Vol 16, No 2 (2017)

Implementation of the system of the medical rehabilitation fulfilled and which has proved the efficiency both in foreign countries, and in the Russian regions which have begun to approve and introduce the basic principles of the European model of rehabilitation isn’t possible without the correct training of specialists. The article reveals the purpose of professional activity of a doctor of physical medicine and rehabilitation, describes the experience of the emergence and development of Physical and rehabilitation medicine in Europe and the world.

Rehabilitation is the coordinated application of medical, social, pedagogical and professional actions to prepare (or retrain) patients for optimum of functioning. To solve the problems identified in the definition, it is necessary to comply with modern principles of rehabilitation. Rehabilitation of adults and children at the inpatient or outpatient and in intensive care units based on the biopsychological model of disability in accordance with universal principles: patient-centered approach, multidisciplinarity, earlier initiation of rehabilitation activities, continuity, succession and continuity. So human health is described using categories of ICF: activity, participation, functions, structures, environmental factors and personal factors. Rehabilitation diagnosis is established in the categories of the ICF and is a list of patient problems. The tasks for the specialist in the team are established based on the identified problems in the categories of the ICF. The educational program for rehabilitation specialists should include training in the use of the ICF and the formulation of a rehabilitation diagnosis. Conclusion: The ICF is an instrument for implementing the above principles of rehabilitation.

There are many methods of stroke treatment and one of them is surgical revascularization with extracranial - intracranial bypass. The aim of investigation is to value effectiveness of surgical revascularization using the functional magnetic resonance imaging. Two groups of patients in the recovery period (more than 1 year) of the stroke were investigated. Patients in the first group were after cerebral bypass surgery (11 persons). The second group included patients after conservative therapy (8 persons). MRI study was made at 1.5T system (PHILIPS). The paradigm for the functional MRI included small ball squeeze in response to a visual cue. We examined patients from group №1 before surgery, in the early postoperative period and in the recovery period. We tested the neurological status before and after surgery (in the recovery period). The levels of neuronal activity from the stroke region (precentral gyrus), supplementary motor cortex and contralesional hemisphere were compared. All this structures are responsible for the motor function of the damaged upper extremity. A significant increasing level of neuronal activity was found in the stroke region in the group after conservative treatment (p < 0,05). There were no significant differences in the levels of neuronal activity between two groups in the supplementary motor cortex and contralesional hemisphere. The comparing of patients with extracranial-intracranial bypass in dynamics before surgery, after revascularization and in the recovery period of ischemic stroke didn’t show any significant increasing level of neuronal activity in the stroke region. In the surgical group a significant decreasing level of neuronal activity was observed in the contralesional hemisphere in the recovery period (p < 0,05). According to the data from neurological examination an absence of any progressive dynamics of the motor function was found in the 50% of surgical treated patients. The negative dynamics was observed in the 30% of surgical treated patients. The significant increasing of neuronal activity in the stroke region was found in the medical treatment group. The extracranial - intracranial bypass surgery did not show increasing level of neuronal activity in the ipsilesional cortex between patients in the early postoperative and recovery periods. Motor function recovery of the damaged upper extremity took place in the 20% of patients after surgical revascularization.

Purpose of the study: To assess the opportunity of diagnosing functions of the fine motor skill by the «Multi-touch» method. Materials and methods. Evaluation of physical activity wrist in normally conducted out in 43 healthy subjects of both sexes, aged from 21 to 63 years, the mean age of 46.29 years, without neurological, orthopedic pathology. For this purpose, we measured the performance of breeding fingers using the method of «Multi-touch» with the calculation of standardized breeding range I-II fingers. The study of physical activity wrist with central hemiparesis using the method of «Multi-touch» was conducted in 42 patients with ischemic stroke and movement disorders in the upper limbs with impaired function fine motor skill used for this movement rating scale: Fugl-Meyer Assesment (FMA), 9 Hole peg test (NHPT), Rivermid index author’s method «Multitouch». To assess the reliability of the «Multi-touch» method were calculated: 1) internal consistency; 2) construct validity; 4) test-retest reliability. Measurement error is calculated as the standard error of measurement (SEM), the Minimal Detectable Change (MDC95) in absolute values and in percentage terms (MDC95%). Conclusions. Defined percentile definition standards standardized breeding range I-II finger which lies in the range of 2.36 to 2.8 cm. The high internal consistency (r Spearman 0.98 p <0.0001), stable performance during the second measurement (p = 0.08 Wilcoxon), high correlation method «Multi-touch» with the clinical assessment scales brush motor activity (r Spearman 0.64 p <0.001), the selectivity of reaction with the scales do not meet the conductive fine motor function (r Spearman with the index Rivermid -0.38, p = 0.05).

An early rehabilitation of patients with acute cerebrovascular accident is one of important tasks of multidisciplinary team in the conditions of separation, of reanimation and intensive therapy of primary vascular separation. A research aim was an estimation of efficiency of «new» model of organization of early rehabilitation as compared to a former model for patients with acute cerebrovascular accident. Patients with acute cerebrovascular accident there were 940 cases. They were divided by 2 groups: first, are 484 patients in age 65,9 ± 0,46, passing treatment in June - December 2015; second are 456 persons in age 66,6 ± 0,45 observed in a corresponding period 2016. We watched the dynamics of the Rankine scale. In the first group a tendency was traced to the decline of this index from 3,18±0,05 to 3,11±0,07 points (p>0,05). In the second group in a dynamics the reliable improvement of index happened from 2,83±0,09 points to 2,56±0,09 points (p<0,05). During the complex rehabilitation program in the second group, the indexes of functional end of patients became better as compared to the first group. Application of «new» model of organization of early rehabilitation in of reanimation and intensive therapy of primary vascular separation allowed promoting the level of the rehabilitation potential.

In order to study the effectiveness of combined acupuncture methods, the examination and the early rehabilitation course for 70 patients with acute ischemic stroke, divided by random sampling into 3 groups, were held. In the main group (30 people), the basic treatment complex was optimized by the combined use of dynamic electroneurostimulation (DENS) and acupuncture. Monitoring of the status of two comparison groups (20 people each), corresponding to the main group by sex, age and severity of neurologic symptoms was conducted simultaneously. In the first comparison group, basic therapy was supplemented with DENS, in the second - with acupuncture. Assessment of the severity of neurological deficit was carried out on the scale NIHSS, to assess the patient’s activities of daily live after a stroke, Barthel ADL index was used. Monitoring was carried out in the 1st and 15th day from the beginning of treatment. Positive dynamics was observed in all groups, however, in the main group at the end of the course of treatment, significantly higher scores (p <0.01) on all scales were obtained, compared with the comparison groups. In the main group (where patients received DENS therapy combined with acupuncture), on the 15th day from the beginning of treatment, a decrease of neurological deficit on the NIHSS scale was 5,2 points, Barthel Index increased for 30 points. Thus, the combination of two highly effective techniques (DENS and acupuncture) in one procedure causes a more pronounced recovery of lost functions among patients who had cerebral ischemic stroke and, therefore, more rapid adaptation to everyday life.

The background of this study was the need of introducing a new and effective method for treatment of pressure ulcers (decubitus) in patients after spinal injury or stroke. Therefore the prospective post-registration randomized comparative study of new treatment option on the base of native collagen application was conducted. 100 patients after spinal injury or stroke with decubital ulcers with different severity were included. Group I (control) included 63 patients who received the standard complex therapy and debridement. Group II (study) included 37 patients: treatment of pressure ulcers was carried out by additional method - supplementation of bioplastic material based on native type I collagen (medical device Collost: gel 7% 1.5 ml, membrane 60x50x1,5 mm). Patient assessment was conducted in the dynamics on the base of clinical, laboratory and instrumental methods. Results. The use of bioplastic material Collost in treatment of pressure ulcers resulted in more rapid reduction of peripheral edema; more pronounced granulation tissue formation in the area of decubitus and more pronounced wound healing. There was improvement of cytogram, reduction of microbial content, reduction of pain intensity and pain duration compared to traditional methods of pressure ulcers treatment. Often the result of treatment was «complete healing» and «good result» of treatment in accordance with subjective assessments by doctor and patient. The good tolerability of bioplastic material Collost was also determined: no allergic reactions were detected in any cases, no toxic effect in line with dynamic control of clinical status and biochemical analysis. So clinical and biochemical safety of Collost in decubitus ulcers treatment was determined.

Background: Restoring the ability to walk is one of the priority tasks for the rehabilitation of spinal patients. Methods: The purpose of our clinical study was to assess the applicability, efficacy and ergonomics of the electro-mechanical exoskeleton «ExoAtlet» in patients with paraplegia as a result of spinal cord injury. The duration of the clinical trial was three calendar months between June and September 2016. Each training program consisted of 10 training sessions, including walking in the ExoAtlet exoskeleton, lasting about 60-80 minutes, 5 times a week, for 2 weeks. In the trial were included 10 patients. Results: There were 2 developed complications associated with unilateral overload of the distal joints of the lower limb/ Exoskeleton training is safe if selection criteria are met and do not require special monitoring of the cardiovascular system. The speed of the walking in the exoskeleton in the pilots is different and, first, depends on the level of injury of the spinal cord. Conclusion The proposed training program in the exoskeleton «ExoAtlet» leads to a decrease in the tone of the muscles of the lower limbs and improvement of the psycho-emotional status in the examined patients.

Results of complex treatment diabetic polyneiropatyi the bottom finitenesses with use сочетанного applications of polarized light on area of a pancreas, segmentary areas and neurovascular bunches popliteal realy the bottom finitenesses with the subsequent influence by a method of the general elektroforezy 1% of a solution gudrolyzaty placentae are submitted. The complex approach to purpose of regenerative therapy with use of the new medical techniques confirmed with the data of researches of parameters of whey of blood is developed: a level of sugar, the general cholesterol and its fractions LPVP and LDL, triglycerides, an alpha-amylase, tactile sensitivity, reflexes, vibrating sensitivity.

In this study on the basis of DSD-test of 90 healthy adults we identified physiological values of vegetative activity provision index of skin sympathetic reactions in paravertebral skin areas (cervical - 120-145 mkA; thoracic - 95-135 mkA; at the lumbar level - 85-125 mkA). Results of this study allow to use the proposed method of diagnosis in medical practice for the evaluate the sympathetic regulation of tissue of the spine and for the objectification of the clinical manifestations of vegetative neuropathy of vertebral component of the spinal nerves.

Trophic system disorder and blood microcirculation local changes two factors mentioned in all theories of osteochondrosis [1,2]. Anatomical and functional transformations in spinal motion segment are thought of as consequence anabolic and biochemical process failure, which connected with microcirculation disorders in vertebra’s body on the background of metabolic and trophic providing changes and intervertebral disk degradation [3,4,5]. Patients with diagnosed degenerative disk disorder’ segmentary-reflex sings was examined for measuring of nailfold capillary blood cell velocity and volume measurements on four positions - both thumbs and big toes. Nailfold capillary blood cell velocity and volume measurements were registered non-invasive method by using ultrasound unit. Acquisition of research data carried out before and after course of standard treatment and including abdominal decompression procedure №10. Survey sample include 70 human subjects (34 male and 36 female). Average age 42,21 (±11,86). Control group 14 male and 21 female (35 patients), average age 42 (±11,81). Experimental group13 male and 22 female (35 patients), average age 41(±12,17). Microcirculation sings significant differences was revealed between control and experimental groups. Statistics indicate about increase level of nailfold capillary blood cell velocity and volume measurements in both groups but more high-level was registered at experimental group