Voprosy kurortologii, fizioterapii, i lechebnoi fizicheskoi kultury最新文献

Patients with traumatic cervical injury of the spinal cord show clinical symptoms of tetraplegia. Furthermore, the motor function of the upper limbs is a key function for such patients, because it has a significant impact on the quality of life. One of the components of the definition of rehabilitation potential is the identification of the possible functions' ceiling and compliance of the patient's current condition with known model characteristics.

Objective: The aim of the study is to determine the predictors of upper limb functional motor activity in patients in the late period after spinal cord injury (SCI).

Material and methods: The study included 190 patients with SCI: 151 men and 49 women. The mean age of patients was 30.0±12.9 years, the age of SCI - 1.9 [0.60; 5.40] years, in 93% of cases SCI was traumatic. Patients were classified using the ASIA International Neurological Standard. Upper limb function was evaluated using a short version of the Van Lushot Test (VLT). Stimulation electroneuromyography (SENMG) from the median and ulnar nerves was performed. The distribution at the motor level (ML) was as follows: C4-C6 - 117 patients; C7-D1 - 73 patients; depending on the severity of injury (SI): type A and B - 132 patients; upper limb motor score (ASIAarm) was 25.0±12.2, on VLT - 38.3±20.9. The factor loading of 10 factors was evaluated simultaneously in a linear discriminant analysis, the cut-off point was 20 and 40 scores on VLT (25 and 50% on the International Classification of Functioning, Disability and Health without the domain «balance»).

Results: According to SENMG, denervation changes were detected in 15% of median and in 23% of ulnar nerves. The rank significance for the VLT threshold of 20 scores was: ASIA_arm - 100, functional tenodesis (FT) - 91, ML - 73, SI - 18; the classification tree had one branching at the ASIA_arm point of 17.3 score. The rank significance for the threshold of 40 scores was: ASIA_arm - 100, ML - 59, SI - 50, FT - 28, M response from the median nerve - 5; the classification tree had one branching at the ASIA_arm point of 26.9 score. The results of multivariate linear regression analysis confirmed the highest factor loading of ML predictor, motor score for upper limb (ASIA_arm) in both cases (R=0.67, R₂=0.45, F=38.0, p=0.00 and R=0.69, R₂=0.47; F=42.0, p=0.00, respectively).

Conclusion: In the late period after a spinal injury the leading predicative value for functional motor activity has the motor score of ASIA for the upper limb. The ASIA score more than 27 scores is the prediction of moderate and mild impairments, and less than 17 - severe impairments.

Becker muscular dystrophy (BMD) is inherited X-linked neuromuscular disease characterized by progressive fatigue, atrophy, hypotonia and muscle weakness, that is predominantly located in muscles of pelvic girdle, femurs and lower leg. There are only singular studies at present showing the efficacy of different training programs for patients with muscular dystrophy, and there are no recommendations allowing to detect the optimal motor regimen, that is effective and safe for such patients.

Objective: To evaluate the efficacy of regular dynamic aerobic exercises in children with BMD, who are able to self-sustained movement.

Material and methods: The number of patients equal 13 with genetically confirmed BMD at the age from 8.9 to 15.9 years were examined. All patients took the course of exercise therapy for 4 months. The course was divided into 2 stages: the preparative (51-60% of the individual functional reserve of the heart (IFRH) with 6-8 repetitions of every exercise) and the training (61-70% of the IFRH with 10-12 repetitions of every exercise). The training duration was 60 min. The motor capabilities of patients were assessed by the 6-minute walk test, timed up & go test, MFM scale (sections D1, D2, D3) at the initial stage and during dynamic observation after 2 and 4 months.

Results: Statistically significant positive dynamics of indicators was revealed. The average distance in the 6-minute walk test at the initial stage was 526.9±12.7 m, after 4 months was 545.2±13.0 m (p<0.05). The average uplift time at the initial stage was 3.9±0.2 s, after 2 months was 3.5±0.2 s (p<0.05). The average running time for the distance of 10 m initially was 4.3±0.1 s, after 2 months was 3.8±0.1 s (p<0.05), after 4 months was 3.8±0.1 s (p<0.05). There was some positive dynamics in the evaluation of uplift and movement capabilities (D1) by the MFM scale: initially the indicator was 87.7±1.5%, after 2 months - 93.4±1.4% (p<0.001), after 4 months - 94.5±1.3% (p<0.001). Clinically significant adverse effects were not registered during the training courses.

Conclusion: Aerobic trainings without weight combined with exercises on a cycle machine for 4 months allow to improve movement capabilities and are not characterized by clinically significant adverse effects in children with BMD.

Disabled persons, who have undergone lower limb amputation (LLA) due to obliterating atherosclerosis, are a special group among patients with coronary heart disease (CHD). In the developed countries, 25-35% of patients was performed high LLA in the first year of critical ischemia, ant the number of interventions is steadily increasing. The development of personalized medical rehabilitation programs (MR) for such patients is relevant.

Objective: To scientifically substantiate the therapeutic effects of MR in patients with CHD and LLA.

Material and methods: The research design was a prospective cohort comparative study of MR therapeutic effects. The research subject was a change of physical activity tolerance (PAT) in patients during the implementation of recommended MR programs. The study object was 102 patients aged from 45 to 74 years. All patients were distributed by the random numbers method. The examined sample of patients was divided into two clusters. The first cluster consisted of 52 patients with CHD and LLA: study group included 1 - 26 patients, who were performed MR (kinesitherapy, manual mechanokinesitherapy, breathing exercises) and comparison group consisted of 1 - 26 patients, who were performed the preparation to prosthetics). The second cluster included 50 patients with CHD (study group consisted of 2 - 25 patients, who were performed MR and pharmacotherapy, and comparison group consisted of 2 - 25 patients, who were performed only pharmacotherapy). Clinical, instrumental and laboratory methods of examination were used in the research, as well as indicators of psychophysiological status and life quality, subjected to adequate statistical analysis.

Results: Dosed physical activities improve clinical and psychophysical statuses, as well as life quality of patients with CHD and LLA, increase contractility and optimize diastolic myocardial function, raise PAT, improve central and intracardial hemodynamics levels, neurohumoral regulation and lipid metabolism. The efficacy of personalized MR programs for patients with CHD and LLA is 88%, and standardized programs is 76%. The determinants of MR efficacy are base PAT values, as well as indicators of myocardial contraction and diastolic function.

Conclusion: The MR in patients with CHD and LLA forms obvious cardiotonic, vegetative correcting and lipid lowering healing effects.

The search for new rational ways to improve the effectiveness of treatment and rehabilitation measures of patients with true eczema continues to be one of the pressing issues in modern clinical dermatology.

Objective: The comparative analysis of influence of different variants of SCL: balneotherapy and balneotherapy combined with magnetic laser therapy on the dermatological status, IL-4 and IL-13 level, psycho-emotional state and QOL evaluation in patients with true eczema.

Material and methods: The study involved 112 patients with true eczema undergoing spa treatment (SCR) (54 in the balneotherapy group and 58 in the balneotherapy group combined with magnetic laser therapy. The effectiveness of SCR was assessed using the EASI, HARS and MADRS scales, and the DLQI questionnaire. The dynamics of IL-4 and IL-13 plasma levels were studied. The duration of the study was 6 months and 14 days.

Results: After 14 days of SCR, a statistically significant reduction of the EASI index was more pronounced in the balneotherapy group in combination with MLT compared to the balneotherapy group (p=0.041). Balneotherapy combined with MLT contributed to a statistically significant reduction in the HARS and HDRS scores. The decrease in IL-4 and IL-13 levels was statistically more significant in the balneotherapy group in combination with MLT. The combined use of balneotherapy and MLT in comparison with the balneotherapy group was accompanied by a more pronounced improvement in QOL. The combined use of balneotherapy and MLT in the follow-up phase showed a long-term positive effect: 6 months after completing SCR, the number of patients who had clinical remission was statistically significantly higher than that of the balneotherapy group (87.4% vs 22.5%).

Conclusion: The combined use of balneotherapy and MLT compared with balneotherapy in patients with true eczema on SCR was shown to be advantageous. The complex application of balneotherapy and MLT decreases inflammatory biomarker scores, improves dermatological and psychoemotional status, QOL parameters and is well tolerated.

Neurogenic urination disorders in children are often clinically represented by urinary incontinence (UI). The prevalence of UI reaches 8.6%, but tends to decrease in frequency with age. One of the methods of non-drug therapy of UI is extracorporeal magnetic stimulation (ExMI) - a type of non-invasive peripheral magnetic stimulation, which is widely used in adult urological practice. However, the effectiveness of the method in children has not been studied.

Objective: To study the effectiveness and safety of ExMI in the rehabilitation of children with neurogenic UI.

Material and methods: A prospective open randomized comparative clinical trial included 75 children (from 5 years to 16 years and 6 months) with neurogenic UI, who were divided by simple randomization into a main group (n=39), who received a standard rehabilitation and ExMI program for 21 days, and a comparison group (n=36), in which the standard rehabilitation program did not include the use of ExMI.

Result and discussion: A prospective open randomized comparative study revealed that the clinical effectiveness of the ExMI method in the complex rehabilitation of children with neurogenic UI is 94.8%, which is 25.4% higher than in the comparison group. After treatment, patients in the main group had a noticeable decrease in UI episodes, an increase in the micturition volume, and an improvement in the quality of life. Patients with various background neurological pathology responded to treatment, which indicates the common pathogenetic mechanisms of the development of LUTS in these conditions and the independence of the final effect from the basic diagnosis.

Conclusion: The use of the perineal ExMI method in children with neurogenic UI increases the effectiveness of rehabilitation and is a promising and safe direction of rehabilitation treatment.

Objective: To conduct an analytical review of the available literature data on thermoneutral «dry immersion» (TSI) - a method that simulates the state of weightlessness/microgravity.

Material and methods: The review included data from electronic databases: Scopus, Web of Science, MedLine, Wiley, World Health Organization, The Cochrane Central Register of Controlled Trials, ScienceDirect, PubMed, elibrary, CyberLeninka, disserCat.

Results: The extensive database of in vitro studies contains information on the reduction of cell proliferation, invasion, migration and increased apoptosis of thyroid, breast, lung, stomach, colon cancer cells, Hodgkin's lymphoma, glioblastoma, leukemia, melanoma, osteosarcoma of a human under the influence of microgravity. The vast majority of works are devoted to experiments on healthy people to finding out the mechanisms of action of long-term continuous microgravity. The study of the therapeutic effect of TSI as a physiotherapeutic procedure of one or repeated sessions was carried out by individual authors. Positive results of a short stay in the unsupported model were obtained in the treatment of children with perinatal disorders, cerebral palsy, patients with hypertension in a state of hypertensive crisis, Parkinson's disease, skin burn II gr. The results of the analytical review provide an opportunity to begin scientific research on the effectiveness and safety of thermoneutral «dry immersion» in the complex rehabilitation of cancer patients.

Globally, 13% of the population has difficulty conceiving. In Russia, the proportion of infertile marriages ranges from 8 to 17.5%, with half of all forms of female infertility being the uterine form. The main etiological factors for impaired endometrial receptivity are infectious diseases leading to the development of chronic endometritis (most often found in tuboperitoneal infertility), dishormonal background associated with the development of hyperplastic processes in endocrine infertility, uterine fibroids, chronic endometritis and endometriosis. The frequency of detection of uterine cavity diseases in patients with repeated unsuccessful IVF programs ranges from 18 to 50%. The review examines the etiological factors and other causes of endometrial pathology leading to the development of chronic endometritis, possible mechanisms for the development of impaired growth and receptivity of the endometrium, and, as a consequence, the impossibility of pregnancy. Therapeutic strategies for restoring endometrial thickness and receptivity using pharmacological and non-pharmacological methods are described. Based on the analysis of literature data, it is shown that the use of physiotherapeutic factors in treatment programs that have pronounced anti-inflammatory, immuno- and hormone-modulating, reparative-regenerative, metabolic, vasocorrective and defibrosing effects allows for a relatively short period of time to improve endometrial receptivity, normalize hormonal levels and restore fertility in women of reproductive age, which ensures the possibility of successful embryo implantation, fetal development and childbirth.

Laser therapy as a physiotherapeutic method has been successfully used for a long time in the treatment of various pathologies, but the action mechanisms of low level laser therapy (LLLT) remain understudied.

Objective: To perform the analysis of published results of LLLT investigations, to describe the physical principles of photobiomodulation, its action mechanisms on various cells and tissues, therapeutic intervention and efficiency of the technique.

Material and methods: The search of articles was done for the period from 2014 to 2022. The preference was given to the articles for the last 5 years in the PubMed database depending on keywords: low level laser therapy, photobiomodulation, exosomes, monocytes, macrophages.

Results and discussion: This article represents the current conceptions about the action mechanisms and reproduced effects of low level laser therapy, the photobiomodulation influence on the inflammation and reparative processes in human body by intervention on cells and their signal pathways. The discussion of research results and probable causes of conflicting data are performed, as well as the efficacy assessment of laser irradiation in different conditions and diseases is made.

Conclusion: Laser therapy has certain variety of advantages, among which: non-invasiveness and availability, long-term service of equipment, stable intensity of light radiation and the ability to use in various wavelength ranges. The technique efficacy was proven for a large number of diseases. However, for the successful application of photobiomodulation in clinical practice in current evidence-based medicine, additional investigations are necessary to determine the best dosimetric radiation parameters, as well as further study of action mechanisms on various human cells and tissues.

Vacation is an essential feature of modern life for many people, and there is a fundamental assumption that short-term leave contributes to physical improvement and, thus, it is an improving the quality of life factor.

Objective: To study physiological and a number of psychophysiological body characteristics of the Magadan region residents when moving from northern latitudes to the conditions of the southern band in the summer period for vacation.

Material and methods: Through year-round psychophysiological monitoring of a group, consisting of 19 male northern residents volunteers (mean age 33.2±1.5 years), a sample (15 men) was formed. These participants left the territory of the Magadan region for summer vacation during the research period. The mean vacation length was 47±6 days. The subjects were analyzed by the main indicators of physical development, cardiovascular system, heart rate variability, as well as individual psychophysiological characteristics.

Results: Short-term departure from the Magadan region did not cause significant changes in the main indicators of physical development, which was manifested in the absence of statistically significant differences in the indicators of body mass, total fat in the body and body mass index. A similar tendency was noted about the main cardiovascular indicators, except the significantly lower value of myocardial index on the post-vacation period, the reduction of which demonstrates a decrease in the total amount of dispersive abnormalities and, in general, an optimization of the cardiovascular system. At the same time, the conducted analysis of heart rate variability indicators shows a change in sympathetic-parasympathetic balance towards higher parasympathetic activity, which demonstrates the positive effect of summer vacation. Negative tendencies of the vacation effect manifested in a slight speed increase of a comprehensive visual-motor reaction, as well as in an increase of the harmful habits number.

Conclusion: The obtained results of the study expand knowledge about the positive contribution of summer vacation to the health and well-being of working population of the Northern region, and also show that the vacation activities positive results can be assessed on the basis of the indicators of the heart rate variability, the myocardial index, as well as on the basis of the objective and subjective assessment of the psychophysiological condition analysis. These findings fully provide the basis for further research in the sphere of summer vacation activities organization as a public health resource.