Vol 8, No 2 (2026)

BACKGROUND: Dysphagia is a common complication of neurological diseases and intensive care consequence syndrome, associated with a high risk of aspiration pneumonia, nutritional deficiency and mortality. In Russian clinical practice, there is no validated scale that allows you to simultaneously assess the severity of dysphagia, determine the safe texture of nutrition, form an individual speech therapy program and be used at all stages of rehabilitation, including the post-extubation period in intensive care units. Based on international recommendations and the experience of many years of treatment of patients of various profiles in a rehabilitation center, the speech therapy team has developed the dysphagia scale.

AIM: The aim of the study was to validate the developed “Clinical Brain Institute’s Dysphagia Scale”.

METHODS: A non-randomized prospective single center validation study was conducted on the basis of the departments of medical rehabilitation and intensive care of the Clinical Brain Institute (Berezovsky, Russia) in 2024. The study included 100 patients (mean age 57.6±14.6 years; 56 women, 44 men) who were hospitalized for at least 12 days. SDC includes 12 clinical sites with a 6-level gradation, covering the oral and pharyngeal phases of swallowing, saliva control, cough reflex, the state of the muscles of the articulatory apparatus, the need for tracheoesophageal disconnection, and the effectiveness of swallowing at different bolus volumes. Each patient underwent three independent examinations on the day of admission and three on the 12th day by six medical speech therapists with different experience. The reliability of the scale was evaluated using the Cronbach alpha coefficient (internal consistency), the Cohen and Fleiss aligners (interexpert reliability), and the Spearman coefficient (retest reproducibility). Sensitivity to changes was tested using the Wilcoxon W-test.

RESULTS: Internal consistency was α=0.990. Inter-expert reliability between the most experienced specialists ― κ=0.918 (p=0.003); When comparing specialists with different experiences, the minimum value is κ=0.759, which remains within acceptable consistency. The retest correlation is ρ=0.91 (p < 0.001). After 12 days, the average score significantly decreased, which confirms the sensitivity of the scale to therapeutic dynamics. No adverse events were reported during testing.

CONCLUSION: The level of psychometric properties of the Dysphagia Scale of the Clinical Brain Institute (KIM) is sufficient to include multidisciplinary teams of rehabilitation departments in the practice of medical speech therapists for diagnosis, assessment of the severity, dynamics of the condition, development of treatment protocols and during clinical trials.

BACKGROUND: Despite the widespread use of neuromuscular electrical stimulation in the rehabilitation of children with cerebral palsy, the effects of personalized selection of stimulation modes based on the predominant motor deficit remains insufficiently investigated. Studies comparing the effectiveness of different modes of neuromuscular electrical stimulation in the setting of sanatorium-based rehabilitation are lacking.

AIM: To evaluate the effects of different personalized modes of neuromuscular electrical stimulation on spasticity, muscle strength, and functional endurance in children with cerebral palsy (spastic diplegia) undergoing sanatorium-based rehabilitation.

METHODS: A prospective, open-label, randomized controlled trial was conducted in 70 patients aged 8–16 years with cerebral palsy (spastic diplegia), corresponding to levels II–III according to the Gross Motor Function Classification System, who underwent sanatorium-based rehabilitation between 2024 and 2025. Participants were randomized into two groups: standard rehabilitation (control) and standard rehabilitation supplemented with personalized neuromuscular electrical stimulation. The intervention course lasted 21 days (5 sessions per week). The mode of neuromuscular electrical stimulation was selected individually according to the predominant clinical deficit. Outcomes were assessed before and after the intervention using the Modified Ashworth Scale, goniometry, manual muscle testing, the Timed Up and Go test, the physiological cost index, and the six-minute walk test.

RESULTS: Personalized neuromuscular electrical stimulation was associated with a reduction in spasticity; most pronounced in the antispastic mode of neuromuscular electrical stimulation (p < 0.001). Between-group analysis demonstrated the superiority of the antispastic mode (ε²=0.38–0.66). An increase in passive ankle range of motion (increase of ≥5 degrees), corresponding to a clinically meaningful improvement, was observed. Improvements in muscle strength were primarily associated with strength-training mode. Functional mobility improved significantly in the antispastic and strength-training groups (p < 0.001; Cohen’s d=1.17–1.85), whereas no significant changes were observed in the endurance-training or control groups (p=0.104 and p=0.135, respectively). No adverse events were reported.

CONCLUSION: Personalized neuromuscular electrical stimulation enhances the effectiveness of sanatorium-based rehabilitation in children with spastic diplegia, providing clinically meaningful reductions in spasticity and improvements in functional outcomes.

The development and progression of cardiovascular diseases such as atherosclerosis, hypertension, coronary heart disease, heart failure, and others is determined by the interaction of genetic, environmental, and behavioral factors. In recent years, epigenetic mechanisms have been considered key regulators of the cardiovascular system, influencing gene expression without altering the DNA sequence. The expression of disease-associated genes is regulated by epigenetic mechanisms. The epigenome plays a key role in executing cellular programs, regulating gene transcription and altering chromatin structure and accessibility to transcription factors. Epigenetic enzymes depend on metabolites to perform their modifying functions, thereby establishing a link between metabolism and epigenetics. Cellular metabolic processes include glycolysis and β-oxidation of fatty acids, as well as energy metabolism. Cardiovascular metabolic dysfunction contributes to the development of cardiovascular disease through inappropriate epigenetic modifications of histone proteins, DNA, and RNA. Key elements of this process are transcription factors that interact with regulatory DNA sequences, altering gene expression. Advances in epigenome analysis have provided insights into the pathogenesis of cardiovascular diseases by identifying disease-associated epigenetic changes in cardiomyocytes and other cardiac cell types.

This review examines recent discoveries in the field of epigenetic regulation of cardiac disease, highlighting the role of epigenetic enzymes and non-coding RNAs, which offer new opportunities for personalized medicine in cardiology. Understanding these epigenetic pathways is critical for the development of new biomarkers and epigenetic therapies and cardiac rehabilitation aimed at slowing or reversing maladaptive cardiac remodeling and improving clinical outcomes.

Stroke remains one of the leading causes of long-term disability worldwide, with motor dysfunction being one of the most common and persistent consequences. Traditional rehabilitation often relies heavily on passive therapy, which can be limited by insufficient training intensity, low patient engagement, and weak integration of intention, action, and feedback. In contrast, active rehabilitation emphasizes voluntary patient participation and uses interventions based on intention and enriched with feedback to stimulate recovery through neuroplasticity.

This review summarizes the physiological basis of active rehabilitation, focusing on the mechanisms of neuroplasticity, motor intention detection, and feedback intervention. Additionally, it explores how rehabilitation strategies should adapt to the acute, subacute, and chronic phases of post-stroke recovery. However, clinical implementation is still hindered by inter-individual variability, signal instability, heterogeneity of protocols, and the difficulty of determining the optimal timing and dosage of intervention.

Therefore, an approach that takes into account the stage of the disease and the individual characteristics of the patient is necessary to develop effective rehabilitation systems. In general, active rehabilitation represents a promising link between engineering innovations and clinical neurorehabilitation, and future development directions include multimodal probing, closed-loop intelligent control, home systems, and digital patient twins.