Vol 4, No 2 (2022)

ORIGINAL STUDIES

Prospective Study of the Possibility of Correcting Various Forms of Aphasia, Taking Into Account the Processes of Neurodynamics in Speech Rehabilitation in Patients with Chronic Brain Damage

Kharitoshkina E.A., Bushueva E.V.

Abstract

Background: The relevance of the study is associated with the high incidence and severity of speech dysfunctions in patients with chronic brain damage. Sydromal speech disorders associated with lesions of the right hemisphere of the brain, in contrast to the left hemisphere syndromes, are characterized by a blurred structure of the defect itself, less resistance to external influences, a large volume of the neurodynamic component, which should be taken into account in rehabilitation as a factor that makes a significant positive contribution to the achievement the result of correctional and rehabilitation work. A comprehensive method of correctional and rehabilitation work with this category of patients, differentiated according to the forms of aphasia and taking into account neurodynamic processes, is currently absent, which constitutes a significant medical and social problem. Aims: Approbation and evaluation of the effectiveness of complex methodological and methodological approaches to the correction of various forms of aphasias, taking into account the processes of neurodynamics in speech rehabilitation in patients with chronic brain damage. Materials and methods: 80 patients with various forms of aphasia (dynamic, semantic, acoustic-mnestic) resulting from severe right-hemispheric brain injuries were examined, including 40 patients in the main group and 40 in the control group. The assessment of the effectiveness of rehabilitation work on the horizon of 6 and 12 months was carried out by monitoring the dynamics of the disease. Methods and experience of rehabilitation work, structured according to the most common forms of aphasia, are described in detail. Results: The presence of stable improvements in the state of speech function was shown in patients with various forms of aphasia 6 and 12 months after the beginning of rehabilitation in patients, including cases of complicated dynamic aphasia. Methodical, methodological and practical recommendations for the correction of various forms of aphasia are given, taking into account the processes of neurodynamics in speech rehabilitation in patients with chronic brain injuries, indicators of the dynamics of rehabilitation of patients with Federal Scientific and Clinical Center of Intensive Care Medicine and Rehabilitology confirming the effectiveness of correctional and rehabilitation work are given. Conclusions: The effectiveness of an integrated approach to the rehabilitation of patients with various forms of aphasia, taking into account the processes of neurodynamics, based on a combination of speech therapy classes, therapeutic intervention, measures of neurometabolic support and carrying out general strengthening measures has been proven.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(2):72-82
pages 72-82 views

Features of Cranial Bone Reconstruction in Patients at Various Stages of Rehabilitation

Varyukhina M.D., Vorobyev A.N., Levin D.V., Ilyina A.A., Kolesov D.L., Shaybak A.A., Radutnaya M.L., Yakovlev A.А., Gorelova E.S.

Abstract

Background: Postoperative skull bone defects are one of the urgent problems of neurorehabilitation. Skull bone defect limits the scope of rehabilitation measures, complicates patient care, and leads to secondary complications. Significant risks of postop complications demands making a decision about surgery individually. Surgery timing varies widely and remains controversal. Aims: to formulate the features of skull bone defects reconstruction in patients at various stages of rehabilitation based on the analysis of the frequency and structure of postoperative surgical complications. Materials and methods: The retrospective analysis of cranioplasty results was performed in the 129 patients treated in Federal Scientific and Clinical Center of Intensive Care Medicine and Rehabilitology from 2018 to 2022 at various stages of rehabilitation (intensive care, inpatient, outpatient). The features of surgery, frequency and structure of surgical complications dependent on rehabilitation stage were analyzed. Results: A total of 129 patients were included in the study: 84 men (65%) and 45 women (35%). The average age of the patients was 43.2±13.9 years. The average timing of cranioplasty surgery was 79 days [IQR 60; 133]. Seventy two patients (56%) were operated on at the intensive care stage of rehabilitation, forty (31%) and seventeen (13%) patients were operated on at the inpatient and outpatient stages, respectively. In total, complications occurred in 16 patients (12%). Intensive care patients required careful preoperative preparation, correction of homeostasis and metabolism disorders. In our series, postoperative complications were observed in 12 patients on intensive care stage (17%); all cases of hydrocephalus occurred only in intensive care patients. In patients operated on at the inpatient stage of rehabilitation, complications occurred in 4 cases (10%), while there was no statistically significant difference in the incidence of complications in patients from the intensive care and inpatient subgroups (p=0.334). Complications in patients at the outpatient stage of rehabilitation were not observed in our series. Conclusions: Cranioplasty surgery is possible even in somatically burdened patients at the intensive care stage of rehabilitation. It allows to expand the scope of rehabilitation measures and facilitate medical care. When planning surgical intervention in the early stages after the cranioplasty surgery, it is important to take into account the increased risk of hydrocephalus manifestation.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(2):83-89
pages 83-89 views

REVIEWS

Rehabilitation Environment for Patients with Chronic Impairment of Consciousness

Nekrasova I.Y., Borisov I.V., Kanarsky M.M., Pradhan P., Deriushkin V.G., Sorokina V.S., Petrova M.V., Stern M.V., Yarotskaya I.A.

Abstract

The article discusses aspects of providing care to patients with chronic impairment of consciousness at the post-hospital stage: it describes the difficulties faced by relatives of patients caring for loved ones at home; the prospects for the use of remote technologies for the rehabilitation of patients are indicated on the example of the experience of foreign researchers; the experience of creating a rehabilitation environment similar to home (Casa Iride model) is presented with an indication of its strengths and weaknesses. Thus, the basis of modern remote and mobile rehabilitation services should be system platform IT solutions that, based on the principles of digitalization, ensure coordination of interdepartmental interaction and efficient use of resources in the process of providing post-hospital rehabilitation care to patients with severe consequences of organic brain damage.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(2):90-104
pages 90-104 views

Sound Impact on Health and Rehabilitation

Danilov A.B., Simenko E.V., Ikhlef A.

Abstract

The impact of sound on the human body is enormous. There are different types of sound vibrations that have both positive and negative effects on health. In this review, sound is considered as a factor that is important for regulating the state of human health, with an emphasis on its cognitive functions and mental activity. It also describes technologies for the use of sound in the treatment of neurological diseases, anxiety and depressive conditions, and in restoring the functioning of patients. The influence and use of sound is considered at different levels of its manifestation: ultrasound, infrasound, white noise, sounds of nature and music. A great potential of sound exposure has been found in the treatment of neurological diseases, mental disorders, pain syndromes, as well as in improving cognitive functions. It is proposed to introduce sound monitoring and music therapy as an important element of rehabilitation medicine.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(2):105-110
pages 105-110 views

New methods and technologies, discussions

The Effectiveness of Sanatorium Rehabilitation of Patients with Coronary Heart Disease after Myocardial Revascularization Against the Background of Post-Corneal Syndrome

Kosov V.A., Trebina N.P., Drubachevskay L.M., Pavlov A.I., Slivinsky D.V., Shakula A.V.

Abstract

Background: According to the literature, the use of natural and preformed therapeutic physical factors with proven anti-inflammatory effect and improvement of endothelial function is promising as a personalized treatment and rehabilitation of patients with heart and cardiovascular system damage after COVID-19. Aims: of the study is to develop new rehabilitation programs for patients with coronary heart disease with mutual burden syndrome after suffering COVID-19, allowing to improve the quality and effectiveness of specialized medical care in a sanatorium. Materials and methods: In representative groups of patients with coronary heart disease who underwent myocardial revascularization on the background of postcovid syndrome, the features of the clinical-functional, metabolic and hemostatic state were studied. Results: Three new programs have been developed and scientifically substantiated for operated patients with coronary heart disease with mutual burden syndrome at the sanatorium-resort stage, complementing the standard treatment with the complex use of normobaric hypoxytherapy, hyperbaric oxygenation, halotherapy and ozone therapy. The effectiveness of the applied new medical rehabilitation programs has been evaluated, taking into account the severity of the mutual burden syndrome according to clinical, functional, laboratory and sociological indicators. Conclusions: The highest effectiveness of rehabilitation programs has been proven, including a combination of these therapeutic factors in patients with severe functional classes according to NYHA and the degree of severity of the mutual burden syndrome on the CIRS-G scale.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(2):111-121
pages 111-121 views

SHORT COMMUNICATIONS

The Effect of Selective Hypothermia of the Cerebral Cortex on Metabolism in Patients with Prolonged Impairment of Consciousness

Mengistu E.M., Petrova M.V., Shevelev O.A.

Abstract

A pilot study was conducted among patients with chronic impaired consciousness in order to assess the response of energy expenditure at rest (REE) during craniocerebral hypothermia. It was found that REE increased in 70.59% of patients, and decreased in 29.41%. It is assumed that the decrease in REE is associated with preserved metabolic activity in the intact parts of the cerebral cortex and may indicate the presence of rehabilitation potential, and the decrease indicates the presence of gross damage that excluded the selectivity of hypothermic exposure.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(2):122-124
pages 122-124 views

Speech Therapy Rehabilitation of Patients with Aphasia in Intensive Care

Polikarpova O.S.

Abstract

A clinical example shows the role of a speech therapist in communication between doctors and patients with severe brain damage. An individual approach to the provision of speech therapy to patients in intensive care units significantly increases the effectiveness of rehabilitation.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(2):125-127
pages 125-127 views


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