Vol 15, No 2 (2016)

One of the key strategies for the prevention of Post-Intensive Care Syndrome (PICS) in patients with acute cerebral insufficiency is overcoming bed-rest mode in the protocol of intensive therapy. The aim of this study was to refine mechanisms of the Cerebral Injury Protection System response to passive verticalization in acute nontraumatic subarachnoid hemorrhage (SAH). Seven patients with angiospasm after SAH were included in the study. Under of multimodal monitoring (ICP, PICCO+, cerebral microdialysis, CT-perfusion, transcranial Doppler), patients underwent verticalization to 60-90 degrees on a tilt-table. At the upper points, we observed lowering ICP with a simultaneous increase in cerebral metabolism, which provoked the development of perfusion-metabolic imbalance in the metabolic penumbra area. Conclusion. Verticalization has an activating effect on the functional state of the brain, which in conditions of the angiospasm-related failure of autoregulation of cerebral blood circulation can promote increasing areas of ischemia.

In a double-blind, placebo-controlled study examined the state of the motor function of the upper extremities, the level of inflammatory factors and endothelial and hemostatic parameters in 96 patients with acute ischemic stroke, divided into 3 groups: 1st - the standard treatment was supplemented by dynamic electric; in the 2nd - conventional schemes of management of patients with stroke were held against the backdrop of the placebo effects of dynamic electric and 3rd - Use only standard medical complex. After three weeks of therapy, the patients in group 1 showed faster (after 7 procedures) and expressed (by 1.3 times to the end of follow-up) an increase in muscle tone in the paretic upper extremities than in the comparison groups. Optimization of treatment of dynamic electric contributed to the restoration of function in patients affected joints of the upper limbs to 82.7%, the improvement of life on the scale of Rivermid, Rankin and Barthel 1.4; 1.2 and 1.3 times, respectively, higher than the value in the comparison groups. When included in the complex treatment of stroke patients, dynamic electric showed a reduction in the level of blood serum proinflammatory cytokines IL-1.beta and IL-6, 1.9 and 1.6 times, respectively, the level of fibrinogen is 1.3 times the content of the adhesion molecules in 1.3-1.6 times, and endothelin-1 in 1.3 times, which was significantly different from the respective figures in the two groups of patients. inclusion in the treatment of patients with acute ischemic stroke dynamic electric, triggering a cascade of regulatory processes in the body, improves motor function of the affected limb, significantly increases the level of household adaptation patients corrects the level of pro-inflammatory cytokines, has a positive effect on the state of endothelial and hemostatic parameters, which increases efficiency treatment.

Among the causes of pain the inguinal region are diseases of the lumbar spine and joints of the pelvis, pathology of organs of abdominal cavity and small pelvis, inguinal hernia, and hernia of the thigh, tunnel neuropathy. Conditions such as vertical installation acetabular component, excessive lengthening of the lower extremities, impingement of the iliopsoas muscle after hip replacement surgery can also cause pain the inguinal region. The facet joints can be a source of pain in which the pain from the lumbar region may radiate to the inguinal region. For conditions involving pain inguinal area referred gynecological diseases, menstrual disorders, acute and chronic pathology of abdominal organs and urinary systems, inguinal and femoral hernias, cancers. Tunnel neuropathy - pathology of the peripheral nervous system where peripheral nerves are affected with the passage in the anatomical tunnels, particularly in the pelvic area. In the presence of tunneling neuropathy inguinal area is determined by local tenderness of the nerve trunk palpation, motor and sensory impairments. Among tunnel neuropathies groin area are most common neuropathy of the branches of the femoral, ilio-inguinal and femoral-sexual nerve. In the diagnosis and treatment tunnel neuropathy important paranervous injection into the area of suspected nerve compression, which can confirm or rule out nerve compression at the considered level. Interventional methods of pain treatment using the ultrasound navigation provides high accuracy and efficiency of performance of medical-diagnostic procedures, and lower consumption of local anesthetic and decrease the frequency of side effects and complications.

Do The article reflects the results of an examination of 57 patients with ischemic stroke in the early recovery period. It was found that two-thirds of examinated patients with an ischemic stroke had a malfunction of the temporomandibular joint (TMJ). It was clinically manifested by pain, limitation of motion of temporomandibular joint, pathological bruit and lateral deviation of the mandible during patient's mouth opening, as well as tenderness of the masticatory muscles and temporomandibular joints. The degree of TMJ's dysfunction was determined according to the «International Classification of Functioning, Disability and Health». Every fifth patient had "mild level of dysfunction", two of three - «moderate level of dysfunction», and one of seven had «heavy level of dysfunction».

According to foreign and domestic authors incidence frequency of tonus increasing in the paretic limbs a year after having a stroke is about 65-67% (Sommerfeld DK et all, 2004, Adam’s apple, AS et A.L., 2012), which results in active patients verticalization the formation of posture Wernicke-Mann. Proper patient positioning make it possible to minimize the risks of posture Wernicke-Mann. Given that the muscle tone increase is a step in the recovery of motor function in patients with focal brain lesions - the task of experts competently direct reflex activity to prevent an uncontrolled increase of the tone of the affected limbs. The article deals with the starting date of the postural correction in patients undergoing brain catastrophe and place of postural correction within developmentally caused kinesitherapy. The article also provides a list of required equipment, describes the different positions of the patient with an explanation of their positive and negative sides.

Scientists extensively discussed the necessity of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD), the main objectives of which are to reduce symptoms and improve the quality of life. It was found that the rehabilitation measures have a positive impact on important aspects of the patient’s life. The results of several studies show that pulmonary rehabilitation could increase performed physical activity, oxygen consumption and patients’ endurance, reduce the frequency and duration of hospitalization, and greatly improve the efficiency of therapy. It follows that the improvement of treatment strategies in patients with COPD should provide rational conversion of standard schemes of therapy and rehabilitation in accordance with their clinical, pathogenic, functional and economic feasibility. Pulmonary rehabilitation is currently viewed as a key strategy in the management of the respiratory system diseases. The selection process for the rehabilitation of patients are taken into account their functional status, severity of dyspnea, motivation level, and smoking status, although the creation of individualized programs for the integrated treatment of patients with COPD remains an unsolved problem of scientific and practical medicine. According to the GOLD recommendations (2014), the minimum length of an effective rehabilitation is 6-12 weeks (at least 12 sessions, 2 times per week, for at least 30 minutes). A complete rehabilitation program should include physical exercise, smoking cessation, nutritional therapy, patient education and psycho-emotional support. However, until now we have not any effective programs to maintain a therapeutic effect for a long time. A perspective area of pulmonary rehabilitation is a special yogic breathing exercise.