Журнал «Вестник Восстановительной медицины» имеет качественный охват целевой аудитории по профильным медицинским тематикам. Издание существует с 2002 года, имеет стабильную аудиторию и представлено на ключевых выставках, что позволяет создавать различные рекламные спецпроекты.
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Main topics of the latest issue
ORGANIZATIONAL AND METODOLOGICAL FOUNDATIONS OF REHABILITATION MEDICINE AND MEDICAL REHABILITATION
The Covid-19 pandemic could reach several million people worldwide. Presumably, 5-15% of them will need medical rehabilitation after suffering from pneumonia and acute respiratory distress syndrome. A comprehensive search was performed in the databases MEDLINE, CENTRAL, EMBASE, Web of Science and MedPilot, CyberLeninka, and eLIBRARY on-drug rehabilitation methods that prevent the development of Covid-19 complications. The goals of medical rehabilitation at the preclinical stage are to achieve the correction of diseases that contribute to the development of Covid-19 complications (COPD, bronchial asthma, rhinosinusitis, diabetes mellitus), mainly due to non-drug methods. Non-drug technologies have a number of advantages over medications that have a side effect, and such as glucocorticoids and antibiotics lead to a worse prognosis of the underlying disease. Medical rehabilitation in the intensive care unit is aimed at reducing the risk of complications and increasing the functional reserves of the body, as well as reducing the area and degree of lung damage, preventing extrapulmonary complications, including secondary infection. The main goal of medical rehabilitation in a hospital is to reduce the severity of symptoms, resorption and repair in the lesion of lung tissue, reduce the development of fibrosis, and provide bronchial drainage to prevent secondary infection. In addition, timely transfer of the patient to a specialized stage of medical rehabilitation can increase the functional reserve of the respiratory muscles and exercise tolerance. The second, specialized stage of medical rehabilitation can be carried out in the conditions of a sanatorium-resort organization. The goals of this stage are not only to reduce symptoms and increase tolerance to physical activity, but also to improve the quality of life, psychological rehabilitation, and recovery.
Keywords: Covid-19, medical rehabilitation, Spa treatment, prevention of complications, inhalation therapy, vibrotherapy, climate therapy.
Coronavirus infection causes lung damage and leads to the development of disabling conditions. The development of the Covid-19 pandemic leads to a one-stage increase in the number of patients who need assistance not only from infectious disease specialists and intensive care specialists, but also from rehabilitation specialists. However, patients suffering from other non-infectious conditions need rehabilitation despite the pandemic. Thus, rehabilitation specialists are faced with new tasks to organize rehabilitation in the epidemic for both patients with Covid-19 and patients at high risk of infection, but without coronavirus infection, to develop specific programs for pulmonary rehabilitation, data collection on the nature of disability, organization of outpatient programs and telerehabilitation.
Keywords: coronavirus infection, Covid-19, pneumonia, physical and rehabilitation medicine, medical rehabilitation, rehabilitation program, telerehabilitation.
REHABILITATION MEDICINE AND MEDICAL REHABILITATION TECHNOLOGIES
Recent evidences show that balneotherapy applications can affect the immune system, which has an important role in the containment of Covid-19 infection outcomes. It is interesting to consider if balneotherapy, through medical water baths and mud applications can be a suitable treatment in order to influence human immunity in people who have not acquired the infection and in subjects discharged from hospital after Covid-19 recovery. In particular, balneotherapy seems to improve the immune response efficacy, with an effect mediated by mental stress reduction and a direct action, consisting in the modulation of the abnormal inflammation and the enhancement of the immune system, through changes in both cell-mediated and humoral immunity. The main changes demonstrated on human immunity, after balneotherapy, are linked to an increase in the levels and the activity of cells involved in the immune response such as neutrophils and monocytes and to a reduction of the pro-inflammatory cytokines produced by a dysregulated inflammation. Even if further in vitro researches and clinical trials on this topic should be conducted, at present Spa centres, if hygienically controlled according to WHO and national recommendations, may be considered safe places to attend and useful settings to counteract the outcomes of residual unbalanced immunity after Covid-19 infection.
Keywords: spa therapy; balneotherapy; hydrotherapy; mud therapy; immune system; immunity; Covid-19; cell-mediated immunity; humoral immunity; immunomodulation; rehabilitation; inflammation; spa environment; health.
The article presents analyzis of the data of the clinical course of Covid-19 and probable pathogenetic mechanisms of lesions, which are presented in foreign and domestic literature. The hypothesis about the hematotoxic effect of the SARS-CoV-2 virus is considered, which may cause its multi-system action. An analogy is made of the pathogenesis of multiple organ lesions in case of viral infection and in acute poisoning with hemolytic poisons and iron preparations, in which the development of metabolic acidosis, toxic hemolysis, and an increase in free hemoglobin and iron ions in the blood plasma are the central link. The article proposes to use a set of diagnostic measures aimed at confirming the hematotoxic component during SARS-CoV-2 infection and methods for assessing the severity of the condition, adopted in clinical toxicology.Taking into account the experience of treating acute poisoning with hemolytic poisons, attention is focused on the importance of using alkalizing therapy in order to remove the products of hemoglobin breakdown and prevent acute nephritic failure. When confirming the presence of a toxic factor, methods aimed at eliminating toxic products of hemolysis can be used – antidote therapy and methods of surgical detoxification. This complex of therapeutic measures in clinical toxicology is effective, aimed at the prevention of acute renal failure and toxic coagulopathy. The authors believe that the hypothesis of a hematotoxic factor in the pathogenesis of Covid-19 requires a targeted therapeutic strategy and targeted study.
Keywords: coronavirus infection, Covid-19, SARS-CoV-2, hemolysis, iron poisoning, free hemoglobin, chelate therapy, iron-binding therapy, acidosis, efferent therapy, hemoglobinuria nephrosis, toxic coagulopathy.
The use of physical rehabilitation methods, in particular respiratory rehabilitation for pneumonia, allows to increase the tolerance to physical activity, improve oxygen consumption and endurance of patients compared to the initial level, reduce the frequency and duration of their hospitalization, as well as significantly improve the effectiveness of drug therapy. In the first stage of assisting patients with pneumonia of various genesis, therapeutic exercises are recommended that improve drainage function of the bronchi and promotes the discharge of bronchial mucous. Prescription of physiotherapeutic methods of treatment, which have a bactericidal, anti-inflammatory, anti-edema and resorption effects, significantly increase the effectiveness of complex therapeutic measures.
A comprehensive approach to the treatment of pneumonia can produce better results by using all therapeutic physical exercise and physiotherapy options that have proven effective over many decades.
Keywords: pneumonia, physical rehabilitation, Covid-19, therapeutic exercise, physiotherapy.
Rehabilitation measures lead to an increase in the duration and quality of life of patients. The current trend towards intensification of the treatment process, early discharge of patients from hospital, as well as the duration of cardio rehabilitation programs, raises the question about the place of their implementation. The purpose of this work was to assess the readiness of patients who have undergone acute coronary syndrome (ACS) and coronary revascularization to undergo rehabilitation programs, including the use of remote technologies. The study was multicenter, conducted in hospitals of Ivanovo, Voronezh and Omsk, using a single original questionnaire agreed by the researchers. 232 patients were examined, including 124 patients with myocardial infarction, 59 patients with unstable stenocardia and 49 patients who underwent coronary revascularization. The results of the study indicate that the majority of patients who have undergone acute coronary syndrome and coronary revascularization are ready to undergo cardio rehabilitation programs, but, as a rule, in hospital or sanatorium environments. Only half of the interviewed patients have access to the Internet and know how to use it, and only 15% of the respondents are ready to undergo rehabilitation remotely. Remote ways of communicating with patients and monitoring the implementation of rehabilitation programs require both improving the ways of their technical support and raising awareness and training of patients to work with mobile devices and registrars.
Keywords: acute coronary syndrome, myocardial revascularization, cardiorehabilitation, remote patient monitoring.
Recently, due to significant improvement and cheapening of the new generation of full genome sequencing technology, it has become possible to identify acquired mutations in individual cells of the hematopoietic system. This has led to the detection of clones of hematopoietic cells with acquired mutations in certain genes in middle-aged and elderly people and made it possible to characterize a new prepathological state - clonal hemopoiesis. Clonal hemopoiesis is defined as the appearance and clonal expansion of cells of the hemopoietic system with genetic changes that give these cells certain advantages in proliferation and/or resistance to adverse factors in comparison with other hemopoietic cells. This phenomenon is found mainly in individuals after 55 years of age and is practically not found in individuals of young age. At this age, most individuals show signs of cardiovascular pathology of some degree of severity. This review discusses some aspects of the possible impact of clonal hemopoiesis on cardiovascular diseases.
Keywords: hemopoietic system, clonal hemopoiesis, cardiovascular pathology, diagnosis, treatment and rehabilitation.
The aim of the study: to analyze the ratio of acute myocardial infarction and unstable angina, the stages of medical rehabilitation in the structure of acute coronary syndrome in employees and senior citizens of the Ministry of Internal Affairs during treatment and medical rehabilitation.
Materials and methods: The study examined 805 patients with ACS for the period 2012-2018, of which 227 were employees of the Ministry of Internal Affairs. All patients underwent a complete diagnosis of acute coronary syndrome in accordance with the standards of examination and treatment. With clinical validity, in some cases, coronary angiography and stenting of the coronary bed were performed.
Results: The number of cases of hospitalization with ACS of employees and pensioners of the Ministry of Internal Affairs with ACS in 2012-2018. It was distributed as follows: in 2012 - 144, 2013 - 114, in 2014 - 158 and in 2015 - 135, 2016 - 147, 2017 - 66 and in 2018 - 41, respectively. The maximum frequency of hospitalizations with ACS among employees of the Ministry of Internal Affairs was recorded in 2014 - 91. The largest number of hospitalizations with ACS from 2012 to 2018 inclusively occurred among pensioners of the Ministry of Internal Affairs - 578 and 227 ACS among employees of the Ministry of Internal Affairs, respectively. At the same time, out of the total number of patients with ACS, 805-604 (75%) underwent MR stage I, 201 (25%) were transferred to stage II MR in the Pakhra branch of the SCG, Thus, with AMI and NS, employees and pensioners In 25% of clinical cases, the Ministry of Internal Affairs requires stage II MR.
Conclusion: With the development of ACS, AMI prevails among the employees of the Ministry of Internal Affairs, NS is more often diagnosed among pensioners of the Ministry of Internal Affairs. In the treatment and rehabilitation of AMI, employees of the Ministry of Internal Affairs less than half the cases, namely up to 38%, require transfer to a rehabilitation center as part of one hospitalization, which is an optimizing element in the stage medical rehabilitation of employees of the Ministry of Internal Affairs who underwent ACS. At the same time, a comprehensive program consisting of exercise therapy: therapeutic exercises for patients with coronary heart disease, breathing exercises, physiotherapy: sinusoidal modulated currents according to the standard method (pulse frequency: 80-100 Hz.) In alternation with balneotherapy, is effective at the rehabilitation stage.
Keywords: acute coronary syndrome, acute myocardial infarction, unstable angina, coronary angiography, medical rehabilitation, persons of dangerous professions.
The single-center randomized comparative study on revealing the clinical efficacy of the complex method of rehabilitation and secondary prevention of cardiovascular disorders in patients with ischemic heart disease with the inclusion of physical training with the use of stabilometric complex with biofeedback (stabilo-training), general iodine-bromine baths and infrared laser therapy in patients with ischemic heart disease in the remote period after surgical revascularization of myocardium.
Observation was made in 60 patients with ischemic heart disease, in remote, not earlier than one year, terms after surgical revascularization of myocardium. Patients were divided into 2 groups by simple randomization method. Group 1, the main group consisted of 30 patients who received a complex rehabilitation method with the inclusion of stabilizing training, general iodine-bromine baths and infrared laser therapy; group 2, the comparison included 30 patients who received a rehabilitation course with the inclusion of general iodine-bromine baths and infrared laser therapy only.
Cardiovascular disorders (CVD) were evaluated using electrocardiography (ECG) in standard leads, echocardiography (ECG), daily ECG monitoring with assessment of cardiac rhythm variability, veloergometry (VEM), stabilometry and a 6-point rating scale and psychological testing with the help of HAM and Spielberg tests. The study results were processed using the Statistica 8 for Windows application package. Preliminary calculation of sample power showed a sufficient number of patients in groups of 30 people. Calculation of statistical reliability of the results was performed by the Student-Fisher criterion. The differences between the two mean values were considered reliable at p<0.05.
Under the influence of the complex with inclusion of statokinesoterapy in patients with IHD of the main group in comparison with the comparison group, more expressed antianginal and antiarrhythmic effects, increase of tolerance of physical activity, physical efficiency were noted. Positive ECG dynamics, increased cardiac output fraction, improved mood and sleep were noted. Positive dynamics of SSN in 85% of patients of the main group and in 65% of the comparison group was accompanied by increased stability in the vertical posture, decreased walking precariousness, improved coordination and equilibrium, decreased indices of the pressure center deviation (CD) in frontal and sagittal directions.
The average rate of displacement of CD and the total area of the statokinesiogram decreased only in the main group of patients, in the comparison group the stated indices of stabilometry remained without dynamics. The total dynamics index of symptom severity decreased by 11±0.03 points in the main group of patients and by 6.7±0.01 points in the comparison group. The revealed positive clinical effects in patients with IHD in the distant period after surgical revascularization of myocardium, a complex method with inclusion of stabilokinesotherapy, allows to recommend this method of sensomotor physical training in complex rehabilitation programs with the purpose of SSN correction, prevention of development of acute coronary syndrome and heart insufficiency.
Keywords: statokinesotherapy, iodine-bromine baths, laser therapy, coronary heart disease, cardiovascular disorders. нарушения.
Worldwide, arterial hypertension (AH) is the most common cardiovascular disease. Despite the fact that today, high efficacy and persistent hypotensive effect of transcerebral pulsed electro- and magnetic therapy in patients with AG has been proven, it seems relevant to develop optimal transcerebral effects for this category of patients.
The aim of this study was to select optimal transcerebral effects in patients with mild arterial hypertension, depending on hemodynamic types of central hemodynamics and microcirculation.
Methods: The study included 82 patients with MAG from 45 to 79 years and the the duration of the disease from 2 to 11 years.Patients in the first group (40 patients) received MDM mesodial encephalus modulation and in the second group (42 patients) combined magnetotherapy (PeMP and PMP).
Results: It was found out that patients with MAG who received MDM had a pronounced hypotensive effect due to improvement of the basic indices of central hemodynamics regardless of the type of blood circulation. As well as MDM causes positive correction of the basic parameters of capillary blood flow, regardless of the initial type of microcirculation. In patients with MAG combined magnetotherapy (PeMP and PMP) causes hypotensive effect, which is accompanied by a favorable restructuring of the basic parameters of central hemodynamics in hyperkinetic type of hemocirculation. Correction of microcirculatory disorders has been established only in patients with spastic type of hemodynamics.
Conclusion: On the basis of the conducted studies it is possible to say that MDM and transcerebral combined magnetotherapy contribute to the effectiveness of treatment of patients with hypertension. Sufficiently high efficacy of applied methods allows to approach them in a differentiated way based on clinical and hemodynamic features of hypertension course.
Keywords: arterial hypertension, combined magnetotherapy, mesodiencephalic modulation, microcirculation, central hemodynamics.
The aim of the study: Combined use of kineso- and laser therapy to correct regional hemodynamic disorders in patients with dilated cardiomyopathy (DCMP).
Material and methods: The study included 100 patients diagnosed with DCMP. The diagnosis "DCMP" was established for patients with dilatation of the heart cavity of non-coronatural origin, increased heart size (final diastolic size of the left ventricle - LV CDR > 6.0 cm). The determination of the CHF FC was made according to the Russian National Recommendations of the RSCS (2018) and OSSN on the diagnosis and treatment of CHF. All patients took differentiated medication-assisted therapy according to indications during 3 months. Patients were divided into 2 comparable groups by sex, age, disease course, severity of the condition, and specifics of medication therapy. Patients of the 1st group were treated with intravenous laser irradiation of blood (ILIB) and selection of unloading therapeutic gymnastics against the background of supporting differentiated medication therapy. Patients of the 2nd group (control) received only differentiated medication therapy. The main method of investigation was venous occlusal plethysmography to evaluate regional hemodynamics with the determination of blood flow (Qr) and regional vascular resistance (Rr) at rest, venous tone (Vt), reserve blood flow (QH) and regional vascular resistance (RH) on the background of a functional load test.
РResults: The data obtained during the dynamic observation (in 1, 3, 6 and 12 months) in the main group showed a reliable increase in the volume velocity of the blood flow at rest (Qr) and the reserve blood flow (QH), a decrease in the regional vascular resistance at rest (Rr) and under functional load (RH), venous tone (Vt), respectively. In the control group there was no reliable positive dynamics, after 12 months of observation indicators of regional hemodynamics significantly deteriorated.
Conclusion: In patients with DCMP, according to venous occlusal plethysmography, the use of relieving therapeutic gymnastics in combination with ILIB on the background of medication therapy has significantly improved the indices of regional hemodynamics. The developed method of non-drug therapy can be used by cardiologists, general practitioners, therapists, doctors of physical and rehabilitation medicine to optimize treatment of patients with DCMP.
Keywords: kinesotherapy, laser therapy, regional hemodynamics, dilatational cardiomyopathy.
Essential hypertension is a frequent diagnosis in power sports athletes, heavy weight categories.
The aim of the study: To evaluate the impact of high-intensity aerobic work on blood pressure and oxidative abilities of hypertensive athletes of power sports, heavy weight categories.
Rеsеarсh mеthods: Examination and physical rehabilitation were conducted in 55 hypertensive representatives of power sports, heavy weight categories comparable in age, sex and main clinical manifestations. Athletes were randomized into two groups: the main group (n=35) and the control group (n=20). Athletes of the main group were trained for 180 days (3 times a week) on an ergometer using a high-intensity interval protocol, while the control group participants were trained for 180 days (3 times a week) using their traditional power protocol. The tasks were performed using the following methods: examination, polling, gasometric analysis, triple blood pressure measurement, muscle tissue oxygenation level measurement and mathematical statistics methods.
Rеsults: After 180 days of physical rehabilitation, the participants in the main group had a 148% reduction in oxygen oxygenation, an increase in capacity and working time at maximum oxygen consumption, and a reliable decrease in blood pressure: systolic blood pressure by 8.0%, diastolic blood pressure by 10.8%.
Сonсlusion: Our protocol for physical rehabilitation of power sports athletes allows us to effectively and safely influence the oxidative capacity of working muscles and blood pressure.
Keywords: artеrial hypеrtеnsion, physiсal rеhabilitation, powеrlifting, aеrobiс work, intеrval mеthod, sports mеdiсinе.
Cardiorehabilitation is a fundamental component of the secondary prevention of cardiovascular disease in patients with acute cardiovascular disease. The article considers the main goals, components, rules of selection and control of intensity and safety of physical training programs during ambulatory cardiorehabilitation.
Keywords: cardiorehabilitation, physical training, exercise tolerance, veloergometry, aerobic exercises, training heart rate, metabolic units.
The gender peculiarities of metabolic status were studied in patients with acute coronary syndrome who underwent outpatient rehabilitation in the day hospital. It was found that in the overwhelming majority of patients of both sexes there was not only an increase in body mass index values relative to normal values, but also the waist circumference as a sign of abdominal fat tissue deposition. In the group of women the values of these indices were higher than in men. They were much more frequently diagnosed with 1st and 3rd degree obesity as compared to men with higher frequency and severity of abdominal obesity. The study of blood lipid and carbohydrate spectra revealed initially more significant fat metabolism disorders in male patients, but in comparison with female patients after rehabilitation measures more pronounced positive dynamics of blood biochemical indices was observed: decrease of values of low density lipoproteins, atherogenicity index and triglycerides. In carrying out stress testing, men, compared with women, both before and after rehabilitation showed a higher tolerance for physical activity and aerobic reserves of the cardiorespiratory system, which, among other indicators, indicates a higher efficiency of their rehabilitation course.
Keywords: cardiological rehabilitation, acute coronary syndrome, metabolic status, lipid metabolism, carbohydrate metabolism, exercise tolerance, stress testing, gender differences.
PSYCHOPHYSIOLOGY, PSYCHODIAGNOSTICS AND PSYCHOTHERAPY IN REHABILITATION MEDICINE AND MEDICAL REHABILITATION
The article contains information on threats to the psychological health of the population in the context of a coronavirus infection pandemic. The article also lists the problems that arise in various groups of patients receiving treatment from Covid-2019, including patients in need of rehabilitation care. The authors analyzed European, American and Russian data on the basis of which recommendations were formulated to assist patients with behavioral, psychological and communication problems.
Keywords: Covid-2019, pandemic, anxiety, depression, psychological assistance, mental disorders, communication, information, rehabilitation.
During a pandemic, threats and risks to people's mental health are growing. However, to date, there is insufficient scientific data on the characteristics of the emotional sphere and attitude to the changing living conditions of various population groups. The data on anxiety, depressive conditions in the context of a new coronavirus infection are especially relevant for providing timely psychological assistance to medical workers, both working directly with the infected and not directly interacting with them.
The paper describes and presents the results of online monitoring of the manifestations of anxiety and persistent emotional states in medical workers who are not at the forefront with Covid-19 patients and other populations in the context of the coronavirus pandemic. 102 people took part in the monitoring (the average age of the subjects was 38.91±11.07 (from 23 years to 70 years), 32 men, 70 women. According to the results of the survey of four groups: medical workers who do not directly interact with patients with Covid-19 (group I, n = 55 people), who work in other areas (group II, n = 47 people), it is determined that the highest level of stress is in the groups of medical workers and residents receiving higher professional medical education (the results are statistically significant, the significance level is p ≤ 0,01). At the time of the examination, these subjects expressed relatively stable individual experiences of the anxiety-depressive complex. They experience anxiety, are prone to fears, and experience psycho-emotional stress. The study allows us to attribute to the risk group not only medical workers directly working with patients, but also medical workers who do not directly interact with them, and also confirms the need for timely clinical and psychological assistance to these groups.
Keywords: anxiety, stress, psychoemotional stress, distress, coping strategies, Covid-19.
The article describes the application of art therapeutic methods of rehabilitation of cardiological patients, specifics of the use of art therapy in rehabilitation processes, the symbolic meaning of the tree, art therapeutic methods using the image of the damaged tree, its algorithms, the schemes of stricture interrogation, interpretation of drawings of the damaged tree, an example of the method use.
Keywords: rehabilitation, art therapy, tree as a symbol, damaged tree, interpretation of drawing.
REVIEWS. LECTURES. REPORT. HISTORICAL SKETCHES
The article tells about the history of the department of physical therapy and clinical biomechanics of the leading domestic center, traditionally dealing with medical rehabilitation and spa treatment. It is difficult to overestimate the significant contribution of employees of this scientific and clinical department to the formation and development of the national school of physical therapy. The traditions laid down by our predecessors continue to this day.
Keywords: physical therapy, history, scientific school, medical rehabilitation, spa treatment.
Spinal cord injury produces muscle wasting, which is especially severe after the complete and permanent damage of lower motor neurons that occurs in complete Cauda Equina Syndrome. Even in this worst-case scenario, we have shown that permanently denervated Quadriceps muscle can be rescued by surface Functional Electrical Stimulation and a purpose designed home-based rehabilitation regime. Here, our aim is to show that the effects are extended to both antagonist muscles and the skin of the thighs. Before and after 2 years of electrical stimulation, mass and structure of Quadriceps and Hamstrings muscles were quantitated by force measurements. Muscle gross cross section were evaluated using color computed tomography, muscle and skin biopsies by quantitative histology and immunohistochemistry. The treatment produced: a) an increase in cross-sectional area of stimulated muscles; b) an increase in muscle fiber mean diameter; c) improvements in ultrastructural organization; and d) increased force output during electrical stimulation. The recovery of Quadriceps muscle force was sufficient to allow 25% of the compliant subjects to perform stand-up and step-in place trainings. Improvements are extended to hamstring muscles and skin. Indeed, the cushioning effect provided by recovered tissues is a major clinical benefit. It is our hope that, with or without our advice, trials may start soon in Europe and Russia to provide persons-in-need the help they deserve.
Keywords: Spinal Cord Injury, denervated degenerating muscle, home Functional Electrical Stimulation, muscle co-activation, Color Computed Tomography, functional recovery, skin.
Wilson-Konovalov disease is a serious progressive hereditary pathology, which is characterized by a violation of copper metabolism and lead to severe changes in the central nervous system and internal organs. In Wilson-Konovalov disease a wide symptoms spectrum of various severity is observed: neurological, behavioral, and psychiatric ones. In the cases of swallowing disorders, voice and speech problems a help of a clinical speech therapist is necessary, who may prolong the patient’s independent nutrition through the mouth and could restore a sonorous voice by the means of speech-therapeutic techniques.
Keywords: speech therapy, massage, voice functions, articulatory gymnastics.
The article deals with the prevalence of chronic gastroduodenitis and duodenal ulcers among population. Special relevance of this problem for adolescents and young people of employment age is shown. Risk factors and pathogenetic mechanisms of this diseases development are highlighted, and the main clinical distinctive signs in this patients’ group are indicated: pain, dyspeptic and psychoautonomic syndromes. The evidences is given concerning advantage of specialized functional food products and food additives in therapeutic and prophylactic diets of patients with chronic gastroduodenitis and duodenal ulcers, which might be considered as etiopathogenetic treatment method for this patients’ group with significant clinical effects, while pharmacotherapy can be regarded only as a symptomatic treatment. High therapeutic efficiency of wheat gems oil and flour inclusion in the diets of this patients’ group is shown.
Keywords: gastrointestinal tract, chronic gastroduodenitis, duodenal ulcer, pharmacotherapy, functional therapy, specialized food products and food additives, wheat germ oil and flour.
The aim of the study is to evaluate the effect of the biologically active food supplement «Osteomed Forte» on pain intensity and quality of life in patients with high risk of fractures undergoing medical rehabilitation.
Materials and methods: Included men and women 40-80 years old, with high risk of fractures. Patients who had already taken antiresorbents were identified in group №1 - they were assigned the investigated product (IP): biologically active food supplement «Osteomed Forte». Patients who had not received antiresorption therapy were divided into two equal groups by simple randomization. Group №2 was assigned to IP. There were no IPs in group №3. All the subjects were conducted: 1. Pain Assessment Score (PAS); 2. Quality of Life Assessment (QUALEFFO-41). The examination was repeated immediately after the rehabilitation course as well as after 6 and 12 months.
Results: The study enrolled 120 people (group №1 n=41, group №2 n=39, group №3 n=39): 10 men, 110 women, average age 65.51±7.92 years. After a course of rehabilitation in all groups, PAS was significantly reduced (2.7, 3.0, 3.5 points, respectively, p<0.01), and the QUALEFFO-41 scores improved on all scales (p<0.05). This trend continued after 6 months. After 12 months, a significantly lower PAS was in group №1 (4.0 as compared to 6.2 and 6.4 points, p<0.05). In group №1, QUALEFFO-41 indices were significantly better than the initial ones (p<0,05) and higher than in groups №2 and 3 «Pain», «Housework», «Mobility», «General Health», «Mental Health», «General Indicator» (p<0,05).
Conclusion: In patients with a high risk of fractures, the course of medical rehabilitation improved the physical and mental components of QOL and reduced the pain syndrome. In patients who took IP as a basic therapy, the achieved effect was maintained after 3, 6, 12 months. In 1 year after the rehabilitation course, the groups receiving IP and antiresorption therapy had better QOL parameters, lower PAS and better bone metabolism indices.
Keywords: osteoporosis, quality of life, antiresorption therapy, vitamin D, calcium citrate, rehabilitation, compression spinal fractures.
The aim of the study: Evaluate the impact of physical rehabilitation complex on balance function in patients with osteoporosis (OP) and vertebral compression fractures (VCFs).
Materials and methods: A prospective controlled study of 40-80 years old men and women with OP and VCFs was conducted. Patients were divided into two groups by simple randomization. The intervention group (1) received an intensive rehabilitation course. The control group (2) received therapeutic exercise using the Gorinevska-Dreving method. Before rehabilitation all patients were tested: 1) stabilometry; 2) Tests: single leg stand, Fukuda test). Re-examination after rehabilitation and one month after the course.
Results:The study enrolled 90 people (65.4±9.1 years). In group №1 after the course of rehabilitation there was a significant improvement in indicators: balance function coefficient (BFC) with open and closed eyes (84.1±8.6%, p=0.01 and 73.8±9.6%, p=0.01); frontal shifts (FS) (1.9 [0.7; 2,4], p=0,01), the area of statokinesiogram (ASKG) (131,9±210,4 mm2, p=0,04); center of pressure velocity (CPV) (12,2±10,1 mm/sec, p=0,001); in the Fukuda test the displacement in degrees has decreased (32.8±14.5, p=0.03), in the test «Single leg stand» the time for right and left leg with open eyes has improved (17.8±31.8 sec, p=0.001, 17.1±30.1 respectively). In group №2 there was an improvement in CPV (2.1 [1.9;5.2], p=0.001); FS movement rate (10.1±3.9 mm/sec, p=0.05). After a month in group №1 the positive dynamics by parameters was preserved: BFC with open and closed eyes, FS, CPV movement speed, SKG area, displacement in meters and degrees in the Fukuda test, standing time on the right and left legs with open and closed eyes.
Conclusions: A physical rehabilitation complex aimed at training back muscles and coordination has improved balance function in patients who have experienced OP and VCFs. Pathological shift of CPV forward in frontal area was corrected and stability was improved. Stabilometry and coordination tests served as reliable methods to evaluate balance function in this group of patients.
Keywords: osteoporosis, vertebral fractures, balance, rehabilitation, coordination training.
PROFESSIONAL SPACE. CHRONICLE OF LIFE. PEOPLE
На 84 году ушел из жизни доктор медицинских наук, профессор, руководитель отделения ЛФК и спортивной медицины Российского научного центра медицинской реабилитации и курортологии (РНЦ МРиК) Минздрава России с 1988 по 2010 гг. Кузнецов Олег Фёдорович.
После окончания в 1960 г. Ярославского медицинского института Олег Фёдорович несколько лет работал терапевтом в ряде районных больниц Ярославской области. С 1964 по 1969 гг. обучался в ординатуре и аспирантуре Центрального института курортологии и физиотерапии, после окончания которых успешно защитил кандидатскую диссертацию, посвященную изучению эффектов и разработке методических аспектов лечебной гимнастики, используемой в комплексном лечении пациентов с гипертонической болезнью.
С 1970 по 1988 гг. работал старшим научным сотрудником в МОНИКи им. Владимирского, а затем в клинической больнице № 6 3-го Главного Управления МЗ СССР, где принимал участие в лечении и реабилитации ликвидаторов аварии на Чернобыльской АЭС.
За время работы в научных учреждениях Олег Федорович разработал оригинальную методику интервальных тренировок и интенсивного массажа асимметричных зон грудной клетки для пациентов с хроническими неспецифическими заболеваниями лёгких. Эти методики прочно вошли в практическую медицину и с успехом используются специалистами ЛФК и массажистами в лечебных комплексах до настоящего времени. В 1988 году О.Ф. Кузнецов защитил докторскую диссертацию, которая стала итогом его многолетней успешной работы, получившей широкое распространение и признание врачей различных специальностей, работающих по программам восстановительной медицины.
С 1988 по 2010 гг. О.Ф. Кузнецов руководил отделением ЛФК и спортивной медицины РНЦ МРиК. Время его руководства пришлось на тяжелые годы перестройки, оптимизации, капитального ремонта основного здания Центра, но в отделении продолжалась научная работа. О.Ф. Кузнецов, как один из ведущих специалистов области физической реабилитации, являлся членом нескольких специализированных Ученых советов ведущих медицинских институтов, автором более 300 научных работ, в качестве научного руководителя подготовил 10 кандидатов наук по специальности «Лечебная физкультура, спортивная медицина, курортология и физиотерапия».
Именно в эти годы О.Ф. Кузнецов обратил своё внимание на лечебные эффекты холодовых воздействий и, несмотря на имеющиеся организационные трудности, разработал методику криомассажа, доказав вместе со своими сотрудниками его высокую эффективность при лечении большого круга социально значимых заболеваний.
В последние годы О.Ф. Кузнецов тяжело болел, но не прекращал контактов с сотрудниками, с интересом и энтузиазмом принимал большие позитивные изменения, происходящие в отделении. Все, кто работал с О.Ф. Кузнецовым отмечали его удивительные человеческие качества: его харизму, чувство юмора, доброту, искренность, умение и желание делиться своими богатыми знаниями.
Смелый, абсолютно преданный медицине Олег Фёдорович Кузнецов всегда будет в нашей памяти.