Stage Of Medical Rehabilitation Research Articles

The use of an exoskeleton in the comprehensive rehabilitation of patients with impaired motor activity

Abstract. Purpose of the study: to evaluate the effectiveness of comprehensive rehabilitation of patients with impaired mobility using the E-Helper exoskeleton and a treadmill in a day hospital. Materials and methods. The study involved 42 patients with mobility impairments who underwent the third stage of medical rehabilitation in the day hospital at the Republican Medical and Physical Education Center, Ufa. The study participants were divided into two equal groups, comparable in terms of the main studied indicators. The patients in the control group (CG, n = 21) received a basic complex consisting of therapeutic exercises, mechanotherapy using the FISITEK 2000TS device, magnetic therapy from the ALIMP-1 device, and sessions with a psychologist. The patients of the study group (SG, n = 21) were additionally prescribed exercises on the exoskeleton and a treadmill for 30 minutes daily, 10 procedures per course. To analyze the effectiveness of rehabilitation, we used the modified Rankin scale and the Visual Analogue Scale (VAS) for pain intensity; to assess the patient»s locomotor function, the Hauser Ambulation Index and the EQ-5D quality of life questionnaire were utilized at the start of the study and at the end of the rehabilitation course (after 14 days). Results. It has been found that the use of an exoskeleton in the patients of the study group contributes to a more significant improvement in locomotor function, a decrease in functional dependence on external assistance, and an improvement in the quality of life of patients with impaired mobility compared to the control group.

Personalized approach to the logopedic rehabilitation of neurogenic dysphagia patients

Aim. To determine the role of personalized approaches in the rehabilitation of patients with neurogenic dysphagia after acute disorders of cerebral circulation (ADCC) in the early recovery period.Materials and methods. The study included 97 patients (53 men and 44 women with the mean age of 69.5) in the early recovery period after ADСС. All the patients were at the second stage of medical rehabilitation. The treatment program included the following methods of logopedic rehabilitation: disinhibition of the act of swallowing; stimulation of the sensitivity of the mucous membranes of the oral cavity; recovery of respiratory and speech functions; selection of the consistency of liquid and solid foods to ensure the safety of swallowing during feeding; selection of the feeding method and appropriate portions to facilitate the patient’s eating.Results. When developing a personalized program of logopedic rehabilitation, the following aspects were considered: the severity of swallowing dysfunctions; the primary speech defect; patient compliance; the degree of cognitive dysfunctions; motivation for recovery.Conclusion. The application of logopedic rehabilitation methods in combination with specialized multidisciplinary care based on personalized approaches can significantly improve patients’ quality of life and reduce the risk of undesired complications.

Art therapy in the correction of the psychoemotional state of patients who have suffered stroke at the stage of medical rehabilitation

Art therapy in the correction of the psychoemotional state of patients who have suffered stroke at the stage of medical rehabilitation

Nutritional status and nutritional support of patients with chronic disorders of consciousness at the stage of medical rehabilitation

Chronic disturbances of consciousness (CDC) are a consequence of severe brain damage and are conditions that arise after emerging from a coma with the preservation of the sleep-wake cycle in the absence of signs of conscious behavior. When conducting inpatient medical rehabilitation of this group of patients, the state of nutritional status is not always taken into account and, as a rule, there is no nutritional support with an assessment of metabolic needs, including the introduction of various modes of physical activity during physical therapy and an increase in physical load on the patient's body. The purpose of the study was to assess the nutritional status and optimize the nutritional support system in patients with CDC at the inpatient stage of medical rehabilitation (MR). Material and methods. The study analyzed the results of examination and treatment of 152 patients with CDC of traumatic origin who received medical rehabilitation from 2016 to 2022 in the Department of Physical and Rehabilitation Medicine of the Nikiforov Russian Center of Emergency and Radiation Medicine, Ministry of Russian Federation for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters. Results. In patients with CDC of traumatic genesis, signs of malnutrition (objective, anthropometric, laboratory) were diagnosed at the inpatient stage of MR, and there were also risks of malnutrition progression with the introduction of additional physical activity. Conclusion. To create an effective and adequate nutritional support system during inpatient MR, metabolic monitoring (indirect calorimetry) is of fundamental importance, taking into account the influence of additional physical activity. The use of a calculation method for estimating energy requirements can lead to hyperalimentation.

STABILOMETRIC ANALYSIS OF MOTOR DISORDERS IN PATIENTS WITH ISCHEMIC STROKE IN THE CAROTID ARTERY IN THE EARLY REHABILITATION PERIOD

The purpose of the study is to analyze stabilometric parameters for motor disorders in patients with an ischemic stroke in the carotid artery in the early rehabilitation period and to monitor their dynamics under rehabilitation therapy with biofeedback (BFB) stabilization training.
 Materials and Methods. The study involved 24 patients aged 44–75. We chose the patients with mild and moderate motor impairments who were at the second stage of medical rehabilitation at Bryansk City Hospital No. 1. The patients suffered stroke 1–6 months ago. The stabilographic study was carried out on a BFB stabiloanalyzer “Stabilan-01-2” (RITM, Taganrog). The stabilometric training consisted of 7–10 sessions and included various computer games taking into account the type of paresis, the severity of coordination disorders and individual load tolerance. At the beginning of therapy, training lasted 5–10 minutes but gradually it increased up to 15–20 minutes. MS EXCEL and IBM Statistica 12.0 were used for statistical analysis of the obtained data. The Wilcoxon test was used to assess the dynamics. All obtained differences were significant (p≤0.05).
 Results. During the study, a change in stabilometric parameters was noted towards a decrease in the main parameters of the stabilographic test (“Frontal spread” (p=0.049), “Mean spread” (p=0.045)) and the Romberg test (“Mean spread” with eyes closed (p=0.046) and “Time rate of statokinesigram area” with eyes closed (p=0.043)), which indicated an improvement in the patients’ motor skills during rehabilitation therapy.
 Conclusions. The results of the analysis allow us to consider stabilization training with biofeedback an effective treatment modality in the early rehabilitation period for patients with ischemic stroke in the carotid artery.

Organization of Remote Rehabilitation in the Russian Federation: a Literature Review

INTRODUCTION. The interruption of the recovery process and the absence of patients’ activities at home after discharge from a medical institution leads to the loss of results achieved at various stages of medical rehabilitation. In this regard, the remote (telemedicine) form of rehabilitation assistance is of particular importance.
 AIM. To present up-to-date data on the legal and regulatory framework for telemedicine in the Russian Federation, as well as an overview of domestic Internet platforms in the field of remote medical rehabilitation.
 MATERIALS AND METHODS. The search for normative legal acts was carried out on the “The official Internet portal of Legal Information” (www.pravo.gov.ru). The literature review was performed using the databases eLibrary, Cyberleninka, PubMed, Scopus, Web of Science (Core Collection) and Google Scholar by July 31, 2023 for the following keywords: telemedicine, remote physical rehabilitation, medical rehabilitation, functional recovery.
 RESULTS. The article elaborates on the legal and regulatory framework of telemedicine in the Russian Federation, provides a list of domestic Internet portals that are now being employed to provide remote medical care.
 CONCLUSION. The remote form of arranging rehabilitation is supported by the regulatory and legal framework and has promising outlooks for development due to the advent of new information technologies that allow for active communication between a medical worker and a patient. Nevertheless, the issues of effectiveness and safety of remote physical rehabilitation remain insufficiently studied, therefore, it is necessary to conduct randomized comparative studies analyzing long-term results.

ОЦЕНКА ТОЛЕРАНТНОСТИ К ФИЗИЧЕСКОЙ НАГРУЗКЕ НА СТАЦИОНАРНОМ ЭТАПЕ РЕАБИЛИТАЦИИ У ЛИЦ, ПЕРЕНЕСШИХ ОСТРЫЙ КОРОНАРНЫЙ СИНДРОМ

Abstract. Introduction. It is proven that integrated cardiac rehabilitation helps reduce mortality and hospital readmission rates and improves the quality of life of patients with acute coronary syndrome experience. Key aspect of integrated cardiac rehabilitation is aerobic training contributing to higher exercise tolerance. Aim. This research aims at assessing the changes in exercise tolerance in acute coronary syndrome patients at the second stage of medical rehabilitation. Materials and Methods. The research involved 162 patients of the Department of Medical Rehabilitation of Adult Patients with Somatic Diseases, who have experienced acute coronary syndrome. To assess the patients’ exercise tolerance, we used the six-minute walk test under electrocardiography control with the Accordix system (Neurosoft, Russia) upon their admission and immediately before their discharge from the hospital. Along with drug therapy, the personalized medical rehabilitation plans included electrocardiography-controlled aerobic training, laser therapy, psychological intervention, and occupational therapy classes. Rehabilitation efficiency was assessed by six-minute walk test (m) and Functional Independence Measurement (FIM) scale (score). The findings were analyzed statistically using nonparametric criteria. Results and Discussion. There were reduced exercise tolerance and limited daily activities in a significant part of cardiological patients before admission to the hospital. Upon completion of the medical rehabilitation course, the patients’ exercise tolerance increased significantly, resulting in better individual exercise tolerances, longer distances covered within the six-minute walk test, and the larger total amount of daily activities the patients can perform. Conclusions. Electrocardiography-controlled physical training based on the patient’s initial stamina level promotes increasing their exercise tolerance, their tolerance to daily activities, their mobility, independence, and, accordingly, their life quality.

Pelaksanaan Rehabilitasi Terhadap Pecandu Narkoba di Kota Ambon

Introduction: The implementation of rehabilitation for drug addicts in the city of Ambon is not yet in accordance with what is mandated by law.Purposes of the Research: This study also aims to analyze and discuss the implementation of rehabilitation for narcotics addicts in the city of Ambon in accordance with Law No. 35 of 2009 and to analyze and discuss the obstacles faced in the implementation of rehabilitation for narcotics addicts in Ambon City.Methods of the Research: The type of research used is normative juridical research using a statute approach, a conceptual approach, and a case approach. The legal materials used are primary legal materials, secondary legal materials and tertiary legal materials.Results of the Research: Although the implementation of rehabilitation is a recommendation by the Assessment Team to victims of drug abuse and drug addicts to carry out medical rehabilitation and social rehabilitation, all stages such as the stage of medical rehabilitation (Detoxification), the non-medical rehabilitation stage and the further development stage have not been carried out properly. Apart from that, the process of implementing rehabilitation for drug addicts is only carried out through outpatient treatment while inpatient treatment is never carried out so that the guarantee for narcotics addicts to receive medical rehabilitation and social rehabilitation in accordance with the mandate and objectives of drugs in the Law cannot be fulfilled properly. Obstacles in implementing rehabilitation for drug addicts in the city of Ambon include: The law or the law itself does not clearly regulate the availability of facilities (rehabilitation centers or places) and infrastructure (financial) to support the implementation of rehabilitation and there is still a lack of medical personnel and staff. - specialist staff to support the implementation of social rehabilitation and medical rehabilitation

Исследование психометрических свойств «Госпитальной шкалы тревоги и депрессии» (HADS), рекомендованной для врачей общесоматической практики, на выборке пациентов с нарушением двигательных функций

<p style="text-align: justify;">The aim of the study is to investigate the psychometric characteristics of the Hospital Anxiety and Depression Scale (HADS) on a sample of patients with impaired motor functions. HADS was used to examine the current psychoemotional state of 73 women and 27 men aged 62.1±13.7 years who were in the hospital for inpatient rehabilitation for motor function disorders arising from a stroke (n=50) or developing against the background of chronic musculoskeletal disorders (n=50). Independent of the psychologist, a psychiatrist examined the same patients, filling out Hamilton Anxiety and Depression scales. A comparison of the findings led to the conclusion of overdiagnosis with the HADS subscales. At the same time, it is shown that the questionnaire items have satisfactory indices of discriminativeness and internal reliability. The combination of low content and convergent validity of some items of the questionnaire allowed modifying subscales, reducing the number of items without prejudice to psychometric characteristics. By comparing the data obtained with an objective external criterion for the Anxiety (HADS-A) and Depression (HADS-D) subscales, new cutoffs (9 points) were determined for diagnosing the presence or absence of anxiety and depression, which allows to use this version of the test more effectively for screening the current psychoemotional state in patients with impaired motor functions who enter the second stage of medical rehabilitation.</p>

ВОЗМОЖНОСТИ ПРИМЕНЕНИЯ МАНУАЛЬНЫХ ТЕХНИК В КОМПЛЕКСНОЙ РЕАБИЛИТАЦИИ У ПАЦИЕНТОВ С МИОФАСЦИАЛЬНЫМ БОЛЕВЫМ СИНДРОМОМ ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА

Manual therapy, as a type of rehabilitation for TMJ pain, should be considered as an effective technique due to the low risk of complications at all stages of medical rehabilitation.

Experience of using rhythmic transcranial magnetic stimulation, extracorporeal shock wave therapy and botulinotherapy in individual motor recovery programs in patients with spastic paresis of the lower limb

Walking disorder is one of the most frequent consequences of stroke and traumatic brain injury, occurring in 80% of cases. Spastic paresis of the muscles of the lower extremity is the cause formed in 20-40% of patients within a few weeks after brain damage. In this case, a complex of symptoms occurs: motor deficiency (muscle paresis), increased muscle tone (spasticity), biomechanical changes in muscles, joints and surrounding tissues, contractures. Recovery of walking is a difficult task due to the peculiarities of its organization in the norm. At the same time, changes occurring in the muscles of the lower limb after a stroke, their modular reorganization, the formation of various pathological patterns, violation of the regulation of movements by the central nervous system, rapidly occurring changes in muscles, ligaments, complicate this process. Improving walking is one of the most important priorities of rehabilitation. Already at the second (stationary) stage of rehabilitation, patients have a lack of proper support on the lower limb, which inevitably leads to excessive load on the second limb, a change in the body scheme, incorrect foot placement, violation of the mechanics of walking (moving from heel to toe) due to plantar flexion / turn of the foot, etc. All this makes patients dependent on outside help, and walking unsafe, increases the risk of falls and complications (arthropathy, contracture, etc.). In this regard, it is important to timely diagnose the totality of changes in the lower limb and create optimal comprehensive rehabilitation programs using highly effective treatment methods aimed at reducing the severity of the motor defect, reducing spasticity and preventing complications. The article discusses the place of rhythmic transcranial magnetic stimulation, extracorporeal shock wave therapy and botulinum therapy during rehabilitation in patients with spastic paresis of the lower limb after a stroke. The results of the protocol of clinical approbation «Complex rehabilitation of patients with lower limb spasticity after focal brain damage at the second stage of medical rehabilitation» are presented.

Resolution of the expert panel «Optimization of care for patients with ischemic stroke at all stages of medical rehabilitation»

Resolution of the expert panel «Optimization of care for patients with ischemic stroke at all stages of medical rehabilitation»

Medical rehabilitation technology for patients after high-tech joint and spine surgeries

Approximately 6 thousand endoprosthesis surgeries of hip, knee and spine stabilization are annually performed in older patients in the Irkutsk region. Patients require a second stage of medical rehabilitation — in a specialized rehabilitation unit. The article presents the technology of medical rehabilitation, which is used for this group of patients, including assessment of rehabilitation prognosis, application of physical rehabilitation methods, correction of somatic pathology and psychological status. Aim: to improve the immediate and long-term results of hip and knee endoprosthetics, spine stabilization surgeries by developing a system of rehabilitation measures based on individual patient parameters and aimed at optimal restoration of function. Materials and Methods. The focus of the investigation was on the patients from the Medical Rehabilitation Department, Clinical Hospital of the ISC SB of the RAS. Patients affected with coxarthrosis, gonarthritis, osteochondrosis of the spine, who had undergone joint replacement or stabilizing spinal surgery in the Medical Rehabilitation Department of Irkutsk Scientific Center of Surgery and Traumatology, 5–7 days before transfer to the Medical Rehabilitation Department of Clinical Hospital of the ISC SB of the RAS. The subjects also underwent clinical, paraclinical, locomotive, physical examination and laboratory test; physical activity assessment and estimation of indicators of the integral rehabilitation scale, the medical rehabilitation scale and the physical activity scale were performed as well. In the course of medical rehabilitation, patients received physiotherapeutic appointments, physiotherapy exercises, correction of somatic pathology, and correction of psychological status. Results. In 2020–2021, 240 older patients were treated in the Medical Rehabilitation Department after large joints arthroplasty and spinal reconstructive surgeries. The technology of medical rehabilitation was used for these patients. As a result, pain syndrome was eliminated, contracture of the operated joint was stopped, locomotor function improved, patients' physical activity and self-care ability were optimized, and somatic disorders were corrected. In addition, our own scales have been developed and improved: the Integral Rehabilitation Orthopedic Scale, the Individual Physical Activity Scale. Conclusion. Implementation of this rehabilitation technology has significantly optimized the outcomes of large joints arthroplasty or spinal reconstructive surgeries.

Мedical rehabilitation of children with spinal dysrafism

The development of a system of staged medical care for the medical rehabilitation of children with spinal dysraphism is an important and urgent task of pediatrics.
 Spinal dysraphism is accompanied by flaccid paresis or paralysis of the lower extremities, as well as a violation of the function of the pelvic organs. In most cases, various deformations of the feet are observed, congenital dislocations of the hip are often found.
 Medical rehabilitation begins immediately after surgical treatment in intensive care units and specialized departments. At the first stage, one of the important tasks is the correction of pelvic disorders. For this purpose, electrical stimulation, drug electrophoresis, magnetotherapy are used depending on the type of neurogenic bladder dysfunction. Currently, the effectiveness of high-intensity pulsed magnetotherapy in children with areflex bladder has been proven. The second stage of medical rehabilitation should be carried out if available in rehabilitation departments, medical rehabilitation centers and aimed at correcting motor impairment. Along with instrumental physiotherapy, modern technologies of physiotherapy exercises are actively introduced, aimed at strengthening the muscles of the lower extremities, preventing muscle atrophy.
 The third stage of medical rehabilitation is the longest, carried out on an outpatient basis and includes various health technologies, such as aeroionotherapy, halotherapy, balneotherapy, and mud therapy.
 Timely implementation of rehabilitation measures with the inclusion of physical factors in the early postoperative period and the consistent expansion of physiotherapy and kinesitherapy technologies at all stages of medical rehabilitation significantly increases the effectiveness of rehabilitation of patients with spinal cord injuries and improves their quality of life.

Rehabilitation of patients after a new coronavirus infection COVID-19 at the second and third stage

BACKGROUND: Patients who have undergone a COVID-19 infection are in need of comprehensive rehabilitation, taking the polysyndromic manifestations of the post- COVID syndrome and comorbidities into account.
 AIM: The purpose of this article is the need to evaluate the effectiveness of medical rehabilitation programs for patients who underwent a COVID-19 infection at the second and third stages of medical rehabilitation from the standpoint of evidence-based medicine.
 MATERIALS AND METHODS: 330 medical rehabilitation programs for patients who had a COVID-19 infection were examined. All patients underwent functional tests: control of blood oxygen saturation (SpO2), spirometry, Stange and Gench tests, testing on the Borg exercise tolerance scale and the MRC dyspnea scale; the EQ-5D quality of life questionnaire was completed. Patients were divided into 2 representative groups (160 and 170 people). The average duration of treatment was 14 days. The methods of physical and rehabilitation medicine: therapeutic exercises, breathing exercises, inhalation therapy were applied to the patients in the observation group. Patients in the observation group underwent rehabilitation treatment programs depending on comorbidities and severity of symptoms in organs and systems. The survey was conducted on at 2 control points: 1 day (first), 14 day (second).
 RESULTS: The observation group showed significantly better recovery results (p 0.05). The average values of the Stange and Gench samples showed a positive trend. There was an improvement in the subjective assessment of the tolerability of the 6-minute walk test on the Borg scale, a decrease in the severity of dyspnea on the MRC dyspnea scale, and an improvement in the quality of life on the EQ-5D scale.
 CONCLUSION: The structure of the rehabilitation programs used in the clinic of medical rehabilitation and recovery treatment was analysed, showing positive results that have indicated the effectiveness of the methods of physical and rehabilitation medicine in patients with various manifestations of post-COVID syndrome.

Issues of ensuring medical care continuity at the stages of medical rehabilitation in patients with the novel coronavirus infection COVID-19

The pandemic of the novel coronavirus infection COVID-19 has led to a public health emergency. The feature of the course of the novel coronavirus infection is the fact that even patients who have had the disease in mild or moderate to severe forms develop various functional disorders, the symptoms of which significantly worsen their functional state in the short and long term, indicating the need for rehabilitation treatment. To ensure the continuity of medical care for patients with COVID-19 at different stages of medical rehabilitation, a standardized assessment of the functional state with the development of a rehabilitation protocol is necessary.

Physical Rehabilitation in the System of Remedial Treatment of Patients after COVID-19: a Review

INTRODUCTION. The global spread of the new coronavirus infection COVID-19 determines the relevance of studying the clinical features and long-term consequences of the disease in children. Respiratory tract lesions in COVID-19 are the most common symptoms in the pediatric population. At the same time, the possibility of the development of gastrointestinal, neurological and psychological disorders has now been established, which is important to consider when designing medical rehabilitation programs for such patients. RESULTS AND DISCUSSION. The article describes modern approaches to the organization of 3-stage medical rehabilitation of patients who have undergone a new coronavirus infection COVID-19. Medical rehabilitation of such patients is aimed at restoring the ventilation function of the lungs, improving bronchial patency and drainage function of the respiratory tract, normalizing the functional state of the cardiovascular system, gastrointestinal tract, muscle tone, increasing exercise tolerance and the defenses of the child’s body. The most important component of rehabilitation measures, in addition to drug therapy and physiotherapy methods carried out for such patients, is physical rehabilitation, that is, the use of physical exercises for therapeutic, preventive and rehabilitative purposes. The authors describe the main tasks, means and forms of physical therapy, motor modes and intensity of load for each stage of medical rehabilitation, the principles of a differentiated approach to the selection of basic physical rehabilitation measures taking into account the target organ, the stage of medical rehabilitation are presented. CONCLUSION. Physical rehabilitation is a mandatory component of the individual medical rehabilitation program for children who have suffered COVID-19. The differentiated application of physical rehabilitation, taking into account the target organ, the severity of the disease, the stage of medical rehabilitation, makes it possible to achieve an earlier and complete restoration of the impaired functions of various organs and systems.

Strengthening medical rehabilitation services in health system: a situation analysis

Objective: to evaluate the effectiveness of changes in the legal framework that regulates medical rehabilitation (MR) in the Russian Federation.Material and methods. We analyzed the valid Order of the Ministry of Health of the Russian Federation of June 31, 2020 No. 788n “Organization of medical rehabilitation of adults”, which came into legal power on January 1, 2021. It was proposed for public discussion on the introduction of amendments (project of amendments). The changes proposed in the project were compared with the original text of the document. Besides, other legal documents on the organization of medical rehabilitation were analyzed.Results. Order No. 788n regulates the stages of MR, specifies the formation and realization of an individual plan for a multi-disciplinary rehabilitation team based on the evaluation by Rehabilitation Routing Scale. The document includes in-house protocols of profile inpatient and outpatient departments of medical institutions, standards for doctor’s offices equipment, organization of day-time inpatient department, and regulations for MR centers. The project of amendments contains a variant of involvement of the existing additional Groups 1 and 2 medical divisions for the organization of MR, and limitation for the Stage 2 of MR in inpatient settings, which is now possible only for patients who need 24-hour care.Conclusion. The proposed changes have evolutionary character. A lot of issues in the regulatory framework of MR remain unsolved. It is necessary to improve the state policy for MR and perform further clinical studies of its benefits.

Application of Physical Factors at the First Stage of Medical Rehabilitation after Radical Surgical Treatment of Breast Cancer

There are a large number of publications confirming the clinical safety of the of physiotherapy application in patients with malignant neoplasms of the breast, but scientific studies on the physical factors complex use in medical rehabilitation of this group of patients in the early postoperative period have not been published yet. Aim. To determine the effectiveness of fluctuating currents in combination with pneumocompression, general magnetotherapy, local magnetotherapy, low-temperature argon plasma applied for patients after radical surgical treatment of breast cancer in the early postoperative period. Material and methods. A prospective, simple, randomized study involving 190 women diagnosed with breast cancer in the early postoperative period after radical Madden mastectomy or radical breast resection (2–4 days) was performed, the average age was 58±10.61 years. The control group consisted of patients included in the course of rehabilitation (exercise therapy, balance therapy and classes with a medical psychologist) fluctuating currents. Low-temperature argon plasma, intermittent pneumocompression, general and local magnetotherapy were added to fluctuations for patients in the main groups. Results and discussion. The analysis of the clinical and functional data showed that in the early postoperative period for breast cancer against the background of the standard drug therapy and the course of medical rehabilitation, the combination of fluctuating currents with intermittent pneumocompression, general and local magnetotherapy significantly reduced the degree of the upper limb edema and the volume of lymphorrhea. The addition of general and local magnetotherapy affects the decrease in the indicators of the shoulder girdle and forearm muscles electrical excitability. Low temperature argon plasma improves the regeneration of the postoperative suture and reduces swelling and inflammation in this area. The dynamics of the decrease in the level of anxiety and depression, pain syndrome and the general condition of cancer patients are most pronounced in the groups that additionally received magnetotherapy. The volume and quality of movements, muscle strength significantly increased in all groups without differences in results. The action of magnetic fields contributes to the increase of tissue oxygenation, due to which an anti-inflammatory and decongestant effect is realized. Fluctuation of the shoulder girdle and forearm muscles leads to normalization of the functional electrical excitability of the muscles by surgical treatment, which allows to restore the motor stereotype of the limb in a short time, and intermittent pneumocompression affecting the skin and tissue structures of the lower extremities and trunk improves the overall lymph flow, which does not lead to stagnation of lymph in the operated area. Conclusion. Thus, the combined application of physical factors against the background of the standard drug therapy and the course of medical rehabilitation significantly improves the result and recovery time after surgical treatment of the breast cancer in the early postoperative period. A comprehensive approach to medical rehabilitation at the I stage led to the preservation of results in the long-term period 1.5 and 6 months after the operation without adverse events.

Impact of the physical rehabilitation onset time in early recovery period of ischemic stroke (second stage of medical rehabilitation) on the level of daily activity and independence

Ischemic stroke (IS) is the leading cause of neurological inpatient care, readmission, and long-term disability. Until now, there is no single point of view on when the second stage of medical rehabilitation after an IS should be started and the amount of the rehabilitation activities.Objective: to compare the effectiveness of the course of motor rehabilitation during the first 30–90 days and 91–180 days after IS.Patients and methods. The patients were divided into two groups: group 1 included 44 patients in whom ≤3 months passed from IS onset, and group 2–39 patients in whom >3 but <6 months have passed since the IS onset. All patients included in the study received physiotherapy exercises, simulator exercises, robotic mechanotherapy, physiotherapy, massage, speech therapy, cognitive training, and secondary IS prevention.Results and discussion. In both groups patients got a positive treatment result: a significant increase in muscle strength, gait stability, quality, and speed. The number of patients who achieved independence (≤2 points on the Rankin scale) before the start of the rehabilitation course among patients of group 1 was 9.4%, after the end of the course – 40.6%. More initially independent patients were included in the group 2 – 28.6%; after a course of rehabilitation, the proportion of independent patients increased to 35.7%.Conclusion. Rehabilitation courses are effective in patients who have had IS, both in the first three months and in the period from the 4th to the 6th month. It is advisable to conduct the second stage of medical rehabilitation earlier after a stroke.