Bulletin of Rehabilitation Medicine

INTRODUCTION. Arterial hypertension (AH) is a socially significant disease. A significant proportion of patients with AH are weather-sensitive, which significantly aggravates the course of the underlying disease.

AIM. To develop programs for restoring the functional state and adaptive capabilities of patients with arterial hypertension and increased weather sensitivity in order to optimize the duration of their spa treatment.

MATERIALS AND METHODS. An observational prospective clinical comparative study of 129 patients aged 62 [56; 68] years was conducted for 12 days. The patients were divided into 3 groups. All patients received general sodium chloride baths, gas-air carbon dioxide baths, parafango applications, hyperbaric oxygenation, therapeutic exercises, cognitive-behavioral therapy, and continuous hypotensive drug therapy. Additionally, the first group of patients received dosed aerotherapy together with therapeutic exercises, and the second group received paradoxical breathing exercises using the Strelnikova method. Before and after the course of treatment, anthropometry, peripheral hemodynamics, heart rate variability, and the psychophysiological state of the patients were assessed.

RESULTS AND DISCUSSION. After completion of treatment, statistically significant differences were obtained in all groups of patients in terms of a decrease in systolic blood pressure (SBP) and an increase in the Well-Being scale scores of the SAN test (according to the Wilcoxon test, p < 0.05). In the first group of patients, after treatment, a statistically significant decrease in elevated pulse pressure, heart rate (HR), integral and frequency indices of heart rate variability (RMSSD, SDNN, LW, IN, PARS) was observed (according to the Wilcoxon test, p < 0.05). Statistically significant differences were revealed between the first and third groups in the level of reduction of initially elevated systolic (U = 54.0, p = 0.02) and pulse BP (U = 55.5, p = 0.023), HR (U = 56.0, p = 0.037), RMSSD, SDNN, LW, IN, PARS (U = 13.0, p = 0.048; U = 34.2, p = 0.033; U = 13.0, p = 0.048; U = 0.0, p = 0.02; U = 48.0, p = 0.033, respectively), and the Well-Being scale of the SAN questionnaire (U = 50.0, p = 0.043).

CONCLUSION. The study has shown the effectiveness of non-drug treatment programme for AH with increased meteosensitivity, including procedures of aerotherapy and exercise therapy, allowing to optimize the terms of health-resort treatment.

INTRODUCTION. Development and improvement of methods and materials used in regenerative medicine for non-drug stimulation of tissue repair will solve a number of clinical problems associated with diseases that impede the normal process of reparative regeneration, such as diabetes, cardiovascular diseases and metabolic disorders. Collagen and its derivatives are already used as components of biomaterials for medical purposes. However, low mechanical strength, rapid biodegradation in physiological environments and weak resistance to enzymes limit the scope and effectiveness of their medical and biological applications.

AIM. The aim of the study is to evaluate the effect of carboxylic acids on the strength, biodegradability and biocompatibility of collagen xerogel, in vitro.

MATERIALS AND METHODS. The mechanical characteristics of the materials were assessed using a TA.XTplus texture analyzer. The biocompatibility of the materials was assessed by light and fluorescence microscopy using fluorescent dyes (DAPI, Rhodamine) and a Calcein AM (CCK-F) cell viability kit.

RESULTS AND DISCUSSION. A xerogel based on denatured collagen with high strength characteristics was created. The parameters of heat treatment and concentrations of carboxylic acids were selected to stabilize the mechanical properties of the hydrogel. It was found that the introduction of citric acid into the hydrogel from denatured collagen and subsequent high-temperature treatment allows to increase the mechanical strength of the xerogel from 59 ± 3 to 82 ± 13 kPa. In addition, the introduction of citric acid into the composition of the xerogel increases its resistance to biodegradation by more than three times. The microenvironment created by the xerogel containing citric acid does not have a cytotoxic effect, but it does inhibit proliferation of fibroblasts.

CONCLUSION. The results of the in vitro study showed that the obtained material can become a promising platform for use both as an extracellular scaffold and as an independent biomaterial for filling the volume of tissue lost as a result of surgery or injury.

INTRODUCTION. Team sports are an important part of adapting activities for athletes with hearing impairment. However, it is necessary to take into account the focus and intensity of physical activity in athletes with hearing impairment, since sports activities can have a modulating effect on the functioning of the circulatory system, the vegetative balance of the athlete’ body.

AIM. To study the features of heart rate variability and reactivity of the autonomic nervous system in the regulation of heart rate in athletes with hearing impairment.

MATERIALS AND METHODS. Male highly qualified volleyball athletes with congenital sensorineural hearing impairment (26.42 ± 1.38 years old) were examined in a longitudinal controlled study. The comparison group was represented by male volleyball players without hearing impairment. The design of the study included a survey of volleyball players in the transition and competitive phases of sports training. Studies of the autonomic regulation of the cardiovascular system were carried out on the basis of a five-minute recording of cardiac intervals in a horizontal position of the subjects using the Poly–Spectrum–12/E complex according to the generally accepted research protocol.

RESULTS AND DISCUSSION. The study shews that the transition phases of sports training in volleyball players with hearing impairment was characterized by a low stress index (SI — 69.52 arb. unit). The values of HR (69.05 bpm), SDNN (58.50 ms), pNN50 (17.80 %), Mo (0.87 sec), AMo (35.85 %), CV (0.35 sec), PSD (3258.00 ms²) were within the normotonia. The competitive stage of training for athletes with hearing impairment was accompanied by a significant increase in SDNN (143.00 ms), Mo (1.07 sec), CV (0.94 sec), PSD (6078.00 ms²), VLF (3968.00 ms²), LF (1577.00 ms²) and a decrease in the stress index (15.76 arb. unit) compared with the group of volleyball players without hearing impairment. Regardless of the stage of sports training, the humoral-metabolic channel of regulation dominated the spectrum of cardionetrvals.

CONCLUSION. The vegetative status of volleyball players with hearing impairment during the recovery period was characterized by moderate dominance of the autonomous regulation circuit with high activity of humoral and metabolic channels of heart rhythm regulation. During the competition period, significant differences in vegetative support were noted in athletes with hearing impairment, which were characterized by high variability and power of the spectrum of cardiointervals, the development of pronounced parasympathicotonia.

INTRODUCTION. Determining the rehabilitation potential (RP) after ischemic stroke (IS) is a key aspect for predicting the restoration of impaired functions and selecting appropriate rehabilitation strategies. Currently, there is no universal and reliable method for assessing RP. Existing protocols are primarily designed to predict outcomes in the acute phase of IS and lack sufficient specificity and sensitivity. Functional magnetic resonance imaging (fMRI) may be considered a potential method for RP assessment.

AIM. To evaluate the feasibility of using fMRI as a predictor of functional recovery following IS.

MATERIALS AND METHODS. The study included 34 patients (age 62.0 [58.0; 65.0] years) in the early recovery period after IS, presenting with hemi- or monoparesis scored between 2 and 4 on the MRC scale, who underwent medical rehabilitation (MR) at the S.I. Spasokukotsky Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine for 12 days. All patients received kinesiotherapy and physiotherapy. To assess baseline status and track changes in functional impairments, the following scales were used: MRCS, MAS, FMA, NHPT, FAT, ARAT, BBT, TUG, Tinetti, BBS, RMI, BI. All participants underwent fMRI with a simple motor task for each limb to evaluate the degree of activation in the cerebral cortex.

RESULTS AND DISCUSSION. Upon completion of the MR course, statistically significant improvements were observed in the Tinetti, NHPT, BBT, BBS, FMA-UE, RMI, BI, TUG, ARAT, FAT, MRCS scales (p < 0.01). Patients with higher cortical activation showed better outcomes in FMA-UE scores, although no statistically significant differences were found compared to those with lower cortical activation. Distinct activation patterns in specific brain areas were observed during the performance of elementary motor tasks. Increased activity in the affected hemisphere during paretic limb movements was associated with a trend toward better recovery, though this did not reach statistical significance (p = 0.056). In patients with low activation of the affected hemisphere, ipsilateral cerebellar hemisphere activation was additionally observed during movement of the paretic hand.

CONCLUSION. The study results do not provide sufficient evidence to confirm the reliability of fMRI in predicting functional recovery. Further research is required to evaluate the effectiveness of this method in clinical practice.

INTRODUCTION. The clinically frequently detected combination of ronchopathy (snoring) and obstructive sleep apnea is an important problem in modern medicine. Correction of this pathology is performed surgically with known success, however, in this regard, it is necessary to point out the features of the condition of most patients that prevent surgical intervention, as well as the observed frequency of recurrence of the process. In addition, the importance of transient factors in upper respiratory tract obstruction, which require correction during the acute phase, indicates the prospects for the development of modern therapeutic approaches.

AIM. To study the effectiveness of the original spectral phototherapy method in the complex treatment of patients with ronchopathy and obstructive sleep apnea syndrome.

MATERIALS AND METHODS. The study included 90 patients (67 men and 23 women) aged 30 to 75 years with bronchopathy and moderate obstructive sleep apnea. The examination of these individuals was carried out using questionnaires, pharyngoscopy, respiratory monitoring, and biochemical analysis (calculating the balance of a number of trace elements) before, 10 days, and 3 months after treatment. These patients were divided into three groups, each consisting of 30 people. In all groups, standard treatment was performed, including positional therapy, exercises for facial muscles, etc. In group 1, they limited themselves to this, while in group 2, they additionally used intraoral mouthguards, and in group 3, mouthguards and spectral phototherapy were used.

RESULTS AND DISCUSSION. The data from the questionnaire survey performed after treatment reflected the regression of disease manifestations in patients of all groups, however, with the priority of the third group, the treatment of which included spectral phototherapy. A decrease in the intensity of snoring and a decrease in the number of episodes of sleep apnea with improved sleep quality was noted after 10 days of treatment in 12 patients of the first group, 18 in the second and 21 in the third, and after 3 months of treatment, the preservation of the therapeutic effect was noted in 9 patients of the first group, 11 in the second and 15 in the third, which correlated with an increase in potassium, magnesium, manganese, and calcium, and corresponded to the transition of OSA from moderate to mild.

CONCLUSION. Spectral phototherapy is an effective method indicated for use in the complex treatment of patients with ronchopathy and obstructive sleep apnea syndrome of moderate severity.

INTRODUCTION. Diastasis rectus abdominis (DRAM) is a pathologic condition of connective and muscular tissue in which there is thinning and stretching of the white line of the abdomen. The latest current statistics indicate that women are at high risk of developing DRAM both during pregnancy and in the postpartum period. The optimal means for DRAM correction is exercise therapy.

MAIN CONTENT OF THE REVIEW. This review analyzes the features of correction of DRAM in postpartum women with exercise. The review was based on the research methodology developed by the Joanna Briggs Institute (JBI) — an international research organization specializing in evidence-based medicine in collaboration with partners; treatment guidelines; and Scoping Review meta-analysis data. Randomized controlled clinical trials, descriptive studies, articles published in English and in full-text, without any restrictions on the date of publication, were also studied.

CONCLUSION. The findings allowed us to determine the main focus areas in the use of physical rehabilitation in the postpartum period to correct DRAM.

INTRODUCTION. Patients who have suffered a stroke require long-term and intensive rehabilitation measures to restore both vital and motor, cognitive, psycho-emotional and other functions of the body. Along with the use of physiotherapy methods, transcutaneous electrical neurostimulation can be used already at the stage of the patient’s stay in the intensive care unit; however, due to the lack of modern information on its effectiveness, this method is extremely rarely included in rehabilitation programs at the early stages.

AIM. To evaluate the clinical effectiveness of using electrotherapy with different durations of procedures at the II stage of medical rehabilitation, including the period of patients with stroke in the intensive care unit.

MATERIALS AND METHODS. A randomized controlled trial was conducted at the National Medical Research Center for Rehabilitation and Balneology between 2024 and 2025, involving 61 patients who had suffered an ischemic stroke. All patients were divided into 4 groups, which underwent a standard medical rehabilitation scheme, as well as additional electrotherapy with a duration of 10, 20 and 30 minutes, a course of 14 procedures. BEFORE the start of the course of procedures, as well as after its completion, muscle strength in the affected limbs was assessed on a five-point scale, as well as an assessment on the Rivermead, Rankin, NIHSS, and rehabilitation routing scales.

RESULTS AND DISCUSSION. A total of 61 patients of both sexes (27 men (44 %) and 34 women (56 %)) took part in the study. The average age of the patients was 59 years. All patients suffered from acute cerebrovascular accident (ACVA) of the ischemic type in the basin of the right/left middle cerebral artery. At the end of the course of electrotherapy procedures in the main group, with an exposure of 30 minutes, muscle strength in the affected limbs in the distal sections increased (shoulder muscles 1.9b. (1.0; 2.3); forearm/hand muscles 1.5b. (0.5; 1.8); thigh muscles 2.2b. (1; 2.5); lower leg/foot muscles 1.5b. (1.1; 1.8)) compared to the control group (0.9b. (0; 1.5); 0.3b. (0; 1); 1.1b. (0; 2); 0b. (0; 0.5), respectively) (p < 0.05).

CONCLUSION. Additional physiotherapeutic treatment in the form of transcutaneous electrical neurostimulation of patients who have suffered a stroke, initiated during their stay in the intensive care unit at the second stage of medical rehabilitation, proved to be more effective in improving the motor activity of paretic limbs compared to the standard rehabilitation programme. The best results were in the group with a duration of electrotherapy of 30 minutes, significantly improving muscle strength in the affected limbs in the distal sections (shoulder muscles 1.9b. (1.0; 2.3); forearm/hand muscles 1.5b. (0.5; 1.8); thigh muscles 2.2b. (1; 2.5); calf/foot muscles 1.5b. (1.1; 1.8)) (p < 0.05) at the end of the rehabilitation course lasting 20 days.