Vol 2, No 3 (2020)

Orthostatic circulatory disturbances during verticalization in post-comatose patients after severe brain damage
Dorogovtsev V.N., Yankevich D.S., Melnikov O.A.

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.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(3):204-216
Application of pulse magnetotherapy in integrated treatment of patients with gonartrosis
Byalovsky Y.Y., Rakitina I.S., Gerasimenko M.Y., Zaitseva T.N.

Background. Osteoarthritis is a joint disease that has a severe progressive nature, which leads to a violation of a number of functions and a limitation of professional capabilities.

Aims: to evaluate the effectiveness of the pulsed magnetic field from the ALMAG+ apparatus with parameters that activate stress-limiting mechanisms, as part of the complex treatment of painful osteoarthritis.

Methods. The study included 75 patients with stage I–III knee оsteoarthritis, who were divided into the main and control groups using simple randomization. All patients received basic therapy, including the use of non-steroidal anti-inflammatory drugs (Diclofenac 25 mg/3 times a day, course — 15 days). Patients of the main group were additionally prescribed treatment with a running pulsed magnetic field (BIMP) from the ALMAG+ apparatus.

Results. In the control group for patients with NSAIDs, positive dynamics of functional indices and pain indices were observed only immediately after treatment. After 3 months after the course of treatment, the intensity of pain and impairment of function returned to the original level. After completing the course of treatment for BIMP in the main group of patients, there was a marked decrease in all of the relevant indices and the degree of expression of the patients. After 3 months after the end of the treatment course in patients of the main group, a marked improvement in the previous effect was achieved according to the LI and Richi tests. By the 6th month, a regression of symptoms occurred — a reliably aggravated pain syndrome and deteriorated functional capabilities when assessed by the Lee index. The intensity of penetration had a tendency to growth.

Conclusions. The use of a pulsed magnetic field from the ALMAG+ apparatus with parameters that activate stress-limiting mechanisms contributed to a significant increase in the therapeutic efficacy of the applied treatment complex, contributing not only to a significant reduction, but in some cases complete relief of the pain syndrome, but also to an increase in functional activity affected knee joints.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(3):217-224
Exercise therapy as a method of anti-relapsetherapy for non-specific low back pain. Comparative study
Novikov A.Y., Tsykunov M.B., Tikhomirov A.Y.

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.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(3):225-232
Probiotics, psychobiotics, and metabiotics: problems and prospects
Oleskin A.V., Shenderov S.A.

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.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(3):233-243
Functional electrical stimulation for restoration of gait and motor recovery after a stroke. Review of scientific literature
Guryanova E.A., Kovalchuk V.V., Tikhoplav O.A., Litvak F.G.

The article presents an analysis of studies on the use of functional electrical stimulation (FES) technology in the rehabilitation of patients after stroke. We reviewed the influence of FES on improving walking speed, kinematics, gait symmetry, the ability to overcome obstacles, the range of motion of the ankle and foot clearance during walking. In the review it is considered FES influence on reducing energy costs for walking, the frequency of falls and spasticity of muscles of the lower limbs. It is also discussed FES influence on increasing confidence and comfort while walking, the speed of adaptation and patient tolerance of functional electrical stimulation devices. A comparison is made of functional electrical stimulation with using ankle orthoses (AFO).

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(3):244-262
Regression of Liquorodynamic Disorders and Ventriculoperitoneal Shunt Overdrain Syndrome Clinic in a Patient After Severe Brain Injury with Posttraumatic Hydrocephalus and a Giant Cranial Bones Defect After Cranioplasty: Case Report
Vorobyev A.N., Shchelkunova I.G., Levin D.V., Lukyanec O.B., Shaybak A.A., Yakovlev A.A.

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.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(3):263-272
Case report: features of radiation diagnostics in the search for complications (after surgical interventions) and the identification of new neoplasms in a patient with Gippel-Lindau disease in a chronic critical condition
Bessonova L.V., Radutnaya M.L., Yakovlev A.А., Yakovleva A., Shchelkunova I.G.

Justification. One of the forms of systemic angioreticulomatosis is the combination of a tumor (angioreticuloma) of the cerebellum with retinal angioma (the so-called Hippel-Lindau disease). With this hereditary disease, the general condition of patients and the prognosis depend on concomitant tumor diseases. Including for a comprehensive diagnosis of this syndrome, radiation research methods are used.

Description of the clinical case. A young patient with Hippel-Lindau disease and a number of neurological disorders was enrolled in a course of treatment and rehabilitation measures at the Federal Center for Pharmacy of the Republic of Poland. At the hospitalization stage in the previous hospital, she underwent microsurgical removal of an intracerebral tumor. During the examination, possible long-term postoperative complications were excluded, however, kidney and pancreas lesions were detected. As a result of the adjusted course of rehabilitation, the patient showed positive dynamics (in particular, an increase in functional and somatic status).

Conclusion. In Hippel-Lindau disease, as one of the forms of multiple angioreticulomatosis, cerebellar angioreticuloma and retinal angioma can be combined with lesions of other internal organs. Therefore, a comprehensive diagnosis of this category of patients is necessary. Timely identification of foci of Hippel-Lindau disease, complications after previous treatment allows you to choose the necessary amount of therapeutic and rehabilitation measures, which in the future can improve the patient’s quality of life and prognosis.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(3):273-279
New methods and technologies, discussions
School of relatives as a necessary condition for rehabilitation of patients with damages of the brain (on the example of FNKC RR)
Pryanikova N.I., Polikarpova O.S., Ibragimova K.S., Bushueva E.V.

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.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(3):280-284

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