Vol 4, No 4 (2022)
ORIGINAL STUDY ARTICLE
Assessment of rehabilitation in children with infectious diseases of the lower respiratory tract using the categories of the International Classification of Functioning, Disability and Health
Abstract
BACKGROUND: Solving the issues of rehabilitation of children after lower respiratory tract infections requires putting up rehabilitation diagnoses in the categories of the International Classification of Functioning, Disabilities and Health (ICF).
AIMS: The study aimed to define the key problems in the ICF categories and make quantitative and qualitative assessments of the changes in the ICF domains in convalescent children with infectious diseases of the lower respiratory tract at the outpatient stage and in one month after the disease.
MATERIALS AND METHODS: The assessment of rehabilitation was performed using the ICF categories for 201 convalescent children with lower respiratory tract infections.
RESULTS: Most of the patients had significant impairments in the following functions: b134 Sleep functions; b152 Emotional functions; b280 Feeling of pain; b440 Respiratory functions; b450 Additional respiratory functions; b455 Exercise tolerance function; b460 Sensations associated with cardiovascular and respiratory functions; b730 Muscle strength functions; b740 Muscular endurance functions; b780 Sensations associated with muscles and motor functions, both at the time of discharge from the hospital and a month after the discharge. Environmental factors (e115 Products and technologies for personal use in daily life; e225 Climate; e260 Air quality; e310 Close relatives; e355 Medical workers; e410 Relationships with immediate family members; e450 Relationships with medical workers; e580 Medical services; e585 Services in education and training) were shown to have an influence on rehabilitation process.
CONCLUSION: The identified range of functioning disorders and the influence of environmental factors indicates the need for medical rehabilitation for convalescent children with lower respiratory tract infections. The rehabilitation should be multidisciplinary and involve psychological and pedagogical techniques, work with the family, and motor rehabilitation techniques to restore workload tolerance.
223-233
The classification of consequences and complications of spinal cord injury in children
Abstract
BACKGROUND: Consequences and complications of spinal cord injury in children which appear at all recovery stages significantly affect outcomes. The Classification proposed in 1994 does not provide a clear distinction between terms "consequences" and "complications" and currently, in our opinion, is outdated and was outdated long ago, since it raises more questions than it contains answers.
AIM: to propose a new classification of spinal cord injury consequences and complications in children covering all periods of the injury course.
MATERIAL AND METHODS: Children with severe spinal and spinal cord injury who have been admitted to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma in Moscow since 2014 were taken into the study. To diagnose their current state, the following diagnostic tools were used: clinical examination, trophological status, neurological assessment by ASIA scale, locomotor pattern, laboratory and instrumental testings; in addition, psychological examination so as to identify child's post-traumatic disadaptation and psychopathological state.
RESULTS: Three years after the injury, spinal cord injury consequences were detected in 96% of injured children; spinal cord injury complications ― in 56% of children who were treated at Clinical and Research Institute of Emergency Pediatric Surgery and Trauma in 2014–2020. The authors have developed a new classification of spinal cord injury consequences and complications in children.
CONCLUSION: The early start of rehabilitation measures and subsequent long-term medical and psychological support of children with spinal cord injury delays the onset of spinal cord injury consequences, prevents complications, as well as encourages the child and his/her parents to comply with the recommendations of the rehabilitation team. Underestimation of the severity of child's condition can lead not only to the deprivation of motor restoration, but also to the deterioration in the quality of family life and to the problem of integrating children with spinal cord injury into the society.
The newly developed classification is an important instrument to improve injury outcomes, child's growth and development as well his/her integration into the social environment.
234-243
REVIEWS
Homonymous hemianopia and visual neglect: I — phenomenology, diagnosis
Abstract
Hemianopia and unilateral spatial neglect are the most common visual-spatial disorders that occur after a right hemisphere stroke. Due to the similarity of their symptoms, health care professionals often need to establish a differential diagnosis between these two disorders.
This article is the first part of the literature review and is devoted to the discussion of the phenomenology and diagnostic methods of homonymous hemianopia and neglect. For the first time in the Russian literature, the use of the eytracking method in patients with homonymous hemianopia and neglect is highlighted. The article also provides criteria for the differences between the two disorders.
The article contains useful information for health care professionals to make an appropriate diagnosis, which implies subsequent rehabilitation procedures. Rehabilitation methods will be described in detail in the second part of the literature review.
244-258
Stroke biomarkers: Issues of diagnosis and medical rehabilitation
Abstract
Stroke is the main death and invalidization factor throughout the world. Stroke prevention, early diagnostics and treatment, as well as proper rehabilitation, are the key research directions to reduce death and invalidization numbers.
Current clinical practice widely uses many biochemical markers (biomarkers) found in blood, urine or cerebrospinal fluid to make therapeutic decisions. Used along with standard examination methods, the potential benefit of stroke biomarkers could be seen in stroke type differential diagnostics, complication development forecasting and rehabilitation events personification.
Many potential stroke biomarkers and combined panels, including those used for rehabilitation intensity estimation, are described in science literature. Among them prevail peptide molecules connected with the damage of neurons and their axons, neuroglia, brain vessels endothelium. Less attention is given to blood proteins, lipids and other metabolites. There appears more and more reliable data on circulating nucleic acids as stroke manifestation and progress markers.
Despite obvious clinical and economical biomarkers prospects, no studied stroke markers are used in everyday clinical practice. That could be caused by obtained suboptimal sensitivity and specificity indicators and difficulties with translational studies organization and conducting. Relevance of stroke biomarkers as a way to control rehabilitation intensity also highlights the necessity to additional researches.
259-270
Problems and prospects of it in healthcare in Russia: modern realities
Abstract
Information and communication technologies penetrate into all areas of everyday life of modern society, learning, helping and replacing human labor. Without information technologies, it is already impossible to imagine the field of medical science: at present and in the near future, they will improve the continuity of health monitoring, take over the prediction of the risks of complications, the adjustment of drug therapy during life and many other processes.
The article is devoted to the problems and prospects of information technologies in healthcare in Russia. The general model of information technologies, problems and ways of solving the restrictions from Western campaigns are highlighted. In view of the digitalization of the healthcare system in our country, the article talks about the need to ensure the continuity and independence from external influence of information technology systems in its full cycle: from client terminals, communication systems, to data storage and processing servers.
The most important factor that allows us to speak with confidence about the development of specialized information technologies solutions in the healthcare system of the Russian Federation is an effective state policy in ensuring the digitalization of the economy: national projects, government programs, changes in legislation, roadmaps for achieving key indicators.
271-282
CASE REPORT
Regression of chronic pain syndrome refractory to opioid pharmacotherapy in a patient after implantation of a spinal cord neurostimulator: case report
Abstract
BACKGROUND: Pain in cancer patients, often poorly treated, cause severe distress for patients and their caregivers, and significantly reduces quality of life. Modern guides for the medical treatment of chronic pain in cancer patients are not effective in all cases, especially when chronic neuropathic pain syndrome occurs. In this regard, there is a need for a multidisciplinary personalized approach to the tactics of chronic pain management in favor of surgical methods at earlier stages of this condition. Nowadays neuromodulation is widely used for the treatment of neuropathic chronic pain syndrome in patients with various pathologies, whereas it is not used routinely in cancer patients.
CLINICAL CASE DESCRIPTION: We introduce a case report of successfully applied neuromodulation in patient with severe chronic pain syndrome due to rectal cancer. Epidural spinal cord stimulation at Th10–Th12 levels allowed to stop the systemic use of opioids and achieve long-term remission. Spinal cord stimulation has shown itself to be very promising and significantly improved patient’s quality of life.
CONCLUSIONS: Our case report evidently shows that current chronic pain management guides and treatment recommendations needs a revision and neuromodulation usage in category of cancer patients should be considered.
283-291
Post-stroke hand synergy formation variant. Clinical case
Abstract
Pathological synergies are a frequent consequence of cerebrovascular accidents and hinders further recovery. The existing concept of the formation of pathological synergies considers them as a compensatory strategy in response to damage to the pyramidal tract, which, due to paresis and increased muscle tone, has acquired a pathological character. Recent studies in primates have shown that the contralateral hemisphere, in particular the reticulospinal and rubrospinal tracts, may be involved in motor control of the hand. The current hypothesis presents the corticoreticulospinal and corticorubrospinal tracts as a back-up system for neuronal reorganization due to injury.
This clinical case describes the role of the white matter of the contralateral hemisphere in the mechanism of formation of pathological flexion synergy, based on data from the analysis of movements and neuroimaging.
292-303
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 74092 от 19 октября 2018.