Vol 2, No 3 (2020)

Objectives. Verticalization of patients after severe brain damage is one of the methods to prevent immobilization syndrome. The recommendations for its safe implementation have been developed for the acute period of the disease. Patients with chronic consciousness disorders, in the post-comatose period, after critical brain damage, need a special approach to verticalization, appropriate to their state.

Aims: to study orthostatic disorders arising from verticalization of patients in the post-comatose period after severe brain damage and prolonged intensive care, and to develop a practical and safe verticalization technique adapted to such patients with chronic consciousness disorders.

Methods. We examined 72 patients after severe traumatic and non-traumatic brain damage: group 1, n = 24 (33%) — with chronic consciousness disorders (vegetative state and minimal consciousness syndrome), group 2, n = 48 (67%) — in consciousness. The examination of patients was carried out on 30–120 and 21–30 days from the beginning of the disease respectively. Passive verticalization was carried out with the help of a functional chair with continuous monitoring of blood pressure, heart rate and oxygen saturation measured for each heartbeat using the bedside monitor, which allowed to stop the verticalization procedure immediately in case of stop-signals.

Results. Orthostatic circulatory disorders during the first verticalization procedure were revealed in the majority (19 out of 24) of patients in group 1 and in a quarter (12 out of 48) of patients in group 2. Orthostatic hypotension (OH) requiring termination of the verticalization procedure was observed in 25% of the main group patients and in 21% of the comparison group patients. The technique of safe verticalization at orthostatic disorders was developed.

Conclusions. Orthostatic circulatory disturbances were observed during the first verticalization procedure 3 times more often in the group with chronic consciousness disorders than without them. Timely interruption of verticalization in case of occurrence of stop-signals was provided by control of these signals in real time that allowed to reduce the risk of orthostatic cerebral ischemia for such patients.

Introduction. Low back pain (LBP) is a global health problem and it concerns approximately 80% of population of the definite age period. Physical therapy (PT) has a systemic effect on the body and it is one of the main methods of increasing the level of non-specific resistance, correction of locomotor disorders. The influence of PT on the formation of persistent remission has not been studied enough.

Aim: is to evaluate the anti-relapse effect of physical therapy methods in patients with LBP. Comparative Study.

Methods. In the study, 2 groups were formed, the main group (52 people), whose patients, along with non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and physiotherapy, received individual courses of physical therapy, including independent classes. In the control group (49 people), patients who refused physical therapy and other types of additional physical activity received only medication and physiotherapy. The study of the effectiveness of therapy included neuroorthopedic examination with the calculation of the integral indicator (II) in points.

Results. The groups were comparable by gender, age, and clinical manifestations of the disease. In statistical analysis, the subjective assessment of wellbeing, at the initial level, after 3 months and 12 months-at the end of treatment, which did not differ in the groups at the beginning of the study, became significantly higher in the main group (p < 0.000001) during follow-up for a year. The subjective assessment of pain by visual-analog scale (VAS) also significantly decreased (p < 0.000001). The integral indicator of biomechanical disorders was significantly lower at the end of the course of treatment, as well as during the catamnestic study in the main group (p < 0.000001).

Conclusion. The study showed a high significance of exercise therapy in the complex of rehabilitation measures aimed at preventing LBP, modulating both subjective well-being and the course of the pathological process, extending the period of remission and correcting pain and biomechanical manifestations.

A large number of recent works deal with the microbiota of the human organism. Of paramount importance is the microbiota of the gut, especially of its “densely populated” distal part, the colon. In the literature, the gut is considered the largest digestive, immune, and endocrine organ. The functioning of the microbiota involves the production of numerous low molecular weight compounds that represent biochemical effectors, co-factors, or signals. An important role is performed by neurochemicals. In order to ameliorate the human organism’s microbial ecology, various drug preparations, biologically active additives, and functional food products are used. Currently popular preparations include selected strains of lactobacilli, bifidobacteria, bacilli, and other live microorganisms (probiotics) and biologically active substances (metabiotics) that result from the metabolic activities of symbiotic microorganisms. Probiotics include a subgroup denoted as psychobiotics that, when applied in adequate amounts, ameliorate the health of patients with psychiatric problems.

Introduction. The frequency of post-traumatic hydrocephalus is 3.9%. The incidence of post-traumatic defects of the skull is 10.46 per 100,000 per year. Overdrain syndrome occurs in 10–12% of cases in patients with long-term ventricular shunting. The presence of a cranial defect causes a violation of blood flow and cerebrospinal fluid dynamics in the area of the defect, a displacement of brain structures under the influence of gravity and atmospheric pressure, which can cause a deterioration in the patient’s condition and a significant slowdown in recovery after a severe head injury. Both craniotomy syndrome and excessive shunting can impede the verticalization and rehabilitation of patients with post-traumatic hydrocephalus and post-traumatic defects of the bones of the cranial vault.

Description of the clinical case. Clinical case demonstrates an example of a differential approach and an algorithm for deciding on surgical treatment in a patient with post-traumatic hydrocephalus and cranial bones defect in case of deterioration during attempts at verticalization in a complex of rehabilitation measures.

Conclusion. The clinical manifestations of trephine skull syndrome and syndrome of shunt overdrain in the patient after severe traumatic brain injury combines post-traumatic hydrocephalus, may be similar. And not always, as demonstrated in this clinical case, narrowed ventricles and the relationship of deterioration to verticalization should be interpreted as a syndrome of excessive drainage of the shunt system. The plastic surgery of the defect of the bones of the cranial vault performed in this case made it possible to improve the patient’s condition and regress symptoms.

As the practice of the Federal Scientific-Clinical Center for Resuscitation and Rehabilitation (FNKC RR) confirms, working with relatives is of paramount importance in the rehabilitation of patients with brain injuries, including those with impaired consciousness, since the main rehabilitation work is carried out in family-home conditions, and In addition, the emotional component of successful rehabilitation of this category of patients is shifted to loved ones. The technology of the «School of Relatives» involves a combination of collective (training seminars) and individual working methods (consultations of specialists of all profiles, of which the speech therapists consultations are especially important in the face of complex tasks of rehabilitation work). With a competent and systematic approach associated with comprehensive training and subsequent information and consulting support for relatives of the rehabilitated patient, it is possible to achieve significant progress in rehabilitation work, as evidenced by an analysis of the experience of organizing the «School of Relatives» in the FNKC RR. The introduction of telemedicine tools contributes to increasing the success of the functioning of the «School of Relatives», which is important not only in the context of the continuity of interaction between relatives and specialists in ordinary conditions, but also ensuring continuous interaction in the context of restrictions on social contacts, including the provision of various types of medical care, in the context of a new pandemic coronavirus COVID-19.