Physical and rehabilitation medicine, medical rehabilitation

The proposed journal was created with the aim of developing a clinical area in the Russian Federation - physical and rehabilitation medicine, which occupies a most important and decisive position in the development of medical rehabilitation of patients with impaired function, structure and limitation of life due to socially significant diseases and conditions. The scientific publication is addressed to a wide range of specialists involved in various issues of medical rehabilitation: clinicians in the field of medical care (neurologists, cardiologists, orthopedic traumatologists, resuscitation anesthetists, pediatricians, neonatologists, geriatricians, etc.), physical and rehabilitation doctors doctors of functional and radiation diagnostics, doctors of sports medicine, balneologists, physical and occupational therapists, speech therapists and defectologists, psychologists and neuropsychologists, nurses and social workers.

The main purpose of the journal is to promote the development of scientific research in the field of medical rehabilitation, the dissemination of the latest data on the effectiveness of advanced technologies for the restoration of various functions and structures of patients after diseases and injuries of the central nervous system, autonomic nervous system, musculoskeletal system, cardio-respiratory system, system metabolism and other systems at various stages of medical care; effective technologies for managing the medical rehabilitation process; urgent issues of the formation of a personnel model for specialists in medical rehabilitation, coverage of clinical recommendations, professional and educational standards for medical rehabilitation, physical and rehabilitation medicine.

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Current Issue

Vol 2, No 1 (2020)

ORIGINAL STUDIES
Balance training at low physical fitness using virtual reality system
Kotov-Smolenskiy A.M., Klochkov A.S., Khizhnikova A.E.

Abstract

Background. Personal degrees of motor activity frequently is a determining factor of human health and longevity. A sedentary lifestyle is a precondition for the development of many diseases and adversely affect the harmonious physical development of a person. The result of poor physical fitness is reduced movement coordination and the balance function, which can cause falls and injuries. Today, it is not always possible for healthy people of working age and adolescents to organize physical education events, however, modern rehabilitation technologies can serve as a solution to this issue.

Aims — analysis of the effectiveness of balance training physical exercises performed in a virtual environment, in people with low physical fitness.

Methods. In the experimental group, a set of physical exercises were performed in a virtual environment, in the control group — in a real environment with additionally created pedagogical conditions aimed at the position of greater instability using gymnastic pads of different stiffness, and foam material bar.

Results. The study involved 20 female volunteers (aged 16 to 17 years), who were divided into two equal groups, comparable in age (р > 0.05). A statistical analysis of the data obtained at the end of the training course showed that experimental and control groups in the maximum torso deviation in the Romberg instrumental test (p = 0.11) when standing on toes with eyes closed (p = 0.24), and the stability time in the Bondarevsky test (p = 0.07) are no longer significantly different.

Conclusions. Performing physical exercises with visual support for biological feedback in a virtual reality system can contribute to the intensification of the learning process, have a beneficial effect on the prevention of a sedentary lifestyle, and also contribute to the training of the balance function, as one of the most important human abilities that determine its motor capabilities.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(1):4-10
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Craniocerebral hypothermia as a therapeutic treatment option for thermal balance disturbances in post-comatose patients
Shevelev O.A., Saidov S.K., Petrova M.V., Chubarova M.A., Usmanov E.S.

Abstract

Background. Functional outcome in patients after cardiovascular, cerebral or traumatic injuries often remains unfavorable, what needs long rehabilitation and care.

Aims. Optimization of chronically critically ill patients treatment using selective craniocerebral hypothermia added to a standard intensive care.

Methods. Use of craniocerebral therapeutic hypothermia device «ATG-01» has greater clinical efficacy in mortality rate, CRS-R rate and modified Rankin scale rate, as well as decrease in disability rate. Treatment algorithm with the use of craniocerebral hypothermia device «ATG-01» has greater efficacy in cost- effectiveness analysis.

Results. Methods of multipositional SHF- radiothermometry and thermomonitoring, as well as non-invasive craniocerebral hypothermia used in chronically critically ill patients for the first time. Results of our research have showed high efficacy of these methods and let us optimistically estimate the perspective to involve CCH in rehabilitation interventions of such patients.

Conclusion. Our results can be used in Intensive Care Units of different medical institutions that provide healthcare to patients with brain damage and common central nervous system diseases that outcome to low level of consciousness.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(1):11-19
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Impact of navigated rhythmic transcranial magnetic stimulation on regaining consciousness in patients after severe brain injury
Borodin M.M., Usoltseva N.I., Gorshkov K.M., Shpichko A.I., Shpichko N.P., Kanarskiy M.M., Gorbeshko G.A.

Abstract

Background. Rehabilitation of patients with chronic disorders of consciousness is extremely important due to severity of the condition and increasing number of such patients. Disorders of consciousness have led to inability of self-care, need for constant care and complete dependence on outside assistance. Applying noninvasive brain stimulation and rhythmic transcranial magnetic stimulation seems to be perspective methods of rehabilitation.

Aim. to evaluate the efficiency of rhythmic transcranial magnetic stimulation of left dorsolateral prefrontal cortex using local navigation in patients with chronic disorders of consciousness.

Methods. This prospective study was carried out in patients with chronic disorders of consciousness after severe brain injury. All patients received 10-day treatment with active high-frequency rhythmic transcranial magnetic stimulations of the left dorsolateral prefrontal cortex. Revised coma recovery scale (JFK Coma Recovery Scale-Revised, CRS-R) was used to evaluate the effectiveness of the procedure.

Results. After the treatment with rhythmic transcranial magnetic stimulations according to CRS-R 8 out of 12 patients improved their score. The best response was observed in patients in minimally conscious state. There were no cases of adverse events during the treatment.

Conclusion. High-frequency rhythmic transcranial magnetic stimulations provide an opportunity to improve level of consciousness in patients after severe brain injury. Using navigation system allows to rule out an inaccuracy in determining the dorsolateral prefrontal cortex. As a result this study proposed the effective and safe protocol for rehabilitation of patients with chronic disorders of consciousness.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(1):21-27
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Nutritive rehabilitation of the patients after recovering from coma
Petrova M.V., Shestopalov A.E., Yakovleva A.V., Krylov K.Y., Mengistu E.M.

Abstract

Background. Along with the measures to restore the basic body functions and prevent secondary brain injury, one of the key areas of modern rehabilitation is nutritional and metabolic support.

Aims: to improve the results of the treatment of the patients by optimizing the system of nutritional and metabolic rehabilitation using enteral, parenteral, combined parenteral-enteral nutrition methods, who are undergoing rehabilitation after recovering from Coma resulting from injuries and diseases of the central nervous system.

Methods. In a prospective cohort study, the results of the study and complex treatment of 113 patients after recovering from Coma as a result of brain injury of various etiologies who were undergoing rehabilitation in the period from 2017 to 2019 in the FNRC RR were analyzed.

Results. Indirect calorimetry has proven to be the most accurate method for creating an effective and adequate program of nutritional and metabolic support in patients in chronic critical conditions who recovers from the coma. In patients who recovers from the coma, due to the excessive process of hypercatabolism, increasing protein requirements: the average protein requirements for a patient who recovers from the coma are 1.26–1.5 g of protein per kg/weight. Conducting optimal nutritional support for patients recovering from Coma involves determining the functional state of the gastrointestinal tract. To build an effective and adequate program of nutritional and metabolic support where accurate determination of energy needs is of great importance.

Conclusions. The indirect calorimetry method is a valuable tool for assessing energy needs, although without taking into account the functionality of the gastrointestinal tract and other factors affecting body compositions, it may not be sufficient to prescribe optimal nutritional support in patients after recovering from Comatose.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(1):28-37
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REVIEWS
Quality assessment in medical rehabilitation
Lutsky L., Treger I.

Abstract

The advances of modern medicine, prolonging the average life-span, and especially the recognition of medical rehabilitation as a vital part of the medical process, have created rapid development in the field among most of the countries worldwide. The dynamic process of the development in the fields of medical rehabilitation in Russian healthcare, has brought up questions about different outlooks, principles and processes of quality assessment in medical rehabilitation. Taking into consideration the differences in the organizational structures and professional tendencies — applying the indicators of quality into rehabilitation practice can prove to be challenging. In the last years the Israeli health system has gained much experience working with different rehabilitation structures. The Obligatory State Insurance of the Israeli health system forced Health Funds to developed optimal indicators for the evaluation of the professional quality in rehabilitation. The accumulated knowledge can help in creating a system for the quality assessment in Russian Federation. Rehabilitation is characterized by a long list of professional performance aspects which are exposed to quality control. That is why it is common to define indicators separately for the structures, processes, and results. In different countries dissimilar aspect of quality are defined as indicators, but all of them are built on similar principles — which focus on the simplicity and objectiveness of information gathering, minimal dependency on the character of the auditor, combining different forms of internal and external examination, and including systems of quality control by gathering questionnaires from the patients and their family members. The chosen quality indicators of the rehabilitation process need to reflect on the different sides of the professional treatment, stimulating a constant increase in quality on account of organizational activities in the industry in general and in separate departments in particular. The International Classification of Functioning (ICF) is widespread over many countries and constitutes the accepted paradigm in the field of medical rehabilitation, and with time may become the optimal platform for developing a system of quality control worldwide.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(1):39-48
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Rehabilitation of patients with chronic headaches
Kadykov A.S., Belopasova A.V., Gubanova M.V., Pryanikov I.V.

Abstract

The worldwide trend towards headache (HA) chronization is an important medical and social problem due to frequent psychological and social maladaptation of patients. Chronic HAs reduce quality of life and patient’s ability to work. The trend towards headache chronization is largely associated with acceleration of the pace of life, constant social and informational tension, leading to emotional disturbances, such as depression, anxiety, and asthenia. Single medical interventions do not seem to have a lasting effect. Thus, such patients require long-term comprehensive rehabilitation with regard to the type and characteristic features of HA, as well as triggers and comorbid condition. Rehabilitation should include adequate long-term drug therapy aimed at preventing exacerbations of HA. Additional approaches may include botulinum neurotoxin injections, physiotherapy (biofeedback, transcranial magnetic stimulation, transcranial electrical stimulation), psychotherapy, comorbid conditions diagnosis and treatment, lifestyle intervention.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(1):49-56
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The Parkinson’s disease rehabilitation — non-pharmaceutical approaches
Ismailova S.B., Ondar V.S., Prokopenko S.V.

Abstract

The article represents clinical trials and attempts of non-drug treatment in Parkinson’s disease (PD). For the first time in the 60s of the previous century, physical exercises were proposed as a correction of motor symptoms in PD. During this period, rehabilitation was considered as a secondary method to the pharmacological and surgical treatment of PD. An analysis of studies conducted over the past 10 years showed that various rehabilitation techniques cannot be compared with each other and that there is no full proof evidence. Initially, the rehabilitation approach was based on empirical experience, but more and more evidence suggest that neuroplasticity is the main mechanism underlying the effects of rehabilitation. Various data indicate an increase in synaptic transmission, an effect on neurotransmission, and a decrease in chronic oxidative stress during physical exposure, which, in turn, can provide a neural basis for rehabilitation in PD. An important issue is whether patients with PD have the ability to reacquire or master new skills. According to reports, the need for non-drug correction in PD is obvious, however, it is necessary to determine the intensity, frequency, continuity of exposure, progressive nature of PD. These recommendations should have an evidence base, and also should correlate with the stages of the disease. The rehabilitation program for PD should be “goal-oriented” and be adapted to the characteristics of each patient individually.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(1):57-65
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Pathophysiological substantiation of the complex approach to rehabilitation of patients with myofascial pain syndrome of the neck region
Shimarova O.V., Malakhovskiy V.V., Zilov V.G.

Abstract

Myofascial pain syndromes are a widespread pathology, which is a condition that is characterized by local muscle stiffness and the formation of trigger points in them. The pathophysiology of myofascial pain syndromes is not fully understood. Studies indicate the role of dysfunction of the end plate of the muscle, impaired proprioreception and sensomotor control, central sensitization. The review presents a modern view of approaches to the treatment of myofasial pain syndrome of the neck region, based on an understanding of its pathophysiology.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(1):66-70
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Early rehabilitation of newborns moved by perinatal hypoxia
Perepelitsa S.А.

Abstract

Rehabilitation of newborns after perinatal hypoxia in the intensive care unit is the subject of study and discussion. The choice of complex treatment, including developmental care, positioning, massage and hydrotherapy, is carried out individually for each newborn. This process involves not only medical workers, but also parents. Creation of a long-term program which is being implemented not only at the hospital, but also at home after the child is discharged.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(1):71-78
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New methods and technologies, discussions
Prospects for microbiota-oriented therapy in neurorehabilitology
Beloborodova N.V., Chernevskaya E.A.

Abstract

Intensive accumulation of data on the role of bacteria in complex regulatory mechanisms of the nervous system allows us to predict the transition to a new level in the treatment of brain dysfunctions. This problem-oriented article analyzes recent publications that reflect the relationship of changes in the profile of microbiota metabolites with the course and outcome of the disease in patients with central nervous system damage. Based on the results of biomarker monitoring in patients with prolonged neurorehabilitation in the Intensive care unit, the authors justify a metabolomic approach for correction in the microbiota–gut–brain system.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(1):79-85
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Mobile rehabilitation service as an innovative technology in the activity of the center for patients with consciousness (on the example of FNKC RR)
Pryanikova N.I., Polikarpova O.S., Ibragimova K.S., Bushueva E.V.

Abstract

In the last decade, considerable attention has been paid to the development of medical and social services including rehabilitation services, for citizens at home. Particularly noteworthy are patients with impaired consciousness, high-quality rehabilitation and social work with which at home has not been carried out before. According to the research materials, the creation of the Mobile Rehabilitation Service (MRS) in the Federal State Budgetary Institution «Federal Scientific and Clinical Center for Reanimatology and Rehabilitation» has allowed to accumulate and actively practice the unique innovative experience of mobile rehabilitation of clients with impaired consciousness. The data on the served contingent and the indicators of the effectiveness of the rehabilitation, convincingly confirming the need and high medical and social significance of the innovative technology — the mobile rehabilitation service. The experience of MRS FNKC RR seems appropriate to scale and replicate in the framework of medical rehabilitation institutions in the country.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(1):86-92
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