Physical and rehabilitation medicine, medical rehabilitation

BACKGROUND: Remote rehabilitation expands access to necessary care for patients with breast cancer by eliminating transportation barriers, reducing infectious risks, and overcoming limitations in specialist availability.

AIM: To evaluate the effectiveness and safety of different models of remote medical rehabilitation in outpatients with breast cancer.

METHODS: A prospective controlled nonrandomized study included 80 patients with stage I–III breast cancer undergoing neoadjuvant therapy. The main group received remote rehabilitation and was subdivided into two subgroups: one using a specialized interactive DAR platform and another interacting with a multidisciplinary rehabilitation team via messaging applications. The control group was monitored by an oncologist and received medical care in accordance with clinical guidelines. At baseline and after 6 months of follow-up, the following outcomes were assessed: quality of life (HeartQoL questionnaire), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale; Spielberger–Khanin Inventory), treatment adherence (COP-25 quantitative assessment scale), and instrumental and functional parameters (echocardiography; Six-Minute Walk Test).

RESULTS: Patients in the main group demonstrated significant improvement in quality of life and reduction in anxiety levels compared with the control group. Functional capacity remarkably increased in the main group, whereas a decline was observed in the control group. Preservation of left ventricular function was noted in the main group, whereas a significant reduction was recorded in controls. The most pronounced positive changes were observed among users of the specialized DAR interactive platform compared with those communicating via messaging applications.

CONCLUSION: Remote rehabilitation models are effective tools for maintaining and improving functional activity and psychoemotional status in patients with breast cancer. The additional use of specialized interactive platforms within a hybrid remote rehabilitation model provides greater clinical benefit, whereas simplified communication channels remain an important alternative for patients with limited access to digital technologies.

BACKGROUND: Spinal deformities represent a group of conditions characterized by abnormalities in spinal alignment. The primary manifestations include impaired postural alignment accompanied by various clinical complaints. Acquisition and analysis of new data aimed at prevention of spinal deformities in children remain relevant.

AIM: To investigate the prevalence of different types of postural disorders in school-aged children and to evaluate their association with clinical manifestations of spinal deformities.

METHODS: A prospective cross-sectional study included 3505 school-aged children who underwent sanatorium treatment at the Children’s Sanatorium Bykovo of the Ministry of Internal Affairs of Russia between 2020 and 2025. Of these, 405 children meeting inclusion criteria were selected and divided into two subgroups: younger school age (7–10 years) and middle school age (11–14 years). Sagittal spinal curvature was classified according to Staffel; deviations in the frontal plane were described as scoliotic posture or scoliosis. Characteristic complaints associated with spinal deformities were assessed using a questionnaire. Significance was evaluated using Student t test and Pearson χ² test, with p < 0.05 considered significant.

RESULTS: No signs of spinal deformities were identified in 60 children (14.8%). In the first subgroup (n=161), deviations in the sagittal (47.8%) and frontal (52.2%) planes occurred with similar frequency. In the second subgroup (n=184), frontal plane deviations were more common (64.1%; p=0.025). Increased lumbar lordosis was associated with obesity in 90.7% of cases (p < 0.001). Scoliosis occurred twice as often in the second subgroup (32.8%; p=0.012). Combined sagittal and frontal plane deviations were observed in 27.2% of cases. Complaints characteristic of spinal deformities were reported by 47.8% of children and were twice as frequent in the second subgroup (63.6%; p < 0.001). The most common complaint in both subgroups (52.6%) was reduced physical activity level.

CONCLUSION: Scoliotic posture is more frequently observed in older school-aged children. Scoliosis is typically preceded by sagittal spinal deviations. Obesity appears to be one of the contributing factors to lumbar hyperlordosis. Postural disorders are associated with decreased physical activity in approximately one-quarter of affected children.

The legacy of the COVID-19 pandemic may represent an even more serious global health challenge than the acute infection itself. The neurological consequences of SARS-CoV-2 infection may progress to chronic brain tissue damage, leading to clinical manifestations of neurodegenerative diseases. Post-COVID-19 neurological syndrome and neurodegenerative disorders, such as Alzheimer disease and Parkinson disease, share common pathological features, risk factors, and underlying mechanisms. Immune-mediated mechanisms constitute a key component of the post-COVID-19 neurological syndrome and may initiate a neurodegenerative cascade. Chronic inflammatory processes triggered by SARS-CoV-2 infection promote the aggregation of misfolded proteins and neuronal loss, which are hallmark features of neurodegeneration.

Given the high global prevalence of COVID-19 during the pandemic, health care systems should be prepared for a potential increase in the incidence of neurodegenerative diseases in the coming years. Addressing this challenge requires interdisciplinary collaboration integrating immunology, neurology, virology, and systems biology to develop effective individualized therapeutic strategies for one of the most persistent consequences of the COVID-19 pandemic.

This review examines the complex relationship between COVID-19 and neurodegenerative diseases. SARS-CoV-2, its RNA, and proteins act as potent immunomodulatory agents capable of inducing chronic neuroinflammation even after viral clearance. Advances in modern biomedical technologies have enabled the identification of proteomic, genetic, and imaging biomarkers that may serve as predictors of risk and potential therapeutic targets. Elucidation of these molecular interactions provides important insights for future research aimed at developing innovative therapeutic and rehabilitation interventions.

Transcranial magnetic resonance–guided focused ultrasound is a rapidly evolving noninvasive treatment modality for neurological disorders associated with movement disturbances. The greatest clinical experience has been accumulated in patients with essential tremor and Parkinson disease. Despite the minimally invasive nature of this intervention, adverse effects have been reported, including postural imbalance, which may occur in 75%–90% of cases. The most pronounced disturbances are detected in patients undergoing high-energy exposure, as well as in patients with extension of the treatment area into the subthalamic region.

The present clinical observation describes the characteristics of balance disturbances and changes in gait biomechanics in a 63-year-old patient with pharmacoresistant essential tremor who underwent focused ultrasound brain surgery. As part of the preoperative assessment, magnetic resonance imaging and computed tomography of the brain were performed; based on computed tomography findings, the skull density ratio was calculated. Given the low skull density ratio, modification of the standard magnetic resonance–guided focused ultrasound protocol was performed. In the postoperative period, following high-energy exposure in the region of the left ventral intermediate nucleus of the thalamus with extension into the posterior subthalamic region, regression of tremor in the right extremities was noted; however, clinical assessment of the patient’s condition, as well as comparative stabilometric analysis in the preoperative and postoperative periods, demonstrated alterations in balance and gait.

Thus, on the one hand, the unequivocal efficacy of the focused ultrasound method in essential tremor is clearly demonstrated; on the other hand, the possibility of adverse events is evident, which, despite regression of the main clinical manifestation of the disease, may lead to insufficient patient satisfaction with treatment. Further studies will help identify factors leading to balance disturbances, improve the selection of patients for focused ultrasound interventions, and develop fall-prevention programs aimed at reducing gait and balance disorders in this patient population.