Vol 1, No 4 (2019)


Medical rehabilitation of patients with diseases of support-motor apparatus in the Tver region

Chichanovskaya L.V., Bakhareva O.N., Anisimova T.V., Baharev S.A.


The rapid development of science, including emergency medicine, resuscitation services, and the improvement of technologies in orthopedics, traumatology, neurology, and neurosurgery are expanding the possibilities of restoration of functions in patients with diseases of the musculoskeletal system. The most effectively impaired functions are restored in the first 3 months from the moment of injury or surgery.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):2-4
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Methods for evaluating the effectiveness of project activity in the field of modern technical means of rehabilitation

Khrapilina L.P.


The article presents the results of the analysis of methods for assessing the effectiveness of project activities related to technical means of rehabilitation. Particular attention is paid to the competitive selection of projects, in the process of which the assessment methods used in specific organizations specializing in financing promising research and R&D projects, as well as their implementation in practice, are used. According to the results of the analysis, it was found that the key role, both in the course of competitive procedures and in assessing the interim and final results of project implementation, is assigned to a comprehensive expert method. The examination of projects is considered as the implementation of specialized assessment, analytical and / or research activities aimed at ensuring the development of recommendations regarding the feasibility of financing projects and their practical application, as well as forecasting effectiveness, taking into account the relevance in practice. The key subject of the assessment is the expert, to whom certain requirements are made, and a strictly formalized procedure for conducting examinations is established for him. Other individual methods were described (the procedure for selecting projects, the methodological substantiation of project examinations, the selection of experts, the organization and formation of the procedure for conducting examinations, the selection of criteria and indicators for evaluating a project, evaluating the effectiveness of a completed project), their strengths and weaknesses in the context were substantiated conclusions about the effectiveness of project activities in the field.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):5-10
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Rehabilitation of patients with early scoliosis after stage corrections of spine deformations by growing systems

Nikolaev N.S., Petrova R.V., Syundyukov A.R., Kornyakov P.V., Yakovleva S.K., Kuz'mina V.A.


Idiopathic scoliosis is a large etiological group in the structure of early scoliosis which requires the use of modern effective surgical methods for correction of deformity, in particular, using various structures with possible staged distraction (growing structures). Dysplastic changes in the musculoskeletal tissue are very important in the pathogenesis of scoliosis. Active correction of the tone of the muscular-ligamentous system of the spine in the postoperative period is of great importance in the recovery of such patients. Individual rehabilitation programs are aimed at consolidating the result of the operation (correction of the sagittal profile and normalization of the body balance), improving respiratory function, fast recovery of motor activity (in order to prevent hypostatic and thromboembolic complications), increasing self-esteem and patient satisfaction with the results of the operation. The purpose of the study is to assess the effectiveness of an integrated approach to the rehabilitation of patients with early scoliosis after correction of spinal deformities by growing systems. Materials and methods. A retrospective analysis of the results of a comprehensive rehabilitation of patients (n = 15) with idiopathic infantile scoliosis (mean age 8.6 ± 1.0 years) was performed. This group of patients was operated using a growing system with stepwise corrections using the Growing Rods, VEPTER technique. The algorithm of rehabilitation of the studied group of patients using the parameters of activity, participation, degree of dysfunction in accordance with the International classification of functioning (ICF) is presented. Evaluation of the effectiveness of the results carried out taking into account the criteria of the pain scale (VAS), verticalization time, indicators of walking, coordination, support capacity, balance of body and strength (on the CSBS platform), self-perception, psychological comfort, functions, satisfaction with the treatment. Results and discussion. In all patients, a normal sagittal profile was formed, satisfactory correction was achieved, and body balance was normalized. After a comprehensive rehabilitation course, we observed statistically significant improvements in balance, balance and load distribution, and postoperative pain was stopped. Early verticalization was successfully carried out, walking indicators reached values exceeding the conditional "norm". Assessment of coordination, support ability, balance of the body and strength on the CSBS platform showed a uniform improvement in the index of symmetry, the average value of the load on the limbs. Patients' self-perception and the level of psychological comfort before discharge were rated at 3 points, patients evaluated spinal function after surgery at 2.7 points, satisfaction with treatment was 3.5 points. Characteristics of signs of activity and participation, the degree of dysfunction within 6 months after surgery went from a score of 3-4 to a score of 0-2 (dynamic improvement). Conclusions. Correction of scoliotic spinal deformity with the help of growing systems due to improved respiration function, correction of the sagittal profile and body balance, restoration of motor activity and increased self-esteem and satisfaction with the results of the operation improves the quality of life of the patient. Due to the lack of clinical recommendations for rehabilitation in the postoperative period of patients with scoliosis (with early development), taking into account the age characteristics of this group of patients, the algorithm for their rehabilitation used in the Center shows good results in the restoration of functions and satisfaction with the treatment.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):11-19
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Comparative analysis of treatment of patients with neck fractures of the femur

Titov R.S., Fine A.M., Vaza A.Y., Bogolubskii Y.A., Mazhorova I.I., Bondarev V.B., Sergeev A.Y.


Purpose of the study. Based on the analysis of case histories to determine ways to improve the results of treatment of patients with hip fracture and reduce duration of rehabilitation period. Material and methods. From 2012 to 2018 in the emergency department of traumatology of the Sklifosovsky Clinical and Research Institute for Emergency Care were treated 865 patients with a hip fracture. For analysis of these patients they were divided into 2 groups. The control group consisted of patients who were treated from 2012 to 2016 - 569 patients. The main group - 296 patients treated from 2017 to 2018. Results. Preoperative hospital stay in the main group was reduced in the 2-fold. The number of non-operated patients was reduced by 2 times. It was increased in the number of hip arthroplasty from 46.3% to 53.0%. It reduces the average time of operation in bipolar arthroplasty from 65 to 48 minutes, in total arthroplasty - from 89 to 63 minutes. It reduces the average blood loss during arthroplasty from 626 ml to 277 ml. The preoperative thrombosis of the lower limbs was detected in 9% of primary and 15% of the control group. Number of bedsores decreased from 2.5% to 1.7% and reduced mortality from 3.3% to 1.3%. Conclusion. All patients with a suspected fracture of the proximal femur, regardless of age, should be admitted and examined. Indications for surgery are vital. The purposes of the examination of the patient are identifying ways to quickly patient's condition compensation. For the prevention of thromboembolic complications is necessary to perform venous ultrasound before and after the operation. Detection of floating thrombus in the veins of the lower extremities before surgery is an indication for surgical prophylaxis of thromboembolism. Diagnosing floating thrombus up to 5 cm in the postoperative period may be an indication for conservative treatment. Such measures as multimodal analgesia with combination of non-steroidal and opioid analgesics before and after operation, patient-controlled analgesia in the postoperative period, high volume surgical wound infiltration with a solution of local anesthetic during surgery allows to activate the operated patients for 1-2 days after hip replacement. Reducing the duration of the operation leads to reduction of blood loss during the arthroplasty by improving the surgical technique and intravenous tranexamic acid infusion.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):20-26
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The reabilitation after replacement of achilles tendon

Sergeev S.V., Minasov B.S., Kolovertnov D.E., Karpovich N.I.


This study reveals the new method - endoprosthetic Achilles tendon. As a result of the study the optimal implant was created, operational surgery of Achilles tendon endoprosthetics was modified and the recover program was formed. Current method allows to avoid immobilization of the operated limb but to carry out early rehabilitation activities and exercises with intent to restore triceps muscular strength. The remote results in 6 month's after Achilles tendon replacement in 34 patients were excellent, in 46 patients were good and in 1 patient were unsatisfactory.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):27-31
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Management of patients in the post-operative period after the hip joint replacement accessed by low-invasive access

Nikolaev N.S., Efimov A.V., Petrova R.V., Kovalev D.V., Ivanov M.I.


Up to 1.5 million total hip arthroplasty is performed annually in the world. In Russia, at least 300 thousand patients a year need hip replacement surgery. High tissue invasiveness during surgical approaches presents special requirements for the rehabilitation process in the early postoperative period. Accelerating and making it more efficient is possible with the use of the least traumatic operating access. The purpose of the study is a comparative analysis of two models of the organization of rehabilitation in the postoperative period after hip arthroplasty: using standard Harding surgical access and the minimally invasive Rottinger access. Material of the study - patients operated on with standard Harding access (group I, n = 227) and front-external Rottinger access (group II, n = 266). Criteria for inclusion of patients in both groups are primary coxarthrosis without previous surgical interventions, exclusion criteria are connective tissue diseases, severe comorbidity. Group I patients underwent postoperative rehabilitation according to the standard protocol, group II - according to the rehabilitation concept "ERAS, fast-track". To assess the effectiveness of the rehabilitation at all stages in both groups, the rehabilitation potential was assessed on the rehabilitation routing scale (SRM), the dynamics of the pain syndrome on the visual analogue pain scale (VAS), the verticalization period was taken into account, the main assessment scales of the patient's motor functions and psychological status were used in hip arthroplasty: Harris scale, quality of life questionnaire (EQ - 5D), modified Rankin scale. Results and discussion. The proportion of hip arthroplasty using MIS access in the total number of operations increased from 0.7% in 2015 to 10.1% in 2018. The studied groups are comparable in terms of the ratio of men and women, average age, number of observations, BMI and the volume of blood loss. The surgeon duration and the duration of the stationary phase in group I exceeded the similar parameters of the II group. The modified Rankin scale at admission and discharge in all patients showed moderate disability, starting indicators and results after 3 months were more prosperous in group II. Both groups had an equivalent score on the Harris scale before surgery and after 3 months after it, more pronounced positive dynamics of the quality of life on the EQ-5D scale ("thermometer") was noted in group II. A decrease in pain after surgery compared with baseline, with regression to 0.8-1.0 points by 3 months after surgery, was noted in all patients. The assessment on the rehabilitation routing scale did not differ in both groups. At the stationary stage, group I patients walked with additional support on crutches (100%), group II - on a cane (92.5%). On long days 4-6, 82.8% of patients of group I and 91.7% of patients of group II passed long distances. At the end of stage I rehabilitation, 83.7% of group I patients and 92.5% of group II were sent to the outpatient rehabilitation stage, the rest were transferred to stage II of rehabilitation in a 24 - hour hospital. The third stage of rehabilitation, all patients went on an outpatient basis at the place of residence. At the follow-up stage, the data of a telephone survey of group II were analyzed (n = 68, 25.6% of the respondents). By 3 months, the Harris score exceeds 90 points, satisfaction with the operation is 97%. As a result of the use of surgical MIS access for hip arthroplasty, all patients had good rehabilitation indicators. Conclusions. The general approach to managing patients after hip arthroplasty is similar for all types of surgical access, however, MIS-access creates the most favorable conditions for the rehabilitation of patients in the early postoperative period: a positive attitude of the patient, reduced blood loss, reduced surgical incision, the possibility of early activation and transition to the general regime for 6-7 days. The results of the study showed the advantages of a model for the organization of rehabilitation in the postoperative period after hip arthroplasty using mini-invasive access over standard surgical access. Group II patients (MIS access) had a higher level of physical activity and a low level of pain in the early postoperative period.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):32-38
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Limb amputations and prosthetics

Sergeev S.V., Minasov B.S., Rios E.A.


Currently, the number of patients with high-energy injuries of large segments of the skeleton due to road traffic and catotrauma is increasing. The number of patients with vascular pathology and disorders of the endocrine system is also increasing, which leads to a sharp increase in the population of patients who underwent limb amputation. Patients who underwent limb amputations present a significant medical and social problem. Stump malformations formed due to violations of surgical technique during reconstructive operations often complicate prosthetic fitting and the social adaptation of patients in this group. The possibilities of external prosthetics manufacturing are currently booming. Limb prosthetics manufacturing is a complex orthopedic, technical, biomechanical and general medical process, which results in medical and social rehabilitation. Functional results depend on the timing of prosthetics manufacturing. An important condition for safe walking is the preparation of a disabled person from the first days after amputation. An important role in the patient's rehabilitation is played by the school of walking, the purpose of which is to form the correct stereotype of walking, to learn how to walk on the prosthesis on various surfaces and to master actions in emergency situations.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):39-41
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Problem issues of medical-social rehabilitation of elderly and senior persons at the modern stage

Puzin S.N., Memetov S.S., Sharkunov N.P., Kim V.V., Litvinova Y.V.


The article analyzes the needs of the elderly and senile in medical and social assistance and rehabilitation. Some problems in solving medical and social problems of the studied category of persons are reflected. Measures are proposed to eliminate the causes that reduce the quality of life of the studied contingent. Attention is drawn to the need to simplify the examination procedure at the ITU bureau for elderly and senile people, both with a view to establishing a disability group, and for compiling an IPRA, including providing disabled people with technical rehabilitation equipment.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):42-44
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Significance of social factors for efficient provision of assistive devices and technologies for the disabled persons. Automating the process of customized selection of a wheelchair

Vasilchenko E.M., Khokhlova O.I., Karapetian K.K., Gaev A.A., Orekhova E.N.


Objective: to develop an algorithm for customized selection of a wheelchair for the disabled persons with limited mobility followed by design of a software allowing to automate the process of wheelchair selection. Materials and methods. Analytical review of English literature was performed to address the issues in prescription and utilization of the assistive devices and technologies (ADT). The regulatory documents governing the ADT prescription in the Russian Federation (RF) were studied. Russian market of the wheelchairs for the disabled persons was analyzed. Ten disabled persons with traumatic spinal cord injury to the department of medical rehabilitation of the Centre were examined to pilot the software for automated wheelchair selection. Results. After the literature review results were structured, the major groups of factors that should be considered when selecting a wheelchair were identified: 1) anthropometric measurement, 2) physical and functional capabilities of the disabled person, 3) level of everyday activity, 4) availability and physical capabilities of the caregivers, 5) particularities of the environmental factors. The algorithm for customized selection of wheelchair was designed. The database comprising the technical characteristics of 141 wheelchair models that are taken as a basis of the software was developed. IBM-compatible computer was used to develop the software. Programming language: Delphi, data base management system: Microsoft Access 2013. Piloting results showed the effectiveness of the software. In all cases appropriate wheelchairs were selected. Conclusion. Within current study the software for automated process of customized wheelchair selection was piloted. The software takes into consideration the level of activities and participation of the disabled persons and significant environmental factors which allows to customize the ADT prescription.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):45-55
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Correction of cerebral thermal balance disruption in therapy and rehabilitation of patients with cerebral pathology

Shevelev O.A., Petrova M.V., Saidov S.K., Chubarova M.A., Usmanov E.S., Pranil Pradkhan -.


Temperature monitoring of the brain using radiothermometric technology allows you to assess the imbalance of the thermal balance of the brain, and the technique has shown the possibility and information content of its use in the diagnosis of cerebral lesions. In healthy individuals, at rest, the average temperature of the left (36.74 ± 0.37 ° C) and the right hemisphere (36.64 ± 0.32 ° C). In boxing athletes who received "planned" minor traumatic brain injuries after training sparring, the average temperature of the left (38.4 ± 0.28 ° C) and right temperature (38.2 ± 0.45 ° C), which is significantly elevated. Patients in chronic critical conditions showed a monotonous temperature distribution in the left (36.98 ± 0.18 ° C) and right hemispheres (36.88 ± 0.21 ° C). The temperature heterogeneity of the brain in this category of patients was less pronounced compared with healthy individuals, athletes after sports head injury.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):56-63
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Approaches to the technical means of rehabilitation selection using the ICF

Bodrova R.A., Aukhadeev E.I., Akhunova R.R., Khusainova E.R.


The international classification of functioning, disability and health (ICF)is a classification of health components, allows to objectively determine the health status of patients, make a forecast of impaired functions and helps to assess the effectiveness of rehabilitation activities. The article describes the approach to the choice of technical means of rehabilitation with the help of ICF. UF allows you to objectively determine the health status of patients and to choose technical means of rehabilitation depending on the degree of disability: if an absolute dysfunction (96-100%) - functional beds, anti-bedsore mattress, gel cushion, wheelchair with headrest and armrests, the absorbent means absorbent diaper, chair - chair with sanitary equipment, a rigid splint with fixation of multiple joints, etc.; in severe functional disorders (50-95%) - anti-bedsore mattress, wheelchair with manual drive to move at home, wheelchair with manual drive to move on the street, anti-bedsore pillow, chair-chair with sanitary equipment, adsorbing agents, absorbent diapers, orthopedic shoes with a hard back, hard splint with fixation of several joints, walkers, anti-bedsore pillow, chair - chair with sanitary equipment, absorbent means absorbent diaper, orthopedic shoes with a hard heel, a hard splint with fixation of multiple joints, etc.; at moderate impairments (25-49%) - cane 4-point with a wide base, the axillary crutches with the device anti-skid bandage on the shoulder and the knee joint, the splint on the hand, stopiteration, etc.; in milder disorders (5-24%) - cane single-bearing alternator, the functional brace with shoulder and ankle etc.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):64-71
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Place of neurourology in the clinical neurology system. Neurourological rehabilitation

Kadykov A.S., Shvedkov V.V., Korshunova E.S., Pryanikov I.V.


Disorders of urination of an obstructive and irritative nature are found in almost all major diseases of the nervous system and their symptoms are largely reminiscent of dysuric disorders in the local pathology of the urethra and bladder. Proper diagnosis and timely treatment determine not only the quality of life, but sometimes the very life of patients. Only the combined efforts of neurologists and urologists in the framework of the clinical direction "Neurouroscience" allows us to timely diagnose the cause of urination disorders and carry out the necessary treatment and rehabilitation measures.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):72-76
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Catheters for intermittent bladder catheterization, as a technical tool for rehabilitation of patients with neurogenic lower urinary tract dysfunction: issues of the organization of disabled providing

Kezina L.P., Salyukov R.V., Tishchenko G.E.


Bladder emptying dysfunction accompanies many neurological diseases. Such bladder dysfunction leads to the risk of serious complications developing which can negatively affect neurorehabilitation. The main method of treating neurogenic bladder emptying dysfunction is periodic catheterization. When periodic catheterization is going to be used, preference should be given to modern lubricant catheters with fixed hydrophilic coating. According to the law of Russian Federation, disabled people can receive such catheters for free as a technical tool of rehabilitation. The article discusses the law aspects of obtaining catheters for periodic catheterization by a disabled person with lower urinary neurogenic dysfunction.
Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):77-81
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Joseph Moiseevich Mitbreith



Physical and rehabilitation medicine, medical rehabilitation. 2019;1(4):82-83
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