Vol 4, No 3 (2022)

ORIGINAL STUDY ARTICLE

Rehabilitation of patients with post-stroke aphasia using transcranial direct current electrical stimulation (tDCS)

Belopasova A.V., Kadykov A.S., Berdnikovitch E.S., Dobrynina L.A.

Abstract

BACKGROUND: Rehabilitation of patients with post-stroke aphasia is an important medical and social goal. The use of traditional methods of rehabilitation is often not effective enough, which forces us to look for new methods aimed at restoring lost functions.

AIM: The aim of this study is to determine the effectiveness of non-invasive brain stimulation using transcranial direct electric current stimulation (tDCS) in patients with post-stroke aphasia.

MATERIALS AND METHODS: 28 patients with motor post-stroke aphasia were examined according to the method of L.S. Tsvetkova with co-authors. All patients received a traditional rehabilitation complex: psychological and correctional classes with a speech therapist-aphasiologist; neurometabolic therapy. 14 patients (Group I) additionally had transcranial direct electric current stimulation; 14 patients had placebo transcranial direct electric current stimulation.

RESULTS: All patients with post-stroke aphasia showed an improvement in expressive and impressive speech, however, in patients who had true transcranial direct electric current stimulation, the improvement in expressive and impressive speech was higher than in patients who had placebo transcranial direct electric current stimulation. There were no complications from the use of transcranial direct electric current stimulation.

CONCLUSION: Based on the results of the study, it can be concluded that it is expedient to include the non-invasive transcranial direct electric current stimulation method in the rehabilitation of patients with post-stroke aphasia.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(3):132-139
pages 132-139 views

Possibilities of endoscopic evaluation of swallowing function in patients with chronic disorders of consciousness

Kondratyeva E.A., Lesteva N.A., Verbitskaya E.V., Kondratyev S.A., Petrova A.B., Ivanova N.E., Kondratyev A.N.

Abstract

BACKGROUND: The period of coma in some patients after severe brain damage ends with a transition to one of the forms of chronic disorders of consciousness ― a vegetative state/unresponsive wakefulness syndrome or a minimally conscious state. Almost all patients with chronic disorders of consciousness have dysphagia of varying severity, and therefore nutrition of this category of patients is carried out initially through a nasogastric tube, and then through a gastrostomy. Early tracheostomy cannula removal may lead to the development of aspiration and pneumonia. Dysphagia is often not diagnosed in chronic disorders of consciousness patients.

AIMS: Analysis of the results of fibrooptic endoscopic assessment of swallowing in chronic disorders of consciousness patients to identify the relationship between the presence and severity of dysphagia with the level of consciousness, data on the coma recovery scale, as well as the duration of consciousness disorders and dynamics of recovery of consciousness.

MATERIALS AND METHODS: The study was of a prospective type, conducted in the period from 2019 to 2021. 39 chronic disorders of consciousness patients (18 ― vegetative state/unresponsive wakefulness syndrome, 18 ― minimally conscious state "minus" and minimally conscious state "plus" and 3 patients with a level of consciousness corresponding to the emergence from the minimally conscious state). The average duration of chronic disorders of consciousness was 7.7±9.4 months. All patients underwent a neurological examination using the CRS-R upon admission to the hospital and a month later, an endoscopic examination of the swallowing function was performed with scores calculated according to the Federal Endoscopic Dysphagia Severity Assessment Scale (FEDSS) and aspiration assessment scale in accordance with the Rosenbek criteria.

RESULTS: Dysphagia of varying severity was detected in 36 patients (92.3%). The correlation of the total CRS-R score with the degree of dysphagia (Ro=-0.481, p=0.002) was found. The degree of dysphagia did not depend on the chronic disorders of consciousness duration.

CONCLUSION: Regardless of the chronic disorders of consciousness severity (vegetative state/unresponsive wakefulness syndrome, minimally conscious state "minus", minimally conscious state "plus") before tracheostomy removing and switching to the oral feeding, it is necessary to perform fibrooptic endoscopic studies of swallowing to detect dysphagia, determine its degree, which is a method of preventing complications of the decanulation consequences.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(3):140-153
pages 140-153 views

REVIEWS

Neurological manifestations in patients with new coronavirus infection COVID-19

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

Abstract

Most commonly, COVID-19 presents as a respiratory disease, but a growing body of clinical evidence shows that neurological symptoms and complications contribute significantly to the clinical spectrum of the disease, especially in patients with severe disease. The public health impact of the long-term (or even life-long) consequences of the disease may be much greater than the acute manifestations of SARS-CoV-2 infection. As the pandemic has evolved, the number of neurological manifestations as part of the clinical spectrum of the disease has increased. The diverse neurological manifestations of COVID-19 range from mild symptoms (myalgia, headache, fatigue, dizziness, anosmia, ageusia) to more severe manifestations such as encephalopathy, encephalitis, acute and chronic polyneuropathy. Neurological symptoms and complications of COVID-19 do not necessarily require direct infection of structures in the peripheral or central nervous system, but may occur secondary to a severe systemic reaction to SARS-CoV-2 infection outside the nervous system. The neurotoxicity of SARS-CoV-2 infection may be secondary to immune-mediated pathogenesis and coagulation dysfunction. To substantiate the therapeutic choice, it is necessary to study the pathophysiological processes and clinical trials.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(3):154-180
pages 154-180 views

Possibilities of using biomechanical human motion capture systems in medical rehabilitation (review)

Sheiko G.E., Belova A.N., Rukina N.N., Korotkova N.L.

Abstract

Biomechanical motion capture is the most accurate non-contact instrumental method of studying human locomotion and is increasingly being used in the medical rehabilitation of patients with various diseases. Human motion capture systems are promising tools for clinical use to assess and control the correct execution of movements, as well as to identify injury risk factors.

Currently, human motion capture systems are mainly used only in scientific research. The development and implementation of biomechanical motion capture systems in clinical practice can help doctors determine the best solution when planning medical rehabilitation and, thereby, reduce the recovery time of patients.

This review aims to present up-to-date data on motion capture techniques and features of their application in the medical rehabilitation of patients with diseases of the nervous system. The review provides a brief overview of the existing technologies for the study of locomotor functions. The principles of operation, advantages and disadvantages of optoelectronic, electromagnetic, inertial and ultrasonic measuring systems are presented. The review describes in detail the possibilities of biomechanical motion capture in conducting a personalized diagnostic process, planning and evaluating the results of medical rehabilitation in patients with stroke, Parkinson's disease, cerebral palsy, spinal cord injury and multiple sclerosis.

The search was conducted in the databases eLibrary, PubMed, Scopus, Web of Science and Google Academy (Google Scholar). The review includes studies in which motion capture systems were used and spatial-temporal, kinematic, kinetic and electromyographic parameters were analyzed.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(3):181-196
pages 181-196 views

Mechanisms of low-temperature rehabilitation technologies. Local deep hypothermia in patients with arthritis

Tereshenkov V.P., Shevelev O.A., Zagorodniy N.V., Khodorovich N.A., Khodorovich A.M., Petrova M.V., Zhdanova M.A., Mengistu E.M., Kostenkova I.Z., Sheveleva E.O.

Abstract

Among all pathologies of the musculoskeletal system, osteoarthritis and rheumatoid arthritis are the two most common diseases the course of which is caused by a chronic inflammatory process. The leading clinical manifestations of osteoarthritis and rheumatoid arthritis are pain and synovitis.

This review analyzes the recent data on the pathogenesis of pain syndrome and synovitis, as well as the most commonly used surgical or conservative treatment and rehabilitation methods. The technologies of use of low-temperature effects in the rehabilitation of patients with arthritis are considered. The original concept of a new method for the relief of pain and synovitis in the knee joint by using local deep hypothermia and a hypothesis of mechanisms of its action are presented.

The purpose of the review is to provide a comparative analysis of the effectiveness of various methods of therapy and rehabilitation in patients with osteoarthritis and rheumatoid arthritis, as well as to evaluate the mechanisms of local deep hypothermia in the relief of synovitis and knee pain.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(3):197-209
pages 197-209 views

Technical Report

Features of clinical reasoning in physical rehabilitation

Zverev Y.P., Builova T.V.

Abstract

The article is devoted to the analysis of the clinical reasoning of specialists in the field of physical rehabilitation, in particular, specialists in physical therapy and occupational therapy. Despite numerous studies, the topic of "formation of clinical thinking" remains insufficiently studied and has its own peculiarities in the field of physical therapy.

The key features influencing clinical reasoning in physical rehabilitation are revealed. They include the use of movement as one of the main means of diagnosis, rehabilitation, evaluation of effectiveness, as well as the goals of rehabilitation interventions; focus on patient activity and participation (according to the International Classification of Functioning, ICF); patient mobility; interactivity and multidisciplinarity. The autonomy extend in professional activity has a significant impact on the formation of clinical reasoning of specialists.

Conceptually, clinical reasoning in physical rehabilitation may be defined as the combination and interaction of cognitive, affective and psychomotor skills. At the same time, effective clinical reasoning is narrative, adaptive and collaborative, contextual and it utilizes a biopsychosocial approach to the patient.

Physical and rehabilitation medicine, medical rehabilitation. 2022;4(3):210-218
pages 210-218 views


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