Vol 5, No 2 (2023)
ORIGINAL STUDY ARTICLE
Significance of the second stage of medical rehabilitation after arthroplasty of large joints
Abstract
BACKGROUND: Until recently, the three-level system of medical rehabilitation adopted in Russia assumed the implementation of each of the stages in various medical organizations. The lack of funding within the budget and the basic compulsory medical insurance program led to limited access for patients to the trajectory of the completed cycle of medical rehabilitation after surgical interventions, which reduced the effectiveness of the provision of profile high-tech medical care.
AIM: is to demonstrate the effectiveness of the system for organizing rehabilitation care for patients after arthroplasty of large joints of the lower extremities in a stationary (second) stage in a medical rehabilitation center.
MATERIALSAND METHODS: The data of the medical information system on patients treated for three months at the second (inpatient) stage after arthroplasty of the hip and knee joints in the conditions of the Medical Rehabilitation Center were used. The effectiveness of rehabilitation was assessed by tests and scales: rehabilitation routing scale (RRS), visual analog scale (VAS), Borg exercise tolerance scale, Hospital anxiety and depression scale (HADS), European quality of life questionnaire (EQ-5D); Medical research scale (MRS), index Leken.
RESULTS: 308 patients (306 operated) were treated after medical rehabilitation measures at the first stage with a RRS score of 4-5 points, of which about 80% — after primary and revision arthroplasty of large joints. Upon completion of rehabilitation measures, a statistically significant improvement in all functional indicators was noted. Despite the ambiguous opinion of scientists about the need for inpatient rehabilitation after arthroplasty, according to our data, arthroplasty and the subsequent stage of medical rehabilitation using modern technologies in a hospital significantly improve the clinical status, reduce or eliminate pain, increase motor activity, improve the psycho-emotional background and the patient s quality of life. Stationary (second) stage of rehabilitation was effective in 100%.
CONCLUSIONS: The results of the work of the medical rehabilitation center proved its organizational feasibility, clinical effectiveness and advantages: continuity and phasing of rehabilitation in a single institution; continuity of observation of the patient during the interaction of multidisciplinary rehabilitation team with the participation of the operating surgeon, an anesthesiologist-resuscitator. The quality of rehabilitation is improved by the concentration of high-tech therapeutic and regenerative agents and experienced specialists, the correction of concomitant pathology, explanatory work with patients to increase compliance.
97-106
Application of the International classification of functioning, disability and health in medical rehabilitation of children with severe traumatic brain injury
Abstract
BACKGROUND: The problem of rehabilitation of patients with severe traumatic brain injury has been and remains very important and relevant for both adults and children. Patients with severe traumatic brain injury often develop severe physical, mental, emotional and cognitive impairments, which are often difficult to correct and require long-term treatment, including rehabilitation, relying solely on the body's potential, which is accompanied by a heavy financial burden for the patient, his family, and society in general. The introduction of new diagnostic methods, the improvement of resuscitation measures, the use of modern methods of neurosurgical intervention and timely rehabilitation can increase the proportion of children who survived after severe traumatic brain injury and their quality of life.
AIM: to evaluate the effectiveness of medical rehabilitation of children with severe traumatic brain injury with the participation of a multidisciplinary rehabilitation team and relatives of patients.
MATERIALS AND METHODS: The study included 50 children with severe traumatic brain injury. Two groups were distinguished by the randomization method: the main group — 25 patients (50%) and the control group, which included 25 patients (50%). The follow-up period was 1 year after the onset of severe traumatic brain injury. In the main group, an individual plan for early rehabilitation was drawn up on the 2nd day after a severe traumatic brain injury in intensive care. At the first stage of rehabilitation, which is carried out in the intensive care unit and the neurosurgery department, an individual medical rehabilitation plan was developed for the children of the main group, depending on somatic indicators and the severity of the condition, and a rehabilitation diagnosis based on the International classification of functioning, disability and health was established. In the control group, after transfer from the intensive care unit to the specialized neurosurgical department, patients received basic rehabilitation therapy: articular gymnastics, paraffin therapy, and psychological support.
RESULTS: In the main group, more effective changes were noted in domains associated with impaired structure and function of the nervous system, which led to improved activity and participation, self-service. In patients of the control group, there were no significant changes in the state of functions, activity and participation.
CONCLUSION: The early start of complex medical rehabilitation of children with severe traumatic brain injury reduces disability and accelerates the process of the patient's socialization, which is more clearly demonstrated by the International classification of functioning, disability and health approach. The use of International classification of functioning, disability and health for with severe traumatic brain injury in children in medical rehabilitation departments is a good tool for setting rehabilitation goals, choosing rehabilitation measures and assessing the effectiveness of rehabilitation.
107-119
REVIEWS
Organ-specific manifestations of "long COVID"
Abstract
The COVID-19 pandemic has severely affected the healthcare system across the globe and caused significant morbidity and mortality. The occurrence and importance of the post-COVID-19 sequelae was realized when a sizable proportion of patients appeared to continue suffering from various symptoms for many months and years after having recovered from the acute phase of infection. These complications were observed in multiple organ systems and not only in the respiratory tract. Multidisciplinary efforts are required to manage these patients as the complications are variable in terms of location and severity.
The post COVID-19 condition (long COVID) represents a number of different post-viral syndromes that require an appropriate classification. Collection of a large amount of data is required for all the physical and neuropsychiatric symptoms that persist for more than 12 weeks without an alternative explanation. The process of data collection and analysis should be controlled for all confounding factors including the consequences of intensive care hospitalization, social isolation, and other effects.
The current absence of the effective treatment reflects the unclear causes of the post COVID-19 conditions which cannot be targeted properly until their mechanism is established. Timely collection of data and identification of physiological mechanisms underlying the long-term clinical manifestations of C0VID-19 are vital for the relevant design of effective therapies.
120-140
Mechanisms of low-temperature rehabilitation technologies. Natural and artificial hypothermia
Abstract
The literature review covers an analysis of the typical protective and adaptive reaction mechanisms that develop in small rodents that spontaneously hibernate under the cold snap, together with warm-blooded animals and humans during circadian fall of the body temperature at night time and in a course of a slow-wave sleep, along with induced artificial therapeutic hypothermia.
The general features of neuroprotection states development in natural endogenous and induced hypothermia are highlighted, which include metabolic, epigenetic and biophysical reactions that ensure the formation of nonspecific tolerance of the brain to potentially damaging effects. Significant attention has been devoted to the participation of hibernation proteins, opioids and antioxidant systems in the processes of safe exit from state of torpor in animals and in implementation of sleep restoration functions. Taking into account the circadian nature formation of endogenous brain’s hypothermia at night and in the phases of slow sleep, it is suggested that periodic temperature exposure on the cerebral cortex can be applied in order to restore the disturbed circadian rhythms. From the standpoint of common mechanisms of endogenous and induced hypothermia, selective hypothermia of the cerebral cortex can be considered as a nature-like technology.
Based on the extensive experimental material indicating a significant neuroprotective potentials of low temperatures during hibernation, diurnal hypothermia as well as artificially induced hypothermia, it was stated that implementation of the technology for selective hypothermia of the cerebral cortex in order to prevent the negative consequences of cerebral catastrophes are a perspective trend.
141-156
An outlook of early rehabilitation of stroke patients using VR technologies
Abstract
Among all the latest technologies, virtual reality (virtual reality, VR) can be a powerful and promising tool for achieving the main goals of rehabilitation. It has been experimentally proven that rehabilitation based on virtual technologies is able to recreate a realistic perception and corresponding reaction in a patient, thereby improving the quality of cognitive and motor rehabilitation with the least cost. However, the success of such rehabilitation depends mainly on the technologies and techniques used by doctors.
This study is devoted to the important problem — application of virtual reality technologies in patients with acute impairment of cerebral circulation at the stage of early rehabilitation. We focus on the neurophysiological aspects of the VR technology application and the mechanisms of the brain’s neuroplasticity during application of virtual reality. The characteristic features of modern approaches to application of virtual reality are highlighted. Also, a novel concept is proposed for the modern VR-technology application in intensive care unit patients. In conclusion, we discuss the possibilities of VR-technologies application, allowing for the simulation of any situation, as well as a possibility of synchronous playback of a music track with walking simulation in ICU patients in the acute period of stroke at the stage of early rehabilitation.
157-166
CASE REPORT
Rehabilitation of a patient with post-covid syndrome: A clinical case
Abstract
After the COVID-19 pandemic, medicine faces the need to rehabilitate patients with post-COVID syndrome, asthenia, cognitive impairment, and low physical tolerance.
We present a clinical case of a patient at the 3d stage of rehabilitation. The rehabilitation diagnosis according to the ICF and the rehabilitation programme are presented.
After COVID-19, the 52-year old patient suffered from general weakness and forgetfulness, she dropped objects (e.g., broke dishes), could fall, had an impaired sense of smell and occasional shortness of breath. She could not attend to herself and could not leave her home without help. The multidisciplinary rehabilitation course helped the patient to cope with all domestic tasks after 3 weeks, with the psychological support from her husband. The rehabilitation results according to the corresponding estimation scales show an improvement of the physical tolerance, cognitive functions and asthenia. Cerebrolysin was included into the rehabilitation programme to increase the patient's potential for rehabilitation.
The addition of Cerebrolysin to the rehabilitation programme has speeded up the recovery process and increased the effectiveness of non-medical treatments.
167-174
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