Bulletin of Rehabilitation Medicine

INTRODUCTION. The problem of recurrent antibiotic-resistant urogenital infections is increasing, and standard therapy is becoming ineffective. Sanatorium-resort treatment of chronic inflammatory diseases of the pelvic organs in women allows us to solve these problems with the help of natural and preformed physical factors.

AIM. To study the clinical effectiveness of comprehensive sanatorium treatment programs in patients with chronic endometritis.

MATERIALS AND METHODS. A prospective randomized trial included 73 patients, aged 35 ± 10 years, diagnosed with chronic endometritis. The control group (n = 25) received «basic» therapy with amplipulstherapy, sodium chloride baths. The comparison group (n = 24) received «basic» therapy and manual therapy. The main group (n = 24) received «basic» therapy, high-intensity pulsed magnetic field and manual therapy. Diagnostic criteria: immunohistochemical examination of the endometrium, echographic examination, dopplerometry of pelvic vessels, laser Doppler flowmetry.

RESULTS AND DISCUSSION. After treatment, an increase in the uterine arterial perfusion index was noted in all groups compared with baseline values. The median indicator increased in the study groups by 2.36 times, 2.4 times, and 2.6 times, respectively (p < 0.05). The decrease in the maximum peak speed in the comparison group and the main group exceeded the indicators of the control group (p < 0.001). The systolic-diastolic ratio decreased in the comparison group and the main group (p < 0.05). A decrease in stagnation in the venular microcirculation, a normotonic type of microcirculation, improvement in endothelial function (p < 0.01) were revealed in the main group.

CONCLUSION. An algorithm has been developed. In case of endometrial hypoplasia, decreased uterine perfusion, increased uterine artery resistance index, «basic» therapy is recommended, including sodium chloride baths and amplipulstherapy. With an increase in the maximum peak blood flow rate, an increase in the systolic-diastolic ratio, it is necessary to add a course of manual therapy to the «basic» therapy. When detecting violations of venous outflow, it is recommended to include high-intensity pulsed magnetic therapy.

the lack of convincing evidence of a therapeutic effect.

AIM. To evaluate the effect of complex rehabilitation using EPS and activation of the proprioceptive apparatus on the indicators of the functional state of patients with long-term consequences of spinal cord injury with partial spinal cord injury.

MATERIALS AND METHODS. A prospective study was conducted with the participation of 29 patients with long-term consequences of spinal cord injury with partial spinal cord injury. The catamnesis of the disease was 3.7 ± 0.5 years. Comprehensive rehabilitation included epidural electrical stimulation by implantable electrode and activation of the proprioceptive apparatus. The neurological (ASIA scale) and functional (CSIM III scale) status of the patient was analyzed. Motor function was evaluated using 10-meter Walk test; M-responses of limb muscles — using electromyography, temperature and pain sensitivity — using esthesiometry.

RESULTS. An increase in muscle strength and M-response of the muscles of the extremities, normalization of the motor deficit index, reduction of the walking test time, increase in movement speed and the patient’s independence index were revealed. There is an improvement in temperature and pain sensitivity at the level of damage and in the dermatomes located distally. The effect decreases in dermatomes far from the level of the electrode installation; but with increase in the number of courses the effect increases.

DISCUSSION. The results obtained indicate that this rehabilitation complex, including UES, has a positive effect on the functioning of both the motor and sensitive spheres.

CONCLUSION. Application of EES and activation of the proprioceptive apparatus improves the functional condition of sensorimotor sphere in the long-term consequences of spinal cord injury with partial spinal cord damage. Repeated rehabilitation courses have cumulative effect.

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.

INTRODUCTION. In the treatment of cardiovascular diseases, the use of hydrogen sulfide, which is a universal gas transmitter and performs many physiological functions in the body, is of interest.

AIM. To evaluate the effectiveness of sulfide balneopeloid therapy (SBPT), carried out at the Klyuchi resort (Perm region), in patients with arterial hypertension (AH), as well as their combinations with coronary heart disease (CHD), prediabetes and cerebrovascular disease (CVD) with chronic ischemia brain (CHM).

MATERIALS AND METHODS. A comparative randomized prospective study was conducted at the Klyuchi resort (Perm region), which studied the effectiveness of SBPT in patients with hypertension in various comorbid combinations. General inclusion criteria were the presence of hypertension and age from 40 to 70 years.

RESULTS. The results of a study of the effectiveness of different durations of SBPT in patients with hypertension showed that when a course of SBPT was carried out for 14 days, the hypotensive effect was less significant, while mid-term observation revealed that the hypotensive effect after a 21-day course of SBPT persisted for up to 6 months, and after 14-day course — 3 months. In patients with hypertension and prediabetes, complex therapy, including 14 days of SBPT, helps reduce the severity of clinical manifestations and improve quality of life; causes redistribution of fat deposits, improvement of blood pressure profile, aortic compliance, endothelial and neurogenic circuit of skin microcurrent regulation; reduces the serum concentration of vascular endothelial growth factor (VEGF), leptin, and also increases the serum concentration of transforming growth factor beta 1 (TGF-β1). When treating patients with hypertension and coronary artery disease using SBPT, an increase in the activity of the parasympathetic part of the nervous system, a lipid-correcting effect, improvement of endothelium-dependent vasodilation and exercise tolerance. The results of a study of patients with hypertension with CVD and MS showed that patients who received a course of SBRT had a significant improvement in cognitive functions.

DISCUSSION. The effects that develop during SBPT are associated with the polymodal effect of the H2S molecule on the main metabolic signaling pathways and regulatory mechanisms of the body’s hormonal-humoral systems, which leads to optimal regulation of micro- and macrohemodynamics, favorable changes in lipid metabolism, trophological status and trophic factors.

CONCLUSION. SBPT, carried out at the Klyuchi resort (Perm Region), is effective in patients with hypertension, including various comorbid combinations — hypertension and prediabetes, hypertension and ischemic heart disease, CCI.

INTRODUCTION. Post-stroke speech disorders are one of the important reasons for the decline in the functioning of patients. According to statistics, the incidence of dysarthria among patients after stroke varies from 24 to 64 %.

AIM. To evaluate existing methods of rehabilitation of post-stroke dysarthria, attempt to create a classification of methods, assess the possibility of use in modern conditions and the effectiveness of these methods.

MATERIALS AND METHODS. A literature review was conducted using the eLibrary, PubMed, and Google Scholar databases over the past 5 years (2019–2023). Key words used for the search: “stroke” (stroke in foreign databases), “rehabilitation”, “dysarthria”. The criteria for inclusion of articles in the review were as follows: year of publication of the scientific work from 2019 to 2023, full-text articles, works that include the author’s methodology or its modification, meta-analyses, descriptions of clinical cases. Exclusion criteria: descriptive articles, works based on statistics of post-stroke dysarthria, works describing the organization of speech therapy support without specifying methods, coincidence of identical works in different databases.

RESULTS. The literature review included 16 full-text articles, based on the results of which it can be said that speech rehabilitation, repeating trends in motor rehabilitation, is moving in the direction of increasing the use of various equipment, and there has been an increase in the use of invasive techniques.

CONCLUSION. This review highlights the current trends in speech rehabilitation in adults.

INTRODUCTION. Subacromial impingement syndrome (SAIS) is one of the most common reasons that makes patients seek treatment for shoulder pain.

PURPOSE. To assess the effectiveness of surgical and conservative treatment of patients with subacromial impingement syndrome.

MATERIALS AND METHODS. The clinical results of 48 patients with SAIS stage 1, 2 according to Neer, divided into 3 groups, were analyzed: 1) conservative group without rotator cuff tears (16 patients), 2) conservative group with partial rotator cuff tears (16 patients); 3) surgical group (16 patients). The patients of the conservative groups were treated according to the rehabilitation protocol including myofascial release techniques, physiotherapy, manual therapy, exercises. The patients of the surgical group underwent an arthroscopic subacromial decompression. The follow-up period was at least 24 months. The clinical condition of the patients was assessed using ASES, VAS scales and SANE questionnaire.

RESULTS. The study did not reveal a statistically significant difference of the surgical and conservative treatment groups according to VAS and ASES. There was a statistically significant difference in the results of the SANE questionnaire (p = 0.008) with better results in the conservative groups. Longer rehabilitation was noted in patients of the surgical group.

DISCUSSION. Ketola et al. compared clinical results of surgical group of patients who underwent the subacromial decompression and the conservative group who performed the exercises. There was no statistically significant difference found in VAS level results, subjective shoulder function assessment. Paavola et al. have not found statistically significant difference in VAS scale results between surgical group, group of diagnostic arthroscopy and conservative group of patients with rotator cuff tendinopathy.

CONCLUSION. The conservative treatment of subacromial impingement syndrome with physiotherapy and manual therapy let achieve good and excellent results.