[Application of exoskeleton with functional electrostimulation for rebalancing of patients in acute and early recovery periods of ischemic stroke]. / Primenenie ekzoskeleta s funktsional'noi elektrostimulyatsiei v vosstanovlenii ravnovesiya u patsientov v ostrom i rannem vosstanovitel'nom periodakh ishemicheskogo insul'ta.

Static motor disorders are the main cause of falls and decrease of daily activity in patients after previous ischemic stroke. OBJECTIVE: To study impact of robotic mechanotherapy with functional electrostimulation (FES) on rebalancing in patients in acute and early recovery periods of ischemic stroke. MATERIAL AND METHODS: The number of patients equal 60, divided into 2 groups, were examined. Study group included 30 patients, who were treated in an exoskeleton with FES; control group consisted of 30 patients, whose walking and balance recovering was carried out with exercise therapy. RESULTS: The study group showed a more pronounced improvement of balance indicators by Tinetti scale compared to the control group (11 [8; 13] against 8 [6; 12]; p=0.0281) at the end of treatment. Patients of study group demonstrated significantly better results both by Tinetti scale and stabilometrical parameters in acute period of stroke compared to the control group. CONCLUSION: Application of exoskeleton with FES in patients in acute and early periods of ischemic stroke contributes (to a better balance recovery), which may be achieved by long-lasting verticalization and large repetition of the correct walking pattern during rehabilitative trainings.

[Medical rehabilitation of children with obstructive uropathy]. / Meditsinskaya reabilitatsiya detei s obstruktivnoi uropatiei.

Obstructive uropathy in children is predominantly urinary system malformation and one of the leading causes of chronic renal failure. Antenatal ultrasound can detect obstructive uropathy in infants. It is important to conduct diagnostics not only to identify the obstruction level in urinary system, but to assess renal function, renal blood flow and urination. Children are given conservative and surgical treatment methods to restore urodynamics, prevent infectious complications, improve renal blood flow. Currently, there are no principles, approaches and technologies for medical rehabilitation of patients with obstructive uropathy, therefore, the use of selective chromotherapy, which has an activating effect on regional circulation, and sound stimulation improving muscles tone of pelvis and ureters, is pathogenetically reasonable and promising. OBJECTIVE: To develop technologies of physiotherapy application (sound stimulation, selective chromotherapy) for inclusion in comprehensive medical rehabilitation of children with megaloureter. MATERIAL AND METHODS: Clinical observations and special examinations have been performed in 90 children with megaloureter aged from 1 to 10 years. The patients were divided into 2 groups: 30 children (study group) received sound stimulation combined with selective chromotherapy; 30 children (the 1st comparison group) - sound stimulation; 30 children (the 2nd comparison group) - selective chromotherapy (blue spectrum). General clinical methods, ultrasound of kidneys and bladder with Doppler monitoring of intrarenal blood flow, functional methods of bladder examination were used. RESULTS: The positive effects of separate and combined application of sound stimulation and selective chromotherapy on clinical and laboratory indicators, urodynamics of urinary tract and renal blood flow in children with megaloureter after surgery have been revealed. The efficacy of selective chromotherapy use in children with megaloureter and comorbid neurologic bladder dysfunction has been proven. CONCLUSION: Modern technologies for the application of physiotherapy, namely selective chromotherapy and sound stimulation, to include them in the comprehensive medical rehabilitation of children with megaloureter, have been developed for the first time and their high efficacy has been proven.

[Questionnaire of the Ryzhikh National Medical Research Centre for Coloproctology is a new tool for assessing chronic pelvic pain and pelvic organ dysfunction]. / Oprosnik NMITs koloproktologii imeni A.N. Ryzhikh ­ novyi instrument otsenki khronicheskoi tazovoi boli i narusheniya funktsii tazovykh organov.

The article presents the work of a multidisciplinary team of experts from various fields of medicine to optimize the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ for use in clinical practice. The survey of respondents was conducted from June 28 to September 28, 2021. As a result of this survey, by repeatedly making edits and clarifications during communication with respondents, the final version was obtained, which allows assessing the patient's subjective sensations by the nature and localization of pelvic pain, sensitivity disorders and pelvic organ function. The main objective of this Questionnaire is to differentiate patients with neurogenic pain from a huge number of patients with chronic pelvic pain. This aspect will allow a more targeted approach to the diagnosis and pathogenetically justified treatment of patients, including after appropriate instrumental examinations. The work of a multidisciplinary team implies a higher degree of objectification and terminological accuracy of the Questionnaire under discussion. The presented version of the «Questionnaire for assessing chronic pelvic pain and pelvic organ dysfunction (QCPPD) of the Ryzhikh National Medical Research Centre for Coloproctology¼ will be primarily used in coloproctological patients with pelvic pain problems and anal incontinence and obstructive defecation. Further studies will be directed to the clinical evaluation of the results of the work carried out.

[Capacity of vibroacoustic therapy for correction of respiratory manifestations of post COVID-19 syndrome]. / Vozmozhnosti vibroakusticheskoi terapii v korrektsii respiratornykh proyavlenii postkovidnogo sindroma.

The search for therapeutic strategies for the correction of post COVID-19 syndrome is an urgent task of medicine. One of the frequent manifestations of post COVID-19 syndrome is the prolonged persistence of respiratory syndromes - dyspnea and cough. Vibroacoustic therapy is promising methods in the complex effect on broncho-pulmonary symptoms of COVID-19. OBJECTIVE: To study the effect of vibroacoustic pulmonary therapy implemented through the BARK VibroLUNG apparatus on the clinical and instrumental parameters of patients undergoing COVID-19 with residual respiratory symptoms. MATHERIAL AND METHODS: The effect of vibroacoustic therapy (5-day course of 2 sessions) on dyspnea and cough and respiratory function in 60 patients aged 18 to 75 years who underwent COVID-19 of varying severity for more than 12 weeks before the start of the study, with the presence of distant respiratory symptoms, was investigated. Patients were divided into two equal and age-matched groups - without (1st) and with (2nd) chronic bronchopulmonary pathology. RESULTS: Analysis of comorbidity of patients with respiratory phenotype of post COVID-19 syndrome showed frequent presence of concomitant cardiovascular pathology (76.7%). The predominant patient complaint was dyspnea (93.3% in both groups): 29 patients (96.7%) in the non-lung group, and 27 patients (90%) in the chronic lung group. The mean mMRC dyspnea score for all patients was 1.1±0.49 points (1.2±0.5 points in the first group and 1.0±0.45 points in the second group). Cough was observed less often - in 18 patients of both groups (30%), mainly in the second group. During the course of vibroacoustic therapy in the 1st group, the number of patients with dyspnea decreased from 96.7 to 30%, in the 2nd group - from 90 to 10%, the total mean mMRC dyspnea score decreased to 0.2±0.4 (Δ 82%), and a complete regression of cough syndrome was achieved in both groups. Also, an increase in forced expiratory volume in 1st second and peak expiratory flow indicators was revealed both in the general group of patients and in the group of patients without chronic lung pathology. CONCLUSION: The results obtained during the study of the use of vibroacoustic therapy in patients with respiratory manifestations of post-COVID syndrome, including the presence of chronic bronchopulmonary pathology, allow us to conclude on the effective correction of dyspnea and cough during treatment. Vibroacoustic therapy is a promising non-drug method of exposure to bronchopulmonary manifestations of post-COVID syndrome in patients during rehabilitation.

[Virtual reality technology in medical rehabilitation of patients with ischemic stroke]. / Tekhnologiya virtual'noi real'nosti v meditsinskoi reabilitatsii bol'nykh s ishemicheskim insul'tom.

Rehabilitation of patients after an ischemic stroke is a complex and time consuming process that requires coordinated interaction between specialists of different specialisations. Functional outcomes in patients can vary from asymptomatic lesions to complete incapacity and depend on the location of the stroke, premorbid background, the time of initiation of therapy, its duration, and other factors. Goals of medical rehabilitation include not only motor rehabilitation, but also the restoration of cognitive, affective, visual, speech and many other disorders. The development of rehabilitation methods that have a minimum number of contraindications or no contraindications remains relevant. One of the promising methods that complement traditional rehabilitation is virtual reality technology. The article describes modern technologies of virtual reality and methods of their application in medical rehabilitation.

[Implementation of robotic mechanotherapy for movement recovery in patients after stroke]. / Primenenie robotizirovannoi mekhanoterapii dlya vosstanovleniya dvizheniya u patsientov posle insul'ta.

Lower extremity dysfunction after a stroke can vary from mild to extremely severe and significantly reduce the functional independence of patients. The restoration of walking is one of the key components of rehabilitation, it requires a balanced approach and the participation of a multidisciplinary team. In the last decade, new rehabilitation methods have appeared that meet high safety standards and have a minimum set of contraindications. One of the promising methods is robotic mechanotherapy. The article presents an overview of modern technologies of robotic mechanotherapy, its types and recommendations for use in medical rehabilitation.

[Meteocorrective effect of physical and balneal factors in patients with joint diseases]. / Meteokorrigiruyushchee deistvie fiziobal'neofaktorov u patsientov s zabolevaniyami sustavov.

The environment has the potential to adversely affect human health. Among the variety of adverse factors, one of the leading is the weather, including its abnormal patterns, helio- and geomagnetic disturbances, and extreme hydrometeorological phenomena. Currently, the study of mechanisms of weather and climate factors impacting sick and healthy organisms is warranted by the need to determine the main clinical types of meteotropic (pathological) reactions and development of scientific-based programs for their prevention and treatment with the use of non-drug methods. OBJECTIVE: To identify the patterns of meteotropic reactions to biotropic weather conditions and evaluate the meteocorrective efficacy of physical and balneal factors in patients with joint diseases. MATERIALS AND METHODS: We studied the features of weather-related disorders in 165 patients diagnosed with osteoarthrosis/osteoarthritis, including those after total hip and knee arthroplasty. Most patients (55.7%) had cardiovascular comorbidities. All patients received balneal and physiotherapeutic procedures in addition to background drug therapy and exercise therapy. The patients were divided into 3 groups: Group 1 (55 patients) received general sodium chloride baths and exposure to alternating magnetic field (AMF); Group 2 (54 patients) received «dry¼ carbon dioxide baths and AMF; Group 3 (56 patients) received general baths with the antioxidant and antihypoxic agent Mitofen, and AMF. The weather-sensitivity and severity of meteorological reactions were evaluated using questionnaires, and self-observation diaries, correlated with medical and meteorological weather forecasts. We used the WAM method (well-being, activity, mood), the Abbreviated Multifactor Personality Inventory (AMPI), and the Hospital Anxiety and Depression Scale (HADS). Medical and meteorological weather assessment was performed using a modern medical and meteorological complex (AMMC). RESULTS: Increased weather sensitivity of varying severity was confirmed in 140 (84.8%) patients, and 25 (15.2%) patients were classified as conditionally weather-sensitive. The most severe meteotropic reactions were noted in patients with cardiovascular comorbidities (55.7%) and older individuals with a compromised medical history (29.1%). The use of balneal and physiotherapeutic methods in the medical rehabilitation programs had a positive effect on the manifestations of autonomous disorders and psychological dysadaptation; also, they contributed to the increase of adaptation and functional reserves of the organism exposed to biotropic weather conditions. The effects of the factors were manifested by the reduction of severity of meteotropic reactions. The high effectiveness of general baths with antioxidant and antihypoxic action was revealed in 71.8% of patients with cardiovascular comorbidities. The meteocorrective effect of sodium chloride baths was less pronounced (29.7%), although the majority of patients after the treatment course showed an improvement in their psychoemotional status (39.7%) and a decrease in severe weather-related exacerbations during spastic weather (from 17.6 to 6.7%). CONCLUSION: The meteocorrective efficacy of complex non-drug methods in patients with joint diseases, including concomitant cardiovascular diseases, has been proved.

[Hyperbaric oxygenation in outpatient rehabilitation of COVID-19 convalescents]. / Primenenie giperbaricheskoi oksigenatsii v ambulatornoi reabilitatsii patsientov, perenesshikh COVID-19.

Searching for drug and non-drug modalities for the rehabilitation of patients with the post-COVID syndrome is an urgent public health challenge during the COVID-19 pandemic. Hyperbaric oxygenation is a promising method as a part of complex rehabilitation after COVID-19 due to its antihypoxic, anti-inflammatory, antioxidant and anticoagulant effects. OBJECTIVE: To study the effect of hyperbaric oxygenation as a part of comprehensive outpatient rehabilitation on clinical and functional parameters in COVID-19 convalescents. MATERIAL AND METHODS: The effect of hyperbaric oxygenation on clinical and functional parameters of 45 COVID-19 convalescents was studied: 22 males and 23 females aged 40-60 years. Patients were divided into three groups of 15 subjects each, depending on the CT stage of COVID-associated pneumonia (CT-0, CT-1, and CT-2-3). RESULTS: Patients in group 3 (CT-2-3) were on average in the older age group, had a higher body weight and a higher percentage of fat mass according to bioimpedance measurements, compared to the other groups. Most clinical-functional and laboratory parameters in this group were within normal or subnormal ranges. In addition, high cholesterol levels (total cholesterol 6.5±1.2 mmol/L) and subnormal levels of C-reactive protein (9.3 mg/L) were noted in group 3 patients. After comprehensive rehabilitation, an increase in the distance walked in the 6-minute walking test with a significant trend in the CT-0 (467.9±37.7→531.5±44.3 m; p<0.01) and CT-1 (533.9±74.3→570.1±57.8 m; p<0.05) groups was observed. A significant decrease in norepinephrine level in the group of COVID-19 convalescents with CT-2-3 (Δ 13%), and a decrease in glutathione peroxidase in all three groups (6465.0±1637.3→5101.0±1353.3, 6587.8±1919.3→5418.1±1289.7, 7699.5±1747.9→6620.1±1702.1 units/L in groups 1, 2 and 3, respectively; p<0.05) were recorded. CONCLUSION: The use of hyperbaric oxygenation in comprehensive outpatient rehabilitation of COVID-19 convalescents was associated with benefits, given the improvement of functional parameters, laboratory signs of limiting low-grade inflammation, sympathoadrenal activity, and oxidative stress.

[Drinking mineral waters: problematic issues and prospects of use in treatment and rehabilitation]. / Pit'evye mineral'nye vody: problemnye voprosy i perspektivy ispol'zovaniya v lechenii i reabilitatsii.

The article is devoted to the use of drinking mineral waters in the treatment and rehabilitation of patients with various pathologies. The results of numerous studies carried out in previous years have proven the ability of mineral waters to positively influence the functional state of the digestive system, eliminate various metabolic disorders, and affect the processes of hormonal and immune regulation. However, due to the current lack of educational programs for the training of doctors at medical universities, as well as further training in the basics of balneology, medical workers often encounter difficulties in determining the most suitable schemes for the use of mineral waters for a specific pathology. It is known that today there are quite a lot of bottled waters on the market that do not have a healing effect, but are quite suitable for use as table waters. The latter circumstance, combined with not always correct information about the real healing properties of waters, creates certain difficulties even for doctors. In addition, there is a need for a certain clarification of the methods of prescribing mineral waters, taking into account the magnitude of mineralization, the main cation-anionic composition, the nature of the disease and the phase of its course. Taking into account the fact that drinking mineral waters are actively used in the treatment of many diseases, including in children and the elderly, the task of fully and competently informing doctors of different specialties, and with their help, patients, about the features of specific mineral waters available in different regions of the Russian Federation, their unique capabilities, optimal methods of therapeutic use.

[Medical rehabilitation of children with bronchial asthma]. / Meditsinskaya reabilitatsiya detei s bronkhial'noi astmoi.

Medical rehabilitation of children suffering from bronchial asthma is based on the complex use of natural therapeutic factors, drug, non-drug therapy and other methods in order to achieve control over the disease and long-term remission. The use of non-drug technologies is necessary taking into account the pathogenesis of the bronchial asthma development and is aimed at relieving bronchospasm, reducing the activity of allergic inflammation in the bronchi, improving their drainage function, strengthening the respiratory muscles and increasing exercise tolerance. When carrying out rehabilitation measures it is important to observe the basic principles of medical rehabilitation. An individual medical rehabilitation program is drawn up taking into account the assessment of the child's clinical condition at each stage with the diagnosis of the initial rehabilitation status, the establishment of a rehabilitation diagnosis and an assessment of the rehabilitation potential. The article presents the data of the analysis of scientific publications and our own research allowing to draw up an algorithm for the formation of an individual program of medical rehabilitation for children with bronchial asthma.

[COVID-19-associated diarrhea].

In addition to the typical clinical picture of respiratory symptoms and intoxication, the SARS-CoV-2 virus is also characterized by a gastroenterotropic effect. Diarrhea is one of the most common gastroenterological symptoms of COVID-19 and is detected, according to the various authors, in 2-49.5% of cases, including children. The presence of diarrhea aggravates the patient's clinical condition, limits the possibility of carrying out the necessary diagnostic manipulations, and complicates the selection of therapy. The article provides an overview of the scientific literature on the formation of diarrheal syndrome in patients with COVID-19. Objective. Analysis of scientific publications studying the pathogenesis, incidence, clinical features, aspects of diagnosis and therapy of diarrhea in patients with COVID-19. Material and methods. A search was made for scientific publications on the electronic resources PubMed, Google Scholar and eLIBRARY.ru. Results. The pathogenesis of diarrhea in a new coronavirus infection is complex and includes, among other things, the effect of the virus on the angiotensin-converting enzyme 2 receptors, inducing an inflammatory process in the gastrointestinal tract mucosa, neurotropic effect on the autonomic regulation of intestinal motor activity, disturbance of the colon microbiota, liver and pancreas damage. Another important pathogenetic aspect of diarrhea in COVID-19 is iatrogenic one, i.e. a side effect of drugs used in the treatment of a new coronavirus infection and its complications, and the activation of opportunistic clostridial intestinal flora against the background of antibiotic therapy. The variety of pathogenetic mechanisms of diarrheal syndrome formation allows us to speak of "COVID-associated diarrhea" as an independent clinical phenomenon characteristic for the new coronavirus infection. Mandatory diagnostic algorithm of a patient with COVID-19 and diarrhea is the fecal analysis test for toxins Cl. difficile, while the possibility of endoscopic examinations during the pandemic is limited. Compliance with the hygiene measures, diet correction and nutritional support, rational antibiotic therapy of COVID-19 complications, careful use of antiperistaltic antidiarrheal drugs, nonspecific therapy (antiviral, rehydration, adsorbents) are considered as the main therapeutic approaches for diarrheal syndrome against the background of COVID-19. The administration of probiotics and antibacterials should be considered in case of confirmed clostridial co-infection. Conclusion. Diarrhea is a frequent clinical manifestation of COVID-19 and can affect the course of the disease. The complex genesis of diarrheal syndrome requires further study of therapeutic strategies and nutritional support for patients after COVID-19.

[Adherence to treatment as a factor in increasing the effectiveness of psychological rehabilitation programs for stroke patients using augmented reality technology]. / Priverzhennost' k lecheniyu kak faktor povysheniya effektivnosti programm psikhologicheskoi reabilitatsii bol'nykh, perenesshikh insul't, s ispol'zovaniem tekhnologii dopolnennoi real'nosti.

PURPOSE OF THE STUDY: Studying the contribution of treatment adherence to the effective use of the Visual Medicine hardware and software complex (HSC) in the psychological rehabilitation of stroke patients. MATERIAL AND METHODS: The results of the use of APC in 81 patients undergoing a standard course of medical rehabilitation have been investigated (50 men and 31 women, average age 57.3±11.7 years). Compliance using the psycho-diagnostic questionnaire «Level of Compliance¼, which examines social, emotional and behavioral compliance; the state of higher mental functions (HMF) in dynamics by neuropsychological examination (tests for simultaneous and visual-spatial gnosis, kinesthetic, dynamic, spatial and constructive praxis) are studied. RESULTS AND CONCLUSION: It is shown that the use of a hardware-software complex helps to recover motor skills. However, the degree of positive dynamics of changes in the HMF state depends on the contribution of patient adherence to treatment, in particular, their «social compliance¼. It has been established that preventive diagnostics of social compliance at the average level, according to the questionnaire «Level of compliance¼, can be an indication for inclusion in the rehabilitation plan of training sessions with the program «Visual Medicine¼. Deviation towards low or high values signals the appointment of a medical psychologist consultation with the aim of further psychocorrectional work to achieve the optimal level of social compliance.

[Modern medical and meteorological assessment of Moscow weather and the effectiveness of non-drug methods of increased meteosensitivity correction in patients with joint diseases]. / Sovremennaya mediko-meteorologicheskaya otsenka pogody Moskvy i effektivnost' nemedikamentoznykh metodov korrektsii povyshennoi meteochuvstvitel'nosti u patsientov s zabolevaniyami sustavov.

Weather is one of the leading negatively acting on the human body factors. Abnormal regimes and extreme hydrometeorological and geophysical phenomena form the most biotropic external conditions that can have a negative effect and provoke weather-related exacerbations in people with chronic non-infectious diseases. Today, the problem of the climatic and weather factors influence acquires a new content and becomes relevant in connection with the global climate change and its regional manifestations. PURPOSE OF THE STUDY: To scientifically substantiate the need for medical and meteorological monitoring to determine the most biotropic weather conditions in the Moscow metropolis and to evaluate the meteorological effectiveness of non-drug rehabilitation methods. MATERIAL AND METHODS: 335 patients diagnosed with osteoarthritis of various locations, and after total hip and knee arthroplasty, were included in the study. Patients were divided into 4 groups: 67 patients of the 1st group received "dry" carbonic baths and exercise therapy; general radon baths and exercise therapy were prescribed to 60 patients of the 2nd group; 61 patients of the 3rd group received general sodium chloride baths and exercise therapy; 84 patients of the 4th group got local cryotherapy and exercise therapy procedures. The study of weather sensitivity was carried out by the questionnaire method. Psychological examination was carried out using the tests HAM (health, activity, mood), Mini-Mult (Abbreviated multifactor questionnaire for personality research) and HADS (Hospital Anxiety and Depression Scale). RESULTS: 272 (81.2%) patients had increased meteosensitivity, which was accompanied by mild manifestations in 24.3%, moderate severity in 48.2%, and severe ones in 27.5%. The effectiveness of the balneotherapy and cryotherapy methods was confirmed by positive dynamics and a clear regression of meteopathic reactions in 76.1% of patients after a general radon therapy and in 61.7% after «dry¼ carbon dioxide baths. Total sodium chloride baths did not have a significant meteorological effect. However, a positive trend in psychological testing indicators was noted, which indicates an improvement in psychological adaptation after a course of treatment. Local cryotherapy procedures helped to reduce only severe meteopathic reactions from 14.3 to 8.3% and improve the psychoemotional state, which may be the choice when it is impossible to use balneotherapy. CONCLUSION: The increase in the frequency of biotropic weather conditions (hypoxic and spastic) is observed in the climate of the Moscow metropolis. This contributes to the increase and aggravation of the meteopathology manifestations. The effectiveness of non-drug methods in the prevention of increased meteorological dependence in patients with joint diseases has been proved.

[The effect of complex use of nicotinic acid electrophoresis and air bubble baths on microcirculation in patients with diabetic polyneuropathy]. / Vliyanie kompleksnogo primeneniya elektroforeza nikotinovoi kisloty i vozdushno-puzyr'kovykh vann na mikrotsirkulyatsiyu u bol'nykh s diabeticheskoi polineiropatiei.

AIM OF STUDY: To study of the effect of the combined impact of nicotinic acid electrophoresis and air bubble baths on the state of microcirculation (MC) in patients with diabetic polyneuropathy (DPN). MATERIALS AND METHODS: 60 patients with DPN and type 2 diabetes mellitus with a disease duration of 6 to 25 years were examined and treated. All patients were divided into 2 groups: 30 patients of the 1st group received the combined impact of nicotinic acid electrophoresis and air-bubble baths; 30 patients of the 2nd group - only electrophoresis of nicotinic acid according to Vermel. The dynamics of the MC state was evaluated according to laser Doppler flowmetry (LDF). RESULTS: Before treatment, in most patients with DPN (98%), according to LDF, a spastic type of MC was established. After a course of treatment, it was found that the combined use of nicotinic acid electrophoresis and air bubble baths in patients with DPN has a more pronounced corrective effect on the condition of the MC than the use of Vermel's electrophoresis of nicotinic acid only. CONCLUSION: Complex therapy, including electrophoresis of nicotinic acid and air bubble baths, has a pronounced effect on the condition of the MC in patients with DPN and is pathogenetically justified for the treatment of this category of patients.

[The role and significance of the physical factors in the treatment and prevention of erosive-ulcerative lesions of the stomach and duodenum]. / Rol' i znachenie fizicheskikh faktorov v lechenii i profilaktike érozivno-iazvennykh porazhenii zheludka i dvenadtsatiperstnoi kishki.

This article covers the issues related to the use of the natural and the preformed physical factors for the treatment and prevention of erosive-ulcerative lesions of the gastro-duodenal area. The existing schemes of their therapeutic treatment provide for the influence only on the separate components of the pathological process which does not allow to achieve the proper correction of the local organic and functional disturbances or the associated systemic disorders. In this context, the purpose of the present article is to demonstrate the importance of the inclusion of various physical factors into the therapeutic programs designed for the treatment of the inflammatory and erosive-ulcerative lesions of the upper digestive tract including the stomach and the duodenum. The present review is focused on the modern data available from the current publications in the scientific literature concerning the possibility and the effectiveness of the application of drinking mineral waters, balneotherapy, and pelotherapy in the combination with secondary prophylaxis and a variety of the rehabilitation modalities for the treatment of the patients presenting with the inflammatory and erosive-ulcerative lesions of the upper part of a digestive tube. It is concluded that these measures, taken together, can efficiently eliminate the said pathological conditions and correct the accompanying systemic disorders. The currently available methods of physical therapy can be not only supplementary to the generally accepted therapeutic modalities but also constitute their basis their basis.

[The fundamental principles behind the evaluation of the bioclimatic potential of the Alma-Ata health resort (Kazakhstan) for the medical purposes]. / Osnovnye printsipy otsenki bioklimaticheskogo potentsiala kurorta Alma-Ata (Kazakhstan) dlya meditsinskikh tselei.

This article reports the results of the analysis of long-term observations carried out at the Almaty health resort (Kazakhstan) with the purpose of evaluating of balneotherapeutic potential of this facility with special reference to the elucidation of its seasonal dynamics and characteristic of the comfort conditions for the inclusion into the program of spa and health resort-based treatment and climatic therapy programs.

[The non-medicamentous methods for the prevention and treatment of the patients presenting with neurocirculatory asthenia and concomitant enhanced meteosensitivity].

OBJECTIVE: The relevance of the problem stated in the title of this article comes from the significant increase in the prevalence of the functional cardiovascular disorders having been documented during the past years especially such as circulatory asthenia that most frequently affects the young people of the working age suffering from the systemic neurogenic imbalance in the organism and can be seriously aggravated by the influence of biotropic weather conditions and be responsible for enhanced meteosensitivity that has negative effect on the quality of life and impairs the effectiveness of the therapeutic interventions. AIM:  The objective of the present study was to provide the scientifically sound substantiation of the feasibility of the application of the non-medicamentous methods (including the interval hypoxic training and «dry¼ carbonic baths) for the prevention and treatment of neurocirculatory asthenia complicated by enhanced meteosensitivity and evaluate the therapeutic effectiveness of these approach. MATERIAL AND METHODS:  A total of 50 patients with the verified diagnosis of neurocirculatory asthenia were recruited to participate in the study. All the patients were divided into two groups. 62% of them exhibited the well apparent meteosensitivity and were included in the study group 1. Group 2 was comprised of the remaining patients (38% of their total number) presenting with neurocirculatory asthenia who did not suffer appreciable changes in the general physical and mental state under the influence of varying weather conditions. The patients of both groups received the identical combined treatment consisting of interval hypoxic training and taking «dry¼ carbonic baths. Monitoring of the main meteorological parameters was carried out on a daily basis. It was combined with the assessment of the weather conditions from the medical perspective, the evaluation of the physical performance capability of the patients based on the results of the veloergometric testing, and the estimation of their functional state of the autonomous nervous system with the use of the data obtained in cardiointervalographic studies. In addition, the state of the microcirculatory system was evaluated by means of laser Doppler flowmetry and making use of a capillary blood flow analyzer. The psychological status of the patients was characterized using a computer-generated version of the abridged multifactorial questionnaire for the elucidation of the manifest personality-scale anxiety (Spielbeger's State-Trait Anxiety Inventory). All these studies were carried out both before and after the course of non-medicamentous therapy. RESULTS:  After the course of the combined non-medicamentous treatment had been completed the health status of the patients comprising the two groups was found to be improved as appeared from the decrease of the number and severity of subjective autonomous manifestations, the positive changes in the functional state of the cardiovascular system and the autonomic nervous system as well as in the general psychological status. The most clinically significant result of the treatment included the reduction in the incidence of the severe meteopathic reactions in the patients of group 2 (from 14% before to 3% after therapy). The frequency of moderately expressed meteopathic reactions likewise decreased (from 31% before to 14% after the treatment). CONCLUSIONS:  The study has demonstrated that under the environmental and climatic conditions of the of Moscow region formation of biotropic weather factors of the hypoxic type (39%) constitutes a serious risk factor contributing to the development of imbalance in the vegetative nervous system and its exacerbations in response to variations of weather parameters. The application of the non-medicamentous therapeutic modalities (including interval hypoxic training and «dry¼ carbonic baths) for the management of the meteosensitive patients presenting with neurocirculatory asthenia is pathogenetically justified, and they can be recommended for both the treatment and prevention of weather- dependent pathological processes and their exacerbations.

[Restoration of the complicated locomotor functions of the upper extremities in the patients surviving ischemic stroke].

During the late and residual periods of stroke, it is necessary to pay attention to the training of complex spatial movements along with the traditional restoration of the balance and strength of para-articular muscles and the mobility of the paretic limb joints. The objective of the present study was to evaluate the effectiveness of robotic therapy for the recovery of the functions of the upper extremities in the late and residual periods of stroke. The study involved 52 patients who had survived ischemic stroke in the middle cerebral artery. The patients were divided randomly into 2 groups. All of them performed therapeutic physical exercises based on the standard technique during 5 days a week for 3 weeks. In addition, the treatment included massage, laser and pulsed current therapy. The patients of the main group (n=36) were additionally trained to perform complex spatial movements with special emphasis on their speed, fluidity, precision, and agility with the use of the Multi Joint System (MJS) robotic electromechanical device (40 min, 5 days/wk x 3wk). The analysis of the results of the study has demonstrated the statistically significant difference in the degree of improvement of the range of motion (ROM) in the elbow and shoulder joints, the speed and the accuracy of these movements between the patients of the main and control groups. It is concluded that the instrumental restoration of complex spatial movements of the upper extremities during the late and residual periods of stroke contributes not only to the improvement of the functional capabilities but also to the enhancement of independence and personal adjustment of the stroke patients.

[The influence of the climatic and weather conditions on the mechanisms underlying the formation of enhanced meteosensitivity (a literature review)]. / Vliianie klimata i pogody na mekhanizmy formirovaniia povyshennoi meteochuvstvitel'nosti (obzor).

The present review concerns the problem of the influence of the climatic conditions on the human body, the creation of the medical weather forecast service, the development of non-pharmacological methods for the correction of meteopathic disorders, and the reduction of the risk of the complications provoked by the unfavourable weather conditions. The literature data are used to analyse the influence of climatic and weather factors on the formation of enhanced meteosensitivity and the development of exacerbations of chronic non-communicable diseases under the influence of weather conditions. It is concluded that marked changes of the weather may lead to an increased frequency of exacerbations of the chronic non-communicable diseases. The influence of weather and climate on human health is becoming an increasingly important factor under the current conditions bearing in mind the modern tendency toward variations of the global climatic conditions and their specific regional manifestations. The authors emphasize the necessity of the identification and evaluation of the predictors of the development of high meteosensitivity for the prognostication of the risks of the meteopathic reactions and the complications associated with the changes in weather conditions as well as the importance of the improvement of the existing and the development of new methods for the non-pharmacological prevention and correction of enhanced meteosensitivity with the application of the natural and preformed physical factors.