Vol 24, No 1 (2025)
- Year: 2025
- Published: 15.02.2025
- Articles: 13
- URL: https://journals.eco-vector.com/2078-1962/issue/view/11500
Full Issue
Articles
Effectiveness of gait training with electromyogram in stroke patients: an experimental longitudinal pilot study
Abstract
INTRODUCTION. Weakness in the tibialis anterior muscle caused by acute cerebral circulatory failure affects the speed, endurance, safety and quality of gait. Among various rehabilitation methods, electromyogram amplitude biofeedback (BFB) can be used. However, the available evidence on its effectiveness is conflicting.
AIM. To study the possibility of restoring the function of the tibialis anterior muscle when walking by the biofeedback electromyogram amplitude training method in patients in the early recovery period of cerebral stroke.
MATERIALS AND METHODS. In this study, we examined 22 patients (16 men and 6 women) who had suffered their first hemispheric ischaemic stroke and were in the early recovery period, with lesions in either the right or left cerebral hemisphere (15 right / 7 left). The patients received biofeedback walking training according to the electromyographic amplitude of the tibialis anterior muscle and an individual rehabilitation program. Prior to and following the rehabilitation program, gait biomechanics studies and examinations with clinical scales were conducted.
RESULTS AND DISCUSSION. There was a significant improvement in clinical scales of assessment of walking skills and safety as a result of rehabilitation. The Dynamic Gait Index (DGI) indicator is approaching the low risk of falls parameter (> 19 points), as a result of which walking becomes safer. The objective diagnosis revealed typical changes and asymmetries associated with hemiparesis. A notable finding was the asymmetry in ankle joint amplitudes during the swing period, which was significantly greater than that of the contralateral side and the control group, characterized by foot drop syndrome.
As a result of the training, the rhythm coefficient and the maximum electrical activity of m. rectus femoris and m. hamstring of the contralateral side significantly improved. Clinically and instrumentally, the walking function of patients with hemiparesis has a number of significant and minor improvements during the treatment period. Nevertheless, there is no evidence to suggest that these changes can be attributed to the training program implemented for the target parameter, namely the activity amplitude of the m. tibialis anterior.
CONCLUSION. The effectiveness of training according to the target parameter of electromyogram amplitude for automated locomotion (walking), in the presence of paresis of the central genesis, can be questioned and requires further research.
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Principles of physical factor selection in the early postoperative period of breast cancer treatment: a randomized controlled study
Abstract
INTRODUCTION. Current models of onco-rehabilitation do not consider the patient’s functional impairment during combined treatment until the patient becomes incapacitated and the impairment develops into a chronic condition.
AIM. To develop algorithms for selecting physical factors depending on the clinical and functional state of patients after radical surgical treatment of breast cancer (BC) in the early postoperative period.
MATERIALS AND METHODS. The study involved 179 women who underwent radical Madden mastectomy or radical breast resection for breast cancer from stage IА to stage IIIА (in the early postoperative period — 2–4 days). All the patients were randomized into 5 groups: the standard rehabilitation course included general magnetotherapy (n = 37) exercise therapy, balance therapy and classes with a medical psychologist, supplemented by prescribing low-temperature argon plasma (n = 35), pneumocompression (n = 35), fluctuorization (n = 35) and an electrostatic field (n = 37). The pain syndrome (VAS), the difference in the circumference of the upper extremities (cm), muscle strength according to the Medical Research Council, the volume of movements in the shoulder joints, postoperative sutures according to the POSAS scale, daily volume of lymphorrhea, peripheral blood flow and life quality according to the SF-36 questionnaire were evaluated.
RESULTS AND DISCUSSION. The study found that general magnetic therapy normalizes the microcirculation efficiency index and the bypass index, reducing congestion on the operated side, and improves the quality of life. Adding pneumatic compression to the complex affects the volume of lymphorrhea by 2.2 times; fluctuorization reduces pain by 2.2 times and increases the range of motion in the shoulder joint by 1.8 times; the electrostatic field affects the reduction of edema, pain syndrome and neuropathy by 2 times; low-temperature plasma improves the regeneration of the postoperative suture and reduces edema and inflammation in this area by 1.3 times.
CONCLUSION. An integrated approach to medical rehabilitation at an early stage proved effective in maintaining results for up to 1.5 and 6 months following the surgery. There were no adverse events associated with this approach.
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Psycho-emotional state of mentally retarded children before and after going on holiday: a pilot study findings
Abstract
INTRODUCTION. The specific climatic and geographical conditions of the northern region can negatively affect the psycho-emotional state of children and adolescents with disabilities. One of the most common diseases among children with disabilities is mental retardation (MR). Addressing the issues of comprehensive rehabilitation of children with disabilities living in the Far North, increasing the availability of health resort treatment, promoting socialization and adaptation, and improving the quality of their lives is a priority.
AIM. To study the effectiveness of summer recreation in the resort area of the Black Sea coast on the psycho-emotional state of mentally retarded children permanently residing in the northern region.
MATERIALS AND METHODS. The study included children with disabilities in public educational institutions with instruction under adapted programs in Magadan (n = 37 children, mean age 13.89 ± 2.66 years). The majority of the subjects (94.6 %) were diagnosed with mild (F70) and moderate (F71) mental retardation. The study was conducted using the House-Tree-Person test and included three stages: stage 1 took place 2 months before the wellness holiday; stages 2 and 3 were conducted 2 weeks and 2 months after the wellness holiday, respectively.
RESULTS AND DISCUSSION. The study found a reliable improvement in the indicators of the psycho-emotional state of the subjects 2 weeks after departure for summer holidays in the parameters: mood decline (p = 0.039); anxiety (p = 0.0001); unmet needs for social and emotional contacts (p = 0.037); fears (p = 0.0001). Two months after the summer holidays, the improved level of the psycho-emotional state indicators persisted, the analysis showed a reliable decrease in the values for the following parameters: mood decline (p = 0.001); anxiety (p = 0.0001); unmet needs for social and emotional contacts (p = 0.015); fears (p = 0.006).
CONCLUSION. The analysis of the findings obtained in the study demonstrated positive trends in the psycho-emotional state of children with mental retardation living in Magadan region before and after their departure for a summer wellness holiday in the resort area of the Black Sea coast. Notable improvements were observed in the parameters of anxiety, communicative activity, and the levels of manifestation of fears and depressive symptoms.
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The effect of myofascial release on heart rate variability in subjects with autonomic dysfunction: a randomized controlled trial
Abstract
INTRODUCTION. Autonomic dysfunction (AD) is characterized by changes in the afferent or efferent components of sympathetic and parasympathetic neural control that are associated with pathological conditions. Heart rate variability (HRV), as one of the key indicators of autonomic regulation, is known to be associated with many chronic diseases and mortality. Thus, interventions aimed at improving autonomic regulation and increasing HRV are important for public health. Myofascial release (MFR) — a form of self-massage aimed at relieving tension, reducing pain, and increasing range of motion, can have a positive effect on autonomic regulation.
AIM. To evaluate the effects of a physical rehabilitation complex using myofascial release on HRV in individuals with AD based on Firstbeat-monitoring.
MATERIALS AND METHODS. For this randomized controlled trial, 128 subjects with AD, having a dominant influence of the sympathetic division of the autonomic nervous system, were selected and randomly divided into two groups: MFR (n = 64) and control (n = 64). Both groups were given a physical rehabilitation program, including aerobic exercises, flexibility exercises, and breathing exercises. The MFR group, in addition to the main program, was exposed to self-massage. The study lasted for 12 weeks. Before and after the study, HRV was recorded in the time and frequency domains using the Firstbeat device (Finland).
RESULTS AND DISCUSSION. It was found that physical rehabilitation programs in individuals with AD contributed to an increase in the temporal parameters of HRV: mean square deviation of differences between the intervals in the MFR group (p = 0.001), in the control group (p = 0.039); standard deviation of the mean interval in the MFR group (p = 0.000), in the control group (p = 0.012). Also, after physical rehabilitation programs, a change in the parameters of the frequency domain of HRV was observed: an increase in the total power in the MFR group (p = 0.006), in the control group (p = 0.014); an increase in the power in the high-frequency range in the MFR group (p = 0.008), in the control group (p = 0.016); a decrease in the ratio of low-frequency to high-frequency power in the MFR group (p = 0.013), in the control group (p = 0.038).
CONCLUSION. The application of myofascial release as part of a physical rehabilitation program can facilitate changes in certain parameters of heart rate variability (HRV), reducing sympathetic activity and increasing parasympathetic activity in individuals with AD.
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Effect of High-Intensity Focused Ultrasound on sleep quality measures in obese doubled chin women: a randomized controlled trial
Abstract
INTRODUCTION. The double chin is an excessive accumulation of fat in the pre- and post-platysma that can manifest in various forms and sizes. Thin individuals might manifest a double chin, similar to those who are afflicted by obesity. It may result in a reduction in the definition of the mandible and give the perception of obesity or aging.
AIM. To evaluate any effect of High-Intensity Focused Ultrasound (HIFU) on sleep quality measures in obese women with a double chin.
MATERIALS AND METHODS. Typically, 60 women aged 35–50 years were selected from AL Qasr-Alaini Hospital and were equally divided at random into groups A and B (n = 30). Group A (HIFU with exercise) received 3 HIFU sessions, a session/month/three months with adouble chin exercise (daily). Group B (Exercise group) received daily double chin exercises for only three months. Pre- and post-intervention, we assessed body mass index (BMI), hormonal changes (cortisol level), submental fat, and sleep apnea Apnea-Hypopnea Index.
RESULTS AND DISCUSSION. The results revealed no significant effect in age, weight, and height in both groups (p > 0.05). Post-three-month intervention, group A demonstrated a statistically significant decrease in the predetermined assessed outcomes compared to group B (p < 0.001).
CONCLUSION. There was established a significant impact of HIFU on measurements of sleep quality in obese doubled chin women.
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The psychophysiological technology with biofeedback in complex rehabilitation of post-stroke patients: a randomized controlled study
Abstract
INTRODUCTION. Psychophysiological technologies with biofeedback (BFB) are a promising area of in medical rehabilitation (MR) for post-stroke patients.
AIM. To evaluate the effectiveness of the MR-program including psychophysiological technology with BFB for patients with an ischemic stroke (IS).
MATERIALS AND METHODS. The study includes patients in the early recovery period of IS with mild to moderate motor deficits, cognitive dysfunction and emotional-volitional disorders. The complex MR program for the main group 1 patients (MG1, n = 30) included psychophysiological BFB-technology based on the beta-rhythm parameters of Electroencephalography (EEG); the main group 2 (MG2) patients (n = 55) received psychophysiological trainings with BFB based on heart rate. The patients of the control groups (KG1, n = 30 and KG2, n = 30) received only standard MR. To control the effectiveness of MR, we analyzed the changes in physiological parameters (HR, blood pressure (BP)), EEG parameters, cardiointervalography (CIG), as well as the results of the Montreal Cognitive Assessment Scale (MoCA), the well-being, activity, and mood questionnaire (WAM), the Hospital Anxiety and Depression Scale (HADS), and the Motivation for Success test according to T. Ehlers.
RESULTS AND DISCUSSION. BFB-training based on the EEG beta rhythm showed a statistically significant improvement in the cognitive status of the patients in MG1 according to the MoCA, a decrease in the level of anxiety and reaction to external influences, which was confirmed by the dynamics of systolic BP (SBP) and HR, as well as the achievement of a moderately high level of motivation with reliable differences from baseline values and compared to Control Group 1 (p < 0.05). The course of biofeedback training based on the HR parameters showed a reliable change in the CIG parameters, a decrease in SBP and HR in the patients of MG2; statistically significant increase of the WAM questionnaire parameters (p < 0.05).
CONCLUSION. The integration of psychophysiological technology with biofeedback in comprehensive rehabilitation protocols enhances the efficacy of post-stroke cognitive-motor rehabilitation, particularly in patients with high cardiovascular risks.
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Advanced capabilities for in vitro stress diagnostics: a review
Abstract
INTRODUCTION. The effects of stress negatively affect both physical and mental health. Recently, there has been a sharp increase in interest in studying evidence-based methods for diagnosing stress and effective interventions for its correction.
AIM. Comprehensive assessment of modern possibilities of stress objectification using laboratory diagnostics of its markers based on data from literary sources.
MATERIALS AND METHODS. To select publications, we studied the PubMed, Web of Science (Web of Science Core Collection and Medline), Cochrane Library databases, included data from meta-analyses and review articles, full-text articles investigating the relationship between laboratory biomarkers and stress. The search depth of publications was 10 years, from 2014 to 2024, and a number of earlier, fundamental works on the neurophysiology of stress were also included in the review.
RESULTS AND DISCUSSION. The biological basis of stress manifestations is a growing area of interest for scientists, as evidenced by the increasing number of publications on cortisol and dehydroepiandrosterone (DHEA) over the past 10 years. The review reflects a modern view on the role of laboratory markers in stress diagnostics. Biomarkers such as cortisol (the level of the surge after awakening, the average level of cortisol during the day, the daily curve of cortisol, cortisol in the hair), salivary alpha-amylase, DHEA, etc. are described, information on their sensitivity and specificity in the verification of acute and chronic stress conditions is analyzed.
CONCLUSION. Cortisol is the most reliable and frequently used laboratory marker of both acute and chronic stress, while the study of other potential biomarkers continues to grow. Psychometric questionnaires and functional diagnostic methods reflecting the degree of sympathetic activation are widely used in stress diagnostics. The integrated use of various diagnostic tools, including laboratory biomarkers of stress, will provide a multimodal approach, will contribute to a more complete picture of the stress response and will increase the degree of verification of stress conditions.
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Post-stroke synkinesis: clinical and rehabilitation aspects. a review
Abstract
INTRODUCTION. Involuntary associated movements (synkinesis) are a common occurrence in post-stroke patients. In Russia, the Marie-Foy classification subdivides these movements into global, imitative, and coordinator types. In the English-language literature, they are referred to as “motor irradiation,” “motor overflow,” “mirror movements,” “abnormal communication,” and others. Despite attempts to utilize synkinesis as a means of restoring function in paretic limbs, their rehabilitative value is still insufficiently investigated.
AIM. Based on literature data, to study the features of pathological synkinesis in post-stroke patients, and to evaluate the possibility of their use to optimize rehabilitation methods (kinesitherapy).
MATERIALS AND METHODS. The bibliographic search was carried out in PubMed, Web of Science, and Scopus databases. The following keywords were used: global synkinesis, mirror synkinesis, motor irradiation, abnormal coactivation, PNF, rehabilitation. The review focused on English-language controlled randomized trials and reviews over the past 20 years. A total of 152 sources were reviewed, 77 of which met predefined criteria and were selected for the narrative review.
RESULTS AND DISCUSSION. The analysis of the literature indicates that basic traditional classification of post-stroke Marie-Foy synkinesis should be preserved, but this requires some additions. The following types of post-stroke synkinesis should be considered: global, respiratory-brachial, imitation, coordinator and anomalous. In addition to kinesiotherapy via proprioceptive neuromuscular facilitation, these techniques can be employed in conjunction with various other methods, including functional electrical stimulation, bilateral training, mirror therapy, Taub restrictive therapy, and others. Coordinating and abnormal synkinesis have the greatest rehabilitation value. In the residual period of a stroke, persistent abnormal synkinesis may limit voluntary motor skills and requires inactivation. In this case, orthopaedic fixation, reflex-suppressive positions, Perfetti therapy, biofeedback and virtual reality robotic simulators are recommended.
CONCLUSION. The traditional Marie-Foy classification of post-stroke motor synkinesis has no alternatives but needs to be supplemented. It is advisable to distinguish the following types of synkinesis: global, respiratory-brachial, imitation, coordinator and anomalous global, respiratory-brachial, imitation, coordinator and anomalous. The most valuable material for kinesitherapy techniques is coordination and anomalous synkinesis. In the residual period of stroke, the remaining abnormal synkinesis limits voluntary motor activity and requires inactivation.
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Rationale for the use of electrophoresis of drugs in post-stroke patients with visual impairments: a review
Abstract
INTRODUCTION. Disorders of vision and oculomotor functions are widespread among patients who have suffered a cerebral stroke. The rehabilitation system for patients who have suffered a stroke makes use of physiotherapy methods that can significantly improve haemodynamic processes and regeneration. Among the best-known physiotherapeutic methods is drug electrophoresis.
MAIN CONTENT OF THE REVIEW. This review discusses the results of studies investigating the efficacy of electrophoresis techniques using various drugs developed for use in patients after stroke, including those complicated by visual impairment, based on publications in the international and domestic databases PubMed, Medline, Cochrane Library, and eLIBRARY.RU.
CONCLUSION. At present, there are already prerequisites for further development of the method of endonasal electrophoresis of neuroprotective drugs in patients with post-stroke after-effects. The application of this technique is most suitable for patients suffering from a stroke and concomitant visual impairments. However, these approaches are still under investigation and require randomized trials to ascertain their clinical efficacy in a representative patient population.
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Effect of physical activity on the immune system in the normal state and in various diseases: a review
Abstract
INTRODUCTION. Regular physical exercise has a beneficial effect on health, affecting all body systems and reducing morbidity. Muscle fiber activity during exercise helps reduce levels of inflammatory markers and stimulate anti-inflammatory responses. The ability to maintain homeostasis while exercising and adaptation to exercises depend on physical fitness, comorbidities and other factors, so the exercise program should be tailored to the individual.
THE MAIN CONTENT OF THE REVIEW. Immune system activation in response to exercise is mediated by cytokine signaling. The main source of cytokines during physical activity is the skeletal muscles themselves. Cytokines produced by myocytes (myokines) during muscle contraction play a key role in providing communication between working muscles and other organs and tissues. Numerous studies have shown a positive effect of moderate intensity exercise on myokine secretion. People with chronic infectious or non-infectious diseases often demonstrate low-grade systemic inflammation and low levels of circulating myokines. Moderate intensity exercise has anti-inflammatory effects in inflammatory conditions and diseases. Exercise is a popular non-pharmacological adjunct to traditional treatments and rehabilitation for many diseases.
CONCLUSION. Understanding the relationship between exercise modalities and myokine response helps to optimize treatment and rehabilitation recommendations for populations with different needs, such as patients with cancer, chronic inflammatory diseases, or post-viral infection syndromes.
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Autonomic dysfunction in long COVID patients: a review
Abstract
INTRODUCTION. The new coronavirus infection COVID-19 has had a significant impact on the health of populations around the world, causing not only respiratory symptoms, but also a wide range of systemic disorders, including autonomic dysfunction. The autonomic nervous system plays a key role in regulating vital body functions such as heart rate, blood pressure, respiration and metabolism. Disorders of the autonomic nervous system can lead to serious health consequences, including chronic fatigue, orthostatic hypotension, tachycardia and other symptoms that can markedly impair the quality of life of patients.
AIM. To analyze the available scientific data on autonomic nervous system dysfunction in long COVID patients, its possible pathophysiological mechanisms of development and potential methods of correction.
MATERIALS AND METHODS. We have searched for full-text publications in Russian and English over the past four years in eLIBRARY.RU, PubMed, Web of Science databases using the keywords: autonomic dysfunction, SARS-CoV-2, orthostatic insufficiency, COVID-19, long COVID.
RESULTS AND DISCUSSION. The review examines in detail the pathophysiological mechanisms of autonomic dysfunction in long COVID patients. The clinical manifestations and approaches to its correction are considered. To date, many symptoms of autonomic dysfunction have been identified in long COVID patients.
CONCLUSION. The analyzed studies indicate the presence of a causal relationship between the new coronavirus infection COVID-19 and the symptoms of autonomic dysfunction. However, it is necessary to further study the pathophysiology and characteristics of the spectrum of symptoms of autonomic dysfunction associated with COVID infection, to understand its natural course, to optimize treatment and rehabilitation measures based on a personalized approach.
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Risk analysis of information security in medical rehabilitation centers: problems and outlook. A review
Abstract
INTRODUCTION. The article discusses the main aspects of information security risks in medical organizations, including medical rehabilitation centers. The team of authors noted a number of problems that may arise in the digital space of the health system. First of all the loss of personal data of patients, the unauthorized access to diagnostic, analytical results and the misuse of treatment and rehabilitation methods.
AIM. To identify particular risks to information security in the sector of digital healthcare.
MATERIALS AND METHODS. The research material included representative databases on PubMed, Google Scholar, CyberLeninka, eLIBRARY.RU. These phrases and words were used as search tools: information security in medicine, information security in rehabilitation, personal data protection, information security in health, telemedicine, and artificial intelligence in medicine.
RESULTS AND DISCUSSION. A team of authors reviewed available scientific sources, systematized and presented a concise overview of the key issues relating to the security of information, the use of information and communication technologies and artificial intelligence in digital healthcare, with particular reference to medical rehabilitation centers. The analysis of the presented scientific and literary data leads to the conclusion that a competent combination of strategies is required to ensure the safety of patients at the level of a medical institution and at the regional and federal levels.
CONCLUSION. The combination of patient safety strategies depends on the specifics of the provision of medical services. The formation of a unified digital medical environment at the national and then international level, with the development of standardized automated workplaces for specialists and compliance with data confidentiality requirements, will significantly enhance the performance of medical institutions. Additionally, it can help strengthen patient’s confidence in the medical services provided.
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Effect of the rehabilitation on distress levels among patients undergoing surgical treatment for cervical cancer: a comparative randomized trial
Abstract
INTRODUCTION. Diagnosis and management of cervical cancer (СС) can be distressing for patients. They may also face complications from surgical treatment that compromise their quality of life and require rehabilitation.
AIM. To investigate the effect of rehabilitation programs on the level of distress in surgically treated cervical cancer (CC).
MATERIALS AND METHODS. The randomized trial included adult patients with СС stage 1A–1B undergoing surgical treatment. The group receiving comprehensive “active” rehabilitation (СС-1) received psychotherapeutic support, lifestyle changes and other rehabilitation measures for 1 year. The “passive” rehabilitation group (СС-2) received interventions according to current local clinical guidelines. Distress was assessed using the modified International Psycho-Oncology Society Distress Self-Assessment Scale (IPOS score) for 3 years after surgery.
RESULTS AND DISCUSSION. Before surgery, all patients with СС had IPOS scores in the range of 6 points or higher (6.9 ± 0.9 for the СС-1 group and 6.9 ± 0.8 for the СС-2 group), indicating a significant level of distress before surgery. At all follow-up time points, the scores in the СС-1 and СС-2 groups were statistically significantly lower than at baseline (p < 0.05). From month 1, the IPOS score was significantly lower in the СС-1 group than in the СС-2 group: 4.8 ± 1.5 points in the СС-1 group мы 5.8 ± 1.1 points in the СС-2 group (p < 0.05). The differences between СС-1 and СС-2 remained statistically significant up to 24 months after surgery. At year 3 the IPOS score was 2.8 ± 2.0 in the СС-1 group and 3.8 ± 1.7 in the СС-2 group.
CONCLUSION. The faster and more pronounced reduction of the IPOS score in the СС-1 group demonstrates the effectiveness of a comprehensive «active» rehabilitation program. The highest level of distress at baseline emphasizes the need to initiate psychotherapeutic support in the post-diagnosis phase before surgical intervention.
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