Bulletin of Rehabilitation Medicine

INTRODUCTION. Pisa syndrome is a postural deformity that can lead to impaired posture control and balance in patients with Parkinson’s disease (PD), which increases the risk of injury and reduces the quality of life.

AIM. To study the effect of the Pisa syndrome on postural control, balance and gait of patients with Parkinson’s disease.

HYPOTHESIS. It is assumed that patients with PD with the Pisa syndrome will have specific features of postural control and balance, which must be taken into account when developing rehabilitation technologies for correcting postural disorders.

MATERIALS AND METHODS. As part of the comparative study, 30 people of both sexes were examined, all study participants received levodopa drugs in an individual dosage selected by a neurologist-parkinsonologist. The subjects were divided into 2 groups of 15 people each according to the principle of the presence of the Pisa syndrome and its absence. Criteria for inclusion in the groups: voluntary informed consent of persons with PD for the study; age from 45–80 years, stage 2–4 of Hoehn-Yahr Parkinson’s disease, absence of other diseases and gross cognitive impairment. The diagnosis was carried out using the COBS Physiomed stabilometry system and the EQ-5D-3L questionnaire, a diary of falls and a dynamic gait index (DGI). The reliability of the differences was determined by the Mann-Whitney U-test. Data processing was carried out using the Statistica 10 program.

RESULTS. Significant differences were revealed in the parameter of the coordination index of the Standing Balance test for the right leg and on the EQ-5D-3L scale at a significance level of p < 0.05, in the group of people with PD without the Pisa syndrome, the quality of life was significantly higher, the number of falls was significantly higher in the group of people suffering from PD with the Pisa syndrome towers.

DISCUSSION. Walking with a change of direction and multitasking is the most significant problem for people with PD with the Pisa syndrome, the differences between the groups are significant at a significance level of p < 0.01.

CONCLUSION. Patients with PD and Pisa syndrome have altered gait associated with body tilt forward, instability and decreased balance control.

INTRODUCTION. One of the key psychophysiological features of a subject who has lost his health is sensorimotor response, reflecting the features of neuroplasticity, and allowing us to understand how much a person is able to adapt to the changed living conditions that the disease inevitably imposes. In turn, achieving the desired result of rehabilitation will become more effective if, when building rehabilitation measures, it is taken into account how a person with certain health problems treats his changed condition, that is, to determine the type of attitude to the disease of a participant in rehabilitation measures.

AIM. To study the features of simple and complex sensorimotor reactions in boys and girls with different types of attitudes to the disease.

MATERIAL AND METHODS. 160 subjects (average age — 21 ± 2.3 years) of both sexes were examined. The main criterion for the sample formation was the different level of health of the study participants. Respondents with 2 and 3 health groups were selected. The diagnosis of the types of attitude to the disease was carried out using the “Type of attitude to the disease” technique. The fixation of the sensorimotor response was performed using the Rebus computer technique, which allows recording a simple and complex sensorimotor reaction.

RESULTS AND DISCUSSION. It was revealed that harmonious (25 %), anosognosic (10.6 %) and ergopathic (20.6 %) types of attitude to the disease predominate in the group of subjects. Shown: 1) subjects with anosognosic type have the highest accuracy of a simple sensorimotor reaction (−0.12 ± 0.12), compared with the other two identified types of attitude to the disease (p < 0.05); 2) subjects with anosognosic type have the lowest values of the average execution time of a complex sensorimotor reaction (361.51 ± 31.14), compared with subjects with a harmonious (386.19 ± 32.18) and ergopathic (396.50 ± 50.05) type of attitude to the disease; 3) the quality (R = 0.299, R² = 0.090 at p = 0.020) and accuracy (R = 0.293, R² = 0.086 at p = 0.023) of a simple sensorimotor reaction affect the type of attitude to the disease.

CONCLUSION. In subjects with different types of attitude to the disease, the features of sensorimotor response differ from each other. The most effective sensorimotor reactions are performed by subjects with an anosognosic type of attitude to the disease. The type of attitude to the disease and the parameters of sensorimotor response, such as the quality and accuracy of a simple sensorimotor reaction are related to each other.

INTRODUCTION. Breast Cancer-Related Lymphedema (BCRL) is the most common complication after radical treatment of breast cancer (BC). Currently, there are no molecular therapeutic targets whose pharmacologic action could prevent edema, making it necessary to study the efficacy of non-pharmacologic techniques.

AIM. To study the effectiveness of non-medication technologies in BCRL to develop recommendations for practical application based on the analysis of systematic reviews and meta-analyses of randomized controlled trials (RCTs).

MATERIALS AND METHODS. The search was conducted in the Physiotherapy Evidence-Based Database (PEDro, 2002–2024) using the keywords: “lymphedema”, “upper limbs”, “breast cancer”. A total of 203 sources were selected as of March 2024.

RESULTS AND DISCUSSION. Numerous studies have found that the use of early postoperative physical exercise with a gradual expansion of the load in patients at risk of developing BCRL is a safe and effective method of rehabilitation. The effectiveness of early preventive use of manual lymphatic drainage (MLD) in 4 RCTs was studied in a Cochrane review. However, the clinical effectiveness of early prophylactic use of MLD to prevent BCRL remains insufficiently proven. In contrast, prophylactic use of compression sleeves has been shown to reduce and delay the onset of arm lymphedema in women at high risk of developing BCRL during the first year after breast cancer surgery. Studies have also confirmed the effectiveness of an early Prospective Surveillance Model using bioimpedance spectroscopy for early detection and immediate treatment of BCRL. It has been proven that in order to reduce the volume of a limb with BCRL, it is necessary to prescribe an intensive phase of complex decongestive therapy (CDT) for at least 3 weeks. Studies have also proven the effectiveness of using a standard or improved intermittent pneumatic compression device in the rehabilitation phases, including at home.

CONCLUSION. To reduce the risk of development and progression of BCRL, modern exercise therapy techniques should be used to increase physical activity in order to control body weight, and educational techniques for self-massage and self-application of compression bandages should be actively used. The “golden” standard for conservative treatment of BCRL remains CDT, which is based on MLD. At the same time, the wider use and development of new methods of hardware lymphatic drainage that imitate MLD, which is a highly resourceful and costly method of treatment for BCRL, is justified. To confirm the clinical effectiveness of improved hardware pneumocompression, additional RCTs assessing long-term treatment results are required.

INTRODUCTION. Diabetes mellitus (DM) in patients with lower extremity injuries is a global health problem. The combination of these pathologies in one patient requires rehabilitation measures to restore maximum functional activity and maintain the patients’ initial quality of life. Diabetes as an independent pathology has a negative impact on the patient’s health and also aggravates the recovery period after traumatic bone injury, increasing the risk of adverse outcomes in the early and late postoperative periods.

AIM. To analyze the scientific data of the last ten years on the use of medical rehabilitation methods in patients with lower extremity injuries and diabetes mellitus.

MAIN CONTENT. The search was conducted in Web of Science, PubMed, and Scopus according to PRISMA guidelines and initially identified 181 records. Of these, 45 articles were included in the study with publication periods 2013–2023. Key words used: lower limb injuries, diabetes mellitus, rehabilitation, mechanotherapy, physical therapy, physiotherapy. The literature review analyzes publications on the basis of which a description is made that in case of injuries of the lower extremities in patients with diabetes, the participation of specialists from a multidisciplinary team is necessary to draw up an optimal rehabilitation program aimed at preventing the occurrence of complications and their progression, achieving a speedy and complete recovery of lost functions. A personalized approach, individually selected therapy methods and the use of modern technologies will help achieve the best results in the recovery of patients with diabetes and lower extremity injuries.

CONCLUSION. The review formulated a conclusion about the main objectives of rehabilitation: which include: control of glucose levels and metabolic disorders; examination and care of damaged tissues in order to prevent the development of ulcers and infection of injured skin; gradual increase in physical activity; goals should take into account the individual characteristics of the patient; the use of physiotherapy methods to improve microcirculation and activate tissue regeneration (transcutaneous electrical nerve stimulation (TENS), electrophoresis, magnetic fields, ultratonotherapy, cryotherapy, laser therapy, darsonvalization, pulsed electric fields, ultrasound therapy, ozokerite therapy and peloid therapy); the use of mechanotherapy with biofeedback and robotic systems to increase overall endurance, strength, improve balance function and form the correct walking stereotype (rehabilitation track with visual feedback about walking C-Mill).

INTRODUCTION. There is high prevalence of post-stroke motor and neuropsychological disorders. However, they are usually considered without interrelation with each other, and rehabilitation methods are also considered in the context of a monodomain effect on specific functions.

AIM. To analyze the available scientific evidence on the role of psychophysiological technologies with biofeedback in clinical medicine and medical rehabilitation.

MATERIALS. 50 sources were analyzed, 25 of which are high-level evidence-based articles (randomized controlled trials, meta-analyses, systematic reviews) published in databases Elibrary.ru, Medline, Web of Science, PubMed and Scopus for the period of 2009–2024.

RESULTS. The complex effect of the BFB method on the physical symptoms and psychological state of patients, as well as the possibility of using physiological indicators for adaptive biofeedback, has been studied. The greatest amount of evidence is available about the positive effect of technology using BFB on the psychoemotional state of patients and the state of the cardiovascular system. Significant results were obtained when using BFB-electromyographic-training in the complex therapy of headache and related emotional disorders. All studies have a high level of reliability of evidence and credibility of recommendations. Great progress has been made in the development of innovative psychophysiological technologies, including the use of hardware and software complexes, electroencephalography and neurointerfaces.

CONCLUSION. Psychophysiological technologies with BFB demonstrate effectiveness in the rehabilitation of patients with psychosomatic disorders, borderline conditions and a number of neurological diseases (headache, epilepsy, spinal injury, stroke). Further research is needed to form an evidence base, clarify the mechanisms of action and algorithms of prescriptions, taking into account the physiological and psychological component of the therapeutic or rehabilitation process.