Stages Of Rehabilitation Research Articles

The effectiveness of laser sculptural uvaloplasty in a patient with ronchopahty and severe obstructive sleep apnea syndrome

Objective. To present a clinical case of successful application of laser sculptural uvulopalatoplasty in a patient with ronchopathy and severe obstructive sleep apnea syndrome.Materias and methods. The article describes a clinical case of successful application of soft palate surgery – laser sculptural uvulopalatoplasty – in a patient with ronchopathy and severe obstructive sleep apnea syndrome.Results. After the described surgical intervention, rehabilitation stage was wihtout complications. A complete relief from night snoring and apnea in the patient has been achieved. The obtained results and the absence of complications after surgery were registered in the patient for the next 5 years and more.Conclusion. Laser sculptural uvulopalatoplasty is a safe and effective method of treating patients with ronchopathy and obstructive sleep apnea syndrome, even severe one, which provides a stable and complete relief from night snoring and its complications.

The Role of the International Classification of Functioning in Early Rehabilitation of Patients with Ischemic Stroke in Kyrgyzstan

The subject of the study is the process of early rehabilitation of patients after stroke. The aim of the study is to assess the role of the International Classification of Functioning (ICF) in the early rehabilitation of patients with ischemic stroke. This classifier was used to analyze the functional state of patients and develop individualized rehabilitation programs aimed at the most complete restoration of lost functions and improving the quality of life. As a result, it was found that the integration of the International Classification of Functioning into clinical practice contributes to a more effective and targeted recovery of patients after stroke. The classifier is a key point in determining short-term and long-term goals for the patient, assessing the rehabilitation potential and prognosis, drawing up and changing an individual medical rehabilitation plan, managing the medical rehabilitation process and forming further recommendations upon discharge, as well as involving related specialists to solve problems with barriers. It is recommended to implement the ICF at all stages of rehabilitation of patients after a stroke.

Psychological-Distress Factors in Patients With Breast Cancer: A Qualitative Meta-Synthesis.

To systematically review and integrate qualitative-research results pertaining to psychological distress in patients with breast cancer and to clarify its causes and drivers. Patients with breast cancer experience psychological distress in the stages of diagnosis, treatment, and rehabilitation, which seriously affects their quality of life. Through comprehensive qualitative research, the study comprehensively describes the experiences of patients with breast cancer to guide medical personnel in taking better care of them. A systematic review and synthesis of qualitative studies. Qualitative studies were included if they were related to the psychological-distress experiences of patients with breast cancer. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise study quality. Data were synthesised using the Thomas and Harden method of thematic and content analysis. Nine electronic databases (PubMed, Embase, Cochrane Library, CINAL [via EBSCO], and PsycINFO, China Knowledge Resource Integrated Database, Wanfang, Chinese Biomedical, and Weipu) were searched from inception until February 2024. Thirteen studies were included in the meta-synthesis. Four analytical themes were identified: diagnostic and therapeutic, individual, environmental, and interpersonal factors. Psychological distress is a subjective feeling influenced by interactions among individual, therapeutic, environmental, and interpersonal factors, and it is commonly encountered among patients with breast cancer. Therefore, to optimise the management of psychological distress, the characteristics and external environment of patients with breast cancer should be carefully considered when delivering routine nursing care. Patients experience psychological distress at different stages of breast cancer; however, the causes of psychological distress at different stages differ. Medical staff should implement targeted psychological-distress intervention measures based on factors relevant to different stages. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42023417364).

The Effects of Using Modern Technologies in the Neurorehabilitation Process of a Patient after Traumatic Brain Injury – A Case Study

This study presents an analysis of the case of a 44-year-old male patient who experienced a traumatic brain injury, resulting in spastic quadriplegia, meningitis, right-sided craniotomy, ventriculoperitoneal shunt placement, and right hip arthroplasty. Data was collected over a four-year comprehensive therapy process involving treatment periods, during which the patient was under the care of an interdisciplinary team and participated in an individualized rehabilitation program, consisting of 3-4 hours of physical therapy daily for 5-6 days per week. The material included results from functional tests, muscle tone assessments, and balance evaluations. Numerical data from robotic gait therapy devices were also considered. With the consent of the patient and his family, the therapy process was documented via video recordings and photographs, which were then used for a retrospective visual analysis of recorded material at various stages of rehabilitation. For this purpose, the ShapeCare.Fizjo device was used, along with Blaze Pose software, based on a moving person’s skeletal detection model. The results indicated that comprehensive therapy using innovative tools such as C-eye, ReoGo, ReoAmbulator, and LeviActive system improved the patient’s balance and motor skills, as well as facilitated the gait re-education process. The use of modern technologies in neurorehabilitation not only optimizes therapeutic outcomes but also reduces the risk of musculoskeletal strain for the therapist during their professional work.

Current Management of Pediatric Patients with Post-Burn Scars: Case Study

Background. Post-burn scars are common among pediatric patients. Pathological scarring is clear indication for conservative or surgical management of pediatric patients who continue to grow and develop after the resolution of burn injuries. Such lesions can significantly reduce patients' quality of life and, moreover, cause significant functional and aesthetic discomfort. Clinical cases description. The results of observation over two children (2 years 7 months and 12 years) with developing post-burn scars are demonstrated. Successful management method using physiotherapeutic complex (including monopolar radiofrequency treatment combined with ultrasound therapy, photodynamic therapy, and close-focus X-ray therapy) is presented. Conclusion. Modern trends in post-burn scars management are based on timely implementation of effective and safe methods early on rehabilitation stages and tissue restoration after burn injury to prevent pathological scarring and achieve control over its activity.

VR-Aided Ankle Rehabilitation Decision-Making Based on Convolutional Gated Recurrent Neural Network.

Traditional rehabilitation training for stroke patients with ankle joint issues typically relies on the expertise of physicians. However, when confronted with complex challenges, such as online decision-making or assessing rehabilitation progress, even seasoned experts may not anticipate all potential hurdles. A novel approach is necessary-one that effectively addresses these complexities without solely leaning on expert experience. Previous studies have introduced a rehabilitation assessment method based on fuzzy neural networks. This paper proposes a novel approach, which is a VR-aided ankle rehabilitation decision-making model based on a convolutional gated recurrent neural network. This model takes various inputs, including ankle dorsiflexion range of motion, angular velocity, jerk, and motion performance scores, gathered from wearable motion inertial sensors during virtual reality rehabilitation. To overcome the challenge of limited data, data augmentation techniques are employed. This allows for the simulation of five stages of rehabilitation based on the Brunnstrom staging scale, providing tailored control parameters for virtual training scenarios suited to patients at different stages of recovery. Experiments comparing the classification performance of convolutional neural networks and long short-term memory networks were conducted. The results were compelling: the optimized convolutional gated recurrent neural network outperformed both alternatives, boasting an average accuracy of 99.16% and a Macro-F1 score of 0.9786. Importantly, it demonstrated a strong correlation (correlation coefficient r > 0.9) with the assessments made by clinical rehabilitation experts, showing its effectiveness in real-world applications.

Correction of immune disorders under the influence of pharmacotherapy and extracorporeal magnetic stimulation with patients after surgical treatment of prostate adenoma

BACKGROUND: The course of benign prostatic hyperplasia is associated with immunological disorders at the systemic and local level. Despite the wide arsenal of pharmacological agents for the treatment of benign prostatic hyperplasia, some patients undergo surgical treatment. Postoperative management programmes should be aimed at reducing the risks of complications, including infectious-inflammatory complications. In this regard, the inclusion of immunomodulatory pharmacotherapy and therapeutic physical factors in the course of reconstructive treatment is reasonable and justified. AIM: To study the role of the complex effect of pharmacotherapy and extracorporeal magnetic stimulation in the correction of immune disorders with the patients after surgical treatment of benign prostatic hyperplasia. MATERIALS AND METHODS: There have been observed 88 patients after surgical treatment of benign prostatic hyperplasia, who underwent a medical rehabilitation at stages II and III. At stage II 43 patients in the comparison group underwent standardized drug therapy, individual exercise therapy; in the main group 45 patients additionally were prescribed immunomodulatory therapy with Tameritis. At stage III the patients of the comparison group continued pharmacotherapy, exercise therapy, and transrectal magnetic therapy; in the main group 45 patients were additionally prescribed extracorporeal magnetic stimulation. A method of enzyme-linked immunosorbent assay was used to study the content of interleukins (IL); IPSS-QOL (International Prostate Symptom Score – Quality-of-Life) and SF-36 (The Short Form-36) were used to assess the quality of life. Confidence level (р) 0.05. RESULTS: After the second inpatient stage of rehabilitation the patients of the main group after surgical treatment of benign prostatic hyperplasia had a decrease the level of pro-inflammatory IL by 47.5% on average (p 0.01) with an increase in the level of anti-inflammatory IL-10 by 36.2% (p 0.01). After the III outpatient rehabilitation stage, a positive dynamics significantly increased and amounted to 63.2% (p 0.01) and 51.9% (p 0.01), reaching the normative values in the population. It should be noted that the achieved results have been preserved in a long time. In the comparison group the positive dynamics was significantly lower (p 0.05; p 0.01) in all the cases after the II and III stages of rehabilitation. The patients of the main group were observed a decrease in the severity of urinary disorders (p 0.01), restoration of quality of life (p 0.05) according to IPSS-QOL and SF-36 questionnaires at significant inter-group values (p 0.05) with the same confidence. CONCLUSION: The integrated use of pharmacotherapy and extracorporeal magnetic stimulation with the patients after surgical treatment of benign prostatic hyperplasia provides significant correction of immune disorders, restoration of physical and mental health.

The impact of rehabilitation on the recovery of executive functions in stroke patients with different location of the ischemic focus.

Cognitive dysfunction is part of the clinical picture of stroke. Most of the executive dysfunctions are diagnosed in the early stage of rehabilitation, a few weeks after the vascular incident. Coexistence of executive dysfunctions with other disorders in stroke patients may hinder patient's functions, slow down the rehabilitation process, and disrupt self-awareness, interpersonal communication, and professional activity in everyday life. Ninety patients after ischemic stroke were examined (right hemisphere stroke: N = 33, left hemisphere stroke: N = 57). The study group (N = 45) consisted of patients rehabilitated in the Department of Rehabilitation and Physical Medicine of the University Teaching Hospital of the Military Medical Academy in Lodz, Łódź, Poland, in whom a comprehensive neurorehabilitation program was implemented, consisting of motor and neuropsychological rehabilitation. The control group (N = 45) consisted of patients awaiting admission to the department, who were covered by comprehensive environmental rehabilitation including exercise therapy and neuropsychological therapy. Executive function was measured with 3 popular diagnostic tools: the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT part A, TMT part B), and the letter test and category test with the Verbal Fluency Test (VFT). The tests were carried out twice: the first time before the start of rehabilitation and 5 weeks later after its completion. Although patients with right-hemispheric stroke showed better improvement in executive functions, stroke location did not prove to have significant impact on how effective the rehabilitation was. Right hemisphere stroke patients showed greater improvement in restoring executive functions after rehabilitation compared to left hemisphere stroke patients. The location of the stroke did not significantly correlate with the efficiency of the rehabilitation setting. Int J Occup Med Environ Health. 2024;37(4).

Changes in Y-Balance Test Scores During Months 4, 5, and 6 of ACL Reconstruction Rehabilitation.

The anterior cruciate ligament (ACL) is well researched since injuries typically result in lengthy recoveries and rehabilitation periods until athletes can return to full activity. Although a large body of literature on the early and late stages of rehabilitation following ACL reconstructive (ACLR) surgery exists, less is known regarding the mid-phase of ACL rehabilitation and healthy versus injured limb differences in functional testing during this stage. The purpose of this study is to determine if Y-Balance Test (YBT) scores obtained during the mid-phase of ACLR rehabilitation change over months 4, 5, and 6. Case Series. Research laboratory. Patients or Other Participants: A total of 27 participants (17 females; 18.96±3.02 years (range 15-24); 173.63±10.29cm; 72.55±17.83kg) who sustained a unilateral ACL injury, experienced no episodes of instability or knee giving away, had not suffered a previous ACL injury, and expressed a desire to return to sport at the end of rehabilitation came in once a month following ACLR to participate in a battery of tests. YBT scores in the anterior, posterolateral (PL), and posteromedial (PM) directions in the healthy and reconstructed limbs. A main effect for limb was observed for the anterior (Healthy: m4: 78.8cm±5.8, m5: 79.5cm±5.2, m6: 79.4±5.8; Reconstructed: m4: 77.2±5.9, m5: 78.5±5.1, m6: 78.1±6.4, p=0.023) and PM (Healthy: m4: 80.0cm±8.7, m5: 81.0cm±9.1, m6: 82.9cm±8.9; Reconstructed: m4: 79.3cm±6.8, m5: 79.4cm±8.2, m6: 81.1cm±8.5, p=0.013). directions indicating that the reconstructed limb performed worse than the healthy limb. A main effect for time was observed for the PL direction (Healthy: m4: 78.8cm±5.8, m5: 79.5cm±5.2, m6: 79.4cm±5.8; Reconstructed: m4: 77.2cm±5.9, m5:78.5cm±5.1, m6: 78.1cm±6.4, p=0.023). The YBT measured improvement in the PL direction across time in the reconstructed limb. In the PM and anterior directions, the YBT did not measure these same improvements across this period.

The use of autofluorescence stomatoscopy in the algorithm of diagnosing of the oral mucosal abnormalities of patients with tuberculosis infection

AIM. To evaluate the feasibility of using the autofluorescence stomatoscopy in dental examination of patients with tuberculosis infection.MATERIALS AND METHODS. The objects of the study were 75 patients aged 21 to 65 years (average age 47.9±2.1 years), 48 men and 27 women (64% and 36%, respectively) who are at the stages of treatment and reha bilitation of the underlying disease (pulmonary tuberculosis) in a specialized tuberculosis sanatorium. The design of the study included the generally standard stages of a comprehensive dental examination of patients, in which diseases of the oral mucosa and the red border of the lips were additionally detected using autofluorescence stomatoscopy, as well as a laboratory Candida test was carried out. The clinical picture of the diagnosed pathological conditions of the oral mucosa, autofluorescence images and their pathomorphological features were compared. The reports of the examined persons regarding the autofluorescence stomatoscopy were evaluated.RESULTS. It was shown that diseases of the oral mucosa and the red border of the lips in patients with tuberculosis infection are highly common (92%), are found more often in males and differ in the heterogeneity of their structure, which is dominated by candidiasis of the oral mucosa, traumatic lesions and various forms of cheilitis. The features of autofluorescence images of pathological conditions of the oral mucosa of different nature of the origin are marked. Positive feedback from patients after the autofluorescence stomatoscopy was recorded in 100% of cases.CONCLUSIONS. The use of the autofluorescence stomatoscopy in the algorithm of dental examination of patients with tuberculosis infection is appropriate because it allows to implement the principle of oncological alertness among specialists, helps the doctor to obtain additional information about the pathological process in real time and increases the motivation of the examined persons to maintain dental health.

Analysis of Biomechanical Gait Parameters in Patients after Total Hip Replacement in the Early Recovery Period

INTRODUCTION. The widespread use of total hip arthroplasty (THA) places high demands on the restoration of a normal gait pattern and is one of the key goals of rehabilitation. AIM. Determination of key parameters of walking in patients after THA to assess the effectiveness of restoration of the physiological gait pattern. MATERIALS AND METHODS. In a control prospective study, the main group consisted of 23 patients (11 men, 12 women, aged from 41 to 75 years, mean age 63.9 ± 9.4 years), who in the first 8 weeks after planned THA, moved with the help of assistive devices. supports (two crutches or walkers) who underwent stage II of medical rehabilitation; control group — 27 healthy people (12 men and 15 women, aged from 42 to 73 years, average age 60.9 ± 9.9 years). Spatiotemporal and kinematic gait parameters were recorded before and after the rehabilitation course using a gait simulator with biofeedback equipped with three sensors. For each leg, spatiotemporal and kinematic biomechanical parameters were separately recorded. RESULTS. All spatiotemporal gait parameters on both limbs and pelvic mobility in the sagittal plane in patients in the early recovery period after THA before the start of the rehabilitation course are significantly different from healthy people. After a course of rehabilitation, the studied gait parameters approach physiological values. The main asymmetry is observed in the single support phase from 16 % at the beginning of the course, to 10 % at the end; sagittal pelvic mobility are 2 times higher than the physiological normal meaning at the beginning of the course, without significant changes in dynamics. DISCUSSION. Disturbances in the gait pattern are observed in the majority of patients undergoing THA. Step symmetry is one of the significant parameters of walking, according to which the primary global assessment of its quality is carried out. Asymmetry of the single support phase of the limbs is a natural development of compensatory motor reactions after endoprosthetics. CONCLUSION. The gait parameters “step frequency” and “step cycle” quickly change after a course of rehabilitation and can be used to assess the locomotor activity of patients during short courses of medical rehabilitation in the early recovery period. Indicators of stance and swing phases, their symmetry changes much more slowly, can serve as criteria for assessing the effectiveness of measures taken at the stages of rehabilitation in the dynamics of gait restoration.

Use of the ECG-Controlled Six-Minute Walk Test to Assess Exercise Capacity: a Comparative Cohort Study

INTRODUCTION. In clinical practice, stress tests are carried out to draw up an individual patient rehabilitation plan, assess tolerance and optimize the load, and evaluate its clinical effectiveness. The Six-minute walk test (6MWT), in the presence of contraindications to the bicycle ergometer test or the impossibility of performing it, is a tool for assessing the response of the cardiovascular and respiratory systems to the load being performed. There is no description in the literature of the relationship between the distance traveled during 6MWT and the peak metabolic equivalent (MET) assessed during the bicycle ergometer test. AIM. Study the relationship between 6MWT indicators and the results of bicycle ergometer test in patients who have suffered a myocardial infarction. MATERIALS AND METHODS. During the examination, 56 patients underwent a symptom limited bicycle ergometer test and 6MWT, the peak MET and the distance traveled during 6MWT, as well as changes in the ECG during both tests were assessed. RESULTS AND DISCUSSION. The average values of maximum heart rate during the bicycle ergometer test and ECG-controlled 6MWT did not differ significantly. The distance in meters during 6MWT and the power of the exercise performed during bicycle ergometer test in MET have a significant relationship, which indicates the comparability of the data from these tests as a criterion of exercise tolerance. CONCLUSION. The use of 6MWT and bicycle ergometer test allows us to assess various aspects of cardiorespiratory function and physical fitness in patients undergoing a cardiac rehabilitation program. Further study of the possibility of using ECG-controlled 6MWT in the early stages of rehabilitation is necessary to create the most effective and safe physical training for patients who have suffered a myocardial infarction.

Effects of 6-Week Weighted-Jump-Squat Training With and Without Eccentric Load Reduction on Explosive Performance.

To compare the effects of 6-week barbell weighted-jump-squat (WJS) training with and without eccentric load reduction on explosive performance. Twenty well-trained male athletes were randomly assigned to either an experimental group (n = 10) or a control group (n = 10). Participants completed 12 WJS training sessions (6 sets of 5 repetitions of barbell back squat at 30% of 1-repetition maximum[1RM]) twice a week over a 6-week period. While thecontrol group used 0% eccentric loading (ie,traditional WJS), theexperimental group utilized a 50% eccentric loading reduction with a mechanical braking unit (ie,eccentric load set at 15% of 1RM). Performance assessments, including countermovement jump, 20-m sprint, standing long jump, and 1RM barbell back squat, were conducted both before (pretests) and after (posttests) the intervention. Both theexperimental group and thecontrol group demonstrated a significant increase in countermovement-jump height (+6.4% [4.0%] vs +4.9% [5.7%]; P < .001) and peak power output (+2.3% [2.7%] vs +1.9% [5.1%]; P = .017), faster 20-m sprint times (+9.4% [4.8%] vs +9.2% [5.5%]; P < .001), longer standing long jump (+3.1% [2.5%] vs +3.0% [3.3%]; P < .001), and higher 1RM back squat (+6.4% [4.0%] vs +4.9% [5.7%]; P < .001) from pretests to posttests. However, there was no significant condition × time interaction for any variable (all P ≥ .294). Both WJS training methods, with and without load reduction in the eccentric phase, effectively enhance explosive performance. Nevertheless, athletes in later stages of injury rehabilitation or intense training may find reducing eccentric load a more tolerable strategy for achieving similar performance gains compared with traditional isoinertial loading.

Cyanotic heart defects in children: neurological aspects of the problem

Background. The goal is to justify the need to monitor neurodevelopment in children with congenital heart defects (CHD) and to study neurological disorders in patients under 3 years of age with cyanotic heart defects. Materials and methods. Modern research on the neurodevelopment of children with CHD were analyzed. Sixty-two patients with cyanotic heart defects who underwent examination and surgical treatment at the Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine were studied. They are divided into 2 groups: group 1 are children with critical cyanotic CHD and group 2 — with non-critical cyanotic CHD. The control group consisted of 35 healthy patients. A neurological examination was performed using standardized neurological scales. Data processing was carried out using the Stata 12.1 licensed statistical package. Results. Neurodevelopmental disorders were diagnosed in 33 (53 %) of 62 children with cyanotic CHD: in group 1 — in 29 % of cases and in group 2 — in 24 %. These groups were statistically homogeneous in terms of gestational age (p = 0.492) and body weight at birth, with no significant difference from the control group. Older age is characterized mainly by delays in the stages of motor development (16 % in group 1 and 15 % in group 2) and speech disorders (7 % in group 1 and 3 % in group 2). Acute disorders of cerebral circulation (6 % in group 2) and the presence of epileptic seizures (up to 3 %) were characteristic of children under 1 year. Apgar score was lower in patients with critical cyanotic CHD with neurodevelopmental delay and a longer duration of artificial circulation during surgical treatment. Conclusions. 1. Neurological disorders were diagnosed in 53 % of patients with cyanotic heart defects: in 29 % with critical heart defects and 24 % with non-critical heart defects. 2. Older children are characterized mainly by delays in the stages of motor development and speech disorders. Behavioral disorders are more typical for children with non-critical CHD. Acute disorders of cerebral circulation and the presence of epileptic seizures were characteristic of children under 1 year of age. 3. The influence of body weight and gestational age on neurodevelopmental disorders is excluded. The severe state of children with neurodevelopmental delay at birth and an increase in the duration of artificial circulation during surgical treatment were found. 4. Interdisciplinary examination of patients with cyanotic heart defects, including examination by a pediatric neurologist, as well as a follow-up is necessary for timely referral to the next stages of rehabilitation.

Exploring the effectiveness of eHealth interventions in treating Post Intensive Care Syndrome (PICS) outcomes: a systematic review

BackgroundIt remains unclear how to optimise critical care rehabilitation to reduce the constellation of long-term physical, psychological and cognitive impairments known as Post Intensive Care Syndrome (PICS). Possible reasons for poor recovery include access to care and delayed treatment. eHealth could potentially aid in increasing access and providing consistent care remotely. Our review aimed to evaluate the effectiveness of eHealth interventions on PICS outcomes.MethodsStudies reporting eHealth interventions targeting Post Intensive Care Syndrome outcomes, published in Medline, CINAHL, PsycINFO, Embase, and Scopus from 30th January 2010 to 12th February 2024, were included in the review. Study eligibility was assessed by two reviewers with any disagreements discussed between them or resolved by a third reviewer. Study quality and risk of bias were assessed using the Mixed Method Appraisal Tool. Further to the identification of effective strategies, our review also aimed to clarify the timeline of recovery considered and the outcomes or domains targeted by the interventions.ResultsThirteen studies were included in our review. Study duration, eHealth intervention delivery format, and outcome measures varied considerably. No studies reported a theory of behavioural change and only one study was co-produced with patients or carers. Most studies were conducted in the early post-discharge phase (i.e., < 3 months) and had feasibility as a primary outcome. The cognitive domain was the least targeted and no intervention targeted all three domains. Interventions targeting the psychological domain suggest generally positive effects. However, results were underpowered and preliminary. Though all studies were concluded to be feasible, most studies did not assess acceptability. In studies that did assess acceptability, the main facilitators of acceptability were usability and perceived usefulness, and the main barrier was sensitivity to mental health and cognitive issues.ConclusionOur systematic review highlighted the promising contributions of eHealth with preliminary support for the feasibility of interventions in the early stages of post-critical care rehabilitation. Future research should focus on demonstrating effectiveness, acceptability, the cognitive domain, and multi-component interventions.

Analysis of legislative basis for medical rehabilitation in Russia

Background. In recent years, there have been significant changes in the regulatory documentation related to medical rehabilitation, caused by the need to consolidate the principles for rehabilitation of patients in post-COVID period and standardize the procedures used for it. Therefore, it is important to analyze the existing regulatory framework and the proposed changes that will come into force in the near future.Objective: to assess the regulatory legal acts governing the provision of medical rehabilitation in Russia.Material and methods. Regulatory legal acts and their drafts were obtained through the reference and legal systems “Kontur Standard”, “ConsultantPlus”, and the Federal Portal of Draft Regulatory Legal Acts. The following electronic libraries, databases and other sources were used to collect secondary information: eLibrary, Google Scholar, PubMed/MEDLINE, Yandex and social networks.Results. Article 41 of the Constitution of the Russian Federation guarantees the right to health protection and medical care. Within the latter the use of medical rehabilitation can be considered. Going down to the next level, the term “medical rehabilitation” is found in Federal Law dated November 27, 2011 No. 323-FZ “On the fundamentals of health protection of citizens in the Russian Federation”. However, the requirements in the field under consideration are specifically described in Orders of the Ministry of Health of Russia No. 788n and 878n, which establish a three-stage provision of medical rehabilitation and give specific time instructions for the frequency and duration of care prcedures. The conditions for the transition of patients between the stages of medical rehabilitation are presented, and creating interdisciplinary rehabilitation teams is specified.Conclusion. The analysis of innovations in the regulatory framework showed no fundamental changes in the regulation of medical rehabilitation. At the moment, there is a need to expand it by regulating the activities of multidisciplinary rehabilitation teams. A more detailed elaboration of normative documentation regulating the provision of medical rehabilitation to children is necessary.

Blood-brain barrier breach after acute cerebral hypoxia in infants

Background. Neuronal lesion, including hypoxic-ischemic damage to the central nervous system (CNS) in perinatal period, leads to the release of neuron-specific enolase (NSE) into peripheral bloodstream. Consequently, NSE can be considered as a biological marker of nervous system injury. Based on NSE level analysis, timely rehabilitation for newborns can be provided, thereby reducing the likelihood of complications associated with CNS injury.Objective: retrospective assessment of NSE level in peripheral blood over a 24-week period in infants of different gestational age with perinatal hypoxic-ischemic CNS damage.Material and methods. The study included 49 newborns who had suffered perinatal hypoxic-ischemic CNS lesion. Gestation period differed from 32 to 41 weeks. The control group consisted of 28 healthy full-term infants. NSE levels were measured using enzyme immunoassay. Patients of the main group were additionally divided into subgroups depending on Apgar scores at the 1st minute after birth, gestational age, as well as predominant CNS lesion – hemorrhagic with intraventricular hemorrhages or ischemic with periventricular leukomalacia.Results. Throughout the observation period, NSE concentrations were inversely correlated with Apgar scores: lower Apgar indicators were associated with higher NSE levels. In addition, the subgroup of 32–33-week gestational age had significantly higher NSE concentrations compared with 34–36-week, 37–41-week subgroups, and control group. NSE levels in infants with periventricular leukomalacia were consistently lower than those in newbornes with intraventricular hemorrhage starting from the 1st week. Notably, a delayed increase in serum NSE concentrations was observed at the 4th week.Conclusion. The obtained data indicate that blood-brain barrier permeability for NSE is preserved during perinatal hypoxicischemic CNS injury. Serum NSE concentration measurement can serve as a valuable tool in clinical practice for assessing the effectiveness of therapy at the stages of treatment and rehabilitation.

Neuroinflammatory Biomarkers and Their Associations With Cognitive, Affective, and Functional Outcomes 3 to 12 Months After a Traumatic Brain Injury: A Pilot Study.

Neuroinflammation is an important feature of traumatic brain injury (TBI) that remains poorly understood in the 3- to 12-month period post-TBI. The purpose of our pilot study was to examine the relationships between biomarkers of neuroinflammation and functional outcomes in TBI patients 3 to 12months postinjury. TBI patients (n =36) 3 to 12months post-TBI were recruited from a South Florida TBI clinic from May 2022 to June 2023. The Disability Rating Scale, Satisfaction with Life Scale, NIH Toolbox Sorting Working Memory, Neuro-Quality of Life Cognitive Function, Anxiety, Depression, and Sleep assessments were performed. Multiple plasma biomarkers were assayed. Analysis of variance was used to compare between-group results. Linear regression was performed to analyze relationships between biomarkers and outcomes. Brain-derived neurotrophic factor concentrations were higher as postinjury time interval increased and were associated with cognitive battery outcomes. S-100β and glial fibrillary acidic protein were associated with anxiety score and hospital length of stay; S-100β was also associated with depression. Interleukin 6 was associated with cognitive function score and time since injury. We found S-100β, glial fibrillary acidic protein, Interleukin 6, and brain-derived neurotrophic factor to play a larger role in the TBI recovery period than other biomarkers examined. Clinicians should continue to monitor for symptoms post-TBI, as the neuroinflammatory process continues to persist even into the later rehabilitation stage.

Longitudinal assessment of knee joint proprioception using weight-bearing and non-weight-bearing tests throughout rehabilitation after anterior cruciate ligament reconstruction

ObjectiveEvaluate active knee joint position sense (JPS) throughout rehabilitation after anterior cruciate ligament reconstruction (ACLR). DesignLongitudinal. SettingMotion laboratory. ParticipantsTwenty-two individuals post-ACLR and 22 activity-matched non-injured controls performed weight-bearing and non-weight-bearing knee JPS tests. The ACLR participants performed at three functional timepoints: T1, able to perform single-leg sit-to-stand; T2, able to hop maximally; T3, cleared for return to sports. Controls performed on one occasion. Main outcome measuresConstant, absolute, variable errors (CE, AE, VE) and interlimb symmetry estimates (100% signifying perfect symmetry), for 40° and 65° knee flexion target angles. ResultsFor the weight-bearing 40° condition, CE and AE of the ACLR knee significantly increased from T1 to T2 (P = 0.010) and T1 to T3 (P = 0.002). Consequently, interlimb asymmetry for AE significantly increased from T1 (AEsym% = 101.2% ± 55.4%) to T3 (AEsym% = 139.7% ± 54.8%). Compared to controls, AE for the ACLR knee was significantly smaller at T1 (P = 0.016). No other significant differences were observed. ConclusionsSmaller JPS errors at early rehabilitation while weight-bearing may have been due to heightened quadriceps activation and increased γ motor neuron sensitivity, compensating for deficient ACL mechanoreceptors. In contrast, non-weight-bearing testing did not reveal changes over time. Clinicians are advised to consider these distinctions when assessing proprioception at different rehabilitation stages.

The development of approaches to medical rehabilitation under after-troubles of acute disorders of cerebral blood circulation using International Classification of Functioning

The article presents social hygienic characteristics of contingent of persons admitted to second stage of rehabilitation in specialized rehabilitation department after ischemic stroke at early recovery period. The attention is focused on necessity of multidisciplinary approach to rehabilitation measures, taking into account the International Classification of Functioning that permits to achieve more significant results in implementation of rehabilitation measures, to reduce the number of possible complications of this disease in later period, as well as to accelerate process of returning of studied category of patients to full-fledged life.