Contents magazine № 2 (96) april 2020

ORGANIZATIONAL AND METODOLOGICAL FOUNDATIONS OF REHABILITATION MEDICINE AND MEDICAL REHABILITATION.

Abstract:

Chronic Musculoskeletal Disorders (MSDs) are age-related conditions, linked to functional impairment and decreased quality of life (QoL). As a result of the increased life expectancy in Europe, great attention has been focused on investigating the impact of these diseases on QoL. Thermal environment is a suitable place for providing interventions (mud therapy, bath, exercise, etc.) for chronic MSD patients. Our narrative review aims to assess if Spa therapy may improve QoL in patients with chronic MSDs. We searched randomized clinical trials and clinical trials screening PubMed and Google Scholar databases from 2016 up to March 2020. We included 14 trials testing Spa therapy interventions concerning osteoarthritis, rheumatoid arthritis, chronic shoulder pain and fi bromyalgia. In conclusion, even though limitations must be considered, evidence shows that Spa therapy, especially in combination with rehabilitation approach, can signifi cantly improve QoL of patients with chronic MSDs.

Keywords: spa therapy; balneotherapy; mud therapy; quality of life; rehabilitation; exercise; aquatic exercises; health; musculoskeletal disorders; osteoarthritis; fi bromyalgia; low back pain.


DOI: 10.38025/ 2078-1962-2020-96-2-3-6

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Abstract:

The article describes modern approaches to the organization of rehabilitation in patients with limb amputations and exarticulations: it highlights technology of using the International Classifi cation of Functioning, Disability and Health, as a tool allowing to form rehabilitation diagnosis, rehabilitation prognosis, assess rehabilitation potential, determine the purpose and plan of rehabilitation, as such as to give recommendations at end of rehabilitation course in the process of rehabilitation in patients with amputations. Taking in to account the limitations of mobility and self-service opportunities assessed by the rehabilitation routing scale, we propose a tactics for patients’ transfer from the fi rst to subsequent rehabilitation stages. The presented approach allows to optimize the rehabilitation process and to achieve designed results.

Keywords: аmputations, limbs exarticulation, rehabilitation medicine, rehabilitation diagnosis, routing, multidisciplinary approach, prosthetics


DOI: 10.38025/ 2078-1962-2020-96-2-7-12

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Abstract:

Objective: determine the level of knowledge about the organization of medical rehabilitation among the heads of medical institutions.
Materials and methods: A survey of 216 people studying in continuing education courses in the specialty «Organization of Health Care and Public Health» was conducted. The questionnaire included group characteristics data (work experience as the head of the institution, place of work, the presence of a specialized department) and test questions. A frequency analysis, calculation of the average score, a comparative analysis of percentages and means in the selected groups, a correlation analysis of the experience and awareness of the respondents were performed.
Results: the average score in the general group is 2.4 ± 0.18, in the group of outpatient institutions managers 2.3 ± 0.29, hospital managers 2.6 ± 0.21. There is no signifi cant diff erence between the average scores of the two groups (t= -0.78, p=0.44); 4 (1.9%) of the respondents answered correctly for all of the test questions; 52 (24.1%) of the respondent gave no correct answer. A signifi cant relationship between the health management experience and the average rating was not found in the general group (p = 0.44), in the group of outpatient institutions managers (p=0.13), hospital managers (p=0.56). We found a correlation between the average score and the presence of a rehabilitation department: in the general group (t = -13.6, p <0.05) and in individual groups: t = -16.3, p <0.05, t = -9, 1, p <0.05. Conclusion: low awareness of health care managers about the organization of medical rehabilitation was found.

Keywords: medical rehabilitation, knowledge of healthcare management specialists, heads of medical institutions.


DOI: 10.38025/ 2078-1962-2020-96-2-13-17

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REHABILITATION MEDICINE AND MEDICAL REHABILITATION TECHNOLOGIES

Abstract:

Ankylosing spondylitis is a chronic infl ammatory disease from the group of spondylarthritis, characterized by damage to the predominantly axial skeleton, gradual formation of functional disorders of the spine and joints, leading to temporary or permanent disability and poor quality of life for patients, mostly young. In recent years, much attention has been paid to the study of the eff ectiveness of kinesitherapy in patients with ankylosing spondylitis. Studies have been conducted that confi rmed the positive eff ect on the function of the spine and joints of regular exercises performed at home, regular group exercise and their combination with physiotherapy methods. However, due to the imperfect methodology of conducting these studies and the lack of a standardized approach in evaluating the eff ectiveness of therapy in these patients, further detailed researches are needed to select the required amount of kinesitherapy for patients with ankylosing spondylitis and develop a standardized assessment of its eff ectiveness.

Keywords: ankylosing spondylitis, non-pharmacological treatment, kinesitherapy, rehabilitation.


DOI: 10.38025/ 2078-1962-2020-96-2-18-23

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Abstract:

The aim of the study was to estimate rehabilitation efficiency in the sportsmen and physical culture professionals with a shoulder pain syndrome.
Materials and methods: 980 patients with a shoulder pain syndrome undergo rehabilitation treatment. The reasons of acute or chronic shoulder pain syndrome were: acute trauma (7% of cases) or chronic microtraumatization (93% of cases) of shoulder tissues during the physical culture activities and sport. Rotary cuff pathology was diagnosed in 88% of patients, long head of biceps pathology – in 5%, acromioclavicular joint pathology – in 4%, the subacromial bursitis in 2% of cases, damage of the glenoid labrum (Bankarta) in 1%. Clinical methods (including the quality of life questionnaire -DASH) and instrumental methods (USD and MRI) were used. The diff erentiated rehabilitation programs (with the use of modern physical therapy methods) were recommended considering features of shoulder pathology, a patients clinical condition and their physical (including sports) activity.
Results: Excellent and good results were stated in 98% of patients with a shoulder pain syndrome. 2% of patients were directed for the surgical intervention (rotary cuff and glenoid labrum restoration). Compensation of a shoulder pain syndrome was stated in 82% of patients; in 16% of patients the pain syndrome had signifi cantly decreased. In 87% of patients function of the injured shoulder joint was restored, in 11% of patients – it signifi cantly improved. Strength of shoulder muscles and a humeroscapular rhythm were restored and the quality of life (according to the DASH questionnaire) improved in 98% of patients. Conclusion. Use of the diff erentiated programs of rehabilitation using modern physical techniques allows to receive excellent and good results in all patients with a shoulder pain syndrome involved physical culture and sport.

Keywords: shoulder pain syndrome, rotary cuff of a shoulder, rehabilitation, modern physical therapy techniques, physical culture and sport professionals.


DOI: 10.38025/ 2078-1962-2020-96-2-24-28

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Abstract:

The article highlights the basic principles of massage usage in patients with cervicobrachialgia with for pain syndrome relief and movement restoration. We found diff erences in regional blood circulation reaction and the neuromuscular system response in the aff ected limb responding to main massage techniques (rubbing and kneading), that makes possible diff erentiated methodological approach to massage procedures. In patients with muscle-tonic and neurodystrophic clinical manifestations, it is preferable to use a kneading technique in massage procedure. In the presence of vascular manifestations or moderate pain syndrome, the massage procedure can involve both rubbing and kneading. Revealed therapeutic eff ects, good tolerance for massage is an important evidence for its use as treatment method in patients with cervicobrachialgia, improving patient’s quality of life.

Keywords: cervicobrachialgia, classical massage, upper limbs, regional blood circulation, neuromuscular apparatus.


DOI: 10.38025/ 2078-1962-2020-96-2-29-32

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Abstract:

The aim of the study was to estimate the eff ect of new physical rehabilitation complex using of mechanotherapeutic methods on spine muscle strength in patients with osteoporosis (OP) and vertebral fractures (VF).
Material and methods: Study comprised of 90 osteoporotic patients aged 50-80 years old (65.4±9.1 years) with OP VFs who were randomized as 2:1 into intervention group (group1, n=60) and control group (group2, n=30). Patients in group 1 received an intensive rehabilitation course including back muscle training with mechanical loads #10; sensorimotor training on double unstable platform #10; kinesohydrotherapy in a pool #15; physical exercises in a gym #10. Group 2 was prescribed only physical exercises in a gym #15. All patients undergo tenzodynamometry on BackCheck diagnostic unit (Dr. Wolff , Germany) at baseline, in 3 weeks at the end of rehabilitation course and in a month of follow-up.
Results: In group 1 after the rehabilitation course muscle strength improved in trunk extensors (TE) from 15.8±10.1 to 21.7±13.1 kg (p<0.001), trunk fl exors (TF) from 14.5±9.1 to 18.9±10.2 kg (p<0.001), left lateral fl exors (LLF) from 12.8±7.2 to 17.5±9.6kg (p<0.001) and right lateral fl exors (RLF) from 13.2 ± 7.1 to 17.8 ± 9.2 kg (p<0.01). Strength defi ciency signifi cantly decreased in all muscles (p<0.001 for TE and TF, p<0.05 for LLF, p<0.01 for RLF). The achieved eff ect lasted for a month of follow-up. In group 2 positive dynamics of strength was observed after 3 weeks only in TE and TF (p<0.05), however, after a month of observation, the strength of all the studied muscles did not diff er from the baseline (p>0.05).
Conclusion: The new 3-week complex of physical rehabilitation using of mechanotherapeutic methods lead to increase of spine muscle strength and improvement of muscle strength defi ciency in patients with osteoporotic VFs. Rehabilitation eff ect lasts for at least a month after the treatment completion.

Keywords: osteoporosis, vertebral fractures, physical rehabilitation, muscle strength, spine deep stabilization system.


DOI: 10.38025/ 2078-1962-2020-96-2-33-40

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Abstract:

Musculoskeletal system diseases require active motor rehabilitation, as a rule, but presence of severe pain syndrome might become a barrier, leading to the development of kinesiophobia and reducing motivation for treatment in patients. In recent decades, non-invasive methods of pain control, in particular virtual reality (VR) and augmented reality (AR) have been commonly used on a par with drug therapy. The purpose of this study is to provide a scientifi c base for the eff ectiveness of including a high-tech VR device (Vive Focus Plus EEA Virtual Reality Helmet), in to psychological rehabilitation of a pain syndrome in patients with chronic degenerative-dystrophic diseases of major joints and spine. The study involved 84 patients (24 men and 60 women aged 56±14.4) of a rehabilitation hospital with a severe pain syndrome and motor disorders corresponding to ICF Class 1 or 2. To analyse the characteristics of the subjective pain perception, the method of multidimensional semantic description based on the adapted Russian version of the McGill Pain Questionnaire was applied, and the Tampa Scale was used to kinesiophobia assessment. The VR technology was implemented via usage of the Vive Focus Plus EEA Virtual Reality Helmet tool (10 procedures). The eff ectiveness of using VR technology was evaluated through monitoring of pain dynamics and the kinesiophobia level prior to the study onset and at the end of hospitalization. As a result, the study has shown that there was no nosological specifi city in the description of pain, or the diff erences in its verbal characteristics representing nociceptive and neuropathic components. Technology of ‘virtual immersion in 3D reality’ makes it possible to infl uence eff ectively on pathophysiological mechanisms links in the development of chronic psychologically determined, neuropathic and mixed-origin pain.

Keywords: medical rehabilitation, psychological rehabilitation, pain, kinesiophobia, virtual reality (VR) tools, augmented reality (AR) tools, degenerative-dystrophic joint diseases, degenerative-dystrophic spine diseases, nociceptive pain, neuropathic pain, verbal characteristics of pain.


DOI: 10.38025/ 2078-1962-2020-96-2-41-48

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Abstract:

Neck pain is an actual problem of our time, one of the leading causes of temporary disability. Most often, cervical pain is non-specifi c, and is manifested by myofascial pain syndrome. Neck pain therapy is a big problem due to the lack of unifi ed eff ective treatment protocols and at the same time with the abundance of methods off ered. According to the results of some studies, the pain syndrome may be associated with a violation of proprioreception and dysfunction of the postural muscles of the neck. Accordingly, neuromuscular activation techniques can be eff ective in the treatment of myofascial pain syndrome of the neck. The purpose of this pilot study is to research the various eff ects of using neuromuscular activation methods in patients with myofascial pain syndrome in neck muscles.

Keywords: chronic cervical pain, neck muscles, trigger points, impaired proprioception, neuromuscular activation, and the postural muscles of the neck.


DOI: 10.38025/ 2078-1962-2020-96-2-49-53

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Abstract:

For the fi rst time in clinical conditions a study was carried out for estimation of average amplitude (AA-EMG) and frequency of oscillations repetitions parameters during dynamic and static exercises performance. We found that in healthy individuals EMG amplitude depends on the character of physical exercises performed. The largest EMG amplitude was registered when performing static exercises. It was found that in acute stroke patients, while performing fl exion and extension of fi ngers, low-amplitude EMG activity was registered stretched for entire movement cycle without a clear peak of extremum. When performing static exercises, the amplitude and frequency of EMG oscillations changed signifi cantly in a positive way.

Keywords: Electromyography, sick and healthy patients, average EMG amplitude, frequency of oscillation repetition, dynamic and static exercises.


DOI: 10.38025/ 2078-1962-2020-96-2-54-58

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Abstract:

Facial nerve neuropathy can manifest itself with gross organic and functional disorders. The esthetic defect worsens social adaptation and quality of life. However, there is no consensus, protocol or algorithm of treatment of the patient with this pathology. In article we present a modern way of treatment and rehabilitation of patients with neuropathy of a facial nerve of various etiology. Conservative and surgical types of treatment are applied during the diff erent periods of a disease. Surgical methods of treatment can be divided into two groups: reconstructive, decompressive and also plastic. The choice of a type of operation is defi ned individually with many factors, including an etiology and time of a disease. Both the new and tested by time techniques are applied. Conservative therapy includes corticosteroids, antiviral, antibacterial drugs depending on a clinical situation. Traditionally specialists of policlinics and hospitals appoint additional therapy (group B vitamins, cholinesterase inhibitors, antioxidants, neuroprotectors, nootropic drugs), however single small researches couldn’t enforce these drugs recommendations. Botulinum toxin type A is eff ective in the acute and chronic periods of a disease. Depending on a clinical situation of botulinum toxin type A are injected both in aff ected, and in healthy part of the face. Patients with incomplete eye closure are given keratoprotection as early as possible, and blepharography is performed in case of pronounced defi cit. As an alternative method, botulinum toxin type A injections are used into the upper eyelid lifting muscle. One of the most eff ective methods of rehabilitation of patients with facial nerve neuropathy is therapeutic physical education such as neuromuscular retraining with biological feedback. The most optimal combination is the injection of botulinum toxin type A and therapeutic physical education.

Keywords: facial nerve, facial neuropathy, Bell palsy, facial asymmetry, botulinum therapy, botulinum toxin type A, rehabilitation, Kabat.


DOI: 10.38025/ 2078-1962-2020-96-2-59-67

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REVIEWS. LECTURES. REPORT. HISTORICAL SKETCHES.

Abstract:

Restoration of motor functions in patients with spinal cord injury (SCI) is a priority problem of this patient’s category medical rehabilitation. Despite the achievements of modern medicine, the level of movement restoration after SCI is often insignifi cant, many patients stayed confi ned to a wheelchair. Secondary complications (osteoporosis, obesity, cardiovascular, respiratory, urogenital, trophic and other disorders) used to develop in the injured people as a result of low physical activity, they aggravate the course of the main disease and complicate the process of medical rehabilitation. A hope for rehabilitation specialist and patients is associated with the appearance of robotic exoskeletons (RES), that might become an innovation means for improving the mobility of patients with SCI. The purpose of the review is to provide information on the possible benefi ts and disadvantages of the use of RES in the rehabilitation of patients with SCI. This article discusses the general characteristics of modern exoskeletons and the conditions of their use for patients with paralysis of the lower extremities. The article presents Information on the eff ectiveness and safety of the use of exoskeleton devices in neurorehabilitation, as well as data on limitations and problems associated with exoskeleton use in clinical practice. The results of meta-analyses and randomized studies on the potential benefi ts of the RES usage both in everyday life and in rehabilitation of patients with SCI are presented. The infl uence of walking training in the exoskeleton on the degree of motor functions improvement, overall physical activity level and body weight in patients with SCI is highlighted. The article draws attention to the unsolved problems and further perspectives of RES application in patients with SCI. It emphasizes the necessity for protocols standardization and large randomized comparative clinical trials organization with prolonged observational period of patients in order to determine exoskeletons usage potential.

Keywords: neurorehabilitation, robotic devices, exoskeletons, spinal cord injury, invalid, paresis.


DOI: 10.38025/ 2078-1962-2020-96-2-68-78

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Abstract:

Medical rehabilitation in our country is under reformation currently and new rehabilitation system model is being created. In this regard, it is particularly important to study path of our predecessors and pioneers of this scientifi c direction. The article analyzes the experience of organization and establishment of industrial rehabilitation system for patients and disabled persons, created on the basis of Nizhny Novgorod research Institute of traumatology and orthopedics and medical-sanitary unit of Gorky automobile factory in the 70-s of the previous century. The article focused on both medical and socio-economic effi ciency issues of the established system, which has been a school of excellence in Russian Federation for many years. Knowledge of this experience could be of great value for current specialists, because, as our compatriot A.M. Gorky said, "Without knowing the past, it is impossible to understand the true meaning of the present and the goals of the future".

Keywords: professional, comprehensive rehabilitation of patients and disabled people, interdisciplinary approach, school of excellence.


DOI: 10.38025/ 2078-1962-2020-96-2-79-83

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Abstract:

Research of eff ective treatment methods in patients with pseudoarthrosis and lower extremities long bones defects remains today very relevant. In the structure of traumatological patients general disability it takes up to 33.1% of cases. Surgical techniques are used, such as: intramedullary osteosynthesis, method of open reposition and bone fragments fi xation by metal structures, method of transcutaneous osteosynthesis. They are recognized as eff ective treatment methods in patients with pseudoarthrosis and lower extremities long bones defects, that greatly improves treatment outcomes. Unfortunately, when they are used as single intervention, unsatisfactory therapy results occur in up to half of the cases. Concomitant structural and functional changes of the limb – such as regional blood circulation insuffi ciency, presence of extensive cicatrical soft tissues defects, changes in bone segment length, joints contractures, etc. – interferes bone consolidation and requires an application of additional treatment methods. Thus, the generally accepted treatment approach in patients with pseudoarthrosis and lower extremities long bones defects is a combination of surgery, pharmacotherapy, methods of physical therapy and physiotherapy in order to optimize the processes of osteoregeneration in non-union area.

Keywords: pseudoarthrosis, lower extremities long bones defects, intramedullary osteosynthesis, open reposition technique, transcutaneous osteosynthesis, stimulation of osteogenesis, non-union fracture, osteostimulating drugs.


DOI: 10.38025/ 2078-1962-2020-96-2-84-89

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HEALTH-RESORT TREATMENT

Abstract:

In modern sanatorium-resort organizations there is an urgent need of eff ective innovative physiotherapeutic methods usage along with basic resort treatment, that is especially important for patients’ resort treatment duration reduction. Extracorporeal shock wave therapy (ESWT) is evidence-based physiotherapeutic method.
The aim of the study is to evaluate the high clinical efficacy of ESWT method in comparison with traditional methods of treatment at the sanatorium-resort complex «Vulan».
Materials and methods: ESWT method eff ectiveness study was carried out in 111 people with shoulder joints and periarticular tissues pathology of various etiology aged 30-79 years (average age 45.5 years), disease duration from 1 year to 10-12 years (average 4.5 years).
Results: According to the Swanson Score, in patients of the main group (n=57) «pain score» improved from 3.5 (before) to 8.3 (after), that is 2.3 times. “Activity in everyday life” raised from 4.7 to 8.6 (1.7 times), the volume of active movements increased from 3.2 to 7.9 (2.5 times). According to the Likert scale, patients reported a subjective improvement in their own well-being by 4.6 point. According to VAS scale a decrease in pain syndrome intensity was recorded (2.2 times in average). In patients of comparison group, who received basic resort treatment, positive changes were less signifi cant.
Conclusion: Objective and subjective data obtained in this study indicates a high clinical eff ect of ESWT in a complex health-resort treatment of patients with humeroscapular pain syndrome.

Keywords: shoulder pain; method of extracorporeal shock wave therapy; assessment of the functional state of the body.


DOI: 10.38025/ 2078-1962-2020-96-2-90-93

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SCIENTIFIC LIFE

Abstract:

Authors present a concept of early rehabilitation in children with spinal cord injury in a surgical department. The patient’s route at an early stage of rehabilitation is defi ned: general intensive care unit, intensive care ward in neurosurgical department and general ward in neurosurgical department. Three main stages of early comprehensive rehabilitation are also defi ned: perioperative, adaptation to motor defi cit, motor retraining. Goals of early rehabilitation and role of multidisciplinary team involved in the care are stated as well. Article shows the role of various physical training techniques and rehabilitation tools eff ectiveness in patients’ care, complications prevention, motor retraining, persistent self-care skills acquisition, improvement of mobility and quality of patients' life.

Keywords: spinal cord injury, comprehensive rehabilitation, multidisciplinary team, staged early rehabilitation, rehabilitation tasks, techniques and tools for curative physical training, technical means for rehabilitation.


DOI: 10.38025/ 2078-1962-2020-96-2-94-101

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PROFESSIONAL SPACE. CHRONICLE OF LIFE. PEOPLE.




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