Vol 2, No 4 (2020)

ORIGINAL STUDIES
The effect of virtual reality based cognitive-motor training on psychophysiological parameters and balance function in the elderly
Khizhnikova A.E., Klochkov A.S., Kotov-Smolenskiy A.M., Fuks A.A., Suponeva N.A., Piradov M.A.
Abstract

Background. Balance dysfunction is one of the most common problems in older people. Research shows that response time to visual and auditory stimuli is an indicator of inhibition processes that play a critical role in maintaining balance in the elderly, and time reaction tests can predict the risk of falls in the elderly. One of the advantages of virtual reality technology is the ability to implement cognitive-motor training. It is considered that training in a virtual environment helps to improve the reaction to a rapid change of environment, attention, space-time memory, and planning, which has a beneficial effect on postural functions. Nevertheless, the effect of training in a virtual environment on neurodynamic processes has not been sufficiently studied.

Aims: to study the status and dynamics of psychophysiological indicators and their relationship with the balance function after cognitive-motor training in a virtual environment in patients with CCI.

Methods. The study involved 24 people. The experimental group included 14 patients with a confirmed diagnosis of chronic cerebral ischemia. A group of 10 healthy volunteers were tested on the UPFT-1/30 «Psychophysiologist» system. Patients included in the experimental group were tested using clinical scales (the Berg balance assessment scale and the MOCA scale) and instrumental assessment on UPFT-1/30 «Psychophysiologist». All patients underwent cognitive-motor training on the «Rehabunculus» virtual reality system (Russia), aimed at restoring the balance function.

Results. After the course of cognitive-motor training in a virtual environment, the patients showed a significant (p=0.01) improvement in the balance functions, assessed by the Berg Balance Scale, as well as a decrease in the number of errors and an improvement in the stability of visual-motor reaction test. In addition, a negative correlation was found between the median response time and the balance function on the Berg scale (r=-0.715).

Conclusions. The speed of reaction to a visual stimulus can serve as markers of the adaptation processes of the nervous system to cognitive-motor training in virtual environment, which, in turn, have a positive effect on balance function.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(4):292-302
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Quality of models of scales of consciousness level, functional state, and general somatic severity in patients with consequences of brain damage in intensive care and rehabilitation department
Kiryachkov Y.Y., Petrova M.V., Pryanikov I.V., Kolesov D.L., Parfenov A.L., Bosenko S.A.
Abstract

Background. The approach to the use of scales for assessing the level of consciousness, functional and general somatic status for rehabilitation and intensive care units is statistically and clinically insufficiently substantiated.

Aims: development and substantiation of a typical scheme for the clinical use of scales of the level of consciousness, general somatic and functional status of patients with consequences of brain damage of various etiologies.

Methods. A single-center prospective, retrospective study that included 118 patients on 20–50 days after traumatic brain injury, anoxic damage; consequences of acute cerebral circulatory disorders, and neurosurgical operations. In groups of patients who are in a coma, vegetative status, a state of minimal consciousness and a state of clear consciousness, the analysis of the statistical quality of clinical scales was carried out: scales of consciousness: the Glasgow Coma Scale (GCS); FOUR (Full Outline of UnResponsiveness); Coma Recovery Scale-Revised (CRS-R); the Glasgow Outcome Scale (GOS); the Extended Scale of the Glasgow Coma (Glasgow Outcome Scale Extended, GOSE); Rancho Los Amigos scale — scale of consciousness and interaction with the environment (the Rancho Los Amigos scale, RLAS); Functional status scales: DRS (the Disability Rating Scale); modified Rankin Scale mRS; Barthel Activities of Daily Living (ADL) Index; Functional Independence Measure (FIM); Karnovsky Index; Rivermead Mobility Index self-assessment of everyday life opportunities in Merton and Sutton (checklist self-maintenance Merton and Sutton community NHS trust); Scales of General somatic severity: assessment of multi-organ dysfunction on the APACHE II scale (Acute Physiology and Chronic Health Evaluation); APACHE IV scale; SAPS II scale (Simplified Acute Physiology Score); SOFA scale (Sequential Organ Failure Assessment). The functional state of the ANS was recorded using HRV parameters by recording 5-minute RR intervals of the electrocardiogram.

Results. There are 4 groups of patients who are in a state of coma, vegetative status, a state of minimal consciousness and a state of clear consciousness. In 67 patients out of 118 examined (56.8%) after brain and brain damage as a result of TBI, anoxia, stroke, the parameters of ANS functional activity are in the zone of pathological (sympathetic/parasympathetic hyperactivity) values. Manifestations of sympathetic/parasympathetic hyperactivity is progressively reduced from the patients in a coma to patients in clear consciousness.

Conclusions. Various scales of the level of consciousness, functional and general somatic severity of patients with the consequences of brain damage, objectively differ in clinical significance in the gradation of coma–vegetative status–minimal consciousness–clear consciousness.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(4):303-314
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A new stimulating method in a complex of speech therapy measures to restore the function of swallowing in severe brain damage
Pryanikova N.I., Amosova N.N., Berdnikovitch E.S.
Abstract

Background. The significance of this study becomes more relevant due to the higher incidence and complication of dysphagia in patients with severe brain damage as a result of stroke, traumatic brain injury, and other diseases and injuries.

Aims: the study aimed to assess the effectiveness of the new stimulating method — "passive-active logopedic cryomassage" for restoring impaired swallowing function (dysphagia) in patients with severe brain injury, used in the system of speech therapy measures at the early stage of rehabilitation in the neurointensive care unit.

Methods. The study involved 96 patients with dysphagia caused by severe brain damage, who received speech therapy assistance aimed at restoring the impaired swallowing function in a system of early rehabilitation measures carried out in a neurorehabilitation department. The severity of dysphagia was evaluated using an integrative assessment of swallowing function scale.

Results. The practice of using the new method developed in combination with thermal and tactile stimulation (passive-active logopedic cryomassage) indicated its higher efficiency in comparison with the traditionally used methods of speech therapy stimulation. In the course of this study, there were three categories of patients: patients with a rapid positive effect, patients with a delayed effect, and patients with no apparent positive effects. There was an analysis of all possible causes of different therapeutic effects.

Conclusion. The new method of combined low temperature and tactile stimulation — passive-active logopedic cryomassage — can be approved with all its indications and contraindications for widespread use in the clinical practice assisting speech therapists in the restoration of impaired swallowing function in patients with severe brain injury.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(4):315-321
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The application of high intensity and low intensity magnetotherapy in rehabilitation of patients with COVID-19: a randomized controlled pilot study
Silantyeva E.S.
Abstract

Background. Rehabilitation of patients after severe pneumonia associated with the new coronavirus infection requires the searching for effective tools to restore impaired functions, including methods of hardware physiotherapy.

Aims: to evaluate the effectiveness of the application of high-intensity electromagnetic field (HIEF) in rehabilitation of patients after pneumonia associated with COVID-19.

Methods. 40 patients were examined and treated at the outpatient stage of rehabilitation after severe pneumonia associated with COVID-19. All patients received a set of rehabilitation measures, including daily sessions of therapeutic exercises (No. 15) and magnetotherapy procedures (No. 15). Patients were randomly separated into 2 groups: 20 patients in the treatment group (TG) who received HIEF therapy (BTL-6000 Super Inductive System) and 20 patients in the control group (CG) who received low-intensity magnetotherapy (BTL-4000 Premium device). Results. During the course of therapy, there were no patients who dropped out of the study, and no undesirable side effects and complications were identified. The high clinical effectiveness of the complex of rehabilitation measures has been proven, more pronounced in the group of patients receiving HIEF therapy. The results were confirmed by reliable dynamics of clinical indicators according to the valid questionnaire and positive changes in spirometry data.

Conclusions. Application of high-intensity electromagnetic field (HIEF) is advisable in complex outpatient rehabilitation of patients after severe pneumonia associated with COVID-19.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(4):322-328
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REVIEWS
Clinical application of high-precision neuroimaging methods in newborns with brain injuries
Perepelitsa S.A.
Abstract

In order to reduce postnatal dysfunction of the central nervous system and prevent irreversible consequences, the concept of early rehabilitation of newborns has been formulated and implemented. When planning a rehabilitation program, an individual approach to the child is required, taking into account the characteristics of his development. A comprehensive assessment of the anatomical and functional state of the brain of a newborn with the help of high-precision neuroimaging technologies that can be used at different stages of rehabilitation treatment deserves special attention.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(4):329-336
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New methods and technologies, discussions
Spectral analysis of sleep EEG in patients with chronic disorders of consciousness by multitaper discrete Fourier transform
Kanarskii M.M., Nekrasova I.Y., Borisov I.V., Yankevich D.S., Kolesov D.L., Lukyanets O.B., Gorshkov K.M., Shpichko N.P., Krylova T.N., Kovaleva N.Y., Lutkin O.Y., Evstifeev V.V.
Abstract

Background. In recent years, EEG spectral analysis has become increasingly popular due to the development of computer technologies. Among the methods of spectral analysis, various variants of the window Fourier transform are most often used, taking into account the non-stationary nature of the EEG signal.

Aims: study of the spectral composition of sleep EEG in patients with chronic disorders of consciousness by the method of discrete Fourier transform with windows in the form of spheroidal sequences.

Methods. In this article, the spectral composition of the sleep EEG of 32 patients with impaired consciousness was studied using a discrete Fourier transform with windows in the form of spheroidal sequences. For spectral analysis of EEG sleep, we used polysomnography data obtained overnight. To construct hypnospectrograms, visualize data and research results, we used software written in the Python programming language using the NumPy, scipy, matplotlib, mne, yasa libraries.

Results. The correlations between characteristic changes in the spectral composition of sleep EEG and the level of consciousness and the etiology of the disease were detected.

Conclusions. Consolidation of sleep and normalization of other circadian rhythms is an important component of both the somatic state of patients in intensive care and, possibly, will become a therapeutic target for the restoration of cognition in patients with chronic impairment of consciousness.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(4):337-349
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Organization of medical rehabilitation in Japan: condition and prospects
Mitoki K., Belyaev A.F.
Abstract

In Japan, much attention is paid to the development of medical rehabilitation. This is due to serious economic, social and moral losses that society suffers in connection with an increase in the number of disabling diseases and injuries, as well as a marked aging of the population. In Japan, a legislative and normative-methodological base for rehabilitation has been formed, staged rehabilitation has been organized (acute period, rehabilitation, outpatient). Equipment standards, staffing and other standards for rehabilitation services have been developed, depending on the type of disease. Great importance is given to patient routing and treatment quality assessment. Specialists are being trained: rehabilitologist, physical therapists, occupational therapists, speech therapists, nurses, social workers. All specialists are included in the list of staffing standards for medical institutions necessary for obtaining accreditation for medical rehabilitation. Payment for medical care in Japan is based on the insurance principle. The cost and standard term for receiving rehabilitation assistance depending on the disease is determined by insurance standards. An example of the work of a rehabilitation center — the Society for Social and Medical Assistance "Hokuto" (Hokkaido, Obihiro).

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(4):350-356
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Book review
About the monograph by N.S. Nikolaev and R.V. Petrova “Physical rehabilitation of patients after arthroplasty of large joints of the lower extremities”
Novikov A.V., Galova E.A.
Abstract

The article presents the experience of implementing a systematic approach to medical rehabilitation of patients after hip and knee arthroplasty using the example of the Federal Center for Traumatology, Orthopedics and Arthroplasty in Cheboksary. The monograph of the authors — direct participants in the process — contains practical recommendations, author’s techniques, recommended complexes of physiotherapy after arthroplasty of large joints of the lower extremities.

Physical and rehabilitation medicine, medical rehabilitation. 2020;2(4):357-360
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