Vol 23, No 1 (2020)

Articles
Using neuroenergy mapping to build a personalized approach to cognitive rehabilitation of patients with vascular lesions of the brain
Fry A.V., Vorontsova V.S., Pichugina I.M.
Abstract

The article describes the method of neuroenergy mapping as a way to identify the functional impairment of a structural structural brain in cognitive disorders, which in turn allows instrumental confirmation and justification of the causes of changes in neuropsychological status, as well as individually selected cognitive load, taking into account sex, age and characteristics of the lesion the brain of the patient. In patients using the NEC method in 5 standard leads, the state of brain energy activity was recorded. Then he was offered tasks from the album for a neuropsychological examination of A.R. Luria as a cognitive load: in memory, the elimination of superfluous, storytelling and others. After completion of the cognitive load, the indicators of the patient’s brain energy activity were again recorded. According to the results of data processing, patients were adjusted recommendations for cognitive load.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(1):5-8
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Neural network analysis of heart rhythm variability for diagnosis of immobilization syndrome and objectivization of effectiveness of early rehabilitation
Nekrasova J.Y., Yankevich D.S., Kanarsky М.М., Markov A.S.
Abstract

The article discusses the use of a neural network analysis of heart rate variability for the diagnosis of immobilization syndrome and post-intensive care syndrome (PICS) in patients with disorders of consciousness for monitoring the quality of the rehabilitation process. It is shown that there are statistical differences between the curves characterizing the heart rate variability of healthy patients and patients with impaired consciousness. The use of a neural network allows to automatically evaluate the severity of the immobilization syndrome and Post Intensive Care Syndrome, as well as the effectiveness of measures for their prevention and the overall quality of the work of medical personnel.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(1):9-17
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Sternomastoid after cardiac interventions (questions treatment and rehabilitation)
Kosenkov A.N., Vinokurov I.A., Al-Usef A.
Abstract

Sternomediastinitis is one of the formidable complications of cardiac surgery with high disability mortality up to 40%. The introduction of a vacuum-assisted dressing, as well as active surgical technologies in the treatment of these patients, have reduced the duration of hospitalization, the level of disability and mortality. However, a number of unresolved issues remain related to the rehabilitation of these patients.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(1):18-23
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Rehabilitation forecast markers: complex assessment of damaged brain using electroencephalogram (EEG) and somatosensory evoked potentials (SSEP)
Shpichko A.I., Shpichko N.P., Bosenko S.A.
Abstract

Identifying rehabilitatory prognosis markers while the patient is in Intensive Care Unit (ICU) is an important diagnostic task that rehabilitation program depends on. Post-coma recovery procedures reintegrate functions of damaged brain regions in patients with consciousness disorders and aim for improving thalamocortical interactions in terms of neuroplasticity. In this paper we study electroencephalographic (EEG) and somatosensory evoked potentials (SSEP) data of 50 patients with post-coma consciousness disorders as a result of severe brain damage. The reasons for consciousness disorders in studied patients include acute blood circulation arrest, traumatic brain injury and brain hypoxia. Patients were diagnosed with EEG and SSEP on the day of arrival to ICU and between 35th and 45th day of their stay in the hospital. As a result of this study, we identified neuroplasticity markers related to rehabilitatory process on the basis of assessment of data produced by widely accessible neurophysiological methodologies.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(1):24-28
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Current problems of medical and social expertise
Puzin S.N., Dmitrieva N.V., Paikov A.Y., Filippov V.V., Erkenova F.D., Fizitskaya V.D.
Abstract

This article analyses legal framework of medical and social expertise. We have assessed and identified negative aspects of the existing order of interaction between health facilities and bureaus of medical and social expertise during disability determination. We have established the key role of health facilities in determination of persons that need social protection and rehabilitation because of persistent impairments of health. The article reflects significant gaps in the Classifications and Criteria, that are used in practice of bureaus of medical and social expertise, during development and implementation of individual rehabilitation and habilitation plan of a person with disabilities.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(1):29-37
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Telemedicine as a perspective instrument for developing mobile rehabilitation technology (on the example of FNKC RR)
Pryanikova N.I., Polikarpova O.S., Ibragimova K.S., Bushueva E.V.
Abstract

Among the innovative technologies of medical care for citizens with impaired consciousness, a special place is occupied by the technology of mobile rehabilitation service (MRS), with the help of which a wide range of patients are served at home, and their relatives and friends receive extensive counseling. The practice of the Federal State Budgetary Institution “Federal Scientific and Clinical Center for Resuscitation and Rehabilitation” indicates the high efficiency of mobile rehabilitation in this category of patients. Positive experience can be developed, incl. due to the use of telemedicine after completion of the main rehabilitation course. The methodology, in which online sessions and consultations are conducted using video conferencing technology, can significantly increase the territorial coverage of MRS patients, and ensure the continuity of rehabilitation. A special place is given to the interaction of a speech therapist with patients and their relatives, in the framework of which the course of medical and social rehabilitation is continuing. It is stated that the use of telemedicine contributes to the development of remote rehabilitation of handicapped patients with impaired consciousness at home. The accumulated experience allows us to recommend the extensive use of a combination of technologies of MPC and telemedicine, thereby greatly expanding the rehabilitation potential of a significant number of patients at home. It seems expedient to scale up and replicate the experience of MRS FNKC RR within the framework of medical rehabilitation institutions in the country, as well as to raise discussion about the possibilities of expanding the practice of distance counseling and receptions to other stages of mobile rehabilitation.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(1):38-41
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Statistics of melanoma in Russia and Europe
Erkenova F.D., Puzin S.N.
Abstract

The article considers the laws of the epidemic process of skin melanoma in Russia and European countries over the past half-century. Attention is given to the sharp increase in incidence worldwide, and, particularly in Russia. Increasing incidence occurs mainly due to the popularization of outdoor recreation, the fashion for intense tan and frequent tourist trips to mountainous regions and tropical countries. Early diagnosis and prevention are the main measures for reducing the growth of morbidity and mortality from skin melanoma.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(1):44-52
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Learning is light. Not scientists-darkness. Psychology and rehabilitation. Microminiature
Mironova-Khodorovich A.Y., Kiseleva E.V.
Abstract

Microkinesitherapy is a little-known, but the most effective method of rehabilitation of patients, allowing to restore the body’s strength after psychological and physical trauma.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(1):53-56
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Glycogen-storage disease type 1: medical and social alertness
Gimaev I.A., Bondar V.A., Lushnikova E.J., Borisov I.V., Kanarskii M.M., Nekrasova J.Y.
Abstract

Orphan hereditary pathologies are an urgent medical problem. Metabolic diseases have a special place among them. Currently they include about 500 nosological forms, in particular glycogen diseases. Type 1b glycogen disease (GB1b) occupies a special place. In addition to metabolic disorders, patients with this disease have severe neutropenia, which leads to frequent recurrent infectious diseases, such as stomatitis, periodontitis, furunculosis, otitis, colitis, gingivitis. In addition, recent studies showed the presence of lymphocytic dysregulation in patients with GB1b which is associated with T-regulatory lymphocytes dysfunction. It leads to an increased risk of developing autoimmune diseases, such as autoimmune thyroiditis, myasthenia gravis, Crohn’s disease, ANA-associated vasculitis. In addition, there is evidence about the association of GB1b and oncological pathologies, such as giant bone cell tumor, acute myeloid leukemia. According to such a wide variety of clinical manifestations, knowledge of the pathogenesis and possible non-metabolic manifestations is necessary for proper diagnostics and therapy.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(1):57-62
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The use of indicators of the regeneration of decubital ulcers in a comprehensive assessment of the nutritional status of patients in a chronic critical illness
Yakovleva A.V., Altuhov E.L., Gorshkov K.M., Yakovlev A.A., Osmanov J.G., Shestopalov A.E., Shulutko A.M., Shchelkunova I.G., Gandybina E.G.
Abstract

Background: Thanks to advances in emergency medical and surgical care, the number of patients experiencing acute critical illnesses is increasing. However, a group of patients in the so-called chronic critical illness (CCI) was formed. In this category of patients, the problem of treating decubital ulcers is relevant, since they are characterized by a combination of prolonged immobilization, severe protein catabolism, neuroendocrine and metabolic disorders, protein-energy malnutrition (PEN) and tissue trophic disorders.

Aims: Analyze the correlation of the degree of regeneration of decubital ulcers according to the Bates-Jenson scale in the modification S.Y.R. in relation to indicators of the nutritional status of patients in the CCI after brain damage.

Materials and methods: The study included 26 patients with pressure ulcers II, III, IV stage with PEN. To evaluate decubital ulcers, the adapted Bates-Jensen scale in the S.Y.R. modification was used. (with graphic model). The severity of PEN was evaluated by a complex of anthropometric (BMI, shoulder circumference, thickness of the skin-fat fold, circumference of the shoulder muscles) and laboratory (transferrin, absolute lymphocyte count) indicators. The dynamics of anthropometric indicators and the results of laboratory studies were separately considered.

Results: As a result, it was found that the change in anthropometric data correlated with laboratory parameters and the healing rate of decubital ulcers in only 26.9% of cases. Moreover, this correlation between the dynamics of transferrin and the absolute number of lymphocytes with the regeneration of decubital ulcers was observed in all patients. The obtained results demonstrated a direct correlation between the dynamics of healing of pressure ulcers and changes in laboratory indicators of nutritional status (as opposed to anthropometry data) in patients who are in a CCI after brain damage.

Conclusions: These findings provide an opportunity to review the weight of indicators in assessing the severity of protein-energy malnutrition, as well as introducing the rate of regeneration of a decubital ulcer in the presence of a patient into the assessment of the nutritional status.

Medical and Social Expert Evaluation and Rehabilitation. 2020;23(1):63-68
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