Vol 22, No 4 (2023)
- Year: 2023
- Published: 18.10.2023
- Articles: 17
- URL: https://journals.eco-vector.com/2078-1962/issue/view/8386
Full Issue
Articles
Bulletin of Rehabilitation Medicine: Annual Update on Bibliometric Indicators Including Scopus Quartile (Q3)
Abstract
There are three main citation databases in the world (Web of Science, SCImago and Scopus) determining journal quartiles annually according to their own datasets and methodologies. The aim of this editorial is to analyze bibliometric indicators of the journal “Bulletin of Rehabilitation Medicine” (BRM) in Scopus. According to CiteScore 2022, BRM ranked 101/146 in the subject category MEDICINE-REHABILITATION which placed BRM in Q3. Over a past year, BRM increased its citation 51-fold, and its CiteScore 8-fold. In the period of 2019–2022 more than 50 authors from almost 20 countries published in BRM. During the same period almost half of BRM articles received citations not only in Russian journals indexed in Scopus but also in sources from 13 other countries. Besides, BRM produces twice the average number of publications per year in its subject category. Thus, such bibliometric picture of BRM in combination with open access and no article processing charges, demonstrates a strong editorial position of the journal and a clear competitive advantage for authors.
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Transcranial Magnetic and Transcutaneous Spinal Cord Electrical Stimulation a Stroke-Patients Walking Correction: Blinded Clinical Randomised Study
Abstract
INTRODUCTION. The impairment of motor system function due to stroke often leads to patients’ dependence on external assistance. The technique of rhythmic transcranial magnetic stimulation (rTMS) is now widely used in the restoration of impaired central nervous system (CNS) function. In recent years, there has been information about the use of transcutaneous electrical spinal cord stimulation (TSCS) in the correction of motor functions in CNS disorders of various genesis.
AIM. To evaluate the possibilities of combined use of transcranial magnetic and transcutaneous electrical stimulation of the spinal cord in the correction of locomotor functions in patients after ischemic stroke.
MATERIALS AND METHODS. The conducted blind clinical randomized study involved patients who had an ischemic stroke. Study participants were randomly divided into control (n = 12) and experimental (n = 9) groups. Patients in the control group received standardized neurorehabilitation techniques. The participants of the experimental group were offered standardized neurorehabilitation techniques combined with rTMS and TSCS. High-frequency rTMS was performed in the projection of the sensory-motor cortex on the side of the lesion, in the area of innervation of the lower limb. During TSCS, a stimulating electrode was placed between Th11–Th12, indifferent electrodes were placed in the region of the iliac crests, and the lumbar enlargement of the spinal cord was stimulated. The dynamics of neurological deficit was assessed using the rehabilitation routing scale, the Rivermead mobility index, the Berg balance scale, and a six-point scale for assessing muscle strength. The excitability of the neural networks of the spinal cord was determined using TSCS at the T11–T12 level, with electromyographic recording of the evoked motor responses of the muscles of the lower extremities.
RESULTS AND DISCUSSION. The combined use of rTMS and TSCS in the rehabilitation of patients in the acute period after ischemic stroke leads to an increase in the excitability of neuronal networks of the lumbar thickening of the spinal cord, a decrease in the activation thresholds of the RF, BF, TA and GM muscles of the affected limb (by 7.7 ma, 18.3 ma, 24.8 ma and 14.2 ma, respectively). Inclusion of rTMS and TSCS in the rehabilitation course leads to a significant improvement in the rehabilitation routing scale (by 2 points), Rivermead mobility index (by 5.8 points), statokinetic control functions (balance-Berg by 12 points) and an increase in lower limb muscle strength (flexors by 5.1 points, extensors by 6.2 points).
CONCLUSION. The use of rTMS and TSCS can be used as an additional effect within the framework of rehabilitation measures in the acute period after ischemic stroke.
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Personalized Rehabilitation of Patients with Prostate Cancer after Radical Prostatectomy: a Comparative Analysis of Urodynamic Parameters
Abstract
INTRODUCTION. Applying a personalized approach in the treatment of urinary incontinence in patients after RP can significantly improve the rates of correction of postoperative incontinence.
AIM. To study the effect of personalized rehabilitation of patients with prostate cancer (PCa) after radical prostatectomy on the state of functional indicators of the lower urinary tract.
MATERIALS AND METHODS. The study included 60 patients with verified primary resectable prostate cancer who underwent laparoscopic nerve-sparing prostatectomy. Patient ages ranged between 46 and 77 years (median 62.8 years). The patients were divided into main and control groups of 30 people each. The patients of the main group received rehabilitation using a personalized approach. The rehabilitation programs for the patients in the control group were formed on the basis of a syndromic-pathogenetic approach. Functional parameters of the lower urinary tract were assessed using a 24-hour pad test and a comprehensive urodynamic study before and after surgery, after a course of rehabilitation and 1 year after surgery.
RESULTS. Assessment of the degree of urinary incontinence in patients with prostate cancer using a 24-hour pad test showed similar clinical pictures in both groups in the postoperative period in the form of mild or moderate disorders. After the rehabilitation course, a positive trend was observed, however, in the observation group, 66.7 % of patients completely retained urine, while in the comparison group only 40%. Similar trends were observed in a year after a surgical treatment. According to a comprehensive urodynamic study (CUDS), after rehabilitation in the observation group, 76.7 % of patients showed signs of restoration of detrusor activity to the preoperative level with retention of the effect a year after the intervention (p < 0.05). A peak decrease in maximum detrusor pressure was observed in the postoperative period with a partial recovery of the indicator after rehabilitation and after 1 year in both groups. In the comparison group, a more pronounced decrease in detrusor pressure was observed, but the difference was statistically insignificant (p > 0.05).
DISCUSSION. This study tested a personalized approach in the rehabilitation of patients with urological oncology. This concept allows the use of physical and rehabilitation medicine technologies with maximum efficiency by identifying a specific patient model. The results of functional research methods (pad test, KUDI) are one of the potential determinants of the effectiveness of the use of rehabilitation technologies.
CONCLUSION. The results of rehabilitation of patients in the group with a personalized approach can significantly improve the rates of correction of postoperative incontinence.
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Effectiveness of Transcranial Magnetic Stimulation in Patients after Ischemic Stroke: a Prospective Study
Abstract
INTRODUCTION. Despite the fact that a large number of studies are focused on the rehabilitation of patients with ischemic stroke in the early recovery period, currently, much attention is paid to improving existing and developing new technologies in neurorehabilitation at the early stages of the disease. Transcranial magnetic stimulation (TMS) is a promising technology for the rehabilitation and recovery of patients with movement disorders after a stroke, which has a direct effect on the premotor cortex of the brain.
AIM. To assess the effectiveness of TMS in relation to daily activity in a comprehensive medical rehabilitation program in patients with ischemic stroke in the early recovery period.
MATERIALS AND METHODS. The study included 124 patients aged 55–75 years (53.2 % men and 46.8 % women). The main group included 64 people who received the TMS procedure. The comparison group included 60 patients who received an identical course of treatment, but instead of TMS, they underwent a low-intensity headband magnetic therapy. Treatment effectiveness was assessed using the Rivermead Mobility Index, Rehabilitation Routing Scales, and NIHSS. The severity of anxiety and depressive symptoms was assessed using the HADS scale. The total duration of treatment was 21 days. The dynamics of the patients’ condition was assessed before the start of treatment, 21 days after the course of rehabilitation and 3 months after the start of treatment.
RESULTS. The main group showed a significant decrease in neurological deficit according to the NIHSS scale from 15.3 ± 3.6 to 10.1 ± 1.7 (p < 0.05), Rivermead Mobility Index decreased from 5.6 ± 1.9 to 10.5 ± 2.4 (p < 0.05) and Rehabilitation Routing Scale decreased from 4.3 ± 0.8 to 2.5 ± 0.5 points (p < 0.05) since the start of rehabilitation and 3 months after its start. After 3 months, the neurological deficit in the main group was statistically significantly less compared to patients in the comparison group (p < 0.5). A significant decrease in depressive symptoms was found in the main group (χ2 = 28.641; p < 0.001), while in the control group the dynamics was not significant (χ2 = 7.140; p = 0.129); in addition, there was a regression of the anxiety component both in the main (χ2 = 47.949; p < 0.001) and control (χ2 = 12.483; p = 0.015) groups.
CONCLUSION. The use of the TMS device at the second stage of rehabilitation significantly reduces the neurological deficit, increases the mobility of patients, and reduces the severity of anxiety and depressive symptoms.
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Quality of Life Estimate of Patients with Chemotherapy-Induced Distal Polyneuropathy after High-Intensity Pulsed Magnetic Therapy: a Randomized Clinical Study
Abstract
INTRODUCTION. The development of peripheral polyneuropathy in cancer patients after chemotherapy has a high prevalence and represents an important medical and social problem. Currently, a number of physiotherapeutic methods are used to treat peripheral polyneuropathy induced by chemotherapy (PPIC).
AIM. To study clinical efficacy of high-intensity pulsed magnetic therapy in patients with PPIC according to indicative quality of life indicators.
MATERIALS AND METHODS. 90 patients with PPIC were included in the study. The mean age of the patients was 57.3 ± 5.3 years. Two groups were formed by randomization method: control group patients (n = 45) received standard drug therapy; main group patients (n = 45) received 10 high-intensity pulsed magnetic therapy (HIPMT) procedures every other day against the background of standard therapy. We analyzed clinical complaints, pain syndrome according to VAS, EORTC QLQ-CIPN20 scale scores, and quality of life indicators according to SF-36 questionnaire in patients with PPIC on day 20 after the start of clinical intervention.
RESULTS. After the conducted course of high-intensity pulsed magnetic therapy there was a significant increase in the cohort of patients with a lower degree of severity of PPIC, the proportion of patients with PPIC belonging to subgroups 0–1 degree of severity increased by 6.6 % (p < 0.01). Initial limb pain syndrome according to the VAS system in patients with PPIC in the main group decreased from 6.8 ± 1.2 to 2.4 ± 0.8 points (p < 0.05). In the control group VAS changed from 7.0 ± 1.1 to 6.3 ± 0.9 scores (p > 0.05), which was not statistically significant. It was found that inclusion of high-intensity pulsed magnetic therapy in the treatment program allows for more significant positive changes in sensory, motor and autonomous-vegetative manifestations of PPIC. According to the SF-36 scale, statistically significant differences were found in relation to physical functioning in patients of the main group. There was also an improvement in the indicators reflecting the social components of the quality of life in patients who received the course effect of (HIPMT) from 61 [58.6; 64.4] points to 66 [59.7; 70.0] points by 8.2 % (p < 0.05). Psychological health in the main group improved by 17.02 % (p < 0.01). In the control group, there were no significant shifts on any of the scales (p > 0.05).
CONCLUSION. The use of the high-intensity pulsed magnetic therapy procedures proved to be highly effective in correcting the main indicators of the quality of life of patients with PPIС.
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Peripheral Sacral Magnetic Stimulation in Patients with Idiopathic Overactive Bladder: a Single Blind Prospective Randomized Comparative Clinical Study
Abstract
INTRODUCTION. Overactive bladder (OAB) is a symptom complex that includes urgency, frequent urination, imperative urinary incontinence and nocturia. The idiopathic form of OAB is associated with dysfunction of sensory signal transmission at the level of the peripheral and central nervous system, which leads to bladder hypersensitivity. The low level of patients’ compliance to OAB drug therapy and the high level of refusal to take drugs emphasize the urgency of finding new effective methods of influencing the lower urinary tract. Magnetic stimulation (MS) is a non-drug treatment for lower urinary tract dysfunction.
AIM. To study the efficacy and safety of the sacral MS method in women with idiopathic detrusor overactivity (DO) and OAB symptoms.
MATERIALS AND METHODS. A single blind prospective randomized comparative study included 55 female patients with urodynamically confirmed idiopathic DO. The patients were divided by simple randomization into the main group (n = 29), which received MS 3 times a week for 5 weeks with a frequency of 5 Hz per sacral root area (S2–S4), and the placebo group (n = 26), in which sham stimulation was performed.
RESULTS AND DISCUSSION. The study revealed that sacral MS is reliably effective against the clinical symptoms of OAB in idiopathic DO. The dynamics of clinical symptoms is confirmed by changes in urodynamic parameters. The effect of sacral MS significantly exceeds placebo. MS is a safe procedure and is well tolerated by patients.
CONCLUSION. The sacral MS method, the effectiveness of which has been proven in comparison with placebo, is recommended to be included in the treatment regimen of patients with idiopathic OAB. The mechanism of action of sacral MS is associated with the activation of sympathetic and inhibition of parasympathetic influences, as well as changes in supraspinal control and cerebral activity.
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The Role of Computer-Aided Diagnosis in Speech Restoration in Patients with Cancer of the Oral Cavity and Oropharynx after Hemiglosectomy: a Prospective Comparative Study
Abstract
INTRODUCTION. Oral cavity and oropharyngeal cancers usually require extensive surgeries accompanied by damages to anatomical structures and impaired speech function.
AIM. To compare the effectiveness and terms of speech rehabilitation in patients with cancer of the oral cavity and oropharynx using various speech restoration techniques.
MATERIALS AND METHODS. We studied the effectiveness and length of speech rehabilitation in 140 patients with stages II–IV oral cavity and oropharyngeal cancer. The age of the patients ranged from 24 to 70 years. All the patients underwent hemiglosectomy. Combined modality treatment and postoperative speech rehabilitation were performed according to the technique developed in the Department of Head and Neck Tumors of the Oncology Research Institute. Speech rehabilitation effectiveness was studied on the basis of subjective and objective evaluation of speech using the computer-software complex (OnkoSpeech v 1.0).
RESULTS AND DISCUSSION. Impaired speech function of patients was observed before starting combined modality treatment and manifested as a change in the prosodic system of speech and subjective communication difficulties associated with the presence of a tumor. After surgery, all the patients demonstrated impaired speech function, ranging from distorted pronunciation to the complete absence of verbal communication. Speech rehabilitation started 8 to 29 days after surgery: in the study group I, Me = 9.6, in the study group II, Me = 9.8, values did not have statistically significant differences (p < 0.05). At the beginning of speech rehabilitation, to restore activity and coordinate the work of articulatory apparatus muscles and speech expiration, special complexes of articulation and breathing exercises followed by sound pronunciation correction were performed. Postoperative speech rehabilitation resulted in the improvement of speech function in 100 % of cases. In group II, where the correction of sound pronunciation was performed on the basis of speech diagnosis data using the OnkoSpeech v 1.0 computer-software complex, it was possible to achieve a better result of sound pronunciation correction of all the studied sounds, except for hissing (lingual-frontal) [sh], [zh], [shch], [ch].
CONCLUSION. The use of the OnkoSpeech v1. ± software package for speech computer-aided diagnosis made it possible to objectively evaluate and quantify the effectiveness of the correction of the sound pronunciation of six phonemes of the Russian language, improve the results of the correction of sound pronunciation and reduce the time of speech therapy.
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Effectiveness of Complex Medical Rehabilitation of Patients with Postthrombophlebitic Syndrome of Lower Extremities and Obesity: a Randomized Clinical Study
Abstract
INTRODUCTION. The relevance of the development of comprehensive rehabilitation programmes for patients with postthrombophlebitic syndrome (PTPS) is due to the high frequency of disability and a significant reduction in their quality of life. Since obesity and excessive body weight are proven risk factors for the development and progression of chronic vein diseases, weight reduction is one of the important tasks of rehabilitation measures in patients with PTPS and concomitant obesity.
AIM. Comparative study of the influence of complex methods of medical rehabilitation, including various methods of laser blood irradiation (supravascular and intravenous), pulse magnetotherapy and dry carbon baths, on the dynamics of indicators of composite body composition according to bioimpedance measurements in patients with postthrombophlebitic syndrome of the lower extremities and obesity.
MATERIALS AND METHODS. A randomized prospective study was conducted on the basis of the Department of Medical Rehabilitation of Patients with Somatic Diseases of National Medical Research Center of Rehabilitation and Balneology of the Ministry of Health of Russia. The study included 40 patients with PTS of the lower extremities and accompanying obesity, the average age of which was 58.3 [51.5; 68.0] year), randomized to two groups. The patients of the 1st group received Intravenous laser blood irradiation (ILIB) (“Lazmik”, Russia), impulse magnetotherapy and dry carbon baths, as well as therapeutic gymnastics in the hall. The patients of the 2nd group received a complex that included supravascular laser irradiation of blood (“Azor-2K”, Russia), pulse magnetic therapy, and dry carbon baths, as well as therapeutic gymnastics in the gym. Anthropometric measurements (body mass, malleolar volume) were used for the evaluation of anti-edema and lipolytic effects after a comprehensive course of medical rehabilitation, as well as bioimpedance measurement of body composition (“MEDASS”, Russia).
RESULTS. In patients with PTS of the lower extremities and obesity, after carrying out a course of medical rehabilitation using preformed physical factors, including various methods of laser irradiation of the blood (supravascular and intravenous), a significant decrease in body weight indicators was observed (p < 0.001), a decrease in BMI (p < 0.001), total and extracellular fluid (p < 0.001) without significant differences between groups. A significant decrease in the index of fat mass (kg) (p = 0.007) was found in patients of the main group.
DISCUSSION. Maintaining a healthy body weight as well as combating obesity are first-line secondary prevention measures recommended for all patients with PTS of the lower extremities. For the control of the dynamics of the composite composition of the body, an effective and sensitive method is the method of bioimpedance measurement, which allows to estimate the reduction of extracellular fluid (anti-flow effect) and fat mass of the body (lipolytic effect).
CONCLUSION. The method of bioimpedance measurement, used for the evaluation of the composite composition of the body, showed high sensitivity and allowed to establish the greater effectiveness of the developed complex, which includes ILIB with a wavelength of low-intensity laser radiation (NILI) of 635 nm in reducing fat mass.
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Sensorimotor Rehabilitation and Psychotherapeutic Techniques Effect on the Psychoemotional State in the Stroke Recovery Period
Abstract
INTRODUCTION. Stroke is the leading cause of disability of the population. In addition to motor disorders, cognitive and affective disorders contribute to the development of disability. The development of effective neurorehabilitation programs aimed not only at reducing the severity of motor deficits, but also at timely correction of psychoemotional disorders in stroke patients is very relevant for restorative medicine. In view of the proven positive therapeutic effect of physical exercises on anxiety and depression, their protective effect on cognitive functions, it is of interest to study the effect of motor rehabilitation on psychoemotional disorders in stroke patients.
AIM. To study the effect of sensorimotor rehabilitation on affective and cognitive disorders in patients in the recovery period of stroke in comparison with a complex psychotherapeutic technique.
MATERIALS AND METHODS. The study examined 2 groups of patients in the recovery period of ischemic stroke (up to 2 years) with the presence of anxiety and/or depressive disorders, comparable in gender, age, duration and focus of stroke localization, severity of neurological deficit. The 1st group — 24 patients — received a course of sensorimotor rehabilitation without targeted impact on affective disorders; the 2nd group — 25 patients — a course of complex medical and psychological adaptation lasting 18 days. The effectiveness of rehabilitation was assessed using validated scales and questionnaires (Rivermead Mobility Index, 6-point muscle strength assessment scale, modified Ashfort spasticity scale; Berg balance scales, Beck depression, Spielberger-Khanin anxiety, MMSE, MoCA; Schulte Table Methodology, SS-QOL Stroke Quality of Life Assessment Scale). Statistical analysis was carried out using the StatTech v. 2.8.8 program (developed by Stattech LLC, Russia).
RESULTS AND DISCUSSION. The preliminary assessment carried out in both groups showed a twofold predominance of anxiety states over depressive ones, concomitant cognitive impairments were detected in 88 % of patients, among whom attention disorders were most often recorded (there was no intergroup difference in these indicators). After completing the course of both sensorimotor and medico-psychological rehabilitation, both groups showed a significant decrease in the level of situational and personal anxiety on the Spielberger-Khanin scale, positive dynamics on the MoСа scale, the SS-QOL questionnaire, while a significant decrease in the level of depression on the Beck scale was registered only in patients of the 2nd group on against the background of the use of specialized psychotherapeutic techniques.
CONCLUSION. Motor rehabilitation is positively comparable with complex medical and psychological adaptation, it affects anxiety and cognitive functions in patients with ischemic stroke, it can be considered as one of the effective ways to correct anxiety states and prevent cognitive impairment in these patients, while in the treatment of depression the priority is should be given to specialized medical and psychological intervention.
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Drinking Sulphate Mineral Water Action Mechanisms at Primary Preventive and Therapeutic Application under Experimental Stress: a Comparative Analysis
Abstract
INTRODUCTION. Earlier in experimental studies, it was established that sulfate mineral drinking water (MB) under stress causes adaptation effects depending on the mode of its use — during primary prevention or treatment. The question of the role of different modes of drinking mineral water application in the formation of adaptation mechanisms remains unclear.
AIM. To conduct a comparative analysis of the effect of sulfate MW in primary preventive and therapeutic application on the development of adaptive metabolic and ultrastructural reactions in rats in the early post-stress period.
MATERIALS AND METHODS. The experiments were carried out on 54 white nonlinear male rats. Acute immobilization stress was modeled using the Selye method. All animals were divided into 5 groups: the 1st experimental group — the primary preventive effect of drinking sulfate MV; the 2nd experimental group — the therapeutic effect of drinking sulfate MV; the 3rd and 4th groups — controls; the 5th group — intact animals. Drinking sulfate MW (concentration of sulfate ions 1.93 g/l, mineralization 3.05 g/l) was administered intragastrically by 3 ml, a total of 18 procedures. Objects of research: liver and testes. Research methods: biochemical, light-optical, morphometric, electron microscopic. The statistical significance of the differences was assessed using the Student’s criterion.
RESULTS AND DISCUSSION. It was found that the most pronounced development of adaptive-protective reactions (increased activity of the antioxidant system, increased protein synthesis, activation of intracellular regeneration processes) was observed with the action of MW in the primary prevention mode. At the same time, there was the formation of more powerful adaptation mechanisms associated with the additional accumulation of structural and metabolic resources that limit the development of maladaptation and pathological processes. With the therapeutic use of MW, due to post-stress disorders of the mechanisms of regulation, the processes of adaptation and compensation were weaker.
CONCLUSION. The results reveal some features of the mechanism of action of drinking sulfate MW on the development of compensatory and adaptive processes and indicate the need for a differentiated approach in the use of drinking MW to increase their effectiveness in the comprehensive prevention and treatment of the body from the damaging effects of various stress factors.
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Audiovisual Stimulation and Cognitive Behavioral Psychotherapy Complex Application in the Rehabilitation of Patients with Long COVID: a Prospective Randomized Study
Abstract
INTRODUCTION. The COVID-19 pandemic has created threats and risks not only for the physical but for the mental health of people as well. To date, there is insufficient scientific data on anxiety, depression in patients who have undergone COVID-19, and the clinical effectiveness of comprehensive medical rehabilitation programs in patients with post-COVID disorders.
AIM. Tostudy the clinical effectiveness of the use of audiovisual stimulation and cognitive behavioral psychotherapy in the complex rehabilitation of patients with post-COVID syndrome.
MATERIALS AND METHODS. The study included 59 patients with the long COVID disorders from 1 to 6 months after the disease, of which 41 (69.5 %) women and 18 (30.5 %) men aged between 31 and 81, with the mean age being 59.73 ± 1.59 years. All the patients were randomized into two groups. Group I (main) included 29 patients, 9 men, 20 women, the mean age 60.72 ± 2.04 years, who underwent medical rehabilitation using audiovisual stimulation and cognitive behavioral psychotherapy techniques. The II (control group) included 30 patients, including 9 men, 21 women; the mean age was 58.63 ± 2.44 years, who underwentrehabilitation consisting of a standard set of measures. To objectify emotional disturbances, the Hospital Anxiety and Depression Scale (HADS) and the author’s computer program for assessing subjective comfort, situational and personal anxiety were used. Statistical data processing was carried out using the program “Statistica-10“. The degree of differences in quantitative indicators in the groups was assessed by the Wilconson test, the significance of differences between the groups after the treatment was made by the Mann-Whitney test (p). The assessment of qualitative indicators was carried out by analyzing multifield tables using the Pearson chi-square test.
RESULTS. The use of audiovisual stimulation and cognitive behavioral psychotherapy in the complex rehabilitation of patients with long COVID disorder syndrome contributed to the regression of emotional disorders, as evidenced by statistically significant changes in indicators on the HADS, Spielberger-Khanin, State Scale (p < 0.05). No signs of anxiety and depression were observed after the treatment in 27 (93.1 %) patients. Average (reference) levels of situational and personal anxiety were observed in 28 (96.6 %) and 21 (72.4%) patients, respectively. The subjective comfort index reached a high level in 19 (65.5 %) (p < 0.0001) patients.
DISCUSSION. The study showed that patients who had suffered COVID-19 and had long COVID disorders before the treatment were under the influence of a high-intensity stressful situation, experienced high-level anxiety and experienced severe psycho-emotional stress. The use of audiovisual stimulation and cognitive behavioral psychotherapy helped to increase the number of patients without anxiety and depressive symptoms (p < 0.05), reduce the high level of situational and personal anxiety on the Spielberger-Khanin scale (p < 0.05), and increase tolerance to psychological stress and the ability to independently cope with stress and its consequences.
CONCLUSION. A comprehensive rehabilitation program, including audiovisual stimulation and cognitive behavioral psychotherapy, helps to effectively relieve emotional stress and change the inappropriate behavior of patients with long COVID disorders.
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Seasonal Fluctuations in Hemodynamic Characteristics in Patients with Increased Meteosensitivity: a Survey
Abstract
INTRODUCTION. Currently, the Russian Federation occupies one of the first places among the developed countries of the world in terms of mortality from cardiovascular diseases, 3–5 times higher than in developed countries. Arterial hypertension, smoking, diabetes mellitus, obesity, and other risk factors contribute to the onset and progression of cardiovascular diseases, and lifestyle modification and reduction in risk factor levels can slow their development. An increase in physical activity along with a decrease in the total calorie content of food is mandatory for reducing body weight. When combining physical exercises with climatotherapy (health path, physical exercises in the open air), it is necessary to take into account external meteorological conditions, as well as increased meteosensitivity of some patients, which are able to neutralize the therapeutic effects achieved by using, for example, health path.
AIM. To study the frequency and seasonality of the main meteopathic reactions in patients with cardiovascular diseases.
MATERIALS AND METHODS. We conducted a verbal and communicative examination of 735 patients with a body mass index of 25 kg/m2 and over, who were treated in the health resort complex “Vulan“. The analysis of patients’ answers about arterial pressure increases and complaints about other meteopathic reactions during the year according to self-monitoring data was carried out. Macroclimatic characteristics of the location of the health resort complex were also studied. The study was performed as part of the research work under the state assignment of the Ministry of Health of the Russian Federation, reg. No. 121040200110-0.
RESULTS. It was revealed that the highest frequency of increased blood pressure recorded by patients is registered in March, October, November and December, the lowest is recorded in May, June and August. At the same time, the frequencies of other meteopathic reactions, such as fear, anxiety, shortness of breath, and others, are evenly distributed throughout the year.
CONCLUSION. The study evaluated the natural climatic factors of the resort located on the Black Sea coast of the North Caucasus, by the example of the health resort complex “Vulan“ in connection with the search of favorable seasons for the treatment of cardiological patients with increased meteosensitivity. The results obtained allow us to make proposals to supplement the current regulatory documents with the data on the identified favorable periods of health resort treatment for cardiologic patients, expanding the seasonality for referring patients to the resorts of the Black Sea coast of the North Caucasus.
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Organization of Remote Rehabilitation in the Russian Federation: a Literature Review
Abstract
INTRODUCTION. The interruption of the recovery process and the absence of patients’ activities at home after discharge from a medical institution leads to the loss of results achieved at various stages of medical rehabilitation. In this regard, the remote (telemedicine) form of rehabilitation assistance is of particular importance.
AIM. To present up-to-date data on the legal and regulatory framework for telemedicine in the Russian Federation, as well as an overview of domestic Internet platforms in the field of remote medical rehabilitation.
MATERIALS AND METHODS. The search for normative legal acts was carried out on the “The official Internet portal of Legal Information” (www.pravo.gov.ru). The literature review was performed using the databases eLibrary, Cyberleninka, PubMed, Scopus, Web of Science (Core Collection) and Google Scholar by July 31, 2023 for the following keywords: telemedicine, remote physical rehabilitation, medical rehabilitation, functional recovery.
RESULTS. The article elaborates on the legal and regulatory framework of telemedicine in the Russian Federation, provides a list of domestic Internet portals that are now being employed to provide remote medical care.
CONCLUSION. The remote form of arranging rehabilitation is supported by the regulatory and legal framework and has promising outlooks for development due to the advent of new information technologies that allow for active communication between a medical worker and a patient. Nevertheless, the issues of effectiveness and safety of remote physical rehabilitation remain insufficiently studied, therefore, it is necessary to conduct randomized comparative studies analyzing long-term results.
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Reducing Fracture Risk in Postmenopausal Osteoporosis: a Review of Effective and Safe Pharmacological Therapy Providing Adherence to Treatment
Abstract
INTRODUCTION. Postmenopausal osteoporosis (PMO) accounts for up to 85 % of all cases of osteoporosis, complications of which — pathological fractures — lead to a decrease in quality of life and functionality, pain, severe psycho-emotional disorders, loss of ability to self-care, disability and an increased risk of death. Timely prescribed pathogenetic therapy for osteoporosis, including in patients undergoing medical rehabilitation, helps reduce the risk of developing osteoporotic fractures and prevent complications associated with them.
MAIN CONTENT OF THE REVIEW. The literature review analyzes 5 domestic and 47 foreign literary sources, on the basis of which a description of modern methods of treating PMO is made in order to reduce the risk of developing pathological fractures. Poor patient adherence to osteoporosis therapy is associated with low effectiveness of PMО treatment and an increased financial burden on the healthcare system — increased hospitalization rates and treatment costs. The infrequent dosing frequency and good tolerability of therapy help to increase adherence to oral supplements.
CONCLUSION. The review focused on the effectiveness and safety of the oral bisphosphonate ibandronic acid 150 mg once a month, the administration of which to women with PMO demonstrated good tolerability, ease of use and high efficiency, both in reducing the risk of fractures and in increasing bone mineral density, including long-term treatment periods — 5 years.
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Methods for Diagnosing and Predicting Diaphragm Dysfunction in the Recovery Period of a Stroke: a Narrative Review
Abstract
INTRODUCTION. Diaphragm is not only the main human respiratory muscle, it also plays an important role in maintaining intra-abdominal pressure, balance, upper limb motor function, swallowing and speech. In patients with cerebral stroke, the function of the diaphragm can be impaired on the side of hemiparesis in more than half of the cases and may negatively affect the entire recovery process. Moderate clinical manifestations of unilateral diaphragm dysfunction require special examination methods for diagnosis and planning of appropriate rehabilitation measures.
AIM. To analyze the predictors and compare of methods for diagnosing diaphragm dysfunction in patients with hemiparesis during the recovery period of stroke to improve the quality of the rehabilitation diagnosis and the effectiveness of further rehabilitation process.
DISCUSSION. An analysis of publications over the past five years was done. Anatomical and physiological aspects of the diaphragm are identified, and a comparison of manual and instrumental methods for the diaphragm function evaluation are presented. An assessment of diagnostic methods is given in terms of accuracy, accessibility and possibility of use for dynamic monitoring of patients. The main values of normal indicators of diaphragm function and their level in case of unilateral dysfunction are presented. Predictors of diaphragm dysfunction in patients with hemiparesis as a result of stroke are identified.
CONCLUSION. Timely diagnosis of diaphragm dysfunction will ensure the appropriate rehabilitation goal setting during the recovery period of a stroke and will help to optimize the interventions and increase the effectiveness of rehabilitation process. The information is addressed primarily to specialists working in rehabilitation. The search was carried out using the Pubmed and RSCI databases.
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Features of Neuropsychological Support of Patients with Impaired Consciousness at the Early Stage of Rehabilitation: a Narrative Review
Abstract
INTRODUCTION. In the neuropsychological support of patients with impaired consciousness at an early stage of rehabilitation, methodological and practical problems arise related to the choice and procedure for using methods of neuropsychological diagnostics and neuropsychological rehabilitation. To develop methods of working with such patients, it is necessary to address the concepts of the structure of consciousness and the content of consciousness.
RESULTS. The article presents a review of the literature devoted to the problem of the work of a neuropsychologist with patients with impaired consciousness. In the reviewed literature, attention is drawn to the insufficient development of the neuropsychological content of the concept of “consciousness”; methodological and procedural limitations that arise when a neuropsychologist works with patients with disorders of consciousness of varying degrees of severity; the possibilities of conducting and limiting psychostimulotherapy and sensory stimulation in domestic and foreign approaches are discussed.
CONCLUSION. The analysis of publications on the topic of accompanying patients with impaired consciousness reflects the presence of a number of unresolved issues. At the present stage of development of neuropsychological work with patients with impaired consciousness, there is no single approved and detailed protocol regulating the conduct of neuropsychological diagnostics and neurorehabilitation with them. The problem is at the stage of solution and requires further research.
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Dissertation Orbit
Mathematical Modeling of the Risks of Stress-Related Diseases: a Review
Abstract
INTRODUCTION. Stress is one of the risk factors for chronic non-communicable diseases, such as cardiovascular diseases, autoimmune disorders, mental disorders, and neurotic conditions like depression and anxiety. Therefore, it is important to predict and correct stress-related problems early.
AIM. To assess the impact of stress on the human body, a comprehensive review of both Russian and international sources was conducted across databases like PubMed, eLibrary, and CyberLeninka for the period 2011–2023. The search terms used included “stress effect”, “predictive model”, “mathematical modeling”, “stress”, “mathematical model”, and “stress-related diseases”.
CONCLUSION. The literature review has revealed that chronic stress exerts a significant negative impact on the human body, verifiably leading to disorders of the digestive, nervous, endocrine, cardiovascular, and immune systems. At the current stage, stress diagnosis is conducted using both questionnaire methods and instrumental techniques, each having its respective advantages and limitations. Several scientific studies emphasize the importance of mathematical modeling as a tool for simulating the effects of stress on the body and analyzing the key mechanisms predisposing to the development of pathologies. The algorithms for constructing predictive models presented in this publication may serve as a foundation for the development of an automated expert advisory system.
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