Vol 4, No 2 (2022)

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.

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.

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.

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.