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

Neurorehabilitation of post-stroke motor disorders is a relevant and rapidly developing area in modern medicine. Timely correction of the developing pathological gait stereotype is an important task for a physician of physical and rehabilitation medicine. Identification of the central defect in the biomechanics of gait and targeted impact on it using various rehabilitation methods makes it possible to restore the gait function in a patient with post-stroke hemiparesis more effectively.

Objective: To evaluate the effects of rehabilitation using author's technique of shifting the center of gravity of the foot on gait biomechanics in patients with post-stroke hemiparesis.

Material and methods: This article studies a variant of rehabilitation effect on the pathological gait stereotype caused by the violation of the forward outreach of the paretic leg using author's technique of shifting the center of gravity of the foot developed on the basis of the Department of Nervous Diseases of the Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University. A pilot study was carried out with participation of 15 patients undergoing rehabilitation at the 2nd stage in the medical rehabilitation departments No. 2 and 3 of the Federal Siberian Research Clinical Centre under FMBA of Russia (FSRCC FMBA of Russia) in Krasnoyarsk. The patients underwent gait training sessions using technique of shifting the center of gravity of the foot according to the scheme of 10 daily sessions with the duration of 20-40 minutes per day. The function of gait was assessed using the ichnography method.

Results: A comparison of gait function before and after rehabilitation was conducted using the Wilcoxon p-test. The median of the step length of the paretic leg before sessions was 34.31 cm, after sessions 44.84 cm (p<0.01), the median of the step asymmetry, that is, the difference in the step length of the paretic and intact leg, before sessions, was 11.77 cm, after sessions 6.35 cm (p<0.01). Significant improvements in the main spatial parameters of step were obtained against the background of rehabilitation using technique of shifting the center of gravity of the foot.

Conclusion: Training using technique of shifting the center of gravity of the foot improves the function of gait and may be used as a method of motor rehabilitation for patients with post-stroke hemiparesis.

Chronic bronchopulmonary diseases are a frequent concomitant pathology which potentially affects the clinical and functional status of patients of different profiles undergoing rehabilitation in hospital, that should be taken into account in planning treatment.

Objective: To study the influence of vibroacoustic pulmonary therapy (VAPT) on clinical status and spirometry values of patients undergoing in-patient rehabilitation and with comorbid bronchopulmonary pathology.

Material and methods: We examined 60 patients (18 men (30%) and 42 women (70%)) aged between 18 and 75 years (median age 62 [56; 68] years) with chronic lung diseases (chronic bronchitis, chronic obstructive pulmonary disease), undergoing an in-patient rehabilitation for disorders of the central nervous and musculoskeletal systems. The study group consisted of 30 patients who had a 5-day course of VAPT in the individual medical rehabilitation program; the control group included 30 patients who did not underwent VAPT. Qualitative and quantitative characteristics of respiratory symptoms and parameters of spirometry before and after VAPT course were studied.

Results: In this study 37 (62%) of subjects underwent rehabilitation regarding pathology of the central nervous system, 23 (38%) - regarding musculoskeletal pathology, 40 (67%) had concomitant cardiovascular diseases among all patients. Complaints of dyspnea were presented by 96.7% of patients in the study group and 90% of patients in the control group, mean value of dyspnea intensity on the mMRC scale amounted to 2.1±0.89 and 2.1±0.8 scores, respectively. Cough occurred in 83% of patients in the study group and 80% of patients in the control group, mean value on the 6-score daily and night cough scale was 2.0±1.3 and 1.9±0.84 scores, respectively. There has been a decrease in the number of patients with dyspnea and cough to 83.3 and 66.7%, respectively, a decrease in the dyspnea degree on the mMRC scale by 19% (p<0.05) and the cough severity by 22.3% (p≤0.001) in the study group after VAPT. An increase of the peak expiratory flow rate by 5% (p≤0.05) has been revealed according to spirometry data. No significant improvement of the studied indicators has been achieved in the control group of patients. No serious cardiovascular adverse events and complications have been registered during rehabilitation, the results of the patients' questionnaire survey characterize the method positively.

Conclusion: The performed study's results, that showed a regression of respiratory symptoms and improvement of pulmonary function during the in-patient rehabilitation of subjects with comorbid chronic bronchopulmonary pathology, allow to consider VAPT as a promising non-drug treatment method in this category of patients.

The article discusses the need for development of a modern system of sanatorium-resort treatment and medical rehabilitation in the Armed Forces of the Russian Federation. It is proposed to consider different models of sanatorium-resort provision organization in order to accommodate the requirements of different categories of military personnel and their families. This concept will contribute to the improvement of efficiency and quality of provided services. Development of infrastructure, implementation of modern technologies, improvement of staff qualification and creation of conditions for recreation and treatment are the key aspects of successful organization of sanatorium-resort provision.

Postural balance impairment is associated with an increased risk of falls, reduced daily activity, and a decline in patients' quality of life. Given that balance function is one of the fundamental and most vital functions for life, the objective diagnosis and correction of its pathology remain highly relevant in clinical practice.

Objective: To examine modern approaches to the methodology and specific techniques used in stabilometric assessment of postural balance and to analyze the current state of standardization of stabilometry in both clinical practice and scientific research.

Material and methods: The review includes studies of varying levels of evidence (randomized controlled trials, systematic reviews, cohort studies, non-systematic reviews, consensus documents) identified through databases such as PubMed, Mendeley, ScienceDirect, eLIBRARY.RU, Google Scholar, and CyberLeninka covering the period from 2000 to 2025. Modern approaches to assessing postural balance are discussed, along with the main reasons for the absence of unified standardized reference values in stabilometric studies.

Results: Stabilometry - a method of quantitatively evaluating postural balance by analyzing oscillations of the center of pressure projection on a support surface - is considered a modern tool for diagnosing postural imbalance. However, the diversity of protocols used in stabilometric testing, the lack of uniform standards for data processing and interpretation, and the need to account for variable individual patient parameters limit the application of this method in clinical settings and reduce the informativeness and comparability of scientific studies.

Conclusion: To enhance the validity and reliability of stabilometric research, standardization in technical, software, and terminological domains (development of protocols and data processing standards) is required to fully realize the potential of this method.

Backgraund: Rehabilitation of patients with vertebrogenic muscular-tonic and radicular syndromes allows not only to get rid of pain, but also to return a person's ability to move, restore working capacity and significantly improve the quality of life, minimizing the risk of future exacerbations.

Aims: Development of scientifically based approaches to comprehensive rehabilitation of patients with vertebrogenic muscular-tonic and radicular syndromes aimed at restoring lost functions, reducing pain syndrome and returning patients with DDZP to active everyday life.

Material and methods: A total of 89 patients with vertebrogenic muscular-tonic and radicular syndromes with dorsopathy were examined. The average age and duration of the disease in patients were 52.1±7.34 years and 5.0±1.12 years, respectively. The dynamics of the clinical and objective state of patients with DDZP was assessed using various treatment regimens. Statistical processing of the study results was carried out using the Statistica 10.0 software package. Differences were considered significant at p<0.05.

Results: The results of the study demonstrate a significant improvement in the clinical and objective condition of patients with DDD when using various treatment regimens, especially when using therapy according to regimens III and IV. Evaluation of the dynamics of complaints showed that treatment according to these regimens is more effective than according to regimen I. Objective indicators, which include radiographic signs of scoliosis and MRI data, also indicate positive dynamics when using therapy regimens III and IV. In most patients who received therapy according to these regimens, signs of disc deformation disappeared. The identified improvements in ENMG signs during therapy according to III and IV regimens show a decrease in radicular and neuromuscular disorders.

Conclusions: In the rehabilitation of patients with vertebrogenic muscular-tonic and radicular syndromes, the most effective treatment method is courses of manual therapy and acupuncture.

The World Stroke Organization notes the growing number of strokes worldwide. Motor disorders in the paretic limbs are one of the most common consequences of stroke, which significantly affects the quality of patients' daily lives. The possibility of early prediction of clinical and functional recovery of patients after stroke is an important component of the rehabilitation process.

Objective: To develop a model for predicting the restoration of the functional activity of paretic limbs and mobility of patients in the early recovery period of ischemic stroke and to evaluate the results of rehabilitation with a positive and negative prognosis.

Material and methods: The prognostic factors used were the results of an assessment of motor disorders, balance function on the Fugl-Meyer scale and interhemispheric brain activity (Brain symmetry indices in standard electroencephalogram leads), as well as the patient's age, prescription of stroke, and level of vital activity at the time of examination. The functional activity of paretic limbs and mobility of patients were assessed using validated scales (Action Research Arm Test, Modified Frenchay scale, Wolf Motor Function Test, Rivermead mobility index, Hauser ambulance index, Functional Independence Measurement). The TIBCO Software Inc. (2017) program was used to build the model, Statistica, version 13. The Mann-Whitney criterion was used to identify differences between subgroups.

Results: A new method for predicting the functional recovery of paretic limb activity after ischemic stroke has been developed (patent RU2825714C1, publ. 08/28/2024). The forecast model developed by the logistic regression method is statistically significant (χ²=43.26; p<0.001. Operational characteristics of the test (training sample of 91 patients): sensitivity - 84%, specificity - 83%, diagnostic accuracy - 84%. After rehabilitation, a statistically significantly greater increase in the indicators of functional activity of paretic limbs and mobility was revealed in patients with a positive prognosis compared with a subgroup of patients with a negative prognosis.

Conclusions: The obtained model makes it possible to predict the recovery of patients' activity in terms of self-care and movement in the first six months after an ischemic stroke in the presence of limb paresis.

The most striking and widespread representatives of chronic non-infectious diseases are essential arterial hypertension (EAH) and type 2 diabetes mellitus. Recently, in the pathogenesis of the above-mentioned nosologies, theories have become widespread associated with a violation of the regulation of these processes by the central nervous system, which are a consequence of hypoxia of the reflex regulatory centers of the brain. One of the most promising methods for eliminating hypoxia of brain structures is the method of manual-physical influence (therapy) according to the method of A.Yu. Shishonin.

Objective: To study the effect of manual physical therapy on blood pressure (BP) and body composition in patients with EAH.

Material and methods: The study included 144 patients (mean age 59.9±3.7 years) with EAH or high normal BP (prehypertension), divided into 2 groups. The main group included 110 patients (47 men and 63 women), whose BP was measured according to Korotkov and heart rate was recorded, and body composition was also studied at least three times - before the start of therapy, in the middle of the session and immediately after its completion. The control group included 34 patients (17 men and 17 women), who refused both recommended and alternative treatment methods for various reasons, who were measured at the same time as the main group.

Body composition was studied using bioimpedancemetry.

Results: During therapy using the method of A.Yu. Shishonin, the study group showed a significant decrease in SBP by the middle of the course by 11.3 mm Hg, and after completion - by 22.3 mm Hg. DBP significantly decreased after the middle of the course by 3.4 mm Hg, and by the end of therapy - by 4.4 mm Hg. HR by the end of manual-physical correction sessions significantly decreased by 12 beats/min. The fat mass in the study group by the end of therapy significantly decreased by 3.5 kg, the loss of total fluid by the end of the course was significantly 8.3 kg. An increase in muscle mass was recorded, which did not reach the level of reliability. In patients of the control group, changes in bioimpedance parameters were of a multidirectional nature and did not reach the level of reliability.

Conclusion: The method of manual-physical correction according to A.Yu. Shishonin is an effective method for reducing blood pressure and normalizing body composition. Its effect is probably mediated by improved blood supply to regulatory structures, normalization of eating behavior and sympathoadrenal activity within the framework of the «selfish brain» theory.

Introduction: Conservative treatment of patients with scoliosis and kyphoscoliotic spinal deformities is the most affordable and safe method of treatment. Non-surgical treatment of such patients takes a long period of time and includes the complex use of various factors, including physiotherapy, therapeutic gymnastics, swimming, massage, manual therapy, and the use of various types of functional corrective corsets. They are used on a regular basis until the bone growth zones are closed and/or deformity is sufficiently corrected.

The result of using corsets depends on many factors and is not always positive. One of the factors that reduce the effectiveness of this method is the poor tolerance (or intolerance) of these corsets due to pain sensations that occur at the sites of corrective efforts, as well as limited mobility of the spine.

Various methods are used to increase the mobility of the spine (physical therapy with stretching elements, massage, manual therapy).

Traction therapy (stretching of the spine) can be attributed to methods that increase the mobility of the spine. Reports on the effectiveness of isolated traction therapy in patients with various static deformities are contradictory.

Objective: To evaluate the prospects of using traction therapy in patients with significant static spinal deformities using a functionally corrective corset to facilitate the period of adaptation to regular wearing of a functionally corrective corset, and to reduce pain and discomfort from pressure exerted by the pressure zones of the corset; to increase spinal mobility.

Material and methods: The publication describes the experience of using traction therapy in 52 adolescent patients undergoing inpatient conservative treatment for severe static spinal deformities at the stage of using a functional corrective corset.

Results and discussion: As a result of the work, the following conclusions can be drawn: the use of traction therapy significantly reduces pain and discomfort associated with the use of a functionally corrective corset. There were no negative reactions or complications from the use of traction therapy.

Conclusion: Traction therapy should be used in the complex conservative treatment of patients with scoliosis and kyphoscoliosis as an additional method at the stage of using functionally corrective corsets, including difficulties in adapting to corset treatment. Traction therapy can also be used to prepare a patient for an orthosis.

Objective: To systematize current knowledge on biomarkers of fundamental aging mechanisms, their reference and target values for practical application in longevity medicine.

Material and methods: Analysis of scientific literature on 14 key aging mechanisms according to the modern gerontological concept, including genomic instability, telomere shortening, epigenetic alterations, loss of proteostasis, impaired macroautophagy, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, altered intercellular communication, chronic inflammation, microbiome dysbiosis, extracellular matrix stiffness and barrier dysfunction, as well as circadian rhythm disruption.

Results: A comprehensive system of 30+biomarkers with detailed reference and target values is presented. Key biomarkers include: urinary 8-OHdG (target values<5.0 ng/mg creatinine), leukocyte telomere length (target >6000 base pairs), N7-methylguanine (<6-7 μg/g creatinine), dityrosine (≤10-12 μmol/mol creatinine), p62 and Beclin-1 for autophagy assessment, HOMA-IR (<1.5), IGF-1 (100-150 ng/ml), mitochondrial markers, senescence-associated β-galactosidase (<3% positive cells), inflammatory cytokines, microbiome-associated markers, and circadian biomarkers.

Conclusion: The developed biomarker panel provides a scientifically grounded foundation for personalized assessment of aging rate and correction of age-associated changes, requiring regular monitoring every 3-6 months for effective interpretation of biomarker dynamics.