ORIGINAL STUDY ARTICLE

Algorithm for physical rehabilitation of patients with multiple sclerosis: practical experience

Kuzminova T.A., Fedorenko Y.V., Ivanova G.E., Ryabov S.A., Boyko O.V., Boyko A.N.

Abstract

BACKGROUND: Multiple sclerosis is a pressing problem of modern society and healtcare. The high risk of disability of the able-bodied population, together with the observed trend of increase in morbidity and decrease in the age of onset of the disease, create a number of economic and social difficulties. It is well known that current medical treatment of multiple sclerosis is most effective in reducing the frequency of exacerbations and disability progression, but does not affect the already established residual manifestations, indicators of disability progression objectified by magnetic resonance imaging data.

AIM: Evaluation of the effectiveness of using the algorithm for choosing a method of physical rehabilitation, according to the selected models of patients with multiple sclerosis.

MATERIALS AND METHODS: The medical histories of patients aged from 31 to 58.8 (average age 48.9±8.6) years who were in hospital treatment were analyzed (n=504; men — 34%, women — 66%), of which 56% had no disability, 11% had disability group I, 25% had disability group II, and 8% had disability group III.

RESULTS: An algorithm for working with patients in this category was developed from the perspective of functioning in the categories of the International Classification of Functioning, Disability and Health, and Assessment of Impairments, which is a huge part of the medical rehabilitation protocol for patients with multiple sclerosis.

CONCLUSION: The proposed models of patients, including pronounced disorders, make it possible to systematize and standardize the process of rehabilitation measures, improve the quality of provided medical services and provide the population with qualified rehabilitation care.

Physical and rehabilitation medicine, medical rehabilitation. 2023;5(4):269-278
pages 269-278 views

Controlled hypoxia-hyperoxytherapy as a component of a targeted approach in the rehabilitation of patients with multimorbidity: a single-center, randomized, placebo-controlled, prospective study

Lyamina N.P., Lyamina S.V., Skorobogatyth N.V., Ksenofontova I.V., Spirina G.K.

Abstract

BACKGROUND: Multimorbidity is one of the most important public health problems, leading not only to a deterioration in the functional abilities of an individual, but also to an increase in the disability of the population, which determines the need to use effective measures in the treatment and rehabilitation of patients with multimorbid pathology.

AIM: The aim of this study was to evaluate the effect of a two-week medical rehabilitation program including the respiratory therapy method based on short-term intermittent exposure to hypoxia and hyperoxia on the dynamics of hypoxia-inducible factor-1 (HIF-1) and C-reactive protein in patients with multiple chronic diseases. The novelty of this study is due to the peculiarities of the study group — patients with multimorbid pathology.

MATERIALS AND METHODS: A single-center, randomized, placebo-controlled, prospective study (NCT05053672, ClinicalTrials.gov) included 42 patients aged 43 to 68 years with multimorbid pathology: generalized osteoarthritis — 61.9%, knee OA — 21.4%, hip OA — 16.7%, controlled arterial hypertension stage I–II — 90.5%, post-Covid syndrome — 100%. Patients were randomized into 2 groups by the method of numbered identical containers. According to clinical and demographic characteristics of patients, concomitant pathology, C-reactive protein and HIF-1 levels, the studied groups were comparable. The main group (27 patients) received a course (8–10 sessions) of individually dosed hypoxy-hyperoxytherapy on the basis of biofeedback (reoxytherapy) against the background of the standard complex of medical rehabilitation. The comparison group (15 patients) received sham reoxy therapy (placebo treatment) along with standard rehabilitation.

RESULTS: The data obtained as a result of the study in multimorbid patients using reoxy-therapy clearly demonstrated reduction of clinical symptoms, improvement of general well-being according to visual analogue scale and decrease of C-reactive protein as a classical marker of inflammation against the background of stabilization of HIF-1 dynamics.

CONCLUSION: The use of biofeedback-based short-term intermittent exposure to hypoxia and hyperoxia (reoxy therapy) in patients with different initial characteristics in terms of clinical health status and multimorbid pathology is reasonable taking into account modern personalized approaches to medical rehabilitation.

Physical and rehabilitation medicine, medical rehabilitation. 2023;5(4):279-288
pages 279-288 views

Medical convergence technology in the system of comprehensive rehabilitation of children with neurotrauma: our experience of implementation (with case report)

Valiullina S.A., Sidneva Y.G., Zakrepina A.V., Mamontova N.A., Fufaeva E.V.

Abstract

BACKGROUND: The annual increase of childhood trauma with severe consequences is 2% per year (WHO, 2020/21). This motivates rehabilitation specialists to search for new technologies and effective approaches. Timely resuscitation, early specialized and comprehensive rehabilitation care largely determine the outcome of a serious injury and prevent serious consequences. In this context, medical convergent technologies used to provide effective medical care become particularly relevant. This article of scientific, methodological and applied nature is devoted to the description of medical convergent technology implemented in the system of comprehensive rehabilitation care of children with severe neurotrauma.

AIM: The aim of the study was to substantiate and develop an effective rehabilitation technology at the level of unified (convergent) interdisciplinary managerial and clinical-diagnostic medical solutions in rehabilitation of children with severe injuries.

MATERIALS AND METHODS: Children, aged 2–17, (n=420) with consequences after severe traumatic injuries who were admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (Moscow) for treatment and rehabilitation in 2018–2022 with diagnoses: traumatic brain injury, consequences of spinal cord injury, combined trauma, mine-explosive trauma, severe skeletal trauma, infected extensive wounds. More than 300 of these patients had neurotrauma. The researchers used: literature sources on the discussed problem, findings of objective and subjective examinations (clinical examination, neuroimaging, neurofunctional, laboratory, radiation, instrumental as well as questionnaires, surveys, scales; electronic medical histories). To develop medical convergent technology, rehabilitation diagnosis, potentials and prognostic options according to the decision-making algorithm developed by physicians/specialists as well as differentiated personified rehabilitation programs were used. While developing these programs, the researchers assessed specific features of the injury, disease course, severity and level of functional impairment, activity and participation expressed in the criteria of the International Classification of Functioning, Disability and Health.

RESULTS: The researchers have enunciated the essence of the medical convergent technology in the rehabilitation of children after severe injuries as convergence, the alliance of interests from different fields, process of integration of traditional and new approaches which are united by a single goal of managing patients after severe traumatic injuries.

CONCLUSION: An interdisciplinary/multidisciplinary approach with medical convergent technology component in restoring children after severe trauma allows to optimize the rehabilitation process and the patient’s routing within this process. Integrity and continuity in management and rehabilitation of injured patients as well as step-by-step approach, help physicians to choose the most effective tactics.

Physical and rehabilitation medicine, medical rehabilitation. 2023;5(4):289-300
pages 289-300 views

Physical rehabilitation of patients with degenerative diseases of the spine using the David back concept

Andreeva T.E., Petrova R.V., Simkacheva A.R., Kuzmina N.V.

Abstract

BACKGROUND: Physical rehabilitation of patients with degenerative-dystrophic spine diseases is an important medical problem due to the significant decrease in physical activity, work capacity and quality of life of the patient.

AIM: The aim of the study was to evaluate the effectiveness of the developed rehabilitation complex for degenerative lesions of the thoracolumbar spine using biofeedback simulators David 110, 130, 120, 150.

MATERIALS AND METHODS: The study included 30 patients with degenerative changes in the lumbar region (mean age 43.6 years), who underwent a complex of rehabilitation measures for an average of 9.2 days, including therapeutic exercises for the back muscles, physiotherapy, and the training devices David 110 (lumbar-thoracic extension), 130 (lumbar-thoracic flexion), 120 (rotation to the right/left), 150 (lateral flexion to the right/left).

RESULTS: The effectiveness of the rehabilitation complex was confirmed by David back concept functional tests in the form of a statistically significant increase in muscle strength and range of motion in the thoracolumbar region (p <0.05), regression of pain syndrome (p <0.05) on the VAS scale and increased patient satisfaction were noted treatment based on the results of an oral survey of patients.

CONCLUSION: Exercises on David training machines in combination with therapeutic exercises for strengthening the back muscles and physiotherapy have a positive effect in the implementation of rehabilitation programs for patients with degenerative changes in the thoracolumbar spine.

Physical and rehabilitation medicine, medical rehabilitation. 2023;5(4):301-311
pages 301-311 views

Biomarkers — predictors of mortality in patients with ischemic stroke

Golubev A.M., Radutnaya M.L., Zakharchenko V.E., Babkina A.S., Petrova M.V., Lyubomudrov M.A., Yadgarov M.Y., Bondar E.L., Parfenov A.L., Grechko A.V.

Abstract

BACKGROUND: Stroke is a global health problem and the second leading cause of death worldwide, with ischemic stroke accounting for the majority of acute cerebrovascular accidents. Predicting outcomes in patients with ischemic stroke is challenging due to the limited prognostic performance of existing models. The lack of reliable and predictive biomarkers of ischemic stroke used in clinical practice provides a rationale for studies to address this issue.

AIM: The aim of this study was to identify clinical, demographic, neuroimaging and molecular biomarkers of ischemic stroke associated with the fatal outcome of the disease.

MATERIALS AND METHODS: We retrospectively analyzed cases of ischemic stroke confirmed by computed tomography of the brain with a duration of 3 months or less. As factors potentially related to the outcome of ischemic stroke, we considered (1) clinical and demographic characteristics, including sex, age, history of acute cerebrovascular accident, time from stroke to hospitalization, phase and type of stroke, neurological status on admission (level of consciousness, FOUR coma scale), comorbidities (diabetes mellitus, infectious complications, oncological diseases); (2) molecular biomarkers including blood glucose and neuron-specific enolase (NSE) levels at different phases of stroke; (3) neuroimaging biomarkers such as number and location of stroke lesion, total infarct volume, signs of edema, hemorrhagic component according to computed tomography.

RESULTS: 38 patients with ischemic stroke were included in the study. Lesion volume was larger in non-survivors: 123 [44.6–206.2] versus 42.7 [8.2–88.7] ml3 (p=0.032), and cerebral edema was detected significantly more often on admission CT scan than in survivors: 7 (77.8%) versus 10 (34.5%), p=0.022. Stroke lesion volume was a predictor of mortality (AUC 0.739; 95% CI 0.542–0.937; p=0.032). The optimal cut-off for stroke lesion volume was found to be 90 ml3.

CONCLUSION: Signs of edema/brain stem dislocation and cerebral lesion volume >90 ml3 documented at hospital admission are predictors of fatal outcome. Therefore, neuroimaging biomarkers can be used for risk stratification of fatal outcome in ischemic stroke patients.

Physical and rehabilitation medicine, medical rehabilitation. 2023;5(4):312-321
pages 312-321 views

CASE REPORT

Unrecognised autonomic dysreflexia in neurogenic lower urinary tract dysfunction with spinal cord injury as a reason for admission to a cardiac surgical unit

Novoselova I.N., Bershadskii A.V., Popova O.V.

Abstract

BACKGROUND: In Russia, spinal cord injury occurs in 0.7–6.8% of total injuries. Due to emergence of new rehabilitation protocols, it is extremely important to know the time of occurrence of consequences of spinal cord injury and adequate diagnosis of complications, which allows timely identification of life-threatening conditions of one of the body systems.

Clinical case description. We present a clinical case of autonomic dysreflexia in neurogenic lower urinary tract dysfunction after traumatic cervical spinal cord injury in a 17-year-old girl. In traumatic spinal cord injury above the level of the sixth thoracic vertebra, autonomic dysreflexia as a variant of autonomic dysfunction is a common complication. This clinical case will be of interest to clinicians of all specialties who encounter patients with spinal cord injury. It is shown that misinterpreted symptoms of increased blood pressure during bladder filling were the cause of observation and treatment by a cardiologist for arterial hypertension, as well as hospitalization in the cardiac surgery department for planned surgical treatment of renal artery stenosis, which was thought to be the cause of the episodic increases in blood pressure. Lack of knowledge about the presence of autonomic dysfunction in spinal cord injury patients may have led to unnecessary surgical treatment. During the joint management of the patient with a pediatric cardiac surgeon, signs of autonomic dysreflexia were detected against the background of traumatic spinal cord disease at the level of the cervical spine, hypotensive treatment and planned surgical intervention were canceled.

Conclusion. Subsequently, an adequate regimen of periodic bladder catheterization and antimuscarinic drug therapy was prescribed, which successfully reduced the dysreflexia.

Physical and rehabilitation medicine, medical rehabilitation. 2023;5(4):322-329
pages 322-329 views


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