Vol 17, No 2 (2018)

In the formation of medical rehabilitation as a key component of comprehensive care in various diseases, difficulties inevitably arise in interdisciplinary interaction and proper quality control of rehabilitation services. A possible way out in the organization of a unified system of quality assessment at all stages of care, based on metrics, scales and sensitive criteria for the adequacy and adequacy of health services. As one of the variants of such system in the system of obligatory medical insurance of Sverdlovsk region the method of multidisciplinary expertize of quality of medical care for patients with acute cerebral circulation is applied. The set of rules of expertize developed by the authors team, based on the clinical recommendations of professional communities, was tested on a sample of 5 patients with repeated stroke with fatal outcome. The results showed the possibility of reproducibility of the proposed rules for assessing the quality of medical care and the metrics and scales used in medical rehabilitation, in particular the Rehabilitation Routing Scale. The final conclusions require big trials, including the immediate validation of scales.

Disorders of mental activity in the form of a deficiency of various types of activity and / or the appearance of productive psychopathological phenomena are observed in all patients with a pathology of the nervous system. Violations of mental activity in the form of deficiency of various types of activity and / or the emergence of productive psychopathological phenomena are noted in all patients with pathology of the nervous system. Directed effects are necessary not only for restoration / retraining of fallen or decreased mental (including cognitive) functions, special attention needs to be paid to the correction of the so-called "productive" mental disorders (psychotic, emotional and neurotic) that significantly complicate the process of recovery and interaction with patients. As a rule, they are caused by a combination of organic (associated with the defeat of the nervous system), reactive (due to the personality's reaction to the disease, existing life limitations and ongoing medical measures) and premorbid (in particular, endogenous) factors. Specialists in the field of mental rehabilitation can take measures to improve the mental state of patients in an autonomous mode; At the same time, they should be built into the rehabilitation team to have common goals in the restoration (integration) of consciousness, movements, speech, behavior, working in accordance with certain rules with resuscitators, neurologists, speech therapists, physical rehabilitation specialists. Restoration and correction of all manifestations of the patient's activity disorders, including mental activity, require joint efforts of representatives of different disciplines, focused both on the psychopathological consequences of brain diseases, and on the violation of the control of vital functions, and, of course, various deficits of motor and coordination functions. It is necessary to make administrative decisions to create a unified system of training for specialists in the field of mental rehabilitation.

The article presents data on the results of the first phase of the pilot project "Development of the Medical Rehabilitation System in the Russian Federation" held in the Chuvash Republic in 2015-2016. The article details the resource base involved in the pilot project, presents the number of personnel employed in the project, describes the results of the implementation of Phase 1 of the project in the specified timeframe. The current routing orders for 3100 patients (of them 1900 people on the profile of neurology, and 1200 people on the profile of cardiology) were described at the rehabilitation stages during the implementation of the pilot project in the territory of the Chuvash Republic. The list of involved medical organizations, technology of medical rehabilitation is given. It was found that the functional capabilities of Renkin rehabilitators in patients with stroke increased by more than 40%, in patients with myocardial infarction, the test scores of a six-minute walk increased by 9%. The duration of rehabilitation treatment in I and II stages decreased by 20% and averaged 17.1±1.2 days, mortality rates decreased. The data presented demonstrate the high degree of effectiveness of the proposed scheme. Further development of the system of medical rehabilitation in the Chuvash Republic is possible with observance of clear "transparent" routing of patients from the moment of admission to primary vascular departments before taking on dispensary registration in the attached medical organization, maintaining uniform forms of medical documentation, observance of continuity between stages, further increase in the number of those who own modern methods of rehabilitation of employees, an increase in the number of specialized structural units of medical services treatment in sanatorium-resort clinics, using mud, hydrotherapy, preformed physical factors.

The cost-effectiveness of modern rehabilitation is determined not only by functional outcome per se but also by the time needed to reach some progress. The aim of the present study was to investigate how neuropeptides added to conventional rehabilitation can accelerate the recovery of lower extremities movements in chronic stroke. The research was monocentric randomized placebo-controlled. Patients in both groups received exercises and ro-botic-assisted walking therapy and intravenous infusion of 30ml Cerebrolysin® (EVER Pharma) in the study group (40 patients) or isotonic solution in the control group (40 patients) for 14 continuous days. Both groups demonstrated significant improvement measured by 36-Item Short Form Survey Instrument (36-SF), Rivermead Index Mobility (RIM) and Functional Independence Measure (FIM) while the modified Rankin Scale (mRS) did not reveal statistical change in the degree of disability. The mean RIM score was 6 in both groups on the 14th day, however, required time for such outcome assessed by survival analysis was 13 days in the study group in comparison to 14 days in the control group. The difference was statistically significant (Wilcoxon signed-rank test Т=-3,198; р=0,001). The results of this study indicated probable benefits of adding neuropeptides to conventional rehabilitation that could facilitate recovery process and shorten time needed for expected motor improvement in chronic stroke.

An adequate substrate providing and early mobilization for patients with the dominance of aerobic load are among top targets of early rehabilitation of patients with spinal cord injury. Insufficient attention to these priorities leads to muscle loss and lowering of rehabilitation potential. This article contains the professional group (pediatrician, neurologist, physical therapist) results for evaluating physical exercise tolerance at the early rehabilitation stage for children with spinal cord injury using ergospirometry.

The theme of achieving psychological well-being is one of the most urgent for persons with disabilities. The aim of the study is the selection of psychological factors associated with overall psychological well-being and the structural components of psychological well-being in patients with spinal cord injury. With the help of factor analysis in 50 patients divided into five comprehensive factors-the foci that determine the direction of therapist activity in a rehabilitation hospital. It support resilience and emotional status, the development of a positive motivational state (hope), combating social exclusion and widening social contacts, and promoting personal growth, including the development of autonomy

Walking is the most natural and habitual form of exercise for a person of any age and gender. It has beneficial effects on musculoskeletal, cardiovascular, respiratory and nervous systems. In recent years, backward locomotion (backward walking and running) is increasingly used in sports and medicine. Kinetic and kinematic analysis during backward walking showed a number of advantages over the usual method of movement, that can be successfully used in the process of athletic training and for treatment and rehabilitation of various diseases. Backward walking leads to a more cardiovascular and respiratory load and a more significant aerobic and anaerobic capacity of the organism compared with forward walking at similar parameters of physical activity. Backward walking is associated with less overload on knee joints. It is also one of the few natural ways of strengthening the quadriceps. Backward walking training has found its application in rehabilitation programs for different categories of neurological patients with the aim of restoring sustainable body position and gait. Backward walking is used to elaborate the correct pattern of gait in children with cerebral palsy, in persons with hemiplegia after stroke, in patients suffering from Parkinson’s disease and multiple sclerosis, in spinal cord injured patients. Regular backward walking training improves spatial-temporal parameters of walking and balance, increases muscle strength of the lower limbs in these diseases. Tests with backward walking are used for diagnostic purposes - to assess the severity of impaired coordination and motor skills in post-stroke patients and in Parkinson’s disease, to identify the minimal walking impairment in persons with multiple sclerosis and for probability of falling prediction in elderly individuals and patients with dizziness.

Enable SMС-therapy and EHF-therapy in complex rehabilitation of patients with clinical signs of irritable bowel syndrome, which has been assigned based on the type of functional disorders, a positive effect on clinical laboratory parameters in the form of edema and decrease in intensity of all complaints and symptoms, increasing adaptive capacity, on the background of normalization of psycho-autonomic status. The effectiveness of this amounted to 94.4% of constipation and 93.3% in diarrhea. The obtained results were associated with the peculiarities of rehabilitation facilities (X2=to 34.94; p=0,004; r=0,45;), while the maximum contribution to the total statistics Pearson correlations were "significant improvements" and "improvements" with the rehabilitation complexes, including SMС-therapy and EHF-therapy (with diarrhea -X2=3,59 and X2=1,51 ; constipation - X2=2,85 and X2=1,37, respectively).

Persistent disturbances of consciousness in patients occur due to various etiologies and pathogenesis of diffuse lesions of the brain (with strokes, traumatic brain injuries, etc.). Modern researches of physiological bases of restoration of the disturbed functions in these cases are connected with the concept of neuroplasticity within which ability of bark to significant functional rearrangements under the influence of afferent stimulation is proved. In the modern model of rehabilitation of patients with severe brain damage who are in a vegetative state or a state of low consciousness, these provisions are implemented in determining the content and methods of corrective action. The technique of sensory stimulation is currently considered as a promising direction of work with patients at the stage of their early rehabilitation. Despite broad prominence and popularity this method and his unparalleled (Dobrokhotova T. A., 1994; Zaitsev O. S., Dobrokhotova T. A., Gogitidze N. Oh. Sharova E. V., 2007; Ellis E., 1990; Tolle P., Reimer M., 2003; Lombardi F., Taricco M., De Tanti A., 2002; Wood R. L., 1991; Weber P., 1984), diagnostic criteria for differentiation of multisensory effects, taking into account premorbid characteristics of patients (including their sensory profile, leading sensory channel / modality of perception, etc.), have not been determined so far. As part of our research on the basis of the Federal state budgetary scientific institution "Federal scientific and clinical center of intensive care and rehabilitation", the study of the sensory profile and the system of individual sensory preferences of 48 patients with minimal manifestations of consciousness, arising from severe brain damage of various etiologies. On the basis of the obtained data, a typology of sensory susceptibility of patients was developed, variative strategies of multisensory stimulation of patients with different types were determined.