Vol 22, No 2 (2023)

INTRODUCTION. The prevalence of severe spine and spinal cord injuries worldwide is increasing, while the structure and nature of recovery of lost functions remain poorly understood.

AIM. To study the variability of functional activities during continued rehabilitation to distinguish pure rehabilitation goals

MATERIAL AND METHODS. 190 patients with C₄–D₁ tetraplegia 18–60 years old whose were under clinical and functional follow up over a period for 5–7 years after spinal cord injury were examined. They were examed using the motor section of the FIM scale (FIM_m), the VLT scale. The rehabilitation program was standardized and based on the National Clinical Guidelines for physical rehabilitation in spinal cord injured patients.

RESULTS. At admission, the age of the patients was 31 (24.0; 43.0) years, the proportion of patients with DU C₄–C₆ was 117 (62 %), with complete damage types A and B was 134 (70 %) patients, men 151 (79 %). Functional improvement was 19 (12.0; 28.0) points on the VLT scale; 14 (5.0; 21.0) points on the FIMm scale over the entire observation period, and was predominantly noted in the first rehabilitation cycle. The proportion of patients completely independent increased on FIMm activities: eating by 25 %, dressing the upper body by 33 %, dressing the lower body by 20 %, self-care domain by +34 %, wheelchair transfer by 21 %, walking by 5 %, and the proportion of patients completely dependent decreased: eating by 9 %, upper dressing by 13 %, lower dressing by 12 %, self-care domain by 7 %, wheelchair transfer by 21 %, wheelchair mobility by 11 %, and walking by 4.5 %. Changes on the VLT scale domains were balance domain 14 %, 1 finger 18 %, «hand» 26 %, and manipulation 11 %. The gain in food intake activity (FIM) was higher in patients with DU C₆–C₈ (40–50 %) and incomplete motor damage (43 %), on the VLT scale domains similar to C₆–C₈ (12–18 %), and incomplete motor damage (20 %).

CONCLUSION. The most significant functional recovery occurred in self-care and transfer activities, as well as hand and pinch grasping.

INTRODUCTION. In medicine, remote monitoring (RM) is a clinical digital technology with software, sensors and equipment for transmitting signals from patients and analyzing them by a physician. Determination of the nature and volume of motor activity of patients is a key condition in medical rehabilitation programs. However, existing monitoring surveillance systems do not assess these parameters.

AIM. To scientifically substantiate the development of an improved information methodology for remote monitoring of the volume and nature of patients’ motor activity in accordance with their physiological capabilities for rehabilitation in sanatoriums.

MATERIALS AND METHODS. A hardware and software complex was used (certificate of state registration of a computer program No. 2022611766 dated 01.02.2022) with the function of registering motor intensity and heart rate indicators of users. The study involved 80 patients in a 24-hour hospital. 42 patients received a rehabilitation program for chronic coronary heart disease (CHD), myocardial infarction (I25.2 according to ICD-10); 38 patients — for long COVID (U09.9 according to ICD-10).

RESULTS AND DISCUSSION. When assessing motor activity, it was revealed that in patients suffering from chronic CHD with a history of myocardial infarction, the average number of steps per day was 8877,5, and in the U09.9 group — 9430,3 steps per day. The total density of the motor load corresponded to 35-36 %. The ratio of daytime wakefulness to the time of active procedures in the groups corresponded to 27.6 % and 20,1 %. After the rehabilitation course, there was an improvement in vegetative regulation, according to the endurance ratio, the weakening of the cardiovascular system activity in both groups remained, despite some improvement in the indicators in group 1 from 18.50 ± 0.80 to 16.50 ± 0.15 (p < 0.05), the level of hemodynamic load on the cardiovascular system improved only in group 2 from 95,1 ± 5.1 to 80.1 ± 2.5 ((p < 0.01). The adaptive potential of the circulatory system remained reduced in both groups.

CONCLUSION. The developed technology of remote monitoring of the motor regime of patients is intended for rehabilitation and sanatorium-resort organizations to evaluate medical rehabilitation programs according to the intensity of physical therapy, the «training zone of the intensity of motor intensity» according to heart rate and «motor density of rehabilitation measures».

INTRODUCTION. One of the key stages of wound healing is the phase of inflammation, which is a transitional process between hemostasis and wound healing. Each stage of the inflammatory-reparative process is characterized by its own value of the acidity of the wound bed. For example, in the acute stage of inflammation, the acidity of the medium in the wound bed decreases to a pH of 5.5-6. The chronic stage of the inflammatory process, on the contrary, is accompanied by an increase in pH to 8. To date, so far, the effect of biomaterials containing components of the intercellular matrix of the human dermis on fibroblasts under acidosis and alkalosis has not been fully investigated.

AIM. To define the effect of bioplastic material based on collagen, hyaluronic acid and elastin on the viability and proliferative activity of human fibroblasts in conditions simulating the acidity of acute and chronic wounds.

MATERIAL AND METHODS. Bioplastic material was made according to the method described in patent RU 2722744. Adhesive properties and proliferative activity of human fibroblasts were assessed visually using fluorescent microscopy. The number of apoptotic and dead cells was assessed by flow cytometry (BD FACSCanto II) using the commercial FITC Annexin V Apoptosis Detection Kit I (BD Pharmingen). The strength, Young’s modulus, and elasticity of the gels were determined on a TA.XT-plus texture analyzer (Stable Micro Systems, Great Britain).

RESULTS AND DISCUSSION. Using the methods of luminescent microscopy and flow cytometry, we found that the cell viability (namely, adhesive properties and proliferative activity) decreases after incubation on condition mimic of physiological acidosis. We found that, bioplastic material contributes to the preservation of adhesive properties, viability and proliferative activity of fibroblasts in physiological acidosis conditions.

CONCLUSION. The results obtained indicate that bioplastic material based on soluble dermis components can be used as a biologically active component of wound dressings for increase the effectiveness of reparative regeneration, especially in cases of excessive acute inflammation.

INTRODUCTION. Unilateral spatial agnosia (neglect syndrome), is one of the most common disorders resulting from damage in right hemisphere, which is difficult to reverse dynamics, especially in the late recovery period.

CASE PRESENTATION. A 58 year old man with sequelae of cerebral infarction (I69.3 ICD-10) which had a stroke in right hemisphere was admitted for rehabilitation. The results of neuropsychology diagnostic have shown disorders of optical-spatial synthesis, neglect syndrome, cognitive disorder, frontal cortex dysfunction. To restore impaired functions, along with methods aimed at eliminating motor deficits, classical (sensorimotor and cognitive levels) modernized (computer cognitive therapy) methods of neurorehabilitation were purposefully used. As a result, positive dynamics was noted in the form of a significant decrease in the severity of unilateral spatial agnosia, an improvement in the emotional background and the course of cognitive activity.

CONCLUSION. This clinical observation is of interest to neuropsychologists, neurologists, clinical psychologists, physical and rehabilitation medicine physicians. It shows that purposeful efforts to overcome neglect syndrome even in the late recovery period of stroke can have a pronounced positive effect, making a significant contribution to the entire rehabilitation process.

INTRODUCTION. In recent years, magnetic resonance imaging (MRI) has been increasingly used to diagnose early osteoarthritis (OA). Taking into account the fact that nowadays pharmacological agents are not effective enough and often lead to allergization of the body, there is a need to search for new non-drug methods of treatment of patients with knee joint OA that have proven effectiveness.

AIM. To analyze scientific evidence on the use of MRI as an objective method of assessing the effectiveness of medical rehabilitation of patients with knee OA.

MATERIALS AND METHODS. We searched for publications in the PEDro and PubMed for the period from 2000 to March 2023. Suitable articles were to reflect the use of MRI as a criterion for the effectiveness of medical rehabilitation in patients with OA of the knee joint.

RESULTS AND DISCUSSION. As a result of a search in electronic resources, the largest number of works on the subject under study was found in PubMed. According to the literature quantitative analysis, 7256 works were identified, which reflect the use of MRI in medical rehabilitation. The publications in which the effectiveness of medical rehabilitation of patients with knee OA was evaluated by researchers using MRI accounted for 2.5 % of the total number. Most of the publications were in international databases, while they were practically absent in the Russian ones.

CONCLUSION. Despite the scarce research on the matter, we can distinguish the following rehabilitation medicine methods with a proven effect on the ligamentous apparatus, cartilage and soft tissues of the knee joint in patients with OA, according to MRI data: shockwave therapy, physical therapy and ultrasound therapy. However, the need for further scientific research in this direction is obvious.

INTRODUCTION. Due to the demographic aging of the population, the problem of treatment of age-related diseases and prevention of premature aging in modern healthcare has become particularly urgent. One of the most promising approaches is the impact on the molecular mechanisms of aging, including the activation of adaptive systems and suppression of pathological processes in the body. Methods of extracorporeal hemocorrection have proved to be a good idea in this respect.

AIM. To evaluate the effectiveness and safety of hardware plasmapheresis as a technology for correcting aging biomarkers.

MATERIAL AND METHODS. A technique of therapeutic plasmapheresis use was introduced for the correction of aging biomarkers. Twenty-four participants (male and female) aged 40–60 years with an elevated level of one or more aging biomarkers underwent a course of therapeutic plasmapheresis in the daytime hospital. All participants underwent four procedures of therapeutic hardware plasmapheresis once every 3 days with 30 % volume of circulating plasma followed by replacement with colloid (5 % albumin solution) and crystalloid solutions (saline solution) in a 1:3 ratio or only crystalloid solutions.

RESULTS AND DISCUSSION. A comparative evaluation of aging biomarkers before the procedure and 17 and 30 days after hardware plasmapheresis showed that therapeutic plasmapheresis affects the levels of human aging biomarkers in blood. A significant decrease in the levels of such biomarkers as homocysteine, urea, gamma-glutamyl transpeptidase, alkaline phosphatase, creatine phosphokinase, cholinesterase, and uric acid was shown. No significant differences were detected when we performed a comparative assessment of biochemical blood parameters following plasmapheresis with or without albumin replacement on biochemical blood parameters. Stable hemodynamic parameters during plasmapheresis and the absence of adverse reactions in patients confirm the safety and tolerability of the therapeutic plasmapheresis procedure.

CONCLUSION. Implementing this technique into clinical practice will allow the development of approaches to etiotropic therapy of many chronic age-related pathologies. These treatments have the potential to increase life expectancy and improve its quality.

INTRODUCTION. Medication non-adherence is one of the significant public health issue. Low adherence is one of the main reasons for the decrease therapeutic effect in patients with atrial fibrillation (AF), development of complications of AF, which leads to poor health outcomes and increased healthcare costs. Secondary prevention programs in cardiac rehabilitation may improve medication adherence in patients with AF.

AIM. To assess the impact of secondary prevention methods on medication adherence in patients after catheter ablation (CA) performed for paroxysmal AF.

MATERIALS AND METHODS. This is a prospective randomized controlled study with 3 parallel groups of patients with paroxysmal AF after CA (radiofrequency or cryoablation). Patients were randomized into 3 groups in 1:1:1 ratio. The 2 intervention groups received secondary prevention methods, including single-session in-person counseling and for 3 months of distant support (by phone in Group 1 or by e-mail in Group 2). Group 3 received usual care. Medication adherence was assessed using the 4-question scale Moriscos-Green. The medication adherence was evaluated at baseline and 12 months after CA.

RESULTS AND DISCUSSION. A total of 135 patients aged 35 to 79 years were enrolled (mean age 57 ± 9 years, 51,8 % men). At 1 year of follow-up patients from intervention group experienced significant improvement of medication adherence (p = 0,006 for Group 1 и 2) vs control.

CONCLUSION. Secondary prevention methods with remote support improve the medication adherence in AF pts after CA which may positively affect on their health.

INTRODUCTION. At present, there is an urgent need to develop modern rehabilitation programs for COVID-19 patients with long-lasting residual symptoms of the disease, primarily from the cardiopulmonary system.

AIM. To assess the impact of a comprehensive medical rehabilitation program using virtual reality technologies, robotic mechanotherapy with biofeedback and interactive balance therapy on the severity of hypoxic syndrome, shortness of breath and cardiovascular activity in patients who have undergone COVID-19 and have manifestations of post-COVID syndrome (long COVID).

MATERIAL AND METHODS. The study sample consisted of 120 patients aged 40 to 70 years who had suffered COVID-19 within 1–6 months prior to inclusion in the study and had manifestations of SPCN, who were randomized into 2 groups. In the main group (n = 60), a new complex of medical rehabilitation was prescribed against the background of basic treatment: 1) sessions on the robotic biofeedback simulator for lower limb muscle training Con-Trex, #10; 2) balance therapy (sensorimotor training) using the biofeedback simulator «Stabilan 01–2», #10; 3) training on the rehabilitation interactive markerless system with virtual reality technology Nirvana, #10. In the control group (n = 60) patients received only basic treatment: 1) a special complex of therapeutic gymnastics performed in the hall with a physical therapy instructor, № 10; 2) low-intensity laser radiation, № 10; 3) speleo-exposure, № 10; 4) medical massage on the chest area, № 10. Research methods included clinical examination, anamnesis collection and cardiopulmonary testing and assessment of dyspnea severity before the beginning of rehabilitation and immediately after its completion.

RESULTS AND DISCUSSION. In the period from 1 to 6 months after COVID-19, 90.0 % of patients had dyspnea, as well as a decrease in peak oxygen consumption and high values of heart rate (HR), systolic and diastolic blood pressure (BP) at peak exercise. The application of a new complex of medical rehabilitation in patients with post-COVID disorder syndrome contributed to a more significant, than in the standard method of rehabilitation, increase in cardiorespiratory endurance, which is manifested in the increase in the maximum work performed by 12.9 % and oxygen consumption of the first ventilation threshold by 6.3 % and in the decrease in diastolic BP at peak load by an average of 7 mm Hg. hg according to cardiopulmonary testing, as well as an increase in the proportion of patients with mild (up to 60.0 %) or no dyspnoea (up to 26 %) and a decrease in the number of patients with moderate dyspnoea (up to 13.3 %), severe and very severe dyspnoea (up to 0 %). Most of the authors in their studies also note a high frequency of shortness of breath, along with such manifestations of post- COVID-19 syndrome as general weakness, poor exercise tolerance.

CONCLUSION. A new comprehensive medical rehabilitation program using virtual reality technologies, robotic mechanotherapy with biofeedback and interactive balance therapy are recommended to reduce the severity of hypoxic syndrome and dyspnea and improve cardiovascular performance in patients with post-COVID syndrome.