Vol 16, No 6 (2017)

The current strategy of health care in Russia for the period until 2030 is the preservation and strengthening of the health of citizens of the Russian Federation on the basis of increasing access to and quality of medical care; increase life expectancy, reduce mortality, increase the birth rate for long-term development, and the sustainable existence of this branch of the Russian Federation. Among the technologies that allow achieving the set goals, is interdisciplinary medical rehabilitation.

Significant increase in life expectancy, improvement of the medical outcomes, shortening of hospital stays and raised awareness of the rehabilitation achievements triggered increasing efforts demand in finding clinically, socially and cost-effective forms of rehabilitation treatment. One of the most developing types of outpatient rehabilitation is a day rehabilitation facility. It was already proven to be effective in recovery after diseases of the musculoskeletal, cardiovascular, nervous system and after sport injuries. Some recent studies showed even higher effectiveness of the day outpatient rehabilitation is comparison with the similar inpatient programs in terms of long-term functional results and lower costs. The need for outpatient day rehabilitation is increasing worldwide. Israel is one of the countries that has already implemented different types of outpatient rehabilitation services, while the most professional, intensive, technological and multidisciplinary form of them is the day rehabilitation department. Multidisciplinary Rehabilitation Center (MRC), one of the first day centers for multidisciplinary outpatient rehabilitation in Russia, working according to ICF principles, was opened half a year ago. Intermediate data has already shown its high efficiency - the functional goals were achieved in more that 90% cases. However, outpatient rehabilitation development meets several barriers, as reduced adherence of the patient and the family to keep relevant level of participation in the rehabilitation process and transportation difficulties. The possible ways of solving these problems might include active involvement of the patient and the family in the process of planning and carrying out rehabilitation, self-sustained training and group sessions, stimulation of the individual home training while checking the «home work» and the intensive use of modern communication tools for monitoring health data and every day’s rehabilitation process.

Medical advances have resulted in increased survival rates for children with brain tumors. However, due to the toxicity of treatment, cognitive functions such as processing, working memory, attention, programming and control, and executive functions, such as shifting and inhibition, decrease. To choose an effective rehabilitation program, it is necessary to assess the defect. This study shows the first experience of using CANTAB to measure cognitive functions in children who survived posterior fossa tumors and evaluate the effectiveness of rehabilitation with using such equipment as Neurotracker Cognisens, Dynavision D2, Fitlight. Sensitivity to rehabilitation training was shown by the following CANTAB tests: a test of visual pattern recognition memory in a 2-choice forced discrimination paradigm, test for programming and control, tests for spatial working memory, a test for processing. Significant age differences in processing tests, spatial working memory, planning and control were shown. Thus, the battery of CANTAB tests can be used both to assess cognitive performance and to evaluate rehabilitation programs designed to enhance cognitive functions after posterior fossa tumors.

Motor and cognitive functions rehabilitation is one of the principle issues of recent neuro-oncology. The paper considers feasibility of «Neurotracker» training device for working memory and sustained attention diagnostics and enhancement in posterior fossa tumor survivors. The sample included 53 patients, mean age was 11,0. The participants passed 4-8 sessions. The results demonstrate improvement of these functions during the rehabilitation course. Significant difference in performance score among three age groups was revealed.

Purpose of this work is to define the dysfunction of autonomic regulation in patients with chronic cervical spinal cord injury. The study was included 60 patients with traumatic cervical myelopathy (tetraplegia) and 17 healthy individuals (control). It was assessed changes in autonomic nervous systems (HRV) using heart rate variability analysis in a rest, depth breathing and tilt tests. The results revealed corresponding within completeness, not corresponding within level of spinal cord injury and autonomic dysfunction (HRV).

Object: to evaluate the relationships between nutritional status (NS) and motor skills (MS) of children with CNS tumors in remission. The retrospective study includes data of 30 patients with after posterior fossa tumor. Median of remission was 36 months. Males 37% (n=11). Age 6-17 years (median 10 years). MS was evaluated by Bruininks-Oseretsky Test of Motor Proficiency. NS was assessed using anthropometry and bioimpedance analysis. The dietary consumption of the main foods was estimated too. It was revealed that the deficit of somatic store protein (mainly in muscle mass) may have a negative influence on MS and can retard it. Low levels of mid-upper muscle circumference values were significantly associated with the low levels of MS parameters. There was no correlation between body mass index and MS values. Children with higher levels of sweets, pasta, porridge and sausages consumption have lower levels of the total motor composite (TMC). Children who have high TMC ate more fruits, vegetables and meat.

Obstructive uropathies at children are presented by various pathological states which are characterized by a structural or functional obstacle to normal outflow of urine, sometimes the leader to a renal failure. The high prevalence in children's population defines relevance of development of preventive, medical and rehabilitational actions. Development of individual programs of medical aftertreatment for such children at stationary and out-patient and polyclinic stages with use of laser therapy in the postoperative period, a complex of rehabilitational actions with including of laser therapy, SMT-phoresis of therapeutic mud and "dry" carbonic bathtubs promote stopping of inflammatory process, restoration of an urodynamics and functional indicators of kidneys.

The article reveals the author’s technique for restoring the functional state of young athletes after the competitive period, reflecting the need for a comprehensive approach to the restoration of the functional condition of athletes aged 11-12 years, aimed at strengthening the close relationship of working muscles with the nervous and cardiovascular system, biochemical and structural processes in the body. Rehabilitation of athletes after the competition, prevention of injuries and diseases of the musculoskeletal system, in contrast to the rehabilitation of ordinary people, has a number of characteristic features. In addition to performing labor and domestic duties, the athlete must withstand the large physical exertion of modern sports, which make huge demands on the nervous, cardiovascular system, joint stability, mobility, and muscle strength. The article presents key provisions of the developed methodology, describes the results of research on the functional state of young athletes aged 11-12 years, engaged in sports such as football, rugby and hockey, before and after the introduction of the author’s methodology, which is based on the principles of consistency and consistency. The method is a combination of such rehabilitation measures as cryotherapy, ozone therapy, electrostimulation, hydrotherapy, training and regenerative massage, psychotherapy, aimed at restoring the psychoemotional state of young athletes, their emotional response to tough competition and competition situations, as well as normalizing the regime of the day, nutrition and sleep. The results of the study of the dynamics of physical qualities of young athletes, their endurance and resistance to hypoxia, hemodynamic indicators indicate the effectiveness of the developed methodology, the need for its introduction into the practice of medical control of athletic training of athletes 11-12 years, especially during intensive training and competitive activities. Thus, the study, the physiological basis for the use of restorative measures, as well as the data obtained by us in this work on two groups of young athletes, showed the advantage of this method over the traditional methods of physical rehabilitation of athletes in a sports school.