Vol 17, No 3 (2018)

Medical rehabilitation is a complex of interventions allowing to restore (compensate) the functions of the organism, disturbed or damaged because of the disease or injury, to correct the disturbed homeostasis, to stabilize the psychological status, to socially adapt the patient and as a result to integrate the child into society. Currently, three phase rehabilitation is being introduced in Russia, which ensures movement of the patient between all medical services (routing) and continuous provision of assistance in all phases. Phase I (acute period of disease or injury) is carried out in intensive care units, specialized departments of hospitals. Phase II (early restorative period) is carried out in specialized rehabilitation departments of multi-profile hospitals or rehabilitation centers. Phase III is carried out in ambulatory clinics, day hospitals, sanatorium and mobile teams at home. Physiotherapy is widely used in all phases of medical rehabilitation, and physiotherapist is a permanent member of a multidisciplinary rehabilitation team. It is required to develop and apply the optimal reporting form for the most objective and detailed assessment of the rehabilitation service in Moscow.

Dyslexia is a pathological condition characterized by a partial specific violation of the reading process, manifested in numerous errors of a persistent nature and is due to the unformed higher mental functions that ensure the reading process. The aim of this study is to assess the dynamics of the manifestations of dyslexia on the background of pharmacotherapy, nootropic drugs (Cerebrolysin, encephabol, nootropics). A group of children dyslexia (103 children) aged 7 to 12 years, underwent complex neurological, psychological and neurophysiological examination. The results indicate that nootropic drugs have a positive impact on key indicators of reading, writing, and improve speech (phonemic awareness, phonemic memory, phonemic decoding). Treatmentofdyslexiashould always be comprehensive and include methods of psychological, pedagogical and logopedic correction, as well as pharmacotherapy.

Cystic fibrosis - one of the most common monogenic diseases in the world, is inherited by an autosomal recessive type and is caused by mutations in the CFTR gene, the product of which is a cAMP-dependent chlorine channel. By now, there are more than 2,000 mutations in this gene that are divided into classes depending on protein damage, highlighting "heavy" and "soft" mutations in their effect on the severity of exocrine pancreatic insufficiency. However, there is still no clear association between the genotype and the clinical manifestation of cystic fibrosis, such as hepato-biliary pathology, in particular cirrhosis. In connection with this, the purpose of this study was to study the clinical and genetic features of connective tissue dysplasia syndrome in children with cystic fibrosis, to assess the possible modifying effect of polymorphisms of connective tissue genes on the development of fibrosis / cirrhosis in cystic fibrosis. The study included 188 children from 3 to 17 years (median 10 years) with a diagnosis of cystic fibrosis. A statistically significant association of MMP3 polymorphisms and severe clinical manifestations on the part of the hepato-biliary system (classification of Chayld Pew) was revealed.

Perinatal brain injuries play a leading role in the disadaptation and disability of children, and therefore the problem of early rehabilitation of these children is of particular relevance. Among the important tasks of medical rehabilitation of children with consequences of PCNC include improvement of blood supply and metabolic processes in brain tissue, neuromuscular conduction, normalization of central and peripheral regulation of muscle tone. At the present time, innovative technologies have been scientifically substantiated and proposed for inclusion in the complex of medical rehabilitation of children with consequences of PPNC: transcranial and pulse magnetotherapy, nonselective and selective chromotherapy (green, blue spectrum), vasoactive electrostimulation, reflexotherapy. Of great importance in rehabilitation is kinesitherapy: therapeutic massage, therapeutic gymnastics, treatment by «position», Vojta-therapy, fitball-gymnastics, dry immersion, immersion massage, «dry pool». One of the urgent problems of medical rehabilitation of children with perinatal CNS lesions is the development of programs for habilitation. To prevent violations of the neuropsychological development of children of the perinatal risk group, the School for Parents «Healthy Child» was created. An information and training program for the prevention of neurodevelopmental disorders in children of perinatal risk groups has been developed based on the use of information and training programs based on the training of parents.

The article describes the features of medical rehabilitation for girls of different ages. The main stages of using physiotherapy are presented: prevention, therapy, sanatorium-and-spa treatment; the indications and contraindications for the application of physical factors in childhood and adolescence, the types of factors, the timing of the appointment of treatment, the methodological features of physiotherapy in relation to pediatric gynecology at various stages of rehabilitation are refined.

Medical rehabilitation of children with acute cerebrovascular accident is carried out in rehabilitation departments and centers related to the second and third levels of highly specialized interdisciplinary neurorehabilitation. An individual approach to the development of a rehabilitation program should include modern technologies of physiotherapy and kinesitherapy, applied at various stages of medical rehabilitation.

Background: Chronic bronchopulmonary pathology is accompanied by the development of hypoxemia and tissue hypoxia, which leads to the formation of patients with various psychophysiological disorders. Reducing the severity of hypoxia contributes to the correction of these disorders. Aims: to evaluate the effect of enteral oxygen therapy on the dynamics of psychophysiological parameters in children with chronic respiratory diseases. Materials and methods: 106 children with bronchial asthma and chronic non - specific lung diseases were examined: 66 people (the main group) received oxygen cocktails as part of the complex therapy; 40-formed the comparison group. In dynamics, indicators of simple visual-motor reaction were determined, psychological testing was conducted on Spielberg-Hanin scales and «well-Being, Аctivity, Mood». Results: By the end of the course of therapy in the main group the mean time of simple visual-motor reaction decreased from 263,6±8,2 ms to 215,2±7,2 ms (p<0,001), and the standard deviation of the index from 111,2±6,0 ms to 72,1±4,8 ms (p<0,001), which indicates an increase in efficiency and decrease in fatigue. The inverse correlation between the indices of РаО2 and simple visual-motor reaction (rs=- 0,71; p<0,05) shows the improvement of psychophysiological parameters due to the correction of hypoxemia. The favorable dynamics of the psycho-emotional state was observed in 84.5% of the children of the main group and only 65.6% in the comparison group, in which in some cases showed a decrease in psycho-emotional background. Conclusions: The results allow us to recommend the use of enteral oxygen therapy in the complex rehabilitation treatment of children with chronic bronchopulmonary pathology at all stages of rehabilitation.

The study shows the objective data collected during research on hearing ability among 45 children with cystic fibrosis who have been treated with ototoxic antibiotics at least twice and who have not complained of hearing loss. Due to a tympanography testing it has been discovered a middle ear pathology among 13,3% of the cases and an evoked otoacoustic emission helped to identify a hearing disorder in 43,6% of the cases. The said disorder involves first and foremost the outer hair cells function, responsible for the 4 kHz frequency. In the cases of failed testing the hearing dysfuntion occurs on the 0,5 2 4 6 8 kHz frequencies. This obtained data indicates the necessity to conduct an objective hearing monitoring for the patients with cystic fibrosis, who have been treated with ototoxic antibiotics.

Changes of hemostasis in elderly patients who had undergone initial and recurrent stroke are discussed. Changes of coagulation in ischemic and hemorrhagic stroke are compared. The role of age, pathological subtype of stroke, comorbidities (diabetes mellitus, atrial fibrillation) in shaping these changes are assessed. The properties of erythrocytes, their influence on blood rheology are researched.

Emergence of the exoskeletons became the real revolution in the expansion of a barrier-free environment for the SCI patients. The aim was to evaluate the safety and effectiveness of the exoskeleton's application in the complex rehabilitation of the SCI patients. 112 of SCI patients, thoracic level, the late period of trauma, with the syndrome of incomplete spinal cord interruption. Objectively: lower paraparesis - from 0 to 3 points; muscle tone - up to 3 points (Ashworth scale); safe function of the upper extremities. Patients of the main group had walking trainings in the exoskeleton in addition to traditional rehabilitation program. Control group got only traditional rehabilitation program and robotic mechanotherapy on Lokomat. Rehabilitation course included 15 trainings. Blood pressure, heart rate were monitored. It was performed assessment of the neurological status, the ability to walk and using aids on the Hauser index, the degree of self-service and mobility was assessed according to the VFM scale, revealed the features of electromyographic indices of the back and extensors of the hip joint muscles, evaluated the biomechanical parameters of patients walking and their psychological status on the 1st and 15th day of rehabilitation. Results. Hemodynamics values were within acceptable values. Patients of the both groups had improvements in the neurological status - in paraparesis and muscle tone reducing. Main group patient's walking became more stable in the longitudinal and transverse directions, and also less energy-consuming. Improvements in the management of the back muscles and the hip extensor muscles after the end of the rehabilitation course were noted. Training sessions on the exoskeleton contributed to a significant improvement in the psychological status - reducing depression, anxiety, improving well-being-activity. The achieved regression of clinical symptoms allowed the patients of the main group to expand selfservice and mobility.