Vol 14, No 4 (2015)

The article is devoted to one of the topical issues of Russian healthcare - the creation of a system of medical rehabilitation in Russia. Defined tactical, methodological and strategic challenges to the creation of the system. The results of the study on the analysis of the need for inpatient rehabilitation care, the capacity of institutions and the actual creation of the system of rehabilitation in the Volga Federal District. The issues of planning, financing and management of rehabilitation institutions in the Russian Federation. For the development of rehabilitation system in Russia is extremely important transition from planning and financing to states and bed planning the declared quantity and quality of consumer services, as well as funding for the implementation of goszadaniya. An example of the formation of the job on the basis of analysis of the Nizhny Novgorod regional rehabilitation center for the disabled. The correctness of the application of a job can be evaluated during the strategic audit. Implementing this approach will allow to plan the activities of rehabilitation centers and offices not only in quantity, but also the severity of the treated patients. Financing of rehabilitation is advantageously carried out on the implementation of state orders (in the form of grants) on the application of a quality and quantity of consumers, and to ensure the development of institutions (investment) in the framework of programs. For correct distribution of investments intended for the development of institutions, the Ministry of Health may delegate this function by the federal rehabilitation institutions. Creating working to the same standards, tariffs and procedures, rehabilitation system will optimize the flow of consumer services, the process of rehabilitation, training on rehabilitation, financing rehabilitation and identify opportunities for its strategic development. Establishment and operation of common principles on an integrated system of rehabilitation will lead to the solution of the accumulated problems in this sphere.

One of the hot issues of medical rehabilitation of patients with spinal cord injury SCI includes development of an assessment methods of rehabilitative potential (RP), rehabilitative prognosis, extent and quality of the held events. Drawing on the example of 212 patients with SCI that had a median age by 32,3±10,7 years, efficiency of the active mechanotherapy has been demonstrated using biological feedback under the EMG control on the complex of EN-TReeM (Netherlands) directed on the patient involvement into the active rehabilitation process with a view to independence degree increasing in everyday life. While investigating with scales (FIM, VFM), large state of functional alterations was shown, mainly motional and social, for patients with the cervical level of a SCI that corresponded to low RP, in a smaller extent - for lumbar level. As a result of the EMG conducted research a RP lack was established at 7,8% patients; average and low RP at 87,8%; high RP at 4,4%. The results of heart rate variability (HRV) study showed the considerable tension of adaptation processes, especially at the cervical level of a SCI (р<0,01). Patients with the cervical level of defeat also had a more obvious manifestations of alarm and depression in reference to that with lumbar and sacral level of defeat (р<0,05). After carrying out active mechanotherapy improvement in domains was revealed: "Household life" (р<0,05), "Self-service" (р<0,05), "General tasks and requirements" (р<0,05). There in the article a system of RP assessment through the use of clinical (tests, scales) and tool (superficial electromyography, HRV etc.) data of patients with SCI is been supposed on the basis of the International classification of functioning, restrictions of activity and health (ICF) for a further selection of rehabilitative technologies, prognosis and an assessment of rehabilitation efficiency.

Medical and social relevance of the repeat stroke in relation to erderly people is provided. Related pathology combinations of the first and repeat stroke are compared. Characteristics of related illnesses and clinical and biochemical marks as the predictors of the repeat stroke are described. The role of different repeat stroke risk factors (age, gender, average values of blood pressure, dyslipidemia, the level of fibrinogen and C-reactive protein, diabetes) in relation to elderly patients suffering from hypertension is assessed. These risk factors are also taken into account in case of rehabilitation measures and stroke aftereffects. The effectiveness of rehabilitation measures in relation to the repeat stroke is estimated. Relationship between the localization of the first and repeat stroke focus and the effectiveness of rehabilitation taken into account the details of hemispheric interaction is analysed. Recommendations of the rehabilitation programmes development using opportunities of the contrlateral hemisphere are described. The difference between mechanisms of reconstruction after the first and repeat stroke is described. The aims of rehabilitation in relation of the repeat stroke are defined. The most important idea among them is to make patient independent in self-servise, to minimize charges of nursing. The expediency of the prevention and rehabilitation system development taking into account the relative weight of risk factors is explained. Effectiveness and safety of the rehabilitating this category of patients using individual levels of physical load and complex of procedures is argumented.

Article is devoted to the early rehabilitation of patients undergoing treatment in the intensive care unit and intensive care. Traditionally to the patient in the intensive therapy the only criterion for the effective treatment was to preserve his life. Currently, planning aggressive life-saving strategy, it is necessary to assess their impact on the formation of new pathological determinants in the patient's condition after knocking critical condition. The totality of the patient's daily life limiting physical, neurological and psychosocial consequences of stay in intensive care, and is referred to syndrome after an intensive care unit (ICU syndrome). Among dominant factors ICU syndrome is allocated to bed as the main therapeutic strategies of treatment of critically ill patients. Advantages of bed rest in an intensive care unit and intensive care are to reduce pain; facilitating cerebral circulation, energy conservation for restoration and recovery, reducing stress and coronary ischemia, prevention of falls, etc. On the other side of bed rest has side effects on most organs forming immobilization syndrome. Causes of immobilization syndrome are acute cerebral insufficiency, acute damage to the peripheral nervous system complications of health effects. This syndrome appears next to multiorgan simptomokomleksov which include musculoskeletal, respiratory, cardiovascular endokrinno- metabolic disorders. The aggregate of the symptom, in particular cardiovascular, leads to the formation of orthostatic insufficiency and associated disruption of the gravity gradient. Vertical integration is a therapeutic strategy to ensure the normal functioning of the body in a natural upright position, the method of prevention and treatment of immobilization syndrome in patients with any profile. The vertical integration of the patient in the hospital, depending on the implementation of one of the technologies can be passive using a turntable, some models of functional beds, active-passive hardware using Stender-standing frame, active-passive or active manipulation.

This article presents an overview of scientific publications devoted to the experience of the application of high immunosuppressive therapy with autologous stem cell transplantation in patients with a progressive form of multiple sclerosis. In some cases, it noted a positive trend in neurologic status and stabilization of the state of the program after the treatment. Most patients with this pathology after this therapy programs need to be re-integrated rehabilitation. Rehabilitation treatment is aimed at preventing complications of neurological disorders, including, correction of motor disorders. Some patients have expressed disturbances walk restricting the functionality of the group due to increased muscle tone in the lower extremities. One of the reasons that lead to the deterioration of the functional characteristics of the walk is equinovarus. It is now widely used methods of robotic kinesitherapy and mechanotherapy in patients with symptoms of lower mono- or paraparesis have proven to be effective methods for correcting dysfunction of walk. However, due to the severe spasticity of leg muscles in the background equinovarus significantly reduces the quality of life of patients with multiple sclerosis, there is the need to include Botulinum in complex rehabilitation of patients. This type of therapy has shown to be effective in treating a number of diseases of the central nervous system, thereby improving the functionality of the accelerated rehabilitation and restoration of disturbed functions. Based on the study shows the effectiveness of a comprehensive approach to correcting spasticity with repeated courses of robotic kinesitherapy and Botulinum patients who were treated at the medical rehabilitation «National Medical and Surgical Center named NI Pirogov» Russian Ministry of Health.

The work is dedicated to the review of instrumental methods for clinical gait analysis (CGA). CGA is used for functional diagnostics motor pathology entire musculoskeletal system. At the same time walking, how well automated cyclic locomotion, including operation of the entire musculoskeletal system, is used as a functional test. In recent decades the CGA significantly changed the approach to treatment, especially surgery of various diseases associated with dysfunction of the foot. It is not only the actual disease of the lower limbs and large joints and the spine, the central and peripheral nervous system. Currently, the group formed by methods that are required for the conduct of clinical research. The main groups of research methods is to register kinematics, temporal, spatial, dynamic parameters and functional electromyography. Kinematics registered mainly two classes of systems - video systems (the gold standard) and new technical means on the basis of inertial sensors without platform. Basic information of this method are goniogrammy (charts) movements function in large joints, movement of the pelvis and other body segments. Temporal and spatial characteristics are recorded, as a rule, a single instrument - with special tracks that allow you to define the parameters of the functional units of the cycle step, length, width, pitch, speed, distance, and others. To register the dynamic parameters of applied torque platform, recording effort, develops during the passage of platform. To perform functional myography using special multi-telemetry myography that allow recording surface myogram while driving. International professional organizations methodical standards for analysis and description of the identified changes. Analyzed the main possibility of registration of biomechanical parameters of gait in a clinical setting. The above complexes and systems have significantly different capabilities and cost, both equipment and its operation.

Dermal fillers is one of the most popular methods in cosmetic dermatology. In some cases, the use of fillers leads to certain side effects. The aim of the study was to describe ultrasound signs of side effects after fillers and quantitative determination of size, depth and borders of lesions in the surrounding tissues. Under our supervision there were 16 patients with side effects after fillers. Used high-frequency ultrasound skin imaging at a frequency of 22 MHz and 75 MHz with a resolution of 72 and 21 μm. We were able to determine the size, depth, location and boundaries of lesions within the surrounding tissue at all patients. Part of the side effects are diagnosed when conducting a high-frequency ultrasonography of the skin before the second filler injection. Two main types of changes in tissue were identified: inflammatory exudative (granulomatose-exudative) and microsclerotic. By using high-frequency ultrasonography 22 and 75 MHz, we were able to determine the precise location and size of lesions in the dermis and subcutaneous tissue. Preliminary measurement of the thickness of the dermis before the introduction of fillers, for the purpose of determining an individual's depths of drug administration can significant reduce the number of complications.