Vol 3, No 3 (2021)

EDITORIAL

Prospects of using adaptive phage therapy in the rehabilitation of post-COVID-19 patients

Beloborodova N.V., Grechko A.V., Zurabov A.Y., Zurabov F.M., Kuzovlev A.N., Petrova M.V., Chernevskaya E.A., Yakovlev A.А.

Abstract

The work is devoted to the organization of postcovid rehabilitation by developing a strategy of adative phage therapy, which is the production and application of a complex of bacteriophages for a specific medical institution/department based on an up-to-date collection of hospital bacterial strains isolated from the biomaterial of patients of the same institution. Bacteriophages were actively used in the world in the 20–40s of the twentieth century in various fields of medicine, but the rapid discovery of antibiotics and the lack of understanding of bacteriophage biology limited their use. The use of complex preparations of bacteriophages from the collection pure lines of bacteriophages of the SPC "MicroMir" a set of various phages aimed at restoring the human microbiome after a covid infection allowed to sharply reduce the number of antibiotics used in intensive care units and reduce antibiotic resistance with proven safety of phage therapy.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(3):254-259
pages 254-259 views

ORIGINAL STUDY ARTICLE

Progressive resistance power training for gait and balance rehabilitation in multiple sclerosis: a pilot single-arm study

Voinova K.V., Makshakov G.S., Evdoshenko E.P.

Abstract

Background: Progressive resistance training (PRT) has been recognized as an effective rehabilitation tool for people with multiple sclerosis (pwMS), leading to increased muscle strength and improvements a gait, balance. However, still little is known about the effectiveness of muscle power training on gait and balance.

Aims: The aim of the study was to evaluate the effectiveness of 4-weeks inpatient power training protocol on parameters of gait and balance in pwMS.

Materials and methods: 26 subjects aged 18–65 years and Expanded Disability Status Scale (EDSS) score 2.0 to 6.5& Receiving standard rehabilitation with PRT was applied for 30 minutes, 5 days a week for 4 weeks in addition to other rehabilitation methods. The primary endpoint was the time of 6-minute walking test (6MWT) at week 4 (W4) compared to week 1 (W1). Secondary outcomes included the time in Timed 25-foot walking test (T25FW), Timed Up-n-Go test (TUG), 5 times sit-to-stand test (5TSST), Expanded Disability Status Scale Score (EDSS), muscle strength.

Results: After the 4-week course of rehabilitation a significant improvement was reached in all tests. The most prominent was the improvement in the 6MWT with 20/25 (80%) patients showing the increase in the distance walked above the minimal clinically important difference (MCID). Changes in other tests were less manifest: 3/25 (12%) of patients improved above MCID in both TUG and 5TSST, 6/25 (24%) patients — in T25FW. After a 4-week course of rehabilitation, a significant improvement was acquired in the 6MWT. Changes in other tests were significantly less manifest. Muscle in hip flexors improved significantly on the left side: mean (SD) at W1 — 3,96 (0,67) vs W4 — 4,72 (0,46; p=0,04), and showed the trend to significance of the right side: W1 — 3,68 (0,8); W4 — 4,52 (0,65), p=0,08.

Conclusions: The most significant effect was achieved in the primary outcome that was the distance walked in 6MWT. Less disabled patients can show better improvement in further studies, as was defined by T25FW test. Regular exercise can improve daily activity using a program that patients can easily do at home on their own.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(3):260-269
pages 260-269 views

Diagnostic of psychoemotional and cognitive impairments in acute ischemic stroke

Tynterova A.M., Perepelitsa S.A., Skalin Y.E., Reverchuk I.V., Yakovlev M.Y., Tikhonova O.A., Grishina A.A.

Abstract

Background. Early rehabilitation of patients with stroke is an important aspect of modern healthcare. The leading factor in disability is polymorphism of movement disorders, which is associated with dysfunction of various parts of the movement regulation system. Disorders of higher mental functions are another group of functional disorders widely represented among stroke patient.

Aims: To assess the severity of cognitive, psychoemotional, behavioral disorders, the level of self-control and prevalence of certain coping strategies in patients with lesions of the right and left cerebral hemispheres after acute ischemic stroke.

Material and methods. The study included 60 patients with a diagnosis of ischemic stroke. Depending on the location of the stroke, patients were divided into two groups: Group 1 — 30 patients with lesions of the right hemisphere, Group 2 — 30 patients with lesions of the left hemisphere. The study was conducted on the 7th day of treatment and included: assessment of the cognitive status according to the Montreal scale (with additional scales for assessing the functions of the right hemisphere); assessment of the level of distress, depression, anxiety and somatization using the Four Dimensional Symptom Questionnaire; assessment of mental and physical asthenia according to the MFI-20 scale, level of self-control using the Rotter's Locus of Control Scale and coping strategies modality using E. Heim coping questionnaire.

Results. The study established the prevalence of depression, a tendency towards non-adaptive coping strategies, ideational praxis related disorders “understanding of metaphors” and low level of self-control in relation to health in patients with lesions of the right hemisphere. Patients with ischemic stroke localized in the left hemisphere are characterized by a high level of mental asthenia, a choice of adaptive and relatively adaptive coping strategies, and a low level of self-control in respect to interpersonal relationships.

Conclusions. The results of the study show that in the acute period of stroke there are qualitative and quantitative differences in neuropsychiatric symptoms of patients with lesions of the right and left cerebral hemispheres. The predominance of depression, cognitive impairments, and non-adaptive coping strategies in patients with lesions of the right hemisphere even with minimal or moderate motor deficits justifies early examination of the patient's behavioral, neuropsychiatric, and cognitive syndromes. The results of the study indicate the need to develop individual psychological rehabilitation programs for patients with lesions of the right and left cerebral hemispheres during the acute period of stroke.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(3):270-280
pages 270-280 views

Analysis of the structure of psycho-emotional disorders in patients with consequences of CVA who underwent rehabilitation at the FSCCRR in conditions of social and communicative deprivation

Martynova M.V., Petrovskaya M.V., Stern M.V., Kulikov A.S., Milovanova E.V., Petrova M.V.

Abstract

Introduction: Patients of FRCC ICMRR undergo rehabilitation after "cerebral accidents" of acute cerebrovascular accident (ACVA), Traumatic Brain Injury (TBI), brain surgery. During the pandemic COVID-19 (2020–2021), the hard situation of patients dealing with the disease is made more difficult by the visits ban in the hospital. Patients are forced to stay a month or more of loneliness, away from family and loved ones, in conditions of "isolation".

Aims: Was to identify the frequency of occurrence and severity of anxiety and depressive disorders among patients caused by a long stay in the hospital, limited communication with relatives due to the COVID-19 pandemic.

Materials and methods: The study group consisted of 132 patients of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitation (FRCC ICMRR) who were hospitalized during the COVID-19 pandemic (from May 2020 to April 2021); the comparison group consisted of 104 patients who were treated in the FRCC ICMRR in 2019. After studying the medical documentation, 2 groups of patients were formed: the study group of 21 people and the comparison group of 24 people with an identical distribution by gender and age, by the severity of neurological deficit (mild and moderate severity of the lesion), localization of the process, criteria of social activity. The following methods were used in the study: organizational-comparative method; empirical-observation, conversation, questionnaire; psychodiagnostic methods-tests (ODS-2, HADS, STAI), the method of expert assessments, a qualitative method of data processing (differentiation of material by groups, its analysis).

Results: The stress of hospitalisation and unvoluntary isolation makes patient’s mental health much worse, causes mental maladjustment, and often manifests itself in the development of anxiety-depressive pathopsychological symptoms: the frequency of occurrence of personal anxiety increased by 3 times; the severity of the symptoms of situational anxiety increased by 1.5 times, no cases of neurosis were detected among patients of both groups.

Conclusions: To reduce the negative consequences of psycho-emotional stress from unvoluntary isolation, to prevent the formation of social-stress disorder, it is necessary to carry out a number of activities not only in a separate institution, but also at the global level.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(3):281-290
pages 281-290 views

REVIEWS

Mechanisms of low-temperature rehabilitation technologies. Extreme aerocriotherapy

Shevelev O.A., Petrova M.V., Yuriev M.Y., Smolensky A.V., Zhdanova M.A.

Abstract

The mechanisms of increasing the resistance of cells to significant temperature and damaging effects are typical, and cellular tolerance, ensuring the effectiveness of systemic regulation, is an important part of increasing the adaptive and rehabilitative potential of the entire organism. The expression of early genes encoding a wide range of stress-protective proteins increases the resistance of cells not only to significant temperature stimuli, but also to ischemia, hypoxia, and other damaging factors, forming the effects of cross-adaptation. Even a small change in temperature is significant enough to trigger the processes of genomic reprogramming. It seems to us important to consider the mechanisms of low-temperature therapeutic and rehabilitation technologies from the standpoint of cellular response to temperature stimuli. Currently, a large number of low — temperature technologies (HT) are used in medical rehabilitation, which can be divided into two groups: moderately low temperature effects (from –30°C to +20°C) and extremely low temperature effects (from –30°C to –180°C), which includes the technology of extreme aerocriotherapy (EACT). The purpose of the review is to analyze the systemic and local mechanisms of EACT implemented with the participation of the main known stress-protective proteins.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(3):291-300
pages 291-300 views

Cerebral palsy biomarker

Kamilova T.A., Golota A.S., Vologzhanin D.A., Shneider O.V., Sсherbak S.G.

Abstract

Cerebral palsy is a neurological disorder that is attributed to non-progressive injury or malformation that occurred in the developing fetal or infant brain. The motor disorders in cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, behaviour, and by epilepsy. Cerebral palsy is a complex disorder that is likely to be of multifactorial origin. Epidemiological studies have shown that the origins of most CP are prior to labor. A number of clinical risk factors for cerebral palsy have been described in the literature including preterm birth, low birth weight, inflammation, maternal infection during pregnancy and placenta pathology. Hypoxia at birth may be primary or secondary to preexisting pathology, but the currently known clinical risk factors do not explain the majority of cases. Many of these risk factors may have a genetic component. Several single nucleotide polymorphisms, DNA copy number variations and epigenetic patterns increase genetic susceptibility for cerebral palsy. Whole genome sequencing and gene expression studies may extend the percentage of cases with a genetic pathway. Clinical risk factors could act as triggers for CP where there is genetic susceptibility. These new findings should refocus research about the causes of these complex and varied neurodevelopmental disorders on the search for biomarkers of the risk of cerebral palsy. Genomics, proteomics and metabolomics have huge potential for deepening our understanding of many complex diseases by identifying diagnostic and prognostic panels of biomarkers, especially in various neurological disorders, including cerebral palsy.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(3):301-317
pages 301-317 views

New methods and technologies, discussions

Development of paradigms for the diagnosis of "covert cognition" and cognitive motor dissociation in patients with chronic disorders of consciousness

Cherkasova A.N., Yatsko K.A., Kovyazina M.S., Varako N.A., Krotenkova M.V., Kremneva E.I., Broutian A.G., Ryabinkina Y.V., Belkin A.A., Belkin V.A., Suponeva N.A., Piradov M.А.

Abstract

The detection of signs of consciousness in patients with chronic disorders of consciousness is a complex clinical task. In recent decades, instrumental methods have been used to improve the accuracy of diagnostics. The phenomenon of «covert cognition» and cognitive motor dissociation have been demonstrated in a small proportion of patients in studies using instrumental methods in combination with different paradigms. This article describes the main features of the diagnostic paradigms used for such purposes. Currently, the development of its own complex of paradigms is held at the Research Center of Neurology collaboratively with group of neuropsychologists from Lomonosov Moscow State University. The general characteristics of this complex of paradigms are indicated. The practical significance of detecting the phenomenon of «covert cognition» and cognitive motor dissociation in patients with chronic disorders of consciousness is discussed.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(3):318-321
pages 318-321 views

Comparative analysis of the quality of care in patients with coronary heart disease with chronic heart failure in medical and preventive institutions in the Moscow Region

Kosov V.A., Trebina N.P., Svist N.V., Pavlov A.I., Slivinsky D.V., Shakula A.V.

Abstract

In the organization of systematic work on the examination and management of the quality of medical care taking into account the existing recommendations in each medical-preventive institution should constantly work clinical-expert commissions, including: the medical-control subcommittee, the subcommittee to study the death outcomes, the subcommittee of the examination of disability, the subcommittee of the study of surgical complications. The results of the expert study revealed that the indicators of the commission in the provision of medical and diagnostic care for patients with coronary heart disease in the Moscow region hospital are at an average level, compared to the rates of the commission for other types of medical care. Conducting a complex of medical rehabilitation on the basis of a spa organization for patients with chronic heart failure and acute myocardial infarction after coronary artery bypass grafting allows to significantly improve the level of medical and diagnostic care and improve the quality of life of patients.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(3):322-328
pages 322-328 views

Information technology in hospitalization management in a federal medical organization

Nikolaev N.S., Andreeva V.E., Preobrazhenskaya E.V., Vasilieva O.A., Tarasov A.N.

Abstract

The article presents the experience of organizing the management process of planned hospitalization at the Federal Center for Traumatology, Orthopedics and Arthroplasty (Cheboksary). Automation of the process of hospital admission planning, including monitoring of hospital admissions failures and the length of patient stay in the Hospital admission, organization of information support for the staff of the Center's admission department based on the developed MIS "Medialog" module, related to patient registration and registration of documents specific to the federal medical center in the Hospital admission, allowed for ongoing monitoring of hospitalization, reducing the proportion of patients waiting in the emergency department for more than 3 hours, improving the quality of patient flow planning and management.

Physical and rehabilitation medicine, medical rehabilitation. 2021;3(3):329-336
pages 329-336 views


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