dysfunction acquired as a result of tumor treatment on the characteristics of the oculomotor system in pediatric patients for subsequent development of diagnostic criteria and quantitative evaluation of the rehabilitation process. A total of 66 children aged 9–17 years took part in the study, all with tumor treatment-induced cerebellar dysfunction; 54 healthy children of the same age also took part. Three oculomotor tests were performed in which eye movements were recorded by videooculography. We found impairments to holding the gaze on visual objects, significant increases in hypermetric saccades, and difficulty with visual scanning in the patients. These dysfunctions of the oculomotor system inevitably led to impairments to a series of cognitive processes – visual perception, attention, memory, and reading. In addition, the phenomenon of hypermetric saccades should be regarded as a special case of cerebellar ataxia syndrome in the patients. These oculomotor impairments need to be considered for effective rehabilitation measures in this class of patients.