Vol 22, No 3 (2023)

INTRODUCTION. Today, severe traumatic brain injury (STBI) poses a serious threat to the life and health of affected children, which requires long-term expensive treatment and long-term rehabilitation. Improving the diagnosis, resuscitation and neurosurgical care for children with STBI leads to an increase in the percentage of surviving patients, which necessitates the development and implementation of individual early rehabilitation programs. One of the tasks of early rehabilitation is to reduce the spasticity of the extremities, in connection with which transcranial magnetic stimulation (TMS) is used in our hospital. The experience of using the TCMS method in the first month of STBI in children is given, due to which the dynamics of the restoration of lost functions improves.

AIM. Evaluation of the effectiveness of the use of the method of transcranial magnetic stimulation in children in the acute period of STBI with inclusion in the program of early medical rehabilitation.

MATERIAL AND METHODS. 40 patients with STBI who were treated at the GAUZ СRCH MH RT, Kazan were taken for curation. The main group was selected by the randomization method, which included 20 (50 %) patients who received the procedure of transcranial magnetic stimulation in the individual program of medical rehabilitation and the control group — 20 (50 %) patients who received only the standard individual program of early rehabilitation. Patients of the main group on the 10th day after receiving a severe traumatic brain injury were initiated to undergo TKMS in addition to the program of individual early rehabilitation.

RESULTS AND DISCUSSION. As a result of the course of therapy with the inclusion of TMS in the rehabilitation measures, an increase in the motor activity of the affected limb was observed, which led to an improvement in the patient’s self-care.

CONCLUSION. The inclusion of transcranial magnetic stimulation in the program of early rehabilitation of children with severe traumatic brain injury creates suitable conditions for the course of compensatory-regenerative processes in the brain due to the depolarization of the membrane of cortical neurons. In this group of patients, there was a clear increase in muscle strength and a decrease in spasticity.

INTRODUCTION. Balance disturbances are frequent syndromes after a cerebral stroke (CS). The availability of a validated tool for balance and walking functions comprehensive assessments is very important part of real clinical practice, for rehabilitation diagnosis and individual medical rehabilitation plan.

AIM. To determine the psychometric properties of the Motor Activity Performance Assessment Scale (Tinetti Test, TT) for measuring balance and walking in patients with ischemic stroke (IS).

MATERIALS AND METHODS. 200 patients were included, 100 in the early (ERP) and 100 in the late (LRP) recovery periods of IS. The average age of patients was 55 [51; 57] years. The average of IS-duration were 99.3 ± 30.9 days (ERP) and 267.7 ± 27.8 days (LRP). Clinical and demographic characteristics of patients in two groups were comparable. The median and interquartile interval of TT were 20 [14; 24] points out of 28 possible. Content validity and intra-rater reliability were assessed by 10 clinicians. The test-retesting method was used to determine the intra-rater reliability. The Berg Balance Scale (BBS), the Stand Up and Go for Time (TUG), and the 10-meter walk test (10MWT) were used for concurrent validation.

RESULTS. Two-stage linguistic and cultural adaptation made it possible to construct a Russian-language version of TT that was tested in a pilot study of 30 patients. The subsequent study of the psychometric properties of TT demonstrated high level of content validity and internal consistency of TT (α-Kronbach: 0.74 for TT-Balance and 0.72 for TT-Gait). BBS data significantly correlated with TT-Balance scores (r = 0.73, p = 0.001), TUG showed a negative correlation with TT-Gait (r = −0.69, p = 0.02). Retest reliability ranged from 0.72 to 0.86. The Bland-Altman plot showed the loss of one data point for TT-total beyond 95 % CI.

DISCUSSION. The Tinetti test indicates high substantive validity and internal consistency of the scales (the α-Kronbach for the balance and walking sections are 0.74 and 0.72, respectively), which is consistent with the data of foreign authors.

CONCLUSION. The linguistic and cultural adaptation and psychometric testing of the Russian version of the Motor Activity Performance Assessment Scale demonstrated the validity and reliability of this test as a tool for balance and walking assessment in patients with IS.

AIM. To evaluate the effectiveness of using a rehabilitation glove in patients with central paresis of the arm and motor aphasia due to ischemic stroke, and also to study the rate of motor production in the upper limb in these patients.

MATERIALS AND METHODS. We examined 49 patients with hemiparesis and motor aphasia in the early recovery period of ischemic stroke in the left middle cerebral artery. Depending on the fact of conducting training with the use of a rehabilitation glove, patients were randomly distributed into two groups (1, where this training option was implemented, and 2 — without it), comparable in the severity of motor and speech disorders. Within each of them, patients were additionally divided into subgroups, depending on the degree of paresis in the distal part of the affected upper limb: L-mild (in group 1L — 18 people, 2L — 16) and U-moderate (in group 1U — 8, and 2U — 7 patients). On days 1 and 10 of training, all patients underwent functional testing. Treatment and rehabilitation were carried out according to the order of care. Patients of groups 1L and 1U additionally received a course of 10 sessions, including 2 exercises of 15 minutes each for a paretic arm 5 times a week.

RESULTS. Patients of groups 1L and 1U demonstrated statistically significant improvements in the Medical Research Committee Scale, the ARAT Arm Motor Activity Test, the Wasserman Speech Impairment Rating Scale, and the Montreal Cognitive Function Rating Scale. According to amplitude indicators, there was a tendency towards their increase in all groups. A decrease in the number of errors and an increase in the percentage of correct task completion accompanied the development of a motor act. They stabilized in patients with mild paresis of the hand by 5–6 sessions and in patients with moderate paresis by 6–7 sessions.

CONCLUSION. In patients with mild to moderate paresis of the right hand in combination with motor aphasia in the early recovery period of ischemic stroke, when using a rehabilitation glove, there was an improvement in the strength and motor activity of the paretic hand, cognitive functions and speech. Stabilization of task performance indicators should be taken into account when determining the duration of training and timely correction of the motor rehabilitation program.

INTRODUCTION. Problem of evaluation of the motor activity patients undergoing medical rehabilitation and sanatorium treatment remains relevant, including obesity.

AIM. To study the nature and degree of disorders of muscle strength, motor and coordination functions in patients undergoing medical rehabilitation and sanatorium treatment.

MATERIALS AND METHODS. Single cross-sectional study included 160 patients aged 40 to 65 years with normal and overweight. The complex of the study included: functional tests and assess muscle strength and balance.

RESULTS. In patients with obesity, compared with persons with normal body weight of the same age, significantly (p < 0.05) lower indicators of muscle strength of the right and left arms, strength of the abdominal and back muscles, lower endurance of the abdominal muscles and back muscles and longer time to complete the “Get up and walk” test. Also, in obesity, it turned out to be significantly less time to maintain balance in the “Stand on one leg” tests on the right and left legs with open eyes. A statistically significant direct relationship was found between the level of back muscle strength (γ = −0.82, p = 0.0038) and body weight. A significant relationship was also found between the level of endurance of the back muscles to physical activity and BMI (γ = −0.79, p = 0.01). At the same time, there was no relationship between age and the level of endurance of the back muscles to physical activity (γ = 0.107, p = 0.36).

DISCUSSION. In patients undergoing medical rehabilitation and health resort treatment, obesity is associated with a decrease in muscle strength and motor activity.

CONCLUSION. In patients with obesity at the age of 40–65 years, compared with persons with normal body weight of the same age and gender, there is a statistically significant decrease in the muscle strength of the arms, abdomen and back, a longer time to complete the “Get up” test and walk”, as well as deterioration in the function of static balance according to the results of the “Stand on one leg” test.

INTRODUCTION. The literature describes numerous cases of mononeuropathy of the hypoglossal nerve, as a complication of various diseases, as well as after operations for symptomatic and asymptomatic stenoses in the carotid system. For a correctly selected treatment method, it is necessary to carry out a differential diagnosis between damage to the hypoglossal nerve and the cortico-lingual tract. Currently, standard diagnosis of hypoglossal nerve lesions using electroneuromyography is difficult due to methodological limitations associated with its anatomical features and variability.

AIM. To demonstrate the feasibility of recording motor-wave (M-wave) in response to electrical hypoglossal nerve (HN) stimulation and motor evoked potential (MEP) in response to transcranial magnetic stimulation from the muscles of the tongue using the St. Mark’s electrode.

MATERIALS AND METHODS. A prospective study was conducted on 10 healthy volunteers. To register the M-wave during electrical stimulation of HN and MEP during transcranial magnetic stimulation (TMS) from the muscles of the tongue, a St. Mark’s electrode was used. Registration was carried out sequentially from two sides of the tongue.

RESULTS. In all subjects, M-wave and MEP were recorded from the muscles of the tongue from 2 sides. The average latency was in line with previously reported data in the literature. The variability of the difference in the amplitudes of the lingual motor responses was more than 50 % between the healthy volunteers.

DISCUSSION. The results obtained were compared with earlier publications where normative indicators were approved. The amplitudes of the M-wave during stimulation of the HN at the proximal and distal points did not differ significantly from the literature data; the amplitude of the MEP in our study turned out to be higher, which was explained by the increased tension of the tongue muscles during the study. It was also noted that the M-wave can be recorded only at the proximal or only at the distal points of stimulation.

CONCLUSION. Evaluation of conduction along the peripheral segment of the hypoglossal nerve and the cortico-lingual pathway during the abduction of muscle responses using the St. Mark’s electrode is a simple and perceptible approach to assess the functional state of the nervous structures of HN. Method for registering M-wave and MEP with the St. Mark’s electrode is safe, informative and convenient.

AIM. Retrospective analysis of experimental and clinical studies of the effect of sodium chloride baths on the body.

MATERIALS AND METHODS. The retrospective analysis included experimental and clinical studies revealing the mechanisms of action of sodium chloride baths on the human body, as well as their therapeutic effect in the rehabilitation of patients with various chronic non-communicable diseases, which were carried out on the basis of the National Medical Research Center for Rehabilitation and Balneology over the past 60 years.

RESULTS. It was found that sodium chloride baths (HCV) have a distinctive, inherent effect for them, which depends on the concentration of sodium chloride, the temperature of the water in the bath and the initial state of the body. Experimental work has proved the different effect of HCV of different concentrations on the function of the adrenal cortex. It was found that with an increase in the concentration of sodium chloride in the bath, the observed changes were more pronounced. In the experiment, it was revealed that as a result of the action of HCV, general reactions of the whole organism were observed. Baths with a sodium chloride concentration of 30 g/l change the functional state of the brain in the direction of reducing excitability, and baths with a sodium chloride content of 60 g/l in the direction of its increase. It has been established that HCV is an adequate and pathogenetically justified method of treating patients with CKD. The realization of the therapeutic effect of baths was determined by their anti-inflammatory and desensitizing effect, influence on central and regional hemodynamics. Baths with a sodium chloride concentration of 40 g/l had a more pronounced positive effect. Studies conducted in patients with hypertension have proven the benefits of using HCV with a lower temperature of 31–32 °C. It is also proved that in patients of this category, the use of HCV with a concentration of 40 g/l had a more pronounced hypotensive, antianginal effect and led to an increase in physical performance, to an improvement in central, peripheral and cerebral hemodynamics compared with baths with a concentration of 20 g/l. Other studies testified to the beneficial effect of HCV in coronary heart disease, which was expressed in improving the contractile function of the myocardium and increasing the level of physical performance and coronary reserve of the heart. Analgesic, anti-inflammatory, desensitizing effect of HCV was noted in patients with degenerative-dystrophic and infectious nonspecific joint lesions.

CONCLUSION. The presented scientific works of retrospective analysis reveal the mechanisms of the biological and therapeutic effects of HCV. The data obtained are the justification for their use in a number of diseases. For a more successful use of HCV, further regular generalization and analysis of existing evidence-based studies, as well as the implementation of new qualitative randomized controlled clinical trials of the action of HCV, first of all, the determination of the optimal concentration for each nosology, is necessary.

INTRODUCTION. The high prevalence of shoulder pain syndrome (SPS) determines the relevance of the development of new comprehensive methods of rehabilitation of this category of patients.

AIM. To evaluate the clinical effectiveness of shockwave therapy (SWT) and pulsed low-frequency electrostatic field (PLEF) in patients with SPS undergoing medical rehabilitation in a sanatorium-resort organization in comparison with traditional health resort treatment.

MATERIALS AND METHODS. The comparative analysis of medical rehabilitation efficiency was carried out in 90 patients with SPS aged 31–68 years undergoing medical rehabilitation in the health resort complex “Vulan” — a clinical branch of National Medical Research Center for Rehabilitation and Balneology. All patients were divided into 3 groups of 30 persons each by the method of simple randomization. Group 1 patients (control) received traditional health resort treatment, including ozokeritotherapy, physical exercise therapy, electrotherapy with sinusoidal modulated currents and manual massage. Patients of the second group (comparison) received against the background of the above complex 3 SWT procedures on the shoulder joint once a week. Group 3 patients (main group) received, in addition to traditional treatments, 3 SWT and 8 field PLEF treatments administered every other day. The effectiveness of rehabilitation was evaluated according to the severity of pain syndrome (VAS scale), Swanson’s scale for the shoulder. Movement volume before and after rehabilitation was measured with an orthopedic angle gauge. Microcirculation state was assessed by laser Doppler flowmetry (LDF). Leukert scale was used to assess the state of well-being. The results of the study were assessed 18 days after the beginning of rehabil itation measures.

RESULTS AND DISCUSSION. Patients who additionally received SWT and PLEF against the background of traditional health resort treatment noted a significant reduction in the severity of pain syndrome, while in the main group pain regression was noted earlier (on day 4–5), whereas in the comparison group the same results were obtained by the day 14th . In the control group, patients noted significant changes on the VAS scale only by the end of the rehabilitation course. On the Swanson scale, the most significant positive results were also obtained by the patients in the main group: the pain decreased on average 2.6-fold, the volume of active movements in the shoulder joint increased 2.7-fold, and activity in everyday life 1.9-fold. Statistical differences in the Swanson Scale scores with the comparison group were obtained with regard to pain syndrome and volume of active movements. When comparing with the control group, reliable differences were revealed in all Swanson’s scale indicators in both the main group and the comparison group. When studying the dynamics of microcirculation according to LDF data, it was noted that reliable changes in the main indices of the LDF-gram were revealed only in the groups that received innovative physical therapy interventions.

CONCLUSION. Thus, the inclusion of modern physiotherapeutic techniques of SWT and PLEF into the program of health resort treatment of patients with SPS allows to increase significantly the efficiency of medical rehabilitation carried out in the sanatorium organization.